Mistakes I made (and things I learned) as an NHS leader

Jonathan Lewis profile picture

22 February 2021

Jonathan Lewis
Managing director of health and social care, Earnd


The people who run big organisations like NHS trusts can be very different to many of those who work for them. Typically middle class and relatively affluent, leaders may live very different lives to the porters and cleaners and other essential workers in bands two and three that keep trusts running – very likely on a fraction of what leaders earn.

I ran a community health provider from 2011 to 2017. I didn't know it at the time, but I was one of those chief executives who didn't really understand the financial situation of many of those who worked for the organisation.

I really wish I had.

Not understanding the pressures lower banded staff were under can only mean that I did not make as good a set of decisions as I might have. I also didn't realise why changes that seemed obvious to me were resisted by some.

Here are some of the key (and very obvious in hindsight) things I learned.


Lesson 1: Always take the time to listen

As with most community providers, we had a lot of bases with services scattered across a wide area. On paper it made sense to consolidate them and ultimately, we did. But I will always remember a comment one of the administration team members made to me:

"We can't do that as my bus fare will go up £2 each way." Another team member said, "It's going to cost me more in petrol."

While I never forgot these comments, I didn't fully comprehend them and ultimately did nothing about them. And who knows what the consequences were. We may have lost some good staff, which no trust can afford to do. Looking back, I wonder what I would have done differently if I had given the financial situation of my lower banded staff more consideration.


Lesson 2: Tech advances and new systems are important, but so are your people

I thought of myself as an innovative leader – someone who had a bunch of cutting-edge ideas about integrated care and the future of the NHS, but I learned it's often the simple things that make the difference to staff morale. And of course, staff deliver all of the care, so good morale is essential.

The most popular thing I ever did by miles was buy our staff an ice-cream on a really hot day.

Jonathan Lewis    Managing director of health and social care, Earnd

For example, the most popular thing I ever did by miles was buy our staff an ice-cream on a really hot day – my PA's idea. We had about 1,000 staff and I sent around an email saying that we'd put £1 in all salaries at the end of the month to buy an ice-cream because it was hot. Never in my entire career have I had anything like the amount of praise as I got for that – a humbling and enlightening experience.

We also gave out Marks and Spencer vouchers once a year. This caused much angst for those who were not eligible – again something I didn't completely understand. Now I realise that £50 is different to someone on £18,000 a year than it is to someone on the salary of a Very Senior Manager.

I could label this lesson as "little things that make a difference", but it's more accurate to say that understanding lower banded staff (they make up 40% of the workforce of NHS trusts) and generally what makes people feel valued is a big thing – a vital thing.

So when you make your decisions as a senior leader, it's going to be better if you take more account of the needs of your lower paid staff. Ultimately, if you don't have these people on your side it doesn't matter how clever your plan is, it's not going to work.


Lesson 3: The things that matter to your staff need to matter to you

This is a lesson I learned again recently through work with trusts like The Royal Free London NHS Foundation Trust and also conversations with Staff Side in my role at Earnd – a start-up focused on financial wellbeing for employees.

Staff Side always ask penetrating questions and require detailed evidence because they know stress, anxiety and depression are becoming leading causes of absence in the NHS and the thing that worries people the most is their money. This creates personal pressures for them as individuals and system pressures for trusts in respect to increased costs and decreased quality of care.

It's been reported that NHS staff are among the most likely to regularly apply for payday loans that charge extortionate amounts of interest and can send people into negative and dangerous spirals. This doesn't need to be the case. According to the Money Advice Service, payday loans can charge an APR of 1,500% so it's easy to see how they have such a big impact in the lives of NHS employees. But it doesn't need to be this way.

Earnd partners with trusts to provide on-demand pay so staff can access their money as they earn it.

Jonathan Lewis    Managing director of health and social care, Earnd

Earnd partners with trusts to provide on-demand pay so staff can access their money as they earn it. This can help them to better budget and manage unexpected expenses, which can reduce the need to borrow. Importantly, Earnd is free for both staff and NHS trusts.

As we speak to different trusts, we see just how much of a difference this can make in the lives of NHS staff. We're grateful for the support we get from Staff Side and also to the trusts that are ready to step in and make a change.

Day-to-day moments – such as being able to afford petrol to get to work or to get a drink from the vending machine during a long shift – are amazing for us to hear about and make a big difference to staff morale. But on-demand pay creates much larger change too. Fixed boilers, car repairs and a faster way to pay down debts to reduce interest mean people feel more in control of their finances and their lives.


What next?

If you'd like to hear from trust Leaders about their experience with on-demand pay and how it's helping, you can see our conversation with Royal Free London NHS Foundation Trust here.

And if you have any thoughts on these reflections, I'd be keen to hear them Jonathan.lewis@earnd.com.

About the author

Jonathan Lewis profile picture

Jonathan Lewis
Managing director of health and social care, Earnd

Jonathan is the managing director of health and social care for Greensill and Earnd. He has had a wide-ranging career working in private, public and third sector organisations across advertising, social investment television and finance, as well as being a director/non-executive director of over 20 companies including several NHS trusts. As a NHS chief executive for six years, he understands workforce challenges facing the NHS and is particularly interested in how to improve the financial position of NHS staff, in particular lower-banded staff.

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