Tracy Allen, "What is your leadership for?"

Tracy Allen is Chief Executive of Derbyshire Community Health Services NHS Foundation Trust (DCHS), a primary care trust with 4,000 staff.

Tracy was recruited to the NHS Management Scheme straight out of university and, apart from a brief spell in academia, has worked for the NHS throughout her career, close to 30 years. For the first 20 years she worked mainly for secondary (acute) trusts but for the past 10 years she has specialised in primary (community) healthcare.

She established DCHS in 2011 as the Chief Executive and has been there ever since – that is quite a stint as an NHS Chief Executive.

The Care Quality Commission (CQC) has recently rated the Trust as Outstanding overall and Outstanding for well led. Tracy attributes this to “great people who want to do a great job, a really clear set of shared values and a common purpose… and a golden thread that connects the way we go about our jobs every day back to those common values and purpose.” And this was evident to the CQC.

In the next episode of The Compassionate Leadership Interview, Chris is intending to interview Professor Michael West, author of the report ‘Caring to Change: How Compassionate Leadership Can Stimulate Innovation in Healthcare.’ The Trust has given a lot of thought to providing people with the autonomy and space to innovate. This has meant, inter alia, thinking hard about how to handle assurance and governance in a less time-consuming way.

An example of innovation at the Trust is the introduction of health coaching, an approach based on the notion that healthcare is co-created between patient and clinician, rather than dispensed by the clinician. Using this approach the Trust has significantly improved outcomes for leg ulcer patients, for example. Health coaching improves the patient experience, enhances overall community health and wellbeing, delivers best value and is more fulfilling for the professionals involved.

Tracy views her leadership philosophy as closely related to her philosophy about being a good human being. “It’s a people business … it’s the interactions between each one of us every day that determine the quality of the services we are going to provide.” Kindness, respect, teamwork, and feeling comfortable to bring your whole self to work are critical.

The body of evidence that the CQC has built up has established a strong correlation between quality of health outcomes and how people in the healthcare provider feel they are treated, especially minorities. “Looked after people look after people. Hurt people hurt people.” The Trust is trying to create a culture where everyone feels supported and engaged, they all understand what is expected of them, and they truly believe they are all there to care for one another as well as to care for their patients.

Tracy acknowledges the “inexorable” pressures within the NHS – rising demand, resource constraints, workforce challenges. And innovating, working with ambiguity, and empowerment within the context of a system under pressure places ever increasing demands on leaders.

One of the lessons in leadership that Tracy has learnt from experience is the imperative to have difficult conversations with colleagues at an early juncture. Conversations at the right time are kinder than having to work round an individual and postponing the point at which things come to a head. If matters are dealt with well, an individual can be supported to find the right role rather than leaving under a cloud, and everyone benefits. “The compassionate thing to do is to step up and have the conversation. It’s about how you have it.”

One of the people that has inspired Tracy is Professor Donna Hall, formerly Chief Executive of Wigan Council, now Chair of Bolton Foundation NHS Trust and also Chair of The Local Government Network. She introduced ‘The Wigan Deal’, a multi-agency service delivery approach founded on the strengths of individual communities rather than their deficiencies.

Tracy sees the role of the Trust board as acting as an umbrella or filter for what comes down from the centre. Their role is in part to prevent the pressures, financial imperatives, targets and policies from defining the Trust. It can’t all be about counting things and negotiating contracts. But this takes a compassionate approach – time, patience, exploration.

Both the opportunity to start with a clean sheet of paper at the Trust’s inception and the subsequent stability of leadership and organisation have been important in delivering the current culture and level of performance.

Tracy is not resting on her laurels. “We’re not an organisation yet where everyone feels as great about working for DCHS as I do.” Other matters for attention include a gender pay gap and the treatment of BAME staff. And Tracy feels the Trust has only scratched the surface so far in innovatively deploying the assets under its control in service of community health and wellbeing.

Tracy herself has a long-term health condition which has led to two ‘life-changing’ operations. But her self-care regime includes Nordic walking and swimming (at Hathersage outdoor pool.) She has used the Trust’s staff counselling service in connection with the surgery she has had, and has found that her openness about this has given psychological permission to other staff to do the same. She has gone to part-time working: 9 days every fortnight.

In Tracy’s mentoring of ‘almost ready’ Chief Executives, Brene Brown is the leadership thinker that she refers people to most often. And her favourite question to ask aspiring leaders is “What is my leadership for?” The clearer you can get around that, the more people fly subsequently. “It helps you decide where you’re going to stand amidst all that noise.” Tracy’s own answer to the question is “in pursuit of social justice” and this stems in part from her family background. “I really do believe that the NHS is a core part of the potential we have as a country to develop a much more socially just society.”

Tracy has a concern that while there is an enthusiasm for compassionate leadership in the NHS at present, there is a danger that it will be reduced to what can be measured!

And while Tracy is not an optimist about social justice in the UK as a whole right now, she remains convinced that DCHS can be a force for good locally, with that common purpose, shared values and partnership model.