Interview with Fiona Noden – Royal Bolton NHS Foundation Trust Chief Executive (started in post on 1 April 2020)

By Dr Hannah Baird

Chair of the FMLM Trainee Steering Group

What is your background?

I am a radiographer. I was quite a poorly child and clumsy, so I was x-rayed a lot. I became interested in radiology, joined the NHS when I was 18 and ended up running CT and MRI scanners. I am also very opinionated and became the elected trade union official, initially regionally and then nationally. I enjoyed these roles as I am inherently interested in people and fairness. I learnt a lot about corporate management, but realised I could not be both a union official and in management.

I got into management after the director of operations at the time told my line manager “get her a job in management before she kills me”. I then moved to Wigan to take up the role of director of operations and performance, before moving on to the Christie NHS Foundation Trust as chief operating officer, working within the Greater Manchester footprint. And I have now ended up back home in Bolton.

Some people believe if you are a good clinician you will be a good manager, but that is not necessarily the case. While everyone else saw something in me and made clear their expectations of me becoming a leader, I had not seen that in myself. I did not set out to be a CEO, but I have done the aspiring CEO programme, which is a taster to see if it is what you want, and after that I knew I could be a CEO. It helped me to see what others saw. It took a long time for me to see that.

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

There are three things: firstly, providing visible leadership. My overwhelming priority is to ensure that staff are safe, which in turn will make patients safe. It is difficult at the moment, because we are not meeting people face-to-face. Working remotely makes maintaining those connections with people so much harder. Which is a challenge is being new to the role, as I do not have those pre-existing relationships with people.

However, we have created a better Bolton award, where we recognise a team in the organisation for their hard work. I present the award and take the photo, so it gives me an opportunity to meet people. As my induction has been shelved, it has been a great way to get out there.

Secondly, gaining a rapid understanding my exec team both as individuals as well as their roles and responsibilities, has been both important.  I have inherited a truly fantastic team that is not without its challenges. There has been a bit of storming and norming – mainly because I am new – and some rumbling, but my job is to keep them together, particularly as people take on new roles. For example, we knew we had a problem around oxygen, so our director of finance focused on a piece of work around understanding how much oxygen is needed and looking at the number of ventilators and oxygenated beds. She knew nothing of this previously, her skills set is finance, but as this issue is around numbers, she has taken it on and developed a methodology. My job is to share this knowledge across the Greater Manchester system.

And thirdly there’s vulnerability. While I have experience in operations and people, Covid-19 is different, but I am taking comfort in the fact that I know as much about it as the next chief executive. We are all learning together. People keep saying it must be hard to come in new to an organisation at this time, but in some ways it is easier – there is nothing like getting thrown in the deep end. This is no time for hero chief-executives. I am as vulnerable as everyone else trying to manage the effects of this virus, but at least we are working together.

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

Instinct. My Myers Briggs Type Indicator (MBTI) is that I am an extravert and I tend to go with my gut.

I have my exec team as a foil against things and it is about collective decision-making; I would hate to be in a situation where what I say goes without challenge. We need to debate things and make sure everyone’s opinion is heard, particularly at the moment. I can do command and control, but now is not the time.

Being chief executive is my job, I love it and I see it as a privilege. But, you need to have people around you that will hold your feet close to the fire, because if they did not and everyone told you you were right all of the time, you could end up in a dangerous place.

The Christie had a fire a few years ago and I had to co-ordinate the response to it. I learnt a lot about command and control through that event. Before the fire crews even got to the site the unfolding event was on social media and I was getting phone calls from many different people. I learnt much depends on relationships and trust in these situations, so when people realised I was coordinating the response, they were content to wait for me to get back to them when I was ready. You are only as good as your relationships and networking.

Do you think the NHS will change as a result of Covid-19?

It cannot not change. We cannot go back to doing what we did in exactly the way we were doing it. These recent experiences need to inform our future. We will develop a before and an after Covid-19 view. We need to take the best bits of what we did before and combine them with what we are doing well, now. The NHS red tape needs to go. We have not properly recognised until now how innovative our staff are, and that needs to continue as long as it is the right thing for patients. The NHS is very compassionate, but sometimes bureaucracy gets in the way of the compassion and the care of patients. This pandemic has forced us to do away with some of that bureaucracy. For example, we have been talking about creating integrated neighbourhood teams for a while, but now we have just got on and done it – because we have had to.

There will be a big inquiry into all of this. We need to make sure our decision-making process stacks up. It is sometimes harder to get people to make any decision rather than face the fear of making the wrong one.  I do not want to be leading an organisation that in six months’ time is not viable because all we did was focus on Covid-19 rather than ensure it was a constant consideration in a wider strategy.

The NHS will look very different at the end of this and I firmly believe there will be lots of kids who have lived through and taken note of these challenging times who, in 10-years’, will want to come into the NHS.

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