Healthcare Manager Spring 2011

issue 9 spring 2011

healthcare manager

DIRECTOR’S CUT

DEAN ROYLES ON THE FUTURE OF NHS EMPLOYERS

plus At the sharp end: managers speak out Route and branch: greening the NHS

helping you make healthcare happen

e

insuranc

holidays

The added va lue of membership

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mortgage

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motoring

finance

Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus.

More often than not, these benefits will be on an exclusive basis with leading companies.

But it isn’t only excellent terms and value for money we look for in a potential Partner.

The products or services they offer have to be among the ‘best in class’.

They must share our values and deliver a high quality service, including straightforward call-handling and easy-to-navigate websites.

On the UNISON website you’ll find full details of all the criteria we look for, before we award companies with our official Partner accreditation.

All you have to look for when you are looking for a name you can trust is the UNISONplus logo.

For more information visit www.unison.org.uk and click on the UNISONplus logo or call MiPLink tel 0845 601 1144.

You could save the cost of your subscription many times over and guarantee yourself the value for money that you and your family deserve.

issue 9 spring 2011

healthcare manager inside heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Andrew Cheesman inpublic: North East Ambulance Trust

letters & comment:8 Clare Russell on an uncertain future for trainees

features:10 published by

Managers in Partnership www.miphealth.org.uk 8 Leake Street, London SE1 7NN | 0845 601 1144 Managers in Partnership is the trade union organisation providing support and advice to senior managers in healthcare in the UK on employment matters, careers and management practice. We represent their views to policymakers, employers, the media and the public.

MiP conference 2010: in pictures Interview: Director of NHS Employers Dean Royles Green future: A route map for a sustainable NHS On the Frontline: Rosie Ilett takes soundings from managers in Scotland

regulars:20 Legal eye: Looking at compromise agreements Tipster: How to cope with the tough times ahead MiP at work: MiP’s response to the Health Bill MiP around the UK: Reception at Holyrood

backlash:24

I am delighted to introduce the second anniversary edition of healthcare manager, the magazine from Managers in Partnership, the trade union organisation for managers working in health and social care.

So what do you say when you are asked that question: And what do you do? Mutter incoherently and give an apologetic laugh? Well you are not alone, according to MiP vice chair Rosie Ilett, who has been interviewing managers in Scotland and shares her findings in this issue. Also in this edition we are delighted to have an in-depth interview with Dean Royles, as he takes over the helm at NHS Employers, setting out his stall on partnership and the future of bargaining in the NHS. And we bring you an update on the work of the NHS sustainable development unit, which has produced a route map to show how sustainability can be integrated into the culture, practice and training of health organisations.

We hope you enjoy this issue. Do contact us if you have any comments about the magazine or about working in the health services in general.

Marisa Howes Executive editor

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HEADS UP

heads up what you might have missed and what to look out for

Equality

Events

Putting equality into the mainstream The NHS Equality and Diversity Council has developed a new Equality Delivery System (EDS) in consultation with trade unions and employers.

Based on the Equality Performance Improvement Toolkit developed by NHS North West, it is designed to help NHS organisations embed equality into their mainstream business, and covers patients, public health, legal compliance, workforce and leadership issues.

Designed for the NHS by the NHS, the EDS will be driven by good engagement and evidence.

NHS organisations have been hosting regional engagement events involving patients, carers, staff and local interest groups to get feedback on the EDS before it goes live.

Gail Adams (pictured), Unison head of nursing and trade union

Free places for MiP members at Commissioning 2011

For more information on the Equality Delivery System contact EDSProgrammeOffice@newhampct. nhs.uk. For more information on the Equality and Diversity Council contact equalityanddiversitycouncil@dh.gsi. gov.uk.

MiP has secured a number of free places for MiP members at the Commissioning 2011 event at London Olympia on 15 and 16 June.

Commissioning 2011 is a new event bringing together all those involved in delivering the new healthcare agenda: GPs, PBCs, practice and PCT managers, as well as other stakeholders, such as secondary care leads, local authorities, and providers from private and not-for-profit organisations.

The programme will combine hard-hitting plenary sessions and debates with four break-out streams offering a choice of more than 40 different sessions, to provide a balance of inspiration, education and networking.

The organisers carried out research among stakeholders to identify the key areas of concern. These will be covered in

healthcare manager

Executive Editor

Contributors

issue 9 | spring 2011

Marisa Howes m.howes@miphealth.org.uk

ISSN 1759-9784 published by MiP

Associate Editor

David Amos, Emma Dent, Marisa Howes, Rosie Ilett, Helen Mooney, Alison Moore, Victoria Phillips, Jon Restell, Clare Russell, Craig Ryan, Rita Sammons.

All copy © 2011 MiP or the author.

Opinions stated are not necessarily those of healthcare manager or MiP.

member of the equality council, said: ‘It’s essential that organisations work in partnership with trade unions at all levels to deliver these objectives. During these times of transition we must not lose the knowledge and expertise of our existing staff. The equalities agenda is the one clear programme where there are no sides – we share the same objective and aspiration.’

Craig Ryan editor@healthcare-manager.co.uk

Art Director

Warners Print, Bourne, Lincs

James Sparling

Design and Production Lexographic production@healthcare-manager.co.uk

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Print

issue 9 | spring 2011 | healthcare manager

Advertising Enquiries 020 8532 9224 adverts@healthcare-manager.co.uk

the programme as follows:

clinical leadership

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consortia business

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patient services

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partnership working

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Keynote speakers, including Dr Clare Gerada from the Royal College of GPs and Gary Belfield from KPMG, will focus on practical solutions to address the new priorities and challenges and provide case studies and real life examples. The Commissioning Show also hosts a major exhibition with over 100 exhibitors.

To guarantee your free place at the show please do register now by visiting www. commissioningshow.co.uk. Alternatively, please call Chris or Alice on 01926 485 151 and they will be happy to make your booking. This offer only applies until 31 March 2011 so book now.

healthcare manager is sent to all MiP members.

All weblinks mentioned are at www.miphealth.org.uk/hcm healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.

HEADS UP

leading edge Jon Restell, chief executive, MiP Last week I clapped eyes on a slide attempting to chart the possible pathways for staff from the current system to the new system, via the ‘transition’. The columns of current, transitional and new organisations, peppered with question marks and qualifications, were amusing enough. But the tangled mass of squiggles and dotted lines mapping the potential migration routes for staff was hilarious. In any other industry, the slide would be a spoof, a parody, a joke. Only in the health service could it be seen as a fair stab at reality.

I’m not taking a shot at the writer of the slide or other good, skilful people who are trying, for the sake of their staff, to make order from chaos. But the slide is symptomatic of the Government’s breathtakingly negligent lack of a coherent workforce strategy to underpin its own policies.

It’s not as though we don’t have enough to worry about with the mother of all structural shake-ups – the only re-organisation that can be seen from space, as David Nicholson puts it (For our concerns about the health bill, see p22).

Three things have cut the legs from under a decent workforce strategy.

First, the policy approach to management capacity has been driven by finance, and nothing else. Other objectives are being mashed as a result. Look no further than the clustering of PCTs and the unrealistic jobs being created there.

“... ministers and officials are making it up on the hoof.

Nationally, you are lucky to glimpse the still-damp scribbles on the back of the fag packet.”

Secondly, ministers have been management-deniers from the word go – and the rhetoric has beggared belief. Most GPs would be forgiven for believing that in a few months’ time they will be walking around PCT offices pointing at the people they want, and blanking those they don’t.

Finally, ministers and officials are making it up on the hoof.

Nationally, you are lucky to glimpse the still-damp scribbles on the back of the fag packet. Worse, they remain focused on the design of the new system, not the workforce or the transition.

For many managers it is already too late, but even now there’s time for the Government to change gear for the rest. Here’s what it should do.

Do some old-fashioned workforce planning. Make an open, baggage-free assessment of the management capacity – skills and

numbers – needed to do a good job, both in the next two years and under the new system, and plan accordingly. Give this assessment equal priority with finance.

Make it a clear priority to retain sufficient managers and skills, over other considerations, such as GP’s ‘freedom to choose’. Ditch the rhetoric. Talk about managers as an important part of the healthcare team, and foster partnership working between GPs, other clinicians and non-clinical staff in developing new structures and cultures.

Finally, urgently produce – with employers and unions – a credible, comprehensive and robust workforce strategy to support the Government’s policies. Slow everything down if necessary. The strategy must include realistic expectations of staff during the transition and investment in leadership capacity, during the transition and beyond. Most of all, give staff early certainty and clarity about their career options.

MiP is ready to work in partnership to achieve these changes in the Government’s approach. But we’re not here simply to make the best of a bad job, or act as handmaidens to a rushed botch-up. The patience and goodwill of many members towards this Government has run out.

The message for the Government is: if implementation continues like this, then your policies are definitely doomed to fail.

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HEADS UP

Partnership

Airedale best in show MiP joined with Unison to present the HSJ 2010 award for partnership working. The Airedale Collaborative Care Team at NHS Bradford and Airedale

Elisabeth Paice named NHS ‘mentor of the year’ MiP again sponsored the award for mentor of the year at the NHS Leadership Awards.

Jon Restell presented the award to Elisabeth Paice of the NHS London Deanery at the awards ceremony, held in the historic great hall at Barts Hospital, in December.

Professor Paice received the award for her work in supporting many trainee doctors at individual, local and national level. The award citation said: ‘Under her leadership London Deanery has created a cul-

Community Health Services won this year’s award.

The team, which works across the PCT, the local acute trust and the local council, was set up to prevent unnecessary hospital admissions and support early discharge. The team has helped to deliver closer multi-agency and interdisciplinary work, improved clinical networks and reduced costs for commissioners. MiP’s

ture of support and respect for trainees’ lives, careers, talents, concerns. She has influenced national policies supporting trainees’ working lives.

The awards help to meet the aims of the NHS National Leadership Council, recognising the leaders in the service today and fostering the leaders of the future. The award for NHS leader of the year went to Mike Burrows of NHS Salford, which also picked up the accolade for NHS board of the year.

Speaking after the ceremony, Restell said: ‘We support these awards because it’s important to showcase these high calibre leaders in the NHS and we are proud to celebrate them.’

Jon Restell, one of the judges, said: ‘The Airedale team demonstrates all that is good about partnership working. Excellent communications, leadership and a culture of trust enables the team to share skills to achieve the exemplary results for their patients. If anyone wants to see how you can achieve efficiency savings while improving quality, just look at the way they work in Airedale.’

Left to right: Jon Restell, Chief Executive, MiP; Dame Christine Beasley, Chief Nursing Officer; Professor Elisabeth Paice, London Deanery, NHS London; and Sue Perkins, who compered the awards ceremony.

MiP and OU working together As reported in the last issue of healthcare manager, MiP is working in partnership with the Open University to develop a programme of modular courses tailored to suit the needs of healthcare managers and their teams. We have a range of options available already, and MiP members will receive a 10% discount on many of the courses on offer. For more information visit the MiP site on the OU website: www.openuniversity.co.uk/mip

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HEADS UP

inperson Andrew Cheesman:

Interim finance lead on commissioning at Betsi Cadwaladr University Health Board in North Wales

Andrew Cheesman represents Wales on MiP’s national committee. He is proud of the work he does for the NHS, and believes that while finance managers in the health service often get a ‘poor press’ their work is very important in keeping big NHS institutions in check.

‘Finance professionals probably get the worst of it and it can feel like we’re on a hiding to nothing in the health service but we do it because of the contribution we make and feel that we can make a difference,’ he says. ‘This organisation has a turnover of £1.3bn and it can’t work and be successful without managing its finances. And it needs finance professionals to help with that.’

A qualified professional accountant Andrew has worked in NHS organisations across Wales for the last 16 years, currently as interim finance lead on commissioning for North Wales’s newly established Betsi Cadwaladr University Health Board. The board was established in October 2009 following the Welsh Assembly Government’s reorganisation of the health service in the principality. The board is large in size and scope, with three district general hospitals, and

MiP backs TUC march MiP is supporting the TUC march for the alternative to the current programme of public spending cuts.

The march is taking place in London on Saturday 26 March, starting at 11am from Victoria Embankment.

The march brings together those affected to express concerns about the way in which public spending cuts are being implemented and the impact on services and

“This organisation has a turnover of £1.3bn and it can’t work and be successful without managing its finances.”

provides a multitude of community and tertiary services covering thousands of miles and patients across North Wales. It also commissions roughly £100m worth of services from English trusts across the border in Merseyside, Manchester and elsewhere every year.

By Andrew’s reckoning Betsi Cadwaladr is the largest commissioner of English health services outside of England, and with the abolition of primary care trusts and the move to GP consortia in England, the health board could be set to become the largest single commissioner of English health services. ‘We commission £200,000 worth of services a day from English trusts and it’s my job to manage

on peoples’ lives as well as offering alternative solutions to dealing with the deficit.

For those working in the health services it gives us the opportunity to join with other trade unions and professional bodies, voluntary organisations, community groups and service users to voice our concerns about the impact that the cuts and wholesale restructuring will have on the NHS. Details about transport at www.miphealth.org.uk

those,’ he says.

However, the board is hoping to provide more health services to Welsh patients in future, and would like Wesh NHS organisations to work on longer financial timescales of between five and 15 years, rather than the current system of trying to balance the books in year every year. ‘Larger companies and organisations can turn a loss one year into a storming profit the next year but unfortunately in the NHS we don’t get to do this and it’s a shame,’ he says.

The longer Andrew has worked in the NHS the more he feels principled about working in public services. ‘I think the Westminster government’s proposal to disinvest in the public sector is dangerous because there are some areas where the private sector will never be profitable and we need a publicly subsidised state funded health service to cover the areas where the private sector won’t come in because there is no margin for profit,’ he warns. ‘We have to maintain our public services across the UK or the public will suffer where the private sector don’t pick up the work.

Helen Mooney

Senior mangers from South Staffordshire and Shropshire Healthcare show off their award after being named winners in the mental health category of the 2010 Military and Civilian Health Partnership Awards. The team leads a network of seven NHS trusts that enable serving personnel to receive treatment close to their home or base (see Healthcare Manager, Winter 2010). Left to right: Martin Thornley, clinical director, Steve Grange, director of commercial development, and chief executive Neil Carr.

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HEADS UP

Standards

Leadership

Top talent 2 breaks through

In January, the 23 participants in Breaking Through’s second Top Talent cohort celebrated completing their course with an event hosted by Lord Crisp, ex-CEO of the NHS, and attended by a wealth of current NHS leaders, including Sir David Nicholson.

The Breaking Through programme supports NHS staff from black and minority ethnic (BME) backgrounds with the talent and potential for senior leadership roles. Its Top Talent programme supports the development of advanced leadership and managerial skills in senior BME managers and clinicians. More than 50% of the participants on the TT2 programme have secured director level or senior level positions – a testament to their ability and commitment and a demonstration of the success of Breaking Through’s transformational approach.

For more information visit: www.nhsbreakingthrough.co.uk

Telehealth

New technology empowers patients Everyday technology, such as email, the web and social networking, can empower patients but can disrupt conventional relationship between patients and practioners, according to a new report from the NHS Confederation.

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The report, Remote Control: the patientpractitioner relationship in a digital age, published in January, found positive and negative effects from the use of internet and related technology in the NHS, and warned that the introduction of ‘multichannel healthcare’ should not just be seen as a way of cutting costs.

‘The real opportunity lies in elevating shared decision-making to be as important a concern for health technology as cost savings and efficiency,’ said the report.

‘Where this is done, the digital future can offer patients far more opportunities to be involved in decisions about their care, while protecting face-to-face services for the people it has value for.’

The report said that many NHS services offer only a face-to-face service, regardless of what patients prefer. ‘Not only does this focus almost all demand onto the most resource-intensive channel of care, it alienates a growing section of the population for whom digital communication is the default expectation of how to access services.’

NHS is failing the elderly, says watchdog The NHS is failing to treat older people with care, compassion, dignity and respect, according to a a recent report from the Health Service Ombudsman, Ann Abraham.

The report, Care and compassion?, is based on the findings of ten independent investigations into complaints about NHS care for people over the age of 65 across England.

Abraham’s findings show how these ten older patients suffered unnecessary pain, indignity and distress while in the care of the NHS, and found common failings with pain control, discharge arrangements, communication with patients and their relatives, and in ensuring patients received adequate nutrition.

‘The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism,’ said Abrahams. ‘The reasonable expectation that an older person or their family may have of dignified, pain-free, end of life care, in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.’

MiP chief executive Jon Restell said: ‘This is a grim report which reveals systematic failings. As managers we have a responsibility to make sure that our services respond to the needs and concerns of vulnerable service users and their families. And as managers we must make sure we stick up for these patients.

Compalints about the care of elderly patients made up 18% of the 9,000 properly made complaints to the Ombudsman about the NHS last year, and Abrahams investigated twice as many cases about the care of older people as for all other age groups put together.

The full report is available at: www.ombudsman.org. uk/care-and-compassion/home

HEADS UP

inpublic North East Ambulance Service NHS Trust

North East Ambulance Trust is one of a select group of three ambulance trusts who have been granted permission by the health secretary to apply for foundation trust status, and as such it is being watched with interest. Having started consultations on becoming a foundation trust in the summer of 2009, it is now well on the way to winning approval from foundation trust regulator Monitor.

The consultation process was ‘challenging’ but also ‘very fruitful’, says the trust’s assistant director of communications and engagement, Mark Cotton. ‘We were able to identify a number of areas where we needed to bring ourselves up to speed to make ourselves robust for foundation trust application. For example we had to

appoint a doctor and a nurse to the board of directors, as well as strengthen our business plan and tighten up relationships with our commissioners,’ he says.

The ambulance trust’s services include the traditional accident and emergency service, which employs over 1,000 staff dealing with nearly 1,000 emergency calls a day. However, a significant chunk of the trust’s work involves providing non-emergency patient transport, and most recently it has been piloting the new 111 nonemergency number.

The trust’s consultation on foundation trust status allowed it to ‘reach out’ and talk to lots of patients, says Cotton. ‘The response from the public was phenomenal, we were unsure whether they would be interested but we were bowled over

“All emergency services in the past have had an oldfashioned macho culture... we are moving away from that.” with the response and we recruited 7,000 public members in three months,’ he explains. The trust’s main task now is to make sure it is as productive as it can be, while ‘instilling a sense of ownership for the budget’ across the trust, so that all staff see that responsibility for the trust’s finances are ‘not just the job of the finance department’.

Alongside its bid to become a foundation trust the organisation has been working hard on its reputation for equality and diversity.

Equality and diversity manager Jane Miller explains the policies the trust has developed to ensure that it is an ‘equal’ organisation.

Most recently the trust was ranked in the Stonewall top 100 employers for the second year running, recognising its work in establishing an effective equality strategy for lesbian, gay, bisexual and transgendered staff. ‘We have a LGBT staff group who meet regularly and we make sure we are giving them the support they need both for staff who are “out” at work and those who aren’t,’ Miller explains.

‘All emergency services in the past have had an old-fashioned macho culture but we are moving away from that, the issue of equality and diversity is taken very seriously at board level and both the chairman and a non-executive director are members of the trust’s equality and diversity group, which is very important,’ she adds. The trust has also been chosen by NHS Employers as an equality and diversity partner trust, which recognises the good practice within the organisation which can be shared with other NHS trusts.

Helen Mooney

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LETTERS

letters

Letters on any subject are welcome.

Please send to editor@healthcaremanager.co.uk or to 8 Leake Street, London SE1 7NN. We may edit letters for length. Name and address must be supplied, but you may ask for them not to be published.

to the editor

Parting praise I will be retiring at the end of February 2011 and therefore leaving MiP membership.

I have enjoyed my membership and have benefited greatly from the magazine, the meetings, and the contact with local officers. MiP is a thoroughly professional organisation that has a crucial role to play in the NHS. Dan Widdows Harrogate, Yorkshire

Common causes I was delighted to attend the MiP Conference 2010 last November in my capacity as FDA Vice President.

It was interesting to see how the conference differs from that of the FDA’s Annual Delegate Conference and I found the open and forthcoming discussion between David Nicholson and Chris Ham an interesting format for a conference session. There was also a good busy buzz from the speed networking forum.

Both the civil service and the health services have had reputations as good 8

employers with a package of pay, pension, quality of work, job security and working conditions which has been valued by members.

However, all of us face attempts to erode those packages over the forthcoming months and it was clear from the conference that there is much we can learn from each other and knowledge we can share in addressing these issues.

It is apparent that at a time when we are facing unprecedented threats, there are parallel issues of concern and fear for our members, including: apprehension about pay and conditions, including pay freezes

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attacks on public pension schemes

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structural reorganisation and the threat of redundancy: senior managers, in particular, face the stress not only of personal concerns about their own job security and reduced conditions, but also of managing and motivating their staff to continue to deliver highquality services

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increasing workloads

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It is also clear that public servants are subject to ever increasing personal scrutiny and accountability which at times is used as a blunt tool

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to devalue the important work we do.

It is reassuring to know that at such difficult times both MiP and the FDA are able to support their members with strong but pragmatic negotiation, representation and employment advice, and that senior managers and professionals across the public sector have a strong voice and advocate for their interests.

I am looking forward to working in close co-operation with MiP colleagues over the coming year.

Sue Gethin Vice President, FDA

comment

OPINION

“Bluntly, there seems little justification for repeating the 2009 recruitment drive.”

Clare Russell

Human resources management trainee, Surrey Community Health

What now for our graduate trainees?

In 2009, the NHS Institute for Innovation and Improvement was overwhelmed by 12,000 applicants for its graduate management training scheme. Commentators cited several reasons for the quantity and quality of applicants: the fiftyyear old scheme had reached fifth place in The Times survey of graduate employers; many private sector companies had suspended equivalent schemes during the financial crisis; and more graduates were seeking socially meaningful work rather than financial reward.

Eighteen months later, the 280-strong cohort face far more challenging job prospects, while the future of the scheme is uncertain given the impending abolition of the Institute. Will we need such a management scheme in the post-Health Bill world and, if so, what will it look like?

And can the NHS retain the graduates in whom it has invested so much?

Bluntly, there seems little justification for repeating the 2009 recruitment drive. As trusts shave 45% off their management costs, and PCTs, SHAs and arms-length bodies diminish, there will simply not be the same opportunities for graduates within the NHS. To continue to recruit on the same scale would be to waste NHS resources and unfairly raise graduates’ expectations. Furthermore, the one-third cut in the number of HR trainees in 2010 indicates that workforce is not a priority for future development.

Despite continued uncertainty about who will oversee the scheme in future, the Institute has received approval to

recruit in 2011. Yet the scheme will need to change if it is to train managers for a transforming health system. Currently, trainees undertake two placements in different NHS trusts and one “flexi” placement outside. This is one of the scheme’s strengths, as it encourages trainees to compare good practice and question long-established practices in favour of innovation. Their itinerant working life means trainees are some of the only NHS staff who can claim to be employees of the NHS rather than an individual trust.

The Bill’s aim of a decentralised system, is not necessarily incompatible with a national scheme. It would be a great shame if the scheme came under the remit of individual trusts or if trainees received all or most of their experience at the NHS Commissioning Board. The future scheme should place trainees within the plethora of new NHS organisations – foundation trusts, social enterprises and GP consortia – so they can add value, question and learn from practices, and encourage improvement and innovation across the NHS. Can the Institute justify investing so much money in its 280 current trainees in such an uncertain NHS job market?

Finance and HR trainees may look for roles outside the NHS, but this will be more difficult for general management trainees, whose training is more NHSspecific. But even if many do move to the private sector, the investment has not necessarily been squandered. The public sector did a service to the whole economy by investing in graduates during

the downturn. Alumni could also bring back important skills and perspectives if they later return to the NHS. Meanwhile, all NHS jobs are certainly not equal and it is debatable whether trainees accepting NHS jobs at Agenda for Change Band 5 represents an adequate return on two years’ investment.

The Institute deserves praise for supporting and promoting the career prospects of the 2009 cohort. All trainees continue to receive support in career planning, job applications and interviews. Meanwhile, some regions have successfully negotiated trainees access to clearing houses for staff identified as at risk; others have floated the possibility of employing trainees for an additional year as they look for work; while several SHAs aim to introduce trainees into the ‘clinically-led’ NHS through ‘buddying’ schemes with junior doctors. However, these initiatives have been applied inconsistently across SHA regions.

The uncomfortable truth is that the scheme will probably be unable to retain all (or even most) of its 2009 intake and numbers are already being reduced.

In deciding on its future, we have an opportunity to evaluate the scheme and review the training and work experience it offers. However, as its real strength lies in spreading innovation and service improvement through the interplay between a national programme and local experience, this should continue as long as the scheme does.

.

Views expressed are those of the author and not necessarily those of healthcare manager or MiP.

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MiP ANNUAL CONFERENCE 2010

MiP national conference There may be a chill wind blowing through the NHS, but there was plenty of warmth at MiP’s national conference in November, with a great line up of speakers and lively contributions.

Top row (left to right) Chris Ham, Kings Fund, debated size with David Nicholson, NHS Chief Executive; Lez Henry, Nu Beyond, spoke on equality; Lord Howe explained the Government’s proposals for the NHS. Middle row: MiP chief executive Jon Restell with conference chair broadcaster Jenni Murray; delegates networking; MiP chair David Amos with

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exhibitors (top) and delegates share a laugh (below).

Bottom row – the panellists: Dean Royles, NHS Employers, Karen Jennings, Unison, Dr Charles Alessi, Churchill Practice, Gina Tiller, Newcastle PCT; John Nicholls, Scottish Government, Lord Victor Adebowale, Turning Point, Dr Tom Coffey, Brocklebank Practice, Maggie Alexander, Breakthrough Breast Cancer; Alastair Henderson, Academy of Medical Royal Colleges, Rosie Ilett, MiP vice chair, Prem Singh, NHS Derby City, Roswyn Hakesley-Brown, Patients Association.

MiP ANNUAL CONFERENCE 2010

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INTERVIEW

Dean Royles’s move into the hot seat at NHS Employers has been welcomed by NHS unions. But the going will only get tougher. Interview by Alison Moore.

Two months into his job as director of NHS Employers, Dean Royles has seen the NHS battered by snow and flu, a health bill fleshing out a radically different future and the first major initiative he has been involved in – a proposed increment freeze to protect jobs – has been rejected by the unions. And he’s still smiling.

‘It’s an exciting time,’ he says. ‘There is an opportunity to build on that partnership working with unions. I’ve always taken the view that health unions as a whole have been very reluctant to take industrial action. From an employer‘s point of view that adds an obligation on us as to how we react to that.

There is a quid pro quo.’

The proposed increment freeze – which NHS Employers insists is still on the table – was obviously part of that of that quid pro quo. It was rubbished by the unions, but he does not flinch from supporting it.

‘It would have been easy not to enter that debate but from a values perspective – something that we believe was going to secure jobs – it was a legitimate area to enter into discussions [about], even if it was quite difficult.

‘What was disappointing was not to continue the discussions about how 12

issue 9 | spring 2011 | healthcare manager

that could have been made to work.

We thought it was a reasonable proposition to put forward to secure jobs and it was worth entering that discussion.’

Managers, of course, would not have been directly affected by the jobs ‘guarantee’ for bands one to six, but Royles insists there would have been a knock-on effect. ‘The cost saving was such that even higher grades would have a better chance of secure employment. In all grades, it would have given better security of employment’, he says, pointing out that surveys suggest that job security is the biggest issue for 70% of NHS staff.

The national deal would have involved staff agreeing to forego their annual increments for two years under a national framework which would have protected those in bands one to six from compulsory redundancy. The increments add about 2.5% each year to the NHS pay bill but with many NHS staff already facing two years without a cost-of-living pay increase, the additional loss of increments was too much for the unions to support, especially as they felt the jobs guarantee was not watertight.

However, the idea has been popular among some foundation trusts who produced their own proposals for freezes for some staff, though often without any

corresponding jobs guarantee. Does Royles think some trusts will now push forward with their own local settlements? Many organisations will still need to make cost savings and they will revert to ‘Plan A’ to see how they can reduce costs’, he says. Inevitably, with most NHS spending going on wages, this will involve reducing staff costs.

‘We will encourage organisations to be explicit about their financial challenges,’ he says. Incremental freezes could be part of the debate at local level. ‘The financial challenge remains the same even though we have not been able to do something at national level. If we want to achieve something around terms and conditions there is generally a give and a get.’

He suggests organisations might look at other options for reducing staff costs, such as employing new workers on different terms and conditions, or changing the skill mix. ‘There will be different conversations in different organisations,’ he says.

Royles admits he has little good news to offer managers when many are at risk of redundancy and some of their employers are disappearing. But he insists employers do appreciate how well the NHS is managed in many circumstances. ’My local supermarket was bought

INTERVIEW

“In our desire to deliver outcomes, we don’t necessarily promote the ability to deliver change well”

out by a competitor and closed over the weekend for a rebrand. We don’t have the opportunity in the NHS to close for the weekend!’ he says. ‘Promoting the skill of managers to handle change effectively is really important. In our desire to deliver outcomes, we don’t necessarily promote the ability to deliver change well,’ he says.

Royles has not shied away from controversy in his first weeks at NHS Employers, for example by suggesting that

the clinical excellence awards for consultants should be significantly reformed, with employers gaining more control over how the money is used.

But he is reluctant to appear critical of what has been negotiated in the past.

The much-criticised GP deal, for example, was negotiated at a time of concern over recruitment and retention among GPs, he points out. And he is doubtful about the value of reopening discussions on pay systems.

‘There is a sense in which all pay systems have to be dynamic for whatever circumstances we are in. But introducing a new system in the short term costs money, even if in the long term it improves productivity,’ he says.

NHS Employers itself faces an uncertain future. It has two-and-a-half years left to run on its agreement with the Department of Health (DH), which gives it the lead role in representing and negotiating for NHS organisations. And it’s issue 9 | spring 2011 | healthcare manager

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INTERVIEW

part of the NHS Confederation, which is currently mulling over its own future after a revolt by foundation trusts resulted in the Foundation Trust Network deciding to split from the main organisation.

And the NHS is changing rapidly. What was once a relatively simple picture of trusts and PCTs is becoming a very complex landscape with an increasing number of foundation trusts, private providers, social enterprises and ultimately GP commissioning consortia.

Royles insists that, even though organisations won’t all want the same from NHS Employers, it will still have a role in supporting them. ‘One of the things that should be reasonably straightforward through the changes is the need for an employer’s organisation, working with employers, in taking some of these changes through,’ he says.

‘It is about us becoming agile and adaptable. The raison d’etre for an employers’ organisation is that, in the same way that trade unions see strength in numbers, it’s strength in numbers for employers. It’s a stronger voice.

‘We will look at the offer we can make to ensure we engage. There is an issue around national terms and conditions of employment but there is also something of a remit around recognising that the NHS is a good place to work.’

NHS Employers’ in-house expertise and its knowledge base of evidence linking people management and good patient outcomes will be part of this.

And he points out there could be a two-way flow of information and good practice with private providers – some of whom are very good on training and development – while many private sector employers would be envious of the NHS’s staff relations.

The writing may be on the wall for nationally-negotiated pay and conditions but, asked what he thinks the NHS will look like in five years time, Royles says, ‘There is something around recognising that a number of organisations which would retain national pay and it’s important that we support that.’

With the abolition of SHAs and the slimming-down of the DH, some rejigging of responsibilities appears inevita14

issue 9 | spring 2011 | healthcare manager

Dean Royles

At 46, Dean Royles has worked in many different parts of the NHS – from a community trust to the Department of Health (DH). He has experience of the acute sector at Chesterfield Royal Hospital and, from 2007, at United Lincolnshire Hospitals trust, and he also worked as HR director of the East Midlands Ambulance Service.

Royles spent four years at the DH from 2003, as head of HR capacity for England and then deputy director of workforce.

His responsibilities included developing a national HR strategy and work on the European Working Time Directive.

Most recently, Royles was director of workforce and education at NHS North West. As well as heading NHS Employers, he chairs the board of the Chartered Institute of Personnel and Development, which represents HR professionals in both public and private sectors.

Royles lives in Sheffield and splits his working week between London and Leeds – but tries to spend a day a week ‘on the road’ visiting NHS organisations. The time may not really be there in his diary but that sort of grassroots input is vital, he says. He is married with four children.

ble. Who does what will be best determined by who can add most value, Royles suggests. There’s no territory grabbing agenda here, he claims, but there are areas where NHS Employers ‘might have a legitimate role in the future’. Avoiding the costs of duplicating work will be important, as will close working relationships with bodies such as the proposed Commissioning Board.

‘There are certain issues around pay and terms and conditions that the department currently does – such as providing information to pay review bodies.

‘Are they the best place for that in the future?’ he asks. Leadership and board development is another area which might be devolved away from the DH, but there will remain a need for provision above the level of individual organisations.

The new education and training networks for employers – which will develop as SHAs disappear – will be important. ‘There’s something like £5 billion of education money that went through the SHAs that will go through these [new bodies]. There’s a consultation where there’s an opportunity for us to demonstrate our collective voice. My experience is that employers are passionate about making sure that the people they employ are being trained

to deliver the service. This is an opportunity to have a much stronger voice for local employers.’

Royles is outspoken about the importance of partnership working – something his old employer, NHS North West, is well known-for, and he has been praised for promoting there.

He is clear that, despite the earthquakes rocking the NHS landscape, partnership working must stay on the agenda: ‘We have to make sure that we don’t lose some of that partnership working. There is an opportunity to do that in a way that is not dependent on organisational form.’

Leadership development is an area where there may be pressure to come together on a national or regional basis and partnership working with a variety of trade unions – ‘not least with MiP’ – is particularly important. ‘There is a sense that managers are best placed to understand some of the nuances of change,’ he says.

‘We can learn from the private sector but we should also crow about the things that we do particularly well,’ he adds. ‘Good people management is important and there is now a wealth of evidence to support it. If it were a drug that we were not prescribing, people would be outraged.’

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NHS REFORM

Dr Rosie Ilett explores the views and experiences of NHS managers in Scotland, where cuts are beginning to bite and political parties are preparing for Scottish Government elections in May.

All NHS managers work in a complex environment. Everywhere in the UK, roles and organisations are under threat and patient expectations and demands continue to rise. Anti-manager pronouncements by politcians and the media also affect managers.

But against this backdrop, managers continue to work with national and local partners to deliver healthcare and promote health improvement.

Until fairly recently, the Scottish NHS has been less affected by cuts than other parts of the UK. Efficiency savings, the freezing of some posts and reductions in some developments have been the main stringencies required of Health Boards in the past few years.

The minority SNP Government had remained optimistic about future NHS funding and was publicly supportive of healthcare managers. Last summer, the Cabinet Secretary for Health, Nicola Sturgeon, told this magazine that there is no central definition of frontline services or NHS staff, and reaffirmed the importance of managers (healthcare manager, summer 2010). But in October, she announced to the SNP party conference a reduction of senior NHS managers in Scotland over the next

“When people ask me what I do for a living…

I say NHS manager with an uneasy laugh.”

four years. A subsequent Scottish Government publication said that ‘NHS Boards will be expected to cut the number of senior managers by 25% – not because we don’t value the work that they do, but when budgets are tight we must invest every penny we possibly can in frontline services.’ This Scottish budget statement in Novem-

ber 2010 reinforced this message which, although yet to be implemented, appears to indicate a shift in the definition of frontline staff.

As part of my research at the Glasgow Centre for Population Health, I have been looking at how the professional and personal identities of NHS managers affect their decision-making on public health and health inequalities, and have interviewed more than 20 middle and senior managers in NHS Scotland about their experiences.

Managers in the middle Scottish NHS managers are aware of how negative media coverage is directly and indirectly linked to government policies. Colin, a quality manager, says that managers are often blamed for political decisions. issue 9 | spring 2011 | healthcare manager

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NHS REFORM

‘Somewhere along the line the politicians are actually going to have to take responsibility. And the way it is set up just now is the service managers and the NHS managers have a terrible reputation in society, particularly in the media. They are always blamed for everything without actually looking at the root cause, the root cause is the way the system overall is set.’

Claire, a nursing manager, makes a similar point about politicians. ‘I think it’s a game they play in some respects.

It is very easy to say you are not managing this effectively, and there is too much paperwork and too much bureaucracy in the system but actually it is them that impose the bureaucracy.’

Although managers understand their relationship to government, some question how they relate to the healthcare professionals often typified as the essential ‘frontline’. For example, Alison, who works in organisational development, perceives that ‘my job is seen as a luxury and they may get rid of me’.

She admits that ‘sometimes I do think that... it’d probably be more useful to have a health visitor’. But at the same time she recognises her economic value, saying that ‘my job stops the use of really expensive external consultants to do stuff that needs to be done, especially when you’ve got an organisation that goes through continuous amounts of change’.

Other managers made similar comments, evoking the polarised metaphors often applied to different staff groups in the NHS. Barbara, working in a strategic partnership, says that seeing managers as demons and clinicians as angels makes multi-disciplinary working and understanding the impact of cuts, more difficult.

‘I resent being demonised and held up against clinical staff that are seen as being angelic or whatever… locally the 16

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clinical staff value me and my team, and they value the support that we give them. I also know that, if our role was taken away and absorbed into the clinical world, half the stuff wouldn’t get done...the skills aren’t there, that’s not what the clinical staff are there to do.’

When occupations are pitted against one another, organisational culture is affected, and alliances, relationships and even friendships can change.

Chris, a mental health service manager, has noticed changing behaviours, with conflict and competition, not co-operation, becoming more common as the cuts begin to bite.

‘It overshadows everything, and it’s not even so much the cuts themselves that have a big impact, but the culture that it creates of fear, defensiveness,’ he says. ‘I’m certainly seeing more evidence of...anxious staff, and disputes springing up where you might expect a

bit of common sense to prevail. Everybody’s trying to crane their neck up slightly higher than everybody else, saying, “I did this”.’

Managers wanting to manage Work identities are affected by how individuals relate to their role and how their personal values fit those at work.

A number of studies have explored this, including a 2009 study of NHS Managers by Faruk Merali (Social Responsibility Journal, Vol 5 No 2).

Many managers question the inference that managers are not committed to the NHS and its values.

Paul, a clinical network manager, reflects the negative culture experienced by NHS managers. ‘My view is that people work in the health service because they want to. And in almost all cases they could be in more lucrative careers elsewhere. I think as a profes-

NHS REFORM

sion the managers are down there with traffic wardens and estate agents, and in fact even more so.’

As Paul suggests, people make career choices for reasons and motivations that can change over time. NHS managers come from a variety of backgrounds – from clinical posts, from other sectors, and through the NHS management trainee scheme. In my study, 69% had had other careers before joining the NHS, including within local authorities, the voluntary sector, banking and academia. Less than a third had only worked in the NHS, with a number starting in clinical roles such as nursing.

Managers and identities Diversity gives NHS managers experience, connections and knowledge to draw on, but this can make external criticism easier and contribute to managers feeling vulnerable, because they do not necessarily identify themselves as a united group with a clear skill set. My study found different levels of identification with being a manager, and the current environment may affect this both individually and collectively.

A 2008 study by Walsh and Gordon, ‘Creating an individual work identity’ (Human Resource Management Review, No 18) explored the links between occupational and work identities, noting that ‘the greater its perceived distinction and status enhancement, the more likely members will use that group’s identity to create their own individual work identities’. Where an occupational group is or perceives itself to be under attack, individuals may feel conflicted and less willing to discuss or promote their role. As one manager, Nick, implies, being a manager is not always something to be open about.

‘When people ask me what I do for a

“Do we want to take up valuable clinician time by asking clinicians to do things they are not trained to do, or do we want to leave them to do the things that only they can do?” living … I say NHS manager with an uneasy laugh,’ he says.

Those from clinical backgrounds need to balance a health professional identity with that of a manager. A study of nurses moving into management by Sally Sambrook in 2006, noted that their development was ‘fraught with issues of identity’ (Journal of European Industrial Training, Vol 30 No 1), and my study also found ambivalence among managers who had initially trained as nurses.

Gillian, recently appointed as a senior manager said she saw her identity as that of a nurse, ‘because I don’t necessarily see myself as a manager’, and admitted that, if asked at a party, she would say she was a nurse.

It may be the case that their earlier professional identity and the time spent training remains more resonant for some NHS clinical managers than their more recent management role, although this may change during their career.

Managers are needed Any Scottish NHS manager can get an impression of how the public and media see them by googling ‘NHS managers in Scotland’, as I did in November 2010. Of the top ten sites, four referred directly to the SNP announcement about reducing NHS managers and one to a Facebook group advocating cutting NHS managers instead of nurses. This antimanagement background noise does little to support the contribution of NHS managers in Scotland who feel that

their jobs are threatened and that they are, as in other parts of the UK, seen as replaceable by clinicians.

Some, like Jean, look back and see previous examples of imagining that anyone can ‘do’ management. ‘There is a lot of confusion about what a manager is and what managers do. I think the general public in particular don’t tend to be encouraged to think about the positive things the managers do.

And there is little perception of the fact that if we don’t have people who are dedicated to performing those functions, then the functions would have to be performed by clinicians.

‘I think the dilemma and the questions are – do we want to take up valuable clinician time by asking clinicians to do things they are not trained to do, or do we want to leave them to do the things that only they can do?’

In this description, Jean suggests managers perform a functional role that is vital and valuable, and different from that of clinicians, whatever the financial environment. It is clear that many managers in Scotland, as in other parts of the UK, continue to feel motivated and committed to their work, whether they see themselves strongly as managers or as someone loyal to their clinical identity. How the 21st century NHS will eventually construe management remains to be seen, but writing-off the contribution of a cadre of people as unnecessary and replicable seems wrong. From the evidence of my study, the NHS is likely to lose a large number of loyal, talented and creative people whom it will be very difficult to replace.

.

Dr Rosie Ilett is Deputy Director at the Glasgow Centre for Population Health and vice chair of the MiP national committee.

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ENVIRONMENTAL ISSUES

Emma Dent navigates the latest plans to put the NHS on a sustainable footing.

In 2009, a joint commission by medical journal The Lancet and University College London carried a stark warning; climate change poses the biggest single threat to human health in the 21st century, but neither healthcare practitioners or policymakers had grasped the extent of the problem.

Two years on and it seems the message is still not getting through. Sustainability in healthcare remains a niche issue and can hardly be described as being at the top of most health policy agendas, either at na-

First foot forward How NHS organisations are making a difference now.

tional or local trust level.

Yet the need for change remains. In response to the need for a sustainable health system, the NHS Sustainable Development Unit (SDU) has published a ‘route map’ described as ‘a framework for action to develop a sustainable health system’. It states that instead of seeing sustainability as an add on, it needs to be fully integrated into culture, practice and training.

Developed after consultation with 70 NHS organisations and others, including organisations such as the Carbon Trust, the Environment Agency and the World

NHS Oldham has introduced a system which forces computers to turn off at night. It expects to reduce its annual costs by £41,000 a year and reduce its carbon footprint by 800 tonnes a year.

Chesterfield Royal Hospital Foundation Trust has had a joint board and governor sustainability committee in place since 2007.

Policies devised by the committee include working with a local bus company to establish a new bus service to the hospital, stipulating that all food served in the main canteen come from within 50 miles of the hospital and multi-occupancy car parking spaces.

Travel was the focus of work by North Lincolnshire & Goole Hospitals Foundation Trust. Spread across three sites, journeys between them accounted for a third of all staff mileage. The trust has since introduced a staff shuttle bus and promoted cycling to work, by introducing lockable bike storage areas and improving showering and changing areas for staff.

More case studies can be found at www.sdu.nhs.uk.

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issue 9 | spring 2011 | healthcare manager

Business Council for Sustainable Development, the route map focuses on innovation in models of care and technology, behaviour at individual and societywide levels, and standards in system governance and use of resources.

The route map includes a timetable for the work the SDU believes needs to be done in each area between now and 2050. To give two examples: on technology, the NHS needs to move from adopting and investing in sustainable technologies now, to incorporating low carbon technology in all healthcare services and products by 2050; while

ENVIRONMENTAL ISSUES

“The transformation agenda means instead of getting someone to hospital in a better way, there is no need for them to go to hospital in the first place.”

Dr David Pencheon

staff need to understand what they can do now, by 2050 they should demand zero tolerance of unsustainable behaviour.

NHS Sustainable Development Unit director Dr David Pencheon explains why the framework is necessary. ‘Over the last 12 to 18 months a large number of people in the NHS have picked up the baton but there is a challenge in keeping that enthusiasm going and ensuring people learn from each other. And in any area you need to assess your progress,’ he says.

Dr Pencheon says that to be truly sustainable, two key messages have to be understood. ‘There is the message about efficiency – doing what we do better and doing less, and there is the transformation agenda. That means, instead of getting someone to hospital in a better way, there is no need for them to go to hospital in the first place.

Or instead of better ways to treat diabetes, stop people getting diabetes in the first place.’

Although there is evidence that the NHS is taking the sustainability agenda seriously, Pencheon warns that, of all the issues outlined in the route map, the need to change behaviour is perhaps the most challenging. Although technology can be developed and policies adjusted, little real change can be achieved unless the public – and in the case of the NHS, patients – demands it.

The route map outlines, that to be truly sustainable, society, recognising the long term social and health benefits

of tackling health inequalities, expanding green spaces and running low carbon services, must be fully engaged and exert an influence on policy makers. Meanwhile, individuals must know what ‘they can do to be healthier and more sustainable’ and expect to be able to make informed decisions about sustainable health, while also exerting influence. But vital as this is, the message does not always seem to be getting through to the NHS front line.

Pencheon admits that climate change can seem too big an issue for the public to grasp and the threat it poses to health is not being understood. ‘It’s entirely understandable that it’s not at the front of people’s minds.

Patients are occupied with health issues and NHS staff are equally likely to say they are too busy saving patients to be worrying about saving energy,’ he says.

Helen McCallum, director of policy, campaigns and communications at consumer group Which? is particularly interested in the behaviour part of the route map. As a former communications chief at the Environment Agency and Department of Health, she is well placed to understand how to engage the public but admits the scale of the challenge.

‘When I left the health service ten years ago public engagement was not its middle name but now there are some really good examples that show it can be done. However I don’t know if we know how to engage the public in this agenda, vital as it is. If you ask

people about sustainable healthcare they are not sure they care; what they care about is the NHS being able to fix a broken leg,’ she says.

She agrees that the public somehow seem to get left out of debates about the environment. ‘I don’t think we really know how to frame the argument.

Which? will be working with the SDU on this . It’s a difficult task but not impossible. And leaving it off the agenda is not an option either.’

Meanwhile, Dr Pencheon has stark warnings for what will happen if the message does not get through. ‘The risk is that if this is not taken seriously there is a danger that goes beyond cost and reputation. The worst-case scenario is that health becomes a technical exercise, not a humane one, focused in hospitals, that we take our eye off the prevention agenda. And that the NHS will be paying massive carbon taxes from money that should be going into a primary care centred model of care.’

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Emma Dent is a freelance writer and editor.

To read the Route Map go to www.sdu.nhs.uk/ sd_and_the_nhs/route-map.aspx

issue 9 | spring 2011 | healthcare manager

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LEGAL MATTERS

legaleye Victoria Phillips explains the purpose and implications of compromise agreements.

A compromise agreement is a legally binding agreement, usually between an employee and employer, when the parties want to set out the terms and conditions that will apply when a contract of employment is to be terminated or a dispute is to be resolved.

There are a number of circumstances when a compromise agreement can be used, such as redundancy, dismissal or to settle an Employment Tribunal claim.

The purpose is to provide certainty for both parties and it is very important that employees understand what they are agreeing to before signing it.

It is a requirement that an employee being asked to sign a compromise agreement has received independent legal advice from someone professionally qualified (usually a solicitor or qualified trade union adviser) to give that advice. This is set out in s.203 of the Employment Rights Act 1996. In most cases the employer pays or contributes towards the cost of receiving legal advice on the agreement.

Although there is no legal obligation on employers to provide a reference, employees should try to get a reference incorporated into the agreement early on in the negotiations. Any reference provided should be true, accurate and fair; otherwise the employer may be guilty of misrepresentation.

The most important thing to understand about a compromise agreement is that in signing it and accepting the settlement terms the employee is specifically excluding their right to make a claim against their employer in the Courts or an 20

issue 9 | spring 2011 | healthcare manager

Employment Tribunal. So if they are owed wages or benefits such as bonuses or accrued but untaken holiday pay, they need to be dealt with in the agreement.

The only legal claims an employee who has signed a compromise agreement will have against their employer would be if the employer breaches the agreement by, for example, not paying the money agreed, claims for accrued pension rights or personal injury claims. However, some compromise agreements also prevent employees claiming for work-related injuries and illnesses that they were aware of at the time of signing. This would usually be the case when the reason for termination is sickness absence due to stress or depression.

Confidentiality clauses are fairly standard in compromise agreements.

Sometimes a confidentiality clause will only cover the terms of the agreement, meaning that the employee can tell people that they have come to an

“The purpose of a compromise agreement is to provide certainty for both parties and it is very important that employees understand what they are agreeing to before signing it.�

agreement with their employer about the termination of employment or an Employment Tribunal claim, but cannot reveal the terms of the agreement (for example, that they will receive a sum of money).

Some employers go so far as to insist that the employee cannot even tell people that there has been an agreement. The legal advice received by the employee before signing the agreement will explain what they can and cannot say and to whom.

Compromise agreements sometimes contain a non-derogatory statements clause which prevents the employee from criticising the employer or colleagues. In negotiating a nonderogatory statements clause it is possible, by agreement, to make the clause mutual, so that neither party can make derogatory or disparaging statements about the other.

Victoria Phillips Thompsons Solicitors Legaleye is not intended to provide legal advice on individual cases, and MiP members in need of personal advice should immediately contact their MiP rep.

CAREERS

Changing, surviving, succeeding Rita Sammons on supporting your staff through change.

JOB TRANSITIONS

DELIVERY increase resilience build confidence help team through change

maintain productivity reduce absence care for your people

MANAGEMENT CAPABILITY As a manager, you need to be at your most effective at this time of rapid change everywhere in the health sector. You need to manage services even better and deliver successful change and restructuring. Staff will look to you to provide certainty when you are probably at your most uncertain.

Are you doing all you can? Do line managers have the expertise to support their staff? Can people leaving make the right next move with their dignity and self-esteem intact? Are managers helping remaining staff to see things in a positive light and to embrace future goals?

Many managers will have never

build effective processes keep the right people fair and equal opportunities

support all job changers reduce friction retain morale

REDEPLOYMENT faced such severe budget and staffing cuts, and staff will rarely have faced such a tough public sector job market. So you need to think about your outplacement and support arrangements. Do they focus on preparing staff to find jobs in the private sector as well as the public?

Staff who are uncertain and staff who know they are staying also need support. It’s important to remember that however safe somebody’s job might actually be, talk of reduced budgets, job losses and new expectations makes people uneasy, and uneasy people don’t perform at their best.

From our experience of working

across the public sector we see four clear phases in the overall process (see diagram).

Even really good managers need some help and advice when the scale and complexity of what’s happening exceeds their experience. Research shows that uncertainty inhibits people: it prevents them coping effectively with change and delays their journey towards exploring other options. As a manager are you providing the right support to the people who report to you?

.

Rita Sammons is director of NHS Flexible Resourcing.

Tipster: FACING UP TO THE FUTURE MiP chair, David Amos, shares his tips on getting through the tough times ahead

 Be confident you are doing a great job, providing high quality and value for money health and social care services. Don’t forget this.

2 Expect the best you know what good management looks like – make sure you demand the highest standards when changes affect you directly.

3 Get clarity and direction from those responsible for leading the forthcoming changes.

4 Make your voice heard your knowledge and experience of what is good for patients and taxpayers comes into its own at times of upheaval.

5 Self-protection use your networks and support systems to protect yourself, including MiP of course.

6 Do unto others…

7 Take stock what have you learnt during your career and what new skills and knowledge do you need to put you in the best position to continue doing what you do best?

8 Do your housekeeping get your contractual and personal performance paperwork in order, so that you can act fast if you want or need to change jobs.

do what you can to show leadership in these tough times – you know it is satisfying to do so.

issue 9 | spring 2011 | healthcare manager

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MiP AT WORK

Policies will founder without good management MiP’s response to the Government’s Health and Social Care Bill.

MiP is lobbying on behalf of its members to raise concerns about the Health and Social Care Bill. Around the country, we have been getting members’ views on the proposals and their likely impact on quality, and raising their concerns with MPs and officials.

The Bill sets out radical new approaches to commissioning and providing healthcare in England, and means massive upheaval for MiP members. We set out some of our concerns below.

Rapid pace of change risks chaos

It is a huge risk to attempt radical changes in every part of the NHS at once, when management posts are being cut. Organisations are cutting management costs drastically without planning for the future.

Skilled staff are being thrown on the scrapheap to meet short term goals, putting long term provision at risk. MiP believes the requirement for 46% reductions in management costs should be eased to avert chaos in implementing the changes.

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the availability of patient services in a market where providers could fail and services disappear. The consequence of an even greater postcode lottery for the NHS needs serious consideration. Meanwhile, the requirement for consortia to be neutral between public or private suppliers when commissioning services, further threatens the public sector ethos within the NHS. An intermediate strategic tier

consortia, to reach their hoped-for potential, and they need managers to make it happen.

GP commissioning consortia: a governance gap?

All NHS staff, including managers and doctors, need to be robustly accountable but we doubt that Health and Wellbeing Boards will have enough power, or that the National Commissioning Board will be sufficiently resourced. If the only oversight is to be exercised by the Commissioning Board, this represents a significant centralisation of powers.

Successful change needs responsible and orderly management

Price competition: decisions based on cost not quality?

MiP constantly challenges the anti-manager rhetoric which has accompanied the proposals.

Managers are an essential part of the healthcare team, and it is counterproductive to vilify them as some politicians have been doing. Even with excellent change management and planning, it will take three to five years for new structures, such as GP

Competition is not always the best way to drive efficiency. Many services can’t be priced neatly or specified in fine contractual detail. Competition must be driven by quality, not price.

Recent concessions will need careful scrutiny.

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Risks of a competitive market

MiP is concerned about safegaurding

We believe a strategic tier between GP consortia and the National Commissioning Board will still be needed. Many situations will require a co-ordinated approach across much larger geographical areas than GP consortia will cover, needing either specialist knowledge or a strategic decision-making. One example is emergency planning for flu epidemics or other civil contingencies.

The healthcare team working together

MiP is discussing the impact of the proposed changes with other organisations. Many GPs and their organisations, such as the Royal College of GPs, have spoken up for managers, saying they want good managers working with clinicians on the team. We will continue to challenge anti-management rhetoric and the fake distinctions between the frontline and back office. .

The full MiP parliamentary briefing is available on the MiP website: www.miphealth.org.uk

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13:11 Page 1 MiP AT WORK

MiP takes its message to Holyrood

These are uncertain times.

MiP hosted a reception at Holyrood in February, bringing together MSPs and health managers from throughout Scotland to present MiP’s manifesto for health.

Speaking at the reception, Scottish health minister Nicola Sturgeon repeated her election pledge to reinvest all NHS savings in frontline care. She stressed her comittment to quality as the measure of effective health services, and her appreciation of the contribution made by managers.

Jon Restell, MiP chief executive, celebrated Scotland’s long tradition of partnership working between government, employers and unions, but warned politicians against attacks on managers in the forthcoming Scottish election.

‘First, the false division between the frontline and back office undermines the healthcare team delivering a complex system of care,’ he said. ‘Secondly, politicians must not mislead the public into thinking that management cuts will deliver all the savings required.

Management cuts are a drop in the ocean and remove the very people who have the skills to make savings without cutting the quality and safety of services.

Any proposals to cut managers must be based on evidence, not politically attractive percentages, and developed in partnership with managers themselves.

Finally, everyone agrees that public service delivery of the NHS is efficient and equitable, but the drip, drip effect of attacks on managers risks undermining the public’s confidence in public delivery of the NHS.” .

Reduce the uncertainty.

Join MiP. One thing is for certain in such times – you need support.

MiP is the UK’s only trade union organisation that solely represents healthcare managers.

We provide an influential voice, personal support and employment advice, management skills and access to leadership networks.

Our experienced team of employment professionals is on hand to offer one-to-one confidential advice, negotiation and representation and fast access to legal resources.

Join MiP today. Visit www.miphealth.org.uk/joinus

helping you make healthcare happen

issue 9 | spring 2011 | healthcare manager

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backlash

Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.

by Celticus WRONG NUMBER: MORTALITY RATES Looking to justify his market-driven NHS shake-up, PM David Cameron has hit on an unlikely comparator: the French. Downing Street has been referring hacks to OECD figures showing the UK’s mortality rate from heart attacks, at 41 per 100,000, is more than twice that of France, at 19. But what Number Ten isn’t saying is that its figures refer to a single year, 2006, when France had the lowest heart disease death rates in the world.

Furthermore, Britain’s mortality rate has fallen faster than any other country’s since 1980 and on present trends we could surpass France as soon as next year. Merde alors!

Under or over?

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s the NHS overmanaged? Not according to the Government’s own figures. The 2011 Skills for Health report found the NHS was ‘dominated by clinical roles’, with 54% of staff doing ‘professional’, ‘associate professional’ or ‘technical’ jobs. Only 7% of NHS staff are ‘managers and senior officials’, compared to 16% in the economy as a whole. Figures are from the Labour Force Survey, regarded as the most accurate source of employment statistics.

Money-GoRound

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aised eyebrows all round as NHS London brought in a team led by pricey consultants KPMG to support GP consortia in the capital.

And who should pop up as the KPMG partner running the project? None other than Gary Belfield, acting 24

All together now

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question for locals from Portsmouth LINk, one of the ‘Local Involvement Networks’ set up to encourage public involvement in the NHS: ‘Alcohol-related hospital admissions has [sic] hit 1 million a year for the first time, costing the NHS thousands. How can this be reduced?’ And the same question to the people of Solihull. And Warwickshire, Hampshire and Buckinghamshire. It fact, every LINk has been asking the same questions since they all joined Twitter on the same day in June 2009. But it’s good to see everyone tweeting from the same songsheet.

Blood money? director of commissioning at the Department of Health until last year. Belfield held the DH post for just eleven months, after succeeding Mark Britnell, who left to join – you guessed it – KPMG. The Canary Wharf-based firm said it would provide a ‘package of business, finance, governance and personal development support’ for London’s eight ‘pathfinder’ consortia. Cue much anger from London GPs, who say they weren’t consulted over the contract.

issue 9 | spring 2011 | healthcare manager

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ndeterred by the brutal felling of plans to privatise the Forestry Commission, ministers have rushed forward proposals to flog off the NHS blood donor service. Can we really ask

people to donate their blood and organs when someone will be making big bucks out of their generosity?

And could we then blame donors for wanting a slice of the action? Expect more ministerial blood on the carpet over this.

Rebel MDs

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evolution is in the air, and not just in the Mahgreb.

Unrest in the ranks is now threatening to topple the BMA leadership. At a special representative meeting of the union in March, some doctors, who say the BMA has been too soft on the government over the Health Bill, will be demanding regime change and plan a vote of no confidence in Mr Secretary Lansley. Insiders say there is a fair chance the meeting will commit the BMA to total opposition, forcing BMA chair Hamish Meldrum to quit. Offers of asylum most welcome.

Talking shop

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e’re pleased to welcome MiP chief executive Jon Restell to the NHS Twitter community. Follow Jon’s thoughts on healthcare management (and maybe the fortunes of Crystal Palace FC) under the username @Jon_Restell.

Working together for you The Open University and Managers in Partnership have joined forces to encourage greater participation in health sector education and training. Between us, we offer a wide range of modules and qualifications to make a difference to your life, your career and the people in your teams.

Whether you are an Administrator or CEO, Clinical Nurse Manager or Business Manager, there are a range of modules and qualifications that will help develop skills in areas of practice from policy interpretation to research. Our flexible work-based learning fits with busy work and home commitments. Modules are vocationally relevant based on cutting-edge research and learning materials, to ensure that what you learn today, you can apply tomorrow – making an immediate and effective impact to improving levels of care.

Did you know?

• UNISON/MiP members receive a 10% discount on many of our courses • Learning materials reflect the day-to-day practical issues involved in running a hospital ward or clinic.

Postgraduate options designed with you in mind Postgraduate Certificate in Advancing Healthcare Practice (C92) Postgraduate Diploma in Advancing Healthcare Practice (E46) MSc in Advancing Healthcare Practice (F52) MBA (AMBA accredited) (F61) Professional Certificate in Management (C31) Certificate in Professional Practice in Delivering Public Services (K02) Postgraduate Certificate in Clinical Leadership (K04) Postgraduate Certificate in Professional Practice (Children and Families) (K14) Postgraduate Diploma in Advancing Professional Practice (Children and Families) (E70)

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