Digital Transformation » Systems & Software » Resuscitating the Ambulance Service

Resuscitating the Ambulance Service

When Helen Chalmers stepped into the breach at the London AmbulanceService, some of her colleagues thought she was making a big mistake. But,17 months on, she has accepted the challenge, tightened the financialregime and steered the ailing service through its transition to truststatus.

Former colleagues of Helen Chalmers thought she had either gone completely mad or was blindly accepting a poisoned chalice when she joined the London Ambulance Service 17 months ago.

The ambulance service’s record had been described as “deplorable” by a Commons select committee not long before. It had a reputation for being inefficient and a melting pot for low staff morale. And, of course, the LAS had still not lived down the public outrage caused when its control centre computer system crashed for 24 hours in 1992 at the cost of many lost calls and chaos.

But for the then 30-year-old Australian, the finance director’s job at the UK’s biggest and best known ambulance service was an irresistible challenge.

In her usual matter-of-fact manner, Chalmers shrugs off any suggestion of well-meaning heroics. The publicity surrounding the LAS was always worse than the reality, she says.

Indeed, Chalmers becomes a little frustrated by references to the LAS’s negative reputation. “One of the things the public does not have a perception of, what it does not appreciate, is how much has been achieved in the past few years,” she says. “It is a much more innovative and dynamic organisation than people seem to realise.”

And she takes as much pride in the service’s operational performance achievements – it has repeatedly succeeded in responding to over 90% of emergency calls within the patient charter target of 14 minutes – as she does in having stabilised the service’s finances.

The ambulance service, which celebrates its first year as an NHS trust on 1 April, has made significant progress but it has “a long way to go”, according to its chairman Rosemary Day. Financial issues, such as achieving efficiency improvements with available resources, will be key for the organisation which has a turnover of #100m.

Chalmers has come a very long way – both literally and metaphorically – to become finance director of the LAS.

Raised in Adelaide, in the foothills of Australia’s Barossa Valley, she graduated in economics before joining Ernst & Young’s business advisory services team. While she enjoyed the work, she was restless, convinced there was “something more out there” although she was not sure what it was. Also she was ready for a change of scene. Adelaide is a city of one million people and Chalmers was beginning to feel she knew three quarters of them.

Her arrival in London in 1990 at the age of 25 coincided with what seemed to be an insatiable demand for Australian accountants. Chalmers had no great career plan “but I started to see what was possible. If I had stayed in Australia I would have probably been a middle-level accountant in a finance department.”

One of her first jobs was a temporary contract with Islington Health Authority. But what might have seemed a routine placement turned into a career-shaping move. Islington was going through a hostile merger with the Bloomsbury Health Authority and senior management, seeing that their services would not be required for much longer, were abandoning ship.

Within a few months the temp, who had joined at a rate of #20 an hour, found herself deputy finance director. When the FD left soon afterwards Chalmers was left to run the entire finance department.

It was Chalmers first real test as a manager. Not only was she overseeing the running down of the Islington operation, but she had to manage a finance department of 45 staff, most of whom were struggling to cope with the change. Chalmers felt the management had not properly considered the impact the merger would have on employees. The young Australian admits she found the situation “absolutely terrifying”.

But Chalmers was able to prove to herself that she could handle the responsibility.

Richard Knowles, the MSL recruitment consultant who was later involved in her placement at the London Ambulance Service, says the response of an individual to a critical situation can be very telling. “Some people find themselves trying to manage at a level beyond their competence,” he says. Chalmers found that not only could she handle it but she thrived at it.

After Islington Health Authority had been completely integrated within Bloomsbury, Chalmers joined the North West Thames Regional Health Authority as financial controller. The then finance director Colin Reeves, who has since become NHS Executive director of finance and performance, was immediately impressed by her confidence, technical ability and commitment.

The appointment of a 26-year-old woman with a slight antipodean twang to the controller’s job stirred some resentment among a few members of the finance department. “There were occasions where there were tensions in the system,” Reeves admits, “but it was not a reflection on Helen.

It was the sort of thing you might get in any organisation. She handled it well, she worked closely with people and was able to dissipate whatever tensions or conflicts existed.”

Responsible for functions ranging from management accounts, regional banking systems and regional allocations and contracting, Chalmers developed her view of the “big picture” in health service provision. She was also actively involved in education and training initiatives, an area that has continued to absorb her.

By 1993 she was looking for a job where she could be fully accountable.

Chalmers’ ambitions were soon to be realised more fully than she could have imagined. She was appointed director of finance and business development at the East Sussex Ambulance Service. Six weeks later the service embarked on a merger with its West Sussex counterpart. Although the merger had been on the drawing board its announcement came sooner than expected and Chalmers was required to take on the added responsibility of acting finance director of the West Sussex Ambulance Service before and during its shadow trust period. When the merged entity, the Sussex Ambulance Service, gained NHS Trust status in early 1995, Chalmers became the youngest NHS Trust finance director in the country.

By the 1995 financial year end, each of the two units had achieved balanced budgets. In particular the West Sussex unit achieved a capital and revenue break-even position for the first time in three years. She says she implemented strong financial controls to achieve this.

Apart from maximising efficiency gains achieved from the sharing of functions – such as the sharing of a central control facility, Chalmers found a larger and larger part of her role involved developing business in a competitive environment. In particular, the merged entity was highly successful in maintaining existing and winning new contracts from other NHS Trusts for the provision of patient transport services (PTS) – the transfer of outpatients to and from hospital.

Despite the reservations of some of her peers, Chalmers joined the LAS in October 1995. At the time the service was in a state of flux.

The service had just completed its application for NHS Trust status and its response times to emergency calls were still among the worst in the country. There were four critical areas and finance was considered to be one of them. A few months after she joined, Chalmers also had to take temporary charge of overall administration after the chief executive resigned his post.

But Chalmers had the full confidence of her board. LAS chairman Rosemary Day says that one of the things she like best about Chalmers during the selection process was there was no “silliness” about her. “She was not trying to tell me what she thought I might want to hear, she said it as it was.

“She had good experience in the private sector and with two ambulance services and I felt she would be able to deliver something to the development of the trust and its finances.”

Day wanted someone with a clear head, “who would not think finance was everything but who would be strong enough to say ‘if we can’t afford it then you can’t have it’.” Someone who could put the importance of finance in context with the needs and business objectives of the organisation as a whole.

“Since trust status she has been a tower of strength. She has played a full part in helping to develop the trust to where it should be. She has provided a good balanced view and performed as I hoped she would when I selected her.”

Colin Reeves, who has actively encouraged Chalmers’ upward career progression, says he was delighted by her appointment to the LAS. Her rise to such a senior position was achieved despite the potential handicaps of her youth, the difficulties that can arise in adapting to a new country and the relatively limited number of opportunities for female finance officers in the NHS. As a woman, she is still in the minority in terms of NHS senior finance management, he says. Although the NHS is actively encouraging women in finance the actual number of women working in senior financial positions is low compared with the percentage of female nurses and clinical staff.

His view is borne out by recent research which shows that in 1993 the number of women as a percentage of the total qualified accountants within the NHS was 27%. While the figure had risen to 33% in 1995 it was still well short of the target for 1998 of 40%.

The total number of female finance directors had risen from 65 in 1993 to 75 in 1995 with the target for 1998 set at 100.

Chalmers’ early months at the LAS were devoted to preparing the service for trust status. “What we were trying to do was make sure the finances and financial regime would stand up to official scrutiny,” Days recalls.

“Helen was instrumental in making sure they did.”

As acting finance director of the LAS, Chalmers oversaw the service’s transition to trust status in April last year. It was around this time that the service achieved its first 90% response rate to emergency calls within 14 minutes. “It was an extremely exciting time,” she says.

One of Chalmer’s early tasks was to establish a fully accountable, transparent balance sheet for the LAS, a job complicated by the fact the ambulance service’s finances were “inextricably linked” to those of the South West Thames Regional Health Authority of which it had previously been a part.

She also had to re-establish the Patient Transport Service as a core part of the service.

“With PTS you have to put more time and effort in negotiating the contract because the market is so competitive – even though it represents less than 20% of income,” says Chalmers. On the accident and emergency side, the LAS, in theory, has a monopoly because the local NHS hospitals are obliged to buy the emergency transport service from London Ambulance.

In practice, however, there is the potential for a gap between the amount a hospital can afford to pay and what the LAS considers a reasonable charge for the service. So even on the so-called non-competitive side of the business, negotiating skills are brought to bear.

A vast aspect of her job has been to make sure the investment into the LAS from the Department of Health and income from its contracts are used efficiently. In terms of its financial performance, Chalmers says: “we are in month 10 of trust status and we are financially stable”.

“The challenge for us is to use everything we have in the most efficient manner possible,” she says. “To deliver more for every public pound. That is what it has to be all about – do as much as you can with the money you can secure. In the health service cost evens price, that’s the rule.”

Even so, Chalmers insists the public sector finance director’s job is not vastly different from that of a plc FD. “The public sector FD is under as much pressure to meet targets although, of course, in the public sector we have an obligation to break even rather than to give better returns to shareholders.

“If I go above breakeven, then I will be using public money that was meant for something else. If I go below it, then I will be putting more money into the public service or will have more resources to do more things better. But like the plc director, if I don’t deliver then I lose my job.”

Outsiders say it is too early to tell how well the LAS is using its investment.

Patrick Butler, a journalist with the Health Services Journal, says the investment into the LAS in the past few years must be the envy of other ambulance trusts. “But whether the LAS performance has justified the investment is a moot point,” he says.

Perhaps the most sensitive and highest profile investment programme has been in the service’s new computer aided despatch system. Although there was a great deal of public criticism of the slowness with which the new system was being introduced, the LAS efforts – and especially those of technology director Ian Tighe and personnel director Andrew Brown – have been vindicated by industry awards and government recognition of its success.

Chalmers points out that the LAS activity level last Christmas – the busiest period in the service’s history – will be its normal level of activity in two years’ time. According to LAS figures, the service responded to 41,516 emergency call over Christmas and New Year, a 15% increase on the same period the previous year. The LAS must be prepared to cope with that pace of growth in demand.

Unlike some other finance directors, Chalmers is eager to dispel the myths and mystique of finance. “It’s really no different from a housewife running the family budget. It’s just on a bigger scale,” she says. She strongly subscribes to the view that the numbers are not the end in themselves, that they should be viewed as the basis on which management can make informed decisions. A sobering approach is to consider spending decisions in the same light as if one was spending one’s own money. “You are far less likely to come up with esoteric business plans,” she says.

While Chalmers might play down the complexity of the finance function, she certainly does not underestimate the importance of training and good management-employee communications. The LAS management is dedicated to information sharing and cascading information to teams. Apart from regular directorate and senior management meetings, Chalmers attends meetings for her whole team every fortnight and everyone has the right to ask whatever they like. She also holds regular meetings with individuals on her team to discuss issues of concern.

“My teams are brilliant. One of the things I love most is encouraging my teams to achieve certain goals and then watching them do it. I am fairly convinced if I ever were to consider another career it would be personal coaching and motivation.”

Chalmers’ flair for leadership and commitment to community issues are illustrated by her involvement in the Health Finance Managers Association, where she sits on the national council, and her past experience as Brownie leader and president of the Adelaide University Mens & Womens Basketball Club. She is a keen sportswoman, having played tennis competitively in Australia, but she claims sports injuries and work pressures have meant she has become much more of a “couch potato”.

But her busy schedule – 50 to 60 hours a week plus the commute between Waterloo and her home in Eastbourne – doesn’t allow much spare time. Even so, getting away from London at weekends is a personal priority.

Despite her success so far, Chalmers still has not mapped out a career plan for the future.

But there is a strong chance that her next job could be within the public sector. Chalmers, a staunch defender of the NHS reforms, says working in the private sector does not really appeal.

“Loads of people I know have the same commitment to the public sector and ethos of working for the community,” she says. “The public sector in health now allows you to do that and pays you well for it – or at least it pays appropriately for the skills required.”

 

Curriculum Vitae

Name: Helen Chalmers
Age: 32
Born: Sydney, Australia
Education: Unley High School, South Australia University of Adelaide, South Australia (Bachelor of Economics)
Qualifications: Associate of the Institute of Chartered Accountants in Australia

Career:

1986: Joins Ernst & Young, Adelaide.
1990: Financial controller/deputy director of finance, Islington Health Authority.
1991: Financial controller/principal assistant director of finance, North West Thames Regional Health Authority.
1993: Finance and business development director, Sussex Ambulance Service.
1995: Director of finance and business planning, London Ambulance Service.
Interests: Tennis, basketball, touch rugby.

Chalmers on Chalmers:
“One of the things I love most is encouraging my teams to achieve certain goals and then watching them do it. I am fairly convinced if I were to consider another career it would be personal coaching and motivation.”

“Loads of people I know have the same commitment to the public sector.”

Colleagues on Chalmers:
“Helen has been a tower of strength. She has played a full part in helping to develop the trust to where it should be.”

“Chalmers is a proactive and enthusiastic member of the HFMA who is never afraid to speak her mind but always has good reason for doing so.”

“She is intelligent, person-orientated and first-class technically. She takes a keen interest in training and development and is not afraid to devolve and delegate.”

Share
Was this article helpful?

Leave a Reply

Subscribe to get your daily business insights