Transcript: David Flory, Deputy CEO, NHS England

Nicholas O’Regan, Professor of Strategy and Innovation, talks to David Flory, Deputy CEO of NHS England, about the changing face of the NHS


Nicholas: David, thank you for coming to Bristol.

David: My pleasure

Nicholas: What are the key strategic challenges faced by the NHS right now?

David: I think there are many: when we look at the health status across the country right now, depending on which part of the country you go to, you can find that over relatively short geographical distances there are very significant inequalities in health, and very significant differences in life expectancy.

I think that the big challenge for the NHS, for many other parts of the public sector, and for society to get to grips with and deal with is that we have to continually raise the quality of services for patients.  That's about their experience as well as the clinical care that they receive.

We always have to, in this economic environment, seek greater efficiencies and productivity, and we see quality and productivity in that way being very much hand in hand.  A better quality service and a better quality experience for patients is always delivered in a very efficient way.  So the challenges for us looking forward are huge.

Nicholas: The NHS is a large body of course, what would you say are its core characteristics?

David: If we think of NHS expenditure, well over half of the money we spend is in the staff that we employ: a wide range of people clearly, the doctors and nurses, the clinical staff are there, the areas in which people work to make hospitals and other facilities run efficiently and effectively.  So the NHS is its staff and I think the staff, the compassion that they have, the commitment that they show, the professionalism they exhibit every day working in public service is what the NHS is all about.

Nicholas: Could I turn to ask you about strategy: what’s the process for establishing strategy in a body like the NHS?

David: Well it’s very interesting you ask that.  We’re now 12 months on since the last general election of course.  The NHS is a marvellous institution in this country: it’s an industry rather than an organisation in that sense.  But it's operating in a highly charged political environment as well.  So the strategy is driven by the politics.  We saw the coalition government coming in May, and within a relatively short period of time was the white paper setting out the government vision for the future.  It's then the job of everybody, rowing in behind that white paper to think about our strategy and plans going forward.  To think about how we develop the proposals to make them work, to make sure we have input from our staff to all of that but at the very start, strategies about the government and where it wants to go with public services and with health.

Nicholas: What’s your time scale for strategy then: is it the same period as the government?   

David: I think that one of the great things I’ve learned working in government is the time frame that drives everybody is when we think the next election's going to be and what’s going to happen between now and then.  Certainly the bill that's going through parliament now has got much more than the term of Parliament to get to grips with it and take it forward.

Nicholas: Do you benchmark the NHS with other public and private sectors?

David: Absolutely. The service that’s focusing on improving the clinical outcomes for patients, we’re data rich in that sense.  We don’t always use the data that we have as effectively as we can, but benchmarking, comparisons with other health systems in the world, and comparing parts of the NHS here against other parts of the NHS, is crucially important in driving up performance.

Where it doesn’t work sometimes, is when having seen comparators that we think are not as favourable to us as we would like them to be, we start arguing about the data rather than doing something about it.  But overall, benchmarking and that process of comparison is a really important driver for improving services.

Nicholas: So where do you see the NHS in say 10-15 years' time?

David: That’s a very tough question to answer.  I’ve worked in the NHS now for over 20 years and when I started I would never have imagined what I am doing now, I could never have imagined.

You can’t forecast and predict technological advancement.  In a way we can project changes in demography and demands on the service, but the technological advancement and the rate of that is fantastic - new drugs and therapists come along onto the market, and that will continue at an even greater pace forward.

Nicholas: Are there any strategic issues that keep you awake at night?

David: There's a lot of things that I worry about.  I think that it comes with experience in some way.  I think that over the years I’ve learned there’s little point in worrying, but there are lots of things that we can something about.  The services: I worry that there’s something not quite right going on out there that we haven’t spotted and haven’t put right.  So you worry about the things you don’t know in that sense.  And that’s what drives me every day really, to get to grips with those things.

Nicholas: Moving on slightly, there’s a great deal of talk about effective leadership in the private sector and the public sector.  What do you see as the attributes of good leadership?

David: I think that there are many attributes, and in my time in the NHS I’ve worked with some fantastic individuals who are great leaders.  At the most fundamental definition of leadership: you're only a leader if people follow you. When you the other person has a leader and they say to people they're going to go from over there to over here, you're doing something right.

I think it’s about being able to give the compelling vision about where we're going and what we’re trying to do.  To be able to clarify exactly what we need to do within quite often a very complex context and environment.  We need to simplify that, we need to spell out where we’re going and most importantly in leadership I think is that the people who you're leading see the values that drive you, whether they be the values of public service or whatever: they can identify them when they see you behave and act consistently with those values at all times in an uncompromising way.  I think if you do that you’ve got a good chance.

Nicholas: We talked earlier about the possible changes in NHS over the next 10-15 years.  Do you see any management changes or change in management styles and behaviours over the next decade or so?

David: One of the things that I think in terms of expectations of managers and leaders that’s changing now and will continue to change, is that we’ve worked in a way sometimes in the past in which your sole responsibility has been for the bit of the system that you run.  So you could succeed by running a successful organisation, even if those who could commission services for you or you commission from, neighbouring organisations which come together and form providing clinical services, didn’t matter if they succeeded or not - if you did that was good enough.  That won’t do any more.

We need more than just running your own bit successfully, we need you to contribute to the broader system, in supporting patients' needs and improving services for patients across health and social care across different parts of the NHS and our demand of leaders and managers in the future will be able to work in that way.

Nicholas: Moving onto the David Flory Journey, your journey in the health service is a bit of an impressive one. You focus on leading a number of organisations. How do you view your various leadership roles you’ve had so far?

David: I’ve been very fortunate in being in the right place at the right time when opportunities have come up.  But, and twice in the National Health Service, I’ve been appointed Chief Executive with responsibility of setting up a new organisation and a new body.  To have that twice in my career, I’ve been very lucky because it’s the most fantastic opportunity.  It’s great when you’re the only one there, you don’t have to consult with anybody and all that type of thing, you get on and do it but you choose the people and you define the way you want that organisation to be.  You set the tone of how it is and how it’s going to work – with stakeholders, with partner organisations, how you affect relationships, how you set out the expectations for the people you want to recruit, and how you persuade them to come and join in.  All of that is brilliant and I’ve learned so much from doing those things. It’s been great.

Nicholas: The boardroom is a familiar setting for you: how would you view the role of health trusts and health boards and other organisations?

David: I think we make very significant demands.  So many of our members, non-executive members of boards who give time to contribute to running the NHS in one way or another and you can’t come along and do those things without responsibility.  You can’t come along and express opinions on behalf of a group of people you represent. The accountabiliy’s really clear: I think that for people in the boardroom to take on that accountability and responsibility you need to draw on their experience from other sectors to contribute in discussion, and to make sure that we take things forward in the right way.  This brings a great richness to the NHS, and a board with a dynamic mix of executive and non-executives, people from different backgrounds and different perspectives on life can really make fantastic progress.

Nicholas: David, thank you very much

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