Saxton Bampfylde are delighted to bring you Future Health, a short series of interviews from both experienced and emerging leaders in the healthcare sector to consider what the next decade will bring – looking at the challenges, opportunities and need for change.
For our second interview, we speak with Gabrielle Mathews. Gabrielle is a multi-award-winning children and young people’s health advocate. A long-term patient, she role models the inclusion of patients in strategic decision-making as a member of the NHS Assembly. She was a founding Oversight Board member to the Research and Economic Analysis for the Long-term (REAL) Centre at the Health Foundation and is a member of the General Advisory Council at the King’s Fund.
Gabrielle is an academic foundation doctor in North Central London with an interest in co-production and power in both research and policy development. She is currently working at Children in All Policies 2030, an initiative launched in 2021 to implement the recommendations of the WHO – UNICEF – Lancet Commission, through multi-sectoral action.
Her advocacy work extends beyond healthcare; She is a board member of the #iwill movement and a trustee of UK Youth, an organisation that supports over 8000 youth organisation and collectively reaches 4.1 million young people. Through the COVID-19 pandemic, she was a vocal advocate for the rights of children and young people and was celebrated as the 1444th Prime Minister’s Point of Light and awarded a Diana Award for her work.
We are looking ahead to the next decade of healthcare and keen to know how you think it might evolve in that period? Is there more that we can be learning from new generations coming through?
I think we need to be focusing on areas that may seem small but are likely to be most significant. In the past few years we have seen a shift in our expectations of the health system, both in the way people think about their health in general and partly because of more challenged access to services. The NHS has for some time been pushing for people to have more responsibility around risk factors such as smoking and alcohol. At the same time there has also been growth in the ways people can monitor their health conditions and are becoming more aware of risks of such behaviour.
The importance of clinical nurses and advanced health practitioners being the link for patients in the community will be really important in the next decade. There may be unwillingness from the public at first, but the system is looking to give them more responsibility to do that and I think that would be an interesting evolution in approach. Such a significant volume of care can’t all go through GPs – it is a huge burden. They aren’t meant to be gatekeepers, but that is what it is starting to feel like for them. We need better link workers in community settings to navigate people through the health system. Even using small changes about how we communicate and use digital technology.
We also will have more focus on the quality of interactions we have with patients when they are with us – how we engage with them and the information we share, should they want it. Rather than the NHS reaching out asking patients to come in there will be more patient-initiated follow up.
“There is really thoughtful work considering health and the role of the NHS in this. So many people are really committed to that vision and leaders from across the sector genuinely seem to believe in the system and want to make it work.”
We also need to think across the whole system, about what our constituent parts say about our whole. An important aspect of this is our suppliers, who they are and how we are picking to work with people. We position ourselves as an ethical provider and we need to be sure that our suppliers also follow those same rules and share our values. We have a huge amount of power and we should be utilising that to insist we work with the right people.
We can also learn from new generations coming through. I think my generation is more confident saying what we don’t know but equally more confident in our ability to pick up and learn new things. We are more used to a digital approach and so we’re looking at the tasks that make up our jobs and how we use our time at work from a very different perspective.
What gives you cause for optimism in your sector and also where do you think there will the challenges?
There is really thoughtful work considering health and the role of the NHS in this. So many people are really committed to that vision and leaders from across the sector genuinely seem to believe in the system and want to make it work. They see the excellent work going on and those delivering with an ongoing dedication to care and improved health. That’s really clear in our healthcare leaders and in their passion for why they do the job, but they are also prepared to be challenged. That makes me optimistic.
I recently heard a leader describe the NHS as no longer worsening but rather stagnating and even improving in some areas. Whilst this fitted more clearly with how I felt from within the system, there is such a strong external rhetoric about how the NHS is drowning and that is really confusing and difficult to work within. I don’t believe we hear those constantly conflicting messages about any other sector. It feels like we are a political and media football and that is extremely challenging.
People come into this sector because they are committed to caring and they want to do it for the right reasons. But we need to be careful because younger generations are seeing opportunities in other areas and other countries and we want to keep and retain them here. We need to listen to them more and put greater faith in their desire to care and make the lives of patients better.
There are more obvious challenges like infrastructure. We do have a very complex system and people are much more equipped than previously to look at it from an organisational perspective with excellent managers and leaders, but we are so often dominated by questions of performance and finance. If we shifted from that, to look more at safety and quality of care, those messages will undoubtedly resonate better with staff. Financial incentives are not as appealing in a care setting but there is a huge pressure on us daily to deliver quality, safe care. We need to be listening to patient voices more and more and that will motivate those focused on care, rather than financial reward.
What do you believe should be the priorities over the next ten years, that maybe have not been as much of a focus?
Prevention in community care is a key area and I believe that co-production and demand signalling are going to be vital in this area. If we can show people quickly and easily where they can get access to care and support for a whole range of issues it will improve community care. We need more data to be able to do this, but it is about making care easier if we can, and by doing that we would reduce backlog and health issues much earlier on. I don’t think it means having the world-class version of care, but we need to look at what we have learned from seriously impactful events like COVID.
“People come into this sector because they are committed to caring and they want to do it for the right reasons.”
We need to talk to those using the system and listen to them when policy and approaches to care are being developed. Co-production is being talked about a lot more at conferences I attend and it is really exciting to see this shift happening. We have the capacity to do this and that will help drive social improvement and a greater focus on innovation and research. We have funding coming in to the system and we really need to be thinking about how we engage and use the data, information to produce better approaches together.
I think our leadership also needs to be more open about where they can or can’t hear from populations because there’s an unrealistic expectation that they have heard from their population. That is really challenging and we need to address that in policy development.
You won the prestigious Diana Award in 2020 – what did that mean for you and how has it helped to develop your approach since then?
I was born the year after Princess Diana died, but I heard so much about her when I was growing up. She was an amazing person, and utilised her power and privilege so remarkably to go to places that really were dangerous and to shed so much light on people who were not being seen in various ways. It was a huge honour to be associated with that strength and compassion by winning this award. It felt hugely powerful to me.
The network I have developed from other award recipients is something I really value. I have made very strong friendships, and we all share similar views and values and I would not have met them otherwise, I don’t think. Having them around me and seeing what they are doing to make a difference and make a noise is inspiring. We help each other with the transitions and decisions for our careers. Sometimes I feel like I don’t know if I am making the right decisions at some of the intersection points and being able to talk it through with them is something I value hugely.
I am building a curriculum for myself and where I need to learn more, develop my skills and improve. There are so many amazing mentors out there further ahead in their careers and willing to share why they made certain decisions, what they regret and what they don’t. Many of them are so open about stumbling into a certain area, but I think that in today’s environment with so much more communication and opportunity to engage I don’t want to stumble – I really want to feel I have made a choice about what I do or where I go next.
But one of the things that it has really made me think about is that I have been given a lot of opportunity and almost a platform to make a difference. It was a huge honour to win this award and I need to bring value to it. Often when I go to events or conferences I am typically the youngest person in the room, but I feel like I should be sharing that with other, younger colleagues too. I want to invite them into these spaces and conversations to share their experiences and views with senior leaders, as I believe it can benefit all of us and help to drive change. I have gained so much confidence and built genuinely respectful and positive relationships and I want to be able to share that.
What do you admire or want to emulate in the senior leaders that you currently see in healthcare as you progress through your career?
I am learning a lot about what motivates me from leadership. I love the opportunity for advocacy and being able to build relationships and ask people why they have done something or are wanting to make changes. I am not a confrontational person, but I really admire those that can challenge in a constructive way. If it is overly confrontational it squashes engagement so I hope I can find a balance as I progress through my career.
The leaders I really admire are those that are able to meet people and pay attention and hear them and offer advice back. I’ve been really lucky to meet very many people who are willing to share their spaces and time, and that is invaluable. To go in and watch them in their space, hear how they talk to their teams and manage dynamics on a day-to-day basis has made a huge impact on me. They really bring out the best in the people around them. They are thoughtful and committed to reflecting and learning together.
Those great leaders build up a network of other leaders around them and encourage diversity and inclusion and it is amazing and I think will really benefit the healthcare system in the long run. They are passionate, and caring, innovative and open and I am so lucky to have been exposed to that. And they are also showing why we should be educating ourselves about other sectors and the challenges they face to reflect back into the NHS, which I think is important.
Over the last four years I’ve had the pleasure of working with a group of amazing leaders considering Kindness in Healthcare and they have taught me so much about leadership. I’m going to list them but whilst they have a shared passion for this topic, their approaches, leadership styles and backgrounds are so varied and rich: Suzie Bailey, Bob Klaber, Dominique Allwood, James Mountford, Cath Crock, Nicki Macklin, Maureen Bisognano and Goran Henriks.
Across the NHS there are so many leaders I admire but I have learnt a lot from Sarah-Jane Marsh and Camilla Kingdon. Most of my time outside of Medicine is spent in the Youth Sector and the leadership of Ndidi Okezie, Charlotte Hill and Jason Arthur has taught me so much about combining activism and leadership.
Lastly I recently had the pleasure of facilitating a conversation with two individuals I have admired for a long time: Don Berwick and Amy Edmondson and the beautiful combination of kindness, intelligence and curiosity is something I really hope I’ll embody in the future.
We are a system with incredibly high expectations of ourselves and very restricted budgets. We also expect clinical professionals to be business managers – it is almost an impossible task at times. We have the highest commitment to care in our sector, but there are areas that are very challenging at the moment. Safety, for example, is really technical and we are struggling to measure and analyse it but we need to think more about how we are prepared and dealing with it. But with more talking and openness about the challenges I believe we can make a difference. We need to encourage more of that culture, inspiring people to take on leadership, ask questions, listen to their voices and bring change with them.
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