No Longer on Mute: How a Quiet Girl Became the Leader Our NHS Needs

Brigitte: Hello and welcome to DrDoctor Will See You Now, the podcast where we share real stories about real people transforming care across the NHS. Each episode, we sit down with fascinating people - NHS leaders, policymakers, tech entrepreneurs, investors - for conversations that help us to build new perspectives on what the future of healthcare and the NHS looks like. I'm Brigitte, Product Director at Dr Doctor, and I'm joined today by my colleague Lauren, our Commercial Lead. Regular listeners may have noticed that our usual host Tom Witcher is not here. Don't worry, he's absolutely fine. We just jumped on the opportunity to host this particular guest ourselves, as we want to talk about all things women in leadership and what it takes to truly innovate in the NHS. Our guest this week is Dr Jane Padmore, an NHS Chief Executive at Sussex Partnership, mental health nurse, executive coach, researcher, and a truly inspiring force.

I am so excited about this conversation, and I think you're going to learn a lot about how to lead differently. What it's like to be a chief executive and a woman in leadership in the NHS, and what we need to do to change mental healthcare for the better. And also what it looks and feels like to lead with a genuinely different kind of presence at the top. Welcome to the podcast, Jane.

Jane Padmore: Thank you. Thank you for having me.

Brigitte: It's great to have you here. We're so excited. So we wanted to start right at the beginning. So you've spoken previously about the importance of getting to know people's stories, and unique perspectives, and how much that has shaped the choices you've made and how you've gone on to lead. And so we wanted to start by getting to know your story and how your unique perspectives shape what you do and how you do it. So can you start right at the beginning and tell us a bit about your childhood, and what you think your experiences in early life - how you think those shaped the way that you view the world and what you went on to do?

Jane Padmore: Sure. Right back at the very beginning. So I am very fortunate to have grown up in a very stable home, and I think that's a really important thing to state because not everyone is as blessed as I was. I have two sisters, I'm the oldest, and I went to a local school in South London and was born in Wimbledon. And I grew up in a family that worked hard and went on holidays and spent time together. But school was not a particularly happy place for me. I can't say it was traumatic or anything like that, nothing terrible happened, I wasn't extremely bullied or anything like that, but I was mute in primary school. So I would speak occasionally, and I'd speak fluently at home, but I wouldn't speak at school. And I'd often be walking around the playground quite on my own, looking at people playing and thinking, oh, I'd like to be involved, and then getting involved and thinking, I don't understand why this is fun, to be quite frank - and being thought of as not very bright. So I was in the special needs class, I was removed from the main classroom and taken to the library, which I loved - being in the library and being in a smaller group with people who were not achieving and not doing very well. So, in the special needs class, and that went throughout my primary school. And it was a primary school where boys were sometimes hit with a ruler, but girls were told, you've got a pretty smile. So it's a very gendered kind of roles within school. And then at home, women were absolutely celebrated. Women were the crowning glory of the family. I come from a very matriarchal family, in that my mum is one of two girls, she - my aunt also had girls, I'm one of three girls. So, a very female-dominated family. But the role of the females was in the home. It was very much about being a housewife. And I remember my family saying to me, well, why don't you do a secretarial course, because then you'll meet a nice husband. So that was the thing. Or my grandmother would say, there's nothing more unattractive than an intelligent woman. So intellect and being bright was not celebrated. So it suited me to be in a class and not really think about - I didn't even consider myself to be academically able. And I didn't think of myself as - one of my mum's friend's daughter was in my class, and she did really well in her exams, really, really well. So I always saw this really high-achieving girl. And that wasn't me, and I didn't particularly want it to be me either. So when I came to the end of primary school and did the 11+ - everyone did the 11+ then - I didn't pass, but I did very well in it, because you were streamed according to your results when you went into secondary school. And I went from being in the special needs class in primary school to being in the top set in secondary school. So clearly I was academically able, I just didn't speak.

Brigitte: Based on the results from that exam?

Jane Padmore: Yes.

Brigitte: Is that right?

Jane Padmore: Yes. So, and my parents have never been one for getting extra tuition in or anything like that. We would be taken out of school occasionally to go on holiday and we'd have to fill in a scrapbook to say we were doing some work, but they were not particularly academically minded. They were very business-minded. So business was really important. My dad's an entrepreneur. That sort of way of being was more important, and being a female was more important to have your home and nurture at home.

Brigitte: And at what point did you notice that the perception, or what was expected of you, didn't quite fit, and you wanted to do something different than what the women in your family were doing and the blueprint that was being laid out for you?

Jane Padmore: I'm not sure it ever has happened, if I'm honest.

Brigitte: Oh, interesting. Tell us more.

Jane Padmore: So yeah, I tend to do things that are in front of me and want to influence, and then go to the next stage.

Brigitte: Yeah.

Jane Padmore: I've never thought, I want to be a chief nurse, I want to be a chief executive, I want to get a doctorate. You know, when I did my doctorate, I hadn't even ever thought about doing a doctorate, but a young person who was known to our service was murdered by two other boys in our service. And I went, as I do, to the literature, to see how do we work with these young people, because we are all white middle-class women working in South London with these boys who were on the periphery or in gangs. And the literature said nothing about it. And then somebody just said to me, well, why don't you do a doctorate then? So I did a doctorate. So I don't think it's ever - I know it's a very stereotypical thing to say about imposter syndrome, and I don't think it quite encapsulates it properly. I just don't think about it. It's just I've done the next thing in order to make a difference and improve people's lives, or improve quality of services, rather than it being a routine.

Brigitte: Yeah, yeah, makes total sense. And so, following your curiosity and then seeing what the next opportunity is to help you have more of an impact - I'm really curious about your transition from Chief Nursing Officer into Chief Exec, and what you were kind of like - it sounds like that drive to have more of an impact influenced that next decision. What was the reason for going for the Chief Exec role, and what type of impact are you hoping to have, or are you in the process of having?

Jane Padmore: I think I was in a clinical role. I was working in a national specialist forensic service for children, and I was doing research, and I was doing court reports and things like that. And I was spending a lot of my time - I wrote a book, writing academic papers, writing bids for grants, and then I'd have to hire people to do the work that I actually wanted to do. And I got a little bit frustrated with it. And I didn't sit naturally in the academic world because I just wanted to get on and make the change now. And there's this sense and reality that when the research happens, it takes 10 years to get to the bedside. And I wanted to get to the bedside now. And so I remember talking to a number of people who were in leadership about what to do. And actually, Paul Kalaminas, who was going to be the chief executive at SLAM, suggested I go on a CQC visit as a special advisor, to take a week out and think and just reflect on what I wanted to do. And so I went away and I met a chief medical officer from Avon and Wiltshire who said, you'd make a really good chief nurse. And my initial reaction was, over my dead body will I make a good chief nurse, and over my dead body do I want to be a chief nurse. I could think of nothing worse than that, to be quite frank, because I was more interested in getting things done rather than what I perceived as being a chief nurse, which was about governance. And I thought, oh, be open-minded, and I'll go and have a look and have a think. And I came away from a visit to a trust where they were recruiting a chief nurse, and I spent some time with them to see if it was what I'd be interested in. And I thought, well, I do want to do that, but I don't think I should do that yet, because I haven't been a matron, I haven't been a senior nurse, I've been through a very different clinical pathway rather than a nursing pathway. So I applied for a job as a deputy chief nurse and got it, and decided that I would like to be a chief nurse, but I would like to be a chief nurse in a different way. I want to be authentically me, and realising that that meant I needed to have people around me who could do the things that I didn't naturally do and didn't naturally want to do, so that I could thrive in my role and they could thrive in theirs, and appreciate the differences within the team. So that's how I got to chief nurse. I was chief nurse at Hertfordshire for, I think, four or five years, having been the deputy for two years. And I started to think, well, I should quite like to be a chief exec, because then I can really influence things and really move things.

Brigitte: Yeah.

Jane Padmore: Do I want to be a chief executive in an organisation that is already outstanding and doing really well, or do I want to be a chief executive where I can make a really significant difference and work in a way that attended to inequalities and all sorts of other things, at the same time as wanting to move to the South Coast, where a lot of my family are in the south of England, and my husband's family. And I was speaking to Sam Allen, who was the chief executive at Sussex Partnership, and she said, oh, I've got a chief nurse post coming up. So I applied for that and got it. And within about two or three weeks of me starting there, she resigned as chief exec. So August I became chief nurse, November deputy chief executive, January interim chief executive, and April chief executive. So it was quite a - I had thought I would be a chief executive in two or three years' time. It was a lot quicker than that. It's a steep learning curve as well, and a bit unorthodox.

Brigitte: Yeah, in that way. What was your thought process in that time? Was there ever a moment where you realised, okay, this is happening quicker than I expected? Talk us through where your mind went over that kind of six months.

Jane Padmore: I suppose if I look back over my career, it has been a little bit unusual. So I was a Band 7 nurse in West London, and I'd had my last child and he was in nursery, and I needed to work from 8:30 to 4:30 to get back to Brixton to pick him up from nursery. And every day I was late, and every day I was being fined. And they refused to let me change my hours from 9 to 5 to 8:30 to 4:30. So I left, and I went over to the Maudsley, where I became a Band 7 there. And I was asked if I would apply for an 8D post as a lead clinician, because they said basically, we've made a big fuss that it's never been open to nurses before. You're the only nurse that would be eligible because you've got a master's, and we don't want it to - so do you mind applying for it? And I got the job. A number of consultant psychiatrists and psychologists applied for it and I got the job, and I was a Band 7 nurse. So I went from a 7 to an 8D, which is quite daunting, because I actually hadn't got past my thinking of what do I do if I get the job. And then I remember Stuart Bell, who was the chief executive at the time, sent a message to me that said, well done, you're the most senior clinical nurse in the organisation - here's a 12-point improvement plan, because it was in significant difficulties as an organisation. And so my approach to when I became chief executive was, first of all, see if I get the job, and just focus on that. I think applying for a chief executive post is like a full-time job in itself. You have to go into it and you have to research it to make sure it's the right trust for you. It's no good being a chief executive everywhere. It has to resonate with you. The executive team, the chair, the board have to resonate with you, and it's as much about you knowing if it's the right place for you as it is that you're the right place for them. And I think it could be quite detrimental to your mental health if you're in the wrong place. So once I got the job, I had to pause and think, right, oh dear, now I've got the job, what do I do? And most of the executive team left. So apart from me, there's one person that's been on the executive team longer than I have, and for various reasons, some of them because they were retiring or moving on or whatever. So I had to build my executive team, but I also got an independent review of the organisation, because I thought I just need a proper independent review of the finances, operations, quality, governance, and everything. So I've got almost like a state of the nation at the beginning, because that sets - so what is my one, two, three, four, five-year plan for this organisation, and what's the roadmap for it as I go forward. And it helps you stay grounded if you do that, I think, because you can get buffeted along the way.

Brigitte: Definitely. It's interesting trying to piece that together and have the forward view whilst also trying to build an executive team around you.

Jane Padmore: Yeah, established on mutual trust, because they will be interested in what your plan over one, two, three, four, five years looks like. But equally, you might not necessarily want to put that in place firmly until you have the right leadership team around you. So it's a bit of a catch-22, I suppose.

Brigitte: How did that -

Jane Padmore: I think it is both of those. So I think there's something about the words being used a bit too loosely in the NHS, but it is around getting the people with the right values into the trust and into the organisation. And there's the book Good to Great, and in it they talk about getting the right people on the bus, and then developing the roles - not developing the roles and then finding the people. So what was really important to me was getting the team of the right people, and I have a really diverse team - it is like herding cats sometimes, and they are all very vocal with very strong opinions. And when I say set the vision for the next five years, it's not me that's setting the vision. What I'm doing is I see my job as chief executive to cultivate fertile ground. So Colin Hicks, my chief of strategy and now my deputy, he led the development of the strategy. I didn't, he did, and that was very much his piece of work. But we engaged over three and a half thousand people in the consultation process, and we took 18 months to do it. And that was service users, patients, carers, partners, staff, everything. We had big events, small events, focus groups, surveys, and we really put a lot of effort into the development of the strategy so it was owned by the Sussex population, because that's who we serve. We're public servants, we're stewards of the organisation. It's not my organisation. I'm here for a period. It's going to be here long after I'm there. So I need to set it up for the future, both in terms of future leadership, vision, values, and that sort of thing. So I see my job as really about facilitating and bringing the right people together, encouraging them, putting in reasonable adjustments when people have challenges, or amplifying voices that aren't heard.

Brigitte: And how did you identify the team that you needed to bring in around you? You pulled on a thread you mentioned earlier about leading authentically. How do you identify both where your gaps are, where your strengths are, and the people that you need around you - and how do you enable them to be their authentic selves as well?

Jane Padmore: I think I've been very, very lucky in one sense with my executive team. I've got a great team. And I think partly, I met with all of them before they reached out to me before interview, which I think is really important. If anyone's ever going for an executive post, for goodness' sake, reach out and speak to people.

Brigitte: Great advice. It surprises me every time how many people don't do that basic homework.

Jane Padmore: I tend to say to them, I've got half an hour now, whatever it is, you can ask me anything you like. I will tell you if I don't feel comfortable, or if I don't answer. There's nothing off limits. And I am completely honest, warts and all, about the way I run.

Brigitte: It's important to be, though, right?

Jane Padmore: The challenges in the trust, the challenges within the executive team and the board - and so if they still want to do it after that, I also talk about the good things as well, don't get me wrong, because there are lots of positive things. But I think being absolutely honest and genuine and saying it how it is, because we're all here for the same purpose. It's like when CQC come in. Yes, it's hard work, and yes, it's frightening, and yes, it's anxiety-provoking, but ultimately, CQC are coming in to make sure services are good for the population. They're not coming in to trick us, they're not coming in to try and find fault, even though it can feel like that sometimes because we get defensive of our services. But the reality is we're all here for the same purpose, and if you start framing it like that, then it reframes how you receive things coming in. The other thing I did was I proactively advertised in places and asked the recruitment consultants to look for people who were not your stereotypical executive directors - not that I would necessarily appoint them above everyone else, but I wanted a pool of people that maybe weren't your usual candidates.

Brigitte: And with so much change within the NHS, both centrally and locally, it sounds like making sure everybody's aligned on purpose and value is a real grounding factor. But what else do you think has been really helpful to allow you to lead through the various change that comes at you as a chief executive and a wider team?

Jane Padmore: So I know I use this phrase a lot, but it's about authenticity. So if I'm having a crap day, I'm having a crap day, and I'm not afraid to say it. Or I might go into a meeting, an exec meeting, like I did last week, and say, I'm feeling really irritable today, just warning you, I'm feeling irritable - so, Colin or whoever, can you just sense-check me a bit, just be aware this is how I'm feeling. So there's something about being honest about where you're at, but there's also something about taking time to reflect. And I think as chief executives, we very much are in the moment, and you get buffeted by things along the way. And actually, you've got to stay the course, and taking time to reflect and think is as important as doing your emails and reading reports and things like that, and being able to protect that time. But for me, the most important thing - there's people who often say, I've got an open door, and I'm not sure they fully mean it. You can have a physically open door, but it's not open to everybody. So I remember when we moved into our current office, they wanted to put me - so you'd have to go through the open-plan meeting room, through the executive team room, to my office at the back. And I said, absolutely no way am I sitting there. So I planted myself outside, on the corridor, and my office is open and people do pop in.

Brigitte: Yeah, yeah.

Jane Padmore: They know if the door shuts, that means I'm busy and can't be disturbed. If the door's open, anyone can come in. And that means coming in to tell me their children have passed their GCSEs. It could mean they come in to tell me - I had one person come in to tell me they'd made a mistake the other day and to apologise to me for making a mistake and embarrassing the organisation. It was human error, it could have happened to any of us. But having that open door, where people feel safe enough to come and tell you the good things and the bad things, and creating that environment where people are able to test and talk things out - and I can't remember the question you asked, I've gone right off on a tangent.

Brigitte: You answered it beautifully. One thing that's really clear though is that to have the open physical or metaphorical door, and to have people come and speak to you like that, you have to show vulnerability and you have to be authentic, right? You've talked about just being really true to where you're at, and going into the chief exec meeting and saying, do you know what, I'm not firing on all cylinders today. But have you always had that confidence and that ability to be that open with your feelings? Have you ever felt any kind of pressure to hide that, to conceal it?

Lauren: I guess, speaking from experience, when I first went into a lot of the leadership rooms that I was in, I was the only woman in the room. I was hyper-aware of being perceived as being overly emotional. And then I realised, actually, this is why my team trust me and share their emotions with me. And I wondered what your experience was of that.

Jane Padmore: I suppose my experience is I can't hide my feelings. I have an absolute inability to. My lecturers used to say they could tell if it was a rubbish lecture by my face. So I just have this inability, and I cry at the drop of a hat. If I get angry, I cry. If I'm feeling compassion, I cry. If I hear some good news, I cry. I'm a crier, you know what I mean - I have tissues in my office. I'm a crier. So I have an inability to hide my feelings. What I do find I do is I withdraw. So I was in a meeting once, quite recently, where a senior executive of a digital company came to talk to us. And I was in the flow of conversation, and my chief finance officer came in, and then suddenly all of the conversation was directed to him. And Usman is a fantastic ally actually, because he spent a lot of time going, maybe we should ask the boss, maybe we should also - and he was subtly redirecting to me in a way that wasn't overt and wasn't in your face, but was very much, and she's the boss, kind of thing. Whereas I could feel myself physically withdrawing and metaphorically sticking two fingers up. I can't be asked - you have to mean that, because I think you're being disrespectful. So I have to be mindful of withdrawing more than anything else if I'm feeling that my sense of justice is being attacked in some way, or is being challenged in some way. But I just can't not be me. I've tried, and it just comes, I lose it quite quickly. But that allows other people to be themselves as well. I think I've found in my career, the more authentically I show up as myself, the more that everybody around me does, particularly when you're in a leadership role.

Lauren: Yes, I think so. It's wonderfully refreshing though, and I think especially from a woman in leadership, because as you mentioned, sometimes it feels harder to be vulnerable, especially in rooms where there are few women.

Jane Padmore: Yeah.

Lauren: Do you find that - because obviously now you're chief exec of like a over a half million pound NHS trust - um, half a billion. Half a billion. That's a typo on my part.

Jane Padmore: That's all right. Half a billion. And you really wouldn't pay the staff if it was half a million - we'd all be in trouble.

Lauren: And you obviously champion being yourself, champion neurodiversity. Do you feel like - linking back a little to your childhood as well, and how maybe your potential wasn't noticed super early on - do you feel that you notice the potential in others where maybe those around you don't, or slightly earlier than those around you do?

Jane Padmore: I think probably, and it's a double-edged sword sometimes - I'm probably a little bit more accepting of difference and accommodating. And I go to quite far extremes in reasonable adjustments and making sure that people feel supported in their role. So I think I probably do that more. And that comes with some challenges as well, because sometimes you have to balance that with performance, and people have to perform. So it's a really difficult thing to manage. But I think if you see someone and they've got potential, it's important you put the scaffolding around them in order for them to thrive. I would say that the education system when I was at school didn't have that scaffolding, not because anyone was unkind or doing it maliciously - they did it because they didn't understand and they didn't know. Whereas now I feel I know about neurodiversity, for instance, therefore I should accommodate it, and I should make work as acceptable, and as a place where people thrive, because I want people to thrive at work. And I want them to feel like they belong at work. And there's nothing worse than feeling like you don't fit in.

Lauren: Yeah.

Jane Padmore: Or that you're an inconvenience. Because I feel it's - so if I - you can tell me virtually anything has happened that is really awful, and I manage it and I'm fine. But if I don't know where to park, or I don't know how to get somewhere, I go into a complete meltdown. So I know my support, my business administration support team, they go onto Google and they take a picture of the car park entrance for me, so that I don't have to think about that, so I can focus on what I need to focus on. And that's just a reasonable adjustment for me, to help me focus on what I need to focus on, rather than thinking the whole way to where I'm going to a meeting, where am I going to park, do I know where I'm going to park, what would it look like, and becoming completely preoccupied with that. So if I do that for other people as well, I'll get the best out of them.

Lauren: And do you think that your reflective practice - you talked about the importance of creating that space to think, to reflect - do you think that's also helped you work out what you need to be successful as well? Or is this just stuff you've figured out by trial and error over the years?

Jane Padmore: Well, it's really interesting, because when I had a new chair, Sean Duggan, I was talking to him and said, I am autistic, just so that you're aware - I can be a bit blunt sometimes and take things literally. So if you speak to me and you say something literal, I will go away and do it, because I think you mean it literally. And he said, well, what reasonable adjustments do you need? And I thought, that's really interesting, because I think about it for other people all the time, and I hadn't thought about it for myself. And then I was going away the next day to an event, and one of the questions they asked - because there was an award ceremony in the evening - do you have any dietary requirements or any reasonable adjustments? And for the first time I put a reasonable adjustment down. I said, please can I not sit near a loudspeaker, because I can't hear properly and I find the noise unbearable. I thought, gosh, that's the first time - I'm 56, that's the first time I've actually explicitly asked for a reasonable adjustment. And I felt quite sad in a way, because it's almost like you don't think you deserve it for yourself. Whereas I'm very, very happy doing it for other people. But if you think about doing it for myself, it feels very different, and it feels like I'm taking the mickey a bit, and asking too much.

Lauren: Yes. Yeah, I can understand that. It's interesting, though, because there's a theme throughout the way that you talk about your leadership, in terms of doing for others what - or creating an environment for others that you would want for yourself, or for anyone.

Jane Padmore: Yeah.

Lauren: So it's an interesting theme, that you create this space where everyone feels comfortable to ask, and you don't necessarily feel comfortable to ask yourself. And it's nothing to do with who you're asking.

Jane Padmore: Yeah, it's more of a - but I think the flip side to that is I know that I am refreshed and I am restored by being at home, being a mum and a wife, and giving in that way. So I think naturally my sort of giving and nurturing is the way that I restore as well. So it's an interesting kind of thing to live with, because it's exhausting, but it's also the thing that gives me energy and gives me purpose.

Lauren: Yeah. Yeah. How do you manage that balance? You've spoken before about home life and family being so important to you. A chief exec role is not a small job. What does that balance look like for you? And has that been something that's evolved over time, and you've had to figure out what that balance looks like?

Jane Padmore: So I do think this is one of the benefits of being autistic. I do not have a huge social life - I'm pretty antisocial. No, not antisocial, unsocial. My family are my world. So I have work and I have my family, and my family are my social life. I'm not craving to go and get my hair done or my nails done, or go out drinking, or go to the pub, things like that. I'm very happy being at home. I'm very happy cooking and painting and being with my grandchildren and being with my children, and just spending time with them. So to me, it's not a loss. But one of the things - somebody asked me that, probably about - my daughter's 22, so about 15 or 17 years ago - was asking me the same question, because I was doing my doctorate and I had two - the two youngest children were still in primary school. So I started my doctorate when my youngest was born, and finished when he was six. So I had young children when I did my doctorate. And I remember going upstairs into my daughter's bedroom, and she had papers everywhere and pens everywhere, and she was with her friend. And I said, what on earth are you doing? She said, I'm playing at writing essays, because that's what she'd seen me doing.

Lauren: Oh, I see.

Jane Padmore: And I thought, so she's doing her own doctorate. And then she reminded me of it the other day, because this week she found out she passed her law degree at Liverpool.

Lauren: Oh, congratulations.

Jane Padmore: I'm very, very proud of her. Because in her first year, she unexpectedly got pregnant. And I remember she met me at Victoria Station and burst into tears and told me she was pregnant. And I said, it's all right, it's all right - do you want to keep the baby? She said yes. And I said, well, we'll make it work then - do you want to continue with your law degree? And I remember it so clearly, she said, you did your doctorate with young children, so why can't I? So for me, it's possible. That's right. And she's done it, and I'm so, so proud of her. She's done amazing things. Oh, my grandson was two yesterday, so -

Lauren: Oh yeah, what a pair of milestones. Yeah, celebrations all round.

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