Welcome to Voices of Care, the podcast series from Newcross Healthcare that seeks to get to the heart of the issues facing the health and social care sector in the UK by truly determining how we can enable the healthcare workforce of the future. I’m Suhail Mirza, and the NHS is an extraordinary time. Burgeoning waiting lists, funding pressures and people talking of a crisis within its workforce. It’s therefore vitally important to hear from leaders very much at the coalface who are transforming the landscape. I’m delighted, therefore, to welcome Richard Mitchell, the Chief Executive of University Hospitals of Leicester NHS Trust. Richard, thank you very much for joining us today.

My pleasure. Thank you for your time.

It’s always a pleasure to speak with you. It’s been 13 months since you’ve joined the Trust. You’re going back to the Trust. I think you call it home and you’ve just come from an award-winning Trust at Sherwood Forest. What was the thinking behind coming back here after the great success at Sherwood Forest, HSJ Awards, placing second amongst the 119 acute trusts under the NHS Staff survey?

Yes, so, thanks for the opportunity to catch up today. So, I worked at Leicester Hospitals as the Chief Operating Officer for the best part of four and a half years, and I was very fortunate to be offered the role of the Chief Executive of Sherwood Forest Hospitals. I felt lucky to join the organisation at that time. I was really proud of what we did at Sherwood. We focused on trying to listen and truly engage with our workforce and the people who use our services. We tried to focus on being the best possible partner with local authority and health partners in the voluntary sector and the private sector. And certainly, we tried to embed improvement methodology within the organisation and that worked at Sherwood, and I had a great time there. But the opportunity to re-join my local hospitals where my children have been born, where my wife has received care, etc., and to try and make a difference as part of a team for the services that my family and friends used was a wonderful opportunity. What really interests me is how much of the way of working at Sherwood is applicable to Leicester, how much can we box up and say that works? And there’ll be a lot of things that we need to do differently as well.

We’ll come back and look at that in a bit more detail. But stepping back and looking at the big picture, Jeremy Hunt, who’s got a number of different responsibilities now, called the current situation the worst workforce crisis that the NHS and social care has ever seen. Your COO in recent board publication has identified and agreed that the biggest risk for the trust is workforce in terms of numbers and morale. And I think you yourself have gone on record saying 12 years across three trusts sitting on the board, this is the most challenging period that you’ve seen. Do we have a workforce crisis? What is the extent of it on the ground given your 20 plus years in the NHS now?

So, Leicester hospitals at this point in time is certainly a challenged Trust. We face many challenges like the wider NHS, so workforce, access, growing demand for our services, money, and many other things. But I certainly think workforce is the biggest challenge that we face, and I certainly think looking after our workforce and changing the experience of working in our organisations is a key enabler of a better future. So, I’ve worked in the NHS for 21 years now, and I can say that over my 21 years, it now feels certainly more difficult than it has done at any part to bring that to life. I was on call last night, so I was in the emergency department at the Royal Infirmary until pretty late in the evening. What I saw in the emergency department were a lot of people trying to access emergency services. There’s a couple of factors behind that. Certainly, we know that the population is ageing. We also know that during COVID, people have been unable to access healthcare in a timely way. Certainly, some people have been unable to. So, we’re seeing a huge demand on our services coming forwards against a backdrop of undoubtedly the workforce is exceptionally tired, the workforce is aging, so people are looking to retire. Maybe some of the attraction of working in the NHS that had been there previously, isn’t there? So, you’ve got growing demand and workforce pressures.  Whether it’s a crisis? So, I think the definition of a crisis is it’s at a point in time reaching a dangerous or critical situation. It certainly feels increasingly dangerous and critical to me. So, I think we are reaching a crisis point now.

Thank you for your candour. Again, looking at the broader landscape, we’ve had a tremendous transformation in statutory terms. The integrated care systems have now come on board. They’ve been around, of course, for some time, and their ethos and the spirit that runs through them is emphasising collaboration rather than competition. So, looking at workforce and you’ll know this, of course, that Trusts traditionally with the finite resource of workforce to go after, do compete and have competed even in regions that are very close to each other. Do you see the ICS landscape and its mission as offering a hope for greater collaboration and addressing this workforce challenge?

Yes. So, I think I think integrated care and integrated care systems are really important and certainly will be an important enabler of a better future. I’ll come back to the point about hope in a moment. But I think the clue is in the title. So integrated care is about working together on a common purpose. And I think integrated care systems, along with provider collaboratives, offer an opportunity for health partners who previously possibly had been competing and local authority partners to work more effectively together. Whether it is on a single workforce plan or access to services or procurement opportunities or wider budgetary authority. So, I think it is a key enabler. However, I don’t think it’s a panacea. I think it will support the future direction, but we now need to move into delivery mode. That that point around hope. I think hope is really dangerous. I think if you offer people hope and you don’t deliver on it, it becomes a very difficult thing for people to manage. We’ve had hope in the past and things haven’t happened. So, I fully support integrated care systems aligned with strong provider collaboratives. I think collaboration is important. I think competition is important as well because it drives standards. But I think we need to move beyond hope into actual delivery.

And very briefly, obviously there’s a funding squeeze as extra funds have been made available in the Autumn Statement. So, a lot of that will drive efficiencies. That’s one of the goals of ICS. But at the same time, are you beginning to see some nascent steps in, perhaps in your local ICS or more broadly, given your experience with changes taking place?

Yes, So I’ve worked in two integrated care systems. I’ve worked in Nottinghamshire and Leicestershire across both of them I see similarities. So, I think we are we are moving beyond the governance stage, we’re moving beyond just having positive conversations. We can now evidence some change, whether that is around the integration of community services, whether that’s close to working with the local authority and the transfer of money from the NHS to the local authority, whether that is things like standardised offers around welfare and wellbeing this winter we certainly are beginning to deliver. But I think we may find that the future is even more difficult than the past. So, I think we have to be realistic about the challenges that we face. I think we need integrated care systems to more rapidly move into delivery phase. And I also think that we shouldn’t get too fixated on the need to strongly agree with each other. I think it’s important that we have a common purpose. I think it’s important that we have a shared sense of direction where we want to get to in collaboration. But I think it’s equally as important that we feel open and able to disagree with each other. I think groupthink is really dangerous.

Healthy debate, the order of the day. Just turning now into some more of the detail at what you’ve seen in your previous leadership roles and of course at Leicester over the past 13 months about what is working, what we can do. I want to tackle a big issue. It’s part of your 22/23 priorities to look after your people. You’ve been on record in your CEO update in October saying that the workforce is tired, and you’ll know the statistics are broad in terms of workforce data, people leaving, work life balance. Now, I think you’ve quoted James Baldwin before and people will, I’m paraphrasing, people will cope with anything if they know what the reality is. Can we address the wellness and wellbeing issue at the Trust and what people are doing and what you’ve done and what you’ve seen that works well, because this is not an elephant in the room, but I guess it’s something that envelops everything we’re doing.

So I think Leicester, like the wider NHS, we have multiple risks at the moment. I think our biggest risk is the workforce, whether it’s from a wellbeing and a welfare perspective or recruitment or retention. I equally think making Leicester hospitals a better and an easier place to work underpins our ability to resolve all of the other six risks as well. In the NHS, I don’t think we are particularly good at borrowing best practice from elsewhere and undoubtedly three of the best proponents of the work around wellness and wellbeing are Northumbria, St Helens and Knowsley and Leeds Teaching Hospital. And at Leicester we have been actively listening and engaging with those organisations and others to identify what we can do and some of the things that we’ve been doing is we passionately believe in the importance of the staff survey. We’re making progress with that. Last year’s staff survey, we themed the output from that and identified 12 key things which are focusing on getting the basics in place. What are the basics that people need to do their job? And that entails things like access to safe car parking, ideally co-located on site, making sure that the food provision is better than the past, making sure that we have high quality food, that it’s low-cost food, making sure that the Wi-Fi works. Making sure that your computer works, etc. I could go on. We need to be focusing on the basics. I think we’re making some progress, but there’s more to do. Another thing we’re doing is making sure that the organisation is as inclusive as possible, making sure that the experiences of all colleagues are in line with my experience, and we haven’t closed that gap at the moment. But one of the ways we’re doing is heavily investing time and support into our well-established networks. The third thing we’re focusing on is our response to the cost of living. And I passionately believe in this. We know that people are struggling at the moment. I don’t think we should ever assume that we know what is happening in someone’s personal life. So, we have been, I think, moving beyond the boundaries of just being an employer at Leicester hospitals, focusing on, as I say, providing discounted food, free food for people’s children, discounting transport, working with local providers. We’ve been handing out vouchers for clothing for children this winter. And then also we found out that 14% of our electrical bills goes on washing and drying your clothes. So, we’ve been offering people the opportunities for free to wash and dry their clothes on our hospitals. It’s only a small step, but I think it’s a really important step. Then the final thing is, and I think possibly Leicester’s in an unusual position from this, which I’m very embarrassed and ashamed to admit, but for a range of historical reasons, we have been unable to pay our colleagues consistently and accurately on time, and we have to resolve that. People are coming to work and working their socks off, and if we’re not paying them on time, we’re doing them a disservice. So, we’re putting a huge amount of effort into all of our payroll functions and our transactional HR Teams to make sure that people get paid for the work that they do.

No, thank you. And that’s a candid response, I think, to the staff survey. I think the numbers to do you credit is leapt up from I think a 33% response rate to 45%. So, you’re heading in the right direction.

Better still this year, but a lot of work to do.

No, brilliant. Just briefly on wellness, you’ve covered a lot of things there. I found it intriguing because we talk a lot about actions that take place. You’ve mentioned a few of those initiatives and they’re wonderful. Your Chief People Officer in the recent board papers emphasised the response to the tiredness of the workforce by saying ‘We’re also going to look at what we can perhaps ask our workforce not to do’. So, it’s quite an interesting analysis. So that’s part of the initiative as well, not to overburden within the bounds of patient care, of course.

Absolutely. And I think we are very fortunate. You referenced Clare Tierney, we’re very fortunate to have Clare Tierney as our Chief People Officer at Leicester. I think this idea of supporting people to not do things is really important, but it needs to move beyond words into firm action. It’s a bit like priorities. You start listing priorities and you end up with 15 or 20 or 25 things you have to actively deprioritise things. And it’s difficult to do that because we’re work in a complex time. I think what we’re trying to do at Leicester, and I do believe 13 months into it, there is evidence that supports it and it’s beginning to feel like a different organisation, we have to make it as easy as possible for people to do their job and as easy as possible for people to do the right thing. And I think some of the things that I’ve touched on cut through that. So if we during winter, we can make sure that our car parks are safe because we have improved the lighting and we’ve got security on site, if we’re making sure that the quality of the food that people can have is better than it’s been in the past, and we’re reducing the price, if we’re doing everything possible to protect breaks so that people can get an opportunity irrespective of the job that they’re doing. If we are recruiting and retaining people effectively so that you come onto your shift and you recognise the colleagues around you and you’re not worrying about short staff numbers, if we can do all of that, I think it makes it a lot easier for people to do their jobs. Another thing we are trying to do, but we’re a long way away from it is to increase the autonomy in the organisation. It’s still an organisation where far too much comes up to the top. So, the executive team, the senior leadership team for authorisation. And what we’re trying to do is to give people autonomy, to take those local decisions, to say, why are we doing it like this? Let’s stop doing that.

Absolutely. And I think all the evidence shows that organisational change with distributed leadership is far more effective. I want to just have a slight tangential discussion around international recruitment. It’s an element that was in the long-term plan 2019 Task Force was set up by, I think, the current health secretary in the previous incarnation three months ago to increase international recruitment. I just wanted to get your insight about that. It’s a thorny issue ethically sometimes. And even to do it well isn’t straightforward.

No. So, I think I think international recruitment has a really important role in overall recruitment and retention. But as you say, I think it has to be done ethically. The last thing we want to be doing is to have a detrimental impact on any other country because we’re importing doctors and nurses, other healthcare professionals into the NHS. I think it is possible, though, to do it in an ethical way and to benefit the NHS. An example would be at Leicester, we’ve just we’ve just signed an MOU with BAPIO, the British Association of Physicians of an Indian Origin and their sister organisation, BINA, which is for the nurses, and they are an ethical mechanism of supporting doctors and nurses who have trained in India and in the subcontinent to come and work in Leicester. I think another key point of this is around our locally employed doctors who have an incredibly important role to play. Quite often I think up to two thirds of them come from an international background, so I think it is possible to do it. Two final points, though. We need to make sure that these people, colleagues who are joining us from an international background, often making huge life changing decisions, massive commitment to join the NHS, sometimes bringing a family over. We have to make them feel as welcome and as included as possible. And that isn’t always the case. I’ve been looking at the staff survey at Leicester. I’ve been talking to some of our international colleagues and their experience of working in the organisation and their experience of living in Leicester was very different to mine and that’s unacceptable and we have to change that. So, a lot of work to do around international recruitment. The other point is, as I say, is part of the package. I strongly believe that we need to be making sure that we work in partnership with others to strengthen recruitment within the UK. And I’d be probably as bold to say as working at Leicester with other NHS partners and local authority partners. We want to establish Leicester as the place to work across the East Midlands and possibly beyond that, and I think we can do that.

Now thank you for that. That takes me on nicely to the importance of culture, but looking at inclusion, you’ve touched upon it there, vitally important element, and particularly given the demographic of the population that you serve and depending on who you ask, I think 27 languages spoken within a mile and a half of the Trust headquarters, and I think approximately 50% of the population identify as from being an ethnic minority. So I know there’s a lot of work to do, but you’ve done quite a lot of work in terms of supporting BAPIO with the local employed doctors and also with some programs in terms of reverse mentoring, etc. Just be interested to hear because you’re very passionate clearly around that subject.

It’s something I cared passionately about up in Sherwood, and certainly I have looked to build on the good work that was already taking place at Leicester when I re-joined. What is clear, though, and I’ve touched on it, is that opportunity doesn’t present itself equally. That many colleagues for a whole range of reasons, some of which will be linked into protected characteristics, do not feel as welcome in the organisation that I work in as I do. And that may be because I’m the Chief Exec or because I’m white or because I’m male or a range of things. But I firmly believe that we need to ensure that all colleagues feel included in the organisation for a whole range of reasons. It will be good for their own personal mental health. It will have a positive impact on their relationship with their friends and family, and it will also be a key enabler of the overall care that they and the teams are able to provide to our patients. So, some of the things that we’ve been specifically doing, I think there’s two or three examples. The networks were already in place in the organisation, but we have looked to strengthen them, to give them far more of a voice. All of them now have executive support. Clare and I and the Chair, John McDonald and others we have met with all of the networks on a Friday we do something called a Friday focus a little bit like this and we, we engage with wide voices across the organisation. So, we’re drawing attention to the importance of our networks. A second thing has been reverse mentoring. I’ve been involved in that for many years now. When we’re making sure that that is supported in the organisation, it can’t just be tokenistic, though. It has to be a meaningful process and it has to benefit everyone involved. But I think that is important. I also firmly believe that we need to have a leadership team that represents the communities that we serve and the people who work in the organisation. And up until recently, it didn’t. It still doesn’t. But we are making progress, and I’m clear that has to be beyond just ethnicity. So, I’ve referenced the protected characteristics, making sure – there’s this idea what’s the phrase? How can I be something that I don’t see. How can we inspire the future leaders at Leicester if they look at the senior leadership team and think, well, none of them look like me. So, I would suggest that we are making. progress, but we’ve got a huge amount of work to do. But it genuinely is a massive priority for myself and the board.

No, thank you for that. And I know there’s been significant changes in the board. So, final point, if I may. Looking at growing the workforce, which we’ve talked all about, retention. Attraction is very important. Learning and development training. Newcross’s mission is to be the learning partner for life across health care and to offer that training for free. I know there’s been some innovative work that you’ve been doing to go to the local community and to tap parts of the population, perhaps that wouldn’t come front of mind to help them join the offer that the NHS provides.

Yeah, so we’ve touched on, we’ve done a lot of work and we will continue to do important work around international recruitment. We certainly want to establish Leicester as if you are if you’re a doctor or nurse or midwife or an HPA or non-clinical colleague, we want to establish it as that’s the place that I would like to go and work. There’s a lot of work we need to do before that, but we also want to engage far more effectively with our local communities. I don’t think the NHS, well, no, that would be incorrect for me to say. I don’t think Leicester is particularly effective at engaging with its local communities. By and large, the way that we recruit is using NHS jobs. Well, if you’re not a doctor or nurse or one of the other people that I’ve listed and you’re looking for work across a whole range of different professions, you’re probably not going to go on to NHS jobs or think about or wonder what the jobs that are available in the Royal Infirmary. So, we have been setting up a micro site. We’re going back to High Street recruitment. We’re going to have a presence on the High Street enabling our communities to come in and we will explain to them the rich varieties of jobs that we have in the organisation. Actually, why working in the NHS can be a job for life. We’re doing a whole lot of work with different groups within the communities, whether that’s based around ethnicity or other protected characteristics that we are getting out and about. We’re getting on to local radio stations, listening to people. And just the final example was yesterday we met with some of the interns from Ellesmere College. So, Ellesmere College is a local school that goes from 5 to 18 and they support children with special educational needs. And we’ve had for the last three months eight interns in the organisation giving them the opportunity to work in a busy environment, doing a whole range of different, really important jobs. It benefits the organisation. It certainly benefits them. And the expectation is, is that those interns, the majority of them, if not the entirety of them, will get meaningful paid employment at the end of it. But we also want to grow it. And a statistic that you might have not have heard of and I hadn’t heard of before yesterday is that working age adults with special educational needs, I think in their lifetime, only 5% of them will ever get paid employment, which I think is shocking. And we have to work in partnership with others to change that.

I do not know that statistic. And it is shocking and it’s inspiring to hear the initiative that you’re undertaking. One very final question, the change that you’re already beginning to see, Leicester, big changes in the board. You’re creating a strategic workforce plan for 22/27. We can’t go into all the details of digitalisation and new pathways. This is a journey which is herculean. It’s challenging, but I think you’re on record as saying that in order to make such change, you’re taking a broad view in terms of having partners and working not just within the silo of the NHS, because sometimes that does happen. I just want you to expand upon that. That’s quite a bold thing to do.

Yeah. So, on a good day, I’m really excited, empowered, optimistic and hopeful by what I think we can achieve. And today’s becoming a good day. So, I’ve enjoyed the half an hour or so with you. Thank you. What we are trying to do, and I think it’s possible for these two things to co-exist, we are trying to stabilise the organisation, which is really important for the obvious reasons, but in partnership with others. We are trying to be highly disruptive. I want to challenge the status quo. The status quo has not been good enough up to this point, and it’s not going to be good enough in the future for the reasons that we have described. And I think one of the ways to challenge the status quo is to work in partnership. We have got a clear vision at Leicester about where we want to get to. And I’m confident we will get there. But we can’t do it on our own. We have to work more closely with other NHS organisations, whether that is primary care, mental health, community hospitals, integrated care boards. We have to strengthen our pre-existing relationship to the local authority. I think the universities and tech and pharma have a big role. I think the private sector has a role. I think we are too nervous in the NHS about engaging with the private sector, but we’re not strong enough to do it on our own. And clearly the voluntary sector and community groups have a role. So, we are looking at Leicester hospitals to partner with people who have a similar ethos to us, have a shared set of values and ultimately who we think by working with them, they will strengthen our ability to deliver the best possible care that we can do and to be the best possible employer that we can be.

Well, thank you. It’s a breathtaking vision. I think you have gone on record as saying that by 2025, you want the trust to be rated in the top three on the staff survey. And having heard you today and got to know you a little over the past few years, I certainly wouldn’t bet against that. On that note, I’d like to thank you, Richard Mitchell, for your time and your candour today.

Thank you very much.

My pleasure. If you’ve enjoyed this episode of Voices of Care, please like, follow us, subscribe or whether you receive your podcasts. And if you want to have more information about how we are truly enabling the health care workforce of the future, please visit newcrosshealthcare.com/VoicesofCare. In the meantime, I’m Suhail Mirza. Thank you and goodbye.