The physiotherapist and deputy chief executive talks to Mark Gould about the crucial contribution physios can make to leadership teams
Shane DeGaris is a member of what must be one of the smallest and most elite clubs in physiotherapy. He is deputy chief executive of Barts Health – among the biggest trusts in the NHS which runs St Bartholomew’s Hospital – one of the oldest and arguably most famous hospitals in the world. When asked how many physios there are in similar positions he blows out his cheeks to think.
‘Phew that’s a small club. It’s not a large number. There are not many in acute trusts, some more in community and mental health trusts, and if you take all AHPs [allied health professions] that widens it out a bit more. But it’s a joke compared to nurse or doctors and that is one of my biggest bugbears.’
He came to Barts Health in the summer of last year after six years as chief executive of Hillingdon Hospitals NHS Trust, also in London. He is passionate about getting more physiotherapists into leadership roles but the bugbear is, he explains, that there is only one route to the top unlike for doctors and nurses.
‘For a physio or other AHP there is no easy route to the board. If you are a doctor or nurse you can still do your clinical work and work your way up because there are prescribed positions on boards for doctors and nurses but you don’t have to have a therapist on the board. There is only one route for a therapist and that’s through the managerial route – director of operations, chief operating officer, to the board.’
DeGaris was born in Adelaide on the south coast of Australia where he qualified as a physiotherapist specialising in musculoskeletal injury.
‘I was interested in sports and MSK and I played a lot of basketball and as a result of multiple injuries that’s how I got interested in physio. I thought these guys know what they are doing getting people back into action very quickly, they seemed very dynamic. My dad wanted me to do a law degree – it sounded very boring.’
Creating leadership opportunities
He came to the UK in 1996 and quickly found himself in management at the North Middlesex Hospital. ‘I carried out a lot of management roles there. It was a good employer, the superintendent really encouraged people to get into leadership positions. We were helped with management qualifications and there was support for personal development – managerial as well as clinical.’
DeGaris says Barts Health is playing its part in promoting new leaders.
‘I am keen to create a new senior role of director of AHPs to help us set the strategy for AHPs and help unleash the power we have in these professions to help the NHS England Long Term Plan’s emphasis on prevention. Physios have a different sort of background in clinical reasoning that is quite complementary to doctors and nurses so we have a lot to offer in leadership terms. All the resilience you learn as a physio helps in leadership.’
But do physiotherapists want to go into management or do they just want to treat patients? ‘Despair is too strong a word but I do worry that there are not more people willing to put themselves forward for leaders’ roles. Are there more physios wanting to step up than I saw 20 years ago? I’d like to think so. There are certainly more physios in director or executive director roles than when I started.’
He says that AHPs need to get the sort of help offered to doctors who are paid for a certain number of programmed activities in their job plan, which protects clinical time. ‘For a therapist or nurse it doesn’t work like that. Based on my own experience I want to offer more secondments, more opportunities that protect people’s pathways. There are lots of roles in trusts like Barts where people can cut their teeth, find out if it’s for them, and understand how we manage the flow of patients at a bigger scale.’
He says the long term plan presents massive opportunities: ‘The plan is basically about prevention and how we get people looking after themselves better. If you look at the top 10 per cent of patients in general practice that turn up to A&E most frequently it’s those with multiple co-morbidities and long term conditions. Physios have a huge role to play in keeping them as well as they can out of hospital.
Prominent role for physios
‘At the other end – in hospital – they have a huge role in getting people up and as well as they can and out of hospital as soon as possible. Particular pathways include trauma, stroke and elective care where physios can help people get well and out as fast as possible. The plan plays to the strengths of physio – Karen Middleton [CSP chief executive] is quite rightly pushing this hard – you will see a much more prominent role for physios in supporting the wider agenda.’
He envisages that in 10 years the NHS will provide more integrated care with the patient at the centre. This will mean acute staff, including physios, working in the community and doing different work as part of multidisciplinary teams (MDTs).
The top 10% of patients that turn up in A&E most frequently are those with co-morbidities and LTD's
‘Here we come to the dread discussion around more generic skills and therapies. Individual professions absolutely should continue to have their own expertise and skill sets. As long as they are working in an MDT we get the benefits from the sum of the parts rather than trying to dumb everything down to a unified level which doesn’t make sense.’
He feels physiotherapy is a profession that is keen to embrace change. ‘Physio is not one of those professions that is self-centred. It looks to what is the right thing to do where some professions might be less flexible. At Barts we are selling the tale of the plan and it always comes back to the patients’ stories – everyone has an experience like that – we engage staff around the fact that it’s about the patient and, what did [NHS England chief executive] Simon Stevens say? “Think like a patient, act like a taxpayer”, which makes sense.’
Doing the right thing
Last year NHS Improvement published Leadership of allied health professions in trusts: what exists and what matters an evaluation report that contains advice for helping the NHS develop new leaders. DeGaris says the report contains useful tips for anyone thinking about management.
And he says there is a ready market. ‘Hospitals are crying out for good people with clinical backgrounds to go into management. Ask for support and opportunities and you will get them. You have to be prepared to move laterally and be prepared to experience more general management if you have ambitions to become a chief executive or an executive director. I would thoroughly recommend it.
‘It’s a really worthwhile way to still realise your ambitions around doing the right thing for patients but doing it on a much bigger scale and that is as rewarding as treating the back pain I saw in clinic.’
Interested in influencing leadership opportunities?
The Health and Social Care (Community Health and Standards) Act 2003 specifies that medical and nursing board directors must have medical or nursing qualifications. In Feburary, a cross-party group of MPs tabled a motion in Parliament, calling on the government to amend the act and remove this legal restriction, thereby giving AHPs the same access to senior roles.
The CSP supports this view and encourages members to ask their MPs to sign the motion.
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