Final Report > Chapter 5: Management in Bristol > The adoption of Trust status

The adoption of Trust status

12 The management arrangements put in place for the `Shadow Trust', and subsequently for the NHS Trust, built on those that had gone before, and are shown in Figure 2 below, an organisational chart for the Bristol Provider Unit in 1990.

Figure 2: Bristol Provider Unit c. 1990 [11]

13 On 1 April 1991 the UBHT came into existence, with Dr Roylance as Chief Executive. [12] Under the new purchaser-provider arrangements, the UBHT became the provider of services through the BRI, the BRHSC and other hospitals, and the Bristol and District Health Authority became the principal purchaser of those services.

14 The role of Deputy Chief Executive in the UBHT was split between two office-holders: the Finance Director, who was responsible for general management issues, and the Medical Director, who was responsible for clinical issues. In addition, the Director of Operations, Mrs Maisey, who was also the Nurse Adviser, acted on behalf of the Chief Executive in dealings with general managers in the clinical directorates.

15 The system of clinical directorates remained in place. A number of clinical directors referred to the burden of carrying out both clinical and managerial work. Monthly meetings were held between general managers and the Director of Operations/Nurse Adviser, [13] and between clinical directors and the Chief Executive and Medical Director. Clinical directors also met together on a monthly basis as the `Management Board'.

16 Dr Roylance stated that:

`The aim was for the Clinical Director to be "in charge of" the doctors and for the General Manager to be responsible for everyone else, to ensure that the necessary administration and support services were in place for the Directorate to run efficiently. In the discussions which took place before this change it was agreed that the most appropriate way forward would be to view the Clinical Director and General Manager as being in a managerial "bubble", jointly sharing the managerial responsibilities; thus, neither was directly responsible to or for the other. These two were assisted in their management roles by the chief nurse of the unit, a Directorate personnel officer and a senior member of the Finance Department.

`The only other level in management was that at operational level with ward sisters or their equivalents taking full responsibility for wards or their Units.' [14]

17 Dr Roylance stated that the working relationship between the clinical director and the general manager evolved over time, from what he called the managerial `bubble', to the position in which the clinical director was accountable to the Chief Executive, and the general manager supported the clinical director.

Footnotes

[11] WIT 0038 0076 Ms Charlwood; an enclosure to a letter to Miss Catherine Hawkins, Regional Manager, SWRHA, from Dr John Roylance, District General Manager, B&WDHA, dated 31 August 1990

[12] Some parts of the District Health Authority did not become a first wave trust (one of the initial trusts established in 1991), but combined together in order to be managed directly for the early years of the 1990s

[13] Margaret Maisey, Director of Operations and Nurse Adviser 1991-1996, Director of Nursing 1996-1997 at UBHT

[14] WIT 0108 0006 - 0007 Dr Roylance