Suhail: [00:00:08] 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 by speaking to leaders that are truly enabling the healthcare workforce of the future. I’m Suhail Mirza, and any headlines will tell you that the NHS is facing a tremendous crisis. Record numbers of vacancies and people leaving the sector. It’s therefore vital to hear from those leaders that are seeking to innovate and change this trend. I’m therefore delighted and honoured to welcome our guest today, Louise Stead, the Chief Executive of Royal Surrey NHS Foundation Trust. Louise, thank you so much for giving us your time and joining us for this series.

Louise: [00:00:42] It’s a pleasure. Lovely to be here.

Suhail: [00:00:43] Now you have an extraordinary history in the NHS as a clinician, as a nurse spreading back over three decades. The headlines are alarming for those of us that look at the sector. Is it really a crisis that is perhaps one of the worst in terms of workforces that you’ve ever seen?

Louise: [00:01:00] I think it is. I think that there’s no way of putting it in any other context, to be honest with you. We’ve got more and more staff who have decided post-COVID that they want to leave the profession. We’ve got the biggest rise in vacancies. A third of consultant positions that were advertised last year weren’t filled. And on top of that, we’ve got record numbers of vacancies within trained nursing roles. So, yes, it is a really, really challenged environment in which to work.

Suhail: [00:01:30] We’ve also got, of course, the extraordinary environment, a cost-of-living crisis and of course, industrial action on a scale which we haven’t seen for a very long time. What effect would prolonged strike action have in terms of patient care and delivery?

Louise: [00:01:45] Well, it’s definitely going to have an effect on patient care. And you can see that at hospitals where their nursing staff have been striking. The Royal Surrey staff didn’t vote in enough numbers to strike, but that doesn’t mean they’re not sympathetic with their colleagues. But it will take a real change, I think, in policy, people getting around the table, trying to work out exactly what they can do to encourage nurses back into the profession and back into thinking it is the right thing to do and it’s a job for the future. So it’s not just about pay, it’s about conditions, it’s about so many other things.

Suhail: [00:02:20] So, a million-dollar question, I guess is, what can be done in terms of accelerating a resolution of the strike action? Because it is, as you say, it’s not about pay. Nurses have as many of the other workers in the NHS faced real terms, pay decreases over the last decade. But it is a little bit more than that that’s at stake.

Louise: [00:02:39] Yes, absolutely. And I think it is just going to be sitting down and listening really, really carefully and seeing what of those demands can be met. I think there’s a great deal that can be done around flexible working around other sorts of remuneration around how we look at some of those lower bands of nursing. It’s five years to get to the top of a band five. How can we change that and make it more attractive to stay by the bedside because that it isn’t at the moment?

Suhail: [00:03:13] Well, we’ll have to watch this space, I guess. There’s obviously been a significant change in terms of the landscape across the NHS and indeed social care, the statutory basis for integrated care systems last year. Is that having an effect or does that hold a promise in terms of more collaboration, in terms of the workforce? I know you’re of course have your role within the Surrey heartlands ICS and you’re an integrated trust anyway in terms of the community practice that you took over in Guildford and Waverley several years ago.

Louise: [00:03:46] I think there are real opportunities with all of these things, it takes time for them to be delivered, but I think there will be attractions to being employed by a system. And if you just look at our own experience of running community services, we’re seeing nurses move over, we’ve just recently taken out a surgical matron who’s gone to be a head of nursing in the community. Now that isn’t a job she would normally have gone for, but because it’s part of the same trust and she knows she’s going to get the same support and she knows how it all works, she’s doing a brilliant job. That’s a real example of how when you work in those bigger matrix organisations, there are opportunities that when you see the support around you and I think it will be exactly the same with the ICS, you can take those sorts of leaps into the unknown, knowing that there is that support behind you.

Suhail: [00:04:37] And was that part of the thinking when you do take over those services? Was that something that’s evolved in terms of the fluidity of the workforce being able to break down? Because traditionally there have been boundaries between social care and the NHS and in particularly with your profession nursing, it’s not naturally associated in people’s minds with a community setting more in an acute setting.

Louise: [00:04:58] I think that that’s been a bit of an unintended consequence. We took over the community services thinking that if we didn’t have that boundary between getting someone out from the acute and into a different environment, then we’d have that seamless rehabilitation. I mean, there are so many things that have changed as well since COVID. So the benefit of having smaller sites that aren’t on your main acute site where you can keep some semblance of things like green diagnostics has really made a massive difference. And we know more and more that people want to have care closer to home. Bizarrely, it’s turned on its head, isn’t it? So it used to be you wanted to go to the big monolith, which was the hospital. Now, actually, you’d much prefer to go and have your care in a community setting that’s much closer to home, because you know that the expertise and the technology there is just as good as it is at the main hospital.

Suhail: [00:05:54] Just stepping back a little bit, you’ve been at the Trust in various roles now for, I think in your 12th year CEO, in your fifth year. There’s a lot of things that, of course, I’m sure you’re proud of. I wanted to touch upon what I found very interesting was that I think you’re the fourth largest cancer centre in the UK, which is not something you naturally assume, with the size of the trust. So is that something that’s been a strategic policy because that offers great learning and development in terms of career pathways for clinicians?

Louise: [00:06:21] Yes, I mean, it is definitely a strategic intent. I think that we’re perfectly place within Surrey. We have a really big catchment as we’re part of the Surrey and Sussex Cancer Alliance, which I chair. So, there are two cancer centres in that Brighton and the Royal Surrey. And I think once again that goes back to care closer to home and particularly things that we’ve been looking at. Like we’ve had a mobile chemo van that’s been going out. All of those things enable people to have the right sort of care. And you’re right we’re the fourth busiest. So, if you’re a DGH with 500 beds, that’s quite a lot. We get through about 130 deliveries of chemotherapy every day. And, of course, that keeps growing and growing.

Suhail: [00:07:07] I wanted now to focus a lot more on the Trust’s strategy, the 22/25 trust strategy. I think the idea that the workforce has been through a tremendous challenge is an obvious statement. The wellbeing and your true North goals are to support that wellbeing. Now, historically the trust has rated very highly in terms of staff engagement, etc., which is fabulous. But I just want you to elaborate how important that initiative is and what you’ve been doing, because that is truly enabling the workforce to be at the top of their license.

Louise: [00:07:39] Yes, I think that it was something that really hit home during the pandemic. I think that as we’ve come out of that, we’ve got a workforce that is exhausted. And, of course, we’ve got to recover all the targets that slipped during COVID because we couldn’t do some of that work. So not just are we coming out of the most emotionally stressful time for staff, but we’re now asking them to work even harder. And I think we were really conscious of how we needed to support staff. So we’ve sort of got four pillars that we’re looking at around that. So, looking at physical health, looking at mental health, looking at social wellness and also a financial wellness, because all of those things we’ve already talked about the cost of living. All of those things are real issues, particularly when you live in quite an expensive part of the world. In Surrey, you have to get to Guildford and, ten miles up the road you would get inner London weighting. So what’s going to make us more attractive is that support we wrap around our staff. So, we’ve done a lot of things to try and have hardship funds. We make sure that everybody has got access to occupational health and to mental health support online. So, if it’s two in the morning and you’ve got a really bad situation, you can ring someone and speak to someone. We’re trying to put in more yoga and exercise regimes. And we’ve built something called the wellbeing cabin, where we run some of those activities. And I think also just, making sure that people have got easy access to things like musculoskeletal services. So, you come to work, you hurt your back, you hurt your leg, you go straight to see a physio, you haven’t got to think, Oh, well, I’ve got to go and see my GP. All of those things are very supportive for staff. The Royal Surrey talks a lot about being a Royal Surrey family and I think that that’s very important. I think we do have a level of support that I’ve not seen in other Trusts that I’ve worked in.

Suhail: [00:09:41] That’s fabulous. And there’s a couple of initiatives I think if we also broaden that wellbeing to include the importance of inclusion, menopause Cafe, things like that. This is not something that you see as a silo which should be separated from wellbeing.

Louise: [00:09:56] Oh, no, absolutely not. And yes, you’re absolutely right. We’re doing a lot around women in leadership, around some of our disability networks. And as you say, things like the Menopause Cafe have got a lot of traction and are really well supported.

Suhail: [00:10:12] And one of the key things that we’ve seen over the period since the pandemic and subsequently is the ubiquity of technology to enable some innovation, but also people to be able to work in an environment much more effectively. Because one of the key things that you have to do, and I just want to touch upon that briefly is one of your key strategic objectives is patient care. Absolutely, Number one, empowerment of the workforce. But we can’t forget the environment that we’re working in because you’ve made a commitment to deliver a financial surplus, which is a bold commitment given the inexorable demand that we have.

Louise: [00:10:46] Yeah, I’m not sure we’ll be delivering that financial surplus. It would be great to break even. Yes, I think you’re absolutely right. We need to embrace new technologies and digital support for our staff. We have brought in an electronic patient record this year that’s had its challenges, as it does, I’m sure, in every trust. But I think we are now beginning to see some of the benefits of that. You can see if you’re the consultant on call, you can see all your patients and how they’re doing from your computer, you know exactly what’s happening. We haven’t lost a drug chart since. So there are little things like that that make a big difference to the day-to-day. We’re really trying to make sure that things like HR, a self-service, nobody wants to have to try and book their doctor rotas or their locum shifts. It is all ideally going to be something you can do from your phone really easily because all of those things make a difference to everybody’s day-to-day life. And that’s before we start on the sort of medical and nursing technologies.

Suhail: [00:11:48] Just touching upon that. Obviously, we’ve had the urgent and emergency care plan, more ambulances, etc.. One aspect I want to touch upon is obviously the promotion of the idea of virtual wards, and we have some eyewatering numbers, some aspirational numbers, 50,000 patients a month in a couple of years. I mean, it’s a grand plan. It will require agility technologically to deliver and a workforce that’s technologically knowledgeable and agile. Do you see a lot of hope there? I mean, you’re a clinician with huge amount of experience. Where are we out there? It’s early doors, of course, but it’s a vision that perhaps could transform the work workforce.

Louise: [00:12:27] Yes, I think you’re absolutely right. And we’ve talked for years, haven’t we, about it isn’t that we don’t have enough beds because everyone’s got their own bed, but how can we support that care at home? I think virtual wards will make a massive difference. It will allow people to escalate when they need to contact someone immediately. I mean, we’re just starting out. We’ve got very small numbers of patients in our virtual ward and in fact the care they’re getting at the moment is probably the best care anyone’s ever getting because the consultants and the team, our team are so engaged in what’s happening to them because everyone does want this to succeed. It will be difficult scaling it out because people will have to withdraw from that level of intervention. But I think we’ll learn as we go along, but I think is absolutely the right way forward. And if you can communicate easily and quickly with your team via a tablet or whatever, you’ve got the reassurance that you can stay at home. And I think that’s the biggest thing about it for both the patients and carers. They’re so worried they’re going to get it wrong. If you can get that immediate reassurance, then you’re happy to stay at home and know that someone’s going to come out to you.

Suhail: [00:13:38] You’ve talked about the potential and the future technologically. Let’s talk about that briefly around clinical practice, it’s such a huge topic, whether you’re a doctor or nurse or allied health professional. But the use of robotic surgery is ubiquitous and you’re, I think, the second largest provider as a trust. That’s made a dramatic difference in terms of efficiency in meeting patient demand?

Louise: [00:13:57] Yes, absolutely. And it was definitely a strategic intent alongside the fact that we are a cancer centre. So our ambition is always to provide the best and safest care we can for our patients. We know that length of stay is shorter, our recovery is quicker, and that is absolutely what’s important to our cancer patients.

Suhail: [00:14:17] Absolutely. And with the emphasis on efficiency targets, it can only help. One very final question. I’m tempted because you’ve talked about technology and the vision that you have within your strategy. It’s a huge topic, but the promise of AI and data and analytics, we’re beginning to see the fruits of that. That’s very much within the vision of the trust as we look forward.

Louise: [00:14:38] Oh, yes, absolutely. And we already doing quite a lot of that. We have a collaboration with Google that’s looking at the efficiency of looking at mammograms. So, AI versus real people. And then we’ve got some plans in play at the moment, particularly around looking at AI, directing patients in positioning for radiotherapy to make sure we’ve got exactly the best position. And you would expect with being a cancer centre, we’ve got another project underway which is looking at not just the outcomes, it’s looking at behavioural models and AI as patients go through chemotherapy. So, it’s a really exciting study.

Suhail: [00:15:19] Part of the landscape and the ecology of the workforce has changed dramatically. We now have, as you mentioned, flexibility, different roles, technological agility that’s been required. I want to touch upon the importance of learning and development to allow a variegated way for people to enter the profession, whether it’s nursing or medical profession, caring profession, non-clinical. We have to expand the thinking to attract the workforce. So, you’re a visiting professor, of course, at the university there. How have you seen new roles evolving and has that been part of the progress that you’ve made in terms of engaging the workforce?

Louise: [00:15:55] Yes, absolutely. We’ve got roles now that we definitely didn’t have ten years ago. And I think that entrance into healthcare is so diverse now. Apprenticeships have made a massive difference. If you look at the apprenticeship levels going all the way up to master’s and we’ve had a collaboration with the University Business School at Henley in order to use some of that apprenticeship money to look at Masters for some of our more senior managers. And I think that there are so many different ways now that we’re supporting people into healthcare. So, there are, as I said, apprenticeships. We’ve got collaborations with local schools so that people come and have of taster days so they could really see that working in health care is not just about being a doctor and a nurse. People don’t know what radiologists do. They don’t know what nuclear medicine doctors do. They don’t know what our computer analysts do. And actually, that’s a really exciting area to work in health care. So I think if you think any job, we’ve probably got a role in a hospital that does some of that.

Suhail: [00:17:00] Because normally the association, of course, is with clinical roles, but there are a myriad of opportunities in careers, whether it’s finance or marketing, whatever it might be. And I think you’ve instigated the health and social care careers evening at schools to allow people at a younger age to perhaps see the NHS in a more broader context.

Louise: [00:17:17] Yes, and particularly with, we’ve got a school just up the road from us. So really trying to, as I say, expand those horizons about what you can do. Come in and do some work experience with us, come and do some volunteering, see what the other roles could be. Volunteering doesn’t have to be wheeling a trolley round. It can be going to work in the marketing department and seeing what happens there or the comms department. So, yes, we’re really trying to push that to make sure we grow our own and that the real role of being an anchor institution is something that means something in Guilford. And we’re really mindful of our role. As you know, right next to the university between us we employ most of the people in the surrounding area. So, we have to take that responsibility seriously.

Suhail: [00:18:02] And in terms of attracting the workforce, the role as an anchor institution goes beyond simply an employer, but also a contributor to thinking and the local economy.

Louise: [00:18:11] Yes. And I think we’re an active part of the Guildford, Surrey board. So that’s all the people who have a real interest in employing people or developing people or planning for the future of the area. So I think that’s one of the things I take very seriously in my role.

Suhail: [00:18:28] Planning for the future. Looking ahead, I’d like to take the opportunity to meditate upon how important leadership is going to be as we transform the long-term plan, talks around the transformation of services, the context of services. But as a clinician, I hate to remind you, but in your fourth decade as a clinician, but as a chief executive needing it for five years, what advice would you give to those that aspire to now join, follow your footsteps as a nurse, A very different environment, great opportunities and challenges, but who may actually look beyond the vocational interest, but also to leadership potential? What advice would you give because you’ve been in director of nursing roles, many roles over your career. What would be perhaps the two or three key things that you’d say that’s a path for you. You’re welcome and the opportunity is there.

Louise: [00:19:23] So I think the NHS is such a remarkable organisation to work for. So if I think of all the jobs I’ve had along the way, but you’re still under the same umbrella of the NHS and that gives you such opportunity to move sideways as well as to move up. And I think that’s really important. No path to be a chief executive is a straight path. So, I think there are so many opportunities and it’s good to take those different opportunities. You don’t have to be a clinician, you can do a management role, you can do very different roles. I think that leadership in the NHS has changed a lot. We talk about leaders at every level of the organisation. I think in the past, you were a leader when you got beyond a certain band. That’s not the case now. It is very much you might be the leader of a shift or the leader of a small department. And I think that clinical leadership is really important. I know there are lots of chief execs who haven’t had a clinical background. I honestly think it helps me do my job every day. And I think particularly for women in health care, there is a real perception maybe that, you can work part time and you can take some time out and you can absolutely come back and get to wherever you want to get to. I’ve had term-time contracts, part-time contracts. All of those have been brilliant for different times in my life. And I think, the one piece of advice I think I would give to people who want to go into leadership and want to go up the management ladder is, make sure you come into that with your whole self. People want to hear that you’re a scout leader on a Tuesday night. That’s great. That gives you some other insight into the community you’re working in. Don’t feel that this has to be everything because we all come with different parts and different attributes to contribute.

Suhail: [00:21:18] Absolutely. I think the final point for me is also pushing the boundaries in thinking and innovation encompassing systems as we’ve talked about, but also industry, the private sector, government policy. I’m thinking in particular for clinicians and non-clinicians. The NHS has an entrepreneurship program that asks people to challenge what we’re doing in terms of delivery and what’s going on in terms of diagnostics. So I guess it’s, as you say, the whole person. And don’t be afraid to challenge the status quo.

Louise: [00:21:47] No, absolutely. We have a great scheme called Bid for Better. So any of our staff can come and say, I can make this better if you give me a bit of seed funding. It’s sort of a Dragon’s Den for the NHS, but on a very small scale. And people really like that, they really like to say, actually I could make this better and people who’ve won some of that money last year, we do it in conjunction with the University of Surrey, they’ve gone from sort of health care assistants right up to senior managers.

Suhail: [00:22:16] Well, on that inspirational note, I’d like to thank you, Louise Stead, for your time and your passion.

Louise: [00:22:21] Thank you.

Suhail: [00:22:24] If you’ve enjoyed this episode of Voices of Care, please like follow or subscribe wherever you receive your podcasts from. And if you want to understand 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.