Suhail: [00:00:05] Hello, I’m Suhail Mirza and welcome to episode one of season two of Voices of Care. And I’m joined today by Matthew Kershaw, chief executive of Croydon Health Services NHS Trust. In Voices of Care we seek to get to the heart of the issues that are facing the health and social care sector by speaking to leaders that are truly enabling the healthcare workforce of the future. In this episode, we’ll be covering the tumult and transformation in the sector, issues around workforce and waiting times and the small matter of turning the dial on health inequalities to help me deal with that. No pressure, by the way. Welcome, Matthew. It’s great to have you here. Great to be here. Thank you, Suhail. I wonder, before we get into the substantive issues, if you may just spend a few minutes giving us a bit of a picture about the work of the trust, it’s got quite a distinctive demography that it serves, and it also comprises both acute and community provision.

Matthew: [00:00:53] That’s right. So Croydon Health Services NHS Trust is a busy, acute and community combined. Trust in South London. We serve the borough of Croydon and are very proud to do so. Croydon is a borough of 400,000 people and is very diverse, so we have over 50% of our population are from a black, Asian and minority ethnic background. We have significant health inequalities. We have a very high proportion of the population in the core 20 plus five most deprived sort of segment of the population of the country. And with the diversity, the health inequalities and some of the social challenges, it does bring some specific needs, but it also is a hugely vibrant place. And I’ve worked in the health service for over 30 years and it’s the most enjoyable work that I’ve done. And that’s in large part due to the location of where we work and the population we serve and the staff that we employ. And we employ about 4,000 staff. And as you say, we provide a range of acute services, but also a strong community arm as well, with all the range of community services. And a big part of what we’re trying to do is integrate our care both within hospital and community services together, but also across health and between health and care.

Suhail: [00:02:22] Fantastic. And we’ll dive into some of those topics. You talked about your 30 years plus in the sector. Now you bring a huge amount of experience, not just leadership, but you’ve worked with the Department of Health, you’ve worked with QC, King’s Fund, not that long ago that Jeremy Hunt has chair of the select committee, said this was the worst workforce crisis he’d ever seen. You’ve just come out of a winter, a few months ago where you said it was probably the hardest winter you’ve experienced. Can you just flesh out just how challenging it is? The headlines are 7.3 million elective list, big vacancies. I don’t need to repeat the numbers, but just from your experience, just how challenging is the landscape?

Matthew: [00:03:01] Yeah, I mean, it is it’s exacting. I think it would be fair to say and for staff who work in the service, there’s been a combination of pressures, I think, that have added to that challenge. So we’ve obviously had the pandemic and we shouldn’t underestimate the impact that that’s had both going into it during it and the recovery thereafter. That is definitely something that is, I think, part of the context of what we’re currently in. If you add to that straight out from the pandemic into what felt like and sort of continues to feel a bit like a perpetual winter with the emergency and urgent care pressures and load on top of that, then industrial action and the cost of living crisis. It’s lots of things that add to the pressures that are already inherent within the health service for the workers, for the staff, for those of us who are committed to working in the health service. We know it’s not an easy ask, but some of those factors I think, have definitely added to the challenge. That being said, the NHS and the NHS staff are amazingly resilient and in each of those issues people have stepped up and responded fantastically and I’m very proud to be a part of that workforce. But that’s something that you can trade on too much. Sometimes the individual resilience and the commitment and desire of staff. We’ve got to make sure as a health service and broader as a country that we look after those staff that we get recruiting and retention better, that the wellbeing and health of our staff has to be a priority. And we’re doing a lot to try to address that and clearly much more that we can do now.

Suhail: [00:04:47] And I look forward to speaking about your strategy, which you’ve just adopted. Touching upon industrial action. There’s been some progress in resolution, but not completely within the nursing cohort and doctors. How is that impacting the system? And also in terms of the operation of the trust? Because it’s of course. Something that you have to now factor in in terms of your planning?

Matthew: [00:05:04] Yeah, I mean, it’s on one level the disruption and the cancellations of elective activity, because that’s been the net impact, is that we’ve maintained a level of emergency care services and quite rightly that’s essential. But we’ve done that by stopping other things elective procedures, teaching, training, research, other aspects of what the health service does. And so that impact, we have to plan to recover that and get that back over the next few weeks and months. And obviously, the more of that you have, the more difficult it is. It’s a balance, of course, because as I’ve said to staff throughout this process, you know, I respect their right to strike and we’ll continue to do so. But I have a responsibility to ensure we provide a safe service to our population. So we do respect staffs’ right to do that, but we also need to make sure and have done so far that we’ve been able to provide that safe service. The longer it goes on, obviously the cumulative impact of that can make it harder. And so my conclusion would be as soon as possible, I would hope that the parties involved, which clearly isn’t me as an individual chief executive of an organisation, but the parties involved find a resolution and we can move on.

Suhail: [00:06:30] Absolutely. You’ve chosen a hell of a five years to be at the helm since you took over in 2018. Just broadening the picture, you’ve touched upon the integrated nature of the services provided. I think Croydon has been providing community services over a decade now in 2011, and that subject of integration is one that’s close to your heart. I think you’re still a visiting fellow at King’s Fund. You worked at the King’s Fund, where you wrote extensively around this, and I think you were on record as saying for that to work, integration truly to work, you needed three things. You needed good relationships, you needed governance, proper governance, which we hope the health and Care Act has now enshrined on a statutory basis. And thirdly, in your own candid way, you’ve got to make sure people actually do something. And I want to highlight, if we may, what have you seen on the ground in terms of integration and what promise does it hold in terms of workforce collaboration? Because that’s really an important element that puts this together?

Matthew: [00:07:24] Yeah, I mean, it’s interesting to have stuff quoted back at you that you’ve written because I would continue to say that those three ingredients are crucial. I would say the getting on and doing something and having good relationships that allow that to happen need to be at the forefront. The governance needs to be there, but it needs to be catching up with the doing and the relationships because otherwise you can get caught into creating a lovely diagram of how this is all going to work. But for the population and for the staff, the topic that you’ve asked me about that doesn’t mean so much. What they want to know is how does it feel and is it different? Does that make it better for patients and better for staff? And my strong belief is that the more integrated the services are, the better chance there is of providing the best quality of care and the best opportunity and experience for staff. That’s my honest belief. And so an example from our own patch in Croydon, we’ve run for some years now something called Integrated Community Networks. And this is an opportunity or a mechanism whereby we bring health staff from across a range of services, along with social care colleagues and the voluntary sector and other colleagues from local authorities and bring them and work them and create an environment where they can work together.

Matthew: [00:08:46] Looking after a section of the population in Croydon and Croydon is quite a disparate borough. If you’re in the south of the borough, then you’re in sort of the north of Surrey and it feels like that if you’re in the north of the borough in Thornton Heath, it feels very much like in a London and therefore the population needs are quite different and integrated community networks where we can bring primary and secondary community services together with mental health and the care sector, looking at a population and saying what are the needs of that specific population? What does Matthew Kershaw, who’s a patient in that area, need specifically? Because that will be different to what Suhail might need in another part of the population. And we’re trying to flex our services by bringing people together and getting them to look and focus on that population. And that, I think, is a great example of how integrated care can really make a difference to the populations that we serve.

Suhail: [00:09:42] And also it serves, I guess, the career aspirations and the richness of experience for the staff themselves across what have previously been, if it’s fair to say, siloed approaches to care.

Matthew: [00:09:52] Yeah. I mean, one of the things I say a lot when I do trust induction every other Monday, I say one of the opportunities of an integrated way of working is. The breadth of experience that you can get. You can move around doing a whole load of different jobs but in the same place in Croydon because the barriers for moving are much lower. And I think that is an opportunity and an advantage and it’s something that we’re definitely trying to push.

Suhail: [00:10:22] Absolutely. Just touching upon London, it’s a unique market. People have described it as a great training ground for staff. It brings its own challenges and opportunities. I just wanted to flesh out how that’s impacted the London environment in terms of retention and recruitment and also how you’ve seen place based approach to care in London because it’s very distinctive beginning to show a results.

Matthew: [00:10:47] Yeah. I mean, the London effect, it’s definitely there. I’ve worked outside of London and inside of London. I prefer the inside London, and that’s a personal choice. But there is you know, obviously there’s a need and great opportunities outside as well, but there is definitely a London effect. It’s a bit of a draw for lots of people, and I think that’s an advantage that we can that we can build upon. We’ve also got an awful lot of people here. So the sort of the market that you’re working with is significant. There are challenges. The costs, I don’t think we should underestimate and certainly, you know, at the moment, the cost of living crisis is definitely adding to that. And obviously we have the industrial action that sort of sits alongside that. A lot of those things are sort of magnified in London. But I’d say on balance, the opportunities and the advantages of the capital outweigh those challenges. And it is a fantastic city to work in, but very, very different. So you’re in Croydon. It feels quite different to if you’re in Kingston or Richmond or Westminster. So I think it also provides that breadth and that opportunity and that diversity, which I think is a strength in Croydon and a strength in the capital as a whole. You were asking a second question.

Suhail: [00:12:09] In terms of place based here in London, because obviously that is the zeitgeist that we’re talking about community based. We’re seeing this transformation obviously envisaged by the long term plan of more clinical hospital like treatment in people’s homes, in communities. That brings a pressure and an opportunity in terms of the nature of the staff and the provision you’re providing.

Matthew: [00:12:30] Yeah, it does. And we’ve done a lot of work to try to continue that move out of hospital. Another example I’d give is virtual wards, which is an initiative that we’re running in south west London. In fact, Croydon runs the central hub, which provides additional monitoring to allow patients who five years ago or even less might have been in hospital for a week or now they might come for a day, but then they’re at home being monitored virtually. That’s a fantastic development supported by technology, but more importantly, supported by qualified, experienced staff who are working in a remote peripatetic type approach, as our community staff do all the time. And I think that brings with it definite benefits for the patients and for the system because of course it frees up capacity that we can use for other things, but it also brings real opportunities for staff. I’ve spoken to the staff who are involved in that. These are all very experienced people who’ve worked in the health service. Lots of them worked in hospitals. Some have worked in community services. But the opportunity to do something as innovative and as different as that has definitely motivated them and has helped us in terms of recruitment and retention. So I think there are benefits to exactly that sort of thing.

Suhail: [00:13:47] And just slightly touching upon, I know we’re talking about Croydon and the NHS here. I just wanted to take the opportunity because you’ve been one of the hospitals selected to expedite the idea of stopping beds being occupied when they don’t need to be. Community care. The nexus with social care, which of course is part of the work that you’re doing as an integrated trust. I want to just touch upon the social care workforce because the importance of their training and the esteem that they’re held in is not just important, quite rightly in of itself for the social care, but it has a profound impact on your own provision and the NHS.

Matthew: [00:14:24] Yeah, I mean, I don’t think you can separate the two and certainly in my environment in Croydon we try not to. So it’s the health and care workforce that I talk about because they are two sides of the same coin. And to have this distinction between two strong I think is not right. Now, clearly there are different jobs, but they are there are different jobs in the same environment for the same output, which is to try to the Croydon context, provide the best care we can to the 400,000 people who live in Croydon. And a lot of that will be to do with health. A lot of it will be to do with social care and the closer that that is maintained. The better it is for patients, the better it is for the system and the greater the opportunities are for the staff. So we have, as I say, things like the integrated community networks, we’ve created combined teams, frontrunner, which is the program that you’re talking about. We’re the only place in London that’s following that programme, one of the six in the country. That’s to look at the discharge process but not discharge as a right. Well, we must get these people out of hospital to allow the hospitals to work better. It’s about getting people in back into the community and therefore the importance of the social care aspect of that is huge. So we are talking about blending roles where we have health and care staff essentially both doing the same job. They might have come from a background of social care or health care, but actually what we’re looking for them to do is be people who can help progress the care of a patient out of a hospital into their community and a blended role and a hub where those staff come together and work in a single place we think is really quite exciting and could be. I think one of the things for the future for health and care in this country.

Suhail: [00:16:11] No, absolutely. Delving a little bit further now into your clinical strategy, which you’ve adopted for 2023 to 2028. Learning people, culture, leadership is really vital. I just wanted to touch upon that, the importance of culture. We’ve had the NHS staff survey, which has had a varied outcomes across the system. You’ve talked about resilience. Just how important and what initiatives have you seen in terms of supporting for it to be a great place to work because that’s the aspiration on your strategic outcome?

Matthew: [00:16:42] Indeed it is. And yeah, I mean, we talked about it right at the start. The challenge is that staff in the service have been through over the past few years and that’s definitely the context within which we work within that, if you look at the staff survey results for us, you know, we’ve seen some steady improvement which we’re pleased about, but I think it would be fair to say we have a long way to go as an organisation and I think the health service does overall because, you know, people are quite tired and they’ve had, you know, experiences that that will have impacted them. And I think you can’t ignore that. What you don’t want to do is sort of get hamstrung by that and feel that, you know, it’s all doom, gloom and despair, and there’s nothing that can be done to make it better, because that’s absolutely not the case. And actually, ultimately, it’s not about coming up with some very clever new way of working. It’s about treating people as you’d want to be treated yourself with respect, to engage people, to listen, to ask the people who are actually involved in providing the care what they want to develop, how they want to do it, what their ideas are for improvements, because ultimately they’re the people who know it better than, you know, as the chief executive.

Matthew: [00:17:57] It’s my job to oversee that. But do I know how every bit of our organisation works the best? Absolutely not. And doing things like engaging and listening and asking people for their input and leadership is sounds easy. It’s all of course more complicated, but it is absolutely the right thing to be done. And so I think there’s a big aspect about that side of it. I think there is increasingly and I reflect back on my 30 years in the service, the health and wellbeing offer that we give to staff. If I think back to when I started, there wasn’t anything. I mean the health and wellbeing offer was the social club that existed on every hospital site where people used to go for a drink at lunchtime or after work. Those things don’t exist anymore, but we are looking to offer a whole range of we have support programmes, we have mental health first aiders. We have a programme where people can phone in at 24 hours a day, seven days a week to get support, advice about a challenge that they might have at work or indeed outside of work in their in their home lives and things like that I think do make a difference. But ultimately it comes down to how you looked after by your manager, whether you feel valued and respected, whether you feel like you can contribute positively to what’s going on in the organisation and that you’re remunerated fairly and that the working conditions are right. And those are the things that we’re trying to do, the bits that we manage well. But it’s definitely a journey and we are making progress in some areas, but in other areas it feels really tough and that’s the honest answer. And that’s why, you know, my job is to carry on with that and continue to look to make it better every day. And some days I feel like I’ve been successful and moved it on and other days it feels like we’ve gone backwards a bit. And that’s, you know, don’t give up. You’ve got to be resilient in my job. And that’s what you’ve got to keep coming back and working with the staff and asking them what is working and what isn’t working and build on that and make progress for the future.

Suhail: [00:19:59] Absolutely. And I think one of the two features of the workforce, if I’ve got this right at the trust, is that there’s a significant proportion, perhaps a distinctively significant proportion, that actually live locally. That’s not always the case in NHS trusts. And does that have an impact, you know, treating your own? Does that have a dynamic in terms of fulfilment?

Matthew: [00:20:21] Massively. In Croydon, 70%, give or take of our staff live in the borough. That is a huge number. If you’re in central London, that number is significantly lower than that. And so as I say, when I talk to staff, I’m actually also talking to the population that we serve because they’re living next door to their, you know, their patients, their friends, their families who are also being treated in the organization. And that does change the dynamic a bit. It makes the stakes a bit higher. It feels very close. And, you know, it’s a bit like a family. So when families work well, that is the strongest form you can have. When families don’t, then it can be really quite tricky. And so that is something that is always in my mind that we are an organization that is providing essential services to our local population, and a lot of those people are our own staff. And as a consequence, our staff are also the biggest ambassadors for the organization. So if they’re feeling positive about what’s going on, so will the population and vice versa. So yeah, it definitely has an impact. It’s something in our minds all the time and we try to be very present in the place, you know, the Croydon Health Services and organization, we try not to be sort of distinct from and separate to our local population. We want to be part of it and with them and that’s why we try and make sure our connections out there are strong.

Suhail: [00:21:54] And that will also have quite a big impact. Because you talked earlier about the diversity in terms of ethnic diversity, because that, of course, is a high priority under the NHS. People plan and more broadly to reflect within all levels in the organisation. And that’s an iterative process, that diversity In terms of inclusion, yeah.

Matthew: [00:22:14] I mean we try to reflect that in everything that we do in terms of all of our recruitment processes and we have recruitment inclusion specialists who sit on panels at a certain level to make sure that the right questions are being asked. And we’re trying to recruit people who see that diversity as a strength and an opportunity, because that’s absolutely what it is. It makes Croydon what it is. The diversity is broader and deeper than anywhere I’ve ever worked. And as a consequence, the excitement and the opportunity that brings is huge. It does also bring some specific challenges in terms of making sure the services we provide are reflective of the different needs of the population that we serve. So if it was, you know, I look back at jobs I’ve done elsewhere and then nowhere is uni demographic these days, but I compare when I was Chief Exec in Salisbury to being the Chief Executive in Croydon and they are completely different jobs because of the population diversity that is in Croydon. And that makes it for me even more of a of a challenge and an opportunity. And, and we need to make sure that we follow through on that for everybody.

Suhail: [00:23:26] Healthcare quintessentially is always local for that reason. A couple of final points, just to take a wider lens, your own experience is extensive. Don’t want to remind you it’s been 30 years extensive.

Matthew: [00:23:38] It looks like it as well. Most of the time.

Suhail: [00:23:40] You did work with Health Education, England. All the stats are showing that we’re going to need more clinicians and non-clinicians. Social care for 180,000 430,000 NHS. We are seeing people leave voluntarily in significant numbers. That’s going to require not just the cultural infrastructure you’ve talked about, but also perhaps more innovation in terms of how we train and variegated pathway to allow people to enter the sector. How are you seeing signs of that and how important is that going to be?

Matthew: [00:24:11] Yeah, I mean, essential is the short answer to that question. And I mean, again, if I link it into the Croydon context. So we have 400,000 people who live in Croydon and we have the youngest borough in London, the largest number of people under 18 live in Croydon. That’s our future workforce. If 70% of our staff come from the borough and we’ve got the youngest borough in Croydon, then part of our job is to connect with schools, higher education facilities and the population in general and say the health service, the health and care service is a place that you can come and have a fantastic career, do an amazingly important job and be well looked after in the process. And so apprenticeships and lots of different things to get young people into the health service is absolutely where we need to be going now. We’ve made real progress in nurse apprenticeships. We’ve seen a huge development in that area. We need to build on that and look at that in other areas. Therapists, clinicians, other clinicians, doctors and others. But also there’s hundreds of other jobs. We have a big estates and facilities team. What are the opportunities for our local population to get into those sorts of jobs? You know, the managerial work that we do, what are those opportunities for local people? And so doing apprenticeships, training schemes to get direct access, not just through the established routes, is going to be one of the things that I think will mark out successful organisations in the future. Those people who do that and make that connection and get that supply of workforce will do much better than those that don’t.

Suhail: [00:25:55] And that will also allow perhaps a democratisation of access and that will you talk a lot about partnership, of course, as part of your strategic objective, and that will include working across local authorities, education, etcetera. And you’re doing that already?

Matthew: [00:26:09] Exactly yes, we are. And yeah, we’re well blessed in Croydon with the integrated approach that we’ve had for many years. That definitely helps with these sorts of issues. That’s added to with the education side. So we’ve got London South Bank have now got a location in the borough as well as Croydon College. So there are lots of opportunities for us to work across that broader public sector. So it’s not just health and care, education and other parts of the public sector equally important And as I say, I think that will mark out those organisations that who get that will get more success going forward.

Suhail: [00:26:47] And are you seeing just anecdotally an energy and enthusiasm amongst the younger generation for health and social care? It’s certainly been in front of their minds over the pandemic, etc.

Matthew: [00:26:56] I think so, yeah. If you look at the numbers of applications, etc., it would demonstrate that there is enthusiasm and excitement out there that our job in one sense is to use that enthusiasm and then make sure that once people are in the system, whether that be in a training programme or in a job, that they feel like they’re being well looked after and they want to stay because the idea of it sometimes is better than the reality for some people. And that’s why people leave. And we have to be honest about that. It’s a tough job working in health and care. It’s also an amazing job. It’s a massive privilege to do it. And I feel that every day after even after 30 odd years, I still get the same enthusiasm for it. But it is challenging. And so we’ve got to make sure that people know that, but also that we’re looking after people well and they feel that they can make that positive contribution because then the opportunities are limitless to work in health and care, and we just need to make that clear to people and then they will stay and they’ll have fantastic careers and make a huge contribution to where they work and the country as a whole.

Suhail: [00:28:04] Absolutely. One final question, just stepping back further, there’s obviously an imperative for greater productivity. There’s a funding all of these levers and drawing on your vast experience, one of the things that are going to need to be looked at is population health and turning the dial on the disparity in health inequalities. That’s part of your strategic outcome. In terms of the five year plan, it’s a huge question, but just some of the things that perhaps you’re seeing that are giving you hope or some of the initiatives because education, housing, these wider determinants are going to be vital if the NHS is going to deliver the quality of care at scale that it needs.

Matthew: [00:28:42] Yeah, I mean you’re absolutely right. I mean, just quickly, a couple of things that we’re doing that does give me some heart. The first is we’re doing a big programme in Croydon, strengthening communities together, a piece of work actually with the King’s Fund, which is between the statutory agencies and the voluntary sector, to look at how we can really get close to the communities that we serve and leverage the benefit and a huge opportunity that voluntary sector gives us to absolutely get into those deprived communities to say, what does that community need? How can we best help? What can the voluntary sector do? What can the statutory sector do? So there’s a big opportunity there. I think that helps address health inequalities. We’re also in South West London with some funding that’s available, and it’s not only about money, but resources does make a difference. We’re looking with two schemes around health inequalities and health innovation funding to balance that and to spread it into areas where the deprivation is greater. So to not just do it on a per head of population basis, but to spread that out into areas where the need is greatest and obviously living and working in Croydon, that’s really.

Matthew: [00:30:01] Because the levels of need in deprivation terms and health need is very significant In Croydon and in the past we may have got a fair share in terms of population heads. What we now need to do is make sure we get a fair share in terms of the need, because that will then really help us to start to address the fundamentals and the differences that exist between populations across the capital, because we can get more resource to do more for the populations that need that help more so than others. And that’s not to underplay the importance of health everywhere. There is health need in every part of London. It’s just that the health need is different and more acute in some parts than others. And we certainly feel that in Croydon and South West London as an integrated care board is working with us and helping to try to get that funding to match where that need is. And I think that’s a really positive step and one that I’m keen to obviously to pursue.

Suhail: [00:31:03] Well, on that positive note, I’d like to thank you, Matthew Kershaw, for your time and your candour and your wisdom. Thank you very much.

Matthew: [00:30:09] Cheers. Thank you very much.

Suhail: [00:31:12] And if you’ve enjoyed this episode of Voices of Care, please, like, follow or subscribe wherever you receive your podcasts. And if you want to find out about how we are truly enabling the healthcare workforce of the future, please visit newcrosshealthcare.com/voices of Care. In the meantime, I’m Suhail Mirza. Thank you and look forward to seeing you on the next episode.