System leadership viewpoints: Sue Page

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Sue Page is interim Chief Executive of Liverpool Community Health NHS Trust and has more than 30 years’ managerial leadership experience in the NHS. She has worked in London, where she became chief executive of a large acute hospital, and also spent 16 years leading Northumbria Trust. Sue subsequently held a role in the National Performance Support Team to help turn around low-performing hospitals and was formerly the Chief Executive of Cumbria Primary Care.

This interview is taken from our report on the practice of system leadership.

Do you see yourself as a system leader?

The odd thing is, I’ve never thought about myself as a system leader, but apparently other people tell me I am. But from the very beginning I have been interested in integrated care.

What are some of your experiences?

I was very lucky because as a very junior management trainee, I was buddied up with a young lady who was the same age as me and who worked for Kaiser Permanente in California. When she moved to Atlanta, Georgia, she was trying to run the Kaiser model, but with no ownership of hospitals, and trying to get the complete integration of services they seek. And we just continued working together, and it was very good to have an insight into an environment that was very different from the conversations happening in the NHS at the time.

So when I was working in Northumbria we were integrating out of the hospital with children’s services and elderly services, trying to avoid unnecessary admissions wherever possible, and trying to get completely integrated care from cradle to grave. All the leadership programmes were system-wide and everyone then did things together in a similar way and learnt to work together in a similar language. That’s how they learnt to trust each other.

For example, we had Sue Roberts, who became the National Clinical Director for Diabetes. She and others were helping people take control of their own disease, so that we could avoid unnecessary admissions and empower patients.

The clinicians were getting together in rooms and doing baseline clinical audits of their services, asking ‘what, in fact, are our clinical outcomes?’, and doing it with patients, asking them what does the service feel like? How would you like it to change? And getting messages like ‘we don’t like what you do’, ‘I don’t want to keep coming to the hospital to have my blood tested’ or ‘I don’t want pills for weight management, I want to understand my disease and control it, so refer me to a walking group, or whatever’.

So we gave the clinicians space to think and to change the recipe book for the service which they owned. I’ve seen some magic worked in those sorts of rooms.

Now I am told they are continuing to take that approach forward; integrating with social care and GPs, with referral systems to the third sector, and doing that under my successor who was my deputy. What’s been really important is the continuity of both clinical and managerial leadership in Northumbria over 25 years, which has led to fantastic clinical standards for patients and joined-up leadership at all levels in the local system, where people actually trust each other to take risks to make things even better.

So there is something about continuity… Doing the things that you’ve said you were going to do. Some managers go in and out of places too quickly. And there is something about making things work despite the system. But you have to be quite sure of yourself to do that. You’ve got to come in in the morning to do the right thing, and to make it easier for your staff to do the right thing. And that can be easy to say and hard to do.

When I was in Cumbria, I set a deficit budget even though the system above me was telling me that I shouldn’t do that.

I’ve always believed that if you do what is right for patients, the money will come right in the end.

Here in Liverpool I have a badge that says I am a chief executive and I control £140 million of resource for the population of the city and surrounding area. But put that power and resource in a room with all the GPs, community matrons, nurses and other community clinicians in Liverpool, and think what you can achieve. It is that old thing, ‘there’s nothing in this world you can’t achieve if you are prepared not to take the credit for it’.

So I see too many chief executives who see power as becoming bigger and bigger, taking more control, rather than spending their time giving control away. And by doing the right thing, the money will sort itself out. If you get the clinicians in the room, with the patients, get the right recipe books for care and the right journey to good care – and that includes social care – then the money will be used much more effectively. So you need the right debate, with the right data and the right information, and you get there.

In Cumbria, we started doing clinical commissioning before clinical commissioning became a national issue. So we gave the power to the GPs, and gave them leadership training so that they could go and have conversations with other GPs about how they needed to do things differently – but in a good way, not a blaming, shaming way.

What does the future hold?

As for the future, I never thought I would say it, but I would go back to the regional health authority days tomorrow. There are limits to how the current architecture can ultimately hold the system together. You have got CCGs and NHS England, and CQC and the TDA [NHS Trust Development Authority] and Monitor. So system leadership is very difficult.

System leadership does require different skills beyond line management. It means being able to take risks and do things which might be to the detriment of your organisation. And that is very difficult in the current climate.

The Forward View seems to recognise a lot of the current issues and actually sets out a really bold and credible solution to many of the problems that have beset the system.

Would I, however, want to be a young chief executive in the system now? Well, I was nurtured and trained by some really good people and I was very fortunate. But it’s a scary place to be a youngster. One slip and you can be in deep trouble. And when we appoint these new young chief executives to their first job, I really think we need to buddy them up, and have someone to help them.

When it comes to change, a lot of clinicians have said to me over the years, ‘well, we get to the planning stage and we get to the point where we have put all this effort in, and then nothing happens’. Because sometimes the system hasn’t always held the right people to account to get the change. I am sounding rather negative, which is not like me. I do have high hopes for the Forward View and the direction of travel Simon Stevens and others have set.

In Liverpool, this was a challenged trust, and I think we are really turning the corner. I think when the CQC come back, we will have improved. But it would be great if the system had a collective methodology to make these improvements. If we had a system where people could come to trusts on a similar journey and say ‘can we learn from this?’. I’m a big believer in peer reviewing, asking what has worked and what hasn’t, and can we learn to try to get other trusts that are in a difficult position pointing in the right direction? A collective methodology, and a system that enables change, had to be part of that.

Read the next interview: Thirza Sawtell >