Feature: Hospitals trust ‘fires on all cylinders’

A junior doctor working 100-hour weeks hears the call come in, jumps out of his dormitory bed and dives out of the door into total blackness.

It took the young Sir Jonathan Michael a minute to realise that he had not, as intended, run out of the door into the corridor, but had in fact clambered inside the wardrobe.

The chief executive of Oxfordshire’s hospitals laughs across the conference table in his office, remembering the anecdote fondly, but it all could have gone so differently for the doctor of 45 years.

Sir Jonathan was brought up in Bristol, attending his local grammar school, achieving A-Levels in English, French and history and getting a place at university to study social sciences.

But the course of his life changed one day when he went to see a film, the name of which now escapes him, set in a hospital in America.

He told the Oxford Times: “I don’t know why, but I think in reality I went to some awful film about hospitals – it was an American film – but it just triggered something in me, and I remember coming back from the cinema and saying to my parents: ‘I want to do medicine’.”

So Sir Jonathan wrote to a number of medical schools and was invited to an interview at St Thomas’ in London, where he was offered a place to do medicine after completing a crash course in medical sciences.

He qualified in 1970 and has since risen through the ranks. He has worked as a chief executive for nearly 20 years since being appointed to the top job at Birmingham’s Queen Elizabeth Hospital in 1995.

Sir Jonathan said: “I was asked to work alongside the chief as a medical director to try to make sure the financial recovery didn’t crucify clinical care.

“That was a difficult period, but it was in one sense a really good learning experience in that I knew what a bankrupt health organisation looks like and how painful it is to pull it out.”

He then moved to London to become chief executive of Guy’s and St Thomas’ Trust for seven years, steering it through its bid to become a foundation trust.

After a three-year break working with BT Health he was made chief executive of the then Oxford Radcliffe Hospitals Trust.

Remembering his arrival in Oxfordshire, the self-confessed car buff said: “An organisation in Oxford ought to be like a Ferrari – everyone knows it is absolutely the top.

“When I arrived here it looked like a Ferrari but was not firing on all cylinders.

“I hope I have played my little part in actually moving the academic health system in Oxford to a slightly higher plain.

“The trust is performing as well as any large and complex organisation, dealing with hundreds of thousands of patients. An organisation of this size will never be perfect, but I am very proud of it.”

Sir Jonathan said that when he took the reins in April 2010 he wanted to improve the relationship between clinicians and senior management, drive up the “poor” operational performance and escape the financial deficit he inherited.

He added: “That’s one of the advantages I find of being an ex-consultant. I have been there and done that, and got the T-shirt and the blood stains.

“I understand the pressures and the strains the staff face, but I also understand what happens to an organisation if you don’t control the finances and operational performance.”

Since then the trust has merged with the Nuffield Orthopaedic Centre NHS Trust, achieved the status of academic health science centre in 2013 for its work with Oxford Health and the city’s two universities and gone from a financial deficit to a surplus.

Sir Jonathan said he was very proud of the improvement in relations with Oxford University, which culminated in the trust being renamed the Oxford University Hospitals Trust (OUHT) in 2011.

He added: “That was also a reflection on the very significant improved relationship with the university which jealously guards the term ‘Oxford University’.

“Both trust and university had been disappointed to be unsuccessful in the application to become an academic health science centre in 2008.

“Everyone, including the people of Oxford, expected Oxford to be recognised, but it wasn’t and it was because the performance of the health part of Oxford wasn’t good enough.

“When you have one of the strongest medical sciences faculties in the world and a very academic university hospital what you can do together is enormously greater than what you can do separately.”

Sir Jonathan said he worked to strengthen relationships, not just with the two universities, but with other health organisations.

He also introduced a clinical management structure, bringing clinical staff into the management team, devolving clinical decisions and accountably to clinicians.

Sir Jonathan added: “As chief executive I may be the senior manager, but all the care is given by my 11,500 colleagues.

“My responsibility is to set the strategy, the efficiency, the values and culture of the organisation.”

He said his proudest moment was when the trust was given a good rating by the Care Quality Commission (CQC) following an inspection in February last year.

He added: “That was a really, really pivotal moment for me because it was a reflection of the quality of the services and staff.”

But he said one of the biggest changes he has overseen is a shift in culture, getting staff to create a set of values for the trust, then introducing them across all the hospitals and clinics.

He added: “You have to have the right devolved management and clinical structures. Organisations where every decision has to go all the way to the top never work.”

Sir Jonathan will step down from the role at the beginning of next month and said he looks forward to spending more time at his family home near Godalming, Surrey.

The father-of-three, who has a step-daughter with his wife of 10 years Karen, said he has already bought himself membership of a golf club.

But he stressed he is not going to stop work completely and will continue to act as a trustee of the King’s Fund.

He added: “I will try to master the very difficult game of golf, but I am not particularly optimistic of making good progress.

“But I have got my options open. I am going to do a few other things. I am not going to stop working.

“I am going to enjoy being at home because for the last five years I have weekly commuted.”

Although he said he would not dream of giving his successor, Dr Bruno Holthof, advice, he said he hopes the trust continues to go from strength to strength.

He added: “But I hope I leave him with an organisation that is firing on all 12 cylinders, not the eight or nine that I inherited, and wish him luck.

“What I would like is for the healthcare system in Oxfordshire to be recognised as one of the best in the world, not just one of the best in the country.”