Deborah Lee leaves her role as Chief Executive of Gloucestershire Hospitals this month, which means she is also stepping down as a Board Member of Health Innovation West of England, a role she has held since we were first licensed as an AHSN back in 2013. We caught up with Deborah recently and asked her to reflect on her career to date with the NHS and her time as a Board Member.
Tell us about your time working in healthcare.
I trained as a general nurse in the early 1980s and qualified and registered, but then within a few months of finishing decided to go to university to read economics and subsequently did a diploma in Health Economics. I was the first in my family to go to university and it wasn’t something I’d originally even considered. I was lucky in that I was able to practice nursing for the three years whilst at university, doing bank and agency work at the Queen Elizabeth Hospital in Birmingham. This gave me a good understanding of what it’s like to be a staff nurse, although I wouldn’t ever describe myself as a career nurse, and it fuelled my passion further for a career in the NHS, albeit not a nursing career.
After my degree I moved into NHS general management and operational roles and spent a fair bit of my more senior career in commissioning organisations.
I also had a brief foray into the pharmaceutical industry in the late 1990s and worked for Pfizer for about three years as a health economist and NHS policy advisor. I think that’s what shaped my interest in the AHSN model because that wasn’t just about health and the NHS, it was also about wealth and income generation and working differently with industry and commerce. For many years, I was the only NHS chief executive that had worked in pharma, although I now understand there are two of us!
I then came back to the NHS and my first senior commissioning role in 1999. The transition back wasn’t easy and it took me almost a year to find a role. My time working for Pfizer was a very positive experience; they invested in my professional development and the exposure to more commercial ways of doing things has been invaluable, not to mention a very smart company car! However, colleagues in the NHS often viewed this experience with scepticism and I remember at one interview, someone asking me why I wanted to come back from the “dark side”. In 2011, an opportunity for a secondment came up at University Hospitals Bristol (as it was then, before Weston joined) and I decided to apply for it. I was becoming a bit disillusioned with commissioning and the Lansley Reforms that were being proposed. I made the move and within weeks, I really felt that I had found ‘home base’ and have worked in acute hospital care ever since.
I’d enjoyed my time in commissioning, but there was something about acute trusts that really put a fire in my belly. Initially I worked as a director of strategy, planning and performance, and then subsequently as a chief operating officer and deputy chief executive.
I spent about five years in Bristol in those roles and then came to Gloucestershire in 2016 as a chief executive for the first time. Those that have followed my career, will know it was a very tumultuous first few years but, being someone never to shy away from a challenge, I threw myself into it and achieved some pretty positive things over my seven and a half years. Leading the organisation through the pandemic was the most challenging thing I have ever done and something I reflect on as a huge privilege. And it’s from this role that I’m now handing over the reins to Kevin McNamara.
What would you say is the role of innovation in the NHS?
How we perceive innovation in the NHS is quite interesting. Often, we think about innovation as something that is novel, makes a big impact and has a big wow factor. But in the NHS, I think innovation in practice is more about iterations and developments of existing practice, rather than simply introducing something shiny and new.
The ambition of the AHSN in the early days was to get lots of clinicians innovating and supporting them to patent their great ideas and generate income for their organisations through commercialisation, intellectual property and all of that. There are trusts who truly innovate and have patented their ideas and products, but they are small in number.
The reality is that, in my experience with the AHSN, it has been more about the adoption, spreading and embedding of good practice because that’s something that the NHS struggles with. We know what’s the right thing to do, but to get everybody to do it consistently and reliably for every patient is the hard bit. There are numerous technologies and advances in medicine that have a cast iron evidence base but can take years, even decades to roll out consistently. Thrombolysis in stroke care is a good example, which took more than three decades from being proven to be an effective and life-saving intervention to being in routine use (and one that went on to save me from possible death and significant disability).
For me, the real added value of the AHSN has been that it’s identified some key issues and developed robust and focused projects in those areas, and supported trusts to roll them out to a high standard. From that we’ve seen some very significant improvements in outcomes as well as patient experience.
I think the AHSN, now Health Innovation West of England, is in the business of transformation alongside innovation. Some of the most impressive transformations I have been involved in, have been the result of a number of smaller, transaction changes which when implanted together and consistently transform outcomes for patients.
Whilst you were at University Hospitals Bristol, you were part of the original team who developed our local bid to establish the West of England AHSN. What are your memories of that time?
I worked closely on the bid with Sally Pearson, who was the Director of Strategy in Gloucester at the time, and Deborah Evans who had been my chief executive when I worked in the Primary Care Trust, and who of course went on to become Managing Director of the new West of England AHSN.
The AHSN concept was very new, and we pitched our bid with a large amount of uncertainty as to whether it would actually be successful. It was such an exciting ‘sell’, but I don’t think we could really foresee how it would play out in the NHS in day-to-day terms. It did feel like a bit of an experiment but if the vision could be realised, it was very exciting. That’s what spurred us on.
It felt the first time the NHS was recognising and embracing the contribution of healthcare to the wealth of a place, and the idea that you could improve the outcomes of patients and develop innovations and novel solutions in partnership with industry and other sectors.
The NHS was traditionally quite inward looking. It didn’t work easily with partners or with industry, so that felt like quite a new direction of travel. Having spent some time working in pharma and understanding how industry works, I could see that making a profit and helping people are not mutually exclusive, and that was something that chimed with me when we were putting in the original bid for the AHSN.
How do you think we are doing against those original ambitions?
We’ve made huge progress, but I think the vision has also evolved over time.
When I think about the AHSN, and now Health Innovation West of England, what stands out are the areas of work where patients have benefitted from the rollout of good practice. We’ve been successful in bringing good practice to bear on services and particularly in working with services where there’s demonstrable need and room for improvement. I’m proud of programmes like PReCePT to improve outcomes for premature babies, the work we’ve done through SHarED to better support high intensity users of A&E services, and our work to reduce surgical site infections through PreciSSIon.
Health Innovation West of England has been brilliant at capturing the interest of clinicians in a way that often, and I use this word loosely, quangos or arm’s length organisations often struggle to do.
Equally, we struggle in the NHS and in acute trusts in particular to engage clinicians as they are incredibly busy, but Health Innovation West of England has managed to persuade and enthuse clinicians and is responsible for encouraging a number of clinical leaders to come on board. For me, that’s your ‘USP’.
How have you benefited as a Board member?
I’ve always sought out opportunities to encounter people from outside my patch. Health Innovation West of England has been an opportunity for me to engage with the wider region, to engage with people that aren’t doing my day job and aren’t immersed in acute care. I’ve particularly enjoyed working with those board members who are non-NHS, who bring a different approach, a different set of experiences, a different curiosity.
I’ve always felt really valued as a board member and I know the team has worked really hard on building those relationships and to accommodate the different styles, requests, and levels of engagement. My own engagement has come and gone over the years due to the timings of the meetings but despite that I’ve always felt a strong connection to Health Innovation West of England. It’s managed to do something that’s not always easy. I can think of other networks that I’m associated with, and they’ve not quite achieved it like Health Innovation West of England. There’s a lot of good feeling towards the organisation from the NHS locally.
Looking to the future – what would be your challenge to Health Innovation West of England?
In terms of priorities, it can feel like the NHS is all about urgent and emergency care (UEC). I think that Health Innovation West of England’s strength has been its ability to pay attention to things other than UEC.
My parting wishes would be that Health Innovation West of England continues to focus on the things that are important, where there are massive opportunities to improve health outcomes and experience for patients, but that aren’t the ‘usual suspects’ when it comes to national and regional attention.
If you work in hospital management, such is the impact on patients and staff, you begin to obsess about A&E waiting times, people queuing at the front door, people that can’t get out the back door and it becomes all-consuming. When I see the things Health Innovation West of England is working on, it’s so reassuring that there’s an organisation creating this sort of headroom to look at things that are just as important, but don’t always get onto the urgent list.
My challenge to Health Innovation West of England would be to keep doing what you’ve done in the way you do it; hold your nerve and don’t get sucked into some of the day-to-day pressures. In this way, you can continue to ensure the important sits alongside the urgent.
And finally, what’s next for you?
Although I’m stepping down as Chief Executive in January, I’ll be with Gloucestershire Hospitals until the end of March on a part-time basis alongside a new role and from April, I will be working just three days a week which, I have to confess to being pretty excited about!
I’ve reflected on the things in my career that I have enjoyed and what would allow me the sort of work-life balance that has evaded me for the last two decades. And so from April, I’m going to be Programme Director for a brand-new hospital build in Cambridge, so something very tangible. There’ll be lots of work with clinicians to develop the clinical strategy: it all starts with the services, in terms of service design, and the buildings will follow. I think the role is a bit more ‘containable’ but also fun and meaningful, and in the context of the NHS right now, it’s really something quite positive.
So, I’m really looking forward to focusing on that for the next few years and will be sure to look out Health Innovation East when I arrive!
Posted on January 17, 2024
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