HSJ100: The wildcards

The wildcards will later this year form part of the overall HSJ100 list, when the judges will also select the 80 most influential and powerful people in healthcare, after the new NHSE chief is in post.

The wildcards are people who the judges — along with contributions from social media and the HSJ team — feel would not otherwise be among those invited to meet the new chief in their first few weeks in the hot seat.

They may be outsiders from the current health hierarchy, perhaps with a view which does not quite fit the standard narrative, or which comes from an uncomfortable or challenging perspective. Some will have tales to tell which will be hard to listen to: of NHS failings which caused harm or poor experiences which feel far below what they expected or deserved.

We have come up with a list of 20 (strictly 21 as there was one joint nomination) people who the new chief executive could call upon. We excluded the wildcards identified in last year’s HSJ100. We also specified that the wildcards should be alive and therefore able to impart their views. Other than that, our judges and readers had free range to nominate anyone.

The remaining HSJ 100 – the top 80 – will be published in the autumn, when the new chief executive is likely to be in post.

Welcome to the HSJ wildcards.

Anne de Bono, president, Faculty of Occupational Medicine

Dr de Bono has been influential during the covid pandemic for her advice on staff and workplace protection and the whole staff risk assessment testing. But the new chief executive might well want to listen to her on the importance of occupational health going forward – a conversation which is likely to include discussion of the impact long covid could have on the NHS workforce, as well as some of the psychological effects on staff of working through a pandemic which claimed the lives of so many patients and healthcare staff. In her day job, Dr de Bono is a consultant occupational physician at the University Hospitals of Leicester Trust, where she has developed an occupational health service for 35,000 NHS staff and students.

Stephen Chandler, president, the Association of Directors of Adult Social Services

If social care sneezes, the NHS will catch a cold. But despite the importance of social care, some of our judges thought that, alarmingly, ADASS may well not have the ear of the incoming chief executive. Mr Chandler, the director of adult and housing services at Oxfordshire County Council and Cherwell District Council, would be the man to ram the messages home about the need for action on the longstanding issues around social care. The NHS has its own role in supporting unpaid carers, and the care system more generally — where it could do much, much more — as well as carrying on the fight for meaningful social care reform. 

Caroline Criado Perez, writer

The world is designed for men and that is as true of healthcare as of other sectors. Ms Criado Perez brutally laid that bare in her book Invisible women: exposing data bias in a world designed for men which showed how women lose out in many ways – from their chances of being misdiagnosed after a heart attack to medical research modelled around men as the default. She has pointed out how PPE equipment is made to fit men’s dimensions, leaving women with the problem of ill-fitting gowns which could be fatal in the covid pandemic. Women’s outcomes in the UK lag European comparators further than men; and the issue is rising up the agenda: even the Department of Health and Social Care has been calling for evidence on the topic. So the new chief executive might want Ms Criado Perez to get him or her up to speed on the issues.

Mary Dixon-Woods, professor of healthcare improvement studies, Cambridge University

The NHS spends a lot of money on unproven, unevaluated interventions that fail, after costing considerable amounts of money, or successful ones which get forgotten when leaders change. The new chief executive might want to ensure that this does not continue – and Professor Dixon-Woods would be the person to tell him or her how to do it. She has spent much of her distinguished career trying to put some decent evaluation behind quality improvement. She is co-editor-in-chief of BMJ Quality and Safety and has a special interest in the ethics of quality and safety. If the new chief executive were ever to decide that all central initiatives were properly evaluated, it might well be because of her influence.

Clenton Farquharson, chair, Think Local Act Personal partnership board

Mr Farquharson is disabled, with lived experience of health and social care. He is passionate about co-production and the need for change in social care, and has also looked after his mum’s personal budget. Senior leaders rarely hear from people whose life experiences fall outside their world view, he says, and therefore those marginalised by society don’t have their voices heard. But at the same time he sees the pandemic as having offered an opportunity for people to come together and create fairer and more inclusive public services. As a black, disabled man his practical experience of combatting inequality and exclusion is a compelling story the new chief executive ought to hear. 

Rob Galloway, A&E consultant, University Hospitals Sussex Foundation Trust

Getting and keeping the workforce the NHS needs will be a major challenge for the new chief executive. In a global market for doctors, keeping juniors engaged and satisfied with their work – especially in high pressure areas – is very important. Dr Galloway has developed innovative approaches to juniors’ rotas, including self-rostering and annualised hours, and roles, such as clinical fellows, with time away from the coalface to do special projects. He is not the only one who has done this – Dr Linda Dykes did something similar in Bangor – but his work is one of the ways to retain juniors who might otherwise head for Australasia. Other areas of the workforce desperately need flexible thinking, too.

Dame Barbara Hakin, former NHS England deputy chief executive

“Those that fail to learn from history are doomed to repeat it” is worth remembering when taking up a new job. Leaders are often nervous of looking backwards – there can be a stigma about turning to the ‘old guard’ – but there are several very wise and experienced people who have seen NHS England from the inside but now moved largely out of the system – Dame Barbara left at the end of 2015. Several of the leading CEO candidates have little experience of primary care or commissioning but Dame Barbara has both, as well as perhaps unrivalled knowledge of NHS reorganisations. She also ran NHS operations for several years under both Sir Simon Stevens and Sir David Nicholson.

Poppy Jaman, CEO, City Mental Health Alliance

Poppy Jaman has worked on mental health and race equality for a couple of decades, including founding the Mental Health First Aid Programme. She now leads the City Mental Health Alliance, a not-for-profit organisation whose members include city firms, working on mental health in the workplace. For the new CEO, post-covid damage to mental health and the demand this brings is likely to loom ever larger and be tangled with the issues of changes to work wrought by the pandemic, and persisting racial health inequality.

Camilla Kingdon, president, Royal College of Paediatrics and Child Health

The RCPCH has often produced some fiery presidents – think Professor Neena Modi – and Dr Kingdon looks like being no exception. One of HSJ’s judges describes her as “meaning business” and, despite only taking up office last month, she has made waves already with an attack on the cuts in foreign aid which will impact on child health. She has a strong focus on the effect of inequalities and deprivation on child health and in areas affecting doctors. If the new chief executive needs their backbone bolstered when it comes to such issues, Dr Kingdon is the person to do it.

Gabrielle Mathews and Brad Gudger, NHS England and NHS Improvement Youth Expert Advisers

Children and young people make up a third of the country and have borne much of the brunt of the covid pandemic. While they have not been so vulnerable to the disease themselves, lost schooling and university experiences, together with insecure jobs and a high risk of being laid off or furloughed, have affected many of them. The mental health of children and young people – were it not a big enough challenge for the health service – has been further strained by the covid response. As experts by experience, who have gone on to do amazing things to amplify the voices of other young people, the new chief executive would learn a lot from Ms Mathews and Mr Gudger, not only about the transformation required, but also how to go about making it happen in an inclusive and inspiring way.

Ellie Orton, chief executive, NHS Charities Together

NHS charities have come to the fore in the pandemic, with support from the Sir Tom Moore appeal and many other sources, with substantial donations feeding through to the frontline with funding for everything from improved rest facilities to welfare cars for ambulance staff. Longer term, Ms Orton is leading the rethinking of the role of NHS charities to be more complementary to the work of the NHS and could give the new NHS chief executive a perspective of how NHS organisations can develop vibrant partnerships with people who have a passion for the NHS.

Gill Phillips, campaigner

The indefatigable Ms Phillips, who tweets as @whoseshoes, has been a leading force for personalisation in the NHS who encourages organisations to “walk a mile” in patients’ shoes. Her work focuses on improving care for some of the most vulnerable in society through co-production. As the NHS looks to provide increasingly personalised care, Ms Phillips could offer the new chief executive some good advice.

Marcus Rashford, footballer

If the new chief executive wants to think about the broader determinants of health, Mr Rashford is the person to turn to. His passionate advocacy of free meals for schoolchildren during holidays has made him a household name but is born from personal experience of poverty. But his message is a bit deeper than that: he has said “the system isn’t built for families like mine to succeed.” Like so many families, his was in poverty despite his mother working several jobs and he recalls falling asleep in class when he was hungry. As a black boy from a low income family, football eventually provided his way out of poverty but that is not an option open to many. Could the NHS – with so many of its component parts acting as anchor institutions in their localities and entry-level jobs with the opportunity of progression – play a part in offering that leg up to other kids?

Derek Richford, grandfather and campaigner

Several people commented that NHS chief executives need to hear from harmed patients and families: Mr Richford has an extraordinary tale to tell of how his forensic attempts to find out why his grandson died a week after his traumatic birth led to the uncovering of massive failings in maternity services in East Kent. Regulators and commissioners seemed largely unaware of this, and it is only through Mr Richford’s efforts that there has been a court case and an ongoing independent investigation. The difficulty of getting to the truth was only matched by the grief suffered by his family.

William Roberts, head of health and social care, the Innovation Unit

Mr Roberts was described as “very thoughtful in both his professional and personal capacities and perhaps not as high profile as he should be”. A former NHS staffer, he returned to work in the NHS during the pandemic and saw some of the changes being made. But with the perspective of distance, he is now ideally placed to talk about how to transform this into usable policy and learn lessons from this – both in the NHS and in the development of a better, more sustainable, social care system. His is a quietly authoritative but challenging voice which the new chief executive could learn from.

Charlie Sharp, consultant in respiratory medicine, Gloucestershire Hospitals Foundation Trust

Dr Sharp works locally and nationally on service transformation. He is interested in implementation science and has transformed the respiratory pathway, including developing a virtual covid ward in partnership with all parts of the system and an innovative approach to respiratory outpatients, designed to cope with an inexorable rise in patient numbers. Locking in service improvement and innovation is a ‘must do’ after covid. These are not issues unique to Gloucestershire and there are lots of people doing this work, embedded in communities across the country, but Dr Sharp would bring the new chief executive an understanding of the best type of local leadership improving services for patients in true partnership.

Duncan Shrubsole, director of policy, communications and research, Lloyds Bank Foundation for England and Wales

Mr Shrubsole understands the charity sector and particularly the role of small charities delivering services for people with multiple disadvantages. These are the people with the worst life experiences: they find statutory services difficult to access and statutory services find them hard to deal with because of complexity and overlapping needs. Small charities provide much of the services but are challenged by some current attitudes and practice towards them. If inequality matters then the new chief executive needs to reflect on this. Mr Shrubsole understands better than anyone how this plays out in practice and could articulate what needs to be done.

Gareth Southgate, England football manager

Once in a while the new NHS chief executive will need to rally the troops, presenting them with a vision they can buy into and fight for (metaphorically at least). Where might he or she look for inspiration? Forget Henry V on the night before Agincourt or even Aragorn outside the Black Gate and think instead of Mr Southgate. In his letter to “England,” he managed to combine patriotism, inclusivity and an outward-looking view that recognised that the country has changed and will continue to change. And he acknowledged that, in the time of covid, maybe football is not the most important thing. If his management career goes AWOL after the Euros, there’s a job for him as a speechwriter.

Greta Thunberg, campaigner

Sustainability has come back on to the NHS agenda in a big way over the last couple of years with trusts and integrated care systems working on plans to become carbon neutral by 2040. The new chief executive might like to talk to Greta Thunberg, the 18-year-old Swedish environmental campaigner whose efforts to change the world started with her parents’ lifestyle and ended up at the United Nations. She doesn’t compromise – and the older generation do not escape criticism – so it may be an uncomfortable conversation. However, Ms Thunberg is speaking for many of her generation who fear they won’t inherit the earth if organisations like the NHS don’t take climate change seriously enough.

Dame Julia Unwin

Dame Julia is a stalwart of the voluntary sector and served as the chief executive of the Joseph Rowntree Foundation for many years. But it is her work on the importance of emotions and relationships — as much as rational calculation and hierarchical management — which means she should be talking to the new chief executive. She has written of the need to acknowledge the trauma that has been experienced by so many during the pandemic and to think about shared priorities. As the chair of the Independent Inquiry into the Future of Civil Society and as a Carnegie Fellow author of Kindness, Emotions and Human Relationships: the blind spot in public policy, she is ideally placed to help the chief executive understand the importance of the right emotional climate for recovery.

Also read:

The 20 ‘wildcards’ the NHS’s new bosses should listen to

The next NHS CEO will have much to learn from the diverse voices of the HSJ100 wildcards