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Hello, I’m Domhnall MacAuley and welcome to this BMJ leader conversation. Today I’m talking to Charlotte Williams, Deputy Chief Executive, North West Anglia NHS Foundation Trust. But, you didn’t start off in management – you were a scientist…
Charlotte Williams: I studied Science. But, I don’t think life in the labs was really for me, so I decided not to pursue a PhD, but to get into public service, which is what I’ve done ever since.
DMacA: What was the attraction of public service?
CW: Both my parents were, in one way or another, in public service. My mother was a civil servant, in the court service, my dad was in the military, and I was schooled in a household where you used your skills for the greater good. So it was part of me from quite a young age. I was always interested in trying to solve complicated problems and I looked at opportunities to do that and I always thought that issues related to the state, issues related to the challenges of society, were the most interesting. So that was the route.
DMacA: You then did the NHS management program. Lots of people are interested in that programme, tell us about it and what you gained from it.
CW: Huge amounts. I was very lucky to get onto the graduate management training scheme, and I probably didn’t appreciate at the time how attractive and competitive it was.
I knew somebody, through a friend who had done it the year before. And, she said, you get a lot out of it because you get stuck right in at the start, a vocational training process, and not too much academic work. And also not being a “grey suit” which I think I had a bit of a fear of becoming, were I to go into a government department.
And she was right. The training scheme is a real job from day one in a proper NHS facility, with all of its glory and all of its troubles, and working with real amazing people. And, you also get immense support; academic input and also more vocational input through, what at that time was, a national vocational qualification. I got the opportunity for reflective practice. It blended a professional development approach with a traditional management scheme and being on a master’s program. So, I got a lot out of it, intellectually, personally, in terms of working with real people in real jobs. And, also with peer groups and people you were on the scheme with pop up every now and again and you’ve got something in common. It’s quite a good holistic way to understand the health service. And, the real privilege of joining at a quite senior level and being able to have quite a lot of responsibility early on.
DMacA: You also did something else really interesting. You went to New Zealand, where there was a Maori component …
CW: I was very fortunate to be able to choose an overseas elective placement as part of the scheme. Considering placements, I knew I would get time working in hospital, and I knew I would get time working with general practice, but I wasn’t going to get any exposure to mental health. It was pretty obvious, even in the early noughties when I did my training, that mental health was a global challenge. And, at the time of my masters I was interested in the perceptions of culture and behaviour in the diagnostic criteria for mental illness because obviously it’s a bit more behavioural in focus. So, I arranged for placements in New Zealand to look at the interface of Maori and Pacific Islander, communities with the mental health, diagnosis and provision in that country at the time. I looked at the implementation of the Maori mental health strategy which was brilliant on so many levels. But also, it helped me to understand some of the assumptions that we make about particular communities and cultures and how that impacts on their outcomes from a health perspective.
DMacA: You did a Master’s degree as well. Was that part of the training program?
CW: Yes, the postgraduate diploma is part of the training program and then you can undertake a detailed study, to convert that into an MSc, which I chose to do through a qualitative study looking at patient choice in the health service. At that time there was new policy of payment by results- an incentivization model based on payment by case treated. The idea was that as you attracted more patients you would get more income as a provider and was central to a change in the government strategy at the time aiming to bring down waiting lists.
I spent about a year and a half interviewing directors and chief executives of providers in a health system in England to understand how they were going to approach that strategy and what they thought were the benefits and opportunities, which was great. And I had a fantastic health economics supervisor who helped me to understand those aspects in health care.
DMacA: You headed off on this management trajectory but there’s one role in particular caught my attention in the context of what you said about serving the community-your work on cancer care in London.
CW: I worked for about four years in UCL Partners, which was an academic health science partnership in North Central and North Eastern London, as executive director for the London Cancer Program, which was an innovative way of bringing organizations together to think about how they could optimize the outcomes for populations in that area, by collaborating and by following the published evidence for the treatment of certain cancers. London Region had published an evidence review which indicated that the centralization of certain specialist care facilities yielded better outcomes, both functional and mortality outcomes for people with those cancers. We also know alongside this that over centralization of good diagnosis and follow up rehabilitation was unhelpful in terms of sustaining and improving equitable access to cancer care. So we needed to create networks where centres of excellence could support the often more peripheral units where more people lived, and prevent people who didn’t need to come to big centres in the middle of town from having to do so unless for access to that very specialist expertise.
That was the principle. But there are lots of reasons why many colleagues might not have thought it was a good idea. It threatened a number of power bases within the city. We tried to take an innovative approach by using a number of outcome measures which had been derived from patients’ experience, by the opportunity to increase participation in research, and also to consider that living with and beyond cancer outcomes really needed to be part of care, given that the majority of people now live with cancer, don’t die from that cancer, that they continue to have a longer life, which is fantastic.
And we developed some first in type measures of what matters most to cancer patients in order to design some patient outcome measures. And it proved successful. I’d moved on by the time it was implemented but my colleagues who followed that roadmap were successful in making really significant improvements in some pathways and in patient outcomes through that centralisation approach.
It’s helped to bring some of the North London centres up to the European volumes and standards for specialised care. It was fantastic because I got to work with clinical academics, and use the evidence. And it’s very rare that you get a chance to apply published evidence so directly in practice and to see how that takes effect over a number of years. It’s been a real privilege to work on that program.
DMacA: By now, you’ve shot up the ranks, tell us about your current job.
CW: I joined Northwest Anglia NHS Foundation in May 2024, a group of hospital sites in the Cambridge, Peterborough, and Lincolnshire area. I’m the deputy chief executive, which means that I stand in for the chief executive when she is not around and I’m a member of the trust board. My direct portfolio is that I lead for strategy, transformation, digital services, organisational development, and for the relationships with our place partnership of councils, primary care based organisations, voluntary and faith sector groups, etc. And I love it. I really love it. I’ve had a few roles in board positions before, but who you work for and who you work with, and their appetite for improvement and their focus on staff and patients, is so important. And I’m very lucky that in North West Anglia, there is driving commitment, and a high level of ambition for improvement, which fits with my own aspirations. I’ve never been one to ‘keep a seat warm’. I’m always trying to get things done, and it’s great to be able to do that. We serve over 800,000 people, we provide a range of services, district general hospital care, emergency services, maternity and a range of surgical …
DMacA: Now, I’m going to stop you there because I’m not going to let you give me the official figures or any of the official messages, because I want to ask you about you! You posted, on Twitter on New Year’s Eve, to say “it’s nearly midnight on New Year’s Eve, and I’m here with some of the teams working.” Tell us about that.
CW: Yes, I wanted to spend some time with our teams on New Year’s Eve. A lot of the job of leadership in and around health care and, I’m sure, in every sector is helping people to do a great job, facilitating the experts and the talent at that point of care, and making people feel that you’re out at their elbow in doing that, and taking as many stones out of their shoes as possible. Management really is about that. It’s about recognising that half the time it’s about loving the people and helping people to feel safe and to be able to do what they do best. We do have a big commitment in my Trust, and I have always had a big commitment to visibility and the celebration of people. Social media has really accelerated and enabled that for me in recent years. I am quite a big social media user although it’s risky because you put yourself out there. But I think it’s important for people to see that its happening as well as you telling them that you’re doing it. My CEO and I organised our Christmas and New Year’s Eve leave and I was working that period and I thought, if I’m going to be in on duty over the New Year, I need to be properly in over New Year. So, I came into Peterborough City Hospital which is our busiest site. New Year’s Eve was a really bad day for demand, patient capacity and managing the pressure in the East of England. We’d all been on a lot of calls about ambulances and all the teams had been working really hard through the day. I had a quick rest and decided to come back in and see the team. And, totally loved it. I managed to get to meet people some of whom have never seen a manager before in their lives in person, such as security staff and our out of hours cleaning staff. It was good to get some time to do that. It was a really fun thing to have done. I didn’t get to wear a nice “2025” headdress like some of our ED staff as the clock struck 12 but it was good to celebrate and, I hope to be able to do something similar again next time.
DMacA: You also have leadership roles outside the health service, because you’re involved with the Ehlers-Danlos society.
CW: Yes. I just became chair of The Ehlers-Danlos Support UK in December. It’s a support charity for people with hypermobility and EDS disorders, which are many. Essentially, it’s about supporting people of all countries of the UK, raising awareness, providing support and information, and creating equitable access to care for people with these often misunderstood or not very well-known long-term conditions. EDS is a lifelong condition in adults and children with a lot of pain and discomfort and physical limitations on life for many in our community. I have a couple of friends who have the condition and I became aware of the opportunity to help through one of them who was in touch with the charity. Ever since I’ve been involved, it’s been amazing the number of people who’ve reached out to me to say they’ve been affected by the condition, or their children are, or that they are so pleased because no one ever talks about it because it’s not well understood. And although, EDS types do come under the rare diseases group, I think it’s more common than we may realise as diagnosis can be delayed or never made, and when you look at all of the conditions together.
Whilst it’s being on another board, I love my work with EDSUK because, it’s a totally different type of organisation and a real challenge. It really opens your eyes to what it’s like for the third sector and for organisations that rely on volunteering and fundraising, and it brings you very close to people who are struggling every day to get access and be recognised by the system. I like to be able to use things that I know about the health service and about regulation, and supporting employees in what is a very small charity. I feel useful doing it, and I hope it makes a bit of difference. I’ve been there for five years and I’m hoping to do three years as chair. I also think it really helps make me better at my job in the health service.
DMacA: You may have left your scientific career behind, but you’re still involved in St Anne’s Oxford.
CW: I never thought that I would go to Oxford University because neither of my parents had been to university and I went to a comprehensive school. Initially I’d been encouraged to consider applying to Oxford and, I still don’t really know why I got in, but I did. And it completely changed my life both personally and professionally. There were opportunities that I’m sure I can’t even see, that come with the privilege of attending a university like that. And I was always very keen to help enable other people to have that opportunity.
St Anne’s is not a wealthy college. It originally started out as a women’s college, and it started out as a college where you could study from home which, in the light of the pandemic and where we are today, is quite an interesting perspective. But it’s always been about making Oxford inclusive, and that’s an ethos that I can get behind. I can contribute, I suppose, through philanthropic efforts but also in helping to improve access and awareness of the college, and the opportunity for people who might not think about it. I also talk to students about working in the health service to try to encourage them to come this way and use their talents for good. And I really enjoy it. It’s given me exposure to different kinds of academics and some interesting individuals at multiple social events. And, having contact with the alumni through the college has been absolutely fantastic. I was also able to point out to my college that Amanda Pritchard, chief executive of the NHS, was an alumna. https://www.nhsconfed.org/people/amanda-pritchard
And I’ve been able to help them to make contact with Amanda and bring her into the College fold. I’ve learned through these processes that social networking, helping to bring people with different skills and ideas together, can be as powerful as the monetary resources you can mobilise.
DMacA: NHS management has a reputation of being a bit dull so, my final question is to ask you about the NHS Clinical Entrepreneur programme…
CW: I’m of the view that the greatest asset to the health service now and in the future is its people, and that those who see it and dedicate their lives to it have the greatest ideas about how it can be improved. The entrepreneur program is about providing a safe place for people with those ideas to experiment and receive support and guidance from people within the health service and outside, to try them out. If they want to develop a business, or they want to spin out a product, that’s fantastic. But, if not, just stay in the health service and be that innovator, be that catalyst for change and improvement, think differently.
The entrepreneur programme is designed to support our workforce to stay working, and to bring those ideas to life where they are. The value of that to all of us who care about the health service in the long term is invaluable, let alone the commercial benefits that may accrue from different ideas. I love the fact that it’s about developing our capacity for innovation collectively in the health service, because I really believe that innovation is a team sport. You can have all the ideas, all the new products in the world, but if you’re not equipped to take them on board, try them out, and put them into practice, then they don’t really result in benefit for patients.
DMacA: It’s been fun talking to you, thank you very much indeed. And may you continue to be to be that catalyst for change and excitement and entrepreneurship in the NHS. Thank you.
Charlotte Williams
Charlotte Williams is Deputy Chief Executive Officer at North West Anglia NHS Foundation Trust. She leads on quality improvement and innovation, transformation, strategy, digital and organisational development. She began her career on the NHS General Management Training Scheme before joining East and North Hertfordshire NHS Trust in 2003. She joined Ashford and St Peter’s Hospitals NHS Foundation Trust in 2006 before moving to the role of Assistant Director of Operations at North Middlesex University Hospital NHS Trust. In 2010 Charlotte joined UCL Partners as Director of Integrated Cancer and Executive Director for the London Cancer Integrated Cancer System before being promoted to the role of Chief of Staff at UCL Partners in 2013. Charlotte is an Honorary Associate Professor at University of Birmingham, School of Social Policy. She is an Associate Editor of the BMJ Leader healthcare journal, and has published on the topic of patient involvement in major redesign of health services.
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.