Reflections on NHS leadership – a perspective from a recently-retired Chief Executive

By Mary Edwards (former Chief Executive of Hampshire Hospitals NHS Foundation Trust)

I am writing this article just 6 weeks after retiring from a lifetime in the NHS, firstly as a nurse and latterly as the CEO of an acute trust. I joined my last organisation as Director of Nursing 21 years ago and became the Chief Executive 13 years ago. As CEO, I helped secure Foundation Trust status in 2006 and oversaw the merger with Winchester and Eastleigh Healthcare NHS Trust in 2012. However, the scale of the challenge facing the NHS now is greater than it ever has been; likewise the need for skilled and effective leaders has never been greater.

The basic role of a CEO hasn’t changed over that time – the key objective is to surround yourself with the best people and support them so that the core business is delivered to the community you serve. I learnt from others that the CEO role is to act as an umbrella so all the `stuff’ from above doesn’t stop the front-line doing their thing!  What does change is the nature of the challenges around you and your ability to be autonomous in dealing with those challenges. I think the best bit of my time was when we were an early wave foundation trust, able to be responsible for what we did and left alone as long as we delivered the national requirements. 

I have seen the level of funding fluctuate hugely over the years and this really does make a difference.  One can be much more imaginative and developmental in times of plenty. The current post-recession period has provided the biggest financial challenge I have seen, particularly as it is combined with a period where more people are living longer and often being much more frail and dependant when arriving and leaving hospital.

Reflecting on my career, that included working at a DHA, RHA and briefly, the DH, the best bit has been the amazing people I have worked with who kept me going, even when there were dark days – and there were a few! I have learnt many lessons along the way and would like to thank all of those wise and supportive people, in and out of the NHS, who have helped me with this.

My lessons have included always being ready for showers of money when the political mood music changes; have a clear strategic plan and draft bids so that you can make the most of those periods when money appears from nowhere.

Some of the best lessons I have experienced have come at times of real pressure. I didn’t see the scale of change that would result from the introduction of CCGs and my organisation became isolated for too long before I realised how much the game had changed! I have learnt huge resilience from the bad periods and recognise the enormous need for senior leaders to support each other – this can be sadly lacking in the NHS.  We are very quick to criticise each other! Perhaps the notion of a ‘market’ and competition makes us forget we are all facing the same challenges!

Finally, I now realise that change from on high is not just about politicians - senior leaders in the NHS also introduce big changes. My frustration is that sometimes these changes are not always well informed by professional leaders around them. I have learnt that the role of great clinical leaders (from all professions) makes the biggest difference – let them lead and trust them. My experience tells me that they care hugely and are willing to invest a huge amount of personal time into leading and developing the organisation, contributing hugely to the intellectual rigour and keeping you focused on the important things when the external noise may be causing confusion. I benefited hugely by enabling them to maintain clinical practice whilst fulfilling leadership roles so that they stay rooted in the delivery of the core business.

As a recently departed CEO, one recommendation I do offer to the very senior leaders in the NHS is to discourage the constant movement and churn at CEO level - give us time to learn the job (3-5 years) then see the benefits of us staying in one place. I learnt so much from some great CEOs, in all types of organisation, who had been in post for 10 or more years.  It is easy to forget that many of our staff join an NHS organisation in their 30’s and stay till they retire; these staff think of CEOs as itinerants and therefore don’t invest their trust and loyalty in us.  Without support for senior leaders (both locally and nationally), large-scale transformation of the service will not be realised.

Until December 2016, Mary Edwards was Chief Executive of Hampshire Hospitals NHS Foundation Trust, a post she had held since 2003. Prior to that, she had been the Trust’s Director of Nursing. She was also part of the development of national clinical audit programmes and R&D programmes at Wessex RHA and DH.