in conversation with:


Caroline Rassell, Accountable Officer, NHS Mid Essex Clinical Commissioning Group

What does your job involve?

Caroline Rassell

I am the Accountable Officer (Chief Executive) for NHS Mid Essex Clinical Commissioning Group (CCG). I have around 120 staff who are a mixture of finance professionals, commissioners, nurses, as well as a number of GPs to help us make clinical decisions.

The purpose of my role is to make sure that people in Mid Essex ‘Live Well’ within the resources that we’ve got. We work with the hospital, our district nurse provider, our mental health provider, a number of nursing homes and our local GPs to seek to achieve this. 

The biggest challenge that we face in Mid Essex and a big part of my role, is one that most organisations face – ensuring quality but with very limited funds. A lot of the role is focused on figuring out how to do more for less without compromising patient care - this is a massive challenge. 

We’ve also got very similar challenges to the rest of the NHS in terms of working our local hospital so that they can deliver the A&E and cancer targets whilst demand particularly in Mid Essex and complexity of patients is increasing. One thing that is different about a CCG is that we are a membership organisation and not a Crown Body. 

We have a Constitution with all of our GP practices. In effect, I represent the 47 practices in Mid Essex and anything that we want to do, that creates a significant change, we must go out to all of our practices and ask them if they are supportive of it. It is very much about harnessing clinical views to ensure that managerially we can deliver local the national requirements. Obviously, that’s always difficult when you don’t have much money. 

How important is financial training?

I’ll be really blunt and say, I don’t think I would have got this job if I wasn’t an accountant. The position that a number of CCG’s are in means that whoever is leading that organisation needs financial acumen. I was brought in to help turn around this organisation and at that point quality wasn’t an issue - it was money. It was about working really closely with my excellent finance director and ensuring that her and her team had the support and were given the authority that they needed to enable everyone to understand how difficult the financial position was but also how finance can help solve some of the problems. 

For me, the more organisations are getting into financial difficulty the more financial acumen is needed. CIPFA prepares you with real life cases to become be a chief executive - when I was training we did a case study and a P3 project which actually wasn’t about money. It was always about how services were influenced by the amount of resources available – it was service driven. It made you look outside of the numbers and sets of accounts to a much broader picture. I think that that this grounding is so helpful. I’ve been a director of commissioning as well as a chief executive. In both of those positions - it was the financial training that allowed me to be successful at the job.

The numbers tell the story and I think that too often, people think that numbers are reporting on what’s happening. The numbers can be used to predict what will happen but actually the skill is in pulling everything together to make a story for everyone to understand who is not from a financial background. 

What are your proudest professional moments?

I have two. 

About 12 years ago, I was the Director of Specialist for all PCTs in Essex. As part of that role, I helped bring a procedure that was only carried out in London hospitals for cardiac patients to a local hospital. This required negotiation, with clinicians, commissioners, hospital managers and other PCTS which I lead in my role. I was honoured to witness the first procedure taking place at Southend hospital and the difference it meant. People previously were travelling 30 to 40 miles into London to have the procedure. Having it locally also allowed for a quicker recovery time and that was just fantastic. 

I suppose my next proudest achievement is something that we're doing at the moment. In Mid Essex we are in something called the ‘success regime’. We’re under a lot of scrutiny and it is really difficult to try and start any change when all we’re doing is cutting services. We just started a massive piece of work trying to engage the community. We are working with our District Councils, County Council and all our local health partners trying to brand all health and related services as ‘Live Well’.

We’re trying to create a brand and an identity that resonates with the public so that we can have debate about what the offer is for ‘Live Well’ from the public bodies and what the ask is of the public. It’s all about that conversation with the public that the public services don’t have enough money at the moment. Everyone has to take some responsibility and we need to start the conversation. I am really proud of the public that we’ve spoken to, and all of the health and public sector in Mid Essex that have already started to embrace ‘Live Well’. 

What would you say could help you do your job better?

The obvious answer would be to receive the resources that we need. In health we are funded by formula and we are under our formula funding - we struggle hugely with that. 

What would help me more would be less regulations and more trust locally. We are a great group of health and managerial professionals. We could actually make the changes but we get weighted down with red tape and the need to constantly be drawn down into smaller issues that mean we will never be able to make a difference. We need a big change across the whole of the public service because we don’t have the money and quality is not good enough at the moment. I think that it is the micro-management issues that often means we hit the target but miss the point. I would really love to be released from that.