University Hospitals Birmingham NHS Foundation Trust

Tom Stephens

Tom Stephens is an accomplished healthcare leader with a strong clinical background. He specialises in developing strategies and leading teams to achieve sustained P&L success and organisational and industry innovation. He currently serves as General Manager for University Hospitals Birmingham, striving hard for advancement in clinical practices.

In an interview with Life Sciences Review Europe magazine, Stephens shares his insights on the challenges faced by the healthcare sector and its functionalities.

Please give a brief overview of your professional background, roles and responsibilities that you have held before that led you up to your current role.

After a degree in Biomedical Science in 2010, I began my career by participating in an NHS-led program focused on clinical technology within the field of nuclear medicine. I assumed the role of Clinical Technologist and served in this capacity for two years. Then, I joined the Wolverhampton Hospital Trust as Deputy Chief Technologist.

My career trajectory led me to manage the Nuclear Medicine Department at Birmingham Children’s Hospital. During that tenure, a significant organisational merger took place, uniting four separate hospital trusts into what is now known as University Hospital Birmingham. I spearheaded the alignment process for the nuclear medicine departments, particularly emphasising the integration of Heartland and Good Hope.

Later, I was promoted to the position of Operations Manager and eventually ascended to the role of General Manager. Throughout these managerial capacities, I assumed leadership responsibilities for a team of 180 professionals, spread across four different locations. An additional aspect of my role includes overseeing the Major Medical Capital Replacement Program. I am responsible for budget management and project coordination within this initiative.

Could you elaborate on the challenges of overseeing the Major Medical Capital Replacement Program, mainly regarding financial constraints and regulatory guidelines? 

I have encountered multiple challenges during my three-year tenure overseeing the Major Medical Capital Replacement Program. The first significant hurdle is financial. Budgetary allocations have been substantially reduced, putting strain on essential medical equipment replacements such as CT and MRI scanners. While these machines typically have a lifecycle of eight to ten years, according to guidelines, well-maintained equipment can last up to 12 years. When equipment approaches obsolescence, support from the manufacturer often ceases, necessitating the introduction of upgraded alternatives. This becomes increasingly pressing as third-party technologies like AI integrate into the system, rendering older diagnostic images less optimal.

“The societal acceptance of AI is increasing, and it's likely to play a significant role in healthcare delivery in the next 5 to 10 years.”

Another formidable challenge is related to air-handling units, which have gained prominence due to the COVID-19 pandemic. Regulatory updates mandate fresh air intake, requiring the installation of new, three-ton air-handling units on building roofs. However, these roofs were not engineered to support such weight, creating structural challenges.

Moreover, the government has mandated NHS England to eliminate all backlogs by the end of March 2024. This places us under tight timelines, compelling us to outsource work to the private sector to augment our resources. The equipment list on the major medical register has expanded to over 200 items, exacerbating budgetary constraints. To mitigate this, we have considered implementing managed service contracts, wherein we would sell our existing equipment to a third-party company. This company would, in turn, lease the equipment back to us and assume responsibility for timely replacements.

How do you anticipate that the potential privatisation of the NHS might impact the healthcare system in the UK, especially in the domains of accessibility, affordability, and quality of care?

When it comes to the potential privatisation of the NHS, I don’t foresee a shift towards a model where services would require payment at the point of access. Instead, I anticipate the NHS will remain free at the point of contact. The significant change is likely to be in the financial structuring. Currently, the NHS receives tariff recharges from the government for each scan, which facilitates further developments. Under privatisation, these funds would instead go to private providers who may distribute profits to shareholders. Consequently, any funds allocated for diagnostics would be directed towards private-sector investments rather than recycling within the public healthcare system.

An equally important point is the government's introduction of the Capital Departmental Expenditure Limit (CDEL), effectively capping the amount that individual trusts can spend. This mechanism ensures a level playing field, averting the risk of larger trusts gaining an unfair financial advantage. The privatisation efforts would primarily focus on the ownership of medical equipment and the efficiency of patient scheduling.

The age of connectivity also offers promising prospects for streamlining operations. Privatisation could pave the way for a unified IT system across hospitals, minimising time delays and facilitating quicker resolutions to technical issues.

Looking ahead, could you offer insights into prospective legislative changes that you anticipate will significantly affect clinical practices in the near future? How might these legislative shifts alter the landscape of healthcare delivery?

Legislative changes are relatively frequent, and their implications are multifaceted. From an imaging diagnostics standpoint, building regulations have undergone revisions and are now centrally controlled by the government. Additionally, ionising radiation regulations are monitored by the Care Quality Commission (CQC), the governing body that oversees healthcare quality standards.

The COVID-19 pandemic has also catalysed alterations in rules and regulations, most notably in infection control measures. Moreover, post-Brexit dynamics have contributed to increased medical and non-medical equipment costs due to border control changes.

We have also had to navigate industrial action, including strikes among junior doctors over the past six months. Such disruptions necessitate temporary reassigning of roles within the healthcare system to ensure continued functionality.

There’s no doubt we are in a transitionary period. Changing building and radiation regulations, infectious disease protocols, Brexit-related costs, and labour disputes have created a complex legislative landscape. The next few years, however, promise to be instrumental in shaping the operational and financial structure of the NHS and, by extension, the broader healthcare delivery system in the UK.

What advice would you offer to fellow healthcare leaders for navigating the ever-changing healthcare regulations and legislation landscape while ensuring that these changes effectively contribute to enhanced patient care?

Navigating the fluctuating terrain of healthcare regulations and legislation calls for a multi-pronged approach. First and foremost, the well-being of your staff should be a priority. Individual employees should be valued and appreciated, not merely seen as specialised units tasked with delivering results.

In addition, it’s crucial to maintain integrity when setting performance trajectories, particularly in environments where the expectations may border on the untenable, such as demand and response in XML or MUMPS (Massachusetts General Hospital Utility Multi-Programming System). Setting unrealistic goals only sets the stage for future setbacks; it is better to be forthright about what can realistically be achieved.

Another pivotal area for consideration is incorporating Artificial Intelligence (AI) into healthcare. AI holds tremendous potential for augmenting diagnostic procedures. For example, in the realm of CT scans, AI can currently categorise regular scans, allowing radiologists to concentrate on potential anomalies. The societal acceptance of AI is increasing, and it's likely to play a significant role in healthcare delivery in the next 5 to 10 years.