From zero to 360
Rox Smith grew up in Yorkshire and Devon, where her parents worked in retail and factory jobs before her dad re-joined the Navy. From a young age, she was curious about people. This led to an interest in politics and global affairs, and she went on to study philosophy and war, followed by a master’s degree in international conflict at King’s College London. She became fascinated by why societies go to war and its impact on communities and cultures.
After university, Rox joined the Civil Service as a near-miss Fast Streamer, starting out in a junior administrative role under the Labour government. She rose quickly, becoming one of the youngest senior civil servants in Whitehall. Her work spanned education and climate policy, including advising the Secretary of State during the landmark Paris climate negotiations. This experience was especially memorable – it was the first time Rox had worked under a female Secretary of State, offering her a powerful insight into the challenges of leading in a male-dominated environment.
She later became Director of Health Innovation, working across the Department of Health, the business department, and NHS England. It was during her time in government that she developed her trademark leadership style, defined by constant reflection. “The organisation was brutal in terms of 360 feedback,” Rox says. “It is programmed in my brain – in every situation, I think what went well there, and what could be better. But I try not to focus on the negative; mistakes are how we learn”.
Healthcare heroes
In 2020, as the pandemic took hold, Rox made a big decision. She wanted to move beyond strategy at the national level and see the real impact of policies on the ground. So, she took a new role as Strategy Director at King’s College Hospital Trust.
Before she even started, she had an inside view of the NHS that she could never have expected. Whilst on maternity leave with her nine-month-old baby, Rox developed a rare and life-threatening illness – severe acute pancreatitis and sepsis. She spent five weeks in Tunbridge Wells Hospital during the height of the pandemic.
“The experience helped me to understand how hard everybody was working and how complex the environment was,” she says. “It is hard not to be completely overwhelmed by the dedication shown during that time and everything achieved.” It left her with a powerful question: if teams can perform so well in wartime, how can the same strength prevail during times of peace?
Since then, Rox has been struck by how much public opinion toward the NHS has changed, from the early lockdown cheers on doorsteps to tough headlines about NHS failures most weeks: “We have to support each other through, because the current view of the NHS can be hard going for everyone.”
Creative curiosity
At King’s, Rox created the first strategy in a decade – an achievement she’s particularly proud of for the energy, positivity, and shared sense of purpose it inspired. The strategy placed a strong emphasis on diversity and supported a number of brilliant, clinically-led initiatives aimed at improving access to research, enhancing cardiovascular and kidney health, and helping families get the best start in life.
The move from government to healthcare hasn’t always been smooth sailing. Sometimes, Rox says she encounters scepticism. But she’s clear about the role she plays: “I’m not a clinical expert, and that’s okay.” “My role is to be curious, ask questions, and help colleagues believe any problem can be solved. You just need imagination and a bit of courage.”
That creativity is something she’s carried with her from childhood. Rox explains: “I was always writing my own stories, and I’m no different now. I tend to generate lots of images in my head as I’m talking, hearing, and seeing things. The data won’t give you all the answers – and relying on it could mean you could end up doing what you’ve always done.”
One vision
Rox joined UHSussex because she saw something special: “I’d always said that outside of London, this was the only organisation I wanted to work for. As a strategist, you’re drawn to things that are challenging and interesting. I could see that there was so much potential in the organisation to be amazing.”
There’s also a personal connection; Rox’s husband grew up in Brighton, and when her two-year-old broke his leg over the summer, he was cared for by our fabulous team at the Royal Alexandra Children’s Hospital.
Now, she’s leading the Trust’s new five-year strategy, with a laser-clear goal: to bring all its hospitals and services together under one shared vision. “Working as one Trust will create so many benefits – more unified care for patients, more chances for staff to learn and grow, and stronger teamwork across the board.”
Her goal is a happy, healthy workplace where staff feel proud and supported, because “you can’t deliver great care without looking after your people.” Hearing her colleagues say they want their families to be treated at UHSussex, and knowing patients feel truly heard, will be the ultimate measure of success.
Rox believes digital technology will be key in the years ahead – especially in reducing paperwork and helping patients self-manage their health. She’s also optimistic about artificial intelligence: “There’s no doubt that AI is going to bring massive opportunity, helping to free up clinician time to focus on the more complex cases.” She sees similar potential in genomics, allowing us to identify health risks early in childhood.
Juggling all the balls
Rox has two young children, and balancing work and family life isn’t always easy: “Anyone with young children knows how completely exhausting it can be. I travel a lot, so most weeks require military-level planning. But I love my job – the innovation and expertise I see every day is truly inspiring.”
She’s also a passionate Leicester City football fan, an interest she shares with her husband. For Rox, their unlikely Premier League win is a reminder of what’s possible: “They were all good, competent players. But what gave them the edge was that they were a fantastic team and played with consistency and real commitment at every match.
“If they can become the best, so can we – with talent, self-belief, and a plan to get there.”