CEO interview: Neil Carr, chief executive, Midlands Partnership Trust

Neil Carr has been the chief executive of Midlands Partnership Trust, a community and mental health care provider working across Staffordshire, Stoke-on-Trent and Shropshire, for almost 18 years.

He navigated the merger of South Staffordshire and Shropshire Healthcare Foundation Trust with Staffordshire and Stoke-on-Trent Partnership Trust, to form the NHS’s largest combined provider of physical community health services and mental health service - a move he described at the time as being a “momentous step” towards fully integrated care.

Mr Carr strongly believes that when it comes to running organisations, “big is effective”. Indeed, he says there are “20 too many” integrated care systems.

No compromise on quality

Mr Carr began his NHS career as a mental health nurse and worked his way up the management ladder. “I qualified as a nurse in 1979 around the north east, but I decided I wanted to go to a big city, so I went to Birmingham,” he recalls.

He describes how, as a divisional nursing officer, his boss encouraged him to take a two-year, part-time graduate leadership and development training course. This broadened his horizons and saw him return to full-time nursing work with a “different appetite”.

He explains: “I realised if I wanted to influence what was happening in the name of patient care, I could do that most ably by going through a career progression of general management.”

Mr Carr’s early management training years took him well outside the field of healthcare and briefly into the German brewing industry. This taught him in no uncertain terms never to “compromise on quality”.

He continues: “You’ve got to think, what are the ingredients to get the right Stein – or patient outcome?

“I’ve never become a slave to finances. Although I recognise [finance] is important… I’ve always tried to keep a clear focus on why we’re here, and it’s about the patients, and I’ve never tried to lose that.”

After 13 years in Birmingham, Mr Carr rose to become a chief operating officer before “falling out of love” with the role and taking a sidestep into leading liaison psychiatry services for a couple of years.

“But then I committed [to a senior management career] and came up to Staffordshire, where I’ve been for the last 28 years.”

Big is effective

Mr Carr discovered a health system that was insular, with far too many small organisations that “didn’t have critical mass”.

He says: “There was a clear strategy to grow [South Staffordshire and Shropshire Trust], so we could begin to develop subspecialties and strengthen our… research, development and innovation.

“It changed from an organisation that was inward-looking, to becoming more diverse with a complete range of physical, as well as mental health, learning disability and specialist services. I’d like to think I played a small part in that, in saying big is effective.”

Mr Carr’s strong views about “critical mass” and how it aids collaboration extend to the number of ICSs.

I’m not looking to asset strip or go on a collision course [with acute trusts], but the reality is we’ve got to get to some agreements whereby more people can be cared for at home

He argues there are “20 or so too many [ICSs] in the NHS” and adds: “I think we should be looking at [ICS] mergers… that would serve us well in more ways than one. You could have a bigger geography, a bigger footprint, and get more of an economy of scale in terms of clinical services. We should be looking towards consolidation.”

However, despite Mr Carr’s firm belief in scale, he says that the needs of different communities must be at the heart of care planning and delivery.

“We also need to make sure we are tailored in terms of how we meet the population health needs, so it’s on a geography of 50,000 people rather than 500,000. It’s not one size that fits all,” he says.

“The people of [Staffordshire] Moorlands need something different to the folk of Litchfield… or Tamworth.”

‘Shift left’ the only way forward

Mr Carr says working in this more localised way links very well with the Labour government’s ambitions to shift money and resources from acute care and into the community.

“I’m not looking to asset strip or go on a collision course [with acute trusts], but the reality is we’ve got to get to some agreements whereby more people can be cared for at home,” he says. “I think we are too accepting of the status quo, and we’ve got to be prepared to challenge that.”

Mr Carr is supportive of the government’s pledge to create a “National Care Service”.

“We have got to work hard to make that a reality,” Mr Carr says. “I think that’s our future; we’re between a rock and several hard places, and we can’t sustain what we’ve got now.

“I’m not looking to be sycophantic to government, but irrespective of which government and which colour, I think what’s been advocated now is the only way forward.”

Not on the cheap

High on the priority list of mental health leaders and senior clinicians is the review into community services ordered by NHS England in the wake of the Nottingham murders of school caretaker Ian Coates and students Barnaby Webber and Grace O’Malley-Kumar by Valdo Calocane in the summer of 2023. The aim of the review is to ensure patients with serious mental illness are receiving adequate and safe care in the community.

Mr Carr says: “We identified 200 individuals in the system who require a lot of support, monitoring, and intervention, and we have allocated those individuals to key workers in the community with conditions in place [which ensure that] if their worker goes on leave for two weeks, the patient isn’t left floundering.

“Is it sufficient? Probably not. But does it keep the patient and public safe? It probably does. But we do need additional resources and [systems] and have been asked what that would look like. You can’t provide those services on the cheap.”

Another challenge for mental health leaders around the country is the enormous size of the waiting lists for children seeking ADHD assessment and treatment. In some areas of the country, waiting times run into years.

“I think everyone who sits in seats up and down the country like mine would be worried about this issue. I’m absolutely certain we need to up our game to meet the needs of these young people, because it’s whole families who are suffering,” says Mr Carr.

In order to meet these needs, Mr Carr believes the answer lies in investing more in the specialist staff who can diagnose and treat patients within this group.

Keeping motivated

Mr Carr belongs to an exclusive club of NHS CEOs who have held the same job, more or less, for much longer than the average chief executive tenure of under three years.

Asked what keeps him motivated after a long career in the NHS, Mr Carr says that above all, it is the time he spends with different teams within Midlands Partnership Trust’s 11,000-strong workforce.

Mr Carr carves out time to meet with them regularly. He says that during these meetings, staff are often very clear about their ambitions for their work and their patients and set out what they need from him to make this a reality.

“That is what motivates me,” Mr Carr said. “What role [am I] going to play in helping them move forward?”