Fiona Day 0:03   

Welcome to Transformational Thinking for Health Leaders. I'm Dr Fiona Day, Master Practitioner Coach and Chartered Coaching Psychologist. This is a podcast that will help you meet your most complex leadership challenges and transform your perspectives, helping you to become a more effective and creative leader with a deeper understanding of yourself and your own world of work. 

Allison Streetly OBE has recently retired from her full-time role as head of the National Public Health team in NHS England having held a wide range of previous roles in public health at local and mainly national level including as Director of the NHS Sickle Cell and Thalassemia screening programme, where she's been responsible for its national rollout.  So welcome to the podcast, Allison.  

Allison Streetly   

Thank you, very pleased to be here.  

Fiona Day   

Yeah, thank you. So Allison, I'm curious about your early life and career. I know you grew up in Trinidad, and I suppose I'm just wondering how this influenced your development as a young adult, and how and when you moved into public health.  

Allison Streetly 1:12   

Yes, thank you very much. 

I had perhaps a slightly unusual early life compared to many people, and compared to how you might imagine when you listen to me, but I did grow up in the Caribbean. My grandfather went out there in the church, and my father was in the oil industry, and I became very conscious as a child of being a ethnic minority in a community where it was very multi-racial, but I was in the minority. I was also strongly educated about slavery from an early age, and felt very responsible for the consequences of this which had recently been realized in this country. So I think that did impact on me and my awareness of unfairness and inequalities that ignited my interests, I suppose, in broader public health. I think that the other thing was that I worked in Kenya when I was 18 with an organization called Project Trust teaching up in the Iveti hills in Machakos district, in a coffee growing area where we had, me and another girl, a little house with no water or electricity. Again, became very conscious about development issues and wish to go into VSO type work. But then, when I was 21 I worked for Save the Children Fund and setting up famine relief centers in Uganda, in a war zone, and apart from starring on the BBC News quite often, I actually became quite cynical about aid, and turned off the idea of going and saving the world, and really brought my interest in working in the country from which I originated more strongly. So, I think all those factors helped to influence my interest in particularly the social and political aspects of health. When I came to study medicine at Cambridge, I chose to study social and political science in my final year, which had a huge impact on my thinking about health. And from that point, I really, you know, was interested in the wider determinants of health and those other aspects. So I think that's actually quite a logical progression from my early experience into where I landed at. 

Fiona Day  3:34   

What a fascinating journey then from kind of being exposed to the consequences of slavery, and the injustice and the kind of value base that came for you from that, to the work that you were doing in Africa, and then kind of disillusionment, like you were saying, with the aid system, and didn't know that you'd been, you know, interviewed on BBC News several times around that. Through to then, kind of doing medicine. And then I guess, like you say, kind of, you know, being able to choose to do something additional in terms of your medical training as well, and being exposed to the kind of political sciences as well, that I can really see how that's been a kind of really strong foundation for the rest of your career, hasn't it? And I suppose, you know, thinking back over the last few decades, and you know yourself as you've grown into a public health leader over the years. What do you feel is the most important insight you've gained about yourself Allison, over the years? 

Allison Streetly  4:33   

I think self-acceptance and recognition of both my strengths and building of confidence, but also much more comfortable with the fact that I have significant areas for work, working on and being humble about the fact that, you know, everyone has their strong and their the weak points, and I'm certainly someone with quite a spiky profile, and I have been identified as an adult with dyslexic thinking, which actually has been one of the great strengths, I think, of my leadership, but also has given myself and my teams particular challenges and important areas for recognition of drawing in on other people to support those areas where I am not particularly so strong. It's also important in terms of the things which I'm best at doing, and the situations in which I most likely excelled and the situations in which I particularly struggled. So I think as you get older, you usually become more accepting of yourself and more self-aware, and I think that's an important aspect of what I've learned over the years. 

Fiona Day  5:48   

So there's something there about that, that self-acceptance, that such a beautiful concept, isn't it being able to kind of, you know, accept who you are and embrace that, and then really play to your strengths, but not taking your eye of the fact that we've always got areas for growth and development at the same time, and how you've used that your neurodivergent profile to really play to your strengths, and perhaps we can talk a little bit more about that as we go on too. Thank you for sharing that, and I'm aware, you know, your roles Allison, have included leading large teams through significant organizational change in a couple of different organizations. You know, big restructures that you've been responsible for overseeing, and it's something that's increasingly common for health leaders to either choose to do, because it's something that you know is felt to be needed in terms of restructure, or it's something that they're being asked to do for a variety of reasons. I'm curious, Allison, what you learned from your first experience of leading a major organizational restructure that then helped with your second experience when you went through it again. And also, you know, whether you have any further advice for listener’s benefit. 

Allison Streetly  7:06   

Well, I suppose stepping aside slightly, which is what I would tend to do, is that before I became involved in the PHE setup, my role in that with the national screening programs, I had been through various restructures prior to that, and like many, most people in public health will have experienced quite a range of those. So I'd already sort of seen, without being totally in charge, the key sort of challenges that one faces. And in one role, I wasn't able to get a permanent position as a DPH because they were frozen for quite a while, so I was very familiar with some of the challenges, but I think the first role of restructuring of national screening programs and the merger into PHE was a huge challenge. I think it was the most difficult restructure I've experienced, and different bits of the system dealt with it in different ways. I was involved with both being restructured, personally into the local authority and also transferring, at the same time into PHE. So two different transfers, and trying to transfer my team, which I was going to be detaching from with the restructure. So I think separating out your own issues and your own challenges from actually supporting your team is quite important, and quite often you see leaders are so taken up with the fact that maybe they're really struggling with themselves, that that that can impact on the team. So I think it was very important to do that. One of the most important things I learned, really was that you can never give enough information. And both in that restructure and In the more recent one, I just instituted weekly touch bases with the team every week, even if there was no news, to make sure that every week we were touching in and I know that's not perfect, but it did help people feel that I was, you know, trying to share information. So I think communication can never be good enough, but we have to be humble about the fact that we may think there's no news, but people still want to hear from you. So I think that's really an important thing, and I think detaching oneself and one's own issues and challenges and managing and being supported with that from actually recognizing importance as a leader, how your team will be looking to you, and how important that is to set out your vision, be clear what the direction should be and stick with that, which I think is really important to help people feel that you know, there is a future for them and that you have got their back. So I think that's probably something that can be difficult, and suggests that leaders in those situations do need considerable support with coaching and other things to help them cope with not just themselves, but with the important role of helping to keep the team on board as far as they possibly can. 

Fiona Day  9:57   

So I really like the I suppose the way you've positioned that in terms of kind of the taking care of yourself, but not then becoming consumed with that, because it's both isn't it? So you can also be really there for the team and support them, and that sense of helping them to see a way forward, and there's a place for them in that very kind of anxiety provoking time. It's a real skill isn't it, and a really important task of leaders in that context to be able to do that. So Allison, I'm curious about the range of different situations that you found yourself in as a leader, and if you could say a little bit about sort of situational leadership and context specific leadership. 

Allison Streetly  10:39   

Thank you. I think as I developed, I became aware that leadership styles and skill sets and approaches vary in different situations, and the time for pace setting and really performance related leadership is much less than the time for visionary, supportive, coaching styles, but also understanding myself and looking back on where I was really most effective, I realized that I'm particularly strong where there's a lot of uncertainty and where things are changing rapidly. And recently, when I became the lead for Long Covid for Public Health England and then UKHSA, as it transitioned. I think that was a natural fit for me, as many of the people that work in that sort of setting like much more concrete set things. And long covid was a very challenging, uncertain thing, like slippery soap, but I think it suited my skill set. And similarly, when I was responsible for the Sickle Cell and Thalassemia Screening Program, really, no one wanted to do that. They felt it was far too complicated and difficult. So my leadership skill set really fitted with those uncertain, difficult, complex, messy problems, when perhaps many other people would be much more suited to leading in a more steady situation. And I think what I take from that is knowing yourself and understanding yourself will help you to see where you might best fit it's important to also make sure that that's something that you're happier with and you enjoy. But I certainly have found that an interesting reflection on, you know, my skill set, my neurodiverse dyslexia thinking and where I fit, and the importance of recognizing you need different types of leadership in different situations, and different people fit different things better. So I think that's something that I found quite interesting. Some organizations are increasingly recognizing the importance of those different types of thinking skills and where they best fit, and I think that will be important for the health sector to do better on that in the future. 

Fiona Day  13:09   

Being comfortable with uncertainty is a really important leadership skill that is quite hard to learn, but there are evidence-based ways that we can support leaders to help them to be more comfortable in uncertainty, and it sounds like for you, that's something that you've already grown into, and it's a kind of stage of adult development that you've been able to embrace. In terms of, you know, the kind of the differences that you've experienced in a variety, you know, you've worked in so many different roles at the coalface, and kind of, you know, national level, too, I'm curious about the differences that you've observed between leading as a senior civil servant compared to being closer to the coalface in, you know, as a health leader and your you know whether there's any reflections that you're willing to share around that.  

Allison Streetly  14:07   

Well, just taking a step back, I think, building on the comments about managing during transition, I think most senior leaders will also be managers, and it's important in those change times to be clear about your role as a manager in supporting your staff, from your role as a leader, because they are, they are distinct. And I think your question about being a civil servant versus at a more local level, obviously, in the civil service, the managerial style is very strong, and there's often a lot more layers of this, and layers of bureaucracy and process is terribly important. So I think operating in the civil service, it's similar in the sense of the political dimension, but it's just a different level of working and accountability and responsibility. So I think you just you do need to be respectful of the political dimension, which is very strong that a local level you perhaps have a bit more discretion working with local leaders and building that relationship is going to be more personal and easier to achieve if you do it well. So you may have a bit more discretion or scope than you would have at a more senior level. And I think that's, you know, there's a reality  - you have to be pragmatic. I think I have been pragmatic in quite a lot of my roles, that there's a reality. You can be visionary to the nth degree, but you've got to be realistic about where, your scope is for change. So I think that's an important difference to recognize. I think when PHE was established as a new [organisation], you know, within the civil service, that was quite a lot of adjustment for many people, and I wouldn't want to say too many comments about PHE given the history, but I think that was quite a big change from being in the NHS and then other public health people working into local authority and, you know, adjusting to a very different environment from the previous one, where public health was mainly in the NHS. So I think, yeah, there are differences, but perhaps it's more about context. Perhaps in some ways, it's not as different. I think the regional level is more different, in my view, than local to national. In a way, local and national sort of both tied into political agendas. They're just in a different scale, whereas the regional level is a more sort of assurance role. And that's one I think, is more, perhaps arguably, a bit different.  

Fiona Day  16:56   

That's really interesting. And I suppose just thinking about the different cultures and the different levers that you have to pull have available to you in different contexts as well, is just something that I just was just thinking about while you were talking there. 

Allison Streetly  17:13   

Thinking about leadership, obviously it's important to be clear, what sort of definition are you working to on leadership. And there are lots of definitions of leadership. Goldman's definition about a set of behaviors: leadership is a set of behaviors to help people align their collective direction, to execute strategic plans and to continually renew an organizational system, so three things, is quite interesting to me, because public health is often very keen on helping people align their collective direction, but it's really important to recognize that it's about executing plans and delivery to either together across the system or in an organization, and also to perhaps change the cultures and organizations to work in that way, and so I think leadership, what do you mean and understand by leadership, is very important to inform how you know how you proceed and how you behave as a leader, and to be really focused on actually this is about where do we really want to get to, and are we actually not just saying this but are we actually putting in place of things and using the levers to achieve what might be possible? And in terms of levers, obviously, there are different levers and different opportunities. In my experience at national level is if you know a decision is made to do something, there's a window when it suddenly is all happening, and you know, then you're into real, no longer lobbying about the collective direction, but just getting on and doing all the things and drawing in on that opportunity. And that is often a narrow window, a narrow area where you can, where you can really move. So I think local level you're probably working on many more areas and different relationships, but at national level, it's often in my experience like that, introducing a national screening program, you know, we had an opportunity, and we had a window, and I could always see that this was not going to go on forever. We had to get as far as we possibly could in the time available. And so, you know, you've got to be agile. You've got to be clear where you want to go, but you've also got to be very agile, and that's as much about getting the system to work, to deliver as it is about an individual. 

Fiona Day  19:36   

Yeah, I think some of this is also about pace, isn't it? And you know, part of the leader's role is about pace setting, but finding the right pace and being quite flexible. You know, it has to be flexible. It has to adapt to the, you know, the dynamic environment that you're in is, is something. It's quite nuanced, isn't it? I suppose, in terms of, you know, that making sure you are delivering and doing that side of things, and also that you're not burning your staff out, and you're taking them with you. And also you're in a complex system around you in public health. And you know the leadership roles that you've been in, Allison very much as a system leader. And you know this complexity and things kind of moving and changing around you all the time. There's, like, so many moving parts of the system. I'm curious, really, in terms of, you know, your reflections about being a system leader and being effective as a system leader, and what helps, because lots of people who end up in system leadership roles, they've kind of, you know, there's like, a pipeline, isn't it, in a way that you start off with a kind of more minor managerial role, moving in, over time, to leading departments, moving into leading organizations, like many medical directors say, for example. But most public health work does tend to take place across systems. So yeah, what have you learned about being effective as a system leader specifically? 

Allison Streetly  21:01   

Obviously, I, you know, I am who I am, and so my way of leading in the system is influenced by who I am, and in terms of different styles of leadership, I've always been someone who is very strategic, sees to the future, tends to have a clearer vision, which can be very annoying for some people who want to be much more day to day, but that's always been who I am and how I you know, how I think. So that has obviously always influenced the way I operate in systems. There have been times when I've been very involved with the pace setting, style of leadership and much more directive, but consistently, I've always had that visionary leadership, I think, in terms of being effective across the system, then the way you come across, being clear about having an inspiring direction of travel. But what is also so important, but often not really appreciated, is the ability to listen to people early on, to make them feel that you understand where they come from and to respond to what they're saying just can't be underestimated, because if people feel you, you know you understand you've taken some time to understand where they're coming from, you recognize their issues, and you continue to recognize their issues, and you demonstrate that in practice, you're going to be much more you know, able to call on them to help, to help and to engage and to speak your language, and to advocate the things you want to achieve. And so I think for me, system leadership is as much about, you know, getting everybody out there to feel welcome, feel that there's an understanding where they come from, and to demonstrate that really, in practice, not just with lip service, and to build that over time. Because if you can build those relationships over time, that's very much what local DPH is and others do, then they can call on those levers, and they can call up those relationships when needed. I often used to say to Junior staff who would be coming around to ask me something, I'd say, well, oh, I see you. You're here. You want something. Is that right? And, you know, I used to encourage them to build relationships, go around and talk to people, not just when they were asking for something, because I think then there's a more trusting relationship developed. They used to be quite shocked, because they were very keen and coming around. And actually, I used to say, well, actually, you know, I think it's really important you think about building these relationships in a bit more of a sustainable manner, because you're going to need to call them up, and you never know when you might need to call them up. So I think, you know, building that sense of authenticity and authentic listening. And just by the way, your body language and you actually give people time, you make sure the people who haven't spoken get a chance to speak, that everyone in the room speaks, and you don't have one or two people just dominating. You don't have the lack of confidence that everyone has to wait for the senior person to say what the answer is before they say anything. These are important parts of system leadership that's actually going to going to really work. So I think those, those are some of the points I would say, and building those relationships and sustaining them is just so important. That's what good DPH is. But at national level, similar is relevant and to be seen as a genuine person. I think the other thing is, sometimes people feel they need to be the person that does it all. But obviously, if you can pull the levers behind and get other people to be, you know, on your page and speaking up for you instead of needing to say it, it's also going to add a lot more weight to the situation.  

Fiona Day  25:05   

I think there's a lot in that, in what you said there, in terms of, you know, everything from the kind of values that drive you around inclusivity and fairness, going back to our earlier part of our conversation. But also, you know, leadership is a relationship business, isn't it? And being able to put yourself in somebody else's shoes and take perspective is, I think, the key kind of leadership skill of the 21st century really, really important. And I love how you describe there Allison how you have been doing that. And you've also just mentioned a little bit about supporting people in more junior positions, and some kind of mentoring, informal, maybe formal or informal mentoring advice that you've been giving there, I suppose, has that been a part of your role? That kind of mentoring, coaching others? 

Allison Streetly  25:52   

Yes, very much. I was a training coordinator, really, within three months of becoming a consultant. So I was involved with the training scheme fairly early on, then probably a bit less in my middle career, but in the latter years that's been very much a part of I think, as you get more senior and you move towards finishing with your main career, you know you really do want to help develop and support people and so very much mentoring and coaching. I trained as a coach and at PHE we had internal coaching and system…. I think that can be the relationships, right, that can be really, really positive and help people move on at stages in their career when they're blocked. So, yeah, I mean, managers do coaching I suppose leadership roles, they're slightly different, but equally important, and again, making people feel that you understand where they're coming from. They may not have had some of the opportunities I've had. I have had a medical career and degree; they may be coming through different routes. We have people in public health from a wide range of different backgrounds, and there's a place for many different types of people with different skills, and the more we recognize how we bring in those different skills, and we're quite a broad church, then I've always been very keen on trying to support that. Certainly, some of the non-clinical people that I've trained have been outstanding, gone on to be professors and others. You know, I could see that from an early day, how, how capable they were. And I'm proud of recruiting a really diverse range of staff into, certainly the last couple of teams that I had, but also I think in terms of coaching and supporting people, it's very important to try and make sure that you don't have a comfort team where everyone's the same and you actually recruit people who might challenge you. So supporting people from different backgrounds to oneself can be challenging sometimes, but I think it's good to be challenged, and it makes for better teams the other the other side of coaching and development is actually supporting teams to develop, to work well together. And that's a real 21st century thing. And I think face to face is really important for building teams and building relationships in teams, so that teams support themselves and take on leadership roles, as opposed to just the leader. And I think that's something I've certainly thought about more in my later stages in my career. 

Fiona Day  28:41   

I think there's something there about you know you're as a leader. You're leading teams of teams, aren't you? And even if you're not designated as the leader, you're still there. You still need a certain amount of team coaching skills to be able to be an effective member of the team, to really enable it to perform to its best level. You mentioned about kind of you know, as your career progressed, and how your roles or priorities have changed a little bit. I suppose I'm just kind of curious as you now have transitioned from this full-time role as head of the National Public Health team in an NHS England, into this next chapter of your life. Would you just kind of tell us a little bit about I know it's still very early days, but any kind of reflections learning about this, this transition from your main career? 

Allison Streetly  29:35   

Yes, thanks. I think that the first thing to say is, rather than just going forward actually, I think preparing to step back from a main full-time role is really important, and certainly in my appraisals, I found quite often that people are very anxious or reluctant to talk about this, or grateful that you open up the conversation. I have to say, thank you to Judy Curzon and co from PHE for really being positive about guidance on encouraging people to talk about the next step in their appraisals, both in terms of supporting me as an appraiser, but also as part of recognizing the importance of trying to think about this in advance. So I think in terms of preparing for stepping back and one's identity in a new way, preparing in advance, and being open about that, and taking it, you know, taking time to reflect on where one's got to in one's career, what you want to do with the next steps, etc. is really important to be ready. And I found it really helpful to do that so that I felt ready and able to step back. I think the other thing to say for me personally was that after the pandemic and my role, particularly as leading long covid, I was really pretty burnt out. We did have some support, but I did get four weeks time, three weeks off, and a week of sort of study leave after the pandemic, before I came sort of back fully to NHS, England. And that was just so beneficial to me in terms of decompression from what had been, and for many people, has been a hugely demanding time, that really spurred me into recognizing that before I sort of step into whatever I do next, I really did need some time to just decompress and process what I've been through. So now that I step back from my role about two and a half months ago, I have taken some time to just decompress and do some of the other things that I needed to do. And I think people shouldn't be feeling they need to immediately know the answer to what they're going to do next, because it will take time to settle and to work out what's important. But I think preparation before you take that step, to be comfortable and recognize this is a great opportunity to have a fresh start and do new things is really important and will be really important in the way you go forward. And I know that how you finish is also important. So being able to finish in a way that you choose is going to be a lot easier than if you are in a major restructure and you're taking some form of redundancy, perhaps, if you didn't choose that, or you're deciding that what's on offer isn't really very attractive, so you're going to leave. So I think all of those things are important. I don't think people talk about it enough. I think we shouldn't be talking about retirement. We should be talking about life after a main career, moving into part-time roles or other opportunities, such as are widely available. So I think those are important, taking time to work out what you might want to do, where your strengths lie, what the opportunities are, and then putting your mind to that is important. So for me, I'm really glad to have that chance, to have time out, to not spend eight hours sitting at a desk, to be much, much more physically active, and to just be able to attend to some of the things I needed to attend to, and then move positively into that new phase. I think that's what I would say at this point.  

Fiona Day  33:43   

So we've got an inspiring, you know, legacy that you have left from all the work that you've done over, you know, many, many decades here of amazing kind of public health leadership roles Alison, and then, you know, some really cogent advice in terms of helping people to start to prepare for that transition from their main career, as you call it, because, you know, the world of work is changing, and the that traditional three stage model of, you know, education, doing the job and then retirement, kind of falling off a cliff type thing is totally changing, isn't it? And you know, you may still go on and do your own best work yet that's totally possible for you. So just before we close, I suppose, is there anything in terms of kind of what's on the horizon for you, Allison, that you'd like to share? 

Allison Streetly  34:35   

I have re-established an honorary Senior Lecturer role at King's, so I'll be doing a bit of teaching on the Masters in Public Health. I did say I wouldn't be engaging till the autumn term but be doing a bit of teaching and hopefully also finishing off some of the research in relation to evaluation of the sickle cell and thalassaemia screening program, which are things that are dear to my heart. So it’s sort of personal to me. I'm a trustee on our local charity, which has been hugely interesting and educational and is helping to keep me up to date and linked up with an old chief exec who's on Healthwatch, and I can see that the challenge is really about being focused and disciplined about how I want to use my time, because it's going to be, and it is I've already seen, so easy for it to get filled up with so many different things that just are there as opportunities. So I think it's really about being really clear what's good for you, what you want to spend your time on, what you find rewarding. And I guess the more you're comfortable in your own skin and who you are outside that big armour of that large role, then if you're comfortable within yourself, both in your skill set and in who you are and what you stand for, it's going to be a much easier journey.  

Fiona Day  36:23   

Well Allison, thank you so much for talking with me today. I’ve really enjoyed our conversation and hearing in much more detail about all of the experiences that you have had through the course of your career so far. And I really wish you well for this next chapter. 

It sounds like you've, you know, you're really set up for a really richly rewarding chapter. And like you say, you know on your own terms, in terms of actually, this is time for you to decide what you really want to be doing. So thank you ever so much for being here today. 

Allison Streetly  36:38   

Thank you for being great. 

Fiona Day  36:42   

If you've enjoyed this podcast and would like to find out more, head over to www.fionadayconsulting.co.uk, and you'll receive three hours of free CPD, the health career success program when you sign up to my newsletter. And there's loads of other resources to support you as a medical or public health leader on my website too. Thanks for listening.  

Transcribed by https://otter.ai