Digital leadership and flattened hierarchies: How Covid-19 reshaped one NHS trust

Sam Allen, chief executive of Sussex Partnership Foundation NHS Trust, clearly recalls the moment when she realised a COVID-19 pandemic was about to strike the UK. She had seen her friend, a senior manager at a national bank, attend a crisis-planning meeting where no stone had been left unturned. But how would Sam’s team respond?

Although the NHS had its own well-established crisis plans, including a detailed response to a flu pandemic, these had not yet been put into action at a national level. “I started thinking: gosh, if this virus really does take hold, how might this affect the patients, families and local communities we serve? And what are the things that could sink us as an organisation? It was clear that we really needed to get on the front foot.”

At HQ in Worthing, Sam and her top team took steps to make sure the trust would be ahead of the curve. “We made some bold decisions quickly,” she recalls. “Including asking teams to develop solutions that would enable them to work from home and minimise their risk of exposure to the virus. We mobilised our Gold Command structure [a key part of the NHS’s strategic response plan for a major incident] and stood up our incident control room. That was a week before the NHS declared a national Level Four incident. Looking back, I think all those things stood us in good stead.”

Crisis response

Employing around 5,000 people across 120 locations (including hospitals, community centres and clinics), the trust is responsible for mental health services for people of all ages across Sussex. It works not only within the wider NHS system but also with voluntary and charitable groups to tackle the many issues that contribute to mental health problems.

Although the likely impact of the pandemic wasn’t clear in those early stages, Sam and her team decided on a two-part strategy, enabling them to move quickly and with maximum impact when required. The first step was to establish a small number of very clear goals, and the second was to make sure that every staff member was on board with those goals and kept fully up to date. “We very quickly got into a rhythm around communicating with the organisation to keep everyone up to speed via daily briefings and regular webinars,” Sam explains.

The three goals they set were: to keep patients and their families and carers safe; to keep staff safe; and to make pragmatic and proportionate decisions in a timely way. This was vital to help staff cope with major and unplanned changes in their working patterns while also managing the fear and uncertainty of COVID-19 itself, says Sam.

As every manager knows, the best strategy is worth little without great people and great execution. Sam is clearly proud of the way the organisation stepped up. Take remote working, a key plank in the goals of keeping staff and patients safe. “When we started, we could support 150 people working from home at once. That was the capacity of our VPN. Within three weeks, we had scaled up that to thousands.”

Central to this new way of working was going digital – both internally and externally. The trust’s existing mental health helpline was expanded, backed up by five 24/7 assessment clinics, and patient consultations were rapidly transferred online wherever possible. “We had a simple, clinically led vision: any clinician should be able to offer a virtual consultation, and any patient or carer should be able to request one,” Sam explains.

Ahead of the curve

The trust’s forward-thinking structure played a big part in making this possible. Emblematic of this was the role Sam created when she joined the trust: chief digital officer. “So now we have a chief nurse, a chief medical officer, a chief financial officer, a chief operating officer and a chief digital officer,” says Sam.

By creating a space for digital thinking at the boardroom table, Sam had helped to align it with clinical prerogatives – meaning that when rapid changes were needed, the organisation had both the technical and human capacity to respond. “A lot of my peers would have liked to have done this, but they don’t all have the infrastructure and digital leadership,” Sam says.

She admits that digital consultations are not suitable in every case and that there is still work to be done around safeguarding. For example, it can be hard to consult virtually with a patient in an abusive relationship if they are doing the call at home, potentially within earshot of their abuser. However, even some of the trust’s naturally risk-averse clinical staff have come around to the idea. “I’ve had clinicians who were really quite anti it saying to me that actually, now they’ve done it, it works really well,” Sam says.

The trust has now undertaken some 16,000 digital consultations on the NHS’s Attend Anywhere online platform since lockdown commenced, the largest number of any trust in the UK. For Sam, it’s a “phenomenal” result.

Seizing the opportunity

The crisis presented a small bright spot: the chance for learning. Sam was determined that the trust wouldn’t miss out.

“The NHS is very hierarchical. This has been a real opportunity, and we’ve seen our clinicians take the floor as organisational leaders. We’ve seen leadership everywhere. If we can come out of this with flattened hierarchies – clear accountability but more distributed leadership – I think we can achieve a whole lot more.”

Sam has now set up a learning project under the trust’s director of R&D, to capture the key lessons as they come to light, rather than waiting until afterwards, when memories have faded and insights have become blurred. “I want to capture that learning so we can continue to adapt and evolve. We’re going to be living with this virus for some time, so we have to make our response sustainable.”

Sam hopes the project will help the trust prepare for another looming crisis: the anticipated spike in demand for mental health care as the ripples from the initial acute phase spread. “Some of our staff will need support over the coming weeks, as will some of those who have been through ICU and survived. Families and other groups are struggling with the consequences of lockdown. Domestic violence is up 25%, and there’s bereavement and social isolation. There are reports that anxiety and depression are on the rise. You can’t just pack away the ventilators and expect everything to return to normal. We’ll be dealing with the psychological impact for years to come.”

CMI are here to support you through a difficult time – whatever that means for you. Whether you're going through a period of ill mental health, are struggling to cope with work stress, or feel isolated due to working from home, visit our mental health and wellbeing hub to see how we can help.