Welcome to Voices of Care, the podcast series from Newcross healthcare, which seeks to get to the heart of the issues facing the NHS and the social care sector here in the UK. Really, by initiating, engaging with, and through conversations with those that lead the organisations across the health and social care to move the envelope in the discussion about how we enable the healthcare workforce of the future. I’m Suhail Mirza, and perhaps there’s never been a more transformative time with a new legislative framework for the NHS and workforce issues prominent in news articles and specialist journals. It’s vital that we, therefore, hear from people who lead these organisations, and I’m delighted and honoured to welcome Professor Joe Harrison, the Chief Executive of Milton Keynes University Health NHS Foundation Trust. Joe, welcome and thank you so much for giving us your time again.

Delighted to be here Suhail.

I’d like to jump straight in the news. We have had a series of health secretaries, lots of change going on at the top, but honing in on health care workforce issues. We’re going to look at wellness, we’re going to look at digital transformation. But looking at the broad picture, if I may, Jeremy Hunt, in July of this year stated that this is the greatest workforce crisis the nation has ever seen. If I may be so bold as to quote you, you’ve been quoted in Specialist Press saying that you’re worried that the NHS is in danger of sitting around singing Kumbaya as the Titanic sinks. Is it sinking? And if it is workforce wise, where are the lifeboats?

I think we are in danger of allowing the NHS to sink. What I find really interesting is when you look at the demand for doctors’ places at university, for nurses, places, allied health care professionals, people want to be doctors and nurses and allied health care professionals. They want to train. Where we’ve got to play catch up as an NHS is to make sure we capture these individuals, train them appropriately, and then get them to come and help and work in the NHS.

Absolutely, and I think today with the stats showing six-figure vacancies, which is not a new thing, it’s been around from pre-pandemic days. I wanted to touch upon the nurse cohort very briefly. The Trust’s board papers from earlier this month in September highlighted that actually nurses, in terms of your workforce strategy, nurses were keen to work for the trust. So maybe shed a bit of light on you, obviously doing some good things in that regard.

We know that our staff are our most important asset and looking after them and attracting people to come and work in places like Milton Keynes, it’s not a big London teaching hospital. We have to go that little bit further, that little bit faster than other organisations who might rely on their name and reputation clinically to attract the very best. And what we’ve been doing over the last few years is putting our heart and soul into making sure that MK is a great place to work, and we’re now seeing some of the results of that.

Clearly. And to expand that a little bit, drawing on the analogy of a sinking ship, really innovative things is to perhaps create your own one. And I’m fascinated by the partnership that you have with Buckingham University, the first independent medical school. Tell us a little bit more about that, because I it’s something that deserves to be very much more well known. It’s about facing that challenge and in going into national but growing your own medical workforce, it’s a fantastically inspired piece of vision.

We recognise that all of the research shows that if people train locally, then they’re more likely to, once they’ve qualified, stay locally. So back in 2015, we took a decision with Buckingham University to open our independent medical school, and what we’ve seen is several hundred doctors now qualifying over the years, and that really has been positive not only for those qualifying, but also in attracting great people to come and work at MKUH because they want to teach. A lot of the professionals that come through the NHS recognise that they learned from great people. And so, as a consequence, teaching is a really inspiring and interesting skill that a lot of our doctors and nurses want to do and want to pass on their knowledge to the next generation. And so, it really has been a virtuous circle of not only attracting people to come and train in Milton Keynes, but also attracting great people to come and teach in Milton Keynes. And a combination of those two things has really, really helped us.

And looking a little bit further into the future before we dive into looking at wellness, which is such a critical issue and close to your heart and the digital transformation, there is a lot of unique but certainly a pressing challenge for Milton Keynes. If we look at the local Population projections, you’re set to grow, I think, 2.4% annually. If I’ve got my numbers right, which is substantially in excess of the national average. So, doubling the population over the course of a generation, frankly. So that demand is going to be inexorable. I guess this is part of the strategy to make sure that you meet that demand from local talent.

It is and we’re very conscious that we can’t just rob Peter to pay Paul. We have to make sure that other hospitals and other parts of the health and care system around us can also attract great people. This is about growing our own. It is about attracting people who might otherwise go and work in other professions to come and join the NHS. We have over 350 professions in the NHS. There’s a job for almost everybody from plumber through to general practitioner through to the orthopaedic surgeon. So, we want to get as many great people to come and work in Milton Keynes for the health and care system. And that’s what we’re focusing on.

And one very fine point about the independent school, it’s gathered a lot of accolades and some great feedback from people who’ve gone through that.

Yes, there’s no question that we have worked with the University of Buckingham to teach in a different way. There are no textbooks in our medical school. When the student arrives, they’re given an iPad and they’re able to provide feedback on the lecture and the lecturer at the end of each session. So, we immediately know how that’s been received by the individual and what we need to do to change and improve. And that’s very different from a lot of the standard medical schools in the country that rely on textbooks and also only gather feedback at fairly odd times. So, we want it immediately so that we can change immediately.

It’s certainly going to keep the teachers on their toes, if nothing else. If we can move on to wellness wellbeing, it’s at the heart of the NHS People plan, as we know. Going back to the Health and Social Care Select Committee, not this year, but last year described burnout as an emergency situation. The Nuffield Trust has produced research published in July this year quoting actual rates of PTSD within the NHS at 9% above the double, but more than double the average. And I just wanted to get a feel before we look at solutions. The General Medical Council in its training survey found that two-thirds of trainee doctors were reporting some level of burnout. So just to get your feel because you’re literally at the coalface, just how challenging is the situation in terms of wellbeing and burnout?

We know that the global pandemic impacted a lot of people in a lot of different ways and very clearly clinical staff on the front line and those professionals that were supporting that clinical team did go above and beyond. And as a consequence, a number are feeling the effects of that pandemic. Many people listening to this will, I have no doubt be thinking, well, hang on a second, I lost a parent. I lost a member of my family. I’ve been impacted as well. I completely agree with that. And I think that’s a big and here, which is we don’t forget that the NHS team, the Health and Care team as a whole were dealing with the unknown day in, day out, 24/7 for months. And it is that relentless pressure that has ultimately taken its toll on a number of people. And I said at the very start, our workforce is our most important asset, and we now have to go that extra mile to make sure that we look after repair any damage, if we can, to individuals, support individuals so that we can get back to being the great health and care system that we were before the pandemic.

Thank you for your candour. I think it’s important that we are in a post-restriction, COVID restriction world. But the ramifications of that heroism, if I may call it that, to work around the clock with the unknown, which itself is an added stress. I think, you would have seen the Deloitte report in March of this year looking at the economic impact of poor mental health that costs the economy £56 billion. Turning to the imperative now to do something about it, the MK way, your strategy, your workforce strategy highlights compassion at the very centre of what you do. Absolutely mirroring the NHS people plan. Before we talk about digital solutions, I just wanted to give you the opportunity to share some of the things that you’re most proud of. I know there’s a raft of things that the Trust has done, is doing and intends to do to help the workforce, clinical and non-clinical, really traverse its way out of the ramifications of the COVID challenge.

I think the first thing to say, Suhail, is that we are one team at Milton Keynes University Hospital. Whether you’re a clinician, whether you’re a porter, whether you’re an accountant in the finance department, you all matter, and you are all needed to make the hospital work well. And so, when we look at the health and wellbeing offers that we provide to the team, we make sure that it is across the board, and it enables as many people to access as many of the opportunities as we can. If I look at some of the very basic ones, we took a decision four years ago that we would not charge people to come to work by offering free car parking. We’ve expanded that now to a point where because we have invested so heavily in our green agenda, our green technology agenda, by putting solar panels across the site, we now enable staff to charge their electric cars for free, promoting green travel and another benefit to individuals that work there. We recognise that there are going to be some significantly difficult times ahead economically. So, we have decided that we will play our part in providing members of the team with a healthy, affordable meal every day, and that is £2. And instead of coming in and paying a pound for a portion of chips and maybe that’s all you have all day to eat, what we’re saying to members of staff is that we will provide a proper meal for you for £2. We’ve also looked at those members of staff that just do not want to do full-time work anymore and who perhaps aren’t able to. We still know that women carry the vast majority of childcare pressures in our society, whether we like it or not. So how do we support the 70% of our workforce that is female? And so, we’re just, as I speak, bringing in and any hours contract. The NHS has been focused on shift work and it says you can do an early or late or a 12-hour shift. That’s not how millennials want to run their lives. It’s not how individuals, post-pandemic, are thinking about work, and we have to flex and change that. And so, enabling staff to come in and do a couple of hours to come back from retirement, to do a couple of hours at times that suit them as well as the organisation, has received unbelievable support from the team at MK. Unbelievable, because they recognise that it’s an opportunity economically to earn a bit more money if they need to, to pay the gas bill or to pay for food because of the challenging times. And it enables people to come back from retirement who quite often say, I don’t want to do a full shift I’m tired, but I really miss it. And so encouraging people back to work. To contribute has been a fantastic benefit. Those are the sorts of things that we’re looking at and putting all of that into the context of some of the things that your listeners may not know. We know that a significant proportion of our staff I mentioned 70% are female, are either pre- or post-menopausal, or going through menopause. What are organisations doing about the uniforms we’re asking staff to wear? The support that we’re giving individuals and their partners for what are

Absolutely.

We’ve doubled bereavement leave at the hospital. If somebody very close to you dies, are you really going to be back at work in two weeks? The answer to that is very clearly no. So be a sensible employer, show that you care and enable staff to take appropriate time off.

Absolutely. And I’ve had the privilege of spending time with you before and to get some of these initiatives. And they may seem relatively small, but the difference between having a healthy meal, having bereavement leave and in any hours contract, that’s pretty innovative stuff. It’s not something that I’ve seen everywhere. And I guess that was just through feedback from the staff and what they wanted.

It’s feedback from staff. It’s the ability to use technology in terms of rostering and recognition that actually it’s better to have somebody who is qualified helping out on part of a shift than to be dogmatic and say, no, you can only work a 12-hour shift and then have no one. So as a hospital, we want to flex to meet the individual’s needs alongside the hospital’s needs. And we know there’s a happy medium in there that we are finding.

Just to expand that slightly before we look at the digital part, I know that you’re very keen to talk about that. Your workforce strategy has three themes, and one of them is, of course, growing careers, and that’s very important to wellbeing. I have a pathway, whatever cohort of occupation group I’m in. How have you fostered that? Because people now want different things, different routes. There are new roles so just to expand a bit on that, because I think that’s not played so highly in when we talk about wellness, there are offerings, but having a sense of direction in your career aids wellbeing.

As with any time as a chief exec, you need luck and what we’ve seen over the last ten years, nearly ten years that I’ve been in post, is that the size of the organisation has grown considerably because relatively speaking, we’re a newbie in the NHS as a hospital, you opened in 1984. And as we’ve grown, or we’ve grown at a time when all of these new and different demands about skills that individuals want and career pathways and opportunities to innovate outside of the standard roles of the NHS have become available. And therefore, we’ve said, why don’t we try that? Why don’t, we try and ensure that people can move in a different way to how it used to be 10, 20 years ago? And by doing that, it just potentially keeps people in the workforce. It keeps people in MK in a way that perhaps other organisations haven’t been as fortunate to be able to achieve.

It’s brilliant. As you say, retention and attraction are two sides of a coin that has to be looked at closely. I want to jump on to digital transformation, your digital data, and tech strategy, which I think pans out to 2026. You’re on record as quoted as saying that you have to make digital part of the DNA and also to use the digital strategy to align to wellbeing and to offer digital tools that, quote, know who you are. Can you expand a bit, a little bit about some of the digital tools that are being used because technology potentially has the ability to transform the working lives of clinicians and non-clinicians and to help them fulfil what they can do with less challenge?

Absolutely. And we started off this podcast talking about the sort of crisis. And for me, technology offers the NHS absolutely a significant part of the solution. We know we can do more with less. We know that with sensible investment in technology we can enable our workforce to deliver better outcomes. And so, what we’ve been doing at MK is understanding what makes a difference to five different areas. We look at it, we look at what makes a difference to our patients and how we engage them, what makes difference to the team, the staff at the hospital, and what’s going on with clinical technology? I mentioned a moment ago, green technology and also probably the most fundamental part of it all, which a lot of organisations sometimes don’t focus on enough, the real infrastructure. So, when somebody from Apple comes to see us on-site and says, you have the best Wi-Fi of any hospital I’ve ever been to, you say, Well, great. And that’s an absolute. So, investing in the basics in the infrastructure part is critical to making those other four elements work.

And that’s quite an accolade from someone from Apple to come and say that. Can you expand a bit on the smart healthcare environment because that places of work, the infrastructure you mentioned, has a profound, all the studies show, has a profound impact on clinicians being able to work to the top of their license, people to be able to access safer spaces, and to be more productive and with the efficiency challenges, sorry to bring those back to the table, that the NHS faces over the next couple of years. Having a smart environment actually aids not only well-being but productivity potentially.

So if you look at where I think quite a few organisations have got to in the NHS, the electronic patient record, that’s great as a step one. What that enables is a clinician anywhere in the world to have a look at that medical record, if appropriate, obviously, with appropriate governance and to get involved if they’re required. It’s only step one. It’s not the endpoint. And where we are going in Milton Keynes is how we take the data within that medical record and use it with technology to inform identification of the sickest patients. What’s likely to happen to some of those patients? How we can access a view of what we could do with those patients differently. This might sound a bit odd, but realistically, not every patient is the same. And we know that there is now technology available that can help our doctors and nurses to predict what’s going to happen next. And so, using that electronic patient record and the technology’s available, how do we focus what our scarce clinical resources at the, not just the sickest patients now, but also those patients that are going to be sick because technology is getting to a place now whereby, we can predict it much, much better. That’s one example. Another example is that we know that machine learning is making some really big inroads in diagnostics. We know that this country, relative to other health leading countries is behind on diagnostics. How do we use machine learning to screen out those scans that are not requiring and expensive rare clinicians to look at and our normal, for want of a better term, and get those clinicians to focus on the really sick individuals that are requiring of their input. Other areas that we’re really keen on is, very often, we don’t involve the patient as much as we should. And when we talk about smart health care and environment, a key part of that smart health care is the patient. So, imagine a scenario whereby if you phoned your bank, they said to you, you can’t have your balance and we can’t tell you the transactions that you’ve made. You just would change banks immediately. And effectively, that’s what hospitals do with your health care record. We don’t allow you immediate live access to that health care record. So, if we want you to engage in your health care and we want you to take your health care more seriously, we have to provide you the information live in a format that you can readily access and in a way that informs you and enables you to take decisions about your own health care and not just present at the emergency department or wait to be told what’s happening next. I look around the room and people are wearing apple watches. We know that technology is there now to enable people’s blood pressure, people’s pulse, exercise. All of that information is readily available. And if we’re going to get people to take health care seriously, the NHS has to move from fixing sick people into trying to keep as many people well as we can in order that we have the money in the skills to fix sick people.

And I think the studies have shown when you have co-production of health plans and pathways with the patient involved, that in of itself has a dramatic impact in terms of efficiencies and cost savings. So, it’s a breath-taking vision. A long way to go, but fabulous. One final question. Newcross Healthcare itself has a mission to democratise advancements in treatment and care at home. We have a new legislative environment with integrated care systems. We haven’t got the time to go into all of that. But part of what will be required, this technological vision, which will help both wellness and efficiency, will be to ensure that clinicians and non-clinicians have the ongoing training and capability to make that step change into technological change and use all of these things, use the data. Final point is the training environment that you have, how to support that, because that’s quite a big challenge.

The question I asked when we come to training is have you read the user manual for the iPad?

Definitely not!

Very simply, there isn’t one because a three-year-old can pick it up and use it. If we want our patients and our clinicians to embrace technology, we know that these individuals will go home and shout across their kitchen and say, ‘Alexa put Rice Krispies on the shopping list’. Everybody is using technology every single day of our lives. As an NHS, as a health and care system, let’s take the technology that is there now and use it to enable our patients to manage their healthcare as best they can and let’s use it to support our clinicians to operate – I don’t want every clinician operating at the top of their license, because if everybody is operating at the top and they make a mistake, it becomes way, way, way more serious. I want our clinicians to have that bandwidth to be able to operate, yes at the top, and operate with the rest of the team in a in a comfortable zone that’s delivering the best possible clinical health care that we can. So, I think technology and training, the NHS is miles behind. I’ve got 120,000 patients using the technology in Milton Keynes Hospital. Not a single patient has been trained to use that technology because I use myself as the barometer. If I can use it, I can promise you, I can barely use a phone, so I’m the lowest.

Well, I think that offers a tremendous amount of hope. And for me, the technological transformation that you pointed out, I think within new models of care offers, I think the easiest or the simplest way to transform well-being and productivity. But the big takeaway for me is the any-hours contract, I think, promises to revolutionise the way staff are engaged, retained, and attracted.  Probably, we could talk forever but that’s probably a great place to stop for today.  And say, thank you Professor Joe Harrison for you time and always your vision.

Thank you.

If you’ve enjoyed this episode of Voices of Care, please like follow or subscribe wherever you receive podcasts. And if you want to receive more information about how we’re truly enabling the healthcare workforce of the future, please follow us at Newcrosshealthcare.com/VoicesofCare. In the meantime, I’m Suhail Mirza. Thank you and goodbye.