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A view from the other side… of Offa’s Dyke – Dafydd Loughran

A view from the other side… of Offa’s Dyke

by Dafydd Loughran

After the contract war comes the calm. In a funny way it’s a little bit uncomfortable, especially from the familiarity of a Cardiff operating theatre, which Twitter might call a #Huntfreezone. Suddenly, the distraction of noisy neighbours has passed. It makes one peek a little closer at the cobwebs and creaky floorboards of the NHS in Wales.

Without clinical commissioning groups and the troubles of Health Education England, Wales may seem like a greener pasture, and in many ways it is. However, each system brings its own challenges. Clinical leadership, by the admission of many in high places, has plenty of room to grow and conservatively follows the English lead a few paces adrift.

I’m a Urology trainee by background, but my frustrations hauled me towards a Clinical Leadership Fellowship, the Welsh version rather than that of the Faculty of Medical Leadership & Management (FMLM). I wanted to understand what was going on with our health system and why; could this tanker be turned? The Welsh fellows, code named the WCLTFs (Welsh Clinical Leadership Training Fellows), are placed in an organisation for a year, whilst studying for a Postgraduate Certificate in Medical Leadership and an executive Master of Business Administration (MBA) module at the prestigious Massachusetts Institute of Technology (MIT) in Boston.

It was one memorable afternoon at MIT that opened my eyes to the skills we have as clinicians. Around the table were executives from major global businesses, tasked with the ‘diagnostics’ of why a hypothetical company was failing, and how to steady the ship. This was my eureka moment; every day since the start of medical school, we have been encouraged to consider complex information from different sources, work out what’s going on, then make a plan. This way of analysing information is a key skill for those in leadership and managerial positions. As clinicians, we were the best in the room at addressing this task.

Photo credit to the Wales Deanery’s #trainworklive campaign.

So why do we accept that a leadership role may come along one day, once we’ve earnt our grey hair, and are frankly too tired to rock the boat a great deal. There is great value in harnessing clinical leadership skills early in our careers, which is what makes me so excited about the Healthcare Leadership Academy.

During my fellowship year, based at ABCi, the Aneurin Bevan Continuous Improvement Centre, I was given free reign to explore and to really understand the problems, and to experiment with solutions. My wording is very deliberate; we are often far too quick to a solution. Bertrand Russell is quoted to say, “The greatest challenge to any thinker is stating the problem in a way that will allow a solution”. With a little bit of reader’s license, I interpret this to mean that if you can truly understand the problem, and communicate it clearly, then the solutions will come easier to all.

For much of the year, I’ve been working on algorithms to help referral prioritisation. This project has got lots of potential, but in reality it wasn’t on anyone’s radar here 12 months ago. It can be a battle to get organisations to add to their already busy priority list, so be ready for the challenge. If you think of Prochaska & DiClemente’s Transtheoretical Model, you’re starting way down at the bottom, and it usually takes a while – even months – for people to be ready for any change. Understanding that inevitable delay can help you out of any ‘valley of despair’ you find yourself in along the way, and having a good team is invaluable at such points.

As we become accustomed to in Medicine, August brings new challenges. I’ll be joining the clinical artificial intelligence team at Babylon Health in London, whilst keeping one foot in the NHS here in Wales. I’m excited to take on a whole new learning curve, and it’s a good example of the opportunities out there beyond the hospital walls should you find yourself in need of a change.

There are three parting tips which  I will take away from this last year…

  1. Step away for a moment to get the balcony view.

  2. Appreciate the skills you bring to the table.

  3. Take people with you on the journey.


Dafydd Loughran was a urology trainee and has recently completed a clinical leadership fellowship in Wales, before moving on to work at a health technology startup in London.



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