The Dr Louise Newson Podcast - 176 - Introducing new Chief Medical Director, Dr Magnus Harrison

Episode Date: November 1, 2022

Newson Health has recently appointed a Chief Medical Director to ultimately help more women improve their health. In this episode, Dr Magnus Harrison shares a whistlestop tour through his professional life so far as a Consultant in Emergency Medicine via New Zealand, Australia, and Manchester and his experiences in leadership at Stoke on Trent in the wake of the Mid Staffordshire NHS Trust’s ‘adverse mortality’ investigation. Via Harvard, USA and India, Magnus then oversaw the merger of Burton upon Trent and Derby NHS Trusts before the hardest time of his career to date – the COVID 19 pandemic where 8 staff members from his organisation lost their lives. Magnus discusses with Louise what he hopes to bring to the medical leadership and management of Newson Health and the key values that underpin his mission. Magnus’s aims for his leadership at Newson Health: I will be humble and led by professional curiosity to learn how to help more women I aspire to be a compassionate leader, will listen to understand, empathise and ask how I can help Kindness is essential and should underpin all that we do.

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. So today on the podcast, I'm really thrilled actually to introduce to you someone that I've known for a long time, nearly as long as I've known for my husband, which is a very long time. So it's someone called

Magnus Harrison, who's a medical doctor, and we first met in New Zealand in 1995, so many years ago. And life always goes in circles, a massive circle with myself and Magnus, and he's now working with us, which is super, super exciting. So welcome, Magnus, to the podcast today. Hello, Louise. So tell us a bit about I know a lot about you, some things that I might not reveal on the podcast today, but tell me a bit about you, because our medical backgrounds, I mean, we're both medical doctors, but our medical backgrounds, even right from the start in 1995, were very different, weren't they? They've carried on being very different. So if you wouldn't mind describing a bit about where you've come from and what you're doing, and then we can

explain the full circle and why you're here today. I will do. So I'll start a little bit before 95, Louis. So I'm a Newcastle Medical School graduate in 93 and always wanted to do emergency medicine. And I remember really clearly as a third year medical student, the medical registrar working some sort of magic on a patient who came in with a low blood glucose. And on the end of a syringe, this patient just woke up and I thought, how fantastic, get the diagnosis right, get the treatment right, and you make a difference straight away. So I was, one on emergency medicine more or less straightaway. And I did a bit in the northeast of England in Sondland and South Shields and then straight to New Zealand to be an emergency medicine registrar.

And we actually met in the council offices of the New Zealand Medical Council where we were all trying to register. Unfortunately, we all had the right bits of paper. And they signed it off to be able to work. I did a year there. Did almost a year in Sydney as well shortly afterwards again in emergency medicine. but always wanted to try and do research, and there was very little research available in emergency medicine at that time, and had a failed attempt initially in Stoke,

and then I went to work at Manchester Royal Infirmary, which is probably one of the most formative periods of my career. It's where I learnt about medical stats, it's where I learned about diagnostic statistics and numbers needed treat, numbers needed harm, and really set me up for my registrar training scheme in emergency medicine, which was in the West Midlands, and I became a consultant in Stoke,

as a first consultant job. And this is where things all got a little bit interesting. The six weeks in, somebody said to me, do you fancy being clinical lead? And they hadn't identified any particular talent or ability I had. They'd just identified that the other three had had a go, and it was probably wise that I had a try. That's a huge job, isn't it?

I mean, Stoke is a big hospital, big trauma-centred. It's not a small little DDH, is it? It's a big, busy hospital. Yeah, you're absolutely right. nursery centre, medical school that was quite redimentary, embryonic almost at that time, but neurosurgery, kind of thoracic surgery, full on trauma. And at that point in time was one of the busiest emergency departments in the country. And we had 2.6 consultants. The 0.6 was obviously not 60% of an individual. They just did 60% of a job. And there was a realization that

we needed a lead. And I stepped in without really knowing what it was about, but I absolutely loved it, loved the interaction with people, love being able to make a difference. And quite quickly after that, I became clinical director of the emergency department and the acute medicine department. And that led me into working with the team at midstaffes. And it was absolutely the time that midstaffs were having all their difficulties. And that was probably one of the most challenging and yet probably one of the most rewarding times I've had, dealing with essentially an absolutely broken team as a result of what had gone on there. Can you just explain for those that might not know about Midstaff?

Yeah, so Midstaff's Hospital was in Stafford. And those are a bit like you and me, Louise, a bit longer in the tooth. We'll remember what went on at Midstaffes, but it was how to describe. So I've got lots of colleagues there who were bruised and battered by what went on there. They were recognised as having adverse mortality. and for those that are going to scream at the podcast now, I'm quite prepared to discuss the statistics around whether it was adverse or not, but adverse mortality as a result of systemic failures within systems and process in midstaffs.

And the emergency department were pilloried in the press. And I have two really good colleagues that worked there at the time. They'd both left by the time I was asked to help out there. And I led the emergency department in midstaffes as well as stake for a period. And just a broken team who actually all. went to work every day to do the right thing for the patients that are in front of them. And I suppose what I learned from that was the systems, the processes, the cultures all have to be lined up to actually be able to deliver care in the right way.

And none of them went to work at any point in time to do a bad job. You know, it was hugely important and influential for me in my career. And on the back of that, I applied for the clinical executive fast track scheme, which the Secretary of State at the time Jeremy Hunt had put in place. And I essentially was sponsored to have a year, more or less outside of the NHS, got to go to Harvard to do a postgraduate course because reimagining healthcare. Worked with Baroness Cumberledge in the House of Lords. There were 50 of us on the programme.

It wasn't just me as an individual. Don't get that idea. Worked in the House of Lords, spent a bit of time working with EE, the phone company, helping define their healthcare space. was asked to do their keynote speech. I was so far away from Steve Jobs and Tim Cook. It's unbelievable. But we did their keynote health address.

I got to go to India. Went to India because India's got a very different health care system to the UK and there's private and essentially very little public provision. And I reviewed 12 healthcare systems over there to decide what we could potentially bring back in transport into the NHS. and on the back of that year, it was really obvious that I needed to do more to keep myself interested, and I ended up as the medical director

and Deputy Chief Executive Executive, Queen's Hospital in Burton upon Trent. If I'm going on, I apologise. Oh, it's all very interesting and relevant, actually. What became obvious in Burton, and Burton was a small DGH, 160 million pounds, 400-ish beds. Three hospitals, though, in the south of Staffordshire,

what became obvious really quickly was the population we served wasn't big enough to allow physicians to specialise or surgeons to specialise. So it was a really general approach to medicine in the broadest sense. And it was clinically unsustainable, not clinically unsafe, although it had been recognised as a Kio Trust with adverse mortality and went into special measures. We turned special measures around really quite quickly and I wouldn't want to claim any responsibility for that, only for the ongoing plan that I had as a medical director. But it became really obvious quite quickly to me that we're going to have to merge with a bigger organisation. And that's when they

merger with Derby Teaching Hospitals started. And I was one of the two SROs for the patient benefit case. And the patient benefit case essentially is looking at a group of specialties and been able to describe the benefits for the populations that you represent. And it became really quite obvious. Again, I say fairly quickly, it took 18 months to write it. But in six specialties that we'd picked, I could clearly define a benefit for the populations in Derby, and populations in Burton, and I could still do that now. I can still clinically evidence the impact of the merger positively for that group of people. So the merger went through and it was, you know, when you look back on your career and there's those times,

and you know the grin, and you just think, I have no idea how I am in this room, having this conversation. So at that time, we had to go through the Competition Markets Authority, see the CMA. And you know, you hear of the CMA. I didn't realize what they did. And I sat in front of a whole panel of health economists, lawyers over contract law. Then one of their team walked in and he said, I'm the devil's advocate. And his job role was actually devil's advocate in this panel.

And I couldn't believe it. So I was there with the chief exec I was working to at the time, Gavin Boyle. And we both sat there and had to go through a whole patient benefit case with the CMA to prove there was no detriment to help. health and care as a consequence of the merger. So we weren't decreasing competition and as a consequence decreasing the quality of care offered. Unfortunately, we got through first time. Wow. So there were no second bite of the cherry. So we went in and we merged the Bay Trust on the 3rd of July 2018 and I became the medical director and deputy chief exec of the university

hospitals of Derby and Burton. It was medical director for three and a bit years there. And then early this year, 2022, the chief exec moved on, and I became the interim chief exec of UHDB. And I think right now that's the pinnacle of my NHS career. So being able to have implement over the care and health of 1.2 million people, you know, what's not to want about that? I say that, and I say that rather glibly, and I'm looking back now, three rose-tinted spectacles because the last two and a half years, as medical director in the COVID pandemic response, was the hardest thing I've had to do in my career. And for people that are not as close to this, we had eight staff members die as a consequence of COVID. Three consultants died from

COVID in our organisation. And as a medical director, there's always a level of unexpected events that occur when you work out what you're going to do. But having a medical director, you always, been three consultants dying a pandemic. You know, there's nothing prepares you for that. Nothing gets you ready. And then four of the staff members. And we decided really early on into the pandemic that for everybody that died, we would have a minute's silence at whichever particular hospital. We've got five hospitals now in the trust. And one of the consultants who died was a guy called Manjit Singh Riet, who was one of the A&E consultants in Derby. And I'd known Manjit for years prior to being the medical director

and he was one of the original absolute godfathers of emergency medicine nationally and seen all the ambulances pull up outside and they did it in such a way that they could all open the front doors out

so it looked like they'd got wings and they put the blue lights on and we had the minute's silence and I was glad it was raining I'm glad it was raining because everybody was crying and it's making me shiver now just even thinking about it

It was formative moments. But that takes us to sort of the tail end of the pandemic, which is where we are now. And me and you have been having this discussion about what could I bring, what would I offer in use and health? And we'd sort of chatted and we danced around the handbags a bit. And then, and you know, let's not be shy about this. I went for the chief executive job. I didn't get the chief executive job. And the timing just felt right for me to dip my toe into a,

very different arena, somewhere where I am so far away from being a subject matter expert, it's untrue, but somewhere where 15 years of medical leadership and management could be exceptionally useful. But Louise, I'm only five days in, so don't judge me yet. No, but I think it's very interesting because when we both met in 1995 and somebody, if we'd gone to see a futurist or, you know, someone with a crystal ball and said, right, in 22. The two of you be working together, you will be running a menopause clinic and you'll be working with it. We would just go, no way, absolutely no way. And I'm not even interested in, well, I'm interested, of course, but not as a specialty in gynecology. So women's health is

often grouped as a gynecological specialty. So it wasn't really my area of interest. I was always very scientific. I'd got a pathology degree as well as my medical degree. And you're from A&E. You know, so why would you even think menopause or women go into A&E? And of course, how wrong were we? Because we know that menopause isn't about women's health in the respect of a gynecological specialty. It's a multi-system organ problem that affects every cell in our body. And there are a lot of women that go into A&E and are misdiagnosed with various conditions.

But that's only a small part. We also, neither of us wanted to work away from the NHS, you know, but we also, I know we've spoken about it before, we both qualified and we decided to do medicine because we wanted to make a difference to as many people as possible. And I know myself, when I left the NHS a few years ago, as in stopping an NHS GP, I was really sad about it. And my husband kept saying, but you're going to make a bigger difference in bigger ways than you could do just in day-to-day seeing 30 or so patients or 50 patients a day. And it took me a lot to understand that. And it's weird really because when you left your A&E work, Paul, my husband and I often said, well,

why is Magnus doing management stuff? Gosh, he's such a talented doctor. He's this coolest cucumber. He'd run the trauma unit. I can't understand it. And I think because we don't know much, do we, about management, because we're not trained in it as part of our undergraduate training, I didn't really understand the enormity of what you've been doing over the years because it, you know, I remember when you were going to America, we were saying, well, that's nice. I didn't really know what you were doing. But actually, we both want to make the biggest difference to the largest number of people.

And also, we want to work with a team that's dynamic forward thinking can make a difference and enjoy the journey. And no journey is going to be smooth and there's always going to be problems and there's always going to be turbulence. But I think over there, maybe the last year, I have phoned you up with a couple of crisis calls

to say, Magnes, this is really big and I don't know what to do. And you would just laugh and say, yeah, it's enormous. The more I think about the menopause, the more I realise it's affecting my staff. Do you remember? I remember you saying once, Louise, a lot of my staff are either, as a nursing staff, are either your patients, their balance users, or sadly they're giving up or reducing their hours because they're menopausal.

And I think you'd started then to realise, hadn't you, the enormity of what we're trying to do here. So I think two bits to that, Louise, so this is where I've got to sort of clinically fess up to everybody and think there's any number of women who are perimenopausal and menopausal who probably didn't get the best deal from me when I was a clinician working in emergency departments. So how many people have I sent for 24-hour ECG tapes to try and work out what their tachycardia was or even if there was a tachycardia there? I don't know. How many women did I see with type 2 diabetes who were of the right age? And, you know, I know now, because

Me and you've talked about it, and the impact of hormones, even on the acute presentations, should not in any way go unheralded in the future. But each step in my career, what I've done is change the number of people, the population that I represent. And I'm very much, you know, we can both remember those medical school interviews where you're going and you say something quite glib, just want to make a difference. It was quite glib, but I meant it then and I mean it now. and you know if I was on call for trauma I might see one patient in eight hours as you make a diagnosis and pull all the right specialties in to build a treatment plan as you become a medical director you represent the whole population that attends that particular hospital as a medical director in a bigger organization that gets bigger so I've sort of gone from one patient potentially per shift to 300,000 when I was at burton hospitals to over a million at derby teaching hospitals and listen I'm going to quit

statistic now. I've only learned this this week. Thank you, Louise. So it moves from that 1.2 million to 1.2 billion internationally. And the bit I particularly find exciting is the ambition we have, you have, essentially, because it's all down to you, and I'm here hoping to be part of that journey, is to make a difference to women everywhere. And it's that equitable offer that we're searching. We're searching for that sweet spot where there's an equitable offer for everybody so that we can look ahead and look to women who are beyond the tradition. I say beyond the menopause age, I don't really mean that. Menopause goes on from when your hormones drop to the end of life. But the advantage we've got now is that with the right treatment, and I'm not saying everybody should have

HRT, but with the right treatment, we decrease cardiovascular problems, we decrease the type two diabetes, we decrease dementia and we stop the osteoporosis and that's the bits we're know about right now. And, you know, I remember me and you having a conversation during COVID about how many women did I see on our intensive care units who were on HRT. And I remember answering that question, having spoken to both our sets of IT-U concerns, zero. We didn't find a single woman. And that, you know, then you start thinking about the immune modulatory capability of estrogen. Louis, I'd never thought about that before. Never, never imagined it. and the endothelial response to estrogens as well.

I was never aware of this as a doctor. Yeah. But the impact we can potentially have now, by getting it right right now, nationally and internationally, is huge. It's absolutely huge. And I think what's, because it's so huge, it's quite scary. And when things are scary, people often withdraw and don't do it. I think that's what's happened the last 20 years, actually.

There is a bit of gender inequality. there's a lot of sexist ageism. But actually, I'm really interested in healthy aging. And a lot of people think about aging as just a few wrinkles. We're always going to get that as we age. That's fine. But it's about the accelerated aging that leads to diseases, the inflammation. And I think, you know, having the immune system as healthy as possible, we know within a pandemic how important it was. But we also need to know, you know, number one killer is cardiovascular disease. And dementia in women globally. And we need to look at other inflammatory conditions and actually even clinical depression, Parkinson's disease, dementia are thought of to be inflammatory conditions.

If our immune system isn't primed well, it doesn't work well, it fights against us and all these cytokines, these chemicals are produced, they accelerate the way we age. And we talk a lot now, don't we, about sort of fragility and how healthy we can be until the time we die. And the problem is, after the menopause. For a lot of women, their health decelerates, really. It gets older a lot quicker and therefore there's a bigger drain on the economy and you only need to look at one in two women who have osteoporosis after the menopause. One in three have osteoprotic hip fractures. I was told that the mortality from an osteopratic hip fracture was 20% after a year, but a professor of orthopaedics told me yesterday it's 25%. I can't think of, you know,

Most cancers, 25% of people don't die after a year of diagnosis. And I know this is really depressing for the podcast, but actually osteoporosis is never on the front page of a magazine or a newspaper. People think more about breast cancer, but far less women have breast cancer and far less women die from breast cancer, which is wonderful. But we have to look at the diseases that are affecting our ability to work. And also what's really affecting the NHS at the minute is social care.

We know there aren't enough people who are aware. working in social care, in nursing homes, residential homes. A lot of the women that do work in these places are menopausal. We know at least 10% of women who are menopausal give up their jobs, a lot more want to reduce their hours and don't go for promotion. So they're not being cared for by the right people. But we also know, and I'd love to know at a more national level, but I know we did a survey from our patients, Rebecca Lewis had one from her patients, just trying to see how many patients we had in nursing homes, residential homes, care homes, sheltered accommodation, who were on HRT and you can imagine it's the same number as the number in intensive care on HRT at zero. That does not mean HRT keeps you out of these places, but actually HRT we know builds muscle strength, builds bone strength, helps improve cognition, helps stamina.

So a lot of women we see who are older on HRT, they are doing their shopping every day, they're independent. Some of them are still working in their 70s and 80s. And that's really important for their individual quality of life, for sure, but it's more important when you think about social care. So there's also some debate, and I've been talking to a professor this morning from Liverpool about the ethics of denying treatment that's evidence-based. And why is it that we're denying treatment that could have?

help people get back to work and to function better and be healthier, especially women from areas of social deprivation who we know are neglected more. And this is an area that's really close to your heart, isn't it? So I think there's a heck, there's quite a lot in there. There is. To talk about. But I think, I believe the patriarchal male view of medicine to one side, if you just think about osteoporosis, the menopausal women, why haven't we really ever thought

about what the cause of that is? So we treat it almost as a symptom. And, you know, I'm sure your orthopedic colleague tells you that bisphosphonates just make bones, yeah, increases the density, but the more brittle and more difficult to work with. So we rather glibly treat osteoporosis. I don't worry, we've got that covered. Yeah, in actual fact, nobody's thought, why is this actually happening? So that was one thing that resonated from what you just said. I think the social care issue at the moment is massive. And, you know, how many more people would we have working in social care if they were on the right hormones and felt able to work? Who knows? Probably a significant number would be my guess on that. But the health inequalities,

and again, I hate to bring it back to COVID. If we look at COVID data nationally, and you are one of the population that is suffering from the multiple, indices of deprivation, your likely outcome from COVID was far, far worse than it would have been for other groups. And I've got this really concerning worry that those groups, if they're not treated for the menopause in the right way, will also suffer more deleterious health outcomes. I have no doubt. And I think the conjuring act, the trick, the slight of hand that we need to pull now is how we in use and health look at treating more and more people in the most efficient, effective, responsive and equitable way possible. Yeah. And I think, you know, we've got the

ability to do it. So it's very interesting, you know, running a private clinic, everyone thinks it's about treating people with money and it's not actually. And, you know, having the clinic now has enabled us to give a lot of money for research, for education, towards balance app, helping people globally as well. But, you know, we've only been going for four years. So there's a lot more we can do. And having people like you, hopefully, that we can use and abuse, but also be part of this exciting team to transform health going forwards is going to be really exciting. So I'm very, very pleased that you agree to come on board, Magnus, and you've nearly completed your first week, and I managed to detract you from your work to record the podcast. So I think there's short-term plans,

there's long-term plans, there's a lot we can do. And I think the biggest thing is just having your enthusiasm, knowledge and skills that will really help work at pace to make a difference. So the first thing is, thank you, kind words. And just to absolutely reassure you, if I thought for any second that you weren't motivated by making a difference to the patients you represent, you know, we'd have still been chatting, but it wouldn't have been on your podcast. So I'm here completely for that. And, you know, detractors may suggest that it's a private clinic. It is a private clinic, but we're quite an altruistic organisation, and I've seen that already within the first week from a research, from an education perspective and what the plans are going

forward for how we invest wisely, but invest wisely for the entirety of the population we represent. So I'm looking forward to getting you back. I was going to joke and say in a week's time to see what we've achieved, but maybe I'll give you a bit longer to see because I think it's very important to show the world and hopefully some of this conversation to our listeners, how much we are doing behind the scenes, and I'm not very good at singing my own praises and blowing my own trumpet,

because it's a teamwork. It's not me that's doing all of this. But actually, the bigger the team, the stronger we are, the more powerful we are, and the more that we can do. And I think that's really important. And, you know, I've talked a lot before in the podcast about my detractors and people that are bullying

and trying to stop me. But it's not about me anymore, actually. It's about us. It's about us as a team helping women who need the help. And so we're not going to stop. We're here to stay. So I'm very grateful, Magnus, but before we go, I would just like to put you on the spot and ask you for three tips. And I'm going to ask you for three ways that you personally think that you can bring to our organisation to improve the global health of women, because that's our mission. So you and I both know that nothing teaches humility like medicine does, and I have lost more £10 bets on diagnoses than I care to remember. So I think the first thing for me, I will be humble. And I'll be humble because we don't know all the answers all the time. And it sort of links into a professional curiosity is being humble.

you know if we look back through history of medicine we've got a bunch of stuff wrong so let's not perpetuate that let's all be professionally curious and humble and try and think in the right way about what we're doing that's my number one my number two and for anybody that's watched any thing by michael west whether it's in person or on youtube i absolutely aspire to be a compassionate leader. What do I mean by that? Compassionate leadership is listening with absolute fascination to people to understand their particular issue. Now, whether that's in a clinic setting for our clinicians or whether it's, as I manage and lead in the organisation, I will listen to understand so I can empathise in the right way and then ask a question around what can I do to help?

what is my role in providing an intelligence solution to each particular issue? So being humble, I'll be compassionate. And then my third one, and again, we talk about values a lot. But one of the behaviours that sits behind most values in any healthcare setting is kindness. And I think kindness is absolutely essential. It's kindness in spirit. It's kindness in thought. It's kindness in actions and deeds.

But it's kindness in time as well. giving of our time. And for any News and Health employees that are listening to this or anybody else for that matter, if I'm not behaving in those ways, if I'm not demonstrating the humility, the compassion and the kindness, you've got it now, call me out on it. I want to hear. Brilliant. I love it. And I'm very pleased that you're on board working with us because those three values are so important, not just in the clinic, not just in menopause care, in everything that we do and I still use values a lot in my children as well and I think you can't measure kindness we can't do research on kindness it's not so part of our job description but it's so important

because kind people make the days go better and I think that's so key so I'm very grateful Magnus I'm not going to keep you any longer because I would like you to go back and do some work but thank you so much for your time today it's been really enlightening and I've learned quite a lot about you which has been wonderful so thank you Thank you. For more information about the perimenopause and menopause, please visit my website, balance hyphen menopause.com, or you can download the free balance app, which is available to download from the App Store or from Google Play.