How do you solve a problem like NHS workforce planning? Ruth Robertson speaks to Dr Navina Evans CBE about her leadership journey – from starting out as a psychiatrist, to becoming NHS England’s Chief Workforce and Training Education Officer – and the opportunities and challenges of the NHS Long Term Workforce Plan.
Definitions of the acronyms used
ELFT – East London NHS Foundation Trust
ICBs – Integrated care boards
ICPs – Integrated care partnerships
RR: Ruth Robertson
NE: Dr Navina Evans CBE
RR: Hello and welcome to the Kings Fund Podcast, where we explore big issues and ideas in health and care. I’m Ruth Robertson, a Senior Fellow here at The Kings Fund and today I’m delighted to be joined by Doctor Navina Evans CBE, now the Chief Workforce and Training Education Officer at NHS England. But I’m sure many of our listeners will also know you through your successful career in the NHS. Looking back to the start of your career Navina, one organisation was particularly central, the East London NHS Foundation Trust, starting out as a psychiatrist, you progressed onto a range of roles within the Trust, from clinical director and Chief Operating Officer, up to Chief Executive.
Throughout your career, we can also trace one key part of your mission, which you’ve described as working towards the creation of a bigger, more inclusive workforce. I’m really looking forward to reflecting on that journey with you, today during the episode, there is a lot for us to discuss. So, welcome to the podcast Navina.
NE: Thank you Ruth, lovely to be here.
RR: It’s great to be here with you and I wondered if I could start by asking you a bit about your leadership journey so far, what has that journey looked like and from your perspective, where did it start?
NE: So, I think I have to go back to my childhood really because I did not grow up in England, I am an immigrant, I am a woman of colour and I grew up in Malaysia. I remember at the time, being really drawn to the idea of altruism and a health service, free at the point of delivery, accessible to all. I remember learning about it and it seemed like such an amazing thing that existed. I came to school in England and then I went to medical school and then I stayed here and now I am British and I’m very proud to be British. I gave up my Malaysian citizenship to become British.
ONE: of the things that makes me particularly proud about being British is the NHS and I feel so privileged to have had the opportunity to have influence at so many different levels, right the way through my career to get to where I am now. As you said, just to summarise, the key thing for me was always an interest in the power of what people can do, social movements, people coming together to make change, that is, I think what also drew me to psychiatry as a profession as well, because it really was about people, behaviour, communities that can really help, even if you have got a severe illness, mental illness, there are so many other factors that can improve your quality of life. So, it’s been a theme throughout for me.
RR: And how powerful to have had that perspective of seeing the NHS from the outside and admiring it and then being able to come and lead and have this as such an important part of your career?
NE: Totally, I pinch myself, I seriously do, every day, I wake up and think is this a dream and it’s all going to be over but it’s not, it’s real and it is a huge privilege.
RR: I just wonder, as you’ve been going through your journey of leading in the NHS, are there any of those lightbulb moments that stand out to you, moments of particular learning that have really impacted the way you work?
NE: Yes, there are, definitely and I think they are all points at which I’ve had to change my mind, which I always find really interesting, one I think is the impact that patients and their families had on my thinking and I can share with you a story of how … we would have case conferences where we would bring together all the professionals involved in the care and support for a patient and their family. It was a patient who I was really closely working with for a number of years and at that case conference, she and her mother said to the group, I really don’t understand my treatment, I don’t understand the diagnosis, the problem, the treatment.
I was really taken aback because I had spent so long with them and the thing that I realised was that actually I was not speaking or what I was saying, the way I was communicating wasn’t connecting. That was a real lightbulb moment for me, to think, well how come I have had this close relationship and yet, at that moment in time, they were really quite puzzled and confused about what was going on. I took that very personally and really had to think about it.
RR: I wonder if I can move on to ask you how you would describe your leadership style, do you think about yourself as having a leadership style?
NE: ONE: of the things that I’ve been really lucky in, I think coming from a background in psychiatry and mental health is the power of reflection and it’s always been incorporated in my training and I have had psychoanalytic training, I have had my own therapy as part of that and I have always used a mentor and a coach and I’ve been very lucky in that they have always been people that have not let me sit in the nice comfortable cozy space. They’ve always been people who have pushed me to look at things differently and actually one of the enduring habits, I think is keep asking myself what can I do differently because it’s quite easy to slip into thinking, oh well if only that was different and if only so and so would behave differently and if only this organisation was doing this and if only they would do that.
You externalise things but actually the only person that I can control is myself, the only behaviour that I can really control is myself. So, I think for me, the leadership style does keep coming back to, if it’s not connecting … it comes back to that story with that patient, if I’m not connecting, what should I do differently. If it’s not making sense to people, what should I do differently, that’s the first thing, I think. The second area for me, I think is, I really try hard to constantly be curious and to go into the places that make me feel uncomfortable. The third is I really want people to feel comfortable in having a dialogue with me, I think really spending time thinking with people, there is always a way.
RR: You hinted at this a bit earlier but I can see that you’ve had at least a couple of big changes, moving from being a doctor, to then a manager and then most recently, from running a Trust, to developing national policy. To me, they sound like quite substantial changes and maybe moving away each time, from things you’re quite personally invested in. I wondered if you’d share anything on how it’s been, going through those changes and how you face them?
NE: At each stage, yes, you’re right, going from being a clinician to being a manager and then from a clinical manager into being operations. I went into operations, I wasn’t a medical director, which would have been the more natural course. At each stage, I think always making a, what are the things I need to learn and then never being afraid of asking people to teach me. So, when I started as Director of Operations and then Chief Operating Officer, I had to have lessons from our finance team on what do you look at every day, every week, every month in your budget, what are the right questions to ask your operations manager, your beds manager.
All of those things, I had to learn and people are very generous with their time to help you to understand things and similarly then, when I became a Chief Executive, learning again, what it means to be an accountable officer, what are my responsibility, how to be more strategic and not want to fix everything yourself. Then moving into the arm’s length body world, where I’ve never been further away from the point of care, which is where I feel really comfortable. So, to maintain the connection with the people we serve and that common purpose. I think that’s been really challenging but also really rewarding in the development of the long-term workforce plan.
RR: You know, it’s so striking at the moment that you and Amanda Pritchard are both in very senior positions within the NHS, to have you both as role models is, I know an inspiration for many. I was wondering if you have any advice you give to people within the NHS who are facing racial or gender barriers, to career progression?
NE: Yes, of course, yes, absolutely it is something I have experienced and actually I think I still do, one of the sad things is that you might get used to it actually or you over-compensate for it and I think if you speak to a lot of ethnic minority colleagues, women, people with disabilities, people with protected characteristics basically, our LGBTQ+ colleagues, they will all have stories of what it feels like. It’s tiring and it’s weathering and it’s really hard work, however I do feel …well from my perspective, I have always felt you can’t let it get you down, now that’s easy to say but its very much part of how I think and how I work every, single day.
Because I’ve got to the position I’ve got to, I’ve got to use my power and my voice. I hope I’m doing that effectively and I can certainly do better. What advice would I give people? The constantly being aware of it, talking about it, helping people to understand, looking for your allies. Now allyship is interesting, it’s not something that I believe that people can self-assign but I think that you define who your ally is and I think they are around us, there are many around us and I think we should reach out to them and keep going, it’s a lot better than it was. But we do have to keep going at it.
RR: And you’ve written previously about the importance of inclusive leadership, did your time working in East London shape that outlook?
NE: Yes, it certainly did, it really did shape that outlook, so we talk a lot about inclusive leadership, I think of it in a number of ways, there is the right thing to do of course, to be inclusive, I mean I can’t understand how one can make an argument for not being inclusive, it seems quite strange but then there is also something about, we need to get the best out of everybody and equity, diversity, inclusion is for me the core of how you get the best out of everybody. If you look at the constitution of the NHS, it’s an imperative upon us all to do that and again, we have workforce challenges, we have financial challenge, we have to think about quality, we have to think about waste reduction, we have to think about population health and reducing health inequalities.
Everything there has a thread of where the solution is, the thread is, inclusion, whether it’s about patient care, whether it’s about access or whether for me, my focus is now staff, of course. It’s just central to everything that we do but it’s hard to do because it requires the ability to … it’s the people’s skills to release that potential, which is why I think it can be a little bit challenging and daunting for all of us.
RR: I think we all know recently; strikes have led to a lot of conversation about staff wellbeing and workforce retention and I just wondered when you were at East London, what did you learn about what works to establish a culture that really encourages people to stay. It feels like something that we really need to be focusing on at the moment.
NE: Yes, Ruth, so retention forms a big part of the long-term workforce plan, there are three areas that we talk about there, growth and recruitment, retention and reform and people talk about the leaky buckets and I think absolutely, over the last ten years, we’ve traiNE:d record numbers but we have not been able to keep or rather people coming in but there are a lot of people leaving or retiring or wanting to do things differently or actually people who are not able to work because they’re unwell and the environment is very difficult.
So, actually retention is probably one of our biggest leavers in the workforce plan, it’s the most important thing and in NHS England we’ve started to do some work with some exemplar sites around you chunk down what the different interventions could be and you can focus on them in your own organisation. So, if I go back and I haven’t been in ELFT for a while now but ELFT, like many other organisations, you decided to have a focused look at what are the things that your staff are telling you will work for them.
I think that’s really, really important, what are people telling you works for them, things like flexible working, really important and it’s what people … people are telling us they leave and go and join agencies because it gives them flexibility, I mean of course there is financial … but flexibility is a big, big part of that. So, why can’t we recreate that experience for them, it’s a management conundrum, it’s a huge shift in the way in which you organise your rotas and your teams and everything. But it’s not impossible and if we don’t do it, people will vote with their feet.
So, that’s one example but the other is a sense of belonging and the relationship you have with … people talk about the relationship with their line manager being the most critical thing that makes them stay or leave. The final thing I think I would say on this topic is, again we’re at a moment now, where people want to work differently and when we worked on Framework 15, developing the framework for long-term workforce planning, we spoke to a lot of people who were going to be the future workforce, not people like me, who are the workforce of the past, but the future workforce. They tell us they want to work to live, not live to work.
RR: We’ll return to the episode in a moment. Bringing together leaders from across the health and care system, our 2023 annual conference will explore how to ensure the system works for staff and the people who use health and care services. Join us in November to delve into the current and future challenges and opportunities for health and care. Follow the link in the show notes to book your place today.
Welcome back, let me move on then to focus on your national role and talk a bit about the workforce plan. You must have been extremely busy over recent months and building up to and following the publication of the NHS long-term workforce plan. I imagine that’s required quite a lot of personal leadership from you, to get it over the line, so huge congratulations. There has been a lot of reaction over the last couple of months and I wanted to ask you a bit about that, how do you characterise the response, is it what you expected?
NE: We wanted to make sure … I mean, look it’s historic, it’s the first ever workforce plan with numbers, looking into the fifteen-year timeframe as well. We had a scope, we were commissioned to be quite bold and I think we’re grateful for that but there were also restrictions on the limits, for example people are very clear that it doesn’t address social care workforce and that is true. I draw on the experience of being Health Education England which I only joined three years go and they were … it was part of Health Education England’s mandate, workforce planning was.
But my colleagues, who were in Health Education England were very clear that it’s always been difficult to get anything long-term over the line because it was … there were too many factors that got in the way and the fact that we were coming together with NHS England was really important as well. So, we could actually work closer to service, closer to the point of care, to make this a reality. We had a great time, we got lots and lots of people together from different parts of both organisations, we worked with other organisations, we had support from the Kings Fund, the Health Foundation, Nuffield, to help to almost, throughout the process, kick the tyres on what we were doing and be critical friends and challenge.
That was really, really important as well, working with professional bodies, with the education sector, with staff side, I could go on and on and on. So, it was a massive piece of work and it just feels like, because the pressure and the realisation as to how important workforce is, was such a …everything was aligned, as my father would have said, the stars were all aligned to get this done, So yes, it was huge and so many people made it happen, now it’s about delivery and almost immediately afterwards, lots of people were asking, what next.
So, when you asked about the reaction, if it wasn’t challenging enough, it wouldn’t have caused the whole varied reactions. On the whole, welcomed because we’ve got such a thing, so that was welcomed, then looking at the detail, some people were worried about how ambitious it was going to be. Can we deliver, that was a question that was asked, the reform space, of course reform always makes many of us quite anxious and nervous. So, we have to now work on supporting people for whom the reform might impact on them, their maybe professions, the institutions and it might mean something for them, that we have to address.
The final thing I would say is that this is a plan for the people of England and the workforce that we need for the people of England and I don’t remember ever actually being really open about the fact that we train, we grow, we recruit, we retain, we maintain standards for a very specific reason and that is, the care that the people of England receive. So, as an individual, as part of the workforce, that’s what we’re here to do, to serve, that’s the overarching principle.
RR: Another key strand in that plan is about the aim to increase staffing and capacity in primary and community services and I heard you speak, actually at our leadership summit earlier in the year about how you want to be looked after in your later years and what would work for you in the future. I just wondered if you wouldn’t mind sharing a bit more about that vision for being looked after in the future and what that means from a workforce perspective?
NE: Yes, so I think if I could summarise, sum it up, I think that again, in the work that we’ve done on Framework 15, we do address this a bit, looking way into the future and how important it is to have the concept of integrated planning and that we need to start developing scenarios for the future that helps us to think about that. So, what will services actually look like, what will the demand look like and what are the potential for services in fifteen, twenty, thirty years. Of course, we can’t be absolutely clear, the further out you go in time, the less clarity or less certainty there is.
But one thing we know, it’s not going to look the same as it is now and the example I use when I spoke was, I talked about my own multiple conditions which I will live with when I’m in my eighties and I don’t want to be in hospital. I don’t think I need to be in hospital and when I die, I want to die at home and I think that’s not an unreasonable thing to ask for. With that in mind, we all know that shift in service models, actually in our attitudes, our behaviours but also the compact with our communities will also have to change.
So, we need to start working on that now and again, we have a really great opportunity to do that through the ICBs and ICPs in their partnerships with local authorities. So, I think we have to start with what’s the service model going to look like, what’s the service plan going to look like and then from that, we can work backwards, what type of workforce do you need. Somebody said to me the other day, we’re probably training people who go to university now, in health and care, for jobs that don’t even exist yet, in thirty years’ time.
I think that’s really exciting, when you think about the possibility of new roles being developed because innovation, AI technology might release … will release the time for care for that human interaction, which will be different from the human interaction we have right now. So, that local planning and understanding your local population and being able to potentially predict future demand and work backwards, is, I think where we really want to go.
RR: Brilliant, thank you, we’re coming to the end of our conversation but I wondered if I could just finish by asking a bit of an overall question about the workforce plan really, it’s such a positive shift towards better long-term thinking in the NHS. What do you think is the biggest opportunity that presents for the future of health and care?
NE: So, I think this workforce plan, the opportunity is also the challenge, it’s the same thing. Its success will depend on all of the different parts doing their bit and coming together on this really difficult journey. It will require all of us to be thinking, behaving and working differently, every, single one of us, there is no question in my mind about that. That therefore is in itself a challenge, so the challenge is potentially too difficult to do and that therefore we can’t.
But I think if we can predict and have a good risk log and have good mitigations and really constantly keep track of it, I think we should turn problems into a to-do list. So, that would be my final point, I like to think, when I have a list of problems, they become the to-do list. They’re not the reason not to do things.
RR: That’s a fantastic, positive way to end the podcast, spinning our problems around and turning them into a list of areas we need to take action on. Thank you so much, Navina, it’s been wonderful to talk to you and I’m just struck by how lucky we are that you looked at the NHS from afar and decided you wanted to make your career part of making that service work and improve. So, thank you so much, it’s all we’ve got time for today, you can find out more about the NHS long-term workforce plan in our new explainer, which is linked to in the show notes.
The show notes for this episode and all the previous episodes can be found at www.kingsfund.org.uk/kfpodcast and you can get in touch with via Twitter or X as it’s now known, our account is @thekingsfund. The producer for this episode was Natalie Cleverley and it has been edited by Be Spoken Media. Don’t forget to subscribe, share, rate and review this episode wherever you get your podcasts and of course, thank you for listening, we hope you can join us next time.
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