Dame Jackie Daniel: ‘Rinse and repeat’ won’t wash for dealing with the backlog

Matthew Taylor

Hello. Today on Health on the Line I'm speaking to, well, a rockstar health leader. She's a dame. She runs one of the most successful hospital trusts in the country. She's often been a spokesperson for our leading hospitals. The areas in which she's developed a national reputation include university hospital collaboration and action on climate change. Her fortnightly blog is essential reading not just for her thousands of staff, but for anyone with an interest in what's happening in our hospitals, and to cap it all, she’s now to be seen in the acclaimed Channel 4 documentary, Geordie Hospital. She is, of course, Dame Jackie Daniel, and anything she says is really worth listening to.

So, I started watching George Hospital, I mean, it's wonderful, it's heart lifting. How did you enjoy that first episode?

Dame Jackie Daniel

I really enjoyed it. I mean, you know, we’ve done some obviously, we’ve spoken to the film crew and the producers of the programme, but you never really know how things are going to pan out until you actually watch it. So, I was delighted. I just thought it was quite refreshing. I felt it was very different. We didn't want to just, you know, tell the story. The ongoing story of covid. That's, you know, I think we're all sort of slightly fatigued around that [and] we didn't really want to talk about winter pressures. We just wanted to, you know, tell the story about the lives and work of people in our hospitals and hopefully reflect the amazing things they do for patients and their families.

Matthew Taylor

Yeah. And what really jumps out at you because, you know, it's been tough these last two years. And you know, it's partly my job, Jackie, to draw attention to the pressures and difficulties that the health service is under. But when you've been listening to two tales of the NHS in crisis, the difficulties we've got - the kind of level of morale and happiness and laughter, I mean, it's really striking. Is that really how it is in your hospitals?

Dame Jackie Daniel

I mean, of course, you know, not everywhere and not on every day. You know, we've got, you know, we've got close to 18,000 staff. So, but generally, I think that is true. I think it's something that I noticed when I came to work in the north east, it’s something I noticed living in the north east that Geordie spirit is really real. You know, my relatives, when they come up and see me now comment on that, you know, the warm and friendly kind of nature, but also it is that sort of ambition as well to be the best and the kind of spirit and innovation, which I think did come through on the programme, genuinely, every day.

And of course, you know, through the pandemic, we've been working really hard as a leadership team to try and continue to create the environment where people can be the best of themselves each and every day. And that has been tough. But I think we found ways to do that, and you can only do that really by asking staff the important question about what really matters to you. And you know what makes a good day for you?

Matthew Taylor

I'll probably be revealing my terrible kind of prejudices here, but one half of that story doesn't surprise me at all. Actually, researcher has always shown that the north east is one of the happiest, most socially cohesive parts of Britain. But the other half, the kind of ambition, innovation that does feel different when I've done work in the north east in the past, I remember many, many years ago when I was IPPR I tried to set up a commission on public service productivity, you know, because the north east economy was so dominated by the public sector. And to be honest, the notion of productivity in innovation didn't really seem to kind of go down all that well. There wasn't so much enthusiasm for it. So that kind of left me with the sense that the north east was a place of high well-being and cohesion, but not necessarily a place that wanted to be at the kind of cutting edge of innovation. But actually, as the programme shows, you've got both those things going on, haven't you? Yeah.

Dame Jackie Daniel

And and Matthew, I would recognise some of what you said. And I think my partners, my civic partners in the city region would recognise that. And I think what we've been trying to do over the last three or four years, certainly since I joined the trust was bring out that innovation and enterprise in terms of our strategy, but also the way that we work with partners in the city. So, you know, hopefully through the blogs and things, people have heard something about Collaborative Newcastle. That's a really deep and broad programme of work and innovation with all of health and care in the city, but also with local business, the voluntary sector, with the city councils, the two brilliant universities.

You know you've got to work on programmes that the staff can really engage in, and many of our staff are, to connect those big pieces, which are all about health, wealth and the economy and wellbeing. And you know, it's no good, I don't take any joy of being this chief exec of a double rated outstanding hospital, when we've got some of the deep inequalities that have been so difficult to shift over, you know, decades and, in fact, generations. And I think what we're trying to do now, but in partnership, is really shift that and that's incredibly energising for staff. They really get all of this and. I really want to be part of that.

Matthew Taylor

There's so much there, Jackie, that I want to return to later on in our conversation, but before we do, we're speaking just after the government has announced the lifting of restrictions now. I don't know, I hope they're right, I worry that they're not, is the way that I would put it. Because I am concerned it's not just that we’ve had Plan B, people also exercised a lot of restraint, and I just worry about what will happen if all that changes, but you know, we will see. But reading your blogs, it's quite poignant, you first mentioned covid in January 2020, and then very soon after that, there was a visit of Chris Whitty to your infectious diseases unit. So, you really, from the very beginning, right up to now been deeply involved in this. We do all hope that it's coming to an end. And although I'm worried about the next few weeks, I'm more hopeful about the next few months. But what do you, Jackie, what do you draw if it is coming to an end, what do you see as the main lessons of these last two years?

Dame Jackie Daniel

We've learnt an awful lot. So, I guess there's so much innovation and learning through how we've dealt with the pandemic, and we must build on that. You know, lots of chief executives talking about the way that their teams have, you know, got into and accelerated innovation and transformation of services, at a rate we've never seen before. But I think one of the biggest lessons is about long-term infrastructure. So, you know, we've done loads of things during these last two years. I never thought we'd do, you know, one of the big things is building what the biggest covid testing laboratory in the country, which has an innovation lab attached to it and a kind of analytics data analytics centre as a sort of third leg of this thing. Now, building that, first of all, we couldn't have done it without the help of the universities and our partners in City Council and public health colleagues across the region.

But we've done that now. It's there to see it's having a huge impact on the way that we're managing through this pandemic. And of course, we’re talk to, you know, the UK Security Agency now and people like Jenny and her chair, who have been incredibly supportive. But what we've got to do is make sure that we've got lasting legacy of infrastructure and surveillance and new innovation that is there for, you know, God forbid, you know, the next version of Omicron, the next variant or indeed the next pandemic, because my experts tell me, you know, this one was pretty predictable and another one will come. So, for me, that's that's one of the big, the big things that I'm pressing very, very hard to make sure happens.

Matthew Taylor

Yeah. No, really interesting, Jackie and I would just say in passing that I worry that, you know, most scientists think that future variants of covid will be less severe, but I don’t think any of those scientists would say it was certain. So actually, the chance of a bad variant is still high. But yet, we don't seem to be having a conversation which we should be having about how we continue to focus on building our resilience. As someone said to me the other day, you know, with the quality of masks and air filters, the average traveller on a German bus is better protected than many people in clinical settings in England. So, we mustn't take our eye off the ball of thinking about how we can become more resilient.

But going back to your point about innovation and change, and I completely agree with you that we're doing some work on this just to go through those things that have accelerated, whether it's, you know, hospital home and virtual wards, digital consultations, real time public health information, people getting used to doing home diagnosis, something which could be really transformative as the diagnostic revolution accelerates, you know, better collaboration between parts of the health service, local government, voluntary sector, the quest. I mean, it's a long list, actually, when you look at it. How do we maintain the pace of innovation and change, do you think, Jackie?

Dame Jackie Daniel

I think I think we've got off a fairly fundamental rethink. The UK is a bit confused.com in terms of working out which centres do what. And in other countries, certainly across Europe, there are a lot more organised in terms of, you know, for example, you know, it could be Cambridge really focussing on, you know, diagnostics. It could be Newcastle focussing on rare disease and ageing, for example. We’re not, I think we just need to get a lot better organised in the NHS, but broadly across government departments for how investments are made and how we make sure, I suppose, we're using the best of every bit of asset.

And I think the NHS operating framework at the moment is really complex and it needs simplifying, and the obviously, emergence and now of the new integrated care boards and systems are a new feature of that. We've really now got to, I think, look at how we make sure we've got clear accountability and decision making through those multiple layers, get the best use of leadership in the system and with a really clear strategy. And I think we're going to have to go back to the long-term plan. We've got, you know, we've got some operating guidance, which is useful for the here and now. But I do think we've got a step back and re-evaluate the bigger picture and where our priorities are.

Matthew Taylor

Yeah, I mean, I think an interesting element of the last two years has been this combination of strong centralisation in some areas, you think of the kind of vaccine programme, for example, or the kind of rules that have been imposed by government. But then in some ways, they a much more permissive environment in terms of the scope for local leaders to do whatever they have needed to do to cope with these waves. So, there's something there isn't there to learn Jackie about this balance of central and local initiative?

Dame Jackie Daniel

Absolutely. And I mean, dare I say even you know where a strategic vaccine coordination centre for the for the north east and beyond. And dare I say it, you know, the centre played a really important role. Let's not take that away from either the government or, you know, central NHS. But it's the service and it's the leadership, the dispersed leadership, right across the country that's actually delivered it, and contributed to and I think provided some of the best advice on day to day on what work is working and what isn't. So, I've seen the dynamics of that play out really, really interestingly. And, you know, going right back to the early days of the first wave, the lessons I take from that is I talked constantly to the to the experts I had within the organisation about what to do next. And you know, I think I think it's a real lesson. So, I'm really hoping that the less central command and control really comes through in this next chapter, and I'm really hoping that the new integrated care structures and systems allow for that leadership at local level, because that's the thing that's really made a difference throughout the pandemic.

Matthew Taylor

We've commissioned Chris Ham to write a paper on the role of the centre in the context of systems because I think that the system simply won't work unless the centre, as it were, loses an empire and finds a role. There are some things the centre absolutely needs to do, completely, and you know, we're publicly funded through taxation and those are important issues around accountability, strategy, expertise. But if ICSs feel like they're simply the delivery mechanism for, you know, plans developed at the centre, not only is that going to limit that scope for local innovation, but also why would our partners play with us? Why would local government, why would anyone want to work with the NHS locally if all the NHS locally is doing is what they're told to do by the centre?

So, I think that, and I know the centre's doing some of this thinking, this is why we commissioned Chris to do it, because I think our view, Jackie, is that the conversation about the NHS’s operating model must be a conversation for the whole system, not just for the centre. I mean, if systems don't have freedom, local government, for example, will just say, well, look, you know, we've got a lot, we've got a reasonable amount of latitude, no money, but a reasonable latitude, but we can't work with you if you also can't be flexible.

Dame Jackie Daniel

And that's what they're saying to us locally. Indeed. So, I think this is one of the most important jobs for the next sort of six, nine, 12 months. It's really, really top of my agenda to try and work with colleagues to get some clarity on that. And I think the work that you've commissioned with Chris will be really helpful, because we need multiple lenses on it, you know, to make sure we get it right and it needs to be co-produced.

Matthew Taylor

And let's talk about local government about, you know, I've noticed in the last few weeks some adverse comment from local government about the reforms, worries about their representation on ICBs and stuff like that. What's the message you think we need to give the local government to give them the kind of confidence that they can work with us? And also, what is the advice you'd give to other health leaders about how best to work with local government? Because I know that many health leaders have found it difficult, and that's not always their problem. It's sometimes to do with the kind of political volatility of local government.

Dame Jackie Daniel

It's really, really important that you kind of work out what is the kind of common agenda. But, you know, health’s got to lean in. You know, there are sometimes when, during the last three years, you know, it's been, you know, it's not all kind of take, we can't keep doing that from a health perspective. We've got a bit of it, but we've got a history of it, to be blunt. And I think that's partly about over centralisation and a bit diktat, you know, which obviously our local government colleagues absolutely hate, you know, they’re kind of democratic, you know, organisations and that's getting more and more important with as we get into increased devolution.

You know, unless the NHS catches up and aligns with that, there's always going to be this really hard-edge boundary and barrier and there simply won't play in. And of course, what we do then, is I can carry on doing what I'm doing in Collaborative Newcastle, so the city region of Newcastle can, you know, fly ahead and do what we do. But actually, that's not good enough. As a regional anchor organisation in health, I want to be trying to work across a much bigger geography in the north east. So, I think I think we've got to get it right. I think it's vital we've not got a great track record and we need to make sure we concentrate our efforts on it. This is crucial for the next sort of two or three years for all kinds of reasons, not least of all, because, you know, we just increased taxes to do what we do in health. The populations we serve have got an absolute right to be engaged in what we're doing without funding and how we work together to get the best in terms of the priorities that we set together.

Matthew Taylor

But part of that, and I've been involved in some of these discussions about the white paper, Jackie, is we need to put a bit more meat on the bones of what's going to happen in the integrated care partnerships. Because the danger is that we look at integrated care boards and we think, well, we're going to know what they're doing there, that they're going to be recognisable institutions in the sense that they get the money and they oversee what goes on in the health service and maybe a certain degree to which they do kind of, you know, call it performance management. That's all kind of recognisable to health service leaders and local government only has kind of one place on those boards. Now that that is local government having a seat at the table, determining how the health service spends its money, which is an important step forward. But ICPs which are genuinely the partnership body, we're at the moment quite vague, I think about what they're going to do and I think over the next few weeks. And I've urged for this to be part of that white paper, we need to strengthen up what we're saying about what ICPs are doing. So, take one example, I think there's a kind of a welcome proposal that we should try to think about workforce planning to cover health and social care and public health together. Why don't we workforce plan for all of that together and indeed relate that more broadly to local labour market strategy? Now that's something that I think has to be driven by ICPs they don't necessarily have to do the work. They might get other people to the work. But ICPs need to oversee something like that kind of local workforce strategy.

Dame Jackie Daniel

It's interesting because that's exactly what we're doing, Matthew in Collaborative Newcastle. That's exactly what we're doing, you know, integrating care, but also working a strategic level on precisely those sorts of areas. So, it can be done, but I worry. So, in our ICP in the north east, because we're such a big ICS, you know, the ICPs are actually not truly at place, they’re still at sub-regional level. And we can probably make that work, but I think this is part of the issue about allowing. You know, a thousand flowers to bloom, there’s sometimes the co-terminosity, you know, at one level it could be north of Tyne. But I think I see it working more deeply and in a much more integrated work actually in the city region of Newcastle. So, we've got to be careful that we don't overlay, you know, structures that actually are not penetrable and don't work for local government at ICPs. And we've got such a variety, and I'm not suggesting that's necessarily a bad thing, they've got it’s got to be built from what makes sense locally. That we've got to take care that we're flexible enough to, you know, to work with what works for them. And, you know, I'm not always seeing that when I talk to colleagues up and down the country.

Matthew Taylor

I mean, I think part of this Jackie is that there needs to be a healthy challenge between the ICP and the ICB in the sense that, you know, we've been talking for some time and covid has reinforced the importance of this of the need to recognise that the health service is not at the moment a service that responds to need, it's one that responds to demand. And need and demand aren't the same thing. And secondly, that we've been speaking for a long time and all the way back to Wanless, before the long-term plan, about this kind of need for a leftward shift of resources into community, into prevention, into public health, into primary care, moving resources upstream. And we've not really managed to accomplish that. My vision of an ICS that's really motoring is an ICP which is challenging the ICB to say, look, how do we shift from incentivising activity to incentivising outcomes? How do we shift from meeting demand to meeting need? And I think if that happens, that will be a kind of healthy challenge.

Dame Jackie Daniel

Yeah, agreed. Agreed. It's really essential it goes back to, I think, the point that you raise right at the beginning, which was, you know, if the ICBs are not strategic kind of pace setters, you know, part of, you know, trying to get a shared agreement on the really important priorities and almost, you know, allowing integrated care partnerships to figure out how that is best done. You know, we're really going to miss the trick if they simply become a delivery arm and connected to the chain on performance management and review, we've really lost it. So, it is vital because otherwise there'll be little or no incentive to really change the dial and hold people to account for, you know, for doing what you said, which is working with shifting money upstream, trying to work on different a set of priorities to get a different set of outcomes. It's really important.

Matthew Taylor

Yeah, and that's why we're trying at the Confed to kind of make this explicit, because I think that because of the pressures that we're under, because particularly of the elective backlog which the Prime Minister and the Secretary of State have indicated is their number one priority, the danger is that those immediate demands squeeze out this kind of wider analysis of what health is all about. And if you look at the planning guidance, you know that was circulated just before Christmas, you know, there's nothing in a sense wrong with that. But the message in it really is let's focus on doing things like we've always done them, but trying to do them, you know, more quickly. I mean, there is obviously, there's innovation around things like hospital at home or whatever, but that that planning guidance didn't feel like planning guidance for a system-based organisation. So, we need to really open up this this conversation. I think.

Dame Jackie Daniel

We do. We do. So, I think it kind of goes hand in hand in my head with the need to get the operating framework much more simple and certain. So, looking at what are the layers you know of kind of structures at region, and at place and centrally. Are they focussed? Have they got a clear purpose? You know, have we got clarity around accountability? But you know, at the same time, we need to be trying to look, and I appreciate it's been difficult because, you know, no one's really have the headroom, but we have to now create it because I think you're right, the planning guidance was just to kind of a step off from where we've been in the pandemic to where we really need to be in the future. And unless we can think more long term and much more boldly around the ambition, then we're just going to keep rinsing and repeating. And that is just not going to be enough to deal with the biggest backlog we've ever faced.

Matthew Taylor

So, Jackie, before I let you go, I want to just talk about a couple of areas that you've particularly shown leadership in. And the first is, which you’ve which you talked about a lot already, and that is seeing the NHS not merely as a place that spends money, but also as a critical kind of part of the local economy. The role of the NHS as an anchor institution. This understanding of the NHS as an important part of the local economy. That's something that you've talked about a lot and also, of course, in relation to the university and the scope there for you to be part of a wealth generation.

Dame Jackie Daniel

I'm absolutely convinced after 40 years in the NHS, you know, 20 years as a chief exec, that this is absolutely the right territory and people who know me will know I talk about sticky edges, creating sticky edges between organisations both in public and private sector to build rebuild the economy, it is such an important driver of health and wellbeing. But also joining up the assets that we have between things like, you know, organisations like universities and some of our education and training infrastructure, but housing, the voluntary sector, etc, etc. And let's be honest, Matthew, and I’ve been there, you know, if you're a chief executive in a relatively small organisation, you may just be trying to deal with the day-to-day delivery. And that's going to be, you know, facing many, many leaders over the next 12 months and the pressure to perform that.

So, I do think there are organisations across the UK in our NHS, it includes the Shelford group, but not exclusively the Shelford group, who can, if you like, penetrate a slightly more strategic space and provide the connectivity to some of these other big civic organisations that can really help form that strategic rhythm, which will do things like develop a long-term workforce plan. You know, only through doing that, I think, will we really get products like that. So, it's crucial, but probably not something that's on everybody, every chief executive's mind. What we need to do is work out how we play to the strengths of those organisations that can start to contribute to that and support organisations in the system to reap the benefits of that.

Matthew Taylor

Yeah. And you know, I would encourage any kind of ICS chair, chief executive, to speak with you and to and to come up to Newcastle. Because I think the sense there that you have of the NHS being a strategic asset, not just a public service, it's palpably different. And I think it's inspiring for people who may feel a long way away from that idea. But it is, it seems to me, critical for the future. And of course, you've got important assets, you've got strong local authorities got great universities, but nevertheless that sense that you are an asset is very different from how it feels in other parts of the country.

Dame Jackie Daniel

Thank you.

Matthew Taylor

So, Jackie, last thing I want to turn to you and is and I'm concerned here because I think if I'd been speaking to you before COP26 and I'd said, you know, you're a champion of the NHS’s role in tackling climate change, making its contribution to get to net zero, it would have seemed perfectly natural because we were all talking about that. But the attention has shifted. We're talking about it a lot less, you know, and now I almost sense that if I was to say to people, well, what about the role of the NHS in climate change? They’d go, hang on, you know, we've got the backlog, covid's not gone etc etc. How do we sustain the enthusiasm for the NHS whose role in relation to climate change?

Dame Jackie Daniel

Well, I get a lot of that enthusiasm through our staff. You know, they're not going to let me take my eye of this. I mean, it's not, you know, it's not it's not everybody, it’s not all the 18,000 staff. I've got a significant number of staff who are engaged in, you know, clinical teams who are looking at pathway revolution to make them way more greener. We've got people doing all sorts things out about in our region, out on the beaches, you know, in the in the green areas around the city. So, we're deeply focussed. We're deeply focussed as an organisation on what we can do with partners on things, things that really contribute, which is, you know, the heat and light and energy that we use.

So, we're working at kind of macro and micro level, but this isn’t something we can just sort of ignore for a couple of years. I mean, I think, you know, in other parts of our lives, when you sit and watch the documentaries or, you know, whether it's listening to David Attenborough or whoever, it's a ticking bomb, you know? And so, I think there are enough enthusiasts, there’s a really good network of chief execs and clinicians across the UK. And again, the Confederation could, I’ve no doubt, could really, really help keep that group together and make sure that what we're doing is being heard. It is difficult, but it isn't because, you know, when you get a group of enthusiastic staff coming up with innovations making a difference day in, day out, and you've got strategic partners who will work with you about different energy and power solutions. It's just part of what we do here. And for me, I'm not one to take my eye off that ball. It's, you know, what is there for future generations? There is no health without good planetary health. Just simple as that.

Matthew Taylor

One element of this is that I do some work internationally with an international health organisation. And actually, this is one of the areas where people internationally think the NHS is kind of ahead of the curve in terms of its commitment. So, it's also important, I think, in a time when often it can feel that we're not slightly more cut off from the world than we used to be in the past. And actually, this is an area where we seem to be providing leadership and we should carry on doing that, I think. So, Jackie, final question, what are your kind of remaining ambitions? You've achieved so much, you're achieving so much? Do you have any other ambitions you want to share with us?

Dame Jackie Daniel

It's really interesting. You look back, every year is different, isn't it as a leader? The ambitions just as strong as it's been at any time. I think it really is on that on that. Of course, you want to make sure your organisation is well led. You know you don't get to do the other things unless you're doing that. So that's just as a given. But I think it's really realising human potential. I'm just going to use that in terms of making a difference and pushing the boundaries of the space in which we can make a difference. I think that probably best captures where I'm trying to go and it probably best captures where we're trying to go in Newcastle. The world's an increasingly small place.

You know, post-Brexit, we've got to make sure that we're working with our European and international colleagues because, you know, this is urgent. This is really urgent now. But let's be optimistic about that because that's that that, you know, wanting to make a difference in that way creates an awful lot of energy, and it can create innovation at pace, which is exactly what we need now. So yeah, we've still got we've got so much to do.

Matthew Taylor

Jackie, thanks so much. I don't know what I’ll speak to you next, but I know that I'll be seeing you very soon because I will be glued to my TV every Monday evening. Jackie, thanks so much.

Dame Jackie Daniel

Thank you so much. Thank you.

Outro

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