Maidstone and Tunbridge Wells NHS Trust
Miles started his NHS career by completing the NHS general management trainee scheme. He is now in his fourth NHS Trust chief executive role at Maidstone and Tunbridge Wells NHS Trust. Prior to this he worked at The King’s Fund and was an NHS director of operations and director of planning and performance.
Q: Was there a particular job, opportunity or experience which convinced you to apply for the chief executive role?
The work of a chief executive is incredibly varied. I have been fortunate enough to touch every clinical service and part of the NHS during my career which includes working at a regional and national level
It was the variety of my work and experience that gave me the confidence to become a chief executive. Back in the 90s I was a director at one of two main trusts in Sheffield and lead director for a merger there. It was that experience in particular that convinced me to take the step up to chief executive. The merger involved really significant clinical engagement and buy-in to our vision. It was the success of doing this role that really gave me the confident to be a chief executive.
Q: What makes the trust chief executive job rewarding for you?
For me it’s all about people and patients. I love going to our wards, spending time as a support worker and meeting colleagues and patients during the course of their day.
I also really like the feedback we receive, even the challenging comments I get from our patients and staff, it is where I get my inspiration from. I genuinely find our staff inspiring. They give me the motivation and energy to carry on helping people to be the best they can be. Being a chief executive is a great opportunity to help people with their careers and reach their full potential.
I also really like the feedback we receive, even the challenging comments I get from our patients and staff, it is where I get my inspiration from. I genuinely find our staff inspiring.
Q: What skills/qualities/values do you think that clinical professions bringing to senior leadership positions?
Our clinical colleagues can bring a really powerful patient focus to leadership roles alongside their many other qualities. NHS management is a team sport and by default people who are successful as clinicians tend to be so because of their ability to build and work with teams of people. These are the qualities that clinicians coming into management should really hold onto and bring to the fore alongside their patient focus.
What our clinical colleagues also bring with them is their experience in a general sense. That’s not so much about their knowledge in a specific field or success in a specific area. If they fall back to their knowledge gained in a specific service they will get their comeuppance. Most of the time the things you achieve as chief executive are not based on your technical expertise in one area, which still counts, but it is because of your wider skills, experience and knowledge.
Q: What more should the NHS be doing to support clinicians into chief executive roles?
Medical management, in my view, should be encouraged as a legitimate career choice at an early stage.
We often seem to assume that every NHS medical student will become a practising doctor and it’s a failure if that doesn’t happen. That isn’t the way it pans out in other countries, where medical students choose to specialise in management.
I would also recommend that all clinicians gain some form of experience of our wider systems of care covering hospital, community and mental health and the bureaucracy and experience that come with these roles. Most chief executives with a clinical background work their way up through chief nurse or medical director, but actual experience of IT or operations would be helpful.
Our clinical colleagues can bring a really powerful patient focus to leadership roles alongside their many other qualities. NHS management is a team sport and by default people who are successful as clinicians tend to be so because of their ability to build and work with teams of people.
Q: What words of wisdom do you have for clinicians thinking about stepping in to senior leadership roles?
You’re applying for an incredibly rewarding job with great scope and variety. Being a chief executive is a job where you have much more control over what you are doing and the way you use your time. Like so many clinical roles, it’s not a nine-to-five job. What’s important is how you use those 60 - 70 hours a week and that’s really down to you. That’s not something I clocked when I became chief executive. I found it very liberating, how you’re not at someone’s beck and call in quite the same way.
Also, remember no one is an expert at everything and being a chief executive is mostly about not being an expert. It is about being a leader; be confident in your own skin and use whatever knowledge and expertise you have. Don’t pigeonhole yourself as clinical expert and financial novice because if you do, that is how everyone else will see you. You need to have an equal understanding across all aspects of the job regardless of your previous background.
Q: Is there anything you have done or anything you’ve seen done, to encourage clinicians in to senior leadership positions?
I have always worked with other executives to ensure there is talent management of the clinical body – the clinical directors and medical directors of the future. I think about how we can help them and give them the opportunity to progress.
In the past there were more coherent systems at regional level that gave people of all backgrounds opportunities, and it would be good to recreate those. Today, most clinicians get into management via an improvement programme such as an IT initiative, or by taking their turn to organise their clinical department. It is about how you use these opportunities, these jobs that need doing, to ensure they are opportunities for your own personal development.