A podcast about big ideas in health and care. They talk with experts from The King’s Fund and beyond about the NHS, social care, health policy and leadership. New episodes monthly.

Is the NHS really full of ‘overpaid pen-pushers’? Jo Vigor talks to Dr Seema Srivastava, Deputy Medical Director at University Hospitals Bristol and Weston NHS Foundation Trust, Emma Challans-Rasool, Founder and Chair of the Proud2bOps operational network and Director of Organisational Development, Culture and Talent at Nottingham and Nottinghamshire Integrated Care System and Rachel Burnham, Director of Performance and Information at Guy's and St Thomas's NHS Foundation Trust, about the critical role of NHS managers and what it means to bring your humanity to work.

Listen to the full episode here.

General Sir Gordon Messenger's foreword discusses the leadership challenges in the health and social care sector, emphasizing the critical role of strong leadership in improving outcomes. Despite sectoral complexities and immense pressure, the development of leadership and management is inadequate. The review identifies the need for collaborative leadership, equality, and professional training, calling for structural change to create a more inclusive, well-led workforce. The report presents key recommendations for improving leadership development, talent management, and equality standards.

Thank you for joining our second blog discussing the challenges facing NHS managers, why it matters, and what we can do to improve the situation.

In our first blog, we addressed the misconceptions about NHS managers, showing how constant scapegoating harms these vital team members. Despite being crucial to delivering quality care, managers often lack the same development opportunities and recognition as their clinical colleagues, as highlighted in the 2022 Messenger and Pollard report.

In NHS organizations, the triumvirate leadership model includes a clinical lead, nursing/AHP lead, and a general manager. However, when problems arise, managers are often held accountable first, despite carrying the same commitment to patient care as their clinical counterparts.

We recently explored these issues with operational managers and medical staff (Proud2bOps/FMLM/BMJ Leader). NHS structures can reinforce siloed responsibilities, preventing true collaboration. We must unite to build stronger partnerships where managers and clinicians hold each other accountable in a supportive environment.

Join us in supporting NHS managers. Read the full article here.

The NHS is often criticized for being top-heavy with managers, who are portrayed as overpaid bureaucrats stifling innovation. However, managers make up just 2% of the NHS workforce and play essential roles in operational delivery, staff support, and improving patient services. Despite their importance, they face persistent negative stereotypes and lack recognition.

We believe it's time to change this narrative and raise the profile of NHS managers, who work tirelessly to create conditions for excellent care. Clinical leaders must support and advocate for their management colleagues, recognizing their vital contributions.

Join the conversation as Proud2bOps and FMLM host a collaborative session on November 24th to strengthen partnerships between medical and operational managers.

Read the full article here.

In this third blog, we explore why NHS managers and medics struggle to lead collectively with trust. Previous discussions revealed that professional differences and misunderstandings hinder collaboration. A Tweet chat with BMJ Leader, Proud2bOps, and FMLM highlighted common barriers like lack of time, ignorance, and assumptions about each other’s roles.

Clinicians often assume they lead on patient care, but managers are equally focused on patient outcomes. Medical training and early career experiences perpetuate divides between managers and medics, reinforced by different pressures and expectations. The Messenger Review underscores the need for leadership development focused on collaboration.

We propose an "upstreaming" approach to learning, where management and clinical professions engage in joint development early in their careers, fostering shared responsibility. Real-time development, where collaboration and problem-solving are ongoing, is key to breaking down barriers.

Leaders should act now by engaging across professional lines, seeking opportunities for joint learning, and building stronger collective leadership. Join the conversation and share your experiences.

Read the full blog here: BMJ Blog

Distilled Post sat down with Chris Adams and Oliver Bailey of Medinet Clinical Services, a leading clinical services provider to the NHS, to talk sustainable solutions and the key to positive partnerships. The NHS Executive Strategy Summit was an opportunity to hear problems and develop solutions to issues that abound across the NHS, and the conversation started with a discussion on what Medinet’s solution entails. Medinet is a clinical services provider, a role that has historically involved insourcing - providing clinical teams to NHS Trusts that are struggling to cope with demand, and working out of un-used space on site (such as empty rooms or theatres) “that represent a cost rather than a benefit to the Trust”. However, “as a business, we’ve always operated by asking the question - what is the barrier to you being able to see more patients? And how can we pivot and adjust our offering to fill that gap?” Chris offered. 

In recent years for Medinet this has led to the introduction of modular facilities. These environmentally sustainable units are constructed on-site for when Trusts require the insourcing of staff to deal with demand but don’t have the capacity to allow for additional clinicians to operate. The introduction of the modular units has been a huge success: “we’ve got state of the art endoscopy suites in car parks that have been used to see hundreds of patients who wouldn’t otherwise be seen”, Chris said.

With the onset of winter pressures never far from the headlines, the benefits of the NHS working with private healthcare companies is clear to see. But Oliver saw the forming of a positive relationship with Trusts as key to the success of initiatives like these. “As a private provider, we’ve always been universally welcomed into the NHS with open arms… But there’s a distinction between private healthcare companies and what we do - we’re all private companies, but our only customer is the NHS. We’re not charging the maximum rate for an endoscopy, we’re working under a tariff”. Chris concurred, adding that “we approach events like the NESS (NHS Executive Strategy Summit) as a partner, not a vendor”. For Medinet, this spirit of partnership and collaboration is key. 

Indeed, Oliver observed that often there is a perception in the private health provider sector that NHS operational managers “know exactly what they want, how they want to do it, and they’re just looking for a company to push the button for them.” But Medinet operate under the assumption that actually, it’s extremely difficult to commission the service you need (from an operational perspective) without thoughtful collaboration between the private provider and the host Trust. “We’re not just offering a menu of services, we’re trying to listen, really understand the challenges for that specific Trust, and come up with innovative ways of delivering those services at the right price point and in the right way.” 

The conversation turned to the question of sustainability, and how companies like Medinet can be sustainable when a key function of their job is ‘fire-fighting’ in times of crisis for the NHS. “We can’t just run in, thrash out a load of activity and run out. We’ve got to be committed to the long term, asking questions like do we understand how the Trust views that whole care pathway?”, Chris asserted. Medinet have adopted a raft of initiatives to ensure that their insourcing has a lasting beneficial impact on the Trust they are supporting.  This has led to initiatives like training programmes for Trust staff and the implementation of A.I. tools to increase diagnostic accuracy. The logic being that Medinet are not only supporting the NHS as it is, but nurturing and developing the individuals who will be its custodians in the future too.  In a more literal sense, sustainability is achieved through multiple means: the modular facilities are constructed using sustainable building materials and methods, and when insourcing, Medinet ensure that clinicians are sent to Trusts local to them, reducing extended periods of travel. 

The conversation concluded with a reflection on the NHS Executive Strategy Summit. Both Oliver and Chris agreed that there was huge value in hearing directly from operational leadership teams at the event, particularly with regards to their collaborative partner-led ethos. They are used to hearing about the pressures facing the NHS, “but what was really powerful about the event specifically was that it created a context where we were able to find out about the layer below the headlines. What do these problems look like on a day to day basis?” For Oliver and Chris, understanding the minutiae of the problems facing NHS staff is the foundation of a positive and collaborative partnership, and the basis for finding the solutions to those problems. 

The NHS Executive Strategy Summit took place in London on 7th November, organised by Meet Health Events and Proud2bOps.  Distilled Post sat down with some of the operational leadership teams present at the event, including Angela Hillery CBE. Earlier in 2023, Angela was named the number one NHS Chief Executive in the country by the Health Service Journal.

Angela is in the unusual position of having operational oversight of two different NHS Trusts: the Northamptonshire Healthcare NHS Trust and the Leicestershire Partnership NHS Trust. At the NHS Executive Strategy Summit, a common theme that emerged in discussions was the complaint that across the NHS, different parts of the system are not ‘talking’ to each other to a sufficient degree, leading to worsening outcomes. Angela has a unique perspective on intersectional communication across the NHS: “we often contain ourselves within sectors or organisations… In my experience, the more we reach out and connect, the better. Often we use different language in different areas to describe the same thing.” 

She referenced conversations surrounding discharge, which is relevant in the mental health, acute and community sectors; however these different areas separate out the conversation and report on it differently. Angela saw this as a key issue to address in solving wider problems facing the NHS; “If we can get people together across operations and acknowledge that often these are the same issues just manifested differently - the more we can get that understood in operational terms, the more we’ll get staff presenting solutions and crossing sectors.”

Complementing this aim for a greater sense of connectedness across systems is the burgeoning role that technology can play in achieving efficiency and better outcomes in healthcare. “I’m absolutely certain it’s going to be pivotal in terms of what the future looks like”, Angela said. An oft-mentioned topic at the Summit was the prospect of greater care in the community alleviating some of the burdens placed on the shoulders of NHS staff, and Angela was quick to acknowledge that technology was a vital component of implementing innovations such as virtual wards and intermediate care services. 

However, she conceded that “people often underestimate the clinical behaviour change that’s needed and the change in integrated care pathways that’s required to really maximise the potential of those ideas”. She also saw communicating the mutual benefits of care in the community as essential: while there is a benefit to the NHS in terms of bed occupancy, less discussed is the potential for patients to benefit from being cared for from their own home, and empowering them to manage their own care. A huge part of all of this, Angela assessed, was convincing people of the “art of the possible”. From an operational leadership perspective, Angela wants to communicate these new ideas through visible promotion of success stories - “people’s stories make a difference to behaviour. It allows for emotional connection”. 

Angela saw the NHS Executive Strategy as equally vital in improving the culture of operational leadership in the NHS. “It was really, really valuable… Often in the operations sector people are so busy that they’re not connecting as much as might be beneficial”. She identified that taking the time out of a busy schedule to reflect can lead to feelings of guilt amongst leadership teams, but that the act of doing so was invaluable. As she summarised, “operational colleagues need to plan for these moments. They need to plan time to connect with colleagues… They are drawn to the busyness of the day to day, but by taking the time out, I genuinely think they will improve their problem solving abilities and they’ll feel more supported.”

Distilled Post sat down with Professor Kiran Patel to discuss solutions to some of the most pressing issues the NHS is confronting this winter.

Meet Health Events and Proud2bOps are joining forces to deliver the NHS Executive Strategy Summit on the 7th of November in London. Following straight on from the NHS’s first official day of winter, 1st November, the Summit represents a vital opportunity for operational leaders from across the Health Service to make connections and share knowledge and experiences in a supportive environment. In doing so, the Summit will direct leaders to collaborative solutions to some of the most pressing issues facing the NHS, including patient flow, workforce challenges, digital strategies and winter resilience.

As we focus on operational leaders in the buildup to the event, Distilled Post recently sat down with Professor Kiran Patel. Kiran spent 6 years as Medical Director for NHS England (West Midlands), and since 2019 has been a Chief Medical Officer, Deputy CEO and Consultant cardiologist at University Hospitals of Coventry and Warwickshire. Internationally, Kiran has lectured extensively and advised the Thai and Indonesian governments on health system strengthening. 

Winter pressures are looming large from an operational standpoint, with demand for services set to increase with the onset of colder weather. Kiran articulated what resilience should look like, in the face of these pressures: “It’s being able to cope with the multiple challenges that are thrown upon us”. Indeed, following a summer of disruption stemming from strikes across the workforce, Kiran believes that “this winter, we have many mare challenges than usual, to take into context the industrial action we’ve seen”. 

And how do we meet these challenges, including improving patient flow sustainably? Kiran observed that “we tend to think having meetings is the answer… but I think we need to have better structural design, better collaboration, better peer review”. The prospect of integrated, joined-up care is a much-touted goal by operational leaders across the NHS, and Kiran is an ardent advocate: “we need better integration to make sure we see the world from each other's eyes, so that we can appreciate the challenges across primary care, secondary care, public health and social care. I think we need much more integrated visioning, instead of meetings”. 

The challenge, of course, is how that integrative visioning is achieved. The implementation of digital solutions is a promising avenue, but Kiran believes it is still a matter of potential: “I don’t think anybody’s cracked it yet… But the potential  “is more integrated digital sharing, rather than using digital for escalation”. He referenced his site management board at the hospital, which contains a ‘rich data set’ containing information on bed state and patient flow. However, he has no indication of real-time data coming from primary or social care, and doubts that they in turn have access to his data-sets. The consequences of this lack of integration? “We end up being reactive rather than responsive… And we could become responsive with good digital sharing”. 

While he acknowledges that integrative sharing requires a balance - “you clearly want local autonomy with commonality in there as well” - he’s adamant that sharing information across a wide range of stakeholders is key to providing joined-up care, improving flow and alleviating some of the pressures facing the NHS this winter. These issues and more will be brought to the table at the NHS Executive Strategy Summit. Kiran sees clearly the benefits of bringing operational leaders together in this way: “the value is to share solutions and to share challenges. I think if you can share challenges, you can generate collective solutions”. 

The NHS Executive Strategy Summit is on the 7th of November in London, organised by Meet Health Events and Proud2bOps.

To learn more about the event, visit: https://www.meethealthevents.com/nhs-executive-strategy-summit-ness-2023

To learn more about Proud2bOps, visit: https://www.proud2bops.org

Reflecting on the success of the NHS Executive Strategy Summit in early November, Distilled  Post spoke with Barry Mulholland and Jason Roberts. Barry is a partner at MBI Healthcare  Technologies with experience of operational roles within the NHS previously, and Jason is the  Director of Sales and Business Development at MBI. Both were present at the Summit with  MBI, who deploy cutting-edge technology to ensure the quality of healthcare data and  have collaborated frequently with the NHS. 

Barry began by offering a commentary on the critical challenges facing the NHS this winter,  from a data perspective. “We’re in a situation where we’ve got stretched resources  everywhere”, he began. “One of the biggest challenges in terms of the workforce is a  shortage of analysts… if your data is not what we might call healthy, you're always going to  struggle to make the right decisions - especially when resources are tight, and every decision  counts from a financial point of view.” 

He alluded to other disruptions exacerbating workforce shortages, including the elective  care backlog, the ambiguity surrounding the incoming centrally procured data platform  (known as the Federated Data Platform or FDP) and increased demand in Emergency  Departments over the winter months. In the light of these additional disruptions, Barry  surmised that “NHS operations colleagues haven’t really got the time for piloting things and  trying out new solutions”. In order to meet these critical challenges in the short term, he  emphasised the need for experience in the NHS environment and particularly in healthcare data - “we have to wrap expertise round an already stretched resource”. 

The conversation shifted to the obstacles standing in the way of high quality health data.  Jason saw one key problem as being the method by which waiting lists are constructed, with  data derived from EPR (Electronic Patient Record) systems. However, clinicians rarely look at  EPR data when establishing a context for a patient - they are far more likely to go to the last  patient letter or clinical documentation. This kind of data is not reflected in waiting lists, as these clinical sources tend to be unstructured.  

The problem is underscored by what Jason identified as “a partial view of demand”, with  uneven coverage of data: while certain areas such as cancer waiting lists or Referral to  Treatment (RTT) waiting lists are measured, “there’s a lot of it that isn’t measured and isn’t  properly understood. And that hampers plans all the time.” Barry added that invariably,  health data can be messy - “because humans are messy, and therefore the data about  humans is itself messy”. Messy data is further compounded by the number of disparate  systems over which information is supposed to be shared, all of which talk to each other to  wildly varying degrees. Additionally, he referenced EPR implementations as adding a burden  to staff workloads of entering extra data, with no clearly defined roles to do this. 

The discussion made it abundantly clear that solutions are desperately needed to some of  these pressing issues surrounding data management and insights. As Barry said, “it’s almost  impossible to fix unless you can see the full picture - and very few organisations have got that  full picture at the moment”. MBI Healthcare Technologies’ array of digital solutions enables  clinicians greater insights and ultimately leads to better decision making. In a word, it’s  “safety”, as Barry said. He referenced numerous incidents of certain groups of patients  receiving attention at the expense of other groups. “The first thing our solution brings is an  overview of everybody who's waiting and what the risk is around those patients. That allows  you to prioritise better which patients to see and when”. Flowing from improved safety standards is an increased ability to plan well: “Once you’re able to know and see all of the various competing demands for your finite capacity, you can start to plan it better”. He  pointed towards the significant financial benefits too, with huge amounts of time and money  currently being spent on “armies of people” who search through patient records to ascertain  what is going on with a particular patient. By supporting this process, MBI are also relieving  the pressure on staff by shaving the time required to work out what patients need. 

The conversation ended with some reflections from Barry and Jason on the success of  November’s NHS Executive Strategy Summit event, organised by Meet Health Events and  Proud2bOps. “There is so much common ground”, Jason commented. “The challenge of  getting a full picture, that’s universal across the system… And the idea that we should be  doing things manually, I think there was a widespread recognition that the time is up on that  perspective”. “And I think everybody recognised at the event that simply putting fancy  technology on top of data that isn’t accurate will just provide expensive and ineffective  solutions… We need to do something about all the data that’s going into this new  technology”, Barry added. “You have to give full credit to the Summit, for creating a space  where people feel safe to raise those concerns”. 

The NHS Executive Strategy Summit was held on the 7th of November in London, organised  by Meet Health Events and Proud2bOps. 

To learn more about the event, visit: https://www.meethealthevents.com/nhs-executive strategy-summit-ness-2023

After a summer of industrial action and with winter just around the corner, operational leaders from across the NHS are facing a series of significant and sustained challenges. In response to the current situation, Meet Health Events and Proud2bOps organised the NHS Executive Strategy Summit, which took place in London on the 7th of November. The Summit offered operational leaders a rare and vital space to come together and share experiences and practice, with the overall goal of finding solutions to some of these problems through collaborative problem-solving. 

Distilled Post spoke to Salma Yasmeen, the Chief Executive of Sheffield Health and Social Care NHS Foundation Trust. Prior to her appointment in July of this year, Salma was the Deputy Chief Executive and Executive Director of Strategy and Change at South West Yorkshire Partnership NHS Foundation Trust. She was also the Chief Executive of Sharing Voices, an award-winning mental health community development charity that she developed from a pilot project. 

One solution to the sustained pressure the NHS is facing - much-touted at the Summit - was the prospect of greater care in the community. Salma appreciates the potential of an increased role for community care, but was keen to observe that “We haven’t had investment in social care for a decade now… And that means that there’s reduced capacity and capability in our communities to soak up some of that need”. Clearly, if the NHS is to rely to a greater extent on support from communities, significant investment is needed outside of the scope of the NHS. 

Salma suggested that one exciting pathway to community care might involve the development of new roles for community connectors and navigators. Particularly in a mental health context, she has observed high levels of people that need secondary support or crisis pathways. “However, if you ask our liaison teams, there’s a large number of people that have issues around housing and other areas that contribute to their distress… They’re emotionally distressed, but don’t necessarily need specialist input - but they present there because they have anxiety, depression or thoughts of self harm”. Salma would advocate for new community-facing roles that can support people to address what those core issues are. Dialogues with stakeholders outside of the system are vital; as Salma said, “the  people that helped join the dots between the different bits of the system are no longer there”. 

At such a trying time, Salma welcomed the concept of events such as the NHS Executive Strategy Summit. “It’s incredibly important… It gives operational leaders space to reflect, take a step back from the pressure of the day to day, to reflect on our own internal approach and learn from others, and to then come back affirmed that we’re as ready as we could be”. Monitoring and maintaining the wellbeing of staff across the NHS will be vital to withstanding winter pressures, and spaces such as the NHS Executive Strategy Summit help operational leaders such as Salma support themselves to then go and support their own staff. 

The conversation ended with a discussion of what resilience means this winter. “Resiliency is having joined up integrated approach which everybody understands across the system, with additional escalation points”. From her perspective as the leader of a mental health, disabilities and autism provider, Salma believes that her beds are filled nearly 20% with people who are “clinically fit to be discharged, but have got incredibly complex needs with ongoing, high levels of risk”. Managing these complex situations has required innovation, and Salma has focused on working closely with social care partners. Additionally,  “we’ve been working to strengthen the front end of services, liaison services, and we’ve invested in a clinical decision support unit”. Evidently, a joined-up approach that collaborates with partners outside of the system is key to building sustainable resilience.

To learn more about the NHS Executive Strategy Summit, visit: https://www.meethealthevents.com/nhs-executive-strategy-summit-ness-2023