Leading the NHS back to good health

If you want to understand what's going on in your organisation there's no substitute for getting out there and seeing it yourself. I have a uniquely privileged job, as chief executive of NHS Providers, the body that represents NHS Trusts. I can write to any hospital, ambulance, community or mental health trust in England asking to visit and they'll agree to my visit. It's a privilege to be able to go around and talk to the frontline. That’s where you get a true picture of what’s going on.

The NHS is facing the challenge of a deteriorating strategic context as funding fails to keep up with rapidly escalating demand. NHS trusts did a good job of reducing cost from 2010 to 2015, but salami slicing those costs is now providing a diminishing return. When you reach that point you have to go for genuine transformation and that’s where the NHS now is.

There are four key issues in the NHS right now. First, demand is both increasing and becoming more complex. Second, we’re in a period of austerity: funding hasn’t kept up with that growing demand and the system is beginning to creak. Third, we have workforce shortages, partly because of Brexit uncertainty but also because NHS pay is becoming increasingly uncompetitive while the job is becoming more stressful. People tell me, “We don’t mind being asked to do the impossible once in a while but I’m being asked to do it every day.” Fourth, the delivery system is atomised. We need a more integrated health and care system focusing on prevention.

The NHS can’t do everything, any more, on the funding it’s currently being given. We need to have a grown-up debate about this. Either we have to put more money into the NHS which means, based on the current model, pay more tax. Or, we accept that we can’t provide the same set and quality of services to a growing population. The choice is simple and unavoidable.

Leadership in the NHS

In the context of increased demand and pressure, part of the work we've been trying to do is to support NHS leaders to do an increasingly difficult job, leading their organisations through really difficult times.

There are many examples of great leadership in the NHS, such as Marianne Griffiths, chief executive of Western Sussex, an outstanding trust. She is passionately committed to protecting her staff and empowering them to give of their best. They are under the same pressure as their counterparts elsewhere in the country but because of the culture that is being set, staff feel supported.

We have a system of leadership that is incredibly focused on the delivery of day-to-day targets that the NHS is struggling to meet. The level of pressure is extraordinary. But Marianne deliberately creates a fire break so that the pressure from above doesn't get passed down.

Those of us in senior leadership positions need to take responsibility for producing the next generation of leaders. One thing I’m particularly proud of is the role I have played in creating an aspiring CEO programme for the next generation of hospital, community mental health and ambulance Chief Executives. Whilst being an NHS trust CEO is a real privilege, these roles are difficult, high- profile and carry significant personal risk. We were worried that the pipeline of provider CEOs was drying up so we’ve set up this programme, persuaded the NHS system to fund it and I chair the programme board. We now have two cohorts of 14 people gone through or in the programme and I couldn’t be more pleased that nine of the 28 have now become chief executives.

A leadership journey

My personal leadership journey has been an interesting one. I was a classic functional specialist – a communications expert. I quickly realised that, when you become a director and reach the board, your own functional specialist skills become less important. What becomes infinitely more important is your ability to enable, empower and motivate your team and ensure they give their best.

In terms of my strengths, the feedback I get is that people like my energy and passion and they respond to that. But one thing I’ve learnt is that your greatest strengths, when taken to excess, are also your greatest weaknesses. My energy and passion mean I sometimes don’t listen enough and tend to be too dominant. So I know I need to watch that.

It’s important to be evidence-based. For example, it’s not always possible to judge how well you’re doing as a membership organisation – we’re not delivering front line care. So three of the most important things for me every year are our annual staff, stakeholder and member surveys. I’m inordinately proud of the fact that 100% of our staff have said this year that they find our organisation a great place to work and would recommend it to their friends. But, in a spirit of continuous improvement, we won’t rest on our laurels and we’ll want to find three more ways to make NHS Providers an even better place to work.

I’ve also found that, although it can be very painful, you learn most when things aren’t going well. In my last job, leading 12,500 in HMRC’s customer services operation, I’d had a brilliant first year. We’d eliminated 10% of our annual 100 million phone calls by realising that much of your contact is self- generated. If you send unclear customer communications or force customers into complex processes, customers will contact you. We asked our front line call handlers where we were creating unnecessary contact and unsurprisingly they universally pointed to places where simple changes could dramatically reduce inbound call volumes.

We were under financial pressure and had eliminated 10% of our call volumes so we didn’t replace the 10% of customer service advisers who left that year. Then we introduced a brand new computer system that went wrong so the call volumes suddenly went up by 40%. With 40% more calls and 10% less staff, performance went through the floor. For a number of different reasons, including a deteriorating relationship with my line manager, we couldn’t create a plan to deal with that size of shift. So HMRC and I parted company. That was a really difficult time.

When you hit points of real adversity you mobilise your support network and bounce back. I’ve learnt through experience that if you’re not getting on with your line manager it’s sometimes best to walk away. We all want to be successful and make things work but sometimes there are a set of conditions that mean you can't. Don't stay too long in something where you’re getting nowhere.

Coaching can be very valuable. If you’re passionate about something, you can lose objectivity – it can help to have someone you trust, who is outside your organisational line management, who you can really share things with. Someone who is able to get you to think in a completely different way. A coach can also get you to think through clearly what the learning points are and write them down so they really stick.

Chris Hopson was talking to Vyla Rollins, Executive Director of the Leadership Institute at London Business School