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.
#6 Interview with Helen Buckingham, Director of Strategy, Nuffield Trust and Chair of National Voices
We were delighted to have the chance to interview Helen Buckingham as she marks 30 years working in healthcare. Helen’s career has taken her across many different areas of the health and care sector in the UK and she offers her reflections and experience, openly sharing her original and continued inspiration for her work. Joining the NHS as a graduate trainee originally, Helen offers insight, encouragement and advice for future leaders and draws on what she believes is essential in leadership in the sector. We also hear about her role with charitable body National Voices and how it is working hard to amplify the voices of its members as the demand for their services increases inexorably.
Helen, your role in the NHS and healthcare has been wide ranging over 30 years. What inspired you to work in healthcare?
I came into healthcare as a graduate trainee. I am actually the fifth generation of my family to work in healthcare. My mother was a nurse, her father was a GP and his father and grandfather were pharmacists before that. There wasn’t any push for me to be in healthcare, but we were definitely brought up with the view that we have to think for ourselves and have a social conscience.
I would find it really hard to work in a sector where I couldn’t see some connection between what I was doing and having a positive impact on people. There are quite a number of different ways across the public sector that you can do that, but healthcare appeals to me in that you know the directness of the impact and the breadth of what it does.
Lots of people will associate the NHS with hospitals and GPs and clearly that is right but it is also much, much broader than that – there are something like 300 different careers in the NHS.
When I graduated there were two training schemes – one was general management training scheme and the other finance manager training scheme. I opted for the finance training scheme, not because I had a burning desire to be an accountant, but because actually I looked at it and I thought two things: it was a longer training requirement so you got more exposure to more things in that time and you came out with a recognised qualification. I also thought that finance was a good grounding for a wide range of options in the future and it indeed has proved so.
“Inequalities have always been here but they are starting to be taken very seriously, in terms of access to health care and also health status, and I really welcome that.”
Where are the bright spots that will help to move the healthcare system forward in the short to medium term?
I think it’s extraordinarily tough at the moment. In my 30 years in healthcare, I have spent 20 years in local organisations, five years in national organisations and I’ve now been at the Nuffield Trust for five years. In this time, I don’t think I can remember a time when it has been so challenging.
But I do continue to see our leaders and staff working really hard throughout the system. Leaders in healthcare have that ethos of being public servants, helping the public but also often with that servant leader mentality which means they are also serving their staff. In all of this they want to do the right thing despite three years of pandemic and ten years of austerity, they will continue to keep pulling out all the stops.
Connected to that is the sense that ‘doing the right thing’ has broadened over the years. It’s not just about helping a sick person get better (though of course that is so important) but it is also about stopping people getting ill in the first place.
We need to really, really focus on how we prevent ill health. The health and care system was established to provide health and care for all, regardless of your ability to pay and regardless of your position in society. And in recent times there has been a much greater spotlight on inequalities, particularly in the last couple of years. Inequalities have always been here but they are starting to be taken very seriously, in terms of access to health care and also health status, and I really welcome that.
There are 1.5 million people working in healthcare and a similar number in social care and they come to work every day, partly to get paid, but largely to make a difference for the people who need their services. At the lower end of that pay spectrum it’s getting harder for people to make those choices, but they still do it and that really is the example of the public servant ethos which is so very strong in our sector.
You are also Chair of National Voices – a leading coalition of health and social care charities in England. How are you collaborating across this spectrum to improve patient-centred care? What challenges and opportunities lie ahead?
It is a membership organisation with approximately 200 members, ranging from big national charities down to small local charities that work with and for people who use health care services.
National Voices is a really small organisation with less than 15 people in the management team, who are not all full time. It punches well above its weight. We have to make the best use of every minute of those people’s time so we really can make an impact.
Our member organisations can have really quite different needs but our role is about amplifying their voices, particularly for those things which are not condition-specific and can affect a wide range of people who use health and care services.
We have published a number of key reports, particularly during the pandemic and these have been focused on areas which our members told us were important. A few examples would include:
What we need now: this report looked at how people are interacting with the health care service and what they need to experience. They need to be listened to; they need to know that they do not have to tell their story five times to different people; they need to be clear about what’s happening to them and how that’s decided with them.
Paper Works: this looked at the role administration plays in good healthcare: the overall experience of patients; how appointment systems work; and better communication about what’s going on with a patient’s care.
Patient Noun Adjective: with a double meaning of being patient and waiting for care and being the patient. This report focuses on the kind of support that people get when waiting for treatment. This is much more significant now as waiting times have dramatically increased.
I did say at the start of the pandemic (actually before I had the National Voices role) that I feared that the NHS would find out how reliant it was on the voluntary sector the hard way. And I don’t mean just reliant on the services it commissions from the voluntary sector, but also all the other needs which the voluntary sector mops up in its daily work.
However, as National Voices we do have some amazing opportunities because we have such a wide-ranging membership and we can have opinions on almost anything or limited to a particular service area or what a large or small charity thinks.
We also work with the Department of Health and NHS England through the Health and Wellbeing Alliance, which is particularly focused on the role of the voluntary sector in healthcare.
We have developed a consultancy offer so we can help individual organisations, whether they are NHS or independent and we offer collaborations and partnerships. Organisations can partner with National Voices – they pay a certain amount of money and that contributes to our core funding. At Nuffield Trust we do this. The relationship is clearly led by another colleague as it would be a conflict of interest for me, but we are working with them to help us shape our research agenda. Through National Voices, we can talk to charities that have a particular interest in, for example, end of life care, which is one of our research areas. It’s a kind of virtuous cycle which means both organisations can make a better impact.
At National Voices we’ve also trained a cohort of coaches who have lived experience of the health care system, either as patients or as carers, who can act as coaches for individual leaders. This is similar to a reverse mentoring concept, which instead of focusing on ethnic minorities, is focusing on people with lived experience of healthcare – and of course some of our coaches bring experience of being in an ethnic minority too.
The charity sector generally has been particularly badly affected by the pandemic and has seen its income fall and the demand for its services rise. That’s a real challenge for our members, but like many other organisations we have no core funding, and we are always looking for grants which are limited and hugely time consuming. This is a continuous challenge that we face across the voluntary sector and are looking to address at a national level.
“I believe that leaders should nurture their people, bring in those who are better than them and compensate for weaknesses a leader will have (because every leader does).”
Can you share what attributes you look for in senior leaders in healthcare?
The nature of the leader an organisation needs will vary depending on where that organisation is in its lifecycle. To an extent leadership approach depends on the circumstances and I think the best leaders can demonstrate different styles appropriate to those. That is particularly true when we are in a crisis, and that can require a switch from convening leadership to commanding leadership.
My general preference is the servant leadership model, and a model which works through convening people and solving problems collectively. In general terms, I believe that’s the kind of approach which needs to be adopted in a world of complexity, problem solving and ambiguity as there isn’t always one way to do things.
I also believe that leaders should nurture their people, bring in those who are better than them and compensate for weaknesses a leader will have (because every leader does). Ultimately, we want to find leaders who can create great teams as well as those who can lead and support great individuals.
And finally, what advice would you give to aspiring leaders in healthcare?
My main advice is: do it. Don’t be put off by the challenges but do accept that they are real.
There are so many opportunities to do good work but people do need to remember that they will continuously have to learn as things are changing around them. An ability to use evidence and understand quantitative and qualitative data is important. That doesn’t mean that every leader has to be an accountant, but a certain amount of numeracy and a certain degree of literacy, including emotional literacy, is important for anyone in a leadership position.
Particularly in the health and care sector leaders need to remember why they are there. They are in their jobs to make a difference to both the people who are using services and the people running the services, understanding their wants, needs and fears and how to work with them.
You will not always get it right, and to paraphrase Abraham Lincoln, “you can’t please all of the people all of the time”, so it is important that leaders are transparent about what they are doing and why.
The other bit of advice I might give, and this is quite hard when you’re at the early stage in your career, but it becomes even more important at the later stage: pick your boss well. This does come with experience, and I would say it even if every boss was good. It is about the complementarity of skills and personalities, for someone to consider what they need to learn from their boss, what they bring to the relationship, what they can give and what they can get out of it. Not in a self-serving way but in a personal development capacity. It is something that does come with time, but it has been hugely important for me to learn over the years.
Biography – Helen Buckingham
Helen joined the Nuffield Trust in 2017 as Senior Fellow, working on a range of health policy issues. She has 25 years’ experience in NHS roles, including senior roles in national bodies, as well as in both commissioner and provider organisations. In June 2018 Helen took on the role of Director of Strategy and Operations for the Trust. A finance professional by background, Helen’s past roles include Director of Strategy and Organisational Development in a mental health trust; PCT Chief Executive; Chief of Staff at Monitor; and most recently Director of Corporate Affairs at NHS Improvement. Helen is a sector specialist adviser to Saxton Bampfylde’s Healthcare team.
Helen has particular interests in the development and implementation of strategies leading to clear delivery of outcomes. She also focuses on the development of effective partnerships within organisations and across systems, and also between public sector bodies and the populations they serve. Helen was appointed as the Chair of National Voices in December 2020, a role which will enable her to continue her work supporting organisations to look at policies and practice through a truly person centred lens, ensuring that people who use services are never seen as less important than those who deliver them.