Sarah-Jane Marsh, chief executive of Birmingham Women’s and Children’s NHS Foundation Trust
Sarah-Jane Marsh is chief executive of Birmingham Women’s and Children’s NHS Foundation Trust. Ian Halstead caught up with her to discuss her career, her values – and her love affair with Russia.
Society has changed almost beyond recognition in the digital era, but our fascination with espionage remains undimmed; whether its an IT-savvy savant hacking the apparatus of a foreign state, or the mysterious workings of our own GCHQ. Female spies are always the rarest of this secretive breed, so even today, the names of Mata Hari and Ethel Rosenberg remain far more evocative than later generations of their male peers.
Sarah-Jane Marsh was on the cusp of penetrating the murky world of espionage too, after following her studies in history at Lancaster University, with an masters degree in Russian and European Studies at the University of Birmingham – where her specialist subject was the Russian revolution.
“I knew I wanted to work in the public sector. I had no desire to go off and work in banking, or have a job just making profit. I wanted something with a structure around it, because its a big move from full-time education to work,” she recalls. “However, I was also really interested in how history is rewritten to suit the perceptions of the current ruling generation, and the story of the revolution has been written and written again. I’ve always loved history, and been intrigued by how there are different versions of the ‘truth’.
“I had to read Russian as it was spoken in the early 20th century to study original documents, and that was how I became involved with MI5, after I joined the civil service’s fast-track programme.”
Its easy to see the logic of a contemporary George Smiley, as he carefully vetted the young Marsh’s credentials. Intelligent, confident, and thoughtfully ambitious, her specialist linguistic knowledge might well be an asset in espionage activities. This was after all the year 2000… former KGB agent Vladimir Putin had just been elected Russian president and immediately made his personal and imperial ambitions very clear, so every Western intelligence service was scrambling to bolster its Russia team.
However, Marsh had also applied to the NHS’s fast-track management scheme, and by chance, her focus turned in that direction.
“That April, my dad had a heart attack in his early 50s, needed a quadruple heart by-pass in the Walsgrave Hospital at Coventry, and I was travelling from home in Dudley to there every day. I’d never really sat in a hospital before, but gradually started to think about management within a hospital environment.
“I had gone quite a long way through the MI5 recruitment process, but then the job offer suddenly came from the NHS and I joined that autumn.”
Her dad – a Black Country coal merchant – soon recovered, but his illness proved a notable moment of serendipity for his daughter’s career path. Marsh’s first decade inside the NHS climaxed with her appointment as chief executive officer at Birmingham Children’s Hospital, via a spell as planning and productivity director at Walsall Hospitals NHS Trust, and the NHS’s national executive team has continued to carve her name with pride upon its management rosters.
She integrated the Birmingham Women’s NHS Trust into her current organisation, the first such body in Europe, before leading the evolution of Forward Thinking Birmingham, an innovative mental health programme for the under-25s.
A year ago, Marsh was also appointed chair of the NHS England Maternity Transformation Programme Board, tasked with making maternity care safer, and giving women greater control and choice – just after the Birmingham Children’s and Women’s NHS Trust was named trust of the year by the Health Services Journal.
To achieve such progress over a sustained period is impressive. To do so and be so well thought of that seemingly everyone in the regional NHS speaks to her merits is slightly unnerving. Pleasingly, Marsh is very willing to concede that there have been moments of good fortune – and that she’s had the support of key individuals who identified her precocious talent.
“Once you come off the scheme, your progress is up to you. I’ve done enough and achieved enough to be confident that I’ve done a good job, because things just don’t happen by luck, but have also met some people who’ve been inspirational and very supportive along the way.
“At Walsall, for instance, I was working for the deputy chief executive, who was also finance director, and I was the only person in his department who wasn’t an accountant.
“After two months, he moved up to acting chief executive, and asked me to stay in his team. I was only 25 or 26, so no more senior than a ward manager, but I found myself working at a very senior level. It just happened.
“When the new chief executive came in, she knew of the fast-track scheme and saw me as a useful resource in her team. I did several projects for her, and then got promoted, because she trusted me.”
A recurring theme in Marsh’s upward trajectory is self-awareness – about the need to enhance her skill-set for new and ever-more senior roles – and an impressive honesty.
Her rationale for moving to the Birmingham Children’s Hospital (BCH):
“I decided that I’d moved up too quickly, hadn’t acquired some experiences that others had and realised I needed a more operational job; involved with planning, governance, risk and suchlike, and looked for a chief operational officer’s job at a trust in this area.”
Her later decision to go for the chief executives position at the hospital:
“I didn’t apply at first – but quite a few who did were the usual suspects. I’d like to think that the NHS has moved on since then, but the candidates were widely regarded as ‘male, pale and stale’, and quite a few people I’d worked with – including the chairman – encouraged me to apply.”
How she took on the demands of that high-profile role in her early 30s:
“My priority was to get BCH working properly, as it had lost something of its reputation. I’ve always been very transparent about what I haven’t done. There’s a danger at the executive level that people aren’t willing to say they’re stuck, but I did, and asked others with different experiences to help me.”
Her approach to setting the hospital on its long journey to recovery:
“I made sure everyone knew what we needed to do. I don’t mean having a ‘Big Vision’ on a poster, but clarity was very important. You focus on improving the quality of care, need to be relentless in making those improvements, and you surround yourself with good people.”
The factors which then led the BCH to be awarded ‘Outstanding’ status:
“There were lots of reasons, but staff engagement was key, and it took three years of hard work. Making it a great place to work. Making staff feel valued. Encouraging people to move up through the ranks, and even at the micro-level, reminding people to take breaks.”
Marsh also offers a passionate perspective on how the NHS might evolve, and what strategies might help guide it.
“I believe we need a workforce plan, for the next 10 years at least. Today, workforce decisions are driven purely by finance, but we must get ahead of the curve. It takes years to ‘grow’ healthcare professionals, so you need long-term horizons.
“We also need to think about how we can support our people. A lot of the so-called ‘over-spending’ in the NHS is down to the use of temporary staff, because we can’t find the full-time people we need, and we could do a lot more to strengthen the links between where people train and where they work.
“We must adapt too, to how the current generation want to work and live. Someone in their 50s might well want different things from someone in their mid-20s, and it isn’t about ‘wrong’ or ‘right’ values. We have to reflect that, and we need to think their different approaches through.”
Even on such a controversial topic as how the NHS dovetails into our present political landscape, when news bulletins present it as in a state of near-permanent crisis, Marsh is willing to be upfront – and her views deserve to be heard by the widest audience.
“I have no negative words about Jeremy Hunt, but do think the NHS hasn’t been one of the major topics of conversation during elections. I feel that healthcare is being driven by the Treasury, and finance departments, because the NHS dropped off the government’s list of priorities.
“We appreciate that money isn’t endless, but it absolutely isn’t about low productivity. We outstrip all other sectors for productivity, but sometimes the lack of funding is the reason productivity isn’t higher.
“For example, our operating theatres don’t work as efficiently as they could, because we haven’t got the staff, and we can’t discharge patients because the social care structures aren’t there.
“If I was an elderly patient, needing treatment from a system I’d paid into all my life, I’d be very angry if I was on a trolley at night, wondering when I could move into a ward. We must invest, because if we don’t, the real costs are higher. Children don’t go to school. Parents don’t go to work. People develop mental health issues.
“Keeping people as well and as fit as we possibly can should be the building block of our society. We need to change our own narrative about the NHS. We’re being positioned as ‘takers’ rather than ‘givers’, which is simply wrong.
“Politicians and commentators need to understand just how much excellent healthcare contributes to our society and our economy, and we all need to have conversations about what people need.”
As Marsh pauses to reflect, a faint rustling and a bustling can be heard through her office’s creaking wooden walls. Some might say it was simply the sound of children’s feet, scampering along the corridor on a school visit, but it was surely a smattering of distant applause from the founding father of the NHS, Nye Bevan, who was equally passionate about healthcare’s pivotal role in society – and Russia too.
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