Prem Singh – reflections from a career in public service
At the end of 2022 we said goodbye to Prem Singh, our chairman of the past nine years. But before we let him go, we put him in the hot seat one last time to reflect on his 47 years’ public service.
Prem began his career in 1975 when he arrived from Malaysia to begin his student nurse training in Chesterfield. He has made his home in Derbyshire ever since.
By 1982, as an experienced nurse, his abilities for leadership and management saw him take up a series of increasingly senior appointments in social care and healthcare.
In 2001 he took on his first substantive chief executive post, for Chesterfield Primary Care Trust, and became a member of the “1% club” - a phrase coined by The Guardian to describe the-then handful of NHS chief executives from black, Asian and ethnic minority backgrounds, including Prem.
He has been a champion of improving inclusive leadership in the NHS and has used his experience to coach senior executives, many of whom are now in chief executive roles or hold national positions within the NHS.
In 2009 the CEO of NHS England invited Prem to take the lead on inclusive leadership on the National Leadership Council. Prem has remained a champion of inclusivity, drawing on his own lived experiences to promote the importance of everyone feeling valued and respected.
The Health Service Journal named Prem in its inaugural national list of the top 50 most influential NHS leaders from black, Asian and minority ethnic backgrounds.
His influence on the national stage has remained strong, as one of only 25 invited representative chairs to sit on the Chairs Advisory Group hosted jointly by the chairs of NHS Improvement, NHS England and the Care Quality Commission. He has also, until recently, served as the senior independent trustee on the board of the NHS Confederation.
Meanwhile, he has remained grounded in his adopted home of Derbyshire where for the past 20-plus years he has played a pivotal role as chief executive of several large NHS organisations and more latterly as chairman.
In 2004 he took on Central & Greater Derby Primary Care Trusts to develop what became known as NHS Derby City, where he stayed as CEO for a further eight years.
For the past two years, he has combined his role as chair of Derbyshire Community Health Services NHS Foundation Trust with chairmanship of the Staffordshire and Stoke on Trent Integrated Care System and subsequently, the Integrated Care Board, seeing it over the line as a statutory authority and successfully established.
With such a wealth of varied experience behind him, it was time to ask him about the biggest changes he has seen in healthcare during the past nearly half century.
This is Prem, in his own words:
“We sometimes talk about the good old days, and they were, and they weren’t, because not everything was good in the early days. For instance, how we treat patients and people with more compassion has improved significantly. We used to call someone with a learning disability ‘mentally handicapped’, and that was during my time, back in the 80s. And going back further, before my time, the terminology was even worse, talking about ‘mentally retarded’ people. Which is absolutely shocking. Now we are moving to the much more clinically enlightened terminology of people with neurodevelopmental diversity.
“We are also looking after people in much more appropriate settings, away from institutions. Back in the 1990s, I led the closure of three learning disability hospitals in Sheffield. People were ending up in mental health institutions if they didn’t fit into the societal norms, so we have seen huge changes – all for the better.
“I remember Walton Hospital (Chesterfield) with 200 beds, five older people’s wards, a surgical ward and a mental health ward. I remember being there as a student nurse in the 1970s and as a staff nurse in the late 1970s and I managed it when I was a primary care trust chief executive in Chesterfield – even then there were many, many more beds than we have now. The corollary of that is that we are now less bed dependant. We now see the patient’s own home bed, being a bed. So we don’t just talk about healthcare beds or social care beds, we talk about services and what better than for you to sleep in your own bed to get the care you need. It’s not always possible. There will always be a need for hospital beds but we have significantly shrunk that need.
“We have had fantastic advancements in healthcare, with treatments, medicines and technology. You can now have keyhole surgery and go out the same day. I remember the days when if you had a hip operation, you’d go to Ashgate annexe and you’d stay there for four, or five, weeks rehabilitating. With a hysterectomy you’d be up there for two weeks.
“We have seen great advancements: less bed utilisation and more care in more appropriate settings, but we still have a lot more to do because I still believe that largely we have become an illness service in the NHS.
“We are very good at fishing people out of the stream when they have fallen in and treating them and putting them back together, as it were. We need to get up-stream and stop them falling in, in the first place. We need to tackle the wider determinants of health.
“Waiting times, ambulance times, A&E pressures are all massive challenges that we can’t ignore so we must step up together and deliver those things today. But we need to get upstream as well and start looking at how people live, their educational attainment, housing conditions, economic status and employment. The NHS has got to get much more up-stream.
“I’ve seen NHS management shift largely from an autocratic, very macho, blunt- talking style, giving way to a much more compassionate, authentic, and inclusive leadership style. It isn’t universal but it is a much less macho culture. I like to think we are empowering a facilitative learning culture and I like to think we are really strong on this at Derbyshire Community Health Services.
“My profession, nursing, has improved and evolved. Now there are many more higher-level nursing careers that nurses can choose. For example, advanced clinical practitioners and degree qualifications. They operate at the top of their licence and personally, I’d sometimes rather see a nurse who is an expert in something like diabetes care than see a general practitioner. Specialisms are fantastic, I think, although I still believe we need to recognise our nurses more as a profession. They do offer us so much and the value placed on them can be improved.
“We have started to bring in Nursing Associate roles which I think is a great way forward, to create a balanced workforce. We don’t need people specialising in everything. There is a time for basic nursing care.
“The final observation on changes, is that we have seen constant structural changes in the NHS, reorganisation after reorganisation. If I’m honest, those are not always for the better. Some of those changes preoccupy leaders and managers and can be very disruptive for a long time and don’t always yield the results that are intended. And then we constantly suffer from an inherent tension between top-down management and leadership and local determination, and I think that tension will continue to be around because we are tax-payer funded.
“However, if we are serious about system working, getting up-stream, working with local government, the voluntary sector and our communities better, then the NHS hierarchy needs to let go and empower leaders at a local level to really go forward because every place, every community, every system is different. You can’t control this from London.
“I’ve gone full circle because I lived at Ashgate annexe when I first arrived in this country to start my student nurse training, and now my office as chair of this wonderful trust is at Ash Green, just across the road from where I started 47 years ago. But all good things must come to an end, and this is one of those periods of my life.”
Thank you Prem – we will miss you and wish you a very long and happy retirement with your family, wife Kathryn, son Paul and daughter Simran.
“I was 18, very green and naïve and very isolated because I didn’t have any family member in England, never mind Chesterfield. I had a turban on my head which made me stand out. There aren’t many turbans in Chesterfield even today, never mind in 1975 when I arrived.
“There were times I was made to feel like an alien, mainly in town on a Friday night when I was walking across pubs and people would walk out drunk and call me names and hurl abuse, which hurt me really an awful lot. The flip side though, is how lovely my nursing colleagues were.
“The turban and my difference didn’t get in the way at all. They were lovely to me. The women in the kitchens at Ashgate were just motherly and absolutely brilliant to me. They used to ask me: “what can we cook for you, me duck?” The attempts to put together a Vesta curry for me… that was the closest I got to a curry and it’s not like today, you can go to Sainsbury’s and pick up Indian and Thai food… back then, there was no such thing.
“So culturally the general reaction from members of society on the bus or when I was passing pubs was very difficult. I had to take a decision, that I need to get on with my life. Not give up my soul or turn against my belief system but I felt my turban was getting in the way of my nursing, or my ability to relate to my patients because I was so different. Rightly or wrongly. Hopefully today I wouldn’t need to but I kind of felt I needed to adapt. Getting rid of my turban was one of the hardest things to do. It was my identity but what I’ve tried to do is to retain my identity in other ways. But I am still the boy my parents loved and nurtured and instilled in me the kind of values and principles that I’ve hung onto because I’m proud of that heritage."