Meeting Mr Wright: NHS Scotland’s new boss on a lifetime in the health service
He could be called NHS Scotland’s ‘fixer’.
During times of crisis, Scottish health boards turn to Malcolm Wright, who began working for the NHS before he could legally vote or drink.
Wright has been chief executive of six Scottish NHS bodies since the mid-1990s.
But, after more than 40 years of experience across Scotland’s NHS, his latest position may be the biggest mountain he has had to climb.
Wright’s first challenge was handed to him in England. After moving through the ranks at NHS Lothian, in 1989 he became hospital manager at Great Ormond Street Hospital for Children.
The hospital was dealing with “a huge number of highly complex cases” at the time.
“It was a kind of hospital of last resort within the NHS in England,” Wright tells Holyrood.
“So, we saw hugely complex cases coming through, and really learnt about different clinical disciplines having to come together, to work together – working with a family, working with children, to plan that child’s care.
“And seeing children who are hugely vulnerable, getting lifesaving treatment, that really gave me a sense about how multi-professional working could really work to really care for people.”
He took this experience and returned to Edinburgh, where he became general manager of the Royal Hospital for Sick Children in 1992.
“I saw an opportunity to come back and work with clinicians in Edinburgh who I might have worked with before, to really build the sick children’s services in Edinburgh up and the community child health services up, into an integrated children’s model within Lothian,” he says. “And I think we did some wonderful things for children and families in Edinburgh. I learnt a huge amount of my career from that time.”
In 2006, while working as NHS Education Scotland chief executive, Wright was asked to take on the job of interim chief executive at NHS Western Isles.
At that time, Western Isles was one of the poorest performing boards in Scotland, missing financial targets and struggling with leadership issues.
“The health board was having some particular challenges there. I really worked with colleagues just to help that health board move forward,” Wright explains.
“And I’m very pleased to say that they’ve made a lot of progress, since those very challenging days.”
In 2014, it was NHS Grampian’s turn. Grampian had been placed under review, after concerns about patient care and several high-profile departures among its leadership.
Grampian’s medical director and chair both resigned within weeks of each other. Outgoing chair Bill Howatson said the health board faced “significant challenges”.
Wright joined NHS Grampian as interim chief executive in the same month that Howatson stepped down. He ended up being made permanent chief executive and spending five years there.
Speaking about addressing the issues at Grampian, he says: “I suppose I go into these situations with a profound sense of, we’ve got really good staff who want to do really good things and in some cases there are particular issues or problems that we just get a bit stuck by.
“Actually, through good management and good leadership and bringing people together, we can move through those challenges.”
Now, he says Grampian has “some of the best performing integration authorities in the whole of Scotland”, with programmes like ‘virtual community ward’ putting it at the forefront of change.
“If you look at Aberdeen Royal Infirmary, we’ve seen significant capital investment there. The development of a very modern cutting-edge tertiary teaching hospital in Aberdeen, and of course, it was the first major trauma centre to be set up in Scotland, which I was hugely proud of.
“It was a time I look back on with great fondness,” Wright says, smiling.
And then, mid-last year, he was parachuted into NHS Tayside to steady the ship.
Tayside patients were facing long waits for treatment and Scotland’s Auditor General said the board’s finances were in “the most challenging position” she had seen.
The health board’s management team was replaced in April 2018, after it emerged cash from a charity endowment fund had been used to pay for projects including a new IT system.
As Wright saw it: “Tayside had, and still has, a range of challenges.
“But actually, in every situation I’ve been in, the question is: are there talented, professional people who can work together to make things better?
“The answer at Tayside is, absolutely yes. And I was very encouraged by how the clinical community really decided to step up and take clinical leadership forward in Tayside.”
Wright worked with Tayside’s interim chair John Brown, chair of NHS Greater Glasgow and Clyde, to turn around the health board.
“John brought a huge weight of experience around governance, getting the board working well and getting the systems of governance working well,” Wright explains. “John and I worked really closely together, he very much focused on governance, I very much focused on let’s get this organisation really working well.”
He says the board reached out to local authorities to build new relationships, and “there was a huge welcome to that approach within Dundee”.
“There were lots of partners really willing the board to improve and do better. There were a lot of allies in all of that. So, are the issues in Tayside fully resolved? Of course not. But is the board in a better place? Yes, it is. Do we have a really good chief executive appointed? Yes, we do. And are they on a trajectory of improvement? Yes, they are.”
So, where did Wright’s knack for leadership begin?
Born in Blyth, Northumberland, where he lived until the age of 14, Wright’s father worked in the NHS and encouraged his son to pursue a career in the health service.
“I just remember being at school and being very unsure what to do and having a choice of, do you go to university, which was less common in those days, or do you go straight into a job?
“My father talked to me about the National Health Service and how much he enjoyed working in it.”
Wright applied for an administrative leadership trainee position at NHS Lothian and “just before my 18th birthday, I had started my career in the National Health Service”.
He says he did not have “much of an idea of where it would go, but a sense of, this is something big, it’s something important”.
“My first ever experiences were at the old Edinburgh Royal Infirmary,” he recalls.
From there, Wright worked at several NHS Lothian hospitals, including Astley Ainslie Hospital, Deaconess Hospital, Bruntsfield Hospital and City Hospital.
“My first proper management role was at Sighthill Health Centre in Edinburgh, and I look back on that with great fondness, because it involved working with GPs, in some very challenging community settings,” he says. “And just seeing what care is really like on the front line.”
Holyrood meets Wright inside his office at St Andrew’s House.
Three months ago, he was officially announced as NHS Scotland’s chief executive and director general of health and social care, replacing predecessor Paul Gray.
While he brings with him an impressive résumé, this may be his biggest challenge yet.
Over the past 12 months, Scottish health secretary Jeane Freeman has battled issue after issue in the health service. From Queen Elizabeth University Hospital patients dying after contracting infections from pigeon droppings, to a ‘waste scandal’ with body parts stacked up outside Scottish hospitals, drug deaths in Scotland reaching the highest ever level and bullying within the NHS.
On bullying, Wright brings a particular specialty to tackling the problem.
Last year he was awarded a Winston Churchill Memorial Trust fellowship for his work researching effective strategies to manage bullying in the healthcare workforce.
As part of this research, in 2017 he travelled to Australia and New Zealand to examine how other countries are tackling bullying and harassment, in what he says is “an internationally recognised challenge” for all healthcare systems.
What did he learn from that experience? “That we need to work together to create that culture in which people feel psychologically safe,” Wright says.
“And that we not only positively promote that, but we are prepared to intervene when behaviours don’t meet the standards that we’ve set, to be able to have conversations directly and address things at a very early stage before they get into formal processes.
“That’s why I’m really keen to support the cabinet secretary after the Sturrock review that took place in Highland. And I’m really keen that we learn those lessons, and we create the culture and environment in which our staff can really prosper and thrive.”
He says his plans in the top health job involve “a very ambitious programme of reform”.
“I’m hugely confident in the quality of the team of people that we’ve got in here and working with other director generals across government and very much engaging with the [health] service about how can we work with you, how can we support you, to get the outcomes that the cabinet secretary is looking for,” he explains.
“So, access mental health integration, the social care reforms that have been announced, really reinforcing the primary care reforms, the workforce reforms we’ve got, digital reforms.”
Looking ahead at the other challenges facing the NHS, Wright says his role will be to “support the cabinet secretary, reinforce the direction and help to make the system work so we can get better outcomes”.
“I think I have a bit of an understanding about how the thing works,” he says.
“Of course, there are challenges, financial challenges, demographic challenges. And there’s lots of data around that. I guess I’m focused on, OK, what can we do about this together? And how can we bring these things together to get real improvements in service in the communities that we serve?”
Unsurprisingly, Wright says his career of more than 40 years in the NHS has prepared him well for his current post.
He believes he’s learnt the importance of approaching the job “with a degree of humility”.
“I’m somebody who came into the health service straight from school,” he says.
“From a very early age, I’ve learnt about how health services can work, how they can serve vulnerable people, and how, by working together, we can make things better for individuals and families in a range of communities.”
Part of this learning has involved literally getting his gloves on.
“One of the things I really enjoyed doing when I was in Aberdeen, and I’ve enjoyed doing in other places, is actually just getting gowned up and going into an operating theatre,” Wright explains.
“And seeing how teams of people work together with the most vulnerable individuals, you just see the professionalism, you see the training, you see the roles, you see the communication, you get a sense of the atmosphere in an operating theatre.
“You can’t walk away from that without a profound sense of, we’ve got some really good, talented professional people and my job is to support them to do the job that they want to do.”
He continues: “So I don’t come into the job with a sense of this is what I want to happen, I come into the job with a sense of, I can see the possibilities.
“In all of the jobs I’ve done in the NHS in Scotland, what really drives me is the notion that if we work together, we can make huge improvements in the lives of the people of Scotland.”