Annex A > Chapter 8 - Management and Culture of the UBH and the UBHT > The development of the clinical directorate structure > The role of the UBHT Medical Director
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The role of the UBHT Medical Director
151 The first Medical Director of the UBHT was Mr Christopher Dean Hart, [180] since he was, at the time of the formation of the UBHT, the Chairman of the HMC.
152 Dr Roylance said in his statement that:
`At UBHT the role of the Medical Director was probably rather different to that in many smaller trusts. Although the post was designated as one of the executive directors, his role was, in many ways, non-executive and advisory. The Medical Director's position within the organisation was not one of authority or of command, but was advisory: he headed the medical advisory structure and was responsible for giving medical advice to the Trust Board.' [181]
153 Dr Roylance explained that the Medical Director had no line management role. [182] He said that the Medical Director:
`... was elected by the medical staff as a Chairman of the Medical Committee, and he was appointed by the Board to Medical Director because he was Chairman of the Medical Committee, I have to say. It was not a coincidence; the Board wanted the Chairman of the Medical Committee as their Medical Director; unlike the other executive directors, he did not get paid as a Medical Director because he was a consultant. He was paid the national two-session allowance which we have been talking about, the two sessions, but he was not paid as a Medical Director, which is why I keep saying he was very much like a Non-Executive Director.' [183]
154 Mr Wisheart, himself a former Medical Director of the UBHT, [184] said that he felt that the role of Medical Director lay somewhere between an executive and a non-executive director. He said:
`There was no one who was directly responsible to him and his initial remit ... was simply that he was to advise the Board on medical matters.' [185]
155 Dr Roylance described the role of the Medical Director and how it differed from that in other trusts. He said:
`The Medical Director advised me, as Chief Executive, and the Trust Board on medical issues. I met formally with him at Trust Board meetings and at HMC meetings on a monthly basis, and at weekly meetings of the Group of Executive Directors. I also saw him frequently on an informal basis. I believe that the structure of trusts which we were required to adopt was designed with organisations in mind that were very much smaller than UBHT. Thus, at UBHT the role of the Medical Director was probably rather different to that in many smaller trusts. Although the post was designated as one of the executive directors, his role was, in many ways, non-executive and advisory ... he headed the medical advisory structure and was responsible for giving medical advice to the Trust Board.' [186]
156 Mr Baird, who was the Acting Medical Director at the UBHT from November 1996 until March 1997, described the primary role of the Medical Director in 1999 (i.e. after the period of the Inquiry's Terms of Reference) as being:
`... in partnership with the Director of Nursing ... to lead on professional issues in the group of Executive Directors, in Clinical Committees of the Board and the Trust Board itself.
`... A major responsibility of the Medical Director is to assist and support clinical directors in their management of consultant staff, particularly in the areas of performance, health and conduct. This is an important but time-consuming aspect of the role. Links with Clinical Directors are fostered at monthly meetings, at reviews of their job plans, and when the Clinical Directors take up and leave office. The requirement for regular advice is growing.' [187]
157 Mr Wisheart said that as Medical Director it was his obligation to liaise with clinical directorates, all consultant staff, the Chairman of the HMC, executive directors and medical staffing personnel. As such, he was accessible to all those people and that particular part of his role evolved as other issues developed that were not part of his role when he first took up the post. [188]
158 Mr Wisheart succeeded Mr Dean Hart as Chairman of the HMC and Medical Director in April 1992. However, once Mr Wisheart's two-year term as Chairman of the HMC had ended, he remained as Medical Director, and the two posts were split. He explained this change in the following terms:
`When the [UBHT] was set up its policy was that the Chairman of the Hospital Medical Committee should be the Medical Director. When my appointment as Chairman of the Hospital Medical Committee began I was invited by the Trust to be the Medical Director. When my two-year term as Chairman of the Hospital Medical Committee finished it was clear that the job of Medical Director had developed to the point where one person could not realistically do both tasks. For that functional reason the two jobs were separated and I continued as Medical Director.' [189]
159 Dr Gabriel Laszlo became Chairman of the HMC and was welcomed at a meeting of the Trust Board on 14 January 1994. The minutes of that meeting record:
`The Chairman also welcomed Dr Gabriel Laszlo who would take over as Chairman of the [HMC] from the beginning of April. Until now the roles of Chairman of the [HMC] and Medical Director had been combined, but over the three years since becoming a Trust it had become evident that, with clinical commitments, the combination of the two roles was becoming untenable.' [190]
160 Mr Wisheart was asked about the use of the word `untenable'. He said:
`The combination of the two roles, together with one's clinical commitments, had become too heavy, yes. But I think he believed that that would probably apply to any active clinician who also had the chairmanship of the Medical Committee and the Medical Directorship to carry out.` [191]
161 Professor Gordon Stirrat had raised the issue of workload with Mr Wisheart in the later part of the period covered by the Inquiry's Terms of Reference. Mr Wisheart told the Inquiry that he was:
`... satisfied that I could cope with those responsibilities which I had accepted at that particular time. I do not regard myself as being in any way different from a significant number of my colleagues who worked equally hard in one area of their professional life or another. I just happened to choose to do my work where it was rather visible within the Trust and within the NHS.' [192]
162 Counsel to the Inquiry put it to Mr Wisheart that, in contrast to the two sessions per week he was allocated in order to discharge his duties as Medical Director, the current (at the time of his giving evidence) Medical Director had seven sessions per week. Mr Wisheart explained that the obligations of the Medical Director had increased during his period of office:
`... when I began as Medical Director it would have been very difficult to identify what work I had to do as Medical Director that was different from my work as Chairman of the Medical Committee, but by the end of the two years in 1994, a whole portion of work had developed which had not existed two years earlier.' [193]
163 On the arrival of Mr Hugh Ross at the UBHT as Chief Executive in 1995, Mr Wisheart was asked to devote more time to the responsibilities he had as Medical Director. Mr Ross said that he:
`... found that the then Medical Director Mr James Wisheart was assigned only two sessions per week for the Medical Director's role which I felt was inadequate time to devote to the job of Medical Director at UBHT. Not only that, but at that time the Medical Director was not supported by Associate Directors to share the considerable load.' [194]
164 However, Mr Ross acknowledged that throughout the NHS, there was no standard model for the role of medical director. He said:
`From the start of trust status, some trusts had full time Medical Directors right from the start; other trusts, like the one I ran in Leicester, had a Medical Director who only devoted two sessions to the job and I supported that Medical Director with other people to share the load. A whole variety of models were in place.' [195]
165 Mr Ross explained that he was of the view that:
`It is important for Medical Directors to continue with some medical and clinical responsibilities in order to keep their feet on the ground ... and make sure they stay in touch with clinical practice, but I think it is fair to say that a trust the size of UBHT could easily have justified a Medical Director working the majority of their time on Medical Director duties, if not full time, such was the load.' [196]
166 In contrast to the clinical directors who had no extra assistance to enable them to carry out their role, the Medical Director did have support staff to assist him with the extra workload beyond his clinical commitments. Mr Wisheart said he:
`... had an additional person at Trust headquarters who helped me with all my work as Chairman of the Medical Committee and Medical Director.' [197]
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Footnotes
[180] Mr Dean Hart was Medical Director from 1991 to 1992
[181] WIT 0108 0009 Dr Roylance
[184] Mr Wisheart was Medical Director from 1992 to 1994
[185] WIT 0120 0018 Mr Wisheart
[186] WIT 0108 0009 Dr Roylance
[187] WIT 0075 0002 Mr Baird
[189] WIT 0120 0019 Mr Wisheart
[190] UBHT 0020 0007; minutes of meeting, 14 January 1994
[194] WIT 0128 0004 Mr Ross