As part of our HTN Now September 2021 event – where we share live webinar, video and website content of health tech professionals discussing topical issues – we’re also releasing new instalments of our CEO Series.
In our latest interview, we chat to Andrew Morgan, Chief Executive Officer at the United Lincolnshire Hospitals NHS Trust (ULHT), who tells us about the trust’s focus on people first, when it comes to digital innovation…
Hi Andrew, tell us how you came to be a CEO
If I think of my NHS career, I tend to think of it in numbers. I’ve had 19 jobs in 14 different organisations, in eight parts of the country for over 39 years now. I’ve been a chief exec for 17 years, across eight organisations. I describe myself as a ‘jobbing generalist’ – I’m not a clinician, I’m not an accountant, I’m a general manager who has found himself as a chief exec in many different sorts of organisations.
What are you working on at the moment?
I joined ULHT in 2019. This trust and Lincolnshire Community Health Services share a chair, Elaine Baylis, [who] asked me to move across from the community trust, where I’d got them to an ‘outstanding’ rating for CQC. This is a double special measures trust, so we’re in finance and quality special measures, and have been since 2017.
When I joined, getting out of special measures was one of the key measures. What they didn’t tell us was that there was going to be a pandemic a few months after joining. I’ve been here for two years now [but] I’ve sort of lost 18 months due to COVID, so I’ve not [yet] been able to do the changes that I wanted to do.
There are eight things we are juggling at the minute. One is clearly COVID – it’s still here, it hasn’t gone away. Service restoration, all those things that stopped or paused or slowed down during COVID, particularly waiting lists that we have to get back to a more acceptable level. There’s managing all the urgent and emergency care pressures that are looming – because we’re a holiday destination for people, we don’t just suffer from winter. Lots of people come to Lincolnshire and our population increases by about 25 per cent, and that has an impact on our services – particularly in a year when people aren’t really going abroad.
[Another] is all the staffing issues – it’s about how you juggle annual leave, as people stored a lot up during COVID, as well as having a tired workforce. Number five is the vaccination programme – as a hospital hub we started off the vaccine programme back in December [and] we did the health and social care workers. We then handed over to General Practice and the large vaccination centres, to do the population. As we’re now talking about a booster programme and giving people a flu jab, I think we’ll have to reopen our hospital hubs, so that will be a major bit of work.
The next one is setting up an Integrated Care System (ICS) – Lincolnshire is an ICS boundary. Number seven is just manage the money – being in financial special measures, that’s a big issue for us. The final one is what I would call our culture and leadership behaviours – it was clear when I joined that we had a lot to do around people.
If you wrap those eight things up, that’s quite a busy agenda. Some have more prominence at different times of the day and different times of the week. It’s a bit of a juggling act at the moment.
Tell us more about your people and culture strategy
Being part of the Lincolnshire system, we find operating as a system fairly easily because of the geography that we’ve got. I’ve always described our people agenda as quite simple, it’s ‘get them, keep them, grow them’ – how do you attract people? Once you’ve got them, how do you keep them and develop them? And how do you grow them into other, better roles?
If you look at the people plan for Lincolnshire, it’s about more people – that’s number one – and number two is about working differently. Number three is about working in a compassionate and inclusive culture.
I’ve always believed – and that was one of the bedrocks of how we got ‘outstanding’ at my last trust – focus on the people. I’m clear that this is a people business and I know we might be talking technology – but technology is nothing without the people.
It’s a people business and my whole approach is ‘how do you get a happy, well-led, well-motivated, well-engaged workforce?’ Because all the evidence, no matter what sector you’re in, is once you get to that point, you have the foundations for it being an outstanding organisation – whether you’re making cars or selling tins of beans. We’ve got it in patches but not enough.
Is it the number of staff we’ve got? Is it that they don’t feel we care? Is it that the wellbeing offer is not right? Is there any impact of COVID on that? Is it about trust? Is it about commitment? Is it about autonomy? So, we have signed up to the NHS England Cultural Leadership Programme. There is a nationally-recognised programme to tackle cultural leadership. It’s about a discovery phase – you find out from staff what the issue is, [you] then design what you’re going to do about it, and then there’s a delivery.
It’s quite a methodical way of doing it and sometimes we’ll hear things we didn’t like. But ignoring them isn’t the answer. So there’s a lot to be done – I have made some changes here, despite the pandemic. We’ve got a very different exec team, we are trying to create a different culture [and] trying to be much more system-focused – much more outwardly-focused, a key player in the system, an anchor organisation. We’re a big place, we are what they call an ‘extra-large’ acute trust. We’ve got 9,000 employees, we’ve got a budget of about 640-650 million, so it’s not a small organisation [and] we’ve got a number of sites. It’s a big place and it matters.
I’m not an acute trust person by background, I’ve been a chief exec of strategic health authorities, PCTs [Primary Care Trusts], PCT clusters, health authorities [and] I’ve been an ambulance trust chief exec, a community trust chief exec and now I find myself as an acute chief exec. The key thread through all of them is people. How do you manage large, complex organisations? It’s not just about the technical knowledge of ‘how does an acute trust function?’.
That’s why I describe myself as a ‘jobbing generalist’, I’ll turn my hat to anything. Part of my job as a chief exec is what I call ‘storytelling’, so when I’m out there with staff, how do I explain what we’re about? How do I explain where they fit and why their behaviour matters? Or why how they treat patients and work colleagues all matters to us?
[Also, I remind them] that if their role wasn’t important, it wouldn’t be here. So, when people say ‘I’m just a receptionist’, ‘I’m just a porter’, I do like to say, ‘it’s not ‘just’ is it? You matter because we wouldn’t employ you if it didn’t…’, we all have a role to play here.
What about technology?
The technology bit isn’t just about tech – it’s about the people that operate it and it’s about the behavioural bit and the transformational element. If we just think we can buy bits of kit and suddenly the trust is transformed – no, it’ll sit in a box somewhere, or somebody will say ‘that isn’t what I wanted’, or we won’t help them use it differently. We’ll have spent lots of money and we’ll be exactly where we are but with less paper.
My background is the people bit of it and I’m interested in how we equip patients with technology, so that they are informed consumers of our service rather than dependant on us. I can certainly see a version of the future, whereby records are actually held by the patient, not by the service [and] whereby you have far more online consultations, either face-to-face or AI, where you can book on your phone rather than get a letter, and where there is far more remote monitoring of your condition. Part of that is [that] you don’t know what you don’t know.
I would think it’s going to be part of the agenda for the future – how do you maximise technology? How do you empower the patient? Even when you start to join up different agendas, like net carbon zero, if you want to tackle that, some of that will be around transport and travel…and some of the changes we made during COVID about online consultations does reduce the amount of travel.
What we’ve found in some parts of Lincolnshire is then a push-back of ‘but our hospitals are not as busy as they were, there’s not as much footfall’ and that’s got some of our politicians concerned.
It’s not that convenient for patients, is it? If they can stay in bed and consult with a consultant, why would you make them and the consultant travel? There’s those trade-offs between modernising the service versus much-loved institutions. I absolutely understand much-loved institutions but when I wander about our site, I often see quite elderly people wandering around with bits of paper, clearly on their way to a clinic somewhere and you do think, ‘might there have been a better way of doing this?’ Making them travel, making them park [and] pay for parking for probably a 10-minute consultation with somebody. Is there a more technologically-minded way of doing that?
Not all older people are not tech savvy, many of them are very tech savvy. And many of them are pushing – ‘why do you have to do it this way?’
When we say we want to transform the NHS and have it fit for the 21st century, what does that actually look like? I think these are all absolutely legitimate discussions to have but a very clear part of my job is the communications aspect. I love doing media stuff because, as a public service, I think that’s what we should do. [Be] out there explaining to people what we are doing, why we’re doing it and how it might change.
There will always be these tensions, and I think we see it in General Practice – [with] many consultations now done remotely and we’ve all seen newspaper headlines that some people don’t like that, but some people love it. That’s the challenge we have – how do we keep everyone happy?
What have been your biggest leadership challenges recently?
It’s a workforce that has kept things going but it’s very tired and there isn’t any time for pausing. Without our people, it’s quite hard to run a service and trying to do that is going to be a challenge.
On the money…the NHS has had different financial regimes during COVID – and rightly so. On occasion, that’s hidden our financial problem, but it’s not gone away. So, it’s now needing to get people back into that we spend far more money each month than we get in. That’s not a sustainable position for us and we have to do something about that. That’s where we’ll need to get into some of the modernisation, the productivity, the waste.
I think tech can help us with some of the productivity issues and help us redesign some of our pathways, because this isn’t just about buying bits of kit and putting it in a hospital. We’ve got kit, we’ve got scanners…it depends what people mean when they say technology. I am interested in how we empower patients…if we design it around what they found helpful. We need to do more around our patient engagement – would they paint a different scenario for us of what care they would like?
On the high-level strategy stuff, what you tend to find is that everyone wants more prevention, more care close to home. But when they say that they don’t mean they want to substitute it for hospital services – they want both. As an acute trust chief exec we have got to ask the question – is that a deliverable? Does everything that goes on in a hospital need to go on in a hospital? My answer would be no, it doesn’t. Hospitals are still really important parts of society but could it be delivered in a different way? That’s the debate we’ve got to have.
How has your leadership style adapted to more remote work?
Having come from a community trust, you get used to having services delivered remotely, in many different places, with staff you hardly ever see. So, it does drive you to a model that’s about ‘how do you equip them to be as successful as they can be?’ – both in technology-terms, their competencies, their knowledge, but also the trust you place in them. Because you’re not actually there when the service is provided – you can’t walk down a corridor, you can’t stick your head around a door or you can’t move the curtain aside and ask if somebody is alright. You are heavily reliant on their skills, competencies, and all of that.
During COVID, that was how most of us had to operate – many staff working at home, doing remote consultations. We also operate at many sites and I can’t be at every site, so you do need good local leaders who understand the importance of contact with their workforce [and] who do understand that their job is to make success more likely. Your job as a leader is not to torment your colleagues, it’s to make success more likely.
It, therefore, requires you to be contactable, visible, and interested in their wellbeing. I occasionally talk to people about what they think their job is – ‘how do you spend your day? How do you spend your time?’ – I reflect on me and I can spend a lot of days on [MS] Teams, really busy. But, actually, you have to ask yourself, is this being busy or is this being useful?
I think, on occasion, we have busy fools. People who are really busy doing Teams, emails, writing reports and attending meetings, and not actually doing the stuff that matters – which is talking to patients, seeing how their services operate, talking to their staff, and getting stuck into all of that. We’re guilty of it, I get an email every minute, virtually, some days.
Being busy is not the same as being effective and it’s a hard cycle to break out of. It needs people like me to give permission and to role model the sorts of behaviours that we want. I half jokingly say to people that they pay me just to walk about talking to people but that actually is part of my job, to wander about talking to people, and Teams has slightly got in the way of some of that.
I tend to think about the job in three chunks – what is your intent, what is it you’re trying to do? And what is your strategy? Have you chosen the right things to spend your time on? Have plans that will entice your workforce to want to be with you on it…[but] there’s no point having a plan if you haven’t got a chance of doing it.
Sometimes we confuse capacity and capability. We think just having lots of something – like people – will deliver. No, you needs lots of capable people to deliver, with a multitude of skills. Just having a warm body with a pin number won’t deliver your plan.
If you’re going to have a plan, and you have lined up your capacity and capability, you do then need to deliver. What you need to do is stop re-writing the plan, or what I call the ‘magpie approach’ – you see something else, something new and shiny, and you forget the plan you had and go off in search of something bright and shiny over there. Sometimes technology does fall into that category.
We have a five-year integrated improvement plan, as a trust. It takes us up to 2025, so we’re in year two. Its aim is ‘outstanding care, personally delivered’. I’ve said this trust can be ‘outstanding’ by 2025. We’ve set out the roadmap and all of our objectives and priorities, [and] we’re aligning our capacity and capability to it. We’ve got to change our culture and behaviour to get there, we’ve got to make ourselves financially sustainable. But if we do all of that, there’s absolutely no reason why this place cannot be ‘outstanding’.