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Janet King on M&As, engagement, and the NHS

What happened when a high-performing hospital turned around a poorly-performing acquisition

Janet King’s career in the NHS didn’t exactly get off to a flying start. Her early experiences unfortunately echo the stereotypes of what working there can be like.

“After a week I just thought ‘what the hell have I done?’” says the now director of HR and corporate services at Frimley Health NHS Foundation Trust and former personnel officer at the MoD and National Economic Development Office. “They didn’t even know I was arriving. So that was an awkward start.”

Fortunately King stuck it out. Luckily she realised the power of transferring across the HR (or in those days personnel) expertise she already had. “When I joined the NHS I had no concept of what it was really,” she says. “I came at it with zero knowledge of the NHS and all the grades and professions and ways of doing things. It took me a couple of months before I started thinking: ‘hang on, you do know HR so just apply that’. And actually I got hooked really quickly.”

Thirty years later King heads up HR and OD – along with soft FM, estates and capital projects – at a Trust she’s determined has a very different vibe to that she first encountered back in 1987. Her original site, Frimley Park Hospital, has long enjoyed enviable levels of staff engagement and patient care. Its most recent Care Quality Commission (CQC) rating in 2014 was an overall ‘outstanding’.

Which isn’t to say working here has been a walk in the park, says King. And neither would she want it to be. Working within a large, complex NHS Trust is every bit as challenging as an equivalent private sector HR directorship, she feels. Which, along with taking on myriad responsibilities besides HR, has kept things fresh.

“The range of what you’re able to do is unbelievable,” says King. “Even though you have clear terms and conditions of service and a framework there is still so much possibility.

“I think I was only ever HR director for a matter of months before other things, such as facilities, came along,” she adds. “It’s very useful to be responsible for these services because you quickly understand the reality of the decisions you make in HR.”

King’s most recent challenge – the biggest of her career to date – came in 2014 in the form of Frimley Trust acquiring Heatherwood Hospital in Ascot and Wexham Park near Slough. Heatherwood was doing pretty well. But Wexham was a different story, having received an ‘inadequate’ rating overall from the CQC in 2014, and in key areas such as surgery safety and leadership, maternity and family planning safety, and accident and emergency responsiveness.

“Wexham had a very long history of being in breach of its licence and a pretty awful financial performance,” reports King. “[Whereas] at Frimley Park we were rated outstanding and had money in the bank. We were doing nicely, so you might say why would you want to do this [acquire Wexham]?”

But King explains that it was about approaching this as any other organisation or business would an acquisition: “Anybody would say ‘ok that’s got a market we haven’t got, they’ve got assets we haven’t got’. There’s always a compelling reason. We had to hunt very hard for a compelling reason for Wexham. But size does matter and it doubled the size of the organisation.”

Key was negotiating financial assistance to ensure the Frimley team could actually turn around Wexham’s fortunes, without this being a drain on the original site. King’s first step was to quickly launch a cultural analysis. “What I had heard about the issues was pretty shocking, but I didn’t know whether that was fact or fiction,” says King. “So I looked at the turnover, the disciplinaries, the grievances, the tribunals, the results of the staff survey – that’s an annual survey where all NHS Trusts get asked the same questions – and Wexham’s results must have been in the bottom one or two.

“I also did a number of structured interviews with staff; some individuals and some groups. At the same time I thought ‘well I don’t just need this to be about Wexham, I need this to be about Frimley as well, so let’s refresh and make sure we have a good baseline of data’.

“The biggest thing was the values,” reports King. “We have three values at Frimley [Committed to Excellence, Working Together and Facing the Future]. They’re very live. Not only do staff know what they are, they understand them and accept them. And we do all our hiring against them.”

Ensuring a strong sense of the Trust’s vision and values wasn’t about transforming Wexham to be exactly like Frimley culturally, or indeed fixating on uniformity of culture between different departments in the same hospital, says King. HR professionals across all contexts and sectors would do well not to get too hung up on the idea of a totally unified culture, she advises.

“In any hospital if you went into any theatres the culture in there would be different to the paediatric ward, or to the finance department,” she explains. “But it doesn’t matter at all. It just matters that we all behave the same way.”

Another problem area the initial cultural analysis revealed was leadership. “I think the single most influential factor to come out of all of this was quality of leadership,” says King. “They used to call leaders ‘the suits in the tower’ [referring to where management’s offices are located at Wexham]. So we were desperate to get out of the tower.

“In the short run-up to the acquisition I think there were four different HR directors, about 50% of leadership roles had temps in,” explains King. “And also because of their financial performance they kept getting in turnaround directors. By their very nature turnaround directors are often quite aggressive… their job is to pull the money out. I absolutely understand that’s their job but I don’t think that helped. There was just a climate of fear and resentment.”

Making sure senior, head office leaders became much more visible was important, says King. Then it was about ensuring all senior clinicians had the right leadership behaviours.

“I remember having a dilemma with a particular doctor who was amazingly talented but the behaviour and attitudes were not in any way right,” she reports. She explains that in the end it was Radio 1’s no-nonsense approach to Chris Evans’ bad behaviour that helped her realise no talent is ever irreplaceable.

“It was such a big decision, but I thought: nobody’s bigger than the organisation. And if someone’s in danger of wrecking team working – I always make the effort to work with that individual first – but then I kind of shoot to kill… I [also] put myself in the patient’s shoes thinking: could I as a patient put up with that [lack of bedside manner and empathy]?”

Bringing in top clinicians from Frimley to work as clinical buddies with consultants was key, says King. Leadership training, and indeed training at all levels, has also been important. “We had some really big numbers of people go through training, whether it was customer care or appraisals – we’re talking thousands,” says King.

Recognition was another key pillar, along with just generally creating a much more enjoyable, generous and supportive working environment. “Frimley always had recognition schemes but Wexham had cancelled them because of the money,” says King, explaining that within the first few months of the takeover staff had the chance to attend a recognition awards event at a hotel with family members – invaluable in creating goodwill and buzz. “Wexham had also cancelled Christmas on the basis of cultural diversity. So I reinstated Christmas and said we’ll also celebrate other religious festivals.”

Health and wellbeing and other social events have also been rolled out. These are deceptively crucial at a time of serious NHS staff shortages. “We have seen a dip already in nurses coming from the EU,” says King. “That’s going to cause me a problem if it doesn’t pick up again because I have to think where else am I going to get these people?

“So I’m going to do a big set piece on retention to the board... Because some people might think the work that we’re doing on health and wellbeing and all the social activities is the fluffy stuff. But it’s crucial to retaining staff we already have.”

King explains that planned future investment in refurbishment of the building, and a recent revamp of the staff restaurant, are also vital: “I honestly think if you are happy you’re going to give such a better experience to a patient,” she says.

The results of all this activity, even just one year down the line following the acquisition, were powerful. When the CQC team came back in October 2015 they were greeted with a 50% reduction in patient complaints, and the percentage of staff who would recommend Wexham as somewhere to receive treatment having risen to 77%, up from just 45% in 2014 (this has gone up further since).

“The CQC rating was now a sea of green ‘goods’,” says King. “So I said to the boss: ‘we need to have some big town hall meetings with the staff’. He said ‘we won’t need three, they won’t come’. I said ‘they will’. So we had three and there were queues to get in… and when I looked round everyone was tearful; it was a highlight of my career.”

There are still challenges on the horizon, not least Brexit. In relation to this, King is passionate about the Nursing and Midwifery Council English test standard being lowered so those outside the EU are encouraged to work in UK Trusts. “I actually did that test myself and found it difficult!” comments King. “Reducing that down to a 6.5 rather than seven pass rate should make a difference,” she adds in relation to negotiations currently being led by NHS Employers.

King is also keenly watching developments around the unions’ 3.9% pay rise demand. “Whatever the government’s original reasons for the pay cap I feel the argument is now tipping in favour of lifting it,” she says. “Also, allowing NHS employers flexibility to target specialties where we have severe shortages could ease a lot of our problems.” She adds that the NHS must get to better grips with joined up thinking on pay, so different Trusts don’t drive each others’ costs up. Combining resources and leadership in the way Frimley has is a good way of ensuring this approach, she says.

Which all brings King back to the importance of public sector HR professionals receiving recognition for the tough challenges confronted. “I applied for a job in London when I was working for the NHS and this chap said to me: ‘well you obviously come to us with something of a disadvantage… the NHS is not the real world’,” remembers King. “I said: ‘I can absolutely tell you what we do day in day out is definitely real world HR stuff’. And in fact I would say I’ve had the privilege of doing loads of things that private sector HR directors would never dream of doing.”

In fact thanks to HRDs like King many NHS Trusts are now unrecognisable from the stereotype of bureaucracy, disengagement and disorganisation that greeted her back in 1987. And this now (to King’s great pride) includes Wexham Park.

“When I first came I’d walk down the corridor and nobody would even make eye contact with me,” she reports. “So I thought: I know they’re all going to think I’m a bit of a nutter but I’m going to say ‘morning!’ And, do you know, now there are some mornings I find it difficult to get in [because people want to talk].

“It’s a small thing, but it makes me feel I’ve made a difference.”