CEO Series: Nick Hulme, Chief Executive of East Suffolk & North Essex NHS Foundation Trust

In the third edition of our CEO Series, we interviewed Nick Hulme to gain insight into how he has led the trust through Covid-19 and discussed what technologies he thought were crucial in working through the past few months. 

Nick also shared with us his advice for aspiring leaders and what learnings he has acquired during his tenure of leading through a pandemic, and started by telling us of his path to becoming a CEO.  

How did you become a CEO in the NHS? 

I’ve been in the NHS for 41 years and I started as a porter. I left school with only one O Level, so I didn’t have any academic qualifications but I always wanted to do something that made a difference. 

I worked with patients for the first half of my career; I was a healthcare assistant in psychiatry, worked with homeless men for a while, and then worked in the early days of the HIV and AIDS pandemic in the mid-eighties as a healthcare advisor and councillor. I had gotten incredibly frustrated in those days with the demand for healthcare and the inability to manage it. 

I suggested to my boss at that particular time, that we could see more patients with the same number of staff if we changed certain procedures, and she replied with “have you ever thought about management?”. From there, I went into various general management jobs, director of operations in three organisations, as well as deputy chief executive and now as CEO for the past 10 years. I’m NHS through and through, if you cut me, I’ll bleed blue, and I really can’t imagine doing anything else now. 

How has your leadership changed during Covid-19? 

It hasn’t, but on reflection, perhaps it should have done. We deal with situations all the time, and through dealing with those situations, we know the processes to follow; you may get different nuances from one year to the next, but generally you can draw on previous experiences to get you through situations which arise.  

For me, Covid-19 presented a completely unique set of challenges. The learning I acquired was trying to apply my previous experience to a novel and unique situation, rather than taking a step back and finding the differences. One such example was the differences for staff; they have their personal life and their professional life, with some overlap between the two. Covid-19 has blended personal life and professional life into one, where you couldn’t just shut the door on work when you got home, and likewise, leave your personal life at home when you got to work. 

We were all in lockdown, with nowhere to release or relax and your anxieties were exacerbated through the risk of becoming infected at work and bringing that home to your family. For me, the leadership I’ve learnt is to be much more mindful around understanding the environment that our staff are working in, rather than assume it is exactly the same and we just need people to run a bit faster or jump a bit higher.   

What technology has been the most useful over the past few months? 

Attend Anywhere has been the most useful and we got it up and running within 6 days to hold virtual consultations with patients. It was really important for us to keep our patients as safe as we could. 

I think there’s a danger with the use of digital platforms, that we use such platforms as the default as opposed to human contact. I think we now have to take a step back; technology doesn’t work for everybody, for some types of consultations, digital tech is absolutely fine, although you miss the nuances of human to human interaction. Particularly with a telephone clinic or even a video clinic, you don’t pick up those non-verbal clues where if people are understanding what you are saying to them. Also, for example, if a patient is in an abusive relationship, they may share that information in the confines of a consulting room, but they won’t share it if phoning from home on a video call. 

The phrase of 2020 is most definitely “you’re on mute”. I have certainly missed the face to face interaction and even the commute into London! 

I think we have just got to be mindful that technology will not work for everyone forever.   

What learnings have you acquired over the past few months? 

The resilience of individuals is definitely something I have learnt from the past few months.  

I think that the constraints and benefits that we had prior to Covid and took for granted were seen as trivialities during the peak of the pandemic, for example ‘we can never do ‘x’ because…’ and then suddenly during Covid we were doing ‘x’ – whether it was responding to the PPE issue or creating a very different relationship between clinicians and managers to work in that single focus where everybody is pointing in the right direction. When people are together in that single focus, you can achieve extraordinary things. 

The people who I thought were the absolute superstars prior to Covid, have sometimes found it all too difficult, where the people who never really stood out previously, have really put their head above the parapet and been extraordinary.  

The so called ‘frontline staff’, which is a term I don’t find incredibly helpful, are an essential but tiny part of the team. I hope the public now recognise that the people who help keep our corridors clean, the people who make sure the PPE is there, the people who make sure our staff and patients are fed, or those that are not seen as ‘frontline’ such as managers, leaders and others, are as much a part of the clinical team as anybody else who happens to wear a uniform or have a stethoscope around their neck.  

– I’ve known that for a while and I’ve talked about it previously, but I do hope the public recognise that health is a team sport. 

How has the role and usage of data changed for you over the past few months? 

The one thing we’ve never had to do was to look at international epidemiology. We were meeting three times per week for our strategic tactical command meeting, where we all pretended to be very important for an hour and a half! 

That was the first time we had looked at data in other countries; what’s happening in Spain, what’s happening in France, regionally and locally, and that’s one thing that had changed where we were looking at such data. We had to look at that data but it didn’t inform us all that much. 

Moving away from anecdote and allegation with local data was useful, for example, “we are running out of PPE”, well actually, no we are not and here’s the data to prove it; “we haven’t got any surgical masks from the hospital”, well that’s interesting because I’ve got some data here to prove it that says we’ve got over 1.2million masks in the hospital. Having the data and understanding where the breakdown in supply was, was useful. 

Moving forward, data, in terms of how we deal with the backlog of patients who need treatment, how we assess clinical severity and clinical risk, will be more important now than when we were in the height of the pandemic. 

What advice would you give to other CEOs and those that are aspiring to become a CEO? 

Being CEO at a hospital or in a healthcare setting is one of the best jobs in the world; I lead a team that improves 6,000 lives every day, what’s not to like.  

Ok so I don’t have a private jet or a villa in France but I genuinely believe that my team improves and saves lives, and what’s not good about leading that team?   

Is it an easy job? Absolutely not. The main advice I’d give, particularly when thinking about the past 6 months, is for goodness sake look after yourself. Don’t be hero, when you’re in the middle of a crisis such as this one, you don’t realise your potentially making the wrong decisions or behaving in a way that doesn’t reflect the values of the organisation, due to the immense pressure that you’re under. Everybody wanted answers, and we didn’t have answers; don’t be afraid to say to your closest confidants and your team “I just don’t know”, don’t be afraid to pick up the phone and ask for advice.  

You’re not indispensable, look after yourself and each other; look for those early warning signs where either you or your team might be struggling.