We have discovered a better way of working

When the Covid-19 crisis engulfed the Italian health system earlier this year, senior decision-makers at the UK’s National Health Service followed the unfolding situation with concern. Among these was Mark Turner MBA1994, Director of Commissioning at NHS London.

“As the virus began to take hold in the UK, we always knew that London would be the epicentre for the disease,” he says. “So that meant we needed to massively increase our capacity in terms of ventilators and critical care beds – initially from 800 to 1,600, and then potentially to 4,500. By late March, national modelling showed that cases here could be doubling every two to three days and we were instructed to increase this to 7,500 beds potentially within two weeks.”

Turner is based in the London regional office of the NHS, overseeing specialised services and managing a budget of about £5 billion (around 25% of London’s annual health expenditure) to look after the health of about nine million Londoners. It’s a role he has held since April 2019 and, while the pressures placed on senior executives in public health are well known and documented, there’s little doubt that the challenge of responding to Covid-19 has been unprecedented.

“Over a weekend in late March we piled in people and resources to do very rapid planning and that led to the NHS Nightingale Hospital getting up and running at the ExCel Exhibition Centre within less than three weeks,” he says. “It was an extraordinary process to go through.”

The scale and speed of this response meant that, although the frontline was hugely stretched during the surge in cases, there was always just enough capacity; the actual figure of patients requiring ventilated intensive care units (ITU) peaked at slightly more than 1,000, with just over 1,600 beds stepped up. The work of clinicians managing patient care during this period was extraordinary, Turner says.

“The frontline did an absolutely amazing job against a background of all sorts of shortages, constraints and operational pressures. They managed to get London through it.”

The next phase

For Turner and his colleagues, the focus now is on leveraging some of the remarkable changes that have characterised this period to deliver what he describes as a “fundamentally better NHS” over the next 18 months.

That said, he stresses that there is no indication that the Covid battle has been definitively won. Turner and his colleagues now face the need to bring back an array of services that have been reduced or temporarily curtailed as resources were deployed to ITU, and to deal with a substantial backlog of interventions – all while preparing for the possibility of a second or third peak of coronavirus, especially if the public fails to observe social distancing post-lockdown, in addition to the usual winter surge in illness.

“This next phase is in some ways a bigger and more complex challenge,” he points out. “Part of what we have learned is that the virus has affected the most vulnerable and disadvantaged parts of society. In England we have over two million people who are clinically extremely vulnerable and are advised to be shielded. These people will need good access to safe, Covid-free services.”

This means there will have to be a much greater separation of emergency and elective services, with both Covid and Covid-free provision protected by strict infection-control protocols: “When you aggregate the various categories of demand, together with all the new constraints of separation of services and infection control, the challenge ahead is possibly much greater than what we have just gone through,” says Turner.

But if the team is able to pull it off, he adds, the outcome will be a much better National Health Service. And he is optimistic that this will be the case. “What we have found during this period is that, because of clear purpose, really short timescales and a very strong necessity, a really strong spirit of collaboration has emerged across London. In a very short space of time we have come together as a team.

“The forge of the crisis has produced something quite new and different in terms of collaboration, the focus on what really needed to be done and the ability to drop a raft of bureaucracy and get on with what’s important. Working alongside senior clinicians who have been making very tough decisions about prioritising care has also been a privilege.”

A new agility

Turner has seen a new agility in terms of complex decision-making and change management that is not typical in the public sector. Changes have been made fast which, if they can stick, will translate into profound benefits for patients: “We have discovered a better way of working with real agility and world-class talent. If we can continue on this track, delivering digitally enabled care, I am very confident that London can become the healthiest global city. We can be the best place in the world to receive care. Of course, there are many battles still to come and this is far from a done deal.”

While he sees some light at the end of the tunnel, Turner is quick to acknowledge that the coronavirus crisis remains an enormous threat; one that has also been personally challenging and taken a considerable toll on him. Isolated for several weeks from his family, who are based outside London, he has also had to battle the virus himself. At the start of April, he tested positive for Covid-19. Happily, his recovery was complete within two weeks and he is fully returned to work at London NHS headquarters – and to a role that he loves.

“I have been very fortunate to have a career that has unfolded in many extraordinary ways and to have a job that enables me to make a tangible difference. I do credit my time at London Business School with giving me a set of skills and a calling card to be able to embark on this adventure. My MBA was the start of this – it opened doors to opportunities to build the experience over the years that has taken me to where I am now: leading a team that is really doing things that change lives.”