Maneesh Singh talks about the pressures of growing up in an Asian family and how early on in his career he felt he had to work harder than his white counterparts to progress. Now part of the Board at NLAG, he discusses the importance of diversity at Board level and how he wishes to utilise his position to continue to promote an inclusive culture.
What influenced your career choices when you were growing up or in the early stages?
My parents emigrated from India to the UK in 1970 and my father was a doctor. Anybody from an Asian background will resonate with the drive that Asian parents from that generation have to "guide" their children into the professions of medicine and law. Medicine has always been seen as a top profession and failure to gain entry into medical school was seen as a great disappointment. "Education, education, education" was the mantra drilled home from an early age.
Being good was not quite good enough; you had to be the best. At the age of 7 I not only had to learn my times tables to 12 but to 20 and I still remember this today! The pressure to perform in my grades was immense and I don't believe this was the effect my parents had intended but this has left me with a desire to continually improve in my career.
In my teenage years, like many "testosterone driven" teenagers, I wanted to be a fighter pilot but was dissuaded by my mother who reminded me that I may be asked to fire upon people. Travelling and exploring the world was probably a key driver in my career choices. I toyed with the idea of entering the diplomatic service and working as a journalist until I eventually succumbed and applied for medicine.
Unfortunately during medical school I had an appalling attendance record (I was told by the Dean that "it was the worst attendance on record at Liverpool Medical school") but managed to pass my exams and it wasn't until I hit the wards as a doctor that I realised a passion for my career. In fact when I delivered my first baby by caesarean section 3 months into my first obstetrics job I almost felt a calling into this path. Little did I realise that I was entering into one of the most emotionally and physically challenging professions in medicine that would significantly disrupt any work/life balance.
What has been one of the best decisions/influences in terms of your career?
I was fortunate during my career to have been trained by some of the best clinicians in the North-West of England. My final consultant supervisor at Wythenshawe hospital was probably my greatest influence as a surgeon. Now retired, his voice in my head still actively advises me when performing highly complex surgery or when complications arise.
As a consultant people believe that you are trained but like passing your driving test it is essential to continually improve and push the boundaries of patient care by being innovative. When the opportunity arose in 2012 to pioneer robotic surgery in gynaecology, I readily jumped at this opportunity.
During my career I also had the opportunity to perform formal research with another of my great mentors. Often clinicians do not comprehend scientific research and scientists do not understand medicine. I currently work with my mentor in bringing rapid diagnostics in Covid, cancer and other areas such as endometriosis. My drive is to provide equal and high quality care across the globe no matter where you live.
What impact, if any, has your ethnicity had on your career path?
As an impressionable youth in the seventies growing up in Hull there were very few Indian families. There were no role models who were first generation British Indians to aspire to. As many young people with my background we lived two separate lives, one in the home and one in society. Although I had some good friends I always felt an uncomfortable cultural difference.
As I progressed through my career it became apparent that I would have to work harder than my white counterparts to progress my career. I remember working for a respiratory Professor who didn't acknowledge me for 4 weeks as his house officer. Needless to say I worked hard and wore him down. He eventually was pivotal in my first career placement as an obstetrician. At that time a thick skin was essential and a belief that your own ability would eventually be recognised. I fortunately spoke with a British accent but even today many doctors struggle to achieve their career goals due to their ethnic background.
Having worked abroad for many years I would like to add that the UK has the foundation to tackle these issues and the NHS does monitor the effect ethnicity has on career progression. Unlike other countries there is a level of transparency and appreciation that ethnicity can prevent career progression. Now that the issues have been identified it is essential over the next decades to establish a level playing field not only for ethnicity but disability, gender and sexuality.
Fundamentally I do not see myself as being a British Indian doctor, but just as a doctor that provides consistently the best level of care that I can.
Have you ever felt that your leadership achievements were less visible (or invisible) compared to other colleagues?
Certainly in the last century this was an issue but in the modern day this is less so. This may be because I am older, gained experience and have matured. There are many instances that I can recall suggesting a change in strategy only to be laughed at and years later the same organisation adopting my proposed strategy. Frustration may build but it is essential to stay focussed on issues that really matter and that you can address effectively. Learning how to effect change using your team is essential. The credit may not be given to you, but if the change improves patient safety and satisfaction, isn't that what really matters?
Has your ethnicity impacted attitudes towards you as a leader (negatively or positively) at any point in your career? What effect has that had on you and how did you deal with?
There are positives and negatives to ethnicity and individual differences in teams leads to a more complete team. A large number of clinicians and nursing staff are from a variety of ethnic backgrounds. Being a representative for a workforce with different cultural backgrounds and beliefs is a privilege and a responsibility that I do not take lightly.
Understanding different cultural backgrounds and religious beliefs has enabled me to work in different countries and break down barriers more quickly enabling effective communication. Whether teaching in Somaliland, or working with the indigenous population in Australia, being different and understanding difficulties I have had in my own career has made me appreciate others' journeys and barriers.
If you are bullied early in your career, you can either become a bully from learned behaviour or fight against bullies. I hope that I have adopted the latter and hope to provide balance and insight to the boards that I sit on.
Dealing with unfair behaviour towards me has been emotionally difficult especially early in my career. Taking advice from mentors, becoming resilient and understanding that it was not my weakness but that of the perpetrators has allowed me to continue through my career. Workplaces can make a difference but ultimately it is the steady change in societal beliefs and education stemming from primary school age that will have the greatest effect on tackling marginalisation. I believe, the UK as a truly multicultural society, should take this opportunity to globally lead the way to a fairer society.
Is there anything now you’d say to your old self looking back?
Plenty!!! Hindsight is a miraculous tool. It is not the mistakes you make but not learning from those mistakes that is a crime. You don't always get it right but follow your passion whilst keeping your ethical standpoint. Hard work usually pays off but doesn't always. Don't be disappointed if you don't always achieve your goal, it is another step in your journey to be wiser and stronger. Overall it's not about you but the impact on those that are around you that matter. And finally "look before you leap".
What are your current goals?
I have been very fortunate to join the board of NLAG as an associate non-executive director. I hope to continue to learn from my colleagues in becoming an effective non-executive director and to utilise my position to continue to promote an inclusive culture in the organisation and help the executive committee in their drive to improve patient care across the ICS network. My personal goals are to improve health locally and globally and to bring scientific innovation to reality particularly in diagnostics incorporating machine learning and accessible cloud-based systems. Through my commercial company BioCross I believe my team can make great strides into our goal of rapid and cost-effective systems to improve health anywhere with power and a wifi connection.
What progress do you hope to see in accelerating more inclusive leadership and cultures, especially within the UK, in the near future?
Diversity and communication are essential at board level. The boards should represent the populations they serve and the workforce. Board strategy is not always understood by the workforce and effective communication to all staff promotes a cohesive and more efficient improvement in institutions.
The NHS has been under extreme pressures especially over the last 18 months and unfortunately the onslaught is likely to continue this winter and beyond. The role of the board is not just to implement action but to listen and stay connected to those on the front-line. Embedding transparency, self-reflection and accountability are key to improving services and I am pleased to say that this is the case at NLAG.