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Deputy editor Angela Sharda talks to Layla McCay, director of international relations at the NHS Confederation, about her take on leadership, mentoring and the importance of looking at other health systems for inspiration.
Layla McCay started her career in the NHS as a temp medical secretary, typing applications, letters and answering queries when she was a medical student. Today she is director of international relations at the NHS Confederation with a remit to ensure the NHS is able to learn and share international knowledge and experience.
She also leads the NHS European office in Brussels, which is part of the NHS Confederation. The main role is to track, analyse and influence EU policies and legislations that will affect the NHS.
‘At any one time, we might be working on 10 or 12 policies and legislations,’ she says.
Her journey in medicine began in Glasgow. She graduated as a doctor and worked for a few years in the city.
‘I started out by training to be a pathologist but I felt I wasn’t well-suited to it, so I left Scotland and went to South London and Maudsley NHS Foundation Trust where I trained as a psychiatrist,’ she says.
Ms McCay left the NHS for 10 years to pursue other career opportunities. One of her roles was at the Department of Health as clinical adviser to Sir Bruce Keogh, who was the NHS medical director at the time. Then she was head-hunted as deputy medical director for Bupa.
However, her career took an international turn. She moved to Washington DC as policy director at the Global Alliance for Improved Nutrition.
She then went on to provide international health system analysis as part of the Health Financing team at he World Bank, and to teach Global Mental Health at Georgetown University.
After she left Washington she moved to Tokyo and set up a think-tank called Health Centre for Urban Design and Mental Health which she still runs in her spare time.
‘Then I came back to the UK and was keen to get back into the NHS. But given my international experience, I wasn’t sure what role that would be. Then this director of international relations role came up and it was perfect,’ she says.
‘Leadership is everyone being sold on a vision’
Leadership means different things to different people. Ms McCay says that for her it means achieving great things and bringing everyone with you.
‘It’s everyone being sold on a vision, knowing how they can contribute to delivering that vision and feeling like they’re working together to create something great.’
She says that during her career she has been blessed with inspirational leaders. One of the greatest examples she personally witnessed, she said, was when she became a junior doctor.
‘Like many medical students, initially I had no idea of what I was doing and one day the nurse said: “you need to write up that dose for paracetamol”. I couldn’t remember the dose. I was frozen with horror and humiliated,’ she says.
‘So the nurse sat me down and talked through the main drugs that were prescribed on that ward, and some guidelines and treated me like I was a valuable part of that team.’ Ms McCay says that kind of leadership, ‘cool learning’ rather than dictating, helped to empower her as a doctor so she could go forward in her career.
On a personal level, Ms McCay says she does a lot of mentoring. She says her main approach is to tell people to think about where they see themselves in five years’ time and then look for job adverts and see if they meet the requirements for that role.
‘And if you meet the requirements already, what’s stopping you from applying right now? If not, find mentors that can help you, apply for opportunities that will bring you the experience to do that job in five years’ time,’ she says.
Ms McCay says this approach has served her well. For instance, she did not have experience in financial management so she joined a board. She had no management experience so she took a job that involved managing a large number of people.
One job she ultimately wanted required a postgraduate qualification so she took a master’s degree while working. ‘It was a matter of thinking how can I make myself an appropriate candidate?’ she says.
Recently, the Health and Care Women Leaders Network has published a report, Men as Allies.
She says Men as Allies puts the focus on who can help you, not just what you can do.
‘Finding good people who can support you along the way is key. I had many inspirational mentors. Every time I thought I was punching above my weight they would tell me to “keep going” and this has given me some of the most interesting opportunities in my life,’ she says.
‘Awareness is not the same as actions’
Ms McCay says Men as Allies introduces the idea that it is ‘entirely feasible’ that men will be able to support women to achieve more equality in leadership.
‘Awareness is not the same as actions and while there’s quite a lot of will to act, it’s difficult for men to know how,’ she says.
And she acknowledges that men who are leaders in healthcare recognise that there has been system bias over the years so that women are less likely to be in leadership positions.
‘We know that a more diverse leadership team leads to better outcomes. The question is: “are men ready to act?’ It’s my hope and belief that they are.’
There has been much talk recently about the gender pay gap – an area in which the NHS is guilty. A report released by NHS Digital last year showed that women in the NHS are paid on average 23% less than men. For doctors, the difference was 15%, with men receiving £67,788 in basic pay, while female doctors receive £57,569.
She says her advice to women who feel that they are suffering the ‘motherhood penalty’ is to seek opportunities for mentorships and join networks such as the Health and Care Women’s Leaders Network.
‘Find ways of seeking the support. Work together to make sure you’re aware of the opportunities and that you feel empowered and able to grasp them.
‘When hiring, it’s not just about choosing the person that feels right on that day – the one that ticks boxes in the interview. It’s about the pipeline – getting the right people to that interview in the first place,’ she says.
Ms McCay says that in order to do this you need to nurture staff from the earliest stages – ‘developing people and making sure staff get equal opportunities, whether men or women. I would like to see investment in people,’ she says.
‘It’s all about sharing and learning’
With her international experience, is there such a thing as a ‘dream health system’? Ms McCay says she can’t pin one down. Different health systems have different strengths.
She says she regards the NHS as a ‘really-high performing system’, particularly in the context of universal health coverage.
However, she says there is always room for improvement and we can look to other nations to see how they achieved successful integration.
‘It’s a matter of tracking down the real success stories and seeing what we can learn. Somewhere in the world, perhaps somebody is doing something better. We should become familiar with what others are doing and how we can learn,’ she says.
‘The NHS can learn things from other health systems but also teach. This is not about one country telling another how to do things. It’s about sharing and learning together,’ she says.
As international director, Ms McCay is on a mission to track down the most relevant, interesting and successful examples of excellent healthcare in the world to help improve the NHS.