As part of our HTN Now September 2021 event – where we share live webinar, video and website content of health tech professionals discussing topical issues – we’re also releasing new instalments of our CEO Series.

In our latest interview, we chat to Andrew Morgan, Chief Executive Officer at the United Lincolnshire Hospitals NHS Trust (ULHT), who tells us about the trust’s focus on people first, when it comes to digital innovation…

Hi Andrew, tell us how you came to be a CEO

If I think of my NHS career, I tend to think of it in numbers. I’ve had 19 jobs in 14 different organisations, in eight parts of the country for over 39 years now. I’ve been a chief exec for 17 years, across eight organisations. I describe myself as a ‘jobbing generalist’ – I’m not a clinician, I’m not an accountant, I’m a general manager who has found himself as a chief exec in many different sorts of organisations.

What are you working on at the moment?

I joined ULHT in 2019. This trust and Lincolnshire Community Health Services share a chair, Elaine Baylis, [who] asked me to move across from the community trust, where I’d got them to an ‘outstanding’ rating for CQC. This is a double special measures trust, so we’re in finance and quality special measures, and have been since 2017.

When I joined, getting out of special measures was one of the key measures. What they didn’t tell us was that there was going to be a pandemic a few months after joining. I’ve been here for two years now [but] I’ve sort of lost 18 months due to COVID, so I’ve not [yet] been able to do the changes that I wanted to do.

There are eight things we are juggling at the minute. One is clearly COVID – it’s still here, it hasn’t gone away. Service restoration, all those things that stopped or paused or slowed down during COVID, particularly waiting lists that we have to get back to a more acceptable level. There’s managing all the urgent and emergency care pressures that are looming – because we’re a holiday destination for people, we don’t just suffer from winter. Lots of people come to Lincolnshire and our population increases by about 25 per cent, and that has an impact on our services – particularly in a year when people aren’t really going abroad.

[Another] is all the staffing issues – it’s about how you juggle annual leave, as people stored a lot up during COVID, as well as having a tired workforce. Number five is the vaccination programme – as a hospital hub we started off the vaccine programme back in December [and] we did the health and social care workers. We then handed over to General Practice and the large vaccination centres, to do the population. As we’re now talking about a booster programme and giving people a flu jab, I think we’ll have to reopen our hospital hubs, so that will be a major bit of work.

The next one is setting up an Integrated Care System (ICS) – Lincolnshire is an ICS boundary. Number seven is just manage the money – being in financial special measures, that’s a big issue for us. The final one is what I would call our culture and leadership behaviours – it was clear when I joined that we had a lot to do around people.

If you wrap those eight things up, that’s quite a busy agenda. Some have more prominence at different times of the day and different times of the week. It’s a bit of a juggling act at the moment.

Tell us more about your people and culture strategy

Being part of the Lincolnshire system, we find operating as a system fairly easily because of the geography that we’ve got. I’ve always described our people agenda as quite simple, it’s ‘get them, keep them, grow them’ – how do you attract people? Once you’ve got them, how do you keep them and develop them? And how do you grow them into other, better roles?

If you look at the people plan for Lincolnshire, it’s about more people – that’s number one – and number two is about working differently. Number three is about working in a compassionate and inclusive culture.

I’ve always believed – and that was one of the bedrocks of how we got ‘outstanding’ at my last trust – focus on the people. I’m clear that this is a people business and I know we might be talking technology – but technology is nothing without the people.

It’s a people business and my whole approach is ‘how do you get a happy, well-led, well-motivated, well-engaged workforce?’ Because all the evidence, no matter what sector you’re in, is once you get to that point, you have the foundations for it being an outstanding organisation – whether you’re making cars or selling tins of beans. We’ve got it in patches but not enough.

Is it the number of staff we’ve got? Is it that they don’t feel we care? Is it that the wellbeing offer is not right? Is there any impact of COVID on that? Is it about trust? Is it about commitment? Is it about autonomy? So, we have signed up to the NHS England Cultural Leadership Programme. There is a nationally-recognised programme to tackle cultural leadership. It’s about a discovery phase – you find out from staff what the issue is, [you] then design what you’re going to do about it, and then there’s a delivery.

It’s quite a methodical way of doing it and sometimes we’ll hear things we didn’t like. But ignoring them isn’t the answer. So there’s a lot to be done – I have made some changes here, despite the pandemic. We’ve got a very different exec team, we are trying to create a different culture [and] trying to be much more system-focused  – much more outwardly-focused, a key player in the system, an anchor organisation. We’re a big place, we are what they call an ‘extra-large’ acute trust. We’ve got 9,000 employees, we’ve got a budget of about 640-650 million, so it’s not a small organisation [and] we’ve got a number of sites. It’s a big place and it matters.

I’m not an acute trust person by background, I’ve been a chief exec of strategic health authorities, PCTs [Primary Care Trusts], PCT clusters, health authorities [and] I’ve been an ambulance trust chief exec, a community trust chief exec and now I find myself as an acute chief exec. The key thread through all of them is people. How do you manage large, complex organisations? It’s not just about the technical knowledge of ‘how does an acute trust function?’.

That’s why I describe myself as a ‘jobbing generalist’, I’ll turn my hat to anything. Part of my job as a chief exec is what I call ‘storytelling’, so when I’m out there with staff, how do I explain what we’re about? How do I explain where they fit and why their behaviour matters? Or why how they treat patients and work colleagues all matters to us?

[Also, I remind them] that if their role wasn’t important, it wouldn’t be here. So, when people say ‘I’m just a receptionist’, ‘I’m just a porter’, I do like to say, ‘it’s not ‘just’ is it? You matter because we wouldn’t employ you if it didn’t…’, we all have a role to play here.

What about technology?

The technology bit isn’t just about tech – it’s about the people that operate it and it’s about the behavioural bit and the transformational element. If we just think we can buy bits of kit and suddenly the trust is transformed – no, it’ll sit in a box somewhere, or somebody will say ‘that isn’t what I wanted’, or we won’t help them use it differently. We’ll have spent lots of money and we’ll be exactly where we are but with less paper.

My background is the people bit of it and I’m interested in how we equip patients with technology, so that they are informed consumers of our service rather than dependant on us. I can certainly see a version of the future, whereby records are actually held by the patient, not by the service [and] whereby you have far more online consultations, either face-to-face or AI, where you can book on your phone rather than get a letter, and where there is far more remote monitoring of your condition. Part of that is [that] you don’t know what you don’t know.

I would think it’s going to be part of the agenda for the future – how do you maximise technology? How do you empower the patient? Even when you start to join up different agendas, like net carbon zero, if you want to tackle that, some of that will be around transport and travel…and some of the changes we made during COVID about online consultations does reduce the amount of travel.

What we’ve found in some parts of Lincolnshire is then a push-back of ‘but our hospitals are not as busy as they were, there’s not as much footfall’ and that’s got some of our politicians concerned.

It’s not that convenient for patients, is it? If they can stay in bed and consult with a consultant, why would you make them and the consultant travel? There’s those trade-offs between modernising the service versus much-loved institutions. I absolutely understand much-loved institutions but when I wander about our site, I often see quite elderly people wandering around with bits of paper, clearly on their way to a clinic somewhere and you do think, ‘might there have been a better way of doing this?’ Making them travel, making them park [and] pay for parking for probably a 10-minute consultation with somebody. Is there a more technologically-minded way of doing that?

Not all older people are not tech savvy, many of them are very tech savvy. And many of them are pushing – ‘why do you have to do it this way?’

When we say we want to transform the NHS and have it fit for the 21st century, what does that actually look like? I think these are all absolutely legitimate discussions to have but a very clear part of my job is the communications aspect. I love doing media stuff because, as a public service, I think that’s what we should do. [Be] out there explaining to people what we are doing, why we’re doing it and how it might change.

There will always be these tensions, and I think we see it in General Practice – [with] many consultations now done remotely and we’ve all seen newspaper headlines that some people don’t like that, but some people love it. That’s the challenge we have – how do we keep everyone happy?

What have been your biggest leadership challenges recently?

It’s a workforce that has kept things going but it’s very tired and there isn’t any time for pausing. Without our people, it’s quite hard to run a service and trying to do that is going to be a challenge.

On the money…the NHS has had different financial regimes during COVID – and rightly so. On occasion, that’s hidden our financial problem, but it’s not gone away. So, it’s now needing to get people back into that we spend far more money each month than we get in. That’s not a sustainable position for us and we have to do something about that. That’s where we’ll need to get into some of the modernisation, the productivity, the waste.

I think tech can help us with some of the productivity issues and help us redesign some of our pathways, because this isn’t just about buying bits of kit and putting it in a hospital. We’ve got kit, we’ve got scanners…it depends what people mean when they say technology. I am interested in how we empower patients…if we design it around what they found helpful. We need to do more around our patient engagement – would they paint a different scenario for us of what care they would like?

On the high-level strategy stuff, what you tend to find is that everyone wants more prevention, more care close to home. But when they say that they don’t mean they want to substitute it for hospital services – they want both. As an acute trust chief exec we have got to ask the question – is that a deliverable? Does everything that goes on in a hospital need to go on in a hospital? My answer would be no, it doesn’t. Hospitals are still really important parts of society but could it be delivered in a different way? That’s the debate we’ve got to have.

How has your leadership style adapted to more remote work?

Having come from a community trust, you get used to having services delivered remotely, in many different places, with staff you hardly ever see. So, it does drive you to a model that’s about ‘how do you equip them to be as successful as they can be?’ – both in technology-terms, their competencies, their knowledge, but also the trust you place in them. Because you’re not actually there when the service is provided – you can’t walk down a corridor, you can’t stick your head around a door or you can’t move the curtain aside and ask if somebody is alright. You are heavily reliant on their skills, competencies, and all of that.

During COVID, that was how most of us had to operate – many staff working at home, doing remote consultations. We also operate at many sites and I can’t be at every site, so you do need good local leaders who understand the importance of contact with their workforce [and] who do understand that their job is to make success more likely. Your job as a leader is not to torment your colleagues, it’s to make success more likely.

It, therefore, requires you to be contactable, visible, and interested in their wellbeing. I occasionally talk to people about what they think their job is – ‘how do you spend your day? How do you spend your time?’ – I reflect on me and I can spend a lot of days on [MS] Teams, really busy. But, actually, you have to ask yourself, is this being busy or is this being useful?

I think, on occasion, we have busy fools. People who are really busy doing Teams, emails, writing reports and attending meetings, and not actually doing the stuff that matters – which is talking to patients, seeing how their services operate, talking to their staff, and getting stuck into all of that. We’re guilty of it, I get an email every minute, virtually, some days.

Being busy is not the same as being effective and it’s a hard cycle to break out of. It needs people like me to give permission and to role model the sorts of behaviours that we want. I half jokingly say to people that they pay me just to walk about talking to people but that actually is part of my job, to wander about talking to people, and Teams has slightly got in the way of some of that.

I tend to think about the job in three chunks – what is your intent, what is it you’re trying to do? And what is your strategy? Have you chosen the right things to spend your time on? Have plans that will entice your workforce to want to be with you on it…[but] there’s no point having a plan if you haven’t got a chance of doing it.

Sometimes we confuse capacity and capability. We think just having lots of something – like people – will deliver. No, you needs lots of capable people to deliver, with a multitude of skills. Just having a warm body with a pin number won’t deliver your plan.

If you’re going to have a plan, and you have lined up your capacity and capability, you do then need to deliver. What you need to do is stop re-writing the plan, or what I call the ‘magpie approach’ – you see something else, something new and shiny, and you forget the plan you had and go off in search of something bright and shiny over there. Sometimes technology does fall into that category.

We have a five-year integrated improvement plan, as a trust. It takes us up to 2025, so we’re in year two. Its aim is ‘outstanding care, personally delivered’. I’ve said this trust can be ‘outstanding’ by 2025. We’ve set out the roadmap and all of our objectives and priorities, [and] we’re aligning our capacity and capability to it. We’ve got to change our culture and behaviour to get there, we’ve got to make ourselves financially sustainable. But if we do all of that, there’s absolutely no reason why this place cannot be ‘outstanding’.

Next up in our CEO Series – and as part of our planned content for HTN Now September 2021 – we put the spotlight on Janelle Holmes, Chief Executive Officer at Wirral University Teaching Hospitals NHS Foundation Trust.

In this feature we find out how Janelle, formerly a nurse, rose through the ranks to become an NHS leader, and she also shares her thoughts on tech and digital programmes, as well as what it was like being one of the first trusts in the UK to take in COVID-19 patients…

Hi Janelle, how did you become a CEO?

I started out as a nurse, and I’ve been in the NHS for a long time. I worked my way up from a nursing perspective and then took some time out and did some work as an operational transformation lead, which opened some avenues. When I went back into management, I went into general management rather than nurse management and spent quite a lot of time at Salford Royal Hospital.

I worked for Sir David Dalton – [so it was] a good model of leadership and digital. It was probably one of the first digital organisations. I then moved over to Wirral in 2016, first as the chief operating officer and then as the chief executive, from 2018. Did I ever think, as a staff nurse, I’d ever be a chief exec? No, never.

Being from the north as well, I don’t fit the stereotype. I’m not one of those people that you meet, and they say ‘I’m going to be a chief executive in five years’, I just fell into things and enjoyed them and wanted to lead change. That’s how I became a chief executive.

Do you have any leadership learnings to share with our audience?

The biggest challenge in the last year, as you can imagine, has been COVID. Despite my background as a chief operating officer and working through swine flu concerns and major incidents, nothing could prepare us for COVID. We did the blueprint for COVID because we took the first repatriated Wuhan citizens, back in January [2020] – before we had COVID in the country and before it was declared a pandemic in March. We were requested to be the first isolation facility since 1978, I think. We repatriated lots of British nationals and took the passengers from the cruise ship liner – The Diamond Princess – not long after that.

What I learnt was that you’re not an island. Support mechanisms and the partnership working across the system were key and I probably underestimated that as, since then, relationships across the patch – both at Cheshire and Mersey [Health and Care Partnership] and at Wirral-level – have been so much better because we’ve tackled adversity together. That opens avenues for further improvements across the system. I really valued the partnerships and not just with health providers but also local authorities and the support that can be offered.

We had 48 hours to convert what was our staff accommodation into an isolation facility. Everybody was frightened of the unknown – the media coverage was significant and there was a lot of fear from both staff and the local community. A learning from that is the importance of how you communicate – it’s best to be doing that face-to-face, in a genuine way, even if you’ve not got anything concrete to say. People just like to have honest conversations.

It probably comes back to having a nursing background, but it’s important not to ask somebody to do something that you’re not prepared to do yourself. There were patients cancelling appointments because they didn’t want to come on to site. But, when you’ve asked your team to pull together isolation accommodation, I needed to be the first person in there as we received all those people off the coaches, at midnight, when they landed. That was the right thing to do.

From an executive team perspective – being a new team and an organisation that was under the spotlight from a ‘requires improvement’ perspective – the fact that we were able to do that gave some credit to the team-working. From a staff perspective, there have been some issues around culture and staff feeling listened to, so some of that work was really important – putting a face to a name- and those bonds forged working together.

What’s your vision around digital and tech?

From my perspective, when I joined, I came from an organisation that had quite a long history an electronic patient record (EPR) and Global Digital Exemplars. When I landed in Wirral it was the same [but] different systems. We spent a lot of time as team pulling together our strategy, and our underpinning strategies – one of which is digital. For me, it has got to be about improving patient outcomes and patient experience.

To do that, the focus has got to be on having a fully functioning EPR with the ability to share across the system, so that you reduce the amount of hand-offs and time-outs and share information in a timely way. The Wirral Health Record is an important piece of work.

The second [focus] is giving patients access to their own information, so they can make informed decisions and choices, removing the burden on healthcare with more self-service. When you check-in for a holiday, everything is online, and ideally, we’d want the same for patients so that they can manage their own long-term conditions.

The third is about how it supports development of productivity and efficiency – so anything that reduces waste and duplication. And also, being able to use digital in a more effective way – everything we’ve done this year. We wouldn’t have been doing this 18 months ago, everyone was in the office without MS Teams – so how do we use this now to support patients? But we need to recognise people still want to see a face, which is probably what is driving pressures in Emergency Departments.

We [recently] rolled out capacity management and my learning were that all your change programmes to do with digital, need to be clinically led, as far as I’m concerned. If you can get to see capacity over your site that’s important. But a word of warning is that buying the system is not the same as people using it and it making a difference. All those change programmes need to be clinically led.

How have you changed your management style for remote workers?

We’ve had a bit of a forcing function, haven’t we? People couldn’t come in and we managed to set outpatient e-consult up. It was a programme of work that we earmarked about 18 months to two years for – and we switched it on in a month. There’s nothing better than a burning platform that makes you change your style, adapt, and adopt different ways of working. We were on a better footing because we had strong foundations, which made it easier to do some of that work.

I’ve not reflected much on how my style has changed because, when we are in the building, we still use Teams as we don’t want to risk each other. We got back in the room and then when the prevalence [of COVID-19] started to increase again we went back to Teams. I don’t think there’s anything that you can’t do from an online perspective.

[From a wellbeing perspective] I don’t think we’ll understand the true impact of COVID on people’s mental health for the next 12 to 18 months, but we have pre-empted some of that. For back office staff we’ve done a lot around home working and I don’t expect some that to change – it gives us some flexibility and we’ve got a lot of space that could be used for clinical work that’s used for offices. It can be a better work-life balance, as when I work from home that’s two extra hours that I don’t drive.

There’s a lot you can do with frontline staff. They can’t be home office-based but we’re really encouraging people to take their leave – we were one of the only trusts that didn’t stop annual leave during the pandemic, and we actually supported it. A lot of people chose not to take it because there wasn’t anywhere to go but we did do a lot of encouragement around that. And we’ve also thanked them this year by giving them an extra day off for their birthday.

We’ve also got some digital things – we do an employee assistance programme, which is an online programme with access to counselling and specialist psychological support, mental health first aiders etc. There is quite a lot going on around health and wellbeing. We’ve recruited psychologists, specifically to work in our Emergency Department and Intensive Care, because they were the staff dealing with the COVID patients.

How do you look after your own wellbeing as the boss?

There is a lot of responsibility but, from my perspective, there are a few things [I value]. Having a good team and being able to build your own team is important, as well as supporting each other to get downtime and recognising when people are under pressure.

I was on a CEO WhatsApp group, and somebody asked how people were feeling about their execs home working. My view is that you judge people by what they deliver and their outcomes, not the time that you see them in the office. I think that’s a bit more modern. It really is about making work and home life more balanced.

What advice would you give to other people from clinical backgrounds about applying for leadership roles?

I think you must stick your head above the parapet. I come from a working-class background, I went to secondary school and wanted to become a police officer but ended up in nursing. I spent a lot of time thinking that people have degrees and higher education but sometimes you see something and think ‘I could do that job’.

When I moved from nursing into general management I was asked if I’d feel disconnected from patients but, actually, these jobs allow you to influence patient care better than you ever could do as a staff nurse. That is something people should understand – you can influence the future for other people and leave a legacy.

It doesn’t matter what your background is or where you’re from, if you’ve got a passion for improving patient care then you need to step in, we need good leaders in the NHS. There are lots of people out there who probably wouldn’t even think about putting their head above the parapet. Feel the fear and do it anyway!

In our most recent leadership series interview, we speak with Tim Guyler, newly appointed Assistant CEO at Nottingham University Hospitals NHS Trust.

In focus, Tim discusses the technology that has been most useful to his trust and shares his leadership learnings from the pandemic.

Tim also shares his advice for those aspiring to become senior leaders within the health service. 

Can you tell me about your path to becoming Assistant CEO?

My path started through the NHS management training scheme which I applied for and successfully joined after university. At university I studied Business Studies and French in which I probably had some grandiose idea of becoming an international business person and retiring by the time I was 30 (which clearly hasn’t come to pass!) but as part of the course I studied Health Economics which opened up a broader interest of the impacts on society that well-organised health and care services have.

Since then, I’ve undertaken a number of roles in the health service which have predominantly been around operational management and service improvement in several places around the country. But I then came full-circle back to Nottingham where I was born and bred and I’ve undertaken a number of different roles in Nottingham University Hospitals including Deputy Director of Operations, Programme Director for the Whole Hospital Change Programme and Chief Operating Officer, subsequently ending up now as Assistant Chief Executive.

Has your leadership had to change since the start of the pandemic?

It has required a different kind of leadership from all of us; leading at greater pace and leading within greater ambiguity have been the two key aspects of leadership change for me.

In the NHS up until recently, there was incredibly strong focus on seeking to get as much assurance as possible before making changes. This comes down to risk balances and understanding the likelihood of risk, and quite often we would look to get as best an understanding of risk before progressing change.

The Covid-19 situation ‘do nothing risk threshold’ has changed markedly and so the necessity to change was much greater even though what you were changing showed a great deal of uncertainty in terms of how much assurance could be afforded to that change.

So, from a leadership point of view we needed to involve the best people and enable the right people to come to the fore. That’s nothing new – it’s what we’ve always sought to do and is an important aspect of good leadership – but we needed to be better at it than we’d ever done before. We needed to give the right people the head room and support to get on whilst there are unknowns and unmitigated risks.

Pace and leading through uncertainty have been significantly different within the context we are in now compared to what was previous. Leadership should create clarity and support to allow people to make decisions when the situation is unclear and difficult so that we move forwards.

What are the key challenges in your role as Assistant CEO?

A large part of my role is working across the health and care system with partners; I can’t remember who made the comment of ‘if you think competition is hard, you should try collaboration’ but this does often feel very true.

I think there is something in terms of how we drive forward collaborative work to yield greater benefits and I think this is one area where Covid-19 has helped us all – it has allowed us to collectively respond to what we can do as organisations; we have broken down barriers that have previously prevented us doing things, and we have recognised that what we would have previously perceived in terms of risk, pale in significance compared to population outcomes.

We have to try harder and be more willing to take risks, make things happen, and own the implications together; during Covid-19, we have seen some brilliant examples of this happening which wouldn’t have happened otherwise and we need to make sure we continue down this path.

What technology has been most useful to your trust?

Within our hospital, one of our primary systems is Nervecentre and over the years there has been a rollout of handheld devices to do a manner of things digitally. That as a core centre of an information system has been critical as well as the flexibility of that system, where the adaptation of that system around designing IT systems in supporting clinical teams has been absolutely essential.

Having an adaptable system that supports clinical colleagues in capturing and accessing information quickly, to be supported in decision making by clinical information at the point they need it has been absolutely critical.

More broadly speaking, it has been amazing to see the type of work that has been done through the digital and informatics space to get a deep understanding across the populations of what is going on to inform decision making.

Data has been absolutely critical in making good decisions; the IT systems, the modelling systems, the population systems underpinning decision making are important, and as we move into the Covid vaccination program, the IT systems that have enabled population understanding has again helped us massively in planning what the best model is to role the vaccination out.

Can you share any learnings you’ve acquired?

Two main things come to mind; the first is if you ask people to do something with a clear intent, they will do it. I’ve been so humbled by the stories of what people have done – exceptional personal sacrifice in caring for the population across health and social care. The response has been so strong even in dark times.

The second thing is the depth of ability and experience which exists across organisations; we’ve worked very closely with the University of Nottingham and we are very fortunate to be located next to one another in the centre of Nottingham. The university wrote to the CEO and said “we will help in any way we can”, and since then I’ve been the mutual aid link to the university. We are now part of a civic agreement between the universities to do the best we can across the community.

What advice would you give to those aspiring to become senior leaders?

The first and foremost for me is make sure you surround yourself with good people; a previous boss once told me “always employ people who are more capable than you” which I think is sound advice, but to add to that is ‘always look up and out towards people who you can learn from and ask them for their help and advice’. I have always found that when you ask, people are incredibly generous with their time and will help you learn and develop.

Those people can be a huge source of support as you develop. I have been blessed during my career in having really fantastic people around me, supporting me, guiding me, sometime through luck and other times through actively seeking those people out – these people become career defining.

Can you tell me about your path to becoming a CEO?

I haven’t had a conventional route into becoming a chief executive in the NHS. My degree was in Engineering, and after a year teaching in Lesotho, I joined Esso working at the Fawley oil refinery. I spent 13 years in oil covering a wide variety of roles, until I saw an advert for the Gateway to Leadership programme looking for people with commercial management skills to join the NHS. I had been looking for a way to move into the charitable or public sector, and this seemed like a great opportunity. I started at Basingstoke and North Hampshire Hospital in 2005 and have never looked back! The NHS is a fascinating, challenging, inspirational, frustrating, and brilliant place to work.

After seven years in an acute hospital, I joined Solent NHS Trust where I was chief operating officer for five years, working in community and mental health services. The biggest thing I took away from that role was collaborating across sectors to do the very best for patients, and it’s something I have remained passionate about. I was delighted to be appointed to the chief executive role at Hampshire Hospitals – I started my NHS career at Basingstoke, and had my first director role at Winchester, so I knew what great people work across the trust and what a privilege it would be to work alongside them.

How has your leadership changed during the Covid-19 pandemic?

It has always been very important to me to know what it is really like working in my organisation and I try to spend as much time as I can on the wards and with front line teams. Of course, during Covid-19 those important face-to-face interactions with staff have become much harder, and I have had to find other ways to find out how things are. Technology has been a real asset both in how we communicate with staff, public and even patients, but I am all too aware of the barriers of virtual conversations – particularly with many staff often not being able to get time in front of a computer during the working day.

It’s been more important than ever before to really hear what our staff are saying and understand what they are experiencing. In the last few months we held listening events, and one with our BAME champions group was particularly thought provoking. I am struck by Michael West’s definition of compassionate leadership which talks about listening with fascination, and then about doing something as a result.

Another key theme for me has been about trust. I am lucky to be supported by a brilliant group of people in the senior leadership team, and the last few months have meant that we have really needed to trust and rely on each other in ways we haven’t before. Particularly in the first couple of months, we were constantly making rapid changes to how we run our services and adapt how we lead our teams – we couldn’t afford to have everyone working on the same thing. Whether dealing with ever-changing PPE guidance, staff risk assessments, free meals or ward configuration, it was about knowing that we were all getting on with it with our patients and staff at the heart of every decision.

What technology has been most useful to your trust over the past few months?

Who hasn’t become experts with Zoom and Microsoft Teams over the last few months?! We have used both a lot for our internal communications with staff, virtual patient appointments and public engagement.

We were scheduled to do two months of public engagement around our new Modernising our Hospitals and Health Services programme, under the national Health Infrastructure Programme (HIP2) to build a new hospital. We had to move it all onto Zoom, and after having spoken to over 1,000 people using this technology, I can safely say it has been surprisingly brilliant!

From a clinical perspective, we had already set up our radiologists with home reporting and that has proved to be a godsend. We have eliminated our reporting backlog.

For some time, we have been working through a Digital Care programme, and in particular a remote outpatient programme that had just begun to really kick off. Through Covid-19, this has accelerated beyond all recognition and that means that we are faring very well in terms of outpatient appointments delivered. From April – June 2020, over 50,000 non face-to-face clinics took place either via phone or video, which is an incredible achievement and a real team effort.

Our microbiology team have been hugely innovative, and we are very proud to have been the first lab outside of PHE to test in-house for Covid-19. Remarkably, the team had this technology up and running by the beginning of March, which meant we were able to test staff very early and reduced our sickness absence, as well as being able to quickly test symptomatic patients. We also offered early testing to staff of partner organisations to support those in our patch.

Our IT team has been phenomenal in getting people set up to work from home to support those who could work from home to do so, and has been particularly useful for those who have needed to shield but continued to be an important part of our team.

What learnings have you acquired leading through a pandemic?

I have definitely become better at trusting others to get on with things. It has been impossible for one person to be over the detail of absolutely everything, so our incident command structure has had clear delegation and escalation processes. I was totally inspired when I visited one of the labour ward teams who had created a Covid-19 unit in the maternity unit to care for Covid-19 positive mums. As a leadership team we had said that all areas needed to work through how to provide safe spaces, and then individual teams had worked the detail in their own areas. This is textbook leadership for me – we agree the outcome, resources and support, and then don’t interfere in the detailed implementation!

As a health and care system we have come much closer during this time, including daily conversations with partners in mental health, primary, community and social care. We all understand one another’s worlds much better and have a greater appreciation of what each other bring.

I have also had a renewed sense of what is possible. It can be too easy to say that something will take years to change, and yet we made huge changes happen overnight. We need to keep reminding ourselves that the NHS is amazing, and we do amazing things.

How has the role and usage of data changed during the past few months?

As we have moved into restoration, I find that the task is actually much harder. People are tired and the objective is less singular. Keeping people safe from Covid-19 was a single, very clear, overriding priority. Now we need to maximise the diagnostics and treatments we provide to a wide range of patients, while still keeping people safe, within the limitations of workforce capacity, estate and finances. It is more complicated and there are more trade-offs to make. We have competing asks for space and people. The role is still about trying to bring clarity to the situation – we still have a common purpose which is about being able to provide outstanding care for every patient.

Data has become more important during this time, which is great, as becoming more data driven is something I have been advocating for quite a while. I think more and more people are seeing the value in real time, accurate data. We were used to getting sickness absence monthly and suddenly we needed it daily. Back in April, we were discussing the number of patients who had tested positive for Covid-19 three times a day – tracking rises in admissions by the hour. It showed up the gaps in our data systems, but also what amazing people we had who could implement new data capture systems overnight in order to help us care for our patients and support our staff.

What advice would you give to CEOs and teams at other trusts?

Trust your teams. Care for them, support them. Give them opportunities to rest, and opportunities to shine.

Anything else you would like to add?

A huge thank you to the public and communities who have responded so well to the Covid-19 pandemic. In early April we were facing an unimaginable situation of demand for intensive care beds at 10 times our normal capacity. As a result of all the brilliant work by the public and the NHS, we turned that curve.

And a huge thank you to the amazing staff at Hampshire Hospitals and in our partner organisations across Hampshire and the Isle of Wight – you are what makes the NHS the inspirational icon that it truly is.

Angela has one of only a few roles across the country; she has not only achieved an ‘Outstanding’ rating for NHFT on two occasions, but she has also made a massive difference to LPT since joining the trust over a year ago.

Angela is also one of the few CEOs who has pledged to strive towards LPT and NHFT becoming anti-racism trusts – a key message this Black History Month.

Can you tell me about your path to becoming a CEO?

I’ve been in the NHS for 31 years and my interest in the health service started when I was 14. I was in the role of ‘Mobility Assistant’ – probably not a role that is recognised now, but in those times, we were paid to come in and take patients out; this was a learning disability and mental health facility. From this role, and from spending time with my nan who worked in mental Health, I developed a passion for healthcare!

After this role, I went on to become a Speech and Language Therapist: one of the Allied Health Professions, and I was lucky enough to be accepted onto a place at Leicester to study for my BSc. I took this passion forward and specialised in working with people who had learning difficulties and dysphagia (swallowing disorder). I was also fortunate to be able to study for my Masters degree at Birmingham University whilst working and juggling the demands of a young family – looking back now  I recognise how this helped me learn how to manage competing priorities.

From that role, I took on increasingly professional roles; I became a professional lead which meant leading speech and language therapists in a county, and I also became involved in a management board with the Royal College of Speech and Language Therapists.

I was lucky enough to be given opportunities to “dip my toe” into general management responsibilities; this was never my path nor my desire but I think perhaps other people saw something in me that I didn’t see in myself and through those experiences and development opportunities, I became very passionate about leadership and ultimately became a director of operations which prepares you for so much in the NHS.

I was able to visit Kaiser Permanente in San Francisco and United Healthcare in Minneapolis and New York. Both of those experiences gave me a fantastic platform to take a step into a CEO role and I’ve never looked back. In Northamptonshire I’ve been the CEO for seven years and I’m now Joint CEO across NHFT and LPT and I love it! 

How has your leadership changed over the past sixmonths?

Fundamentally, I don’t think my leadership has changed; I still think I’m focused on people and the cultural part of the job and I’m hopefully known for that. I think the difference has been the increase in talking with  people about self-care and their mental health and wellbeing.

With my executive teams, I’m asking them to tell me what their health and wellbeing is like, we score ourselves and we encourage people to talk about it. As much as my leadership style hasn’t changed, it has certainly been an increasing focus on collaboration for us all!

We have seen through COVID-19 that without collaboration you cannot achieve the outcomes that have been set or you need. I’ve always been committed to diversity and inclusion, however COVID-19 has emphasised this further and one of the aspects I’ve committed to is to fully become anti-racist organisations – this can be easily said but it’s not easily done. We have started these conversations, and building upon our BAME listening events, collectively we are exploring what that actually means and discovering how best to co-produce this with our staff.

What technology do you think has been the most useful over the past six months?

Without technology we wouldn’t even be communicating between organisations as well as we have. The tech that I would emphasise would be innovation examples like ChatHealth, a digital text messaging service which started as an offer for young people in LPT , and is available to support parents and carers of children aged 0-19. We are very proud that over 50 trusts around the country are now using ChatHealth.

So, during the pandemic, we’ve increasingly used ChatHealth to support young people and families to get in touch with us for advice and support in relation to their physical and mental health. We’ve also extended the ChatHealth text service to perinatal mental health service users as well; mums are able to use that facility for example if they’re struggling with post-natal depression.

In fact, we’ve also just won a digital innovation award for our website work with children and young people services, so for the Health for under Fives, Health for Kids and Health for Teens public health websites, which I think are great examples of how you can encourage people to access information for themselves and be signposted and supported, and to use a digital platform to facilitate that.

How are you and your trust celebrating AHPs this month?

There are loads of events across both organisations, recognising all the professions within AHPs and the roles they undertake – a true celebration. We kick started on Monday (12 October), I was really pleased to open the event and I gave a sense of my career journey and in that I focused on what I call ‘the ring of people’ who have helped and supported me in my key moments, and I also focused on the ‘doors analogy’ and how doors are opened and closed and whether you step through those or you don’t. I believe it’s helpful to share your personal stories and be open so others can understand that career routes are so varied.

We had some great poster opportunities too from AHPs on their leadership work and we included  a session on diversity within AHPs, and a whole series of other events including a research focus to profile the full range of AHPs that we have across the trusts. It has been great fun for people in planning it, and I think they’ve done a great job.

What advice would you give to those aspiring to take on the role of CEO? 

The advice I would give is that you need to be an authentic leader and value people by recognising everyone is a leader; whatever you do is amplified and you need to understand the importance of that as a CEO.

Also, every touchpoint that you have with a member of staff matters, and I do mean every touchpoint; that could be walking across the carpark, any Microsoft Teams event, saying “hello”, visiting a service, or even in email communication; every touch point matters.

Being a CEO means really you are a Chief Engagement Officer – the way that you engage will inform how others engage, and the way you value people in those touchpoints will make a difference to how people feel in your organisation and therefore the care you provide .

Do you think there has been time to reflect yet based on what has happened over the past several months? How important is reflection in your role as CEO?

I think reflection is an essential part of the role of any leader and  CEOs are no different. We have an East Midlands Alliance for mental health and learning disabilities, which is a group of us in the mental health communities across the East Midlands, and we have been working  together in an alliance – through COVID-19, we have come together every week. What we’ve done is brought ourselves together to share experiences in a very trusting environment as well as co-ordinating our teams to connect over topic areas too. This is one of the ways I’ve managed to reflect, as well as feel supported, other CEO colleagues and my teams have undoubtedly helped me and it’s about finding those ways.

Is there anything else you would like to discuss? 

We do need to consider how to continue to bring in the voice of patients, service users, and carers in services as this has always been pivotal for me and is something that increasingly we are focusing on and challenging ourselves on through Covid.

We currently use different mechanisms such as ‘I want great care’; co-production in building new facilities, such as in Leicester for our Children and Adolescent Mental Health Services (CAMHS) unit, and our recovery colleges are great examples of working together; it’s about the voice of patients and carers being always of the utmost importance and never forgetting this.

How do all  maintain the focus of these voices through COVID-19 and integrate these with  new technologies and  methods of working?

Glen described his entry to becoming a CEO, how his leadership style has changed and adapted during the pandemic, as well as offering his advice to aspiring CEOs.

Can you tell me about your path to becoming a CEO?

I don’t want to sound too boring, but my path was through being a finance trainee, and I joined the NHS from school as a matter of fact. I wasn’t all that academic at school, but I was good with numbers. Just by chance, there was a training scheme available in the NHS – which is why I was drawn to the health service, which sounds pretty unimpressive I must admit, compared to other people who were drawn to the NHS who I now work with.

The NHS trained me, and then I realised that I had joined something really special; you’re not just being any old accountant, you’re actually helping the NHS to work. I moved up to being a Finance Director at a relatively young age, and wanted to be a CEO, so I switched over to being an Operational Director in a large trust and then became a CEO through being a deputy from an operational background. Unusually, I have been a finance director, operational director, and CEO at board level which I think provides a depth of insight when I now ask questions of directors.

How has your leadership changed over the past 6 months?

I like to think I’ve adhered to some of the principles that I have always implemented, in that I believe in allowing people to get on and do their job. One of the things I’ve noticed with Covid-19, is a lot of CEOs are rolling their sleeves up and getting involved in aspects of work that they would have normally let other people do.

One of the things I’m very conscience of, is that through having three of each type of director in ops, nursing, and medical, a lot of what I’ve been trying to do is not being different in this period by trying to think I can manage each of their departments for them, allowing them to carry out their role, but actually trying to help free up their time and deal with more of the external issues.

There has also been a different way of communicating with staff, reassuring staff, and stakeholders in this period, from an NHS perspective we have been very ‘here and now’ and less strategic, but I think it is still important to do the strategic aspects alongside the here and now otherwise we will really get ourselves into a pickle! I have been trying to support those people who do it better than me in terms of responding to what has been an elongated major incident.   

Have you witnessed staff that have previously worked unnoticed, come to the fore during this crisis?

Absolutely, I have been reflecting on this. We have been doing work across the three trusts work on what went well during the period and trying to keep some of the innovation. From a leadership perspective, what has helped is having a single uniting purpose. As a consequence, some of the clinicians who were previously not putting themselves forward to be leaders, were leading.

In all three trusts, clinicians without a highbrow job title were just stepping up and doing what was required. Talking to them, they’ve found it reassuring to work alongside managers who perhaps they would have previously thought “what were that lot doing?” – it has bound the teams together both in a clinical and managerial way, and it has been great!

I knew these people had it in them, but they have just stepped up and done it because they understand the importance of what it was all about.

Do you think the definition of what a frontline worker is has changed due to the pandemic situation?

We’ve had many staff who have taken on different roles; all trusts have; but all of a sudden, you’re talking to your speech and language therapists who are now working on wards almost doing the same job as a surgeon’s assistant. It is like that whole ‘NASA thing’ with everyone playing their part in getting a man on the moon type scenario. We’ve crept away from talking about frontline versus non-frontline because if you were working in supplies during that PPE problem for example, you were very much frontline.

What technology do you think has been the most useful over the past 6 months?

MS Teams was one of those programs which used to load up on my computer and be instantly closed down again, but now it is a familiar friend; the way our group is configured where Hereford is a 2-hour drive from here, and George Eliot a 35 minutes’ drive from here, I suddenly actually felt closer to much of what was happening in the group thanks to digital tech.

We had used video conferencing before for outpatients and MDTs; talking to some of our pathology consultants, who were using video tech for MDTs and being able to screen share and show images – they found this method more preferable than using cramped rooms. Supporting home working, and the productivity of home working has been proven to be really effective. Also, the breast-feeding clinics being conducted via Zoom, amongst other departments, has been very innovative.

We’ve been able to link up clinician’s stories regarding patient care between the three trusts using MS Teams, which has been really effective. We’ve been doing leadership briefings between teams using Facebook Live, which has attracted a much larger audience than previously when asking people to attend a physical room. I see a lot of digital tech sticking, and actually I hope for its continued acceleration. We’ve got a digital hub which is about to launch in our Stratford-upon-Avon site, which will be where we will get clinicians and industry in a room testing out new solutions to how we manage patient care; the pandemic has brought to the fore the embracing of digital technology.

Are there any learnings or advice you would like to share from your experiences over the past few months?

There are fundamental things like learning how to chair meetings on Teams, to tell people they are muted and so on! There has been some interesting human behaviour I have noticed over the past few months, both at local and national level, where people have used Covid as a cover for doing things that they have always wanted to do (some good and some bad), so there has been a bit of opportunism going on, and I’ve had to keep an eye on that.

Otherwise, I have learnt about some of the other individuals in the team and the traditional leadership hierarchy in terms of how you get things done; that wider engagement where people understand what you’re trying to achieve. We need to make sure we do other things of importance with the same level of clarity so everyone gets behind it like they have done in this current period.

Also, thinking about where I have previously wasted time which will definitely not happen in the future; going in to London which takes 2 hours travel time, to attend a 1-hour meeting, and having that take up the whole working day. Also, some meetings having to say “no” to due to the time that individual event will take out of the day.

What have been some of the personal challenges that you have had to overcome in your role as CEO?

For me, it has been around ‘visible leadership’ particularly around the end of April with the peak, where clinical staff were really at the frontline, you want to go there and show them that you are there for them, but you really shouldn’t due to protecting our patients and them, adhering to the guidelines and showing that you are a role model of those guidelines.

Senior clinical leaders have had to find ways of being visible to their staff safely; I have been creating videos and putting them up on the trust website to provide reassurance in letting them know you are here; oddly, I’ve been coming into the office every day when I could have worked from home. I’m at the corner of the Warwick site, and I felt like I needed to be here even though I’m not on the clinical frontline. The hardest part was showing you are there for them without actually physically being there.

What advice would you give to other CEOs and those aspiring to take on the role?

Being a CEO in the NHS is an absolute privilege; it is a fantastic job and sometimes there’s a tendency for us all to moan and state how difficult it is. Take someone with my background, there are some boring old jobs that I could be doing as an accountant, but to be able to be involved in the world’s best health service is fantastic. I would encourage people to aspire to what they can be, and not be put off by some of the media you see around it, because on the whole it is really rewarding and really enjoyable. I’ve been in the NHS for 37 years; I’ve been a CEO for the last 14 years and I wouldn’t choose to be anything else – except for perhaps a striker for Man United!

The advice I would give is that it is the teams around you and the diversity of your teams that really make the CEO role in the NHS a success or a failure. I learnt early on that if you appoint people solely in your image, you just end up with a bunch of mini me types around you; what I’m keen to do is to ensure we have different backgrounds, cultures, ethnicities, and also different personality profiles – we do a lot of the insight  stuff around this. It is about bringing the wisdom of the crowd, and as such, in the NHS we have such diversity that there has never been a problem we have faced where we haven’t got someone who has already experienced it.

Finally, the authenticity of leadership – don’t try to be someone you cannot be.

Tracy also provides advice for aspiring CEOs and aspiring leaders, we discuss key technology projects, as well exploring the value MS Teams has had for her organisation.

Can you tell me about your path to becoming a CEO?

I began my career as a Registered General Nurse (RGN), where after working as a Ward Sister in gynaecology, I moved out into the community and became a School Nurse and studied a degree in health visiting. Later, I studied a masters in health and social care policy. When I was working as a health visitor, I felt there was something more that I needed; I remember having a meeting with my general manager and director of nursing and saying to them “I’m not quite sure what I want to do, but I am sure what I don’t want to do, and that’s become a manager!”.

I had at that time, grand plans to work across the primary and secondary care interface in developing pathways, but before I could come to any proposal my manager went on secondment into a more senior role and advised me to apply for his job. Initially, it was a 12-month secondment – I have never looked back. I then went through a variety of managerial posts before taking my first director role as Director of Performance and Organisational Development in a PCT, to be further encouraged to take an MD role and subsequently become a CEO.

I have been a CEO now for 13 years. I never aspired to be a CEO in all honesty; I was encouraged at different points in my career journey. My philosophy has always been ‘if I have something to offer and something to learn then it is an opportunity’.

How has your leadership changed over the past 6 months?

I have thought about this, and I don’t think my leadership style has changed, however, I do think there are elements of it that have been more emphasised during Covid. I think that I’ve been very reflective about leadership and the type of leadership that most of us aspire to; we do not always get this right in the jobs that we do. Your staff in your organisation are the most valuable resource that you have, and as a leader, it is your responsibly to ensure your staff have the skills and competencies that they need to do the job as well as they can. Also, to inspire them and support them in terms of career development. Being a clinician by background, I’ve always been convinced that you have to empower people to do the right thing! I’ve always had a mantra around clinically led and managerially supported; I’ve not always got this right in every job that I’ve had, however, those two aspects were so important during Covid.

From a clinical empowerment perspective, the only people who knew precisely what to do in the height of the Covid crisis were clinicians; the operational managers really came into their own with identifying the challenges and risks and asked “can you support us?”, and so as a leader you do the checks and balances and support the implementation. This was a key and central part of the approach that we took.

The health and wellbeing and support of staff was all magnified during Covid, due to the impact of people’s lives outside of work. Work-life balance is crucial and my leadership changed in a way that it was very much about the clarity on the leadership and support in that space. I was doing monthly video blogs for staff and changed to doing those weekly; I was really open and transparent about the issues, such as PPE; I’m doing my fourth open letter to staff and the population; I also did a children’s blog which took the form of the story of staff, to explain to children the reasons why their family members had to come to work – the feedback from this was phenomenal.

There were some periods where I felt like I wasn’t doing enough, and as a former nurse, when there is a crisis, your inherent modus operandi is to get stuck in and start to help; I couldn’t do that because I had a different role to play. This demonstrated to me that when the chips are down, take a step back and allow staff to do their jobs with your support.

What technology do you think has been the most useful over the past 6 months?

MS Teams has been my world! I didn’t even know that MS Teams existed prior to Covid, and now, I do nothing other than MS Teams! The program’s ability in allowing us to continue what is almost business as usual through the organisation of vital meetings with the board, other stakeholders, and most importantly staff, has been invaluable. MS Teams has been key, and we had to embrace it rapidly. We have a medical staffing committee every quarter, where prior to Covid, we had a video link with both sites where the maximum attendees hit 12 people at a time; we are now doing meetings over MS Teams where we have around 120 attendees! This is due to not having to come out of theatre/clinic/wards, having to change clothing, and/or get to a location; they can dial in from wherever they are, and we are now having a much broader, deeper and effective dialog, with a broader number of consultants. We would never have thought to have used MS Teams for this before and is now something that we will continue to do as we go forward.

From a technical perspective, we use Nervecentre as our live system, and what we wanted to do was to minimise the number of people going on and off wards to halt the virus spread. We started to use a photography module in Nervecentre and we were capturing over 4.5k images per month. This was so the multidisciplinary team could virtually get together and look at a multitude of sites including surgical, without having to go on the ward and be face to face with the patient.

We also deployed a Dr Doctor video consultation tool, because we had already started doing pilots around avoiding face to face appointments through video consultations and we had a two-year plan to broaden that out; the plan was completed in only 4 weeks! We are now rolling this out Trust wide and we are not looking back!

Also, we implemented a radiology reporting system so that all consultants working from home could see images and scans. There has been a great amount of technology we have implemented at pace, which we will now continue with going forward.

Are there any learnings or advice you would like to share from your experiences over the past few months?

A key learning for me is around population behaviour; I’ve always been of the view that if we are going to change the way populations behave in terms of how they access healthcare and make lifestyle choices, then we have to change things dramatically. I feel there has always been a nervousness in the NHS to change things dramatically, because we are worried about population expectation.

Because the pandemic restricted people attending the Emergency Department, they tended to begin to access healthcare more appropriately – calling 111 for advice, attending their pharmacy, calling their GP to have a conversation rather than attending in person, and actually the tolerance of that was very high; the feedback we’ve had around video consultations has been extremely positive.

We probably do underestimate the population expectation, and their behaviour is perhaps driven by what we have available. What I wouldn’t want however, is people not accessing the right service at the right time.

What advice would you give to those aspiring to take on the role of CEO?

The best CEOs are those people who have really thought about what the role means. My advice would be really think about why you want to be a CEO; it is the best job in the world, probably the most stressful, but it really is a privilege. I feel privileged every day to have the job I have, to be able to lead fantastic people who do such fantastic things. Think carefully about why, and the values that drive that ‘why’.

Also, coaching, mentoring and support is really important; I learn something new every day, and I’m not embarrassed to say “I don’t know” – people think once they get to CEO level, they should know all the answers – you are absolutely not expected to, and if you think you do know everything, you are not in the right space. Becoming a CEO is another stage in your learning and development: embrace it!

Finally, you should be aware that you are only as good as the people who work for you and with you; you have to be able to have a high level of trust and confidence in the people you work with; it allows you to understand people are doing the right thing, in the right way, and for the right reasons.

We chat to Sam ahead of a presentation she will be delivering at the upcoming Mental Health Recovery Summit, supported by HTN. We hear some of the key themes around mental health recovery planning ahead of the session.

We also talk about technology, learnings, challenges and advice for aspiring CEOs.

Can you tell me about yourself?

I’ve been the CEO here for three and a half years, we are a mental health and learning disability provider based in Sussex, and provide some services in Hampshire. It is a real privilege to be a CEO in the NHS, it is also challenging but a really rewarding job.

How did you become a CEO?

I was fortunate enough 5 years ago to get onto the second cohort of what the NHS calls the aspiring chief executives programme; it was a programme developed recognising that there needed to be some development and support for people moving into chief executive positions.

When you decide you want to be a CEO in the NHS, you have to decide which area you want to work in and I think for me the obvious choice was mental health as it is very close to my heart.

Mental health leaders have some really strong skills around partnership working so quite often our organisations are complex and diverse. We have 5,000 staff delivering services over 102 sites and it is different than walking into the main entrance of a big hospital.

It is a great job to have and wonderful to be able to do that in the community where you live.

Could you take me through the past few years in terms of your organisation’s digital maturity and the role of technology this year?

2 years ago, we were fortunate to become a Fast Follower through the Global Digital Exemplar programme, so we’ve had some significant investment into our digital services. When Covid hit, we were pretty well placed from an infrastructure perspective to adopt and scale up the use of digital consultations and other tools we needed.

I think the success of the response was a blend between the digital capabilities in the organisation and the passion that our digital teams have, coupled with really strong clinical leadership and a clear vision. They very quickly developed a vision which was anybody should be able to request a digital consultation and any clinician should be able to offer one.

The teams were just absolutely outstanding in those early days and most of them were working remotely themselves. With really strong clinical buy in, we went from only just introducing online consultations, doing 15 per week, to over 30,000 digital consultations.

We actually had a small number of our workforce, who for a variety of reasons, were in other parts of the world and they’ve been able to carry on working; it is like we have a global workforce now delivering care and support, which has really pricked our imaginations – do they have to be in an office in Sussex or an NHS building to deliver everything?

Having said that, we are learning a lot through this and you need a blended offering as digital isn’t right for everybody all of the time, absolutely not. It really is essential we maintain face to face services. I think also through the recovery phase for mental health, that is one of our big challenges alongside the acute sector in restoring services that are face to face, but equally not going back to before the pandemic because we’ve learnt to do things so much differently.

Are there any key learnings that you would like to mention?

Having a really clear and simple vision and freeing up your teams with a commission to make that happen.

In an odd way, at a time when everyone has tried to pull together with a focus on keeping patients safe and keeping services open, we have discovered so much hidden talent across the organisation. It has been a real eye opener where people have shone in new and different ways. If you can get everybody aligned around a core purpose, teams can be so effective and the real potential that exists right across the organisation can be highlighted.

Could you give me some key points of what you will be discussing at the Mental Health Summit with Draper & Dash?

One of the things I want to tease out is what recovery means for mental health during Covid-19.

Quite often, one of the things you can experience in health care is a hierarchy and from a mental health perspective, what role are we playing, what are our key challenges, what have we learnt and where do we need to think differently.

One of the things we’ve really learned over the past several months that absolutely apply, is the way we do things moving into the future; not losing that learning.

We are absolutely in the thick of recovery from the first few months, but all the evidence tells us that actually the on-going demand for mental health is going to continue for some time to come, particularly with economic stress. We were incredibly resourceful and resilient as leaders, but one of the key things we need to think about in terms of the economic downturn, the EU exit and the impact of that in the new year, is the mental health and wellbeing of our communities. Recovery can get us really focused in on our own services, but as leaders, we need to think about how are we going to look and work with our communities and other partners, employers, community organisations, local authorities and the broader work we are going to have to do to head off what could be an ongoing increasing demand on our services.

We are essentially facing the challenge of two pandemics: the impact of the virus and fallout of that on communities. We need to be thinking about the next one to three years.

What role has data played to you as a leader and your colleagues in the past 6 months?

Data is everything; how can you have a single version of the truth really moving away from dealing with anecdotes and dealing with data but also looking at data over time. Data has driven a lot of actions we’ve taken in response to the virus; workforce, patient, historical data, to do some sort of predictive analysis around demand. Data is increasingly featuring, you can’t do your job well without good data, but you need to be able to turn good data into good information to support decision making. Mental Health is a catch all terms for many different pathways of care and we don’t always articulate that right across the sector and in our health and care systems.

What advice would you give to current and aspiring CEOs?

Do your homework, go and have some conversations. It is a great job but make sure you build your support networks and your peer support networks, because it can be a really lonely job sometimes as well.

Again one of the great things over the last several months is that it has really brought to the fore peer support networks; as a CEO you really need to be looking up and out and not just across the health service but across the industry and other sectors and make sure you have good support networks there.

Is there a technology solution that has been really important to your organisation over the past 6 months?

We have a growing number of peer support workers in our organisation and they do amazing work; they lead our recovery college which has now gone digital and our peer support workers through GoToMeeting and GoToWebinar.

One of the things we have really seen is the importance of digital inclusion and there is definitely exclusion, so at a time where we all think everybody has a device, there are some people that don’t and some that struggle to use devices; it is really important we support them. The banking and utilities sector have done a lot of work here and we need to learn from them.

The other thing we have been doing during Covid is a result of our being such a disparate organisation with staff all over the place, we had an objective of developing our own staff app, and actually we launched that during Covid. Our app has been downloaded over a thousand times by our staff and it has all of our webcasts, news, and staff can access payslips. The top 5 things we heard that staff wanted, we have delivered through our app. Finding new ways to communicate with all staff is vital – not everyone is sat behind a computer and nor do we want them to be!

We talk about the role of technology during the pandemic, innovations to their service, maintaining staff wellbeing and morale, and plans for a recovery phase.

What did Moorfields learn during Covid-19?

Some people may think that an eye hospital may not have seen much changed in a pandemic, especially when compared to a general acute hospital; however, a great deal has changed at Moorfields since the covid-19 pandemic began.

There are the changes you would expect in any public setting to ensure strict social distancing, but as we get used to our new one-way system, temperature checks and how to stop our glasses fogging up while wearing a face mask, we have made some real transformative changes which will improve the way we deliver eye care far beyond the pandemic. 

How has Moorfields innovated its service?

Moorfields has been working on telemedicine solutions to support care for a while now, but when lockdown hit the UK, we had to accelerate our plans to deliver a large amount of remote care very quickly and very effectively.

Since the coronavirus outbreak began, we have held over 10,000 online video appointments to support patients living with a range of eye conditions, those requiring a follow-up review after surgery, as well as running an innovative virtual accident and emergency (A&E) service providing urgent care to those with most immediate needs. We were able to roll this out just two days after increased lockdown measures were announced, and we now host over 600 video appointments a week.

The video consultations run on an easy to use platform which has a virtual waiting room where a ‘virtual receptionist’ can effectively prioritise patients and signpost them to the correct service.

Almost eight in ten A&E patients have been able to get the treatment they need without travelling into hospital, with almost 95% of patients giving the service they received a maximum rating of five stars. This success has highlighted the potential role telemedicine could play in the care we provide going forward, which is not only more cost effective but incredibly convenient for all.

Further opportunities to innovate came when looking at ways to monitor subtle changes in our patients’ sight from home. We’ve expanded our use of apps giving short daily tests. Scores from the apps go straight to Moorfields and an appointment is booked when the scores show the need for one. The pandemic has been a good test for the effectiveness of these apps and our patients and clinicians are impressed with how practical they are.

How has Moorfields managed to keep patients safe?

The safety of our staff and patients has been our highest priority throughout this terribly difficult time and our infection control team has been very busy indeed. Alongside the more common socially distanced waiting rooms, face masks and reduced capacities, like many hospitals we have had to create separate routes around the hospital for patients who have symptoms and those who don’t. We have had to make big structural changes to make this possible, including tearing down entire walls.

It has also been important to consider the needs of patients that haven’t been able to come for an appointment, such as those who are shielding.  Our clinicians have been utilising the power of social media more than ever before to deliver at-home eye care advice and important updates for patients, so they feel cared for from a distance.

How have you encouraged patients to come in for appointments?

Having never faced anything quite like covid-19 before, we had no way of knowing how anxious patients would feel coming in to Moorfields, even when restrictions were beginning to lift.

We have worked very hard, partnering with organisations such as the Macular Society and the Royal National Institute of Blind People (RNIB) to highlight the importance of attendance and to reassure patients that it is safe to come in.

We’ve put out animations and patient-generated videos on our safety procedures and advised our patients on their transport options, but we have learnt there is no substitute to hearing the reassuring voice of a clinician on the phone.

How have you managed to maintain staff wellbeing and morale?

Making sure our staff are feeling well, supported, safe and happy has been crucial to providing the best service possible in these unusual times. We’ve always provided a counselling service to our staff 24 hours a day, but the addition of a dedicated wellbeing space on site, alongside regular staff updates has helped to give our staff the strength needed to think innovatively and creatively in challenging circumstances.

What does the ongoing recovery at Moorfields look like?

We still have a waiting list of appointments and procedures, and we can’t see social distancing leaving us any time soon, but we are finding our feet and learning to thrive in our ‘new normal’.

We are working harder than ever in completely new pathways, with new technology, to ensure that we catch-up as quickly as possible. I have been incredibly proud of how Moorfields has innovated in challenging circumstances and it is clear the nothing can stop us from delivering the best eye care in the world.

In the third edition of our CEO Series, we interviewed Nick Hulme to gain insight into how he has led the trust through Covid-19 and discussed what technologies he thought were crucial in working through the past few months.

Nick also shared with us his advice for aspiring leaders and what learnings he has acquired during his tenure of leading through a pandemic, and started by telling us of his path to becoming a CEO.  

How did you become a CEO in the NHS? 

I’ve been in the NHS for 41 years and I started as a porter. I left school with only one O Level, so I didn’t have any academic qualifications but I always wanted to do something that made a difference. 

I worked with patients for the first half of my career; I was a healthcare assistant in psychiatry, worked with homeless men for a while, and then worked in the early days of the HIV and AIDS pandemic in the mid-eighties as a healthcare advisor and councillor. I had gotten incredibly frustrated in those days with the demand for healthcare and the inability to manage it. 

I suggested to my boss at that particular time, that we could see more patients with the same number of staff if we changed certain procedures, and she replied with “have you ever thought about management?”. From there, I went into various general management jobs, director of operations in three organisations, as well as deputy chief executive and now as CEO for the past 10 years. I’m NHS through and through, if you cut me, I’ll bleed blue, and I really can’t imagine doing anything else now. 

How has your leadership changed during Covid-19? 

It hasn’t, but on reflection, perhaps it should have done. We deal with situations all the time, and through dealing with those situations, we know the processes to follow; you may get different nuances from one year to the next, but generally you can draw on previous experiences to get you through situations which arise.   

For me, Covid-19 presented a completely unique set of challenges. The learning I acquired was trying to apply my previous experience to a novel and unique situation, rather than taking a step back and finding the differences. One such example was the differences for staff; they have their personal life and their professional life, with some overlap between the two. Covid-19 has blended personal life and professional life into one, where you couldn’t just shut the door on work when you got home, and likewise, leave your personal life at home when you got to work. 

We were all in lockdown, with nowhere to release or relax and your anxieties were exacerbated through the risk of becoming infected at work and bringing that home to your family. For me, the leadership I’ve learnt is to be much more mindful around understanding the environment that our staff are working in, rather than assume it is exactly the same and we just need people to run a bit faster or jump a bit higher.   

What technology has been the most useful over the past few months? 

Attend Anywhere has been the most useful and we got it up and running within 6 days to hold virtual consultations with patients. It was really important for us to keep our patients as safe as we could. 

I think there’s a danger with the use of digital platforms, that we use such platforms as the default as opposed to human contact. I think we now have to take a step back; technology doesn’t work for everybody, for some types of consultations, digital tech is absolutely fine, although you miss the nuances of human to human interaction. Particularly with a telephone clinic or even a video clinic, you don’t pick up those non-verbal clues where if people are understanding what you are saying to them. Also, for example, if a patient is in an abusive relationship, they may share that information in the confines of a consulting room, but they won’t share it if phoning from home on a video call. 

The phrase of 2020 is most definitely “you’re on mute”. I have certainly missed the face to face interaction and even the commute into London! 

I think we have just got to be mindful that technology will not work for everyone forever.   

What learnings have you acquired over the past few months? 

The resilience of individuals is definitely something I have learnt from the past few months.  

I think that the constraints and benefits that we had prior to Covid and took for granted were seen as trivialities during the peak of the pandemic, for example ‘we can never do ‘x’ because…’ and then suddenly during Covid we were doing ‘x’ – whether it was responding to the PPE issue or creating a very different relationship between clinicians and managers to work in that single focus where everybody is pointing in the right direction. When people are together in that single focus, you can achieve extraordinary things. 

The people who I thought were the absolute superstars prior to Covid, have sometimes found it all too difficult, where the people who never really stood out previously, have really put their head above the parapet and been extraordinary.  

The so called ‘frontline staff’, which is a term I don’t find incredibly helpful, are an essential but tiny part of the team. I hope the public now recognise that the people who help keep our corridors clean, the people who make sure the PPE is there, the people who make sure our staff and patients are fed, or those that are not seen as ‘frontline’ such as managers, leaders and others, are as much a part of the clinical team as anybody else who happens to wear a uniform or have a stethoscope around their neck.  

– I’ve known that for a while and I’ve talked about it previously, but I do hope the public recognise that health is a team sport. 

How has the role and usage of data changed for you over the past few months? 

The one thing we’ve never had to do was to look at international epidemiology. We were meeting three times per week for our strategic tactical command meeting, where we all pretended to be very important for an hour and a half! 

That was the first time we had looked at data in other countries; what’s happening in Spain, what’s happening in France, regionally and locally, and that’s one thing that had changed where we were looking at such data. We had to look at that data but it didn’t inform us all that much.  

Moving away from anecdote and allegation with local data was useful, for example, “we are running out of PPE”, well actually, no we are not and here’s the data to prove it; “we haven’t got any surgical masks from the hospital”, well that’s interesting because I’ve got some data here to prove it that says we’ve got over 1.2million masks in the hospital. Having the data and understanding where the breakdown in supply was, was useful.  

Moving forward, data, in terms of how we deal with the backlog of patients who need treatment, how we assess clinical severity and clinical risk, will be more important now than when we were in the height of the pandemic. 

What advice would you give to other CEOs and those that are aspiring to become a CEO? 

Being CEO at a hospital or in a healthcare setting is one of the best jobs in the world; I lead a team that improves 6,000 lives every day, what’s not to like.  

Ok so I don’t have a private jet or a villa in France but I genuinely believe that my team improves and saves lives, and what’s not good about leading that team?   

Is it an easy job? Absolutely not. The main advice I’d give, particularly when thinking about the past 6 months, is for goodness sake look after yourself. Don’t be hero, when you’re in the middle of a crisis such as this one, you don’t realise your potentially making the wrong decisions or behaving in a way that doesn’t reflect the values of the organisation, due to the immense pressure that you’re under. Everybody wanted answers, and we didn’t have answers; don’t be afraid to say to your closest confidants and your team “I just don’t know”, don’t be afraid to pick up the phone and ask for advice.  

You’re not indispensable, look after yourself and each other; look for those early warning signs where either you or your team might be struggling.