Top CEOs Roundtable 2021

The NHS probably saw more operational change during the covid pandemic than it had for a decade beforehand. The rapid expansion of intensive care capacity, the use of online consultations, and the deployment of staff into unfamiliar areas were all unprecedented in their speed and impact. But there were also some unwanted consequences of the pandemic – such as the growth of waiting lists for elective treatment and some cancer patients facing delays in their pathways.

But is the NHS at a 1948 moment of truly transformative change? And have there been other, perhaps more subtle, changes which will have a long-lasting impact? Some of HSJ’s top 50 chief executives met remotely to debate these and other key questions.

With the NHS having witnessed radical changes during the pandemic, will these shifts really have a transformative and enduring effect, asks Alison Moore

Sussex Partnership Foundation Trust chief executive Sam Allen said the NHS was at a “defining moment” where leaders needed to be thinking about what the future model should look like as well as restoring and recovering.

One of the key issues to consider would be future workforce: “If the last 15 months has really taught us anything, it’s we need to put our people at the centre of this in terms of their wellbeing, but we also need to be thinking in a much longer-term view of the supply to the workforce,” she said.

“If we don’t think about next year, in 10 years’ time we’re never going to get out of this situation of the number of vacancies that we have. And if we don’t care for our workforce, we’re not going to retain them.”

David Probert, chief executive of Moorfields Eye Hospital FT, felt the pandemic had raised the issue of the workforce becoming too specialised. “We need to think about how we stop pushing people into such narrow corridors and specialisation,” he said.

Dame Jackie Daniel, of Newcastle Hospitals FT, pointed out the NHS has always struggled with demand and its founders expected it to evolve and improve.

However, it operates in a broader social context – she cited the 43 per cent of children living in poverty in the centre of Newcastle, a figure which has grown significantly in the last few years. “I just don’t feel we’re having enough discussion about some of those basic principles and alignment, particularly with social care at the moment,” she said.

Health inequalities

But covid has brought issues of inequality and the lack of a prevention strategy into sharp focus, said Glen Burley, chief executive of three trusts.

“We’ve actually seen people immediately suffering as a consequence of not having those things in place… I don’t think we’ve ever had that moment before, where we’ve really seen the immediate impact of those things in the way we have over the last year.”

Raj Jain, chief executive of the Northern Care Alliance, said: “I already think of it as an event that’s exposed some really deep long-term trends that we’ve not reacted to appropriately, whether that’s inequality or poverty.” One of the consequences, he suggested, was that there would have to be a rethink about the level of investment in primary care.

But there may be opportunities in some of these changes. Ms Allen said that trusts could become real “anchor organisations” contributing to economic wellbeing and financial security, as well as mental and physical health, of local communities.

Greater integration may also offer opportunities for addressing some of these issues. Richard Mitchell, chief executive of Sherwood Forest Hospitals FT, said that the last year had seen the acceleration of moving from competition to co-operation, not just between providers but involving primary care, local authorities and the voluntary sector.

“I think that way of working is going to be essential in the future,” he said. And Dorset County Hospital FT chief executive Patricia Miller said that it was a chance to reimagine how the NHS delivers so it was no longer an organisation based around institutions but services which were based around communities and people’s needs.

Collaboration

The pandemic has propelled some areas into working in a different way already. Angela Hillery, who runs two East Midlands trusts, said chief executives in mental health providers in her area had started to come together, initially for support and now for collaborative learning for teams, with more integrated governance and acceptance of collective responsibility.

And Central London Community Healthcare Trust chief executive Andrew Ridley said that in the London area, medical directors were talking about the available beds as if they were all part of one organisation. “I think that the move to collaboration is really quite profound and quite significant,” he said.

And while in some respects the NHS has been in a command and control position since the pandemic started, there are ways of working differently. Rob Webster, chief executive of the South West Yorkshire Partnership FT, said his area had got “collaboration and freedom… I think we’ve had more freedom than we’ve had for a long time.”

This had included producing an ethical framework to guide staff needing to make hard decisions, establishing a personal protective equipment stockpile for the area and ensuring staff in care homes had access to PPE.

The area had also set up its own commission to look at the impact of the pandemic on black and Asian colleagues, with the partnership board accepting and implementing the recommendations, he said.

We pride ourselves on having the most efficient health service in the world and we can point to that, but it’s been running way too hot

The lack of headroom in the NHS – and the need to build more – had also been exposed by the pandemic, Mr Burley said. “We pride ourselves on having the most efficient health service in the world and we can point to that, but it’s been running way too hot,” he said, adding that this would be an issue to tackle if the NHS was to be “reborn.”

Staff relationships

But has the pandemic changed how NHS staff interact with each other? David Loughton, chief executive of the Royal Wolverhampton Trust and Walsall Healthcare Trust, suggested staff had become “kinder.” He said that staff from different areas of his hospitals had worked together and formed friendships.

As an example, he described how 30 staff from across the organisation had worked together for nine weeks to create 500,000 facemasks. “When they disbanded, they were crying because they were leaving each other,” he said.

But there were some particularly harrowing moments for staff. “Some of our staff will never get over this. I have got a friend who’s an intensive care consultant and he’s going to retire because he wakes up at four o’clock in the morning when he can see the faces of the patients that he said to, I’m going to put you to sleep. Now, you may never wake up. So there’s been a lot of damage done to people as well.”

Ms Miller added: “I think where the extra kindness has come from is people realising that the resilience comes from the value that they place in each other, as human beings, it’s come from those human relationships that are now operating at a deeper level.”

Ms Allen said that staff had supported each other around challenges such as home schooling. The pandemic had been a shared experience which brought people closer together with a shared purpose – although the experience of it had been very different for some groups, such as those from ethnic minorities. “Will we all be brave enough to remain kind to one another or will the historical traits of blame continue?” she asked.

But Mr Probert said that it felt to him like a “watershed moment.” “There is a much greater appreciation that both sets of people [managers and clinicians] work to the same values, both sets of people working incredibly hard,” he said.

Many of the changes which have occurred seem likely to persist: but Frimley Health FT chief executive Neil Dardis pointed out that many of the changes which happened because of the pandemic pressures had not involved much public engagement and had been done as a necessity. In the future, there would be a need to ensure “we take our communities with us,” he said.

How chief executives communicate with and listen to their staff has also changed. Dame Jackie said: “I think I’m listening differently. I think I’m genuinely engaging, listening differently… I have been in tears with groups of staff, as they have recounted their experience. I don’t know how the healing has got to be there, but I do completely agree that it is incredibly traumatic.”

And Mr Loughton added: “The director that I work closest with now is my director of communications. And the way that I communicate now has completely changed from how it was. Before March last year, I was kidding myself that I was communicating with all of my staff. Well, I wasn’t communicating with very many, but I was happy.”

Kate Wilson, senior client partner at sponsor Korn Ferry, said there was a need to create space for chief executives to reimagine the NHS – a “pause among the muck and bullets of what has been going on to actually allow the space to do some reimagining” and plan transformational change.

A dozen NHS trust chief executives came together to explore how leading a trust through the NHS’ greatest emergency had affected them on a personal level. By Alastair McLellan

“I’ve been a NHS trust chief executive for 30 years and I’ve never had a conversation like the one we’ve just been through in the last hour and a half.”

This was how David Loughton, CEO of Royal Wolverhampton Trust, summarised the discussion between a dozen NHS trust chief executives brought together by HSJ to discuss the personal and organisational impact of the pandemic.

The CEOs were all drawn from HSJ’s list of the service’s top 50 trust chief executives published in March. The first part of their conversation focused on how the crisis had affected their roles and the organisations they lead. The second part explored how leading a trust through the NHS’s greatest emergency had affected the chiefs on a personal level.

During this part of the conversation, Rob Webster revealed how he cried as he ran to relieve the tension of the job, Neil Dardis talked about the difficulty of a CEO not knowing the answers the pandemic posed, and Richard Mitchell explained how being honest with colleagues about his own vulnerabilities had changed his relationship with colleagues. Patricia Miller too reaped the benefits of admitting it was “okay, not to be okay”, David Probert revealed his guilt over lost staff and exposing his children to risk, and Raj Jain spoke of feeling haunted by the fate of colleagues lost to the pandemic. Andrew Ridley found the pandemic “strangely liberating”, while Sam Allen felt “lucky” to be an NHS trust chief during such a period.

[Author’s note: this part of the conversation was guided by me to focus on how the pandemic had affected chief executives personally – as I believed it was an issue that had not been addressed. Least it be mistakenly assumed that what follows was a self-indulgent therapy session, it is important to point out that all the chiefs were at pains to stress how the challenges faced by many of their staff were greater than those they faced, and that any personal lessons they had learned during the pandemic were being used to benefit their workforce. As mentioned above – all of this is reflected in the write-up of the first part of the conversation – Alastair]

The conversation about the personal impact of the pandemic astonished the long-serving Mr Loughton. He remarked how different it was from the one that the group would have had before the pandemic in which the chiefs would have been “competing with one another [to show that] my organisation’s doing better than yours.”

Instead he had witnessed his peers “share their weaknesses, their fears, their own feelings.

“We’ve changed as a group of chief executives”, he claimed. “And I don’t think we will ever go back because of the experience we’ve been through.”

Fittingly it was the man placed number one in HSJ’s list of top 50 chief executives that got the ball rolling.

South West Yorkshire Partnership FT chief executive Rob Webster said he had only realised how much the pandemic had affected him when he tried to take a break from the pressures of the job.

“I try and keep well by going out for a run. Running is a great way to do nothing in a world in which you’re not allowed to do nothing. But there were times when I’d be crying while I was running, though I didn’t realise it at first”.

One of the themes of the first part of the conversation was that the pandemic had seen NHS staff become “kinder” to each other, and Mr Webster resolved to be “a bit kinder to myself” and to “recognise that actually I’m not super human”.

Sherwood Forest’s Richard Mitchell agreed: “We’ve been through a huge amount of trauma over the last 12 months, and to look after others we also need to be looking after ourselves.”

This theme was developed by Frimley’s Neil Dardis, who reflected on the “personal challenges” of having to admit that he did not “know the answers” to many of the questions that the pandemic asked of the NHS in its early days.

“I’d never quite taken such an open-ended approach to my leadership”, he recalled.

This approach extended to being more forthcoming to colleagues about the difficulties he was facing in his personal life.

During the pandemic the Frimley chief lost a friend he had know since 11 to cancer. Mr Dardis said he “would never have probably shared that with the organisation”, but that the challenges of the pandemic had made him “realise we’ve all got things going on, that we can’t just leave at the main entrance.”

Mr Mitchell had a similar tale to tell.

“A willingness to share personal vulnerability is really powerful. Both my parents have been incredibly unwell over the last 12 months. Sadly, my dad passed away in March. I wouldn’t have probably told the organisation about that [before the pandemic] but by telling people it’s opened up a whole series of conversations [with colleagues]”.

Patricia Miller, chief executive of Dorset County Hospital FT, revealed that she had spent the first four months of the pandemic off work while she battled breast cancer.

Being ill during this time meant Ms Miller was better able to understand the experience of patients during the pandemic. This “lived experience” fed through to her weekly staff blog in which she tells “everybody everything that happens in my life, unless it’s something that my husband particularly doesn’t want anyone to know.”

The reception to the blog and her willingness to open up about her struggles was revelatory.

Talking about the range of emotions that I went through during covid resulted in a lot of email communication from staff saying that they were seeking help because if I was saying that it was okay to not be okay, then, then it was okay for them to admit that [too]

“I hadn’t appreciated just how powerful that can be in a time when everybody is frightened and knows that we don’t all know the answers to all the problems. Talking about the range of emotions that I went through during covid resulted in a lot of email communication from staff saying that they were seeking help because if I was saying that it was okay to not be okay, then, then it was okay for them to admit that [too].”

Moorfield’s David Probert admitted that he had never thought about how the pandemic had affected him. But hearing his colleagues being so honest with their feelings led him to wonder why that was and to acknowledge that at times during the pandemic he felt “incredibly vulnerable”.

He said he would never use that “awful macho word ‘resilience’” and rejected “all that hero nonsense”, but said his experience of having to do his job, while caring for his sick wife and home schooling his children “made me realise I can dig deep and find another level of energy.”

At the same time, Mr Probert said that at times he felt guilty “sending my children to school every day, [and] not knowing what I was infecting them with when I came home”. He also blamed himself for the illness and death of staff who were redeployed into units dealing with covid positive patients.

For one of our chiefs the memory of lost colleagues, and the fear that they were in some way responsible for their deaths, is still too raw to talk about at length.

Salford’s Raj Jain said simply: “I lost nine staff to covid, and I remember all the names and families. I think that will stay with me forever.”

Get up and walk together

Mr Probert, as with many of the other chiefs taking part in the discussion, talked about his struggle when “people were looking to me for answers, looking to me to be made to feel positive and good.” This was an “awful responsibility”, but it also made “my job feel more real” than at any other time in his 22 year career.

The strange exhilaration of running an NHS trust at a time of an international health emergency hinted at by Mr Probert was picked up by Andrew Ridley from Central London Community Health.

The pandemic was, he said, a time when he did not “worry” about his organisation in the way he would have in the past. He admitted to feeling “liberated” by not having to focus on money, contracts and targets, but instead “just getting on with” responding to the crisis.

This focus had led to a “sense of calmness” which was shared by leaders and their teams as they strove to cope with the “extreme circumstances” they found themselves in.

Sussex Partnership Trust chief Sam Allen reflected that like Mr Webster she had “learned the power of a good cry”.

But the mental health trust chief also said she “felt incredibly lucky to be part of a community of NHS, chief executives, amazing people, driven by compassion and a determination to do their best for their communities and their patients.

“I can honestly say during this last year, I got to know more of my NHS colleagues and peers [and] understand more about their brilliance. There was that sort of overriding sense that people would just be there for you… to give generously.

“I felt genuinely fortunate to have a job in the NHS during this period to have a clear purpose, to be part of something.”

For South Warwickshire’s Glen Burley “the absolute strength of a single unifying purpose” to defeat the pandemic meant chiefs had no choice but to “get up and walk together”.

Fittingly the conversation was bought to a close by Mr Webster. Agreeing with Mr Loughton that the conversation was both “incredibly powerful” and not one he had experienced before, he said it underlined the need for NHS leaders to keep “bringing our whole selves” to their jobs “because it really works”.

 

The pandemic has shown that NHS leaders who place people at the heart of their work create radically human organisations, which are not only more innovative and productive but great places to work, says Kate Wilson

If there is one word that summed up this years’ top chief executive roundtable it is ‘human’. We talked about kindness, vulnerability, inclusion and connectedness.

CEOs spoke about how they had truly had to step into a space of ‘not knowing’ and empowering the people around them. They recognised they had been able to support people to deliver around collective purpose without the relentless focus on targets and finances.

This had unlocked real innovation built on powerful team working and genuine collaboration. They reflected on how it had shifted their listening and their communicating to a whole new level: they had been more open and vulnerable as leaders than ever before.

Finally, they had been kinder to themselves and seen people respond with kindness, humanity and support for each other across their organisations. The conversation was moving, inspiring and a very real example of why these CEOs are leading the way.

This is not only something we are seeing in the NHS through the covid-19 crisis, but a theme that emerges again and again in our conversations with organisations around the globe. In a recent Korn Ferry poll of almost 5,000 business leaders, 69 per cent said that their leaders had shown more empathy during the covid-19 crisis.

The lines between home and work have blurred and we have all entered our colleagues’ lives through the portal of Zoom in ways that have shown the messy human world behind the professional front.

The challenge for the NHS that we explored in the roundtable was: how do we hold on to that and ensure this is a moment of transformation and ‘re-imagining’ and not ‘going back to normal’?

As we start to return to normality what does this mean for the future? Whilst the covid-19 crisis has taken a terrible toll, these chief executives show what an opportunity we now have.

The picture they paint is of very human leadership creating organisations where their people’s ingenuity, generosity and desire to make a difference has been able to flourish and take them through an extraordinary challenge. This is significant.

Korn Ferry research shows that organisations who operate in this way not only create great places to work, but grow faster and are more innovative and productive than their peers. We call these radically human organisations.

The challenge for the NHS that we explored in the roundtable was: how do we hold on to that and ensure this is a moment of transformation and ‘re-imagining’ and not ‘going back to normal’? This is a big question and one that will require some real time to pause and reset. However, one thing is certain, any re-imagining for the future needs to put people at the heart of it.

Kate Wilson is a senior client partner for Korn Ferry.