The Language of Change: Why NHS Finance Must Move Closer to the Front Line

I want to make a difference. I want to make a difference for staff and for patients. The NHS is the biggest employer in the country. They are your patients. If our own staff are telling us it's not a nice place to work, what do you think patients are going to say? Influence and make a change to staff and people that work for you, then they are absolutely going to change the fortunes and the experience of patients. Hello and welcome to the Connexion, where RL Datax's Chief Customer Officer Liz Jones and and Medical Director Darren Kilroy are joined by leaders and colleagues from within the healthcare industry. In the connection, we explore how people and technology in healthcare can come together to create great experiences and support patient safety. We hope you enjoy listening. Hello and welcome to the Connexion podcast. My name is Liz Jones. And my name's Darren Kilroy. And today we are really delighted to be joined with Nikki Briggs, who is going to talk to us a little bit about her back background, her career, her life in NHS finance, both within hospital settings, but also now within NHS England. So welcome, Nikki, welcome. Thank you. And Nikki, this podcast is all around the real you. Well, that's one thing I can talk about without any slides. Hopefully that's why there are no slides. That's right. No prep needed. No prep needed. So, Nikki, as Lisa said, tell us how you came to do what you do now. What's your story? So I always tell people it's funnier to do it in reverse of, I think I'm nine, nearly 10 years as a CFO now, about 15 years in the NHS. Before that, I did a tour of local government, so public sector, so the local government, the police started in the private sector and now wishing. Why didn't I just stay there? And then I would say lifeguard, chicken factory. So it depends where you want to go. Definitely chicken factory. Of roles that I've managed to do. We've got the chicken factory in common, just so you know. So, you know, I think lifeguard, maybe I tried my hand at the healthcare part of it and then realised I'd be better at finance months. Our middle daughter's a lifeguard. So were you a lifeguard? You're not still doing it now, are you? No, no, no, no. That was job free school. So from like, 16, it's a good job to have, you know, like, it used to pay more than working in a shop or bar or anything like that. So it still must be Darren for your kids. But it's pretty cool job, isn't it? Like, yeah, until your friends from school kind of play up and act up and all of that. And if there's no heavy petting and all of those rules that used to be on the side of the pool, well, it stands to be a good stead through life, doesn't it, professionally? But in all ser. Actually, that's interesting because doing something like that at a young age, you've got a level of responsibility versus me, who was just stacking knickers in M and S right, at school. So there's a bit of responsibility there at the get go and some sort of leadership. So go on, take us back then. Or do you want to start at the beginning or the end? I start the network start at the beginning. Yeah. So I literally just did it because it paid the most money and I love swimming, so I was really good swimmer, so it was kind of just keep going down the swimming route. Or do you. Do you. They used to do life saving as a competition, so. Competitive life saving. I mean, no one actually drowned, you know, it was like dummies and everything like that. So from that they said, well, why don't you just get a job when you're 16? Get a job with us? So, yeah, I used to do that in and around school, so GCSE A levels and then when I was at uni, used to come back and just be able to pick it up in between. Nothing's changed. My daughter still does that now. She's at university now and comes back and does that in the holidays. Yeah. And the other one there was then the chicken factory in holidays as well, because you're just kind of maxing out. I didn't work when I was at uni. I kind of maxed out doing two jobs in between. We're going to keep. Keep this brief because it's going to be very weird for the listeners, but what did you do in the chicken factory? Because I did a chicken factory when I was a student as well. I'm thinking chicken run right away here, but it's really hard work. Yeah. So I got moved off the production line because the productivity went down when I joined, because there's a load of old, largely old ladies who I just got chatting to and distracted them, so I wasn't packing quick enough. So basically my job consisted of every 20 minutes doing three different things. One was as the chickens go over your head pulling the legs from the chicken, and then as the kind of legless chickens then come round on the conveyor belt. My other job was then putting them onto A spike with just plastic gloves. So, you know, kind of not much health and safety. And then the third lot of the kind of rotation was literally physically ripping the breasts off the carcass. So that was it. So you'd see me. If I'd miss a leg, I'd be running halfway down there to get the thing. So that was your first foray in productivity. That was my first foray and it was where I realized that if I could use my brain and do a better job, that was absolutely. You know, because there are some people that's all they're able to steer at the stair and fair play to them because it's a really tough job. But also the embarrassment of. My mum refused to let me come in the house with, like, smelling of chicken, so I had to get undressed in the porch. So a bit like Covid times it felt when I got to Covid and my wife did the same and said, stay outside. And so you ditch your clothes there. Because I was working at a hospital at the time, I'm like, oh, my God, I've got flashbacks to the chicken factory. I think giving you a lifelong hatred of chicken dishes or are you still a chicken fan? No, actually, to be fair, it made me realize how clean it is. So I have a lot more room. Freezing cold. Yeah. But I actually think having those experiences. We don't talk about it enough, actually having those experiences, it stays with you and it gives you an appreciation for all of the work that people do in the different job. Which is a lot about what we're on this podcast for. Yeah. I mean, my parents couldn't afford my. I'm a granddaughter of two mining families, so they worked down the pits. The only thing they ever said to us, get a good education so you don't have to do the same. And where was that geographically? Where are you, Nikki, at this stage? Where are the mining folks? So they were all South Yorkshire, so Rotherham. So big pit countries. And from a little place called Royal Marsh, which is famous because Jamie Oliver tried to get them to eat healthy and failed. I think of. Yeah, but the whole community has just collapsed. Once the pits went. I remember that I used to work clinically at Rotherham Hospital in A and E there. And it's absolutely true that when you see how it. Because quite a few male nurses at Rotherham in the AE department used to be minors and. And they'd retrained as nurses and fascinating to see how it had changed the whole. Literally the whole dynamic of the town. So my parents, just before they had Me moved to Lincoln purely for raising kids and where there are people that have got different opportunities, different jobs and to try and break the cycle kind of thing. So lifeguard and chicken factory was in Lincoln, Lincolnshire, did you find. And you might not be able to remember, in the chicken factory days, were the owners of the chicken pumping more and more money into chicken factory production, but productivity not rising. Now what I did realise actually is that it's the same chicken that is sold in Iceland that are sold in Marks and Spencer's, but they just rip the middle bit out and sell it separately as a gun. Not still right now, I'd imagine it's still the same. That's the goujon. That's just the middle bit that you get for free if you buy your chicken from Tesco or somewhere else. But yeah, Marks and Spencer sell it more finished, was it inside the factory. Amazing. And on to finance. Yeah. So you went to uni. Did you go and do business or. No, I did maths. Did you? Oh my God, lovely. So, yeah, loved and did pure and applied, so hated statistics. So you could have gone anywhere with that? Actually, yeah. So drop statistics early. I really didn't. My, you know, lies, more lies and statistics yet. You've seen me at some of the productivity stuff. It's all stats now. But yeah, did pure and applied and then did my kind of. I majored in cryptography, so coding and game theory, all of that stuff. So, yeah, I was telling the story to a couple of friends of I really wanted to be like gchq, so do kind of coding and we're saying I'm a failed spy. Maybe of all we know you are. Yeah, exactly. That's a good job, isn't it? An accountant for the NHS is actually how I've disguised it. But yeah, so that was the plan. But I loved the thought and I think this is what's then helped me in my career is I always say to people, and particularly in this job, because we jump straight to a solution, the NHS is fantastic at jumping straight to a solution rather than defining the problem. I think maths is all about just the only way you prove something that's true is by proving that something else isn't effectively. So I think my inquisitive nature and trying to define the problem has then actually helped me and pretty much nearly all of the roles that I've done. But the reason I ended up in finance was I had a placement year, so I did a four year degree with the third year on a placement because I was A young. My birthday's in July. So I was like, you know, I'm going to be leaving university with similar degrees to other people. What is it that makes me stand out part? Made you stand out because I was a woman in maths, so a bit like women in finance. Senior finance, anyway, kind of had a lot of. You're one of very few people so considered engineering. And I went to work for Vauxhall, so up at Ellesmere Port, so up in the northwest, loved it there. But I happened to be there when there was a turnaround team in. So they were about to close Ellesmere Port and they brought a turnaround team in who I went on a finance trainee scheme and they got rid of my boss and said, well, you're an undergrad, so you can't do any worse than them. Just do it. So we did, like, had a big turnaround project and the thing that I remember from them that was brilliant was one of the most expensive things we were, was scrap metal. So our scrap was really poor. And they just brought a plant engine because a part of gm, one of the best ones, was somewhere in Poland. And they brought that guy over and said, right, you do it here. And that learning that we still not quite got right in the NHS was right, I'm going to put you where you've done it well, come here. So I ended up being exposed and getting quite a senior kind of finance job, going back to university, and they said Vauxhall offered me a job, but I was just really worried that I wouldn't get the qualifications. So I loved finance because I got to go and talk to the people on the shop floor who were quite. They were like, well, you talk in a way that I understand, whereas all finance people don't. So one of the things I found out immediately was all of the comms kind of wasn't landing anywhere. And we were asking people, like, change of shifts and things like that, and silly things like appraisals and timesheets and stuff. And I went over to the shop floor and said, you know, why is this not being done? And they're like, where have you told us this? And they're like on an email and a notice board. Well, they're on the factory. A, they don't log onto the computer, but B, on the notice board, what we found out was almost 40% of staff couldn't read. So we were the kind of headquarters were putting things out. Well, if people can't read, they're not going to know. So I went back to the kind of trust board and said, I think you need to just get people to go and talk at team meetings if you want something to happen. So that kind of just gave me the. Well, actually, finance can make a difference and finance staff can make a difference, but only if we talk a language that people understand. I think that's the one thing that's made me probably stand out more than any, that I simplify finance. But also I'm happy to go and talk to people, the people that are doing the role, the people that are doing those jobs, because we're just an enabling function. So then I just got a graduate scheme job and I had the choice between Transport for London, so coming here, or Cambridgeshire County Council. And I took my dad, who's Yorkshireman, to Cambridge for when I was deciding and we went to the pub and bought a pint and he asked if there was a pie with it because it was so expensive compared to me. And it was like four quid back then. And he was just like, what do I get food with, though? And I really liked the Cambridge scheme because you've got to do every bit of finance. So you had to do. You did six months in audit, which I hated. You did six months in kind of systems, then you did planning, then you did kind of management accounts. So you got to pick everything because I kind of didn't know which bit of finance that wanted to do. So that's how I randomly ended up from a master's degree in finance. And what has been the difference between. You've talked a little bit about, actually some of the things that you can take from the private sector through into your role that you've had in the NHS or roles you've had in the nhs. What about from other parts of the public sector, like councils? How similar do you think it really is? It's really interesting. I think the police was the biggest eye opener, so spending the doing some work with them. I did a big shared service project. They are so hierarchical, really hierarchical. But there are some things that they are brilliant and we could absolutely learn from, particularly around kind of use of bank overtime and things like that. So one of the things, the police have the same issues as us in that there are certain times where they are busier and it's not rostered in. So for them, funny enough, most crime happens on a full moon. Really random, but does happen. So you see spikes, massive, like data wise, big spikes. I think that's because it's quite light at night. Well, there's links to Mental health and a whole load of other stuff. I was going to say it's the like, because certain people, like, grow plants by the moon, don't they? So, like, there's a whole load of moon theory. So obviously the other ones are things like Halloween and then bank holidays, those kind of things, Christmas, New Year. But rather than doing kind of what we do, which is leave it to every individual ward and everyone else to kind of have so much agency and what do we call a headroom and all of that stuff, what they did was say, actually agency, and that isn't a bad thing and bank isn't a bad thing. But they did it for a whole year. So they knew, funny enough, like the nhs, we know when Christmas is going to be. It always surprises me when I talk to budget holders and they've let loads of people have annual leave and then there's loads of agency bill. I'm like this, you know, it is the 25th of December every year, Christmas, we know when it is. So. But what they did was then kept a big pot of. Pot of money at kind of divisional level for the flex and just. But what. They offered that flex to their staff for double rates, so they kind of broke their own pay scale for those specific dates. But they offer them in the January, the year before the April to March starts, so people can plan their leave. They can plan those days. So, yeah, they just didn't see it as a bad thing and it ended up cutting their kind of agency and bank costs, actually, by a lot, because they managed it in a different way. Yeah. There's some healthcare organizations that do that in the us, do you think? Because I know, because there's more fixed patterns, aren't there, in the police as well? I think. What's your take on. You've just given a great example there of how, from one sector to another, you can see things that you go, actually, you could borrow that or do this. I think earlier on you said, you know, not always brilliant at doing that in health and care. Why do you think that is? Is it culture? What's your take on it? Is it just too big to change? I think it's really interesting because. So one thing I don't think it is is people, because I genuinely think that 99% of people come into work to do a good job and you're in healthcare. Like, even when you look at jobs, finance and other careers, people have chosen healthcare because, let's face it, you could have a much easier life and probably a lot more money if you went and worked in the private sector for a consulting firm or whoever. So I do think people are coming to do a good job. I think that part of it is there is something about sharing that we haven't got to grips with. And I don't know whether it's people feel, and I don't know whether it's that kind of regulatory culture that people feel. As soon as I put my hand up and say, I don't know, or does anyone have an idea, we kind of get into the way people, or part of it isn't defining the problem. So everyone thinks theirs is slightly different, when actually the root of it is exactly the same thing. Absolutely. I remember as well, through the COVID through the pandemic, talking about culture and engagement and conversations, how people feel. And I've always had a peculiar interest in sort of the financial elements of clinical life and how you can weave that conversation into the clinical mindset. And historically, I think for clinicians, there's been this reticence to engage them in financial conversations. Cause you worry that there's this perception, which is wrong, that clinical staff will recklessly spend money, they'll swallow up resources, they won't do anything with it. And through the pandemic, I saw that we actually engaged people more directly in that and the clinical staff had to be implicated more in resources, kit, masks, ffp, all that stuff. Stuff. If you break down all those silos, it makes it much more rewarding. And I think, historically, in the nhs, you're talking about the difference with the police and what we can learn from that. There has been a standoff for years, I think, and I was a clinician for many years, in involving all the staff in conversations around, finally, because, as you say there, they've come into ostensibly what they used to awfully call back office jobs in the nhs, which I don't even think that's a thing. Everyone, by definition of being involved in working in the healthcare system, wants to do something better for patients. I firmly believe that you want to make a difference in some way. It might not be immediately apparent what the difference is, but you are doing something. And the more we can, we. In the pandemic, I think, was a great example. I don't know what you found in the pandemic, Nikhiem, what you were doing then. When you get rid of lots of layers of bureaucracy, ostensibly, because you haven't got time to worry about it, people want to be involved in it. Yeah. So I think there's probably two things I'd say that One, I always say to finance people, clinicians are your best friend. They're lying to you if they say they don't do finance because they absolutely get it. And most of them work privately, so they completely get it. They know how to code, they know all of those really, really good things that you need to talk to them about. And also they're competitive in nature. So if you have a conversation about productivity and tell them that their reg is doing more procedures than they are, they're funnily enough, soon starts to take much more notice about it. But there's two. Yeah, one thing I did prior to Covid, so I was working in a hospital at the time, an acute hospital. We had the same thing. We'd had a really bad cqc, there'd been a churn at board level. And I was kind of new in post my first CFO role and came up with the idea of Dragon's Den as a way of just getting the organization engaged in, because I did before as the CFO asked to step into the CFO role, I was the director of transformation because I thought I need to get a board role, cut my teeth, but do it in something that. That isn't quite got the responsibility and the fact that I might, you know, there's always the cfo, if you end up in prison kind of thing that's in the back of your head where you shut the door and go. So the charge of transformation was like, actually, I'm going to put my money where my mouth is as well and do a bit of doing. And I think it was brilliant. Rather than just doing a bigger deputy role, I kind of went and did that role and I said to the team, I've got this really, I've got an idea. And I think that if I can get the organization to do it, we'll get a lot of people engaged in transformation. Rather than thinking productivity is a bad word or SIP or it doesn't matter what we call it, cost improvement, productivity, it eventually becomes like something that people hate because they get beaten around the head about, rather than it being as an opportunity to do better. So, yeah, I managed to convince the board to let me have £100,000. It was capital at the time to run a Dragon's Den event and we were going to run it in person. So we're going to get people in a hall, got a load of local celebrities and stuff. So he'd got kind of the local capital, FM radio DJ and other people like that big organization. So churches, shoes, a big Factory in Kettering. So they offered to come. So they knew nothing about healthcare. And we got people to pitch. And I again, I don't like. I call them the PMO police who love to write project plans, pages of stuff. I asked for people to send it via text messages, videos, Facebook or just do something like that. Makes sells their idea. And we didn't do any coaching with any of them. We got an event set up to us, like 200 staff invited. They all came. We ended up with 10 ideas and they pitched them as if they were Dragon's Den. And we kind of. The only thing we said to them was, don't do a slice presentation. Please God, don't turn off this PowerPoint. And we had some brilliant ones. So we had ones dressed as bees. So the Busy bee was one of the ones which is a brilliant device which looks like a bee and it goes on your hand and it's instead of. So a lot of cannulas go into. Children is really anxious for them. It's not nice. A lot of the time they don't get the level of gel right, et cetera. And this has got a freezing block in it, but it's got vibrations which stops the pain. But a nurse from AE had this idea, but I just couldn't get anyone to listen to her. So then they rolled it out across the whole. So the children's wards, ITU and then in AE as well, and actually said quite a few adults. So people with autism or any kind of neurodiversity. The one that actually won the most was she was a porter and she wanted to basically put effectively a golf buggy. And she'd managed to go to a company to let them lend her a golf buggy for the night to do take patient transport to cardiology and to all the wards from the car park. So there's about five or six that won the awards. Not only that people like churches then donated money, but the buzz that it created across the organization of people realizing, actually if I put my hand up and the one thing we did, and I said to my team at the time, we cannot PMO the backside out of this. Yeah. Because that's the. You're gonna take the oxygen out of it immediately. Yeah. So we need to get those people to then manage their project. So we sit with them, let them see it. Cause there's something really good about someone saying gets rid of the apathy. I think part of our problem across ENHS and most large organizations, the apathy of. I've asked. I've tried. They've said, no, I won't bother the next time. So we got her to run it. She is now a trained nurse because she realized that when people believe in her and the skills that she got, she went on. So it absolutely changed their life on the back of this. And then we run it for a second year there. And then when I went to Leicester, we did a thing called Project Launch where they stupidly gave me a million pounds and said, what could you do? And I had a guy come up to me on that one who was a cancer sufferer and he burst into tears and his wife came up and gave me a big hug and went, you saved his life. He was so depressed, so down because he'd got a manual job, couldn't go back to it after having really bad spinal cancer, joined a Dragon boat racing club. Kind of complete different lease of life. All cancer sufferers. So that's not really health. But it absolutely changed people's lives and things like that. So, yeah, that was another thing that people that are in Leicester will remember that we did have done a. One of the best ones as well is just like stories that stick with you. They're not finite. None of these are finite stories. But one was a dementia garden. So there was a. Inside the kind of adult medicine wards, which were largely the dementia wards, which used to be funny if you. I used to volunteer and as a cfo, you spend a lot of time going out. Largely used to go. You probably can't say it now, and largely go to where people used to smoke because they take my badge off. And people would tell you anything when you go around there and tell you what's going on with your organization. Better than any friends and family. Exactly. But one of the Dragon's Den initiatives, there was a dementia garden. There was a. Like a lot of kind of 1940s hospital. Kettering had a hole in the middle of the ward, so three wards and then all your lift areas. And one of the ward sisters had the idea to get. Create a dementia garden. So we have a little cafe using a. Like an old shed. And they got a local artist, John Mulro, so it looked like a beach, so it looked like a seaside. And a woman came to the opening and said her dad, she'd been visiting in hospital, got dementia, had not recognized her for over a year and recognized her because he remembered taking her to go on the donkeys. So it's that that you can enable. I mean, those are only their kind of token things, but I think that's what's the start in life of. That's the bit that you realize you can absolutely enable, but you do it through people that really want to go. And there are so many. It goes back to the long winded way around seeing your point of there are so many people that want to make a difference. We're not harnessing it in the right way because what we do at the NHS is bore the life out of things by putting a load of process. I'll get killed for this back of the ranch, but put in a load of process around it rather than trusting people that know their job, know their patients, know their area and working with them. Be that clinicians doesn't need to be clinicians, it can be a ward sister, it can be a porter, it could be someone that's walk the same way. And you got to find a way to get them to take ownership and enable them to do that job and then wrap people around them. Rather than, I think, feel like what we often do and organizations do it and then at a greater scale, so do NHS England and everyone else is we create a whole load of generic people who take a problem and go, well, let's do a project management type approach to it, rather than saying, well, let's just engage. But you know, we talk about how patients feel. Well, go and talk to them. At the icb, I talked to all the patient groups. I mean, some of them, you know, particularly I was responsible for primary care and talking to gp. It was much easier to talk to patients than it was to GP sometimes, but that's. You go to a GP surgery. I went to a pharmacy and realized that the same place that they store their drugs, they'd got a tiny little place for coffee and they were also storing them in toilets and everything else. There was no, there wasn't anywhere for anyone in a community pharmacy to sit and have two seconds. You just think all of those things that we all take for granted and they're paid minimum wage, they're not on agenda for change, they don't. They're things like blue light card they don't get. So then we wonder why community pharmacies are closing and we've not. The patients see them as the NHS and the NHS hasn't quite wrapped their arms around. But what you've described there is leadership. Like, as I'm listening to, I'm going, what you're describing is the ability to lead people. So you know, whether or not you're in finance or in a clinical role or in a HR role, that those principles apply. So what do you think it is within you that means that you've got the. We talked about risk appetite, didn't we, earlier? That either the impetus or your risk appetite is. So what is it in you that means that you see the world that way and feel confident to do it. And what would you advise others that are maybe thinking, I'd love to do what Nick is doing, but I'm a bit. I don't know how to do it. I think it's probably three things if I'm honest. One is I'm a beg for forgiveness kind of person. So in Leicester LLR icb, they'd been toy in for a while, the GP saying inner city practices weren't defended, blah, blah. It was halfway through Covid I'd moved to that role and the chief exec said, is there anything in this? We kind of realized there was car hole formula actually is was perpetuating a whole load of health inequalities, doesn't reward areas of deprivation and things like that. And so he said, well, let's just come up with a new formula, let's come up with a new funding formula, let's pay GPS differently. And it was only afterwards. So we started that conversation in October, implemented it in July, so didn't take years of consultation, did it, as a no losers approach. So everyone had to say yes, managed to get all the GPs to sign off on it, all the GP practice, 130 or so of them. And it was only when someone said, afterwards, I presented to NHS England and they said, who did you get permission of and what about the solicitors? And I was like, well, I was a little bit smart in the fact that I didn't change the GP contract. What we did is added a local element on. So I knew that from a legal perspective I was okay, but I was like, well, no one stopped me and I didn't feel like I needed to ask anyone's permission. And the GPS had said, there's that groundswell goes back to the Dragon's Den thing. So there's a beg for forgiveness type approach and you'd understood the problem, so you knew your solution. I'd understood the problem, so I'd spent. But how I understood the problem was I got a load of gps in the room. So the first thing I did was rather than say we got a whole load of data, people got Population Health Faith and got GPS and threw them all in a room and people say, oh, well, Nikki did this. I didn't do that much. What I did was brought people together, brought a whole load of people that, and kind of defined the problem and then said, okay, well, let's work out how we can do that as a solution. So I think one of them is that the second one is I don't need any praise. So I'm really excited when people deliver and if I can give them a route to deliver, I think that works in an ICB because I'm happy to create win win situations where the hospital can go back and say, I beat the ICB and I got this out. And that's why I said so many conversations with CFOs saying, Listen, I think you can sell this to your board as this, but in the background I'm going, well, I've sort of won anyway, but we'll let you pitch it. As you went in and you were really stern and I just don't care who wins in that place. I care about the patient, I care about the output, how we get there. I don't need any personal credit for and I don't need even the organisation kind of credit. Let's just make sure that it's the best thing and the right thing to do. And then the third bit, there's just something in me that I want to make a difference. I want to make a difference for staff and for patients. And I think if you particularly staff, if you make a difference for staff, the NHS one is the biggest employer in the country. They are your patients. If our own staff are telling us it's not a nice place to work, what do you think patients are going to say? It's not going to be any different. So if you can influence and make a change to staff and people that work for you, then they are absolutely going to change the fortunes and the experience of patients. I think if I was overarching as well, I'm an optimist. So I generally think we read too much of the news because we hear about the bad things and we do, you know, as leaders, we have to focus on that because that's a way that we can learn and do better. We could do a lot better to learn from clinicians who do much more of that kind of open learning of where things have gone wrong. And you sit and do your joint kind of investigations, don't you, on your. When there's serious incidents and things like that, you do that kind of. So we could do a lot better at that and taking that approach, from a clinical approach back into the real world. But I'm an optimist. There are probably what, at least more than 70, 80% of people every single day, hundreds of thousands of people, millions every day, walk out of our care settings really happy with their treatment. I think we are the best reactive care service in the world. I think we've got a lot of way to go on doing prevention and those other parts of it, because we are leaning into the reactive nature of acute clinicians to try and do it, rather than actually looking at problems a bit differently. We're always fine with podcasts. You run out of time, you want to keep going. For another, we need to do like episode two. But one thing conscious of Tom, one thing I wanted to ask you, Niki, conscious of what he was just saying there was. So, as you're in your role now, with all that you've said and you're so interested in all that you've been sharing with us, what's your sense now of where the NHS is, for want of a better expression, with that philosophy that you've just outlined there? From your personal perspective, are we making progress in the system, in the bureaucracy at hs? Is there hope for optimism there more widely, how you read it? So I think so. I really do. I think, as with huge organizations actually getting that shift, I think what a lot of us are focusing on, what I'm focusing on particularly are the things that you can make a difference in, because there are some things that you're not going to be able to influence. The transition between NHSE and DH is huge, and you could waste a lot of time and energy getting wrapped up in that rather than focus on, here are all the other things that we've got to do. That job needs to be done and people will engage me and involve me as it needs to be. But actually, what I want to talk to people about is why are you not looking at your cost base? Why are you not looking at your chc? Why your variance? I've still yet to find anyone that makes money out of outpatients. So why are we continually doing it the way that we're doing it? I'm not saying that we need to not do it. Well, maybe we do, because I'd love people. My view of outpatients is, what if you were to design a world where outpatients aren't needed? What would that look like? And that starts with a conversation with clinicians and other people. And I think I always get in trouble because I say the NHS is brilliant at digitalizing really poor pathways, rather than starting with digital as a solution. So what's Your problem and what you're going to digitalize, rather than going, oh, what we're going to do is digitalise us a pathway that we currently do. So I do think there is. I think there is much move as we slim down the bureaucracy. It does therefore need people to stand up, so it needs people to take that ownership. It needs, whether it be trusts, whether it be regions, for them to go. Actually, I want to be held accountable and I really want to do something different. I think we're starting to see it in the finances. You know, we haven't got the game playing that we used to have, of course. Oh, it's all really hard. I'll make my deficit so big that I've got 10, 15% sips that just. That's not real. But we need boards to also be much more about. I think it's a big turning point that we need to do with boards still in taking the ownership of. Well, how could I. What would that look like if we were to start to really shape and do things differently? So I think the shift has started to happen nationally, but the quickest way for any of this to happen is always locally for people to really take ownership. And why don't we have conversations? If I was back working in a trust now and someone said to me, the cost of your endoscopy service is below national average, I'd be like, right, tell me someone that's a similar size, similar organization. I'll go speak to them, I'll get my gastroenterologist, I'll get to go and chat to theirs and we can look at it. And I think clinicians would do the same. They would, because as you say, they're driven by peer performance in a big way. And that's entirely achievable stuff. You mentioned that in terms of that trajectory, in terms of. It would be. I mean, it's already the seventh biggest workforce in the world, isn't it? I don't know what that would make it a nation. What if you think about how much we spend? So I say this to colleagues and that most organizations would be on the FTSE 100. You can guarantee that on that FTSE 100, their chairs, their boards are talking about costs and the costs of their organization, not about just keeping growing and getting, oh, can we get paid more for it? But likewise, The NHS at 200 billion is more than, I think, something like 50% of the countries in the world's GDP. So, again, how are we looking at the total? Whether that be, you know, I always get people to really argue about growth or argue about ERF or margins, rather than going actually as an organization, you're spending £4 billion. How are you using that £4 billion? We talk about mental health. Are we getting the best use of all of that? Hundreds of billions of money? And there's a real school of thought now, isn't there, that there's a way of looking at this as well, which is the NHS is not just a cost, it is a growth driver for the country. Whether or not it's getting people back to work, that the ultimate productivity challenge for the country. But also locally, it's such a big employer, it's onward all the companies that are onwardly part of it. Do you ever think that there's a role there for NHS finance that's different, that is about that kind of. What's that big picture growth driver for the country? I know that's a really big question. So I think NHS finance, but I think finance professions in general are probably going to see the biggest change in the next. I don't even think it's five, 10 years, I think it's two, three years with AI. And I think this is where we've got to move ourselves into being much more of. You know, hopefully you don't need to buy in economists and you just buy. You know, what we start to get is finance folk that can add the intelligence and be much more of that, business partners and start to do, bring people together, bring not just looking backwards, looking forwards, bring in growth projections, look at population health, work with those colleagues to do that. I think that's the world where finance folks need to be and a lot more on that QA governance assurance, because AI will generate something or, you know, RPA will do something, but you need someone that can then interpret it in the right way. So we need a lot of people that aren't just kind of. Someone told me, therefore I do, people that are going to really kind of look at the data and say, actually, this isn't quite right, and be brave enough to put the hand up. So I think it's a brave new world for finance stuff because they're going to have to do a lot more engagement and a lot more, whether be that with technology or be that with people. It's going to be interesting to see how it plays out, isn't it? And I'm conscious we're out of time, really. You've already committed to a certain podcast. I think you did, didn't you? Already said you'd come back. You Already said you'd come back. I think you blinked at the wrong moment. No, seriously. But contrary to that, I wanted to ask you, Polly, as one final question, because we've talked the massive picture, not even big picture, just about your last response there. For a listener listening to us today here now, who's working in healthcare in their own individual role, just listening into the podcast from your perspective, what would be your advice to them about how they can make a difference for finance, for patient care, in their own individual tiny role? We've all got a little tiny role. What can they do to help? So I think everyone can make a difference if they really want to. There's two ways of doing it. One is you bang on the doors of the people that you think you can influence and you annoy them enough, which I've done in a few careers, to say, I think that you can do something, I think we can make this change. The other is I think getting support from people around you. How do you create? So even, you know, like I talked about that Porter, that Porter had an idea what she went away was, was got a company to bring us a gift, a car to show how it would happen. Not just say, I think this will happen, actually come and look at this. And she went to the patient group, went to Pounds basically and said, have you got some patient groups that I can talk to? And one of the biggest complaints actually she then got Pounds said, well, actually our biggest complaint is about the walk from the car park. So for me, I think the key to a lot of this stuff is data, getting the right data. But I'm not expecting a Porter to have done what she did. But how do you have a conversation with someone that might be able to do that? And I think finance can facilitate that. If you find who your local finance person is. This is where everyone will prove me wrong and say no, but hopefully that's. But to me it's the power of patient voice and the power of your voice. But as a single person it's really difficult. So you've got to find like minded people or find a route to tap in it. And because most people won't look a gift horse in the mouth, they will go, well, you're gonna, you're solving me a problem. Well, I didn't know I had a problem. I now know I have a problem. Once someone in my position knows, has found out there's a problem, you can't know that. So you've. Part of it is going to people that are senior enough and going, you've got a problem and they go, actually, I can't ignore it. Now you've created a solution for I always say to no matter how I used to annoy all of our apprentice and say, don't come to me with a problem, give me a solution. I'm happy to hear your problems, but what's your thoughts about it? And it irritates all my team because I'm like, well, I'm not solving it for you. And I think that's the bit that I would say that they need to do. Define the problem, tell someone what the problem is because once you're told, but then walk in with a ready made solution. Here's what I've done and here's a load of people that are supporting it. Absolutely fantastic. It's been so brilliant, so, so good. And you said you're an optimist, right? This podcast is definitely optimistic about the future health and care, but listening to you, I'm like, it is in safe hands, genuinely. Really. I know you don't want praise because that was your number three, but really inspiring actually. People are going to feel motivated from that, hopefully listeners. Well, I hope so. I'm unbelievably proud to work for the nhs. There's a reason I'm here and I've been in it for 15 years and there's people that worked in the NHS a lot longer. So I finished with exactly what I said through a whole load of roomful of finance CFOs is we're talking about pipeline and who's going to be the next cfo. We're looking around and there's not many people put their hands up and there's a lot more people wanting to be deputies or more junior staff and happy to stay there. And I said, well, who's going to do this job if you keep telling them how hard it is? These are privileged positions and there's not a day that I don't wake up and think we're just such a privilege to be able to shape national policy, to be able to make changes on behalf of the NHS that might outlast me. But in any role in the nhs, particularly a leadership role, if we keep telling everyone how hard it is and boards need to listen as well, then why is anyone going to do our roles and why are patients going to. We're playing into that narrative rather than changing the narrative of, of it is difficult. I am not saying so I don't want anyone to listen to this and not think it's all right. It really is difficult. We're really difficult time, but it's difficult. If you work in transport, it's difficult. If you work in the private sector, it's difficult. If you work in manufacturing, it's really blooming difficult. It's just the times that we're in, but we are part of a leadership is to be able to give people a vision and a direction and actually make people really feel valued and want to work for the nhs. And take to say, okay, all of this might be really, really hard, but here's a few things that'll make find those one or two things that will make you feel really good about what you do and your career and working for the nhs. And you'll soon find that one little positive action then breeds that optimism and maybe we'll get a room full of optimists working for the nhs. Brilliant. Here's hoping. Thank you so much, Nikki. Perfect ending. Thank you. You've ended it beautifully. Thanks for listening, everybody. Hope you've enjoyed that and we'll see you again soon. Bye now. Thank you for joining us on today's episode of the Connexion. We hope this episode has provided you with valuable insights on the role that both technology and people play within the healthcare landscape. For more information and resources, visit rldatix.com don't forget to subscribe to the connection on Apple Podcasts, Spotify or any other podcast platform you use. Use. Join us next time as we continue to explore how healthcare is impacted by connecting people and technology. On behalf of the Rldatix team, thanks for listening.