Professor Ted Baker, Chief Inspector for Hospitals at the Care Quality Commission
AUTHORS: Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov
In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.
Today, the subject is Professor Ted Baker, who retired as Chief Inspector for Hospitals at the Care Quality Commission in 2022. Prior to this, Professor Baker held a series of senior leadership roles, and had a successful career as a clinical academic, pioneering the use of magnetic resonance imaging for the heart.
A podcast of this interview is available here:
How did you get to where you are today?
My journey in the NHS started in 1973 when I left school - I was 16 at the time. I went to work in my local NHS hospital as a junior laboratory assistant. That was a great experience, and to some extent I set my ambition on working in the NHS and healthcare from thereon in.
Now, I’m Chief Inspector of Hospitals. I've been linked to the NHS for virtually half a century and I'm awfully proud of that. I went on to qualify as a doctor, and then eventually became a consultant at a teaching hospital - I was very proud to have that post.
I became a clinical academic, and undertook research. Research is one of those things that can get you deeply involved in driving improvements in your specialty. I really enjoyed it, and had some interesting times developing new approaches to diagnosing and treating disease.
Then I stepped into medical leadership roles - clinical director, medical director, and medical director of the teaching trust where I started my career.
I then moved on to be a medical director in another teaching trust. In 2014, I moved to the Care Quality Commission, because I decided that I wanted to use regulation as a way of driving change and improvements in the healthcare system.
Since then I've been at the Care Quality Commission, and in 2016 became Chief Inspector of Hospitals.
What made you switch to leadership positions?
When you're a doctor, you're very focused on care, and the quality of care of individual patients - that’s very important. I was a frontline clinician for 35 years, so in many ways that defines my life as a doctor.
It can be very frustrating, because you can see that the system which supports you and the patient often needs to improve. It needs to change, to innovate, to improve. You find yourself being drawn into: ‘How can I lead that change?’, and ‘How can I make that change happen?’ And so you step into a leadership role because you want to drive improvements in the care you can provide to patients.
When I was a doctor in training, I had that drive to lead change and improvement, and it's very central to my practice of medicine. When I was a consultant - I was a paediatric cardiologist - I had real frustrations about some of the resource restraints on the service I was running.
I was working really hard every hour of the day to drive improvements for my patients, but I could see that the system needed to support the service better. When I got the chance to be clinical director of paediatrics, I stepped into it. It was a brave move, but one I've never regretted, because I could drive real improvements in my service.
But then I started looking at all the other children's services I was responsible for, and wanted to drive improvements in those as well. As you get drawn into leadership roles, there's more you want to achieve. Every leadership role I went to I could see more, and wanted to go for another leadership role to step up more.
I was clinical director of paediatrics, so I drove improvements across paediatrics. Then I started thinking: ‘What about the rest of the hospital?’ ‘What about women's services? What about A&E? What about medicine services? They need to improve as well.’ Then you step into being medical director of the trust, and you can drive improvements across the whole trust.
Eventually, you feel you may be leading the hospital, but that the wider NHS needs to improve to help the hospital improve. That's why I came to the CQC. It's drawing me all the time into what I need to improve, and often that means stepping into a leadership role and taking responsibility, to drive forward the necessary improvements.
How has your understanding and practice of leadership changed over time?
When I started, you didn't get any leadership training or development in medicine. I think there's more now, but there needs to be a lot more, because leadership skills are very important. My vision of a leader was a ‘hero leader’ - someone who has all the answers and all the wisdom, telling people what to do, and barking out orders.
That people would do everything you asked them to do, and everything would be perfect. To some extent that was my view of leadership when I went into it. I soon found out that my understanding of leadership was completely wrong.
Over my career in leadership roles I've learnt more and more about leadership as I've progressed. Leadership development never stops. You don't become a perfect leader. Just as you want to improve the services you're leading, you need to improve yourself and your approach.
Now my view of leadership is very different. It's about being a collaborative leader, and it’s about teamwork. It’s about compassion. It isn't ordering people about, it’s trying to get on people's sides, so they can make the best of themselves, and can contribute best to the teamwork that you want to deliver. It's about empowering others. And it's not about having all the answers.
Sometimes it’s about asking the right questions. It’s about having the humility to understand you don't have all the answers. In fact, you have very few of the answers. Wisdom is much better when it's collective wisdom.
Seeking different views, different understandings, different ways of looking at the problems you're facing, and bringing that coalition of support in to drive improvement is very important. Start off recognising that as a leader you're part of a team - you may have a distinct role in that team, but the whole team is important.
Every member of that team has a different view, and every view is important. This is because the collective wisdom of the team is much better than the wisdom of any individual team member.
Do you have any role models in leadership who have inspired you?
Over the time I've worked in the NHS I've worked with some absolutely incredible people. I've been inspired by what I've seen in terms of people in the NHS. That's not people in the same senior leadership positions - it’s often people at the frontline who have really developed that team leadership going forward - doctors and nurses, very much so.
When you see a really good leader it makes a difference. In the CQC we spend our time inspecting hospitals, reporting on them, and so on, and you can often see in a single ward, outpatient clinic or department how one really great leader makes a real difference to the whole team, and also to the quality of care patients receive.
I've seen lots of inspirational people, and one of the things we don't recognise is their value. A great leader is one who gets a team to succeed, and often we forget the value of that individual leader because we look at the value of the team. Often in the NHS we don't give credit to the people who make a real difference.
A great leader isn't someone who's always at the front driving change - they're often supporting others who are succeeding. A great leader never succeeds at the expense of other people - they want others to succeed.
Some of the most powerful leadership experiences I've had are where I've just had a quiet word with someone, given them support and advice, and helped them succeed in what they want to achieve.
Sometimes you speak to people and you encourage them to drive improvements forward. Then five years later you see everything they've achieved, and realise how much has hinged on that one conversation and that support. All leaders need the support of their colleagues. No one is alone in this.
But equally there are some people who are unique in bringing together that coalition of support, and those are the people I admire, and they're there, throughout the NHS. Often, in the most difficult circumstances you will find the most dedicated leaders.
What advice would you give to medical students and doctors who want to develop their leadership skills?
You really need to think about your leadership skills. Leadership doesn't come naturally to anyone. You need to have insight, to be willing to stand back, and to open yourself up to feedback from others.
Giving constructive feedback is one of the skills that you need. You need to surround yourself with people who give constructive feedback, who will warn you if you've got something wrong, but equally encourage you and stimulate your own thinking. Surrounding yourself with good people is very important.
Building a really strong team is important. I think all doctors are leaders. What sometimes really frustrates me is when doctors talk as though they're not the leaders, or that as soon as they get ‘doctor’ in front of their name they become a leader.
Don't kid yourself that you're not a leader. You are, it's just a question of: are you aware you're a leader, and do you know what you're trying to achieve as a leader?
The first thing a leader needs is a vision. You need to understand: ‘What am I trying to achieve in this job?’ Sometimes you get a sense that people have lost sight of what they're trying to achieve. They're too busy dealing with issues on a day-to-day basis as they come up. They're being reactive.
They're thinking about: ‘How am I going to get through today? How am I going to get through this week?’, when a really good leader is thinking: ‘What do I want to achieve in the next five years, what do I want to achieve in the next ten years, and how can I position what I'm doing now, to make a big difference over time?’ That long-term vision is very important.
What I used to say to newly-appointed consultants - as medical director I've appointed a lot of consultants in my time - is: ‘You'll find it very frustrating, because you'll get into it, and you'll realise that you can't change things as rapidly as you want to. But if you think long-term about what you want to achieve, you can make a real difference.’
Don't get frustrated by the day-to-day. Keep your eyes on the long-term, and focus on: ‘What can I do now that in ten years' time will have made a real difference?’ not: ‘What can I do now to get me through the end of the day?’ That's just managing the day-to-day - which we all have to do - but that's not leadership.
Leadership is thinking long-term. How can I inspire others to achieve what they really want to achieve? How can I support them in doing that, and do I have sufficient insight into how I come over to people? This is very important. You've got to think about how you’re coming over to people.
One of the things that is absolutely essential in leadership is having the right values, and one of the things in my career that I wish people had taught me earlier on is that values are really fundamental to leaders.
Values are not what you pretend to follow, they're what you really follow. And values are not about what you say in public, they're about what you say in private, and how you behave when no one's watching you.
What is my instinctive behaviour? What do I do when I'm challenged about something and I'm in difficult circumstances? Do I do the right thing according to my values, or do I retreat into a defensive posture where I want things to go away?
I think values driving leadership are really important. So what I'd say to people is: recognise you're a leader, think long-term about what you want to achieve in terms of your vision, and be driven by values, real values, that you want to drive what you do.
What does your role as the Chief Inspector of Hospitals involve?
As the Chief Inspector of Hospitals, I lead a team of about 600 inspectors in the Care Quality Commission who spend their time interacting with hospitals in the biggest sense. So it's not just acute hospitals and mental health hospitals, it's also ambulance trusts, and the independent sector as well as the NHS.
We oversee the hospital sector for the CQC. The CQC also has a chief inspector leading on primary medical services, GPs, and other primary medical services, and a chief inspector looking after adult social care.
Together, we cover the whole breadth of health and social care in England, and I look at the hospital sector. My role is really to regulate the hospital sector - and regulation is to some extent holding hospitals to account - but also trying to create an environment in which they can succeed.
For me, central to what I'm trying to do is to try and create an environment in which hospitals can succeed, by identifying their problems and helping them to address those problems. I spend a lot of my time, day-to-day, interacting with hospitals or with other parts of the system to make sure hospitals get the support they need to drive improvements for their patients.
It's ‘regulation in the round’, driving improvement, but also applying the regulations, which are the legal framework in which hospitals operate.
We produce regular reports on hospitals from our inspection process and from our monitoring process. When I came into this role, early on I made it clear that it's important we are transparent about problems.
Because one of the problems that leaders sometimes falsely get themselves into, is this belief that if we keep the problems tight to ourselves and don't share them, then they will go away - we'll be able to manage them, and they won't be worried. But in truth, that leads to problems being buried and not addressed.
What the CQC tries to do is to drive transparency. Recognising that even the best hospital has problems, but being honest about those problems, is the start of dealing with them. Driving transparency is something I've tried to do throughout my career, and in the CQC I've been able to do that, because we have the powers to inspect, and to report.
What I say to my inspectors is: ‘We are looking at services from the perspective of people using them - the patients - and we want to report on the experience patients get’. That's important. And when we report on the quality of care, we're not reporting on the people providing care, we're reporting on those receiving care, and the quality of that care.
If we can be honest about the problems with care, we can then resolve them. What I want to do is to try and be honest about the problems, but also support services in resolving them.
What are some of your key priorities as chief inspector going forwards?
The pandemic has had a huge impact on health and social care. During the pandemic, services were held back from providing all the care they wanted to provide. But also we as regulators have been held back, because we have deliberately stepped back from doing routine inspections and routine regulatory work, because of the pressure it would place on services.
We have to catch up with our regulation, so over the next year to 18 months I want us to catch up with our regulation and provide up-to-date reports on hospitals and services, for those hospitals, but also for the people using them.
We have a backlog of regulation to catch up on, which is really important, and we need to make sure we get on top of that. That's what I'm talking to my teams about at the moment. There’s a second priority I want to focus on, and this comes back to why I joined the CQC in the first place. I joined it after the Mid Staffs report, which was a report into problems in a particular hospital.
But if you read that report, and many other reports or failures in the health system, the issues are virtually always about leadership and culture. The reason I moved from being a medical director for a trust to being a regulator was that I was really frustrated the NHS was not addressing these underlying issues of culture.
I thought being a regulator was an opportunity to address it in a different way. I came into the CQC because I wanted to change the culture of healthcare, or be part of that change. We've released a new strategy as CQC, which is all about changing culture, and one of the central themes is the safety culture.
My immediate priority is to drive forward a really strong safety-focused culture across healthcare. And that isn't about a reactive culture - when something goes wrong we'll do something about it - but a proactive culture. A culture that looks forward, identifies safety risks, and takes the steps necessary to protect patients and staff.
One of the frustrations I have about healthcare is that it has not developed the safety culture that many other industries have, and that's long overdue. I want to work with colleagues across the board, to try and drive forward the right safety culture for the healthcare system.
That will help patients get safe care, and will also take one of the key pressures off staff. One of the key pressures staff face every day is they work in a system that has inherent risks, but we're not honest about those risks and how we're managing them.
There's an assumption built into healthcare professionals that if something goes wrong that's because someone's made a mistake, when in fact things go wrong all the time in complex systems. We're all fallible, we recognise fallibility, and when things go wrong that's an opportunity to learn, and to build better, safer systems in the future.
Every other high-risk industry has recognised that. Healthcare is still in a position where it has this image of itself as infallible, and when things go wrong that suggests that there is fallibility and it's someone's fault. We need to move away from that.
Another priority at the moment is about speaking out. It comes back to transparency. It's about trying to create a strong voice for services under pressure, but also for patients who are not getting a good deal from the service.
One of the key things that features in our strategy is a real focus on inequalities of health outcomes, and it is very clear in this country that one of the real drivers of health outcomes is socioeconomic factors.
Our challenge to the system is: what are we as a healthcare system doing to try and counteract those socioeconomic factors, to make sure that everyone gets an equal chance of the best possible health going forward? It isn't about attacking those factors directly, it’s about making sure that everyone has equal access to the healthcare that they need.
One of the problems we see in the healthcare system is that access isn't always equal. Theoretically, the health system's available to all, but in practical terms, different groups in society often have difficulty accessing the healthcare they need, and we need to go out and support them to do so.
What are some common misconceptions about CQC among healthcare professionals?
One of the problems we have as a regulator is people react to us with a view to us being a traditional regulator in the compliance sense - we come around with a tick box, you've either done it or you haven't done it, and you get a tick or a cross.
That's not how we see ourselves, but it's very difficult because people react to that. There's a real sense that the regulator is seen as the ‘opposition’, and sometimes people say this to us: 'We are doing this just to keep the CQC happy’. What they don't say to us is: 'We want to be partners with you as a regulator in driving forward the best possible care for our patients', and they don’t see us as a partner.
We are desperate to be partners with providers in providing the best possible care. Clearly, we have regulations, but we recognise that most of the improvement will not be driven by application and regulations, but driven by leadership. Leadership within the clinical teams, and directly with the CQC where necessary, to drive improvements.
We produce reports, and they are honest. We don't ‘gild the lily’, we say what we find. What we say in the reports is driven by what patients and frontline staff tell us.
It's always interesting when you go into a trust and report back problems in a service, and the board gets very angry with us for this, but the frontline staff in that service are sending us thank-you emails, saying: 'Thank you, someone's telling the truth at last about our service’.
Surfacing that truth about what's really going on is very important, but we're not doing it to undermine people, we're doing it to help stimulate them to address the problems. We're not reporting on people, we're reporting on the services that patients receive.
When we say a service requires improvement, we're saying the service the patient receives requires improvements. We're not saying it's anyone's fault, we're just saying: ‘We've all got to think about this differently to drive forward the improvements as necessary’.
We're not blaming people for the problem, but we're just saying: ‘You've got to be honest about the problem, because it's until you are you won't drive the improvements that are necessary, and this is what your patients are really receiving in the way of care’.
Do you ever face a problem of hospitals acting differently when you're around, and once you're gone reverting back to old practices?
Yes, I think we do, and we're well aware of that. Most of our inspections are now unannounced, so hospitals don't know we're coming. When we started doing the inspections, they were big ‘set piece’ inspections, and tended to be announced in advance.
There's no doubt that hospitals did an awful lot of window dressing. Of course we could see that, we're not naïve about this. It is interesting that a hospital knows you're coming 12 weeks in advance, but still you go in and find serious problems, and you think: ‘If this is the best they can do when they knew we were coming, what was it like before they knew we were coming?’
There's been a tendency in the NHS to think that getting the paperwork right is the answer. Very early on I said to my team: ‘This is not about the paperwork - if the hospital's got great paperwork that's fine, but find out what's really going on at the frontline, what patients are experiencing, what their frontline staff are saying about the services they provide’. That is much more difficult for hospitals to prepare for.
They can get the paperwork right, and they can paint a few walls. I remember inspecting one hospital and the smell of fresh paint was overwhelming, and they were so embarrassed, saying: 'We didn't paint this just for you', as if somehow that was what would drive our assessment of their service - whether they had just painted the walls or not.
They misunderstood. I think they do prepare for us - less so now - but the good hospitals do not. The fact that a hospital is having to do a lot of preparatory work for the CQC - they should reflect on that.
Because what we're looking for is good quality care for patients every day of the year, every year, day in, day out. The CQC will inspect a clinical service for a couple of days, once every three years or so. We're looking for good quality care throughout those three years, not just for the days we're in. If we see evidence that the service is defensive, that it is preparing for us in those ways, that worries us.
Sometimes an inspection is a good point for services to review what they do and think about whether they can do it better. But we're looking for long-term improvement, we're not looking for just improvement while the CQC's in the building.
Can you paint a picture of what an outstanding hospital looks like?
If any readers want to find out more about it, I suggest they go to our website. There are two reports - one is called: Driving Improvement, Case Studies from an NHS Trust (2017), the other is called: Quality Improvement in Hospital Trusts (2018).
They are based upon our inspection methodology, so do look at those. Essentially, an outstanding trust is not perfect - and this sometimes worries me when people say: ‘How can that trust be outstanding?
Look, they've got a poor outcome in this audit’. It’s that they are focused all the time on improving their services. An outstanding trust has great leadership, a great culture, and it is values driven- and by this I don't mean it has some really good values written on the wall, but that it exemplifies those values in what it does every day. That really is important.
The leadership is not the hierarchical top-down hero leadership - it's collaborative leadership, it's distributed leadership. You need good leadership in every ward, in every clinic, not just in the boardroom. It comes back to transparency.
The first thing we look for in a trust is: are they honest, are they trying to hide things from us, or are they honest about their problems? I say this to every trust I go into: ‘We know you've got problems, all trusts have got problems, what we want you to be is honest with us about them, and explain what you're doing about dealing with them’.
An outstanding trust is not a trust without problems, it is a trust that is aware of its problems, is honest about them, and addressing them. A trust also needs to have openness. It needs its patients and staff to be frank and open about things. One of the things that's changed over the last few years is this issue of the ‘duty of candour’ that was introduced as a regulation.
It is important that we all learn to be open about problems with the general public, but also with individual patients. Another feature of an outstanding trust is there is real involvement of patients. Not token involvement, but real involvement. That is really looking to the patients and public to bring a new insight into their services, and to challenge their thinking.
I was at a conference a couple of years ago on patient safety, and I was saying: ‘Twenty years we've been focusing on patient safety, and it hasn't improved nearly as much as it should - why is that?’ The room was full of patient safety experts, and they were all saying: 'I don't know, perhaps we haven't got enough money, or perhaps we haven't got enough staff' - all the usual excuses.
Then suddenly a lightbulb went on in my head - everyone in the room was thinking exactly the same thing. We are in a ‘groupthink’ where we've learned that we can't improve safety because it's all someone else's fault. That's one of the features of poor leadership - you look to blame other parts of the system for the problems that you're facing.
What we needed in that room were some people who had a different view of what was going on, and of course the ideal people are patients. Patients often bring great insight, great expertise, and great challenges to the system, but you have to be open to that.
That's difficult, because as a professional you don't want to be challenged by your patients, but actually this is very healthy, and helps you achieve real excellence. A great trust gets great involvement from patients and the public.
Great trusts have also got a total focus on quality improvement all the time. Quality is never outstanding in itself unless it's improving. Quality is never good enough - every trust that we go to that is outstanding is always obsessed with improving quality going forward.
You go to trusts that haven't got this, and they'll say to you: 'We can't improve quality because we haven't got enough money, our budget is constrained'. But you go to the trusts that have done this well and they'll say: 'We focused on quality, and when we got quality right, then the budget became much easier to manage’.
Because poor quality isn't cheap, it's often quite expensive. Quality improvement drives much better control of an organisation, but also much better engagement of staff and patients. Quality improvement is very important.
By quality improvement I don't mean quality improvement projects, it is about a quality improvement ethos all the way through the organisation. If you like, the driving force across the whole organisation is: how can we be better tomorrow than we are today? How can my clinical care be better tomorrow than it is today?
I learnt in academia when I was a clinical academic that one of the things that drives quality is this constant focus of looking to improve. That's one of the reasons why research is very good at driving quality, which is why academic medicine is so important, because it is about driving improvements.
It's not just in academic areas that you can do that - you can do it in everyday work. One of the outstanding trusts I went to had a huddle on the intensive care unit to figure out what they could do to improve quality. This was a regular event.
I was chief inspector of hospitals, the chief executive and various consultants and intensivists were there, and the huddle was being led by the ward cleaner, because everyone in that team was involved in driving quality improvement.
It wasn't about a hierarchical system where only the leader had the ideas about what needs to be better - everyone in the team could have ideas about what needed to improve, and how it could be improved - that was really important. It's coming back to leadership and teamwork, and encouraging the whole team to be part of the journey of improvement.
That in a sense sums up where we are in terms of outstanding hospitals. But it is about leadership, culture, and values - these are the fundamental things that drive quality. If you want to follow it up, have a look at the quality improvement report, which I know was really helpful to many trusts in reviewing how they took their services forward.
I've had a lot of very positive feedback from trusts about it, and I've seen trusts turn themselves around dramatically by driving a quality improvement culture across the organisation.
How much of a difference can individual doctors make within organisations if, for example, the leadership team isn't functioning as it should do?
Doctors are all leaders. Many other clinical staff are leaders too - it's not unique to doctors. But once you become a doctor you need to understand that people will follow your lead, and if you don't have the right values or you lead in the wrong direction you will make things worse, not better.
As a doctor, whatever role you're in, you should think about: ‘What do I need to achieve in leadership terms?’ You should never be passive about this.
If you're in a team that isn't working well, be it a small clinical team, a big department or a hospital, you need to think about: ‘How can I make a difference to improve the way this team works?’ ‘Am I in charge?’ ‘I can't decree that things must happen, but I can change things.’
The first thing is to think about your own behaviour and how you come across. ‘Am I going to accept the status quo in terms of the culture I'm working in, or am I going to challenge it?’ I don't mean challenge it in the way of you're having arguments with people about it, I mean challenging it by demonstrating a different culture.
If you bring your own values with you, and stick to those values regardless of the culture you get into, you can begin to change that culture. The only way it will change is by individual members of the team demonstrating it can be done better.
I find it really worrying that as doctors - and other clinicians as well - we end up going into a team that has a poor culture, and as a defensive mechanism we adopt the culture of the team and perpetuate the problem.
When actually, you've got to stand up for what you believe to be important, and not adopt the culture of the team, but find ways of challenging it in a positive way. Because having arguments with people doesn't solve things, but having one-to-one conversations where you get people to think differently, exemplifying your values, and calling on their values, does.
Often, other people in the team will share your values - they just won't be able to demonstrate them because they feel so oppressed by the team culture. For instance, if you're in a team that isn't transparent and open, what can you do to encourage that transparency and openness?
What can you do to shine a light on the problems that the team needs to address, so those problems don't get hidden? The first job I was in as a junior doctor, the bullying and the blame were terrible, and everyone spent their time trying to avoid getting blamed when something went wrong.
If you're on a team where blame is a constant theme, don't become part of blaming other people. Doctors can get very bad at this. A defensive mechanism is to say: ‘There are problems here, and it's all someone else's fault, and they must do something about it’.
But blame is a way of avoiding responsibility. The only way you'll stop the ‘blame culture’ is by not becoming part of it. Likewise, if it's a culture where quality improvement is not to the fore, what can you do in terms of driving quality improvements?
You can do an audit as a kind of tokenistic exercise just to get the paperwork right for your training programme, or you can do an audit to make a difference for patients. If you're doing an audit or quality improvement programme of any kind, it's not making a difference to patients.
You're in the wrong place, because the audits that really matter are the ones that make a difference. Find your own leadership role that can make a difference in that department. You won't change the world, and you may only be there for a few months, so you can't change it permanently, but you may become the beginning of a change that over time can make a real difference.
What problems do doctors sometimes face when they rotate to new wards and departments, and what’s your advice in troubleshooting common issues?
This takes me back to when I started many years ago, and I wish people had given me the advice that I needed at the time. In those days, it felt very much like being thrown in at the deep end. I hope it's not like that now, but it is a great learning experience, and it was hard work.
I really enjoyed the hard work, although it was stressful at times - medicine is stressful at times because we're dealing with people at some of the biggest crises of their lives. Be loyal to your culture and values.
Provide leadership you can provide. Even as an F1, you may think you're at the bottom of the heap, but you're not - there are people below you in the system, and you can provide leadership for them. You can sometimes provide leadership for the people higher up in the hierarchy, in terms of how you behave and what a difference you can make.
Effective leaders are not always at the top of a hierarchy - remember that. What are the problems? Multidisciplinary working is absolutely key to success, so build those bridges with other members of the clinical team, be they nurses, pharmacists, physiotherapists, or radiographers.
Always treat them with respect. Listen to their advice. Some of these people have been in clinical practice for many years. They may not have 'doctor' in front of their name, but they may be really experienced, so build those bridges with other people.
Support your colleagues. Other F1s will be under pressure as well, and you need to work together to support one another. Recognise that this is a team effort, and you need to support them, they need to support you, and you need to build those bridges going forward.
You will sometimes face angry patients - we all do - but remember those patients are going through major crises in their lives, and don't take it personally. Try and help to find a solution for them, however difficult it seems at the time.
Because those patients are having a really difficult time, for whatever reason, and you never know the details of what's going on in their lives that leads them to be difficult as patients. Some patients will be appreciative. One of the strange things about medicine is often the patients who are most appreciative are the ones you did the least for, and the ones who are the most angry are the ones you've done the most for. But that's medical practice for you, and you have to accept that.
Think long-term. Don't think about today or this week, think about what you're trying to achieve long-term in your career as a doctor. That's really important, because all these jobs are for a while, and you're building a career, and as you build that career, you not only want it to succeed for the outside world, you want it to succeed for you.
And it'll succeed for you if you keep focus on what your vision of being a doctor is. When I applied for medical school many years ago, I remember going for an interview and being told: ‘If they ask why do you want to be a doctor, whatever you do, don't say you want to be a doctor because you want to help people.
You've got to say you're interested in science, or the technical sides of medicine.’ But of course, that's actually why I did become a doctor - to help people - and never forget that, whatever happens.
What are some of your proudest achievements?
I did 35 years in clinical practice, and I was a paediatric cardiologist, looking after children's hearts. During one of my very early stays in clinical practice a little baby came in, a few hours old. She was very blue, saturation was about 60 per cent. She was really in extremis.
As part of the team, we resuscitated her, gave it the heart treatment she needed, and she came through. About 25 years later, that very same patient walked into my outpatient clinic with their own child. Of course she had no memory of those hours where I'd been involved with her in the early days, but I saw her there, blooming, with a very healthy child.
She was worried the child might have heart problems as well, but they didn't. The sense of satisfaction you get from seeing your patients do well is probably the biggest positive thing in medicine. And she's just one example - there are many others.
What I'm proud of most is clinical practice and what I managed to achieve for many patients - not for all of them. You've got to have humility - no doctor is perfect, and I recognise perhaps I could have done more for some patients.
But over a career you feel really proud of how well your patients have done and what you've contributed. Their lives are successful, and having been a small part of helping them is great.
When I was an academic, I was one of the first to start using magnetic resonance imaging of the heart, in the days when no one really knew what magnetic resonance imaging was going to be used for. People asked: ‘This technology, what are we going to use it for?' I said: 'Start using it for looking at congenital heart disease.'
I started a programme of imaging congenital heart disease. Now MRIs of the heart are commonplace, but I did some of the first MRIs of the heart in Europe. There have been one or two in the States. I actually started a programme in the States as well, in 1986, when I was out there for a year. And I’m really proud of setting up a cardiac imaging service, which is now a world-renowned service.
People will probably remember me most for when I was clinical director of paediatrics at Guy's. In the mid 1990s it was decided that the A&E at Guy's would close, and the A&E of Thomas' would become an elective cold site, which was very controversial at the time.
The majority of the paediatric specialty work was at Guy's in Guy's Tower, and I was clinical director of paediatrics. I remember as clinical director of paediatrics hearing this decision from the government, and thinking, actually, if we want the paediatric service to be successful, we need to move them to St Thomas' en masse, and that means a new building at St Thomas'.
So I put out a flyer - these were the days before email - to the children's services saying: ‘It's disappointing that the A&E at Guy's is closing, but we've got a great opportunity to create a really world-class children's service, Guy's and St Thomas' together, at St Thomas'’.
That was very controversial, and I felt very lonely, because people got angry with me that I was moving the service out of Guy's. I got a lot of flak about that, and I felt that perhaps I'd gone a bit too far. Ten years later the Evelina opened at St Thomas', and I'd raised the money for it, and got the design in.
The building is wonderful at St Thomas', but their decision to put it next to the women's services and A&E proved to be entirely the right decision. More than anything, what I'm proud of with the Evelina is its great culture.
A few years ago, CQC inspected it and it came out as ‘outstanding’. I wasn't involved in that at all - I kept well away from it because of the conflict of interest. I remember the CQC people coming to me and saying: 'Oh, the Evelina is outstanding by the way', and that really made my day, because it is a great children's hospital.
I know that if I hadn't started off with leading it against a lot of opposition, way back in the mid-90s, it would never have happened. That's one of my proudest achievements. I’m also proud that we've made a good start on changing culture at the CQC.
We're not there yet by any stretch of the imagination, but I came here to change the culture of the healthcare system, and I think we at CQC are driving that, and its latest strategy is very much focused on that. I hope I've started the process that will lead to great improvements in culture, particularly around safety culture. If I could achieve that, that would be the biggest difference I could make in my career, but whether I achieve it or not is still open to question.
What are some important lessons that you learned during your career that shaped you?
In 2005, when I was medical director at Guy's and St Thomas', I felt we weren't in the right place and going in the right direction. So I did a lot of thinking, and it occurred to me that we were not explicit about our values - we didn't talk about values much.
I stood up in front of the board at Guy's and St Thomas' and said: ‘We need to start explicitly talking about values as an organisation, and about what's really important to us as an organisation’.
It's difficult because people think: ‘What's the trust telling me what my values should be?’ I've got my professional values, but I said: ‘It's important that we have a common dialogue against values’. I led a process of discussing values in the organisation, and we came up with some values, which I'm glad to say are still the values of Guy's and St Thomas' to this day.
That had a huge impact on the organisation, in that talking about values became important, and values came to the fore. I think we may have been the first trust to have done that. Shortly afterwards, the NHS was talking about values, and I got a call from the Department of Health saying: 'We've decided to have some NHS values. We hear you've done that at Guy's and St Thomas', can you give us any advice?'.
I said: 'I think you need to go out and consult the frontline staff, talk to them about values, and then eventually you'll get a sense about what those values should be’. They said: 'No, sorry, we've already decided what the values are, they're being announced tomorrow’.
I thought: ‘They've really missed the point, because it isn't about the words, it is about the process, and it is about capturing hearts and minds’. We did that well at Guy's and St Thomas', and a lot of colleagues were supportive of that, and I think it made a real difference.
I learnt that leadership is about vision, but it is mostly about values. I learnt a lot about values during that process - that values are not token, they have to be real, and they have to inform how you behave in private as well as in public.
It's changed my perception and understanding of myself, but also my understanding of leadership. It is not discussed enough that leadership is about looking at yourself, and making sure you're consistent with what you want to be, rather than pretending.
A horrible word which I hate at the moment is about being ‘authentic’. Having said that, it is true that in public you have to be what you are in private, and in private be what you are in public. Those one-to-one meetings, where you have confidential meetings with close friends - if you are saying things differently there to what you're saying in public, you're in the wrong place.
If you're cynical behind the scenes and critical of people behind their backs, you're in the wrong place. You need to be willing to say in public what you're saying in private, and likewise you need to be consistent in private, saying what you’re saying in public. Then you start becoming consistent with your values. I learnt that at Guy's and St Thomas', and it changed me as a leader. That was a key time for me.
Any other advice would you offer to medical students and doctors who are just starting out on their career about how to excel?
Everyone's career will be different, and you must set your own goals. I would say think long-term, and about where you want to be in ten years' time. This is true at any stage in your life - if you don't have a thought about where you want to be, you've got no sense of direction.
I'm not saying think about which particular job you want in ten years' time - because no one can guarantee you get a particular job in a particular hospital - but just generally where you want to be in ten years' time.
Not just what job you want to be in, but what kind of doctor you want to be, and what kind of clinical service you want to be involved in. This is really important, because it isn't about jobs, it's about what kind of person and doctor you want to be.
Keep reinventing yourself. Medical careers are long, and one of the problems that doctors often face is they're in the same job for too long. I'm not saying you need to change jobs, but if you become a consultant in your early 30s and you're going on to your mid-60s, that's 30 years.
And if you think you're going to be doing the same job for 30 years you're in the wrong place. You need to keep thinking about: ‘How can I reinvent myself in this role, or move to another job, but in this role’.
It may be that for a while you're going to do research, you may do quality improvement, or teaching and education, but you're constantly recreating what you are, and what drives you, and what your goals are in life. A medical career - it's a great privilege, and it's a long-term, secure career for most doctors.
But don't get stuck, don't get stale. The most important thing is to be focused on the needs of your patients. I can't say this too much. In medicine what really is important are patients and their experiences. This can be difficult because we focus on the bigger picture.
But we'll all be patients sometime, and we'll have families who are patients. Something that really concerns me is you sometimes hear doctors talking about their experience as patients as if it came as a great surprise to them what it was like to be one.
There was a great series of articles in the BMJ, which stopped about ten years ago, where they had a doctor writing an article about how they didn't realise how awful it was until they became a patient themselves, and it changed them as a doctor.
But as a doctor you don't have to wait until you're a patient to start empathising with patients, surely? We need to start focusing on their experience. Putting your patients first, and thinking about them first is really important.
Those would be my ‘starting off’ points, but everyone's career's different, and all the opportunities are different. It is a great career. Let's be clear about this: if you're qualifying as a doctor, you're qualifying for a great career, which will give you great satisfaction, one way or another.
What's your favourite book of all time?
I've got lots of books. There is an oft misquoted phrase - attributed to C. S. Lewis, but I don't think he ever said it - and that is: 'We read so as to know we're not alone'. Reading is very important, because to some extent it is part of understanding the human experience through other people's eyes.
I love any great book that is about the human experience. My favourite book is David Copperfield by Charles Dickens, because it's a first-person description. What's good about it is it's a different time, a different place, a different experience, but it’s about the human experience, and the human experience doesn't change.
The environments in which we live out our lives are different, but the human experience stays the same. And the book is all about relationships, and people who support David Copperfield, and people who are against him. I read it at school, and I re-read it regularly, and love it every time. Dickens is a great author.
I’d also like to highlight a book which I think is very important. It’s called The Citadel by A. J. Cronin, and it was published in 1937. Cronin was a Scottish doctor who worked in Wales, and he had worked with Nye Bevan of the NHS, in the Welsh coalfields.
The pattern of medical care in the Welsh coalfields was very much the basis that Nye Bevan used in developing the NHS in 1948. It's all about what was there before the NHS and understanding why the NHS was so popular. The publication of the book in 1937 was very popular, and many people feel it led to some of the popular support for the development of the NHS after the war.
The important thing about the book, that's always forgotten, is that it is about the culture of medical practice as well. While the way healthcare is provided has changed, the culture of medical practice hasn't changed nearly as much.
If you read about some of the culture of medical practice there, and you see how he describes it and how he eventually becomes disillusioned with it, you think: ‘Well actually as a regulator I see some of that going on in similar ways in the modern age’.
It does remind you of the importance that we as doctors have as leaders, not just of our teams, but of society, and of the profession as a whole. I’d also like to add that if you're starting out in medicine, you are in a privileged position, and you will enjoy it tremendously. There'll be challenges. But have fun.
Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.
