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Hello. I’m Domhnall MacAuley and welcome to this BMJ Leader conversation. Today I’m talking to Rachael Moses. Tell me about your current role and how you got there.
Rachael Moses: My name is Rachael, and my pronouns are She/Her, and I am a physiotherapist by background. I studied at the University of Hertfordshire and qualified in 2001. I currently work in a portfolio role so I work as a Consultant Respiratory Physiotherapist, I work as a National Clinical Adviser for Respiratory for NHS England, and I work as Head of Clinical Leadership Development at what was the NHS Leadership Academy, now part of NHS England.
DMacA: There are a lot of things that I’d like to ask you, and the first is about the Leadership Academy. How does that work?
RM: The NHS Leadership Academy was formed over 10 years ago and it was a Centre of Excellence for Leadership and, over the past two to three years it’s had a number of families, a number of parents if you like, but now it’s part of NHS England. And NHS England is going through a big restructure at the moment and the NHS Leadership Academy will essentially be incorporated into the new model of NHS England.
It’s really just a space where we bring together a variety of people with a variety of different backgrounds who have skills and experience in leadership. That may be leadership design of programs, leadership strategies, maybe research- people to help try and embed inclusive leadership values across health and care.
DMacA: For someone listening, who’s interested in becoming a leader, how do you join the leadership academy what is the structure and organization?
RM: The leadership academy has its own website. If you just type in Leadership Academy England it will come up and you’ll hit a website. There are two ways you can do it. You can look at the program offers we have for anyone, a lot of our offers are bite-sized learning, and our free learning can be accessed anywhere across the world. That’s one of our inclusive strategies- to share good healthcare leadership. But, you can also access specific offers through your regional academy. Say you’re based in the Southeast, you’d go to the Southeast Leadership Academy landing page and you can have a look at offers there. Browse on the website and if it’s leadership programs you’re after, look at our program content. But actually there are blogs, podcasts, bite-sized learning. There’s a real mixed bag if you’re just interested in exploring what leadership means to you.
DMacA: But, Rachel, you just you don’t just talk the talk… I want to ask you about your own leadership roles because one of the very interesting aspects of your career is that you were President of the British Thoracic Society. Tell us about that as its really quite innovative and exciting.
RM: The British Thoracic Society I hold quite dear to my heart. Respiratory clinicians, regardless of your professional background, whether you’re a doctor, a nurse, a scientist, a pharmacist, it really is a society that helps not only to educate but provide standards of care for people living with respiratory disease. It’s like a very small close knit family and we’re always trying to extend membership. I was actually the first President from a non-medical background so, for the 40 years, all of the Presidents had been doctors, professors, very esteemed academic clinical leaders. So, to be given the role was a monumental occasion for me. But also, showcasing that the whole of the MDT (Multi Disciplinary Team)should have these types of leadership opportunities. I feel very grateful.
DMacA: You weren’t just given the role, that’s a role that you earn. So, tell me how you got to be the President because that’s a pretty prestigious post.
RM: I pay a lot of credit to the amazing doctors that I’ve worked with in my career as a non-medical consultant. I work with a very specific defined scope of practice and I wouldn’t be where I was today if it wasn’t for the doctors that were championing me. It was a same with the British Thoracic Society. I was on a course, doing a presentation, and a chap called Mike Davies gave me the tap on the shoulder and said, ” you know, you should do more within our society, we need more physiotherapists, we need more non- doctors to come in, we need different thoughts, different perspectives…” and, I just started off doing little things, helping on guideline groups, and becoming part of policy teams, listening to how people had developed their career and then, when you get involved in something or you get asked to do something and you do a good job, people tend to come back and ask you to do it again. You don’t always get things right but it’s about having that learning narrative. Thinking, okay, that didn’t quite go how I thought it would go, how can I learn from that and do a better job for next time. So, start off small and then when the bigger asks come in, it’s not having that impostor syndrome, or however we want to define it.
It’s about actually recognizing your strengths and the uniqueness that you have, as someone different in that space, because often you go in those spaces thinking “Oh God, I’m different from everyone, I haven’t got all these letters after my name, or I haven’t academically achieved huge amounts…” It’s resetting your narrative to see what you can bring, rather than what you can’t.
DMacA: I like that idea of resetting your narrative because, you know, you’re a real role model for Allied Health Professionals. How would you encourage your colleagues and other Allied Health Professions to take on leadership roles?
RM: Over the last five years Allied Health Professionals combined have become the third largest workforce behind doctors and nurses and, collectively, we have a real strength not only numbers but in our approach to things being just a little bit different. For me, rather than letting your professional identity define you, it’s about changing your narrative and thinking- what can I bring into that space? So if there’s an advert for a clinical expert or a clinical advisor in stroke, in musculoskeletal, in respiratory, cardiovascular, whatever, a lot of the time we’ll just shut our mind off and think they want a doctor for that, or they want a nurse specialist, but actually we can often be experts in those fields too, just in a different way. Think about the things that interest you, think about where your skills and expertise lie, think about what value you have in that area, and then look for the opportunities that might present themselves. So, looking for vacancies, looking for requests, looking for calls that come out. If there’s a research team doing something, ask how you can be involved. If you know you don’t want to go down a PhD or an MSc route there are other ways you can get involved in research and audit. Try all of these little avenues where people can develop leadership roles because, a lot of the time people think that being a manager is getting leadership skills but, actually, there are so many different facets we can enter now and be part of that collaborative, rather than doing things in our own silo.
DMacA: You mentioned belief in your own expertise and that brings me on to another issue that came up and that is, the use of the word ‘consultant’. I think there has been some controversy about that?
RM: For me the non-medical consultant roles I work alongside, and I work in, are very clearly defined by objectives and in scope, and I think that’s really important. Some of the doctors concerns are valid and I think, if some of these opportunities are being taken away from doctors in training, I think that’s wrong. I think our doctors in training have so many more challenges now than we’ve ever had in our careers. I think we need to be really clear on why these roles are needed and they’re not needed everywhere. But I think that they add real benefit in some specialities, in stroke, trauma, respiratory. Just being really clear, so I would never just say I’m a consultant, Id say I’m a Consultant Physiotherapist. It comes hand in hand. I have a Clinical Doctorate but I never ever use that title in clinical practice. I know people that do but personally I think it can be misleading and confusing and I personally wouldn’t do that. Yes, I think there’s a lot of work to be done redefining but I think getting rid of them completely would be a sad time for our profession.
DMacA: You’ve painted a very positive picture of being a leader, and leading the profession, but I also saw a quotation from you that said ‘being a leader is difficult and uncomfortable’.
Tell me about the flip side of leadership…
RM: I have experienced the very best of NHS leadership and the very worst. The very best of NHS leadership is that feeling of belonging, feeling of being included, valued, appreciated for what you do, and being very clear about your role and responsibility within a team. The very worst of leadership are those toxic traits and narratives that I’m sure we all know about.
For me the hardest part about being an inclusive leader has been challenging the biases that I had within myself, acknowledging the bias that I had in my life and constantly trying to understand and recognize those as I progress through my career and in my leadership career. I think part of that is being an ally and it’s being zero tolerant to those types of prejudices, discrimination, racism, transphobia, ableism, whatever it is, in a senior position. And actually, not only just knowing your own bias and privileges but actually then calling out poor behaviour, discriminatory behaviour, that you see as a senior leader. That can be uncomfortable because often people don’t ask for your opinion or don’t ask for that, but it’s important that we know the responsibility lies with us. Ever since the black lives matters movement, for example, I think we’ve seen a real shift in the acknowledgment of the discrimination and the systemic discrimination that exists within health and care structures and how we, especially as white and British born senior leaders, can help call that out and, hopefully in our lifetimes, eradicate the discrimination that exists. So, when I talk about the uncomfortableness, that’s probably it. But I sit in a very privileged position so while it might be a little uncomfortable for me, for people who are facing this discrimination, it can be very very damaging.
DMacA: The issues of racism, equity and diversity, and discrimination – those words are often used in a theoretical context. I read a description of your personal experience and that really hit home to me. That was when you described being on an interview committee- do you want to tell us about?
RM: I was in one of my first leadership positions. For those that know banding it was an 8A band. And I went from working in a hospital in Newcastle, a very big major trauma centre but it lacked real diversity. Everyone looked like me, sounded like me, acted like me. I’d had a very fortunate career progression, a very typical step by step by step with no barriers in my way, and I took up a leadership position at St George’s in Tooting, which is a very multicultural hospital and part of London. I was managing people from all ethnicities, from people who were internationally educated and recruited, and I was interviewing for a post. When I was telling a person selected that they were successful, I got the response I expected. When I was telling the second choice candidate that they weren’t successful, something felt inherently wrong and I couldn’t work out what it was. After a long conversation with my mentor at the time, who was an amazing woman. She was a black female, and that’s important because the second candidate was ethnically diverse. They weren’t white, they weren’t like me, they weren’t British born. And it was my prejudices when I was interviewing that what I had expected that person to have done in their career was the same as mine, and I judged them for not having that same career path as me.
Before people reach a senior role we need to have a measure of how inclusive people’s behaviours and values are. I think that’s something we need to work on because it’s a choice. It’s a choice that people have to go on when they are afforded the privileges of being white British born. I don’t have a disability. That was the interview comment you spoke about.
DMacA: Something else that really intrigued me, and brought the message home to me, was when you spoke about gender. You spoke about it in a way that really made it real. You spoke about how it’s okay for a male to go and work away from home on a couple of nights a week but, when a woman works away from home, people don’t think that should be the case. That’s a sort of silent gender discrimination.
RM: I’ve been working away from home for nearly 12 years now so I class myself as a ‘weekend wife’, if you like. I’m away working Monday to Friday and then I’m home at the weekend. Certainly, 10 years ago when I started to do this, when I explored the thought of relocating to London for a job, because of the lack of opportunities in the Northeast. Just the the kind of comments, the microagressions, macroaggressions, the rumours, the assumptions people would make about why you’d want to do that for your career, were quite startling actually. I didn’t expect it to be so commonly mentioned. There was definitely a gender stereotype and I’ve got friends that do the same and they’re obviously male and they don’t have. A lot of doctors and dentists in training are now experiencing the same type of gender stereotypes.
DMacA: Finally I’d like to ask you about a different aspect of your life, and that’s your humanitarian work.
RM: Thank you. I have been a humanitarian aid worker for just over 20 years now. I’ve had experience in the British military so I’ve been deployed on operational deployments such as the Gulf War. And ever since then, in 2004. I’d done a little bit of work with the Red Cross beforehand. I don’t agree with war. I think war is a terrible thing but there is something about helping people in the most distressful time in their lives, being part of that medical team who can provide emergency or life sustaining support in conflict zones in war torn countries. I don’t know, it’s just something that I’ve been drawn to ever since. And the people in these countries, the innocent civilians, are often the most humble, caring, compassionate people you will ever meet. I’ve continued with humanitarian aid work. In the last six months I’ve returned from Ukraine and I also work for a medical charity called Medical Aid for Palestinians and I’ve been working for them for around seven eight years now. I highly recommend it to anyone who has an interest. It’s a very rewarding voluntary part of my life that I hope I’ll do for as long as I can.
DMacA: Thank you very much for sharing so much of your life, your leadership journey, your humanitarian contribution to society. It’s just been wonderful talking to you. Thank you very much indeed.
Rachael Moses currently works in a portfolio role as a Consultant Respiratory Physiotherapist, National Clinical Advisor (Respiratory) and Head Clinical Leadership Development at NHS England. Rachael is a clinician passionate about the empowerment of patients, professionals and peers and raising awareness regarding equity, diversity and inclusion. Making sure voice is heard as well as showcasing the huge value of multi-professional working. She has experience working in the military, education, charity and third sector and has spent 22 years working in the NHS.
Rachael was proud to be the first non-medic British Thoracic Society President (2021-2022) and fortunate to sit on several national organisations as well as being an previous Associate Editor for BMJ Leader and Social Media Editor at Thorax BMJ. Some of her biggest professional achievements are being awarded an OBE in the Queen’s Birthday Honours in 2021 and an Honorary Clinical Doctorate in 2022 from the University of Hertfordshire. In her spare time Rachael is a humanitarian aid worker and is grateful to have the opportunity to support critical work overseas and currently works in a voluntary role for Medical Aid for Palestinians.
Professor Domhnall MacAuley
Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.