Following Gloucestershire Hospitals NHS Trust's announcement that CEO Deborah Lee would stand down in March 2024, FEP Director Ian Mean MBE sat down with Deborah to reflect on the past few years.
Faced with a huge black hole of £43 million in the finances of Gloucestershire Hospitals NHS Trust when she took over eight years ago, Deborah Lee’s leadership and inspiration, supported by her executive team and newly appointed Chair, nursed the county’s largest employer back to good health.
Deborah,60, suffered a severe stroke in August 2022 and had surgery for a hole in the heart. However, she was fortunate to make a full recovery which she attributes to the incredible expertise and care she received from the NHS. Two years on, she has now stepped down as Chief Executive of the Trust.
Ian Mean, Gloucestershire director of Business West and former editor of the Western Daily Press, posed some big questions to her about the state of the NHS.
What were your first thoughts, when only weeks into the job, you found that there was a huge black hole in the finances at £43 million?
“I had a very strong inkling that all was not right before I took the job – as you’d expect, I’d done my own due diligence and all didn’t appear as it should. There had been a significant reduction in the cash balances on the balance sheet with no obvious explanation. I had previously had a boss who’s favourite phrase was “cash is king” and she was right!"
“I was however surprised by the scale of it. I was shocked by the obvious distress the organisation was in; staff were unable to get supplies as invoices were not been paid on time or, in some cases, not at all. When the issue was surfaced, we were just a week away from not being able to make the pay run. Thankfully, we were able to access interim financial support although that came with being put into the “financial special measures” regime. We were back on track by year three and have delivered the financial plan every year since."
Is the NHS in crisis?
“It’s not a word I like to use but, without doubt, the NHS is going through a period of intense difficulty, which is immensely challenging. However, there are still great people doing great things everyday and many, many opportunities ahead. I have always tried to lead with a “cup half full” mentality and to seek a way through the challenges rather than be subsumed by them."
“What concerns me now is that many of the current problems intractable and recovery will take many years – there is no silver bullet to the many challenges facing the NHS."
“The NHS has faced something of a perfect storm. We came out of the pandemic with people exhausted both physically and emotionally, demand went up as the people who had not been able access care came back into the NHS with many of them very sick and the pandemic also led to lots of self-reflection with some staff deciding to put family and self above work – understandably peoples’ priorities changed and it put life in a different perspective."
What’s your view about how social care and public health could be prioritised differently so the NHS can do its job better?
“In my view, no Government has tacked the reform necessary in social care – it’s certainly not easy and it will require cross-party working. I am a great believer in a strong social fabric for society and I do think we are fortunate in Gloucestershire to have some very forward-thinking people both in health and social care. The NHS is an incredible institution and, in my view, should remain free at the point of delivery. There is no doubt that the current challenges, including long waiting times, mean patients cannot access always care of the right quality and staff are rightly concerned that they cannot always deliver care to the standards they would like. However, I am incredibly proud to have had the opportunity to be part of the NHS for most of my career.”
“I am always at pains to remind people that our NHS is world leading in so many regards and our primary are services are the envy of many other countries. It’s also a very cost effective model of care when you look at other developed countries. l am an advocate for higher taxes and greater investment in public services but I absolutely recognise that with investment must come a commitment to reducing waste and increasing productivity and I see this an a primary obligation for those of us leading the NHS – we must be and “investible proposition” if we are to continue building an NHS fit for the future that we can all be proud of. Is saddens me that satisfaction with the NHS in 2010 was 70% and is now less than 20% despite the huge efforts of so many."
"Although much of my career has been in acute hospitals, I think the focus of future investment should be in out of hospital care and social care, with a focus on prevention and maintaining independence. The evidence for this kind of investment is very strong but the lead times for the benefits to come to fruition are typically long and therefore not always attractive to those making investment decisions who are often tasked with improving the here and now. I think the new Integrated Care Boards (ICB) are a fantastic opportunity to address this."
Why are ambulance handover times/queues longer in Gloucestershire than other parts of the country?
“It’s multi-factorial and not for the lack of trying by every part of the One Gloucestershire system – we had periods of good performance but then events would de-rail us such as building works, increases in demand, staffing shortages or rises in number of people waiting to be discharged from hospital. If you can’t get someone out of the back door you can’t get a patient in the front door and the result is queuing ambulances – it’s as simple as that but has proven to be far from simple to fix."
“Ask any patient and the vast majority would prefer to return to their own home. For the family, it’s not always so straight forward as inevitably some of that responsibility does fall back on them which, if you work and/or have family commitments isn’t easy. I do think that we need to properly reward carers for what they do – the costs of that would be a fraction of the cost of a nursing home for example and probably more satisfying for everyone involved."
What about the tweet you sent out personally after your husband had taken you to hospital following your stroke at home?
“Fair to say, it got a mixed response! That said, I don’t regret it and, despite some views, it was a considered tweet. As a leader, who has always tried to lead with integrity and authenticity, I felt it was an opportunity to shine a light on an important issue and I would have felt disingenuous has I not spoken up. There was a view that I was “having a pop” at social care and the ambulance trust which, for anyone who took the time to read the tweet, would recognise it was anything but that. I was truly blessed with my outcome thanks to the NHS, but it could have been so very different if my husband hadn’t recognised my symptoms and taken it upon himself to drive me to A&E – if I had waited for an ambulance, I would most likely have suffered significant disability that I would now be living with for the rest of my life. My point was, not everyone has someone who can act as my husband did, and they shouldn’t need to have."
Deborah’s tweet is below
“It was on a Friday in August 2022 that I had a bit of a turn-lopsidiness and unable to speak. Having heard me lamenting ambulance delays, my husband put me in his car and drove me to A&E. From start to finish the NHS serviced me with pace and kindness."
“The one thing I can’t get out of my head is if my husband hadn’t been there at home. Through no fault of its own, the South West has the worst ambulance service than anywhere in the region. I don’t have the answer but government has the power to generate one starting with an overhaul of social care, training, development, pay reform and professionalisation of care workers to build a service that people want to join and feel proud to belong to."
“Care in the communities around people’s homes- not just when they crumple but truly preventative care."
“So, that tweet was a call to arms to government . My husband went to call an ambulance and thought then is it going to take hours? He knew I had to get to hospital very quickly to access the slot busting medication that would prevent gross disability and we were lucky to live not far from the Great Western Hospital in Swindon.”
There is continuing speculation about the future of Cheltenham General Hospital. What are the opportunities for the county’s two main hospitals?
“I really hope we have laid to rest any doubts about Cheltenham’s future with the recent investments - Cheltenham is here to stay without a doubt. I do understand the local feeling about Cheltenham but the reality is that we have two hospitals less than ten miles apart. Economically, and in terms of other scare resources including staff and equipment, it doesn’t make sense to do everything twice which is why we consulted with the public and staff on our Centres of Excellence model. I was delighted to see this paying dividends before I left particularly in the area of stroke care which we centralised at Cheltenham; we saw improvements in clinical outcomes, patient and staff experience and recruitment and retention following the changes."
“As a nurse you don’t come to work to treat patients in a corridor and there is nothing worse than coming to work with shifts not being filled or filled by agency staff on higher pay than you – these were just some of the issues we were trying to address through the changes.”
“I think people underestimate the importance of the working conditions for staff – the NHS hasn’t got this right yet in my view. You will likely have to pay to park your car; you may not get a proper break or have to eat on the go or at your desk or on the ward – if you work nights, you won’t be able to get a hot meal on your shift."
“Pay matters and I am a strong advocate for fair pay but I don’t think it is all about pay; staff feeling valued is as important, and to some staff the most important thing – this is something we were starting to tackle as I left and I know my successor is equally passionate about this."
What do you think your lasting legacy will be in Gloucestershire, and how many marks out of ten would you give yourself?
“Well my legacy will be for others to judge but one of the things I am most proud of is our first Care Quality Commission (CQC) Good rating— when I arrived the in 2016 the Trust was rated as “requires improvement” and always had been; we set out our stall to get a Good rating in the first three years, which we did. It was a whole Trust effort and I will never forget the cheers in the room when I announced it."
“I think we led well as a team during the Pandemic; it wasn’t an easy time for anyone and I will be forever grateful for the team around me at the time especially my Chair Peter Lachecki and Medical Director Mark Pietroni who were truly outstanding but there were many, many more unsung heroes. We got our best-ever staff survey results in the year that followed. I think at the end of that period, and putting modesty aside, given the challenges and this being my first role as a CEO, maybe 8/10 in those first five or so years."
"When I returned after my ill-health, I didn’t find it easy to come back and I felt that I had lost some of the previous momentum. There were some very real concerns coming through about culture that we needed to tackle but were making slow progress on. I have often wonder if we pressed people too hard during the pandemic – we were one of the few Trusts that kept most services going which benefitted patients enormously; I was told that we were the only Trust in the south-west who didn’t cancel a single cancer operation but in hindsight we expected a lot of staff – maybe too much. We also chose to continue with some pretty immense change programmes such as our digital journey, the construction programme and clinical service reconfiguration. These have delivered enormous benefits and are the things I’d reflect as my legacy but the journey wasn’t easy for everyone and perhaps we lost sight of the importance of culture and the value of our people."
What made you decide to step down after eight years?
“People assume it was related to my stoke but I didn’t have some big epiphany as many have assumed! I had always told my family I would step down at 60 and, when 60 was looming, it felt like the right thing for me and for the organisation and, whilst its early days, I have no regrets so far. I am lucky to have landed a role three days a week which is very exciting but gives me a great work : life balance. I thoroughly recommend!"
*Ian Mean MBE is chair of the Gloucestershire Organ Donation Committee and regional chair of the South Central division for organ donation