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Steve Gulati

NHS Leadership Academy Director Steve Gulati on his labyrinthine career journey, his passion for guiding BAME leaders through NHS management, and how his wife’s cancer battle put his work—and life—into perspective.

At university, I studied a combined Humanities degree in English, History and Politics. There, I read Orwell, explored the history of socialism, and looked at the politics of health; all of those things are connected to the NHS. Currently, there’s a prevalent discourse in government that somehow humanities or the arts are ‘low value’ subjects, but this simply isn’t true. The ability to think broadly, to see patterns, to use your imagination—what could be more important?

During my degree, I found out about the NHS Management Training Scheme; I saw the NHS as a place where there was not only a diverse workforce in terms of skills, but also somewhere where there were people of colour at every level of an organisation, rather than just further down. Using my own initiative, I organised some work-shadowing at my local hospital, then applied for the Scheme at the end of my first degree. I got through two of the three assessment stages, but was not then selected at the final assessment centre stage. I ended up pursuing a vocational post-graduate qualification—what was then the ‘Institute of Personnel Management’ (now the Chartered Institute of Personnel & Development, CIPD).

Again, I applied to the NHS Management Training Scheme, this time as a qualified HR & OD practitioner. But the same thing happened: I was rejected at the final stage.

In the early 1990s, I finally secured an NHS position. I loved every minute of working in the NHS: the variety of the work, and the ability to make a difference to patient care and experience, even from a management role. Making those connections was a real ‘light bulb’ moment for me. I flourished, moving to jobs all around England to gain more exposure and experience at Acute Trusts, Mental Health Trusts, community and primary care, as well as some national policy level work. Eventually I ended up on a senior leadership development programme, which is where I completed my MSc. Up to that point, all of my development had been self-generated, but there, I saw all of the benefits that a structured development programme can bring.

…and it was then that I began to question how, why and for whom ‘leadership development’ works in the NHS. Twice, I had been rejected from the NHS Management Training Scheme, yet using my own drive and initiative, I’d become a director in less than a decade. How did that happen? Without wishing to sound arrogant, how did a prestigious scheme like the MTS fail to identify that talent? I suspected systemic problems and knew I needed to do something about them.

There is still racism in public institutions like universities and the NHS. The racism may be more genteel than the ‘boots and fists’ that I experienced when I was a young man growing up in London, but it is nonetheless real. One of the reasons I enjoy working with the NHS Leadership Academy is that so many people there seem to ‘get it’ around equality and inclusion. Moving towards a more meritocratic system is a mighty challenge, but giving people the language to talk about these matters, balancing the creation of safe and challenging spaces for discussion, every individual taking personal responsibility as a citizen (not just at work) to do something practical to improve things; that can all help. In a way, I think that the NHS is like a microcosm of England itself—simultaneously really good at dealing with some aspects of equality, diversity and inclusion, but still unsure about others.

The patient perspective is central to both the Anderson and Bevan programmes. All participants see and hear from patients on the very first day of the programme, and the stories they hear from the patients carry such power, such resonance. We run a session at the first residential called ‘What do I care about? What do others care about?’ where we ask people (working within safe, small groups) to bring a picture of somebody that they care about and tell a patient story that is rooted in health or social care. It’s a powerful thing to do, which requires careful and highly skilled facilitation, but almost every participant recalls and cites that patient perspective when they complete the programme.

My wife was diagnosed with breast cancer when we had a very young family. Before that, I used to get so nervous about work related matters. I’d spend my commute rehearsing presentations. But then when you’re holding your little girl, and the Consultant is himself trying to hold back tears as he gives your wife the diagnosis…after that, how could I ever get nervous about anything at work? What could anybody say or do to me that could be worse than that?

While my wife was unwell, I took a career break. She had a lot of treatment that was both life-saving and life-changing. She was a patient at the hospital where I worked – I suddenly saw clinical colleagues with whom I’d worked using their professional expertise to save a life in the most personal of contexts. Out of terrible depths can come liberation. When I returned to work, humbled and altered by the intensity of the patient experience, I started to blend academic work with my NHS roles.

Something that both Judith Smith and Justin Waring said to me still resonates: in the work that we do at HSMC, and in particular the work with the Academy, having credibility from time spent ‘in the field’ is invaluable. When you’re working with senior executives, what matters most to them is that you understand their world. The hybrid of vocational experience and some academic heft is a powerful combination, especially in applied subject areas. Of course, I’m interested in pursuing a PhD when the time is right for me, but would I trade twenty years NHS experience for a doctorate? I don’t think I would.

If I could, I’d change the NHS in many ways, and I’d start with eliminating the elitism in health and social care. I’d reward people not for their social class, colour, or connections, but for the individual value that they bring and the impact they have on others.

I’d improve the NHS by rebalancing it as a true ‘health’ service rather than just a ‘sickness’ service. I think that was the original Bevanite ‘cradle to grave’ vision.

Finally, I’d love to end the misconception of leadership and management as ‘administration.’ While administration is vital, management and leadership are highly developed relational skills that massively impact on patient experience and clinical outcomes. Health and social care managers matter.

Steve has recently published A long and winding road: non-traditional routes into medical leadership in BMJ Leader, and a chapter on Impact, response and reflection: COVID-19 and health policy in the book Living with Pandemics: Places, People and Policy.