Interview with Andy Ennis, Royal Bolton NHS Foundation Trust Chief Operating Officer and Deputy Chief Executive

by Dr Hannah Baird, Chair of the FMLM Trainee Steering Group

What is your background?

I was a charge nurse on the children’s ward here at Bolton. I went into management, took masters’ degrees, management training courses and aspiring executives programmes, all of which the NHS is very good at providing these days. I then moved into the Chief Operating post and recently added the deputy Chief Executive role (CEO).

What are you responsible for?

Responsibility in these roles vary for different organisations, it depends on what the CEO decides is in each portfolio. I have responsibility for operational performance within the organisation. My main responsibility is to focus on the national standards relating to performance. I also have responsibility for IT and estates. If it is about the running or flow of the hospital, it falls under my remit.

What are the main leadership challenges for you at the moment?

We have gone into major incident planning for the organisation; a command and control structure with the gold, silver and bronze cascade principle. We had been in an autonomous structure where the divisions were responsible for their own decisions, but we had to take back a certain amount of control at this time.

This is the longest-running major incident we have had. We have had more major incidents in the past six years than we have had over the previous 30. Usually, incidents last three or four days, but this looks like it will be 12 weeks, plus.

As ‘gold command’, I have two main responsibilities: to ensure the continued running of the organisation and to start thinking about our operational recovery from the major incident. These actions need to happen concurrently. That is part of the emergency planning process.

Planning has been split into phases; the first three to four weeks are around changing processes in the organisation before moving into the operational phase. We now know what supplies are needed and we are discussing how to manage those resources. The urgent, crisis planning has been done and we are now moving towards the recovery phase, which is the critical part of any emergency plan.

What are your personal professional challenges at this time?

My instinct is to lead, I find it hard to sit back and let someone else take control. But my role was to be the CEO, which meant I needed to be the public face of the organisation, finding out what the issues are and bringing them back to the executive.  That visibility of the executive is vital in reassuring people that we have a plan, we know what we are doing, and we will be ok.

What, in your view, are the key behaviours a leader should demonstrate at the moment?

The executive is responsible for the running of the organisation and there are legal ramifications to this. Our job is to ensure we provide the safest care we can for our patients within the structure, system and processes we have. A large part of this is about keeping staff safe. The situation we are in now is no different to normal in that regard, it is just more intense. I am more worried about what we are not doing, rather than what we are doing around Covid.

I think visible leadership is critical right now, but also incredibly difficult. I want to get out and about, but do not want to go into certain wards simply because I do not want to waste a gown.

Being a spokesperson is also vital. The focus for this is largely on critical care capacity, both regional and national, but I keep reminding myself that while that is important it is also about our capacity to provide care across the Trust; after all, I can only provide oxygen to a quarter of our total bed capacity.

Is there anything you have been able to draw on in this time?

As this is an extended major incident process you have to apply command and control to achieve a level of standardisation. For example, with PPE we have had to create red, amber and green areas and set a standard for that. You draw on your experience and your training.  We were lucky, when the bombing occurred in 2017, we had just completed our training three weeks before. When I looked around that night, I saw several people that had done the training with me. Policies and protocols are often developed and applied after an event, rather than in the here and now. But major incident policies are not like that. We train on them and they help give a structure.

As a clinician, you make decisions based on the training you have had, aligned with the experience you have had. As a manager it is no different. You act instinctively and do things because you have a framework. It is your layering of experience that informs your instinct. As executives, though, we are facilitators rather than managers.

Are there any particular examples of innovation you have seen?

It has to be IT; the amount of IT we have pushed out in recent weeks is incredible: Virtual clinics, pathways we had spent months negotiating are now going ahead without question. Mental health pathways have also started, we should not let go of that now, we need to keep moving with it. Part of recovery includes learning from what we have done, what needs to stay and what needs to go return to what we had before. The frailty team gave me an example the other day of a 97 year-old man with deranged liver function tests (LFTs) who we managed to get home and bring back to a clinic the next day. We would have almost certainly admitted him a few weeks ago and he would have been an inpatient for a few days. Now we achieved a better outcome for him. We need to ensure examples like that do not go back to how they were before.

With thanks to Dr Richard Parris who was instrumental in arranging this interview.