Manager with a mission to ease the pain at the Hospital
New Hospital managing director Rob Sainsbury tells health reporter Krysta Eaves about the challenges he faces as he attempts to reassure an angry and anxious workforce, deal with an outdated facility and cope with the challenges posed by Jersey's growing elderly population.
It has been a baptism of fire for Rob Sainsbury.
He did not have long to acclimatise to his role of Hospital managing director before he was left contending with a nurses’ pay dispute and the pressures that snow can bring to the health service.
But the 43-year-old, originally from Blaenavon in south-west Wales, says he is excited about taking over the helm of the outdated and crumbling Hospital and is looking forward to helping to change the face of the Island’s health system for the better.
Mr Sainsbury, who has previous experience of the trials and tribulations of building a new hospital – including the public discord it can bring, says one of his main objectives is to ensure the new facility will have the right clinical areas and is staffed appropriately.
But the new hospital is not the only item on the agenda for the trained nurse. He is also keen to boost staff morale – with workers, he admits, currently both anxious and angry – and develop new Jersey-based courses to train healthcare staff, as well as enhance care in the community.
It is quite an ambitious plan, but what are his initial thoughts on Jersey’s healthcare system?
‘When I arrived I think I brought the weather with me,’ joked Mr Sainsbury, who replaced Helen O’Shea when she stepped down for family reasons. ‘We had snowmageddon. It was really difficult but, my goodness, I really saw the best of Jersey.
‘I saw such co-ordination between the Hospital, ambulance service, fire service, police and all the public sector.
‘The staff’s commitment really impressed me. People were going over and above making sure the services functioned both in and out of the Hospital. People were on standby for shifts, doctors slept in the Hospital, nurses provided additional cover.
‘While I’ve experienced lots of adverse weather in the UK there was something seamless about the whole operation. It did not need a huge amount of co-ordination.’
Although he says he has been impressed with staff he says the condition of the current Hospital – which requires £2.85 million spent on it every year to ensure the facilities remain safe for patients and staff – is challenging.
‘I have worked in very similar environments both clinically and managerially,’ the former chief operating officer at Northern, Eastern and Western Devon Clinical Commissioning Group said. ‘The buildings are just something we have to navigate.
‘The thing I’m very impressed with is how Helen and the management team have done a good job to try to manage these risks to keep things going as much as possible.
‘More and more problems occur as time goes on. Some of these problems are not fixable in certain buildings. These challenges won’t go away.’
He added that the Hospital’s ability to offer end-of life care was one area that was proving problematic.
‘With end-of-life care we have to make sure our patients are cared for in an environment suitable to their needs,’ said Mr Sainsbury, whose partner works in the States police force. ‘At times we really struggle with that, as there are not many cubicles.
‘We are working hard to make sure that patients are having the best we can offer at that time. It is challenging for staff – they do wonders to manage. We all welcome the future hospital. We recognise it has been a long journey.’
Revised plans for the future facility, which will be built on the current site extending into Kensington Place, were submitted last month. However, the project has faced criticism from some Islanders and politicians who believe it is not being built in the right place.
‘I’ve been involved in a lot of changes to hospital landscapes, particularly back in Devon,’ Mr Sainsbury said. ‘It is a contentious area. People are passionate about their hospital.
‘I lived through the building of a new hospital back in Wales. To build the new hospital it meant the closure of the existing hospital, which was built by the miners.
‘It was really, really difficult. People felt very strongly about where the hospital was, how it looked, how it retained the characteristics. Quite rightly, people showed vested interest.
‘We have to be mindful of that and respectful but my job and my clinicians’ job is to make sure the clinical settings are right and areas are staffed properly. I’m more focused on that.’
He said he did not believe the project would be derailed by the stepping down of a number of political heavyweights, including Health Minister Andrew Green and Infrastructure Minister Eddie Noel, who have been both been driving forces behind the scheme.
‘I feel confident the programme will stay on track,’ he said. ‘I’ve refreshed myself on the original case for change and I’m looking at that through a brand-new lens. I believe that the case for change is still prominent.
‘We are on a time limit, what with the situation of the environment we have here. The primary driver of why we need it hasn’t gone away despite a change in politicians.’
And although he admits that building the new £466 million facility close to a working hospital will cause some disruption he believes the ‘end goal’ will be worth it.
He added: ‘I don’t think any of the building programme works will impact on care delivery in the Hospital. I think we can manage that. We need to make sure our planning is robust. We also need to allay a lot of staff anxiety.’
Staff anxiety and its morale in general is something Mr Sainsbury says he is keen to address, particularly after one nursing union described a ‘toxic’ atmosphere building after it claimed allied healthcare workers had been given a ‘secret’ pay rise.
‘We have a very dedicated and motivated staff who are working very hard,’ Mr Sainsbury said. ‘I’m seeing a lot of people who are working over and above. I’m seeing a lot of goodwill and people doing things that sit outside their responsibilities. I think we have to address that. People will simply burn out. There are some staffing challenges that we need to look at addressing.
‘There has been a lot of unhappiness in terms of the workforce modernisation that I’ve heard about from staff, most recently about nurses and allied health professionals’ pay. These issues affect staff morale. We have a journey to go on around that to build up trust.’
He said one way to boost morale was to make sure that staff were ‘at the heart’ of any changes.
‘We do want a different dialogue with clinicians,’ said Mr Sainsbury, who lives in St Helier. ‘I want them leading the change. We need to get the basics right – the work environment, the pressures in work, the overall terms.
‘We are working hard to resolve these issues but it seems to have been a difficult time to arrive. I’m picking up a lot of staff anxiety and anger.
‘I’ve been there. I’ve worked clinically. I’ve been on a a ward where we’ve had no staff. I’ve had to cover shifts and stagger shifts. There are lots of issues that need to be addressed.’
Although Mr Sainsbury acknowledges that Jersey’s healthcare system ‘coped well’ in comparison to the UK during the winter, he also says the Island is not immune to the global problem of recruiting medical staff.
‘We are realistic,’ he says. ‘We know we might not be able to get some professions in the future. I’m very keen to work with Island-run educators because we could do our own thing and offer more bespoke training courses. We’ve got a unique opportunity here.’
And he has also got high hopes to develop the care that Jersey can offer in the community – something he says will prove beneficial in the future because of the Island’s growing elderly population. A Rapid Response service, run by Family Nursing & Home Care, already provides some care in the community which reduces inappropriate admissions to hospital and in turn eases pressure on beds.
‘I know there has been a lot of investment in Rapid Response,’ Mr Sainsbury said. ‘I’m a huge fan – I’ve been involved in setting up these services in the UK.
‘I would be really keen to see how these services could expand further and in particular have a real focus on preventing ill health.
‘Where GPs could be pivotal is if we can start to identify the needs within our population, specifically our elderly care or frail and vulnerable persons.
‘We need to look at risk stratification, where we try to identify patients who might have lots of ill health problems and multiple social problems to try to do something in a preventative way rather than trying to fix something when they get to hospital.’
GPs could also carry out treatments which are currently undertaken at the Hospital, he said.
‘There are times when some parts of services delivered in a GP setting might be better for us,’ he says. ‘That might mean we need a different payment option in HSSD. I think we are looking at that scenario.’
Mr Sainsbury certainly has a big task on his hands, but how can he measure his success, at least in the short term?
‘Within the first six months I would like to feel that staff are having more involvement in contributing to the change,’ he said. ‘I hope staff recognise me as someone who is visible and understands what is happening at a clinical and operational level. I would say that is a key test.’