Healthcare Leadership outside the NHS
by Tim Crocker-Buque
There has been a greater focus on leadership within the training programmes for health workers in recent years, but all too often healthcare professionals find it difficult to access meaningful leadership experiences during training. The NHS, particularly secondary care services, remains extremely hierarchical and it can take many years for junior staff to be afforded opportunities to take up leadership positions with responsibilities for other staff, organisational strategy, or financial accountability.
However, outside the NHS a wide range of leadership opportunities exist where there can be a great synergy in applying the knowledge and experience gained from your healthcare experience in a different context. One of these is being a Trustee for a registered charity.
The legal responsibilities of a Trustee are to ensure that a charity meets its charitable objects, which are registered with The Charity Commission, and to maintain sound finances. Trustees also often get involved with other aspects of management, including strategic planning, setting an organisational vision, fundraising and acting as a public face for an organisation. Charities come in many shapes and sizes, with an extremely large number of small, local charities often providing health, wellbeing and social care services for people have fallen through the gaps of government provision.
Since 2010, I’ve been a Trustee at Step Forward, which provides counselling, support, mental and sexual health services to young people aged 11-24 in the London Borough of Tower Hamlets. I joined the board to get more involved with the local community when I moved to east London to take up my first post after graduating from medical school. It was a difficult time for small charities, many of whom survive on grants from individuals and local government. At Step Forward, most of our funding came from the children’s department within the Local Authority, and as the substantial budget cuts started to feed through, our funding was reduced substantially. One of my first tasks was to participate in a redundancy process to reduce the organisation’s staffing costs.
This was an extremely difficult time for all involved. It was an intimidating and stressful experience analysing the role of the organisation, working out which services we could continue to provide and which would be cut, and then reorganising the staffing structure accordingly. It was a high-pressure challenge to secure the future of the Charity. It required close working with a diverse group of people from different professional fields to articulate a clear vision for where we wanted the organisation to go. Setting a strategic vision for the future was vital if this process was to be successful.
Afterwards, the Board committed to diversifying and securing the charity’s income streams to prevent having to go through this again. As part of this I was involved in an extensive strategic planning process, setting ambitious but achievable goals for the next 5 years. Through this process I learned how to take a step back from a complex problem and look at the bigger picture, so that the overall vision is not lost in the many small decisions a leader must make.
Despite having been through a significant challenge, both professionally and emotionally, I was very motivated to apply my professional knowledge to identify additional funding streams to meet the vision that we had worked towards. As a Board, it brought us closer together as a team and I was especially motivated to access my contacts in healthcare to secure additional funding for the organisation. It also gave me the unique opportunity to learn how to analyse and make decisions about organisational budgets and financing, including working out the implications of projecting income and costs into the future, which has been an invaluable skill in my future work managing research grants.
Since then we have secured substantial contracts from the local public health department to deliver an expanded range of sexual health services, in collaboration with the local NHS Trust as a junior partner in a joint bid, in a new venture called Forward Thinking. This arose with the move of sexual health into local government following the 2013 Health and Social Care Act reorganisation. As the Board member with healthcare experience I felt as though I was adding value in this process by accessing my professional knowledge and networks.
We have since been awarded a contract from the local NHS Clinical Commissioning Group (who buy healthcare for a local population) to deliver mental health services for young people, as well has having funding renewed to provide support service to local young people who identify as LGBT and specialist services for those who have experienced sexual violence.
It has been extremely rewarding to see the charity grow in recent years and well worth the time commitment and responsibility that comes with being a Trustee. We have trebled our annual revenue and more than doubled our staffing levels.
Earlier this year I was elected to Chair the Board of Trustees and am working with our amazing CEO to expand the organisation to providing a fully integrated mental health, sexual health, substance use, tobacco and alcohol service, by combining our multiple income streams into one seamless service for young people. It would have taken many years in the NHS to gain experience with leadership, strategic planning, organisational management and budget accountability. As a result, I now approach organisational problems differently, taking a wider, more strategic view, which is essential to problem-solving in an organisation as complex and busy as the NHS.
I would recommend being a charity Trustee to any healthcare professionals. To find out more or to find an organisation looking for Trustees visit the National Council for Voluntary Organisations and The Small Charities Coalition.
Dr Tim Crocker-Buque is a doctor specialising in public health medicine, currently undertaking a PhD in the NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine.