‘Insular’ trust has to rebuild ‘hope’ and relationships, says turnaround CEO

The chief executive of a major acute trust has said performance problems caused it to ‘look inwards’ and described how it has been working to ‘build back relationships’ and give ‘hope’ to staff.

A year into the role of chief executive of Nottingham University Hospitals Trust, Anthony May – who was previously chief executive of Nottinghamshire County Council – said “all the [NUH] hospitals, because of their improvement and performance difficulties, were a bit insular”.

Mr May said he had seen similar insularity when he took over Nottinghamshire County Council, also in need of turnaround, more than 16 years ago.

In an interview with HSJ, he said: “My experience of working in large and complex organisations that have performance problems, is that they tend to become insular. I don’t think it’s an NHS thing…

“It’s a feature of large, complex public service organisations. When they’re under pressure, whether it’s money or performance, or in the NHS, it can often be both, that they do tend to look inwards a little bit.”

Mr May described how the trust has therefore done “an awful lot” in the past year to “build back relationships” with NHS England, local councils, health scrutiny committees, MPs, and – in particular – families who believe they were failed by its maternity services, and are now taking part in the independent review led by Donna Ockenden.

The trust has experienced a turbulent few years, first with major problems in emergency care performance; then being rated “inadequate” for its leadership and maternity services by the Care Quality Commission in 2021 and 2022. The high-profile maternity failings are now subject to what is thought to be the largest review of its kind, and Nottinghamshire police are also investigating what happened.

Mr May said the scrutiny had made parts of the workforce “really quite nervous”, and that he felt the organisation “needed hope”.

“We needed to give our staff something to be positive about and we needed a roadmap for the future,” he said, and to do this he launched the trust’s ‘People First’ strategy, after 3,000 conversations with staff, patients and others, during his first 100 days in post. 

Relentless approach to visibility

Mr May said he has been taking a “relentless approach to visits and visibility”, from sending personalised letters to every staff group in the trust, hosting “ask the executive” sessions and spending a third of his week “on the shop floor”.

“Before I arrived [previous leadership] were doing that approach but I’ve turbocharged it,” Mr May said.

He described how the trust’s leadership was encouraging staff to raise more concerns, and to take on things previously seen as unresolvable and “too difficult and too hard”. In contrast he is “not taking that deal”, he said. 

“If you go about it in the right way, eventually you will make us a more stable, better organisation,” he said.

As well as working to improve culture, leadership and maternity services, NUH leaders are grappling with the same performance and financial challenges as other parts of the NHS.

Mr May said the trust was working on a long-term emergency care strategy, and a winter plan that “looks at every part of the system and flow through the hospital”.

“We are like everybody else in the health service struggling with our finances this year. And we’re not asking for extra money,” Mr May said.

He stressed the ongoing industrial actions by doctors is one of the trust’s “biggest challenges” and, like many NHS leaders, called for an urgent resolution.