IN the age of the bland, boring, grey-suited NHS bureaucrat with no experience whatsoever of caring for patients, it seems implausible that a vivacious former nurse should find herself at the helm of Worcestershire’s health service.

Former nurse Sarah Dugan is now in charge of a new NHS trust – Worcestershire Health and Care NHS Trust with 5,000 staff and an annual budget of £155 million – proof that you don’t have to be a bespectacled accountant to wield a bit of power over people’s lives.

The trust, which officially comes into being on Friday, takes over the responsibilities of the dissolved Worcestershire Mental Health Partnership NHS Trust and the provider arm of NHS Worcestershire.

The new organisation will have a disconcertingly wide range of responsibilities, running Newtown Hospital in Worcester and the city’s psychiatric intensive care unit (Hadley Unit) for some of the county’s most vulnerable mentally ill patients. The trust will also manage the county’s five community hospitals in Malvern, Pershore, Evesham, Tenbury and Bromsgrove.

That’s a big responsibility by anyone’s standards, but nurses should be used to that. Mother-oftwo Mrs Dugan, the trust’s new chief executive, trained at the Queen Elizabeth Hospital in Birmingham, has worked on infectious disease wards, in neonatal surgery, as a general nurse and a registered sick children’s nurse and as a health visitor.

She said: “As a manager I regularly go out with clinicians on the wards and have always regularly gone out visiting with clinicians to people’s homes as well as on the wards. I do think it’s a significant advantage to have that clinical experience. I understand the service and some of the challenges the staff face.

“My heart is in patient care. It’s partly about my values. Improving the quality of patient care is what’s important to me. People think I’m a bureaucratic grey suit and don’t realise I was a nurse. Whilst I’m not practising as a nurse, I still have all the values and experience and knowledge I gained whilst I was nursing. I’m still a nurse at heart.”

She is not the only person with clinical experience at the helm of the new trust. Including herself, four people in the new board have clinical experience – medical director Dr Bill Creaney, director of quality and executive nurse Sandra Brennan and Jan Ditheridge.

These names will be known to anyone familiar with NHS Worcestershire and the mental health trust. All of them have been on one of their two management boards. The formation of the trust also brings together linked aspects of care under the same umbrella.

For example, children and adolescent mental health was the responsibility of the provider arm of NHS Worcestershire while adult and older adult mental healthcare was the responsibility of the mental health trust.

The new trust takes responsibility for both and other aspects of care such as the health of prisoners, district nursing and health visiting, which Mrs Dugan hopes will mean a better, more integrated service.

So, what does Mrs Dugan make of the Care Quality Commission report into the failings at the Alexandra Hospital in Redditch where patients had to be prescribed water?

It may not have involved her trust but the report has sent shockwaves through the whole of the NHS and has been a wake-up call for leaders.

She said: “We all want to provide the highest possible quality service but we all recognise to make sure that happens every single time in every single place can be challenging for all sorts of reasons.”

Mrs Dugan said she wanted to pursue closer links with patient groups such as LINk who could give the trust honest feedback about its performance.

Since the CQC report was published Mrs Dugan and others have been performing their own unannounced visits, looking at the same issues of nutrition, privacy and dignity examined at the Alexandra Hospital by the inspectors.

These inspections have been across both community hospitals and mental health inpatient areas and Mrs Dugan said it was important to guard against complacency in any organisation involved in patient care.

The challenges that face Mrs Dugan are huge. Her predecessor in the mental health trust, Dr Ros Keeton, said Worcestershire faced “a tidal wave of dementia”.

Mrs Dugan is not quite so dramatic but said: “We are aware there is an ageing population in Worcestershire with increasing numbers over the age of 85 which is going to be greater than other areas. Nationally, there are going to be increased rates of dementia linked to that. We need to think very carefully about that to plan to provide services for those people.”

The trust will also push on with plans to become a foundation trust.

FTs are NHS trusts with more independence from Government who are held accountable through a public membership who appoint public representatives on a council of governors.

The trust is expected to become a FT by July 2013 and members of the former mental health trust – which had been aiming for FT status – have been written to to ask them if they want to transfer their membership to the new trust.

When I last spoke to some ‘service users’ – the jargon used by NHS leaders to describe patients with mental health problems – some were concerned their needs would be subsumed within the wider agenda of a larger NHS trust with a far greater range of responsibilities.

Mrs Dugan said this would not be the case. She added: “We recognise the importance of mental health services and we are absolutely committed to strengthening them in the organisation.”

The national model is also increasingly that of “care closer to home”, which will mean the community hospitals grow in importance. Mrs Dugan also wanted to put on record her thanks to her “selfless” predecessors in the provider arm and mental health trust for their legacy and for making the change to the new trust as smooth as possible.