After a period of unprecedented change and challenge for the healthcare sector there is much to reflect upon to help aid recovery. In this reflection we believe that there must be a clear emphasis on learnings – what worked and what didn’t – and how these can be integrated in to delivering meaningful and people-centred models for the future.
Saxton Bampfylde is delighted to bring you a short series of interviews from senior leaders across a range of health and care settings to discuss and demonstrate the importance of learning, challenging and innovating to make a positive impact in their own organisations, and more broadly across the sector. We are very grateful to each interviewee who has generously and honestly shared their experiences and learnings with us.
#4 Interview with Andrew Morgan, Chief Executive at United Lincolnshire Hospitals NHS Trust
Andrew Morgan is the Chief Executive of United Lincolnshire Hospitals NHS Trust – a role he took on in the summer of 2019 with the Trust having been in both quality and financial special measures since 2017. Faced fairly quickly with a pandemic, the environment of Andrew’s leadership was challenged more, but his successful approach and commitment to bringing the whole organisation with him is reflected in the fact that ULHT exited special measures in early 2022.
We were delighted to have the chance to interview Andrew as he marks his fourth decade in the NHS and hear his observations as one of its most experienced senior leaders. We talked to Andrew about how he has addressed the challenges of lifting his Hospital Trust out of special measures and the lessons learned from the pandemic and impacts we must strive hard to retain. With a huge emphasis on people and communication Andrew shares his wisdom, experience and commitment to trust and honesty as the markers of his leadership career.
Andrew, you have spent four decades working in the NHS; given your personal experience and the wider external context, what do you consider to be the big priorities for the NHS in the next 5-10 years?
Overall, we want better health, better care and better value for money. I suppose the immediate priority is workforce and if we don’t get the right people, grow them and keep them then it is not going to work very well. We do have to make the NHS an attractive place to work and therefore we need to offer different roles, different shift patterns and a more flexible approach to working patterns. We must make it work for the next generation.
We need to be more respectful of other peoples’ time and not expect them to always fit into our way of doing things. This encompasses waiting times, which are a very big issue, but we need a more customer-focused approach overall. This is all wrapped up in the digital agenda. Most people run their lives on their phones: you can do almost anything except interact easily with the NHS. We’ve really got to sort that out. When we are treating people, the premises need to be better and the equipment more modern.
I think a low base line has developed of what people expect to get from the NHS and with all the money going into it there is a question about the return on investment i.e. the service that is received. For current and future generations it will have to be better. People want more immediacy and easy and quick access. We still send out letters to people with appointments on them that have had no prior discussion in terms of convenience or suitability. That cannot be right.
The NHS is amazing in an emergency but it often falls down on the more routine elements as we don’t have a slick customer-focused approach. Unlike most businesses we have too many customers, and we’re often trying to cut the demand down which is a very counter intuitive to most businesses who need customers to survive. That whole supplier capture bit is challenging but we must make sure it is designed around the comfort and needs of the patients or citizens and not just the convenience of the NHS.
And finally, but hugely importantly, the NHS cannot function without high functioning social care. While it isn’t the NHS it must still be a priority for the Health Secretary and Government more broadly.
Your most recent role has been with United Lincolnshire Hospitals to which you were appointed in 2019 when the organisation was in double special measures and dealing with the fallout of another critical Care Quality Commission report. How have you addressed the challenges at ULHT to exit special measures earlier this year?
I have been a Chief Executive for 19 years in eight different organisations, but really I view myself as a jobbing general manager. I hadn’t run an acute trust before and I didn’t know the intricacies of it but we employ 9000 people and there are people here that do really know the detail and have supported me with help and advice from day one. The Chief Executive’s job is about the strategy, risk, performance and culture, choosing the right people, getting the communications right. From across my leadership experience I have learned that there really are three key areas that must be answered for any organisation: What is the intent of the place and what are its plans?; Have we got the capacity and capability to deliver those plans?; and What are we like on delivery?
On all three fronts more work was needed at ULHT. We have completely simplified the planning and the plans and when we reach difficult times we don’t just rewrite the plan. But we might need to change some of the tactics.
We have concentrated majorly on people. It is a people business: we employ great people to do great things for other people’s loved ones. It is no more complicated than that.
My whole approach is that a well-led, well-motivated, well-engaged workforce will deliver for you. We need to make this a great place to work and a great place to receive care. It is important for me to make my colleagues’ jobs as easy and enjoyable as possible and provide every bit of support that I can. Our job is not to torment people!
It is important for a leader to make the priorities really clear, to provide as much support as possible and then get out of the way and let people get on with their job. But it is also to hold the mirror up at the right point and say: ‘I wasn’t here, I didn’t create this and some of you did, so how are you going to help us get out of it? Do you accept any responsibility for it?” Often people have normalised the unacceptable and got used to things as they are, such as being in special measures. The Trust is all of the people who work here, so it is wrong to expect someone else to put things right. The change needs to come from the people in the Trust. We have to want things to be different and better.
The importance of showing vulnerability and learning from things you got wrong but not repeating the same mistakes again it is vital. Part of the culture here was fear, and I am very much of the forgiveness not permission mentality. I assume we wouldn’t employ people if they weren’t good and I trust them. If they see something that isn’t right I want them to try and make it right.
While we have emphasised the importance of internal issues we have also been a much better system player. We’ve talked to colleagues in the system and not pointed fingers or blamed anyone for our problems. I have also tried to personally have a high media profile, to talk to the public and their representatives about what we are doing, why we are doing it and how they will see the change. We have asked them to please support us and don’t simply criticise us as that will perpetuate a negative cycle and we won’t manage to recruit and build our reputation.
Described as a ‘troubleshooter’ in the health and care sector you have worked with several struggling organisations over the years. You have said that leaders who take on tough jobs should be ‘cherished’ and not ‘pilloried’. What should be done to provide more support to leaders taking on these difficult challenges?
I don’t describe myself as a ‘troubleshooter’, I still go for the ‘jobbing generalist’ title. I do feel it is my duty as a lifelong public servant that if you are approached or asked to volunteer in a troubled organisation that you should accept that role.
However, I do then expect people around me, including the people who put me into that role to support me to be successful: we are all there to be part of the solution, not the problem. Too often the system and the mechanisms make the leader the problem or make them feel like the problem and expect overnight fixes. When a Trust is in special measures there are big things that need to be fixed and that is different from what other Trusts are having to focus on. A Trust in special measures may have a list of national priorities, but also may not be able to do all of those as well as everything else so will require choices to be made. If everything is a priority, then nothing is a priority.
It is the job of other parts of the NHS to help make a leader’s success more likely, not to torment them, or mark their homework and tell them how rubbish they are. There is an element of needing to inspect and regulate and I totally understand and welcome that, but ultimately my success as the leader of an organisation in special measures should also be a joint goal with NHS England. I have to say that in my current role I have had great support from NHS England. They do challenge, but it is much more framed around how they can help and what support we need to succeed.
It is a reality that there are times when people need to be moved on, but this should be done professionally and with respect. This should not be at the expense of pace.
What opportunities do Integrated Care Systems offer to enable emerging leaders to broaden their experience of working in different settings?
Ultimately, I think it brings an opportunity to understand what a system actually is. I have worked in lots of different NHS organisations in different parts of the country, but there are many sectors, such as local authorities or the voluntary sector, that I have not worked in. These are key parts of an ICS. A system allows us to get the right people involved and establish through collective effort what is going to work for the citizen.
It is important to do the diagnostics of what can actually help, what impacts it will have and how it can be made to work better. With this model it shouldn’t matter if you are employed in one part of the system and you are asked to work in another part, if your skills suit it. The opportunity to bring different people’s thoughts and backgrounds is so beneficial, as well as encouraging them to ask why people do things certain ways, or how they can collaborate to help design pathways and think about solving problems differently.
How has the pandemic encouraged any cultural changes in the NHS; both internally and with external stakeholders?
For a start it reminded the public and our representatives how important health is for general wellbeing. All the ‘clap for carers’ activity really reinvigorated the love affair with the NHS. After 70 years in existence it just reminded people of the really amazing life-saving work that the NHS does and the fantastic people it employs. I unashamedly say that I love the NHS and that I think it is the best part of our society. I think the pandemic helped many others to see it in a similar light.
The importance of looking after your workforce has also really come to the fore – with a focus on the whole person and their mental and physical wellbeing and working conditions. Some of our colleagues had to see and do horrendous things and need support now and in the future.
It also showed that things can be done quickly if the urgent need is there. People showed their ability to do that and to work across boundaries. We do need to ensure we keep these approaches.
However, what we can’t do is live off that love affair with the NHS forever. I think we are seeing some of that now with people’s unwillingness to accept long waiting times. We have to do the catch up and we can’t blame the pandemic forever. What we learned during the pandemic is that online appointments and consultations will remain, as for many people they are incredibly convenient. There are those who will benefit from this interaction but we must have the technology which works.
Road to Recovery Series