Speaker1: [00:00:00] That cost us £4.5 million. You've lost. Would I ever want the NHS to go? No way. I'm from the NHS. I love the NHS. How do you get resilience? Hard times often create innovations. You can understand why people get stuck in systems. Why employ a specialist or an expert on something and then tell them how you want them to do it? They really have invested millions in the UK. I wouldn't have been able to afford to go to university. And actually you can't treat behaviour. You need something like positive behaviour support, but it's good for your business to look after your colleagues.

Speaker3: [00:00:36] Voices of Care. The healthcare podcast.

Speaker2: [00:00:36] Rebekah, a pleasure to have you on Voices of Care. Thank you so much for making the time to come and join us.

Speaker1: [00:00:44] Thank you for inviting me. Really privileged.

Speaker2: [00:00:46] It's a privilege of ours now. Priory Group is known so well, hugely respected, particularly around your mental health and wider social care services. I wanted to start with mental health. Mind and the Centre for Mental Health produced a big report in the Big Mental Health report back in November 24, painting a really worrying picture around a mental health crisis that we have. You agree, of course, that there is a crisis and the extent of it. 

Speaker1: [00:01:15] I mean, it's huge. I mean, I really welcome that report. And they put it in front of everybody, and we do need to pay attention to it. They are canvassing the views of people across this country, and I haven't heard it being spoken about enough, actually. I mean, the staggering figures of 1 in 4 people will have a mental health problem at some point in their life. That's all of us affected by it. And the number of people that are dying. In 23 alone, 6069 people died by suicide, 75% of those men. We need to be doing more in this country.

Speaker2: [00:01:49] No, absolutely. And I think the other picture from an economic perspective, not just of course, the human aspect around this is, I think the estimates are around £300 billion to the economy. So it has a huge impact, not just for the families, but of course for all of us. 

Speaker1: [00:02:06] Yes. And at Priory, I mean, we really invest in mental health first aiders, lots of programmes for our colleagues because we realise it's not just the right thing to do, but it's good for your business to look after your colleagues because then they really enjoy what they're doing at work. So, you know, I think it's everybody's issue to look across the piece and see what we can do about mental health.

Speaker2: [00:02:30] Oh, absolutely. And taking a broader picture, your own career, I think you've been at Priory. Now, I hate to remind you, I think you're into the second decade there, 13 years and prior to that, about 14 years within the NHS. So you're uniquely positioned to comment across the whole piece. We've got a government that's dedicated to a mission in healthcare transforming, and I'd like to tackle that in both aspects of NHS and social care. But Priory, in a sense, is almost uniquely placed because mental health you're very well renowned for, but you have a much broader offering which many people still outside the sector don't know across social care?

Speaker1: [00:03:10] Yes, we have 200 care homes, residential for autistic people and people with learning disability. We did used to have older people's homes as well, but that's not part of our core business. And of course, supported living, which is hugely important for people to live independently as they can.

Speaker2: [00:03:27] And you provide both mental health and social care across all four nations.

Speaker1: [00:03:32] We do. Yeah.

Speaker2: [00:03:33] So let's tackle the NHS. If we start there just briefly, a ten-year plan is in the offing. You came out last year, I think, around the change of government and set out a number of priorities that you'd like to see for the NHS and for social care. Let's talk about the NHS. What are perhaps 1 or 2 of the key things... You talked about very powerfully around the idea that actually the current NHS and social care system is unsustainable without fundamental reform? And you highlighted the role of regulation? 

Speaker1: [00:04:07] Yes. I recently met with the new CEO for CQC for example.

Speaker2: [00:04:13] Sir Julian Hartley.

Speaker1: [00:04:13] Yeah. And we have, we've got seven different regulators across Priory. I think they've got things to learn from each other. I do think providers are frustrated at the moment with some of the regulations, especially in the UK, that stops innovative work being done. And I think the regulators, there's a real mindset now to try and work more with providers than they have been in the past. They're kind of learning their lessons from that, and I think that will free us up to be able to meet a diverse needs group.

Speaker2: [00:04:50] Absolutely. And Julian has been a guest of ours here on the podcast and brings a wealth of experience. But as you say, his background is not in social care, but he'll be taking soundings from, of course, yourself and other leaders. You also talked about, this is for the NHS, that we always think about the acute hospital setting when we talk about the NHS. Now, I know there's a mission to shift that to prevention, but in your manifesto call, you also emphasize that mental health, going back to this crisis, must be given prominence in any ten-year plan.

Speaker1: [00:05:27] Yes. I think what we're seeing at Priory now is because of the shift to community, which we're really supportive of that. We don't want people to be in hospital any longer than they need to. As a mother of children myself, you know, I get where everybody is saying about out-of-area placements and we want to work with the NHS to be able to provide that. That's not just Priory, but all the other independent mental health CEOs as well. And I think what we're noticing is that by the time people get to us, they are more acutely ill than they have been. But nonetheless, we approach everybody as an individual. We're good at measuring outcomes. And we're able to say, somebody came in and these were their thoughts and feelings around their life. And when they were discharged, this is, you know, the improved outcome for them. We plot that on scatter graphs. And, you know, it's really an exact science. So being able to put that to your work is really important. The other element of supporting people who are very, very ill is obviously you need a very specialist workforce all the time, prepped up environments, etc. and I think the independent sector has a real role to play that's able to invest in those things on behalf of the NHS and the people of the UK. And that's how we see ourselves, serving the people of the UK. I don't look after anybody differently than I used to look after in the NHS. It's still my mission to help bring people back to their lives as they had them. And our purpose motto is live your life.

Speaker2: [00:07:11] Absolutely. And I wanted to touch upon that because you've talked about workforce and before we talk about social care. But I want to hone in on that because we've obviously got a long-term workforce plan for the NHS, which was issued back by the previous government in '23. I think Mr. Streeting is going to have a look at that. But leaving the politics of that aside, the idea that we're going to need to grow nursing by 92% under those numbers, I wanted to highlight, because this as a nurse yourself.

Speaker1: [00:07:35] Yes.

Speaker2: [00:07:36] You know, as a clinician, Priory has decided, in a sense, to take its own destiny in its own hands and support some of your workforce to become registered mental health nurses, of which there is a shortage.

Speaker1: [00:07:49] Yes, I'm really proud that we've just recently enrolled our 200th apprentice into a nurse graduate program. And we enrol about 45 HCAs a year, and they can earn as they learn. I mean, I went to university when they still got tuition fees paid and a small grant. It was dwindling year by year.

Speaker2: [00:08:13] I remember it well.

Speaker1: [00:08:14] But coming from a family who actually, unless we'd have had that system in place, I wouldn't have been able to afford to go to university. My own father, for example. Very smart man, went on to do a plumber's apprenticeship because he was told, come on, you leave school at 15, just get out there and work. And I think that's why I'm so passionate about giving people learning opportunities. Sometimes we have one parent families who, for whatever reason, it wasn't right for them to stay on at school or that wasn't there. But to be able to now at Priory be able to study for a degree. And we do. We have about 550 people going through apprenticeship programs at the moment to become psychologists, OTs, all different types of careers. I even want to bring it in for our maintenance teams across priories to become electricians, plumbers. We don't need to stop there. We invest £14 million a year in apprenticeships. So really do believe in growing our own people. And you get loyalty and commitment back. I mean, the retention rate for nurses, we've trained ourselves. I think more than 85% of them are still with us X number of years on. 

Speaker2: [00:09:27] Well, that's an astonishing number. When you think about the number of people, I think it's 1 in 5 leave the NHS after qualification. And I think you'll know, of course, the RCN and UCAS stats at the end of '24 showed a really huge drop in some parts of England, 40% of people enrolling in nursing degrees. And as a personal note, your comments resonate deeply with me. I qualified as a lawyer more decades than I want to admit, and I wouldn't have gone to university without the fact that I had a grant. And I think that's a really big issue, because burdening people with debt to become, let's say, clinicians here is something that's going to make the projections of increasing under the workforce plan really difficult. 

Speaker1: [00:10:08] Yes. And one of the things that a group of social care CEOs and I have met together to talk with the big five companies, what can we do about the pressures on social care? And I know you're not going on to social care yet, but what can we do about people's debt from being students if they come and work in health and social care? How can we cancel some of that out from them to give back and have a win-win so that we build up the workforce or offer retraining into nurses? Nursing you mentioned. Is it a 92% increase they need in nurses? Well, there has to be a win-win and a benefit for all. And I don't know if that's something that the government would consider.

Speaker2: [00:10:49] Well, the RCN proposed last year at some point that actually as an incentive, if you complete your nursing and you stay at the NHS for X number of years, your debt will reduce. But you sort of short-circuited all of that. And I think with the University of Bolton, that's the collaboration you've had.

Speaker1: [00:11:05] Yep. And it's a really great collaboration. They work with us and we also invest in a team of nurse educators that help people in their practice. We really invest in preceptorship. That's the period of time when somebody first qualifies as a nurse to make sure. And we've got a national award, actually. 

Speaker2: [00:11:26] For digital online, AI type of...

Speaker1: [00:11:28] To help people have self-reflection, look at their learning needs with their mentor. And I think we've also got a kitemark from Health Education England for the work we're doing. First independent sector. So, you know, I guess I'm here today to bust some of those myths that come out that say, well, you're only taking off the system. No. The independent sector here is to be integrated with our health and social care system and add value to what's in place. Would I ever want the NHS to go? No way. I'm from the NHS, I love the NHS. But there is definitely room for everybody to serve the people of the UK and use taxpayers money cost-effectively.

Speaker2: [00:12:13] Two birds with one stone there. I guess it plays to your lifelong traits of leadership. I think you used a few words that could describe you, a warrior and someone with a passion. I know you were going to become a lawyer at one stage, actually, but law has been lost for that. But this, I guess, plays into that bigger role. And one final thing on education, because it really struck me. You're a big fan of the idea of promoting leadership. The first female CEO at Priory for women, and I think you did your own master's degree at Manchester Business School, and you encourage colleagues to do master's degrees if they want to, male and female, but particularly to support women leadership. 

Speaker1: [00:12:54] I do, because women colleagues often have a lot of experience on their CV, but not the qualifications always. And that could be for lots of reasons. They've been raising their children, you know, really great reasons. So yeah, I have nearly all of my managing directors and I have seven of them are going have been through or gone through a master's in leadership or else an MBA because I really do believe in giving them, I mean, they're serving the people, the UK, they work long hours. And they get that on Priory as well.

Speaker2: [00:13:27] Tremendous, tremendous. Okay, let's talk about social care. That's the other side of the coin we were we were going to touch upon. Now, obviously the government has announced a commission. They still have a vision, I think, for a National Care Service. I believe that's still on the agenda. Now, Baroness Casey is leading that, highly respected individual. Now in your manifesto call back last year around social care, there were a couple of things that you highlighted very, very powerfully. And I think one of them was the idea and we might as well get straight to it. Whatever policy or provision, the true cost of care and funding can't be avoided.

Speaker1: [00:14:04] Yes. And I think there's a difference between older people's services and also working-age adults who we look after in the social care sector. Working age adults generally, they are completely reliant on the local authority's funding, their care or maybe some NHS funding. But, I mean, it's an imperative really. It says a lot about a society, how they care for and support people who are vulnerable. And one of the things that I'm really proud of being British is that we do do that. And I don't want us to lose that strong ethos of caring for people that are vulnerable. But sometimes the system is set up for parents to be a barrier to them being able to access help instead of, you know, opening doors for them. And often times when people have got to our services, they're exhausted. They've fought school systems, they've fought to get provision for their loved one. And one of the biggest compliments I think you can get as a social care provider is when a family member says, I'm really worried about my brother or sister or my son or daughter or mum and dad. I'm now not worried. I sleep at night. 

Speaker1: [00:15:24] I know they're being supported in the way that they want to be and, you know, giving a family something like that after years of struggle is so important. That's what the social care services do. And I do support a national care service because I personally champion care as a career for social care. But also, I think it's really important that the government take on the views of big social care providers because we can see across the whole landscape for them and help to set those standards because social care workforce is really proud of what they do. You know, a lot of people, especially in healthcare, and I can say this because I'm a nurse, will sort of think, oh, if we do healthcare, we can do social care. No, you can't. I mean, I've been a CEO of 240 care homes through the pandemic. What I saw those guys go through the can-do attitude to be able to just support people day in, day out. In winter when it snows, walking, you know, that is the power and the commitment of the social care workforce. And they do deserve to be recognised in this country and not be a second afterthought.

Speaker2: [00:16:35] No, absolutely. And of course, you'll know Sir David Pearson and Professor Smith from Skills for Care and the Social Care Workforce Strategy. The other thing to talk about that specialism that you called for, whatever happens with this commission and we have to wait for a few years, it seems, before we get the definitive answers on that, is that you have made it clear that social care, the provision to people with autism and learning disabilities, that must be highlighted because I'm not sure that's absolutely clear. And also the idea of early intervention, I think, which is what you were hinting at.

Speaker1: [00:17:10] Yeah, and transition from children's services into adult ones, I think, yeah, mustn't be forgotten. And, you know, I mean, you have all the facts and figures. One thing I like about you is you can pull facts and figures from everywhere. But, you know, we have a disproportionate amount of length of stay in hospitals for people with a learning disability or autistic people. And Priory is well placed, as are other independent who have both hospitals and social care to give people a complete pathway. In 2024 alone, we moved 27 people through. We have some bespoke therapeutic placements, BTPs we call them for short, and they become part of your language, don't you? I'm just trying to remember now what BTPs were. Bespoke therapeutic placements. They were specifically designed to say if we create in a mental health hospital because a lot of these patients or all of them are detained under the Mental Health Act, they're in a ward that's very noisy, that can cause distress behaviours. People then don't see them as getting better. They end up staying detained for longer and they can't move into the community while they've got that necessarily. So these bespoke therapeutic placements were actually a brainchild of Claire Reader, who works at Newcross Healthcare. 

Speaker2: [00:18:28] Yes, indeed.

Speaker1: [00:18:29] And we have 19 of those now, and we've been able to demonstrate an average length of stay used to be five years. We get that down to 18 months, because somebody in an environment that's bespoke, created for them, for their needs or for the very complex, and then we work with commissioners, their families, the person themselves, to transition them into community placement. Now, we did 27 this year. We've done 89 over the last, just from bespoke. So 89 people moved out of hospital into community over the last couple of years through proactively pulling people out of the hospital system into community. That is good use of resources. 

Speaker2: [00:19:10] Five years to 18 months, cause on the public purse, where that's being funded by the public purse, potentially has dramatic impact over the whole system.

Speaker1: [00:19:19] Yes. I mean, if we're only doing it in a small way, but is the mission to do as many as we can? Because I'm a mother of an autistic son, and, you know, when different things happen. You think you can understand why people get stuck in systems. And I can see how wonderful life can be lived once you just put the right things in place for people.

Speaker2: [00:19:47] Absolutely. And that's I think those are purpose-built units within the hospital setting to support that. I wanted just to as a slight segue, we talked about the public purse, and we should just tarry their a little on social care. Of course you're aware, we've had the Providers Unite March on Westminster. People really across the industry, challenging the government around the impact of the National Insurance rises. Now, it's a political issue, but I wanted to get your view on the impact that it is having or could have, because providers need to be able to innovate. But of course, that has an impact in terms of operational resources.

Speaker1: [00:20:33] One, I encourage my colleagues, you know, hard times often create innovations. So, you know, I think it's helping us to look at things collaboratively. Having said that, though, I guess the angle I come from is have we considered it from a safeguarding point of view because there's some smaller providers out there who will absolutely not be able to weather this storm and not be able to afford it, and the increases and local authorities can't necessarily compensate them as well, at the same rate, or they have to put the money upfront and they might get their fees up, maybe even 18 months after they've had to do the initial investment. And I guess what is behind people say we're going to hand back packages of care, or we're going to have to close a care home. Those are real people's lives who might have lived there for 20 years, who are feeling very safe and, you know, living a wonderful life with their team that are supporting them. And that is what's at stake here. By not funding care appropriately, that those vulnerable people lose their home where they're very supported and cared for and might be moved elsewhere.

Speaker2: [00:21:42] No. Thank you for painting this. I think so much of the debate at the moment is in the narrative has been around numbers and figures and economics, and quite rightly. But there's a human cost in any of the impact. If that doesn't mean that providers have to give packages back, or smaller providers can't weather the storm, I guess this will carry on as a as a political debate. That leads me nicely onto the issue around the role of the independent sector in the UK healthcare ecosystem. It's not without controversy, even though social care for adults was outsourced, I hate to remind you, a year prior to you going to Liverpool to start your nursing degree, 32 years ago, the independent sector has played a ubiquitous role, but that's not always been accepted. We've got Wes Streeting at the moment promoting the use of private hospitals to support elective care in the NHS being reduced. Amanda Pritchard in February, on record as being open to the use of private capital for funding of the NHS, so their private sector seems to be acceptable. I just want to get your view on that, because one of the election manifesto calls you had was to not criticise outsourcing and to honour the role of the independent sector. Are we getting there? Is that beginning to change that narrative? Not sure?

Speaker1: [00:23:01] I'm not sure, I want us to get there. I mean, Priory is part of a European... 

Speaker2: [00:23:08] MEDIAN Group.

Speaker1: [00:23:08] Yeah. And we have hospitals in Germany and Spain. And one thing I noticed particularly about Germany is the independent sector there is just classed as part of the system. They have their public hospitals like we have the NHS, but there's no sort of moral issue almost that people create with. Like if you've sent somebody to a MEDIAN Germany rehab hospital, it's just part of their care pathway because they don't have any beds blocked. As soon as somebody X days, they then go for three weeks of rehabilitation and then they go on and they measure outcomes really well and show that that system really works. So I noticed the difference between the CEO of Germany, he never has to have any of those debates and what independent sector can, and I'm not coming up with a woe are we independent sector because I'm fiercely proud of what we do and what we achieve. It's more how much could we just unlock if we all worked as a team? And how much could we actually prove in the system? Where is the best way to spend the taxpayers money? So, for example, NHS might want to really invest in oncology care or high-tech equipment, but then keeping a specialist workforce trained all the time and certain mental health conditions, etc. isn't the best use because they don't get the throughput. And where can we all contribute to the best for the people of the UK and just set aside this.

Speaker2: [00:24:43] Ideological barriers.

Speaker1: [00:24:45] Or the media saying, you know, doing FOI to NHS commissioners or ICB saying how much have you spent in the independent sector? And then they, they might say, oh no, they've spent this amount of money, but actually they've saved this because they haven't had to invest in very specialist environments. I mean, we built a ward just one ward recently for 12 patients to keep patients in an NHS area for Lancashire, and that cost us £4.5 million to build the state-of-the-art safe ward. If you think of that, multiplied by just 12 beds across the country.

Speaker2: [00:25:24] Absolutely.

Speaker2: [00:25:25] Where are we going to get that CapEx? So I think we can, you know, work hand in hand to meet the need. I'd love to do a study actually about cost-effectiveness of different parts of the system. 

Speaker2: [00:25:39] That would be a good piece of health economics. We might have to bring you back to see when you've done that study to see what that works. So in a sense, I guess you're saying it's the independent sector is one pathway in terms of patient care outcomes. 

Speaker1: [00:25:51] Absolutely. And maybe can be agile, more agile than the NHS sometimes for various reasons in being able to meet the need for the NHS or for local authorities. And it's a win-win for everybody. 

Speaker2: [00:26:06] Well, I think under the current budgetary pressures that the Chancellor is under, that's something I think everyone should be paying attention to. One final point around the bigger picture that I want to talk a couple of things around the specific services that you've been developing, and that's this other big piece over the last couple of years. I remember the word integration floating around for so long in health and social care, but we've got statutory footing now for integrated care systems. You've called for that to be fundamental across the system because you've seen benefits from your own adoption within Priory of an integrated approach to mental health and social care.

Speaker1: [00:26:46] And I think it stops this argument about who's paying for what. And you know, it just keeps the patient or the resident or service user, if you're in social care at the heart of what you're doing instead of institutions I guess sort of debating things. So the person becomes the centre. And I guess it's looking at that shared value that it doesn't matter if you're in the NHS or independent sector, that's what you want the best for that person. I think if I can also bring in about private equity investment, that's another thing that people go, oh, that must be bad. I think it's really, since I've been CEO of Priory for three years, we've got private equity investors and they really have invested millions in the UK that we wouldn't have had otherwise. You know, one of the things as a chief exec, you know, I wanted electronic care records for all 200 care homes. That bill when you've got 200 care homes is in the millions. 

Speaker2: [00:27:49] Yes. It's the Nourish system.

Speaker1: [00:27:51] Yeah, Nourish system. And I heard a wonderful story, our adult care ops board today because we always start with a resident or a patient story at the board about how somebody, a resident who was very resistant to their care and has used the Nourish system because he can plot his own timelines with his support worker, which we didn't have when people were writing about people. And I guess it's about having an open mind. And forgive me, I'm totally British at heart, even though I speak with a funny accent, but we need to open our minds to look at a bit like Amanda Pritchard said when you said about opening ourselves to people, because I've had so much investment in digital stuff for the people of Britain that I wouldn't have had otherwise if we didn't work every part of the system to see how it benefits people of the UK.

Speaker2: [00:28:40] And I guess as long as safety of patients remains paramount and the outcomes. 

Speaker1: [00:28:45] It has to, because they can't sell their business unless safety and quality is paramount. You know, it's just such a nonsense when they say, oh, it doesn't matter.

Speaker2: [00:28:55] Absolutely. And I think when you're talking about the private sector, I think the, the context of Amanda Pritchard's comments were, I think, to look at just the maintenance and the repair of the estate is £13.8 billion. That's not going to be easily magicked out of the public sector. So really interesting to get your perspective on that. I wanted to move on to a couple of areas of the services that you provide, which have national significance. I know all providers are keen on developing that, but under the mental health rubric, and addiction services are really an important part of what you do. And I've seen reports from Priory showing a dramatic increase in referrals from right across the board, whether it's body dysmorphia, shopping addiction, etc. 

Speaker1: [00:29:44] Ketamine.

Speaker2: [00:29:45] Ketamine. Tell us a little bit about that, because that has a huge impact on all of society. 

Speaker1: [00:29:50] I mean, I don't know whether it's people are talking about it more or what happens and people feel able to say, which is a really great thing because if you can verbalize it. You're on to getting help, treatment, and recovery, whatever. I mean, it's a huge passion of mine, the substance misuse, because I've been a community nurse before, been a health visitor, actually, in the city of Liverpool, in the city of Manchester, and seeing how mental health and also substance misuse just creates families to, you know, families fall apart. They might get into criminal activity or social services or burdened with child welfare issues or things like that. And I don't think anybody means to get themselves into that place. They're often treating a hurt that they have or something.

Speaker2: [00:30:41] You know, self-esteem, it's a number of fundamental factors.

Speaker1: [00:30:44] Absolutely. And we don't believe it's a behaviour at Priory. We believe that it is comorbidity with a mental health problem and substance misuse. So whatever we can do in this country and I don't think we've cracked the problem at all to help people with that. The economic benefits of people living healthier lives physically, socially, within their communities can only help our country reduce spend on negative things.

Speaker2: [00:31:16] Yeah. And I think just one other thing on the addiction, because we could talk about that a lot. There's such a huge issue and I know you're so passionate about it, but I noticed the work that you've done with alcohol misuse. I mean, the tragedy of I think the number and this is an underestimate, if you look at the effects, 10,000 lives we're losing per annum from alcohol. 

Speaker1: [00:31:38] I think it's like the biggest killer of people within a certain age group. I can't remember the figures, but yeah, but that's not talked about either, because people see it as a behaviour that somebody should be able to stop. And if we look at it as an illness, we have a different perspective on it. And it's actually an illness that you can never be cured.

Speaker2: [00:32:04] And I guess that's part of the bigger story of taking the stigma away from all of this, which is what you're talking about. And the specialist services, you talked around autism. You have that very personal and professional motivation there. People with learning disabilities, the numbers of people with autism. And in fact, the number of people waiting for referrals for autism has increased enormously. Let's go back to how important your work in getting the right settings are and the right treatment. You've talked about the therapies that you've already talked about, but you've also instigated behavioural support for your staff to specialise in this area.

Speaker1: [00:32:43] Yes. Can I give you an example of a young man who really inspired me? We'll call him Charlie. Years ago. Oh, gosh, it might have been 6 or 7 years ago, into one of our care homes, a young man was placed. Charlie, 19, had 17 failed placements in his short life up to 19. That's rejection after rejection, after rejection after rejection. And in social care style, how can we help? His autistic complex behaviours couldn't hear very well in one ear. You know, so once you learned all those things about him and I realised we had lots of challenges from the colleagues at this care home saying, he goes or we go. And I said, well, he's staying because he's had a lot of people saying, you go. And I personally, and so did my managing director there at the time, went at weekends, put in extra support. We managed to look at supporting him for about 15 months, I'd say. And then I realised that we weren't set up to look after somebody like Charlie, even though we really wanted to help him and we didn't want him to go back into hospital, he ended up back in hospital. And from that I said, what can we learn? And so set up a pioneering role called an assessment and transition director for complex autism, with their role to help care homes take people directly from hospital, have a case management system almost, and be able to go ahead by looking at the environment, train colleagues beforehand, be there with them to prevent placement breakdown. And I'm really proud that we really have reduced placement breakdown by over 50% from one year to the next. 

Speaker1: [00:34:40] We're getting better all the time because of investing in things like positive behaviour support. These roles that will support colleagues. But I went to look at a hospital that we were looking at to possibly acquire. And as I'm walking through the wards, so not part of Priory, I saw Charlie. He looked thin, pale, and I just thought, oh my goodness, has he been here the whole time? This was about three and a half years ago. Three years ago. And I remember saying to them, he really likes tuna sandwiches because he was saying he doesn't eat, and he likes Pringles. You know if you make him a tuna, he really loves those. And actually, it's our great privilege that we were able to support him again in one of our bespoke therapeutic placements. He rides his bike around the grounds of where he is. He always has a tuna sandwich, sometimes in the basket of his bike. And to see the joy and how he's come on. The other day he was at a family barbecue that he had, and he sat next to his mum for the first time in years, and she could hardly believe he was sat there. You know, those are the differences you can make when you put the right things in place, where you try and do things in a person-centred way. And he actually taught me a lot. And he's on his way, transitioning out into a community placement again now. But I wish we hadn't had to do that detour.

Speaker2: [00:36:04] No, but it's a fabulous example of these fabulous policies and national directives. And we I think we talked about earlier, the NHS England's report a couple of years ago showing people with autism and learning disabilities, I think 57% went out of area hospital. But if we bring it down to the human level that you've just talked about, the other, that story has just reminded me of something I read of your work. I don't often mention guinea pigs in the Voices of Care podcast, but Buzz and Nutmeg were two guinea pigs that helped support one of the people that you were helping who had autism, and it required just a small inverted commas change of protocol. I think that brings the reality back into it, doesn't it? 

Speaker1: [00:36:47] I think this young woman that went to Priory Hospital, Glasgow, who nobody would accept her because of her complex, but she and that's what I think. I mean, I see it in my own son. The dog will tell him how his mood is impacting other people probably more than a human, you know. If he sees the dog tail go down or a dog tail wagging and animals can connect with people in a different way, all of us, no matter what. And you know, the very fact that this young woman could not get the treatment she needed because nobody would take her with a guinea pig. That's just nonsense. So we took the guinea pig, even had its own care plan. And to make sure that, you know. And it really worked. She has gone from strength to strength. She's now in the community after years of hospital and gone with her guinea pig to community placement. 

Speaker2: [00:37:40] And that's important because 41, I think the numbers are from that report 41% of people who are in hospital settings could or should be in community settings, and that has a big impact on numbers and budgets that you've talked about, I think, without a doubt. 

Speaker1: [00:37:57] Yeah, must do. I mean, I just think instead of looking I think barriers, we create barriers sometimes ourselves without, I mean, what really is a guinea pig going to do in a ward? I suppose you could think, what if something happens to the guinea pig? But, you know, we've got to think, how can we and not why we can't.

Speaker2: [00:38:16] And one final point on the cohort, people that you support, particularly with autism and learning disabilities. And this is a vexed issue. I know it's very passionate for you and I think it has economic impact, but I think it has an operational and clinical impact is the subject of overmedicalisation. I think there's a significant I think the stat was 30, 35% of people given psychotropic meds.

Speaker1: [00:38:41] With a learning disability. 

Speaker1: [00:38:43] Who don't have a mental health diagnosis.

Speaker2: [00:38:45] Now, that struck me as bizarre.

Speaker1: [00:38:48] And that's what I meant when social care has got its own very proud professionalism in itself, because I think sometimes people end up on medication like that because we try to treat behaviour and actually you can't treat behaviour. You need something like positive behaviour support. In fact, across Priory, I'm trying to get that into some of our hospitals or our social care colleagues are going into hospital and giving them tips around positive behaviour support for people, and that doesn't have to be somebody with a learning disability. CAMHS, it works, you know, it works in our rehab and recovery for long, enduring mental health issues. So, you know, instead of trying to work with somebody on their behaviour, we go, oh, we must medicate. And then that causes another problem. So we then medicate that. And some people that we've had discharged into social care can be on like 19 medications. And these social care professionals get people down to zero and become different people. 

Speaker2: [00:39:50] Wow.

Speaker1: [00:39:52] They start to live their dreams, they said. One lady recently, there's no doubt that the care home saved her life. I think she was 30 plus stone when she came, Prader-Willi syndrome. She was going into heart failure. Had a ballooning legs, various sores on her. And the team worked with her over a period. So she lost all her weight to get down. Now that was daily going swimming, enjoying walks. They set goals. She really wanted to get to Disneyland Paris. It was her favourite thing. She made it there last year to Disneyland Paris. I saw the pictures of her. She'd lost her weight. She has a boyfriend now, so, you know, she just. She's living her life.

Speaker2: [00:40:37] That's going to bring a whole other set of problems probably. That's amazing. 

Speaker1: [00:40:39] No but she's really enjoying, they said if she'd have stayed at that weight she had about 18 months to live.

Speaker2: [00:40:45] Wow.

Speaker1: [00:40:46] And that's a difference that social care colleagues come at things with a different angle than a medical model or a nursing model. So I'm a bit fierce in that I go, no doctors allowed in the care homes apart from what, you know, they can access, like you and I do like our GP or normal hospital appointments because we don't need to medicalise people's lives.

Speaker2: [00:41:09] Absolutely. One final topic to end with I know your passion for making a difference to people I think comes from early childhood. I think both your parents are missionaries to support making a change with people not waiting to get invited. I think your father went to I think someone who passed away, and that community sense. And this really brought out a lot in the stories you've told, I want to centre on all of this change, whether it's the Social Care Commission, whether it's the ten-year plan. Whatever we're going to do requires, is going to require compassionate and courageous leadership. And I just wanted you to speak a few minutes, perhaps because I know leadership first female CEO, someone who, as a clinician taught themselves at Manchester Business School about business. 2 or 3 things that you would recommend for aspiring leaders in healthcare that you can share from your experience. Good and bad. 

Speaker1: [00:42:06] Good and bad. Wow, that is quite a topic. I think it's important to me to always have touchstones, because when you have things that are really important to you, and I have some touchstones that I always go back to no matter what problem you're facing, and you can kind of weigh it up within that. So I think it's always knowing that you never have the answers. In fact, the more you educate yourself and learn, the more you realize you don't know. So let's have that curiosity. Inquiring minds.

Speaker2: [00:42:34] Socratic principle.

Speaker1: [00:42:36] And know the people. And transformational leadership is hugely important. Inspire people. Because we know we can't create change unless they own it in their hearts and minds. Otherwise, it's just somebody telling you what to do. And when they move on, it goes rebounds back to exactly. So we've got to ignite the passion in people and about what's possible. I think resilience is hugely important for leadership, especially in this climate. In whatever job you do, you need to really be resilient. And how do you get resilience? Well, it's having a really good team. It's talking to people when you find things difficult. It's celebrating. For me, when I feel like resilience is low, I go back to some of our case studies of how somebody's life has changed because of what we help, and it gets you up another day. So I think having resilience, those touchstones that help you make decisions. For me, the patient and the resident is always at the centre. And there's always lots of reasons why you can explain why an organisation has done something, or maybe why a colleague didn't do the right thing. But if it wasn't the right thing for that resident or patient, then we have to deal with that and there's consequences. So having that person always at the centre helps you make decisions in the organisation. And I think if it was you or I and our loved one and you'd want a leader to say those kind of things, wouldn't you? Because they're not putting their organization above your loved one.

Speaker2: [00:44:06] And I think you've been on record as saying, obviously, you take a lot of inspiration from many different people, but Steve Jobs was someone whose wisdom impacted you about the idea of it's not one person alone, it's not the hero leader. It's very much an approach of drawing from your team's expertise.

Speaker1: [00:44:21] Yeah, and that thing as well. Why? I think he said, why sort of employ a specialist or an expert on something and then tell them how you want them to do it. I listen to my team, I acknowledge their expertise. And, you know, I really believed in shared governance and devolved leadership. And I have an excellent team at Priory, actually, of leaders who are really all after the same mission to make things better for the people of the UK. 

Speaker2: [00:44:51] And one final point to the government, I think you've been going back to your manifesto. We're in a period of profound transformation. You encouraged and implored that we should all sit around the table from all parts of the healthcare ecosystem and share wisdom.

Speaker1: [00:45:07] Share wisdom. And I guess for me, and it works both ways, is being willing to listen as soon as somebody thinks this is the way or this is the only way, or we know better, you've lost, you lose sight of your mission. But if we can all think around shared values that we're able to achieve things. I think that is, and I often talk to a lot of important people, I don't know whether they always listen. They nod and they smile, but I don't know whether they've heard. And I've really I think this we need we're into this era now where we've got to be hearers and then action and collaborate. 

Speaker2: [00:45:50] On that very visionary note. Rebekah Cresswell, thank you so much for giving us your time and your wisdom.

Speaker1: [00:45:56] Thank you very much.

Speaker2: [00:45:57] My pleasure. If you've enjoyed this episode, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we're really turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much for joining us today, and I look forward to seeing you on the next episode. 

Speaker3: [00:46:17] Voices of Care. The healthcare podcast.