Healthcare Manager Winter 2010

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issue 8 winter 2010

healthcare manager inside heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Trevor Millar, Director, adult mental health, Western Health & Social Care Trust inpublic: NHS/MOD partnership for mental health

letters & comment:8 Dr Jagdeesh Dhaliwal on the evolving role of the NHS manager

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.

features:10 Open University: Learning at your own pace Interview: Welsh health minister Edwina Hart All change: Chris Ham on managing the reforms

regulars:20 Legal eye: looking at the new equality act Tipster: prepping for an interview MiP at work: tackling gender-based violence; MiP responds to the white paper MiP around the UK: Brent & Scotland

backlash:24

Welcome to the eighth issue of healthcare manager the magazine from Managers in Partnership, the trade union organisation for managers in health and social care.

In this issue contributors discuss the ways in which clinicians and managers can bridge that gap and work together to shape the health services. Chris Ham argues that clinical leaders need to work hand in hand with professional managers to build successful health services and Jagdeesh Dhaliwell calls on managers to be more proactive in promoting their Unique Selling Point – their management skills – to other NHS colleagues, including GPs. We also hear from the Open University about the range of courses they have on offer to managers.

Continuing our tour of the UK, we have an interview with Welsh health minister, Edwina Hart, who explains the Welsh Assembly’s approach to healthcare reform. We also have our regular features on working in healthcare.

And, for MiP members receiving this by post, we enclose a calendar mousemat for 2011, with best wishes for the coming year from all at MiP. Marisa Howes Executive editor

issue 8 | winter 2010 | healthcare manager

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HEADS UP

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

consulting on several proposed changes to the NHS Constitution, which aim to give teeth to the current safeguards for whistleblowers in the 1998 Public Interest Disclosure Act. The changes will:

MPs launch complaints probe

The consultation document is available on the DH website find it from www. miphealth.org.uk/hcm.

The Commons health committee has announced an inquiry into complaints and litigation in the NHS, following criticism of the way complaints are handled from the public inquiry into the Mid-Staffordshire NHStrust.

As part of its inquiry the allparty committee of MPs, chaired by former health secretary Stephen Dorrell, will examine the new complaints system run by the Health Service Ombudsman, introduced in April 2009.

The inquiry will look at the reasons for the recent sharp rise in NHS complaints, the effectiveness of the different mechanisms for handling complaints and plans for handling complaints set out in the government’s recent white paper. The MPs will also examine the rising cost of litigation against the NHS and how it has affected costs and working practices within the health service.

Ann Abraham (pictured), the

healthcare manager

Executive Editor

Contributors

issue 8 | winter 2010

Marisa Howes m.howes@miphealth.org.uk

ISSN 1759-9784 published by MiP

Associate Editor

Jagdeesh Dhaliwal, Martin Evans, Chris Ham, Lauren Hardy, Gareth Hughes, Marisa Howes, Liz McCarten, Alison Moore, Jon Restell, Craig Ryan, Jo Seery.

All copy © 2010 MiP or the author.

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

Art Director

■■ Insert an expectation that

NHS staff will raise concerns about safety, malpractice or wrong doing at work which may affect patients, the public, other staff or the organisation itself as early as possible ■■ Insert an NHS pledge to

Whistleblowers

More protection for whistleblowers Health secretary Andrew Lansley has announced new measures to give more protection to NHS staff who raise concerns about safety or malpractice at work, following concerns raised during the inquiry into the events at Mid-Staffordshire NHS Trust.

The Department of Health is

support all staff in raising concerns about safety, malpractice or wrong doing at work, responding to, and where necessary investigating, the concerns raised ■■ Highlight in the NHS

Constitution the existing legal right to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.

The closing date for submissions is 11 January 2011.

Craig Ryan editor@healthcare-manager.co.uk

Print Warners Print, Bourne, Lincs

James Sparling

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

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Parliament

issue 8 | winter 2010 | healthcare manager

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

Health Service Ombudsman has recently published a report on her first year of operation. ‘The NHS needs to listen harder and learn more from complaints,’ she said. ‘When it fails to do so, it is missing a rich source of insight and information that is freely and readily available and comes directly from service users.

The deadline for submissions is Tuesday 21 December 2010. For more information go to www.parliament.uk/healthcom

healthcare manager is sent to all MiP members.

All weblinks mentioned are at www.miphealth.org.uk/hcm

HEADS UP

leading edge Jon Restell, chief executive, MiP Nothing makes you appreciate the value of something quite like losing it or being about to lose it. It is a seeming psychological fact of life, which in the debate about the future of PCTs is coming to the aid of managers. There have been some truly remarkable statements of support from doctors’ leaders. In the Treasury, concern rises daily about the holes in the Government’s plans. Managers need to do everything they can to amplify this support and harness it. The current heightened prominence of management and managers, far from being a threat, is a massive opportunity to re-make the image and role of managers in delivering healthcare.

Doctors’ leaders have been using some very strong words about the role of managers – but not in the way you’d have thought even a year ago. In recent evidence to the health select committee about GP commissioning, Richard Vautrey, deputy chair of the BMA’s GPs committee, said: ‘We do have

“The current heightened prominence of managers, far from being a threat, is a massive opportunity to re-make the image and role of managers in delivering healthcare.” concerns that senior PCT managers are leaving; the very people who we need in the future to make these changes work.’ He added that experienced health service managers would be vital to the new GP consortia: ‘What’s been lacking is a very clear message from the centre saying we value you and we do want you to stay.’ Echoing the BMA’s position, Steve Field, chair of the Royal College of GPs, was quoted as saying that he wanted to see more support for managers. This is critical support.

Managers should encourage clinical colleagues to support the need for good management at the heart of good healthcare. An already-hard-pressed midwife talking about why she needs the support of good managers to do her job better carries more weight with the public and politicians than anything we can say.

Now is a huge opportunity to make the case for managers as members of a multi-professional healthcare team. To seize the opportunity, and to ensure the current mood is not a flash in the pan, we need to talk and relate to clinical colleagues as never before.

This dialogue has the power to change our mindset and free us from the bureaucratic impulses of the centre. Only by mobilising every healthcare worker in a high performing team, working on the ground to meet the needs of local people, will we meet the challenges of the next three years.

Vetting

Home Office to overhaul vetting process The Government has announced the terms of reference for the long-awaited review of the vetting and barring scheme (VBS) in England, Wales and Northern Ireland.

The VBS aims to protect children and vulnerable adults by stopping people who pose a known risk of harm from working with them.

During the review the Vetting and Barring register managed by the Independent Safeguarding Authority (ISA) will be suspended, although individuals can still be referred to the ISA for investigation and barred from working with vulnerable adults and children.

The government has also launched a review of the criminal records regime, to be led by Sunita Mason. The first stage of the review will run in parallel with the review of the VBS, while the second will look at the criminal record system including what information is held, who has access to it and how the system be simplified.

These internal government reviews are not open to full public consultation although MiP will be consulted as a key stakeholder via the staff side of the Social Partnership Forum.

Further information is available on the UNISON website at: www.unison.org.uk/prru/ vetting.asp or from the Home Office follow the link at: www.miphealth.org.uk/hcm

issue 8 | winter 2010 | healthcare manager

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HEADS UP

NHS leadership awards

Award for prison project Shining a light on good practice

Comedian John Ryan won the award for Mental Health and Wellbeing at the NHS South East Coast health and social care awards for the prison project Beyond Prison. The project sheds light on mental health and diversity issues, with John running some workshops and then turning the research into a comedy show. The project also followed some people after they left prison to show what happens next. The show and workshops were filmed in a prison in Surrey. John is pictured here with Maya Twardzicki from Surrey PCT who coordinates the project.

MiP 2011 subscriptions Members who joined MiP after 1 June 2005 pay MiP subscriptions as set out here.

Members who transferred into MiP from FDA or UNISON when it was launched on 1 June 2005 (founding members), pay the relevant rate of the partner union from which they transferred.

MiP subscriptions are proposed by MiP’s management board, in consultation with MiP’s national committee, and approved 4

by the FDA annual delegate conference. All subscription enquiries should be made to MiP. All subscription rates shown in the table come into effect on 1 January 2011.

Tax relief on MiP subscriptions As a healthcare manager, you may be entitled to tax relief on your MiP subscriptions in the same way as members of other professional organisations such as the Royal College of Surgeons. For more information log into the members’ page of the MiP website: www.miphealth.org.uk

issue 8 | winter 2010 | healthcare manager

Following a high number of nominations, the 29 short-listed finalists for the 2010 NHS Leadership Awards have been announced.

The national awards scheme aims to recognise outstanding leaders working in and with the NHS, and encourages the leaders of the future from every level and background. The winners will be announced at the awards ceremony on Wednesday 8 December.

MiP is again sponsoring the award for Mentor of the Year.

From a strong field of nominees, the finalists are: Martin Hall from Cambridgeshire and Peterborough NHS FT, Patricia Houlston from NHS West Midlands and Elisabeth Paice from the London Deanery, NHS London.

MiP chief executive Jon Restell said: ‘We are delighted to be backing the NHS Leadership Awards again. Mentorship is an invisible resource of enormous power in the NHS. We want our award to shine light on the best mentors, their practice and their achievements, so as to inspire others.’

The NHS Leadership Awards are co-sponsored by MiP, Novartis, CSC and the Institute of Innovation and Improvement.

To view all the shortlisted nominees and details on the finalists for 2010 visit: www.nhsleadershipawards.nhs.uk

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HEADS UP

inperson Trevor Millar:

Director of adult mental health and disability services, Western Health and Social Care Trust, Northern Ireland

Trevor Millar admits that it’s his job that gets him out of bed in the morning: after around 30 years in the NHS, he still gets a buzz from the daily challenge of improving services for patients.

But this is not an easy time to work in Northern Ireland: the effects of the UK spending review are feeding their way down to the administration and money is already tight. However, as one of five directors leading learning disability and mental health services across Northern Ireland, Trevor has been making the case for investment in these ‘Cinderella’ specialties.

‘Learning disabilities and mental health for years had not got the amount they should have had,’ he says. ‘Public opinion was very much in favour of the acute sector and everyone wanted to see a very technologically advanced hospital.

The community care required for individuals with very difficult mental health situations was not there.

‘Myself and the other directors are at the table demanding our share of resources. I’m sure we are now getting our share!’

However, he admits it can be difficult when clinicians come forward with plans that can’t be funded immediately. ‘We have to make decisions that people don’t particularly like or understand. That’s where communication is so vitally important.’

A key concern of the five directors is ensuring equal standards of care for patients across Northern Ireland. ‘Everyone was coming from, not just different viewpoints, but different models of care and pathways of care, and had their own ways of working,’ says Trevor. One of the strengths of Northern Ireland’s system, Trevor believes, is the integration of health and social care, which promotes a holistic approach to care and can improve crucial areas such as discharge planning.

Trevor’s career path has not been

“We have to make decisions that people don’t particularly like or understand – that’s why communication is so vital.” straightforward. After a serious accident aged 17, he was in and out of hospital for two years, something that inspired an interest in radiography and physiological testing. But continuing problems with his legs meant that a radiography career – with constant standing – was risky. So, looking for a career where he could sit down, he trained as a podiatrist. ‘I really enjoyed my time as a podiatrist. It is one of the professional areas where you can really develop a relationship with patients.’

From there he worked as a locality manager before being made trust programme manager of learning disability services in 2000 with a mandate to move services into the community.

‘I got great satisfaction from seeing people who had maybe lived there for 30 years moving into a community setting where they might have a house with a number of other individuals,’ says Trevor.

‘They experienced things that the rest of us take for granted, like going on holiday, and they integrated into the community.

It was gratifying to see the skills they developed.

‘It was really a move forward for us as a trust to move away from institutional care. A hospital with 100 long-stay beds became one with about 40 for assessment and treatment.’

Trevor finds his clinical background helps in his present job – both in getting respect from clinicians and in understanding what is being talked about. ‘It does provide you with the knowledge of what people are going through – but I think staff are more empathic towards me as well.’

Now 50, Trevor’s passion for the NHS runs in the family. His wife is a tissue viability nurse, one of his daughters is training as a mental health nurse, another is considering an occupational therapy career and the third has done work experience in the NHS. Alison Moore issue 8 | winter 2010 | healthcare manager

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HEADS UP

Quality

Commissioning

GPs move New yardstick for hospital death rates centre stage

Experts have agreed a new measure for mortality ratios in the NHS, following criticism of existing techniques in the Francis inquiry into patient deaths at the Mid-Staffordshire NHS Trust.

The new method, published by the NHS National Quality Board, is called the ‘Summary Hospital-level Mortality Indicator’

(SHMI). The indicator can be used by hospitals to help them better understand trends associated with patient deaths.

Hospital mortality ratios are complex indicators, with much international debate over how they should be calculated and used. The variation among existing methods and their complex nature has led to widespread confusion among NHS managers, clinicians and patients, according to the Department of Health.

Professor Sir Bruce Keogh (pictured), who commissioned the review said: ‘We are the first country to make a systematic attempt to engage healthcare providers, academics, institutions of medicine and the commercial sector in developing a clear method for assessing expected hospital death rates. The methodology will be open to public and academic scrutiny… so that it improves and becomes more useful over time.’

The new method will be subject to rigorous independent testing and analysis before being introduced by April 2011.

Conference

Meeting the challenges in health information The Patient Information Forum (PIF) will be holding its annual conference on Thursday 7 April 2011 in Birmingham. The conference, Meeting the Challenges in Health Information, will include sessions on: the ‘Information Revolution’ and ‘Choice’ consultations; the evidence for health information; shared-decision making; the barriers to information equality such as health literacy and digital exclusion; and ways of producing cost effective information.

PIF is an independent organisation for consumer health information professionals. It aims to raise the profile and professionalism of consumer health information by lobbying, networking and providing training to develop information skills. For more information visit their website at: www.pifonline.org.uk/home.

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issue 8 | winter 2010 | healthcare manager

Following the publication of the white paper, the NHS Institute is working with the Royal College of GPs (RCGP) to create a new ‘Centre for Commissioning’.

The centre, which will be launched in December, aims to help GPs and emerging GP consortia develop the skills and expertise they will need to deliver effective service development and clinical leadership.

Dr Clare Gerada (pictured), chair-elect of the RCGP said: ‘It seems natural for us to extend our support to help GPs and the wider primary care team to develop their capability, especially for the new demands on GPs as commissioners. Our aim is to aid primary care in the creation of efficient and effective systems that will in turn deliver good value for money, and, most importantly, improved patient outcomes.’

A spokesperson for the NHS Institute said: ‘From the individual challenges of leadership through to commissioning safe and high quality care for patients, we are working to tailor a range of proven, cost effective and best practice solutions ready for use.’

The centre will be supported by a cohort of 50 GP ‘commissioning champions’ from across the country who will act as development partners and co-deliver the content.

Further details from www.institute.nhs.uk.

HEADS UP

inpublic NHS-Ministry of Defence partnership for mental health

“The military are delighted with the partnership. Outcomes and length of stays are better, crucially reducing time spent in the ‘sick role’.”

healthcare of military personnel aged under 18. The NHS is moving towards accommodating all under-18s within children’s services, but the network recognised that this would not always be appropriate for young servicemen and women, given the nature of their training and lifestyle and the level of responsibility many of them hold. Therefore, the network devised a specific pathway for this group, recognising that some would benefit from treatment within an adult environment.

The link has enabled the network to develop new opportunities for education, training and development for both the NHS and MoD staff. There are opportunities for secondments, shadowing and honorary contracts, which has allowed a two-way relationship between NHS and MoD clinicians, which was previously unavailable.

The military are delighted with the partSLO Pete McCallister and Dr Paul Warren outside Parklands Hospital in Basingstoke, nership, Outcomes and length of stays have Hampshire, one of the hospitals in the NHS-MoD mental health partnership. improved, crucially reducing time spent in the ‘sick role’, and military service-users A unique partnership between NHS inpatient care, they get the best available, have expressed high levels of satisfaction trusts and the Ministry of Defence close to their homes or parent unit – and with the services they have received.

(MoD) is working to provide support to that is exactly what this achieves. It Lt Col Mark Earnshaw said the network serving military personnel experiencing matches the community-based approach had ‘delivered an excellent mental health mental health problems. we follow for our outpatients who are seen inpatient service for military patients In November 2008, the Ministry of Deat our regional military mental health since the award of the contract in early fence awarded the contract for the service centres across the UK.’ 2009. They consistently provide high qualto a network of mental healthcare providThe contract is managed by SSSFT, as ity care, guaranteed access within agreed ers led by South Staffordshire and the prime contractor, via a partnership timelines and deliver a key service for Shropshire Healthcare NHS Foundation board. In addition, a clinical forum has military personnel.

Trust (SSSFT). Since then, servicemen and been developed to share best practice and ‘SSSFT are extremely sensitive to the women have been referred for treatment learning and to develop standardised poli- specific needs of the military patient group and support to NHS Trusts in Tees, Esk and cies and procedures where necessary. and we are confident that this relationship Wear Valleys, Lincolnshire, Somerset, So far, the network has developed a provides the most effective framework for Hampshire, Cambridgeshire and Peterbor- number of collaborative care pathways delivering important in-patient services ough, the Grampian region and Glasgow. and models of care in partnership with the for our personnel.’

This is the only NHS network set up to MoD. The MoD employs service liaison Neil Carr, Chief Executive of SSSFT said: provide integrated services in this way officers, clinicians who provide the link ‘We are delighted with the network workand, in the current tight financial climate, between the NHS and the MoD’s own com- ing relationship and our close harmony the partnership keeps public money in the munity mental health teams. It is a with the MoD. I am proud of our innovapublic sector. mutually beneficial relationship, helping tive approach to meeting the needs of this When the network was set up, the then to develop knowledge and awareness of group of people, providing localised care defence minister Kevan Jones said: ‘I want cultural differences. across the whole country.’ to make sure that when our people require One example of this partnership, is the Martin Evans issue 8 | winter 2010 | healthcare manager

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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

Arts and health

We want your views on a strategy for arts and health. Leicester City PCT, Derbyshire PCT and Lincolnshire Partnership Foundation Trust have joined forces with charity Big Difference Company to develop a strategic case for arts and health in the East Midlands.

The term ‘arts and health’

means many things to many people. The arts are used in a range of health contexts, for example, therapeutic interventions, public health, estate management, mental health and palliative care.

Through consultation with MiP members and other stakeholders the project aims to make sense of this diverse yet important landscape, to ensure that arts can support health and social care to its maximum potential.

I am keen to gather evidence, ideas and thinking around the enablers and blockers of good practice: what are the challenges ahead and what will support health professionals and artists to overcome such challenges together?

We are asking MiP members to contribute to this exciting project.

Contributions will help to ensure that the project is robust; supporting better outcomes within the East Midlands and, we hope, beyond. Send your thoughts on the relationship between arts and health to me at creative.cultural.learning@ gmail.com along with your contact details.

Adam Clarke Project Consultant East Midlands Arts and Health Strategy

Taking care with email

In light of some recent casework I think MIP members need to be aware

of the risks of misuse of NHS email accounts.

I have had cases where members have emailed risky material to colleagues, thinking it was innocent fun! Sending any non-NHS correspondence that might cause offence is usually considered to be gross misconduct and can lead to legitimate dismissal.

Advice from Thompson’s, the union solicitors suggests that members would be unlikely to win an employment tribunal in such circumstances. Legally all email work accounts are the property of the employer and whilst some organisations allow limited and appropriate personal use, this must not be used for social networking sites like facebook, and never for any material of a crude or sexual nature.

Please take care on how you use your work email.

Ray Rowden Associate National Officer MIP

Keep in touch with MiP Do you receive the News from MiP emails? If you are a member of MiP then you should receive the emails MiP send to all members about once a month – or more frequently at times like these when things are changing rapidly. If you don’t get them it could be because your membership records are not up to date.

You can check your details online and update them if necessary on the MiP website. Just go to www. miphealth.org.uk and login to the members’ area. If you haven’t done this before, your username is your MiP membership number and your password is your surname.

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issue 8 | winter 2010 | healthcare manager

comment

OPINION

“the silver lining is our opportunity to develop a fresh, more selfempowered relationship with our work.”

Dr Jagdeesh S Dhaliwal

GP and Associate Professor in Health Services Management, University of Warwick

The evolving NHS manager Sixty-five million years ago an asteroid smashed into the Earth. Its impact, scientists believe, triggered massive climatic change, which led to the extinction of the dinosaurs.

Their demise created an ecological niche that permitted the rise of nimbler, more adaptive mammals.

On 12 July 2010, the coalition government published the NHS white paper, Equity and Excellence: Liberating the NHS. The white paper heralds largescale climatic change in the NHS with the demise of SHAs and PCTs and the formation of GP commissioning consortia.

NHS managers are a resilient species and most colleagues have adeptly negotiated previous successive shock waves of NHS re-organisation.

This current revolution, by contrast, reverberates at a far higher level up the Richter scale. It ushers in a new epoch for health services.

How, then, might today’s healthcare manager choose to intelligently adapt to this new habitat and ensure his or her unique contribution to the provision of health services for patients?

A profound, yet subliminal, change triggered by the white paper, I believe, is the blasting apart of the myth of secure employment in healthcare. The culling of SHAs and PCTs amply demonstrates this. By forcing each of us to confront the brutal truth that we cannot depend upon the NHS to keep us safely in employment, the silver lining that emerges is our opportunity to develop a fresh, more self-empowered relationship with our work. The unwritten contract

of being ‘a cog in the NHS wheel’ in return for a guaranteed monthly pay cheque should be resolutely torn-up by all of us. In place of an outmoded and inherently unhealthy culture of excessive conformity, reliance on topdown decisions and a dinosauresque reticence to innovate, managers can now choose to adopt a mindset through which they see themselves as adaptable and entrepreneurial independent contractors to the NHS. After all, a job in the NHS only constitutes a time-limited contract – not a job-for-life.

This new mindset among managers will resonate strongly with the archetypal independent contractors to the NHS – GPs. The adaptive advantage of this way of thinking is that managers will become far more proactive in developing and communicating their ‘Unique Selling Points’ to other NHS colleagues.

These include technical skills – finance, accounting, health economics, commissioning, IT, HR, estates, project management – but also generic management expertise in three key areas: Research and innovation: What does the latest general management research say? Are you a member of a journal club? We would be aghast if clinicians didn’t keep abreast of research in their fields. Managers should increasingly own and implement management research and education. Sharing this expertise with clinicians will build a new sense of respect and professional prestige.

Portfolio working and networks: A contract-based approach should lead

to a greater impetus to work across a variety of sectors. The only ‘security’ in this new age will come through having a wide network of experience and a wide network of contacts, so increasing the likelihood of picking up the next contract as the previous one ends. The richness this can add promises immense value to the design and delivery of services by enhancing job-satisfaction, encouraging adaptability and fostering innovation.

Risks and decision making: Pareddown management funding and leaner, nimbler organisations will require managers to adapt to more ‘buck-stopswith-me’ decision-making. Living with uncertainty and risk is a pre-requisite.

Experience helps, of course. As does greater familiarity with management research and education – the evidence base for decisions. This echoes the way in which clinicians live with uncertainty and take high-risk decisions. Collective decision-making and responsibility is essential, but the tendency to refer and defer ‘up’ needs to be curbed. This will make the NHS quicker and more responsive for patients and further bolster the value and status of healthcare managers.

Liberating the NHS, like that asteroid 65 million years ago, carries destruction in its wake. It also has the potential to catapult health services firmly into the vanguard of evolved 21st century organisations. How healthcare managers adapt their thinking, is, I believe, critical.

.

Views expressed are those of the author and not necessarily those of healthcare manager or MiP. issue 8 | winter 2010 | healthcare manager

9

SKILLS

Lauren Hardy on a flexible way to develop skills without losing touch with the changing healthcare environment.

Working in health service management has been, and probably always will be, a challenge. As new governments exercise their obligations to advance our ‘free’ healthcare system, managers within the healthcare system continue to adapt and change their ways of working to accommodate new policies.

Among the raft of new policies brought in by the coalition government, is a greater emphasis on patients’ experience of healthcare. This includes improved choice of where patients can be treated, encouraging health and social care organisations to work in a more integrated way, and increased involvement in clinical leadership skills.

There are additional factors contributing to changes in healthcare management, as Julie Charlesworth, lecturer in public management at the Open University (OU) explains. “The recession and public sector spending review have added another dimension to current change. Managers are now having to deal with more redundancies, organisation closures or substantial restructuring. There is also the general uncertainty of job security which adds to stress levels among staff.

“Health service managers need to develop and build on general management 10

issue 8 | winter 2010 | healthcare manager

and leadership skills. It will help in dealing with interagency working across health and social care and between the private, public and voluntary sectors. The cultural differences between these will take careful management to ensure effective working practices, in terms of managing change and resources, improving the patient journey and bringing more involvement from patients and their carers in planning and decision-making.”

The challenges of training It is unrealistic to expect health service managers to take time away from the workplace to develop new skills.

However, distance-learning can provide a convenient way to fulfil professional learning and development needs that help managers deal with the changing environment.

One such provider is the OU. It is the largest provider of part-time distance

learning courses in the UK, with more than two million students having successfully combined studying with work and home life commitments to achieve qualifications. Due to the OU’s method of delivery, managers are not required to take time away from the workplace and what they learn one day can be immediately applied in the working environment the next. Many of the courses include assignments which are based on workplace scenarios. This gives health service managers the opportunity to analyse situations with a view to implementing innovative management changes.

Skills for managers Dr Bob Price, senior lecturer and award director at the OU, directs the MSc in Advancing Healthcare Practice, which is made up of a number of modules that can also be studied individually. ‘The

MiP and MiP is working closely with the OU as part of our Union Learning Fund Open project and will soon be able to offer a range of courses to develop University managerial skills. We want to build a portfolio of training opportunities for MiP members that meet their needs. Our initial discussions involve modular programmes leading to an MSc in Advancing Healthcare Practice, a Postgraduate Certificate in Management and a Masters in Business Administration. We want to hear directly from managers about the type of accredited training which you would find valuable in your career. You can help by completing this year’s MiP health managers survey at www.miphealth.org.uk.

ANDY HENDRY; OPPOSITE PAGE RICHARD LEAROYD

SKILLS

CASE STUDY: Working with NHS Lothian, in collaboration West Lothian with West Lothian Council, the Open

University developed a groundbreaking health and social care management programme to help staff develop their careers and acquire valuable leadership skills.

Based around masterclasses – including communication, leadership, managing diversity, motivation, change management and conflict resolution – the OU created a pilot programme offering diplomalevel qualifications. The programme was successfully delivered through distance learning – with interactive workshops or online interaction – giving students the chance to study flexibly around their work and home commitments.

modules that form part of the MSc provide students with thorough knowledge in areas key to developing their skill sets. For instance, healthcare policy development and implementation – particularly policy implementation in settings where competing policies exist. The course also includes the policy design process and a review of agendas and drivers. Managers can focus on leadership and change agency skills, including the familiar theories, but are encouraged to drill down to consider leadership intelligence and the fit of change agency approaches to different situations and requirements. We also cover practice innovation, teaching students how to review the innovation potential of their organisational environment and the essentials of project design.

‘The key NHS resource is the expertise of staff, especially their skills,’ says Price. ‘So reviewing the skills available is important to managers confronted with new service requirements. We teach these skills, and show managers how to take stock of available evidence and to weigh the merits of the same when planning service improvements, and how to engage in and commission research.

‘Another key area is service improvement and reflective practice, where we encourage students to review current practice and to make a cogent case for change, but also teach dissemination skills, so students can communicate best practice through publication, conference, teaching and weblogs.’

Responding to demand, the Open University Business School has also just launched a new course, ‘Managing across organisational relationships and cultural boundaries’, which revolves around five major themes – managing aims; power, politics and trust; cultural diversity; international management; and the darker side of organising – and will interest managers dealing with complex inter-organisational relationships in public services.

With spending cuts comes the inevitable cuts in training budgets. However, organisations need to invest and equip

When asked, students felt they had gained a range of useful skills, including:  Methods for involving staff in planning and service delivery  Case discussions focusing on workplace issues  Ability to play the management game  Academic knowledge of management theory  Opportunities to apply learning  Networking and learning support  Attention to detail  Techniques for ‘unblocking’ problems.

Line managers could see staff had grown in confidence, that they had a greater belief in their abilities, were better able to plan actions, more reflective and open, and had a better view of the bigger picture. ‘This innovative development programme is our means, and ultimately effective patient care is the end,’ said David A Lee, associate director for workforce and organisational development at NHS Lothian.

their staff with the skills that will help them to navigate the turbulent and changing health sector. Distance-learning, due to its very nature, means organisations can keep staff in the workplace and develop them in a cost-effective manner.

As part of its mission to widen access to education, the OU has developed a website through which it makes some of its course materials available. There is a wide range of resources linked to management and leadership, health practice and more available to download for free from: http://openlearn. open.ac.uk/. These provide excellent resources for CPD and general reference. Academics from the OU also make their research available through Open Research Online, the OU’s research repository from which visitors can browse and download research for free: http://oro.open.ac.uk/.

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For more information about the OU: Hfc-external-engagement@open.ac.uk

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INTERVIEW

Internal markets, private finance, outsourcing – Welsh health minister Edwina Hart is having none of it. Gareth Hughes talks to the women taking NHS Wales in a radically different direction.

The spirit of Nye Bevan is alive, well and kicking, embodied in the Welsh health minister, Edwina Hart. In political terms she is seen as being on the radical left – a label that she would happily live with although, as she wryly observes, labels like that are pretty meaningless in today’s political climate.

Like many politicians before her, she subscribes to the values established by Bevan when the NHS was set up – a service that is free to access and is very much a public service.

The difference between Hart and other politicians is that she adheres strongly to the public service aspect of Bevan’s vision. On the thorny question of the private finance initiative (PFI), she is quick to point out that, although there are PFI hospitals in Wales, they are an inheritance from previous times.

When the health portfolio came her way, Hart ensured that wherever possible staff working for contractors in PFI hospitals were brought in-house as part of the NHS. There is now a definite ‘no-no’ to more such schemes. ‘They are not value for money and it shows that going for a short term fix can often do lasting damage, as some English health bodies are now finding out to their cost,’ she says.

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After the latest reorganisation of Welsh health services, it was said in official jargon that ‘the Minister for Health and Social Services will retain responsibility and accountability to the National Assembly for Wales for the exercise of all the powers in the portfolio’. But strip away the jargon and what we see is a minister making the point that she is very much in charge.

‘I am the head, I have to show leadership and there is no ducking from my responsibilities,” says Hart. Many politicians would want to hold such a service as health at arms length but Hart stresses that you can’t divorce the health service from politics. ‘Issues inevitably land on your desk, so you may as well make it clear from the outset that you are in charge.’

Nevertheless, the minister insists the health service in Wales will not be a political football. She goes out of her way to compliment opposition politicians, who ‘tend to be quite positive about developments’. She acknowledges that the NHS is an ‘emotive issue, but grown up debate about priorities is essential in our democracy. Politicians can always find fault when there are 2,000 hospital admissions each day, 2,700 visits to Accident and Emergency departments

and 1,300 operations.’

Although very much in charge, Hart does rely on a National Advisory Board for independent advice and to provide assistance in the discharge of ministerial functions. By chairing the group she is able to keep her finger on the pulse and ensure that her agenda is kept to. The Board’s meetings are often open to the public, as part of the Welsh Assembly Government’s commitment to open government.

On taking over the health portfolio in 2003 from GP-turned-politician, Dr Brian Gibbons, this ex-trade unionist has certainly made her mark on the department. Anything that smacked of the marketplace was definitely out. The structure of twentytwo local health boards that she inherited was an inefficient a way of delivering the service, she says, and she acted at once to change it. The reorganisation of NHS Wales, which came into effect in October 2009, created single local health organisations. These are responsible for delivering all healthcare services within a geographical area, replacing the English-style split between trusts and local health boards that existed previously.

INTERVIEW

“These people can make a difference between success and failure... And I’m pleased to say that in Wales we have excellent managers.”

Ben Birchall/PA Archive/Press Association Images

is not necessary to embrace the marketplace to produce a modern health service. Neither, unlike David Cameron, does she see the voluntary sector as a prime provider of services, but rather as a source of ‘additionality’.

By ending the internal market in the NHS and establishing single organisations delivering all healthcare services in seven regions, she hopes that a more co-ordinated approach to healthcare delivery will emerge, benefiting both patients and staff in the long-term, while enabling the health service to relate to partners in local government and the voluntary sector.

The seven health boards that emerged are formally accountable to the minister through the chief executive of NHS Wales. They are responsible for planning, designing, developing and securing delivery of primary, community, and secondary care services, as well as specialist and tertiary services for their areas, in accordance with identified local needs and within the national policy and standards framework set out

by the Minister.

It took two consultation exercises to arrive at the current structure and while Hart regards the restructuring as a real achievement she regrets the time it took to achieve. Asked if she has any regrets about anything she has done as health minister, she says, ‘I could and should have introduced this change a great deal sooner but two consultations take time.’ She concedes that such a major change could not have been introduced without the consultation process, but Hart is clearly a minister impatient for change and often seems irritated by the time that change can sometimes take.

Mrs. Hart is undoubtedly proud that in holding this portfolio she has pushed forward a reform agenda without compromising her commitment to the public service. She is convinced that it

Throughout this major systemic change, job losses were kept to a minimum, she says. Many senior managers were re-deployed ‘to other useful duties’. Hart is particularly scathing about the tendency of many politicians to deprecate the role of managers and administrators. ‘We need good health managers. The idea that doctors and nurses can do everything is plainly ridiculous,’ she says. ‘No, you do need managers to deliver an efficient service. These people can make a difference between success and failure in the delivery of health solutions. And I’m pleased to say that in Wales we have excellent managers.’

When pushed to make comparisons with what is happening over Offa’s Dyke, Hart is diplomatic enough to say such comparisons are ‘like comparing apples and pears.’ The health service in Wales has to take account of the fact that Wales is a great deal poorer country than England, a country whose economy was until quite recently based on heavy industry. As a consequence Wales has health outcomes that are poorer than its peers, a severe burden of chronic disease, and persistent healthcare inequalities. Wales has among the highest incidences of cancer and heart disease in Europe and a high proportion of elderly people. Half a million people – a sixth of the population – will have a hospital stay in any given year. issue 8 | winter 2010 | healthcare manager

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Welsh Assembly Government/ Llywodraeth Cymru

INTERVIEW

Opening a new breast care centre at Prince Phillip Hospital in Llanelli in August.

Age-standardised death rates are higher than in England and, although cancer mortality in Wales is declining, progress significantly lags behind international achievements. One-third of all Welsh adults (approximately 800,000) have at least one chronic condition and 57% of adults are overweight or obese. Inequalities in health and health care are another big issue. The ageing Welsh population is also stretching resources: the number of people aged over 75 will increase by 75% by 2031. Faced with all these factors, Hart has successfully argued her corner with her cabinet colleagues and healthcare spending has increased by 27% a year since 2003-4.

There are many differences between the Welsh and English approaches to healthcare. There has been a strong agenda in Wales on health education and encouraging lifestyle changes. ‘Prevention is better than cure,’ says Hart. ‘We need to get our people to take their health seriously and take some responsibility for their bodies.’ Patients in Wales come into contact with the NHS 22 million times each year, with 80% of contact taking place outside of a hospital. But Hart 14

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believes the number of patients visiting hospitals is still too high and can be lowered with more treatments taking place in the community.

Unlike England, there are no prescription charges in Wales. Pressed on whether this policy could be maintained in these times of public expenditure constraint, Hart is adamant that it can, drawing attention to the Welsh Assembly Government’s declared view that ‘the policy promotes the benefits of good health, supports self-care and underlines the commitment to provide the best possible access to healthcare for the people of Wales”.

Hart has also scrapped car parking charges in hospital grounds, a policy much criticised at the time by Ben Bradshaw, then a Labour health minister in the Westminster government. Hart’s populist measure will be spared in the forthcoming cuts if she gets her way. ‘It is just a small amount of cash, and the benefit to patients and their visiting families is great and therefore, it should remain.”

In a bid to save cash, Hart has also decreed that all uniforms in the Welsh NHS should be standardised. So there should no longer be any confusion

about who one is talking to in Welsh hospitals.

With almost 91,000 people working for it, the NHS is Wales’s largest employer, so the relationship between the minister and the trade unions is crucial in delivering a decent service.

Here, Hart has an impressive track record. ‘I have found them open in discussions, helpful and wanting to be involved.’ She welcomes union involvement in change and points out that a trade union official chairs her shared services review.

Failure on the part of the minister to act decisively in the tightening financial environment now facing Wales would mean continuing to struggle with poor health, unsatisfactory performance and financial deficits over the coming years.

While the scale of the fiscal challenge for NHS Wales is undoubtedly considerable, Hart is firm in her belief that services can be improved and efficiencies realised to improve the quality and safety of care for all.

A recent report from the Independent Commission on Finance and Funding for Wales presented compelling evidence that Wales was underfunded by some £300m per year and the total level of resources will clearly have an impact on investment decisions. But Hart insists that ‘the NHS has, and always will be, a priority for the Assembly Government demonstrated by 40% of our budget being invested in health and social services.

‘This has increased significantly since 1999 and now stands at £6.3bn,’ she adds. ‘With that significant investment, we now have more staff, new buildings and equipment, and waiting times have fallen and patient care has improved. As Minister I have outlined the reality of the challenges that face the NHS and of course the need to make savings to manage continual increases in the demand for services. It is a challenge, but the NHS in Wales can meet that challenge.’

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Gareth Hughes is a freelance journalist and political commentator for ITV Wales.

NHS REFORM

Clinical leaders need to work hand in hand with professional managers if the government’s reforms are to succeed, writes Chris Ham.

The Coalition Government’s plans for NHS reform mark a decisive break with the past. In place of top down performance management, the government is proposing to improve patient care by devolving budgets to general practices. Management costs will be cut by 45% as strategic health authorities and primary care trusts are abolished and front line clinical teams are empowered to drive performance improvement.

After a decade or more in which politicians have used ‘targets and terror’ to bring about change in the NHS, the emphasis on devolution to the front line is to be welcomed. The decision to implement GP-led commissioning on a universal basis from 2013 is a bold attempt to show what can be achieved when two tiers of management are abolished and general practices are put in charge of most of the budget. Previous experience has demonstrated that primary care led commissioning can deliver improvements in care, although never before has so much emphasis been placed on general practices as agents of change.

A major challenge in implementing the government’s plans is to ensure that GPs have the management sup-

port they need to commission services effectively. Planned cuts in management costs mean commissioning consortia will have less generous budgets to buy in support than primary care trusts, raising questions about their ability to hire the expertise required.

One of the consequences could be the formation of consortia covering large populations, as only by pooling budgets will the resources for management support be sufficient.

If this happens, there is a risk that consortia will be more remote from individual practices than PCTs, thereby undermining a major part of the rationale behind GP-led commissioning. One way of squaring the circle would be for consortia to work through ‘locality structures’ that give practices a real

“A major challenge in implementing the government’s plans is to ensure that GPs have the management support they need to commission services effectively.”

opportunity to influence commissioning decisions and create a sense of ownership of the work of consortia. As the new commissioning structures are established, the trick will be to find a way of combining the benefits of working on a larger scale with the necessity for these structures to be responsive to the aspirations of primary care teams.

Another challenge will be to avoid a dip in performance during the transition from top-down performance management to GP-led commissioning. Many of the most important improvements in patient care under the previous government resulted from increased investment linked to the achievement of national standards and targets. Managers played a significant part in delivering these improvements and in ensuring that the government’s ambitions were realised, knowing that their jobs were on the line if they failed to deliver.

The benefits can be seen in much shorter waiting times for treatment and significant improvements in care in areas of clinical priority like cardiac and cancer services. In addition, there have been reductions in healthcare associated infections and increasing attention has been paid to quality and issue 8 | winter 2010 | healthcare manager

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NHS REFORM

A long and winding road

A brief history of leadership and management in the NHS 1950s & 1960s Initially the NHS was organised into three separate parts:

. . .

GPs (with dentists, pharmacists and opticians) local government (including preventive services such as health visiting and child welfare) hospitals

Hospitals were usually run by a hospital secretary, matron and medical superintendent. The need for better administration in the NHS was soon recognised, driven primarily by concern about rising costs.

1970s With the tripartite structure widely recognised as a source of problems, the 1970s saw the advent of 14 regional health authorities (RHAs) in England, responsible for planning local health services, and 90 area health authorities, sharing boundaries with local councils who were responsible for social services. GPs remained independent contractors. Consensus management by multi-disciplinary management teams was usual, with an administrator, treasurer, nurse and doctors. The 1980 Health Services Act created 192 new district health authorities (DHAs) in England, with powers devolved to smaller units of management.

1979 to 1997 In the early 1980s several management initiatives attempted to improve accountability and save money in the NHS. The 1983 Griffiths Report found there was no coherent local management structure.

The report said: ‘If Florence Nightingale were carrying her lamp through the NHS today, she would be searching for the people in charge.’ It recommended the introduction of general managers, and that doctors should be more involved in management. The 1990 NHS and Community Care Act created an internal market beween purchasers and providers, with hospitals established as NHS trusts. In 1995, DHAs and Family Health Services Authorities were merged into single bodies, and eight regional NHS offices set up.

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1997 to 2010 The Labour Government introduced significant reforms and increased investment in the NHS.

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‘The New NHS: Modern, Dependable’, 1997 Set out to replace the internal market by a system called ‘integrated care’, based on partnership and driven by performance.

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Health Act 1999 Replaced GP fundholding with primary care groups (PCGs) and established the Commission for Health Improvement (which has evolved into the Care Quality Commission) to scrutinise the quality, governance and financial management of health trusts, along with the National Institute for Clinical Effectiveness.

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The NHS Plan 2000 Proposed significant new investment, with many performance targets and standards, and annual inspection of NHS bodies.

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NHS Next Stage Review 2008 The ‘Darzi review’ placed renewed emphasis on clinical leadership, with a national Leadership Council being established in 2009.

2010 onwards Recent years have seen an increasing focus on leadership rather than management, with all political parties promising to move away from ‘command and control’ towards a shared agenda between managers and clinicians.

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‘Liberating the NHS’ 2010 The coalition government set out some of the most radical plans for the NHS since it began, removing SHAs and PCTs, and establishing a National Commissioning Board, with local commissioning carried out by consortia of GPs.

A matron from the 1950s; Iain MacLeod (minister of health 1952-1955); Baroness Robson, chair of the South West Thames RHA; Norman Fowler (secretary of state for health and social services, 1981-1987); Kenneth Clarke (secretary of state for health, 1988-1990); Frank Dobson (1997-1999); Alan Milburn (1999-2003); Lord Darzi; Andrew Lansley (2010-).

NHS REFORM

“The point to emphasise... is that those leading major change programmes should focus on ‘both/ and’ rather than ‘either/or’”

safety, for example in the quality and outcomes framework in primary care and the publication of outcome data in cardiac surgery. Performance management has also contributed to sound financial performance, to the extent that the Treasury has recently taken back cumulative underspending of the order of £5.5bn.

The task for the government is not only to sustain these improvements but also to build on them by tackling areas of under achievement, such as England’s relatively poor cancer survival rates.

This must be done at a time when the NHS budget is growing only in line with inflation and when far reaching organisational change is already underway. With GP-led commissioning at a very early stage of development, and experienced managers losing their jobs as cuts in management costs begin to bite, there is a clear and present danger of performance falling back in the transition from the old order to the new.

What can be done to manage these risks? A good starting point is to recognise that an organisation as large and complex as the NHS requires excellent management and leadership at all levels. While GPs and other clinicians have a critically important part to play in this process, they need to work in partnership with general managers and colleagues with specialist skills in finance, human resources and related functions.

High-performing health care organisations like Kaiser Permanente and Mayo Clinic exemplify what can be achieved through partnership. These organisations devolve power to frontline clinical teams and are founded on a belief that improvements in patient care result from ‘commitment and not compliance’. They therefore invest heavily in selecting and developing clinical leaders, especially doctors, who have the commitment to deliver the best possible care within the resources available.

These clinical leaders work hand in hand with experienced managers in their quest to be the best. There is no sense that clinicians are good and managers bad, rather a pragmatic recognition born of experience that they have complementary contributions to make to performance improvement.

This is, of course, how many of the most successful NHS organisations are run, a realisation that appears to be dawning belatedly on the Department of Health.

As well as recognising the value of partnership between managers and clinicians, the government should reconsider the role of targets and performance management during the transition. Evidence from research into successful companies shows the value of managing a series of ‘dualities’ in the pursuit of high performance.

These dualities include promoting competition and supporting collaboration; devolving power to the front line and providing leadership from

the top; and managing through the hierarchy while working through networks.

The point to emphasise about this research is that those leading major change programmes should focus on ‘both/and’ rather than ‘either/or’. The implication is that more attention should be given to fine tuning the position of the NHS on each of these dualities rather than lurching from one extreme to the other. Until GP-led commissioning is firmly established, leadership from the top and by experienced managers at a local level is essential to ensure a smooth transition.

All of these arguments point to the critical role of managers in implementing the bold agenda set out in the NHS white paper. At a time when the BMA could yet prove a stumbling block for the government, the Health Secretary would be well advised to find an opportunity to praise managers rather than bury them, and to enlist their support in the work that now needs to be done. Not only is this smart politics, it is also what history indicates is needed to make change happen

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Chris Ham is chief executive of the King’s Fund and is chairing a commission on leadership and management in the NHS which will report in Spring 2011. Further details at: www.kingsfund.org.uk/ leadershipcommission

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LEGAL MATTERS

legaleye Jo Seery explains some of the provisions of the new Equality Act. The Equality Act 2010, which became law on 1 October, brings together all the various antidiscrimination laws in one act. As such, it does not change existing provisions significantly. But it does provide protection for those who are discriminated against because of their association with someone who has a protected characteristic (such as gender, age, disability, sexual orientation or race).

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to a prohibited question in their appointments decision , this may be good evidence in a discrimination claim.

So, if a man is refused flexible working to look after an elderly parent when other workers without such responsibilities have been allowed to work flexibly, he may be able to argue – as age is a protected characteristic – that he has been discriminated against because of his association with his elderly parents.

Harassment by third parties Employers are now liable for harassment by third parties, such as clients or customers, not just for harassment by other employees. So a black care worker who is subjected to racist abuse by a service user may have a discrimination claim if their employer does not take appropriate action.

An employer will only be liable for harassment by third parties if they are made aware of at least two previous incidents of harassment and have not taken any reasonable steps to prevent it.

Prohibited questions For managers, one of the key new provisions of the act covers the asking of health-related questions at job interviews. Section 60 provides that an employer may only ask a candidate about health-related issues in order to help them decide whether they need to make reasonable adjustments as part of the selection process; to determine whether the candidate can carry out an essential job function; or to take positive action to assist a disabled candidate and to monitor the diversity of applicants for the job.

Asking a question about disability or health – known as a ‘prohibited question’ – is not in itself discriminatory. However, if the employer uses the answers given

Reasonable adjustments The employer has a duty to make reasonable adjustments where a person is defined as disabled in the Equality Act: they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.

This will depend on the facts. For acts of discrimination occurring from 1 October 2010, it is no longer necessary for employees to show that their condition affects one of the specific capacities (such as mobility, manual dexterity, speech, hearing, eyesight and ability to concentrate) to demonstrate that they are disabled.

Provided the employee shows that they have a disability as defined, then

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where there is a provision, criterion or practice which puts a disabled person at a substantial disadvantage in comparison to people who are not disabled, the employer is under a duty to take reasonable steps to ensure that the disabled person is not at a disadvantage.

Equal pay Section 77 provides that a contractual term restricting or preventing employees from disclosing relevant pay information is not enforceable.

So, if a male employee has a clause in his contract which prevents him from disclosing pay information to a female colleague who asks for it in order to determine whether she has an equal pay claim, it is unenforceable.

Witnesses to harassment One of the most misreported aspects of the act has been that any employee who feels offended by something said by a colleague can claim to have been harassed: for example, a male employee seeing a female colleague being subjected to sexist comments from their boss.

Such witnesses to harassment may can only bring a claim if they can show that the conduct was related to a protected characteristic – such as gender – and that the conduct had the purpose or effect of violating their dignity, or creating an intimidating, hostile, degrading, humiliating or offensive environment for them.

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Jo Seery Thompsons Solicitors

CAREERS

Assessing your options It’s time to get serious about the future, says Liz McCarten.

With the prospect of fundamental restructuring and swingeing cuts to NHS management levels, now is the time to prepare for that job search.

First you need to regain the control taken from you by the loss of your apparent job security. Even NHS Chief Executive David Nicholson admitted feeling ‘powerlessness’ when he lost his job in 2001 (Healthcare Manager Autumn 2010). Don’t just stand in the middle of the road and watch the headlights coming towards you.

Don’t wait to be declared supernumerary or put into a redeployment pool. It will sap your confidence and take away all sense of initiative. Getting stuck on pay protection might sound OK, but it’s a backward step in career terms and you could end up resenting it.

So how do you find your new job?

Look at the NHS Jobs website for

internal jobs and the Health Service Journal website for external roles.

Match your skills and experience against the jobs to make sure the vacancies are available and appropriate. If you’re thinking of moving out of the NHS or healthcare, search online to find out about what’s available, salary levels and experience.

If your area of work is being phased out, don’t despair. Look at how you might use your skills elsewhere. Don’t assume employers will know what your experience means – spell it out and make the most of it.

It’s crucial that your job search strategy uses a variety of mediums – direct application, specialist recruitment agencies, printed adverts, networking and job boards. Make sure you track your applications and follow them up where necessary. Don’t underestimate the time you will need

for applications and follow up, or how many applications you might have to make before being offered an interview.

Try using new ways of networking and finding roles, like LinkedIn.com, where organisations search CVs to fill tens of thousands of jobs each month which may not be advertised. You can put your CV online to be trawled and join professional networking groups – but only give an email address as your contact. Never give a phone number or address online. If you don’t have your own email address, free email is provided by lots of organisations including Google and Hotmail.

Good luck – and remember, you will need to be focused, persistent and patient.

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Liz McCarten is director of Careerworks and works on MiP’s learning and development strategy..

Tipster: preparing for an interview We’ve all had that nightmare interview. These tips will improve the odds of landing the job.

 PREPARATION The first tip is to actually do some!

 Know your CV Interviewers will pick up on elements in your CV, so remember what you wrote and why it contributes to your application.

3 Know the job spec You should have matched your skills and experience to the job specification in the application. The interview is the time to reinforce how you match each element. Be ready to volunteer information about any aspects the interviewer doesn’t cover.

4 Know the organisation Don’t ask questions like ‘Do you have a website?’ If you are ill-prepared, it will be held against you. Check the organisation’s website, company report, if applicable, and elements like Corporate Social Responsibility, environmental record, clinical specialisms, research record, personnel and structure.

5 No surprises If you are applying for an NHS or related role, be clear about the reporting structure and grading of the post so there are no surprises. If it’s lower than the grade of your current role, make sure you can explain why that’s OK for you – and them.

6 LEAVE MOney UNTil later In the private sector, never talk about money at the first interview. If asked, deflect the question (eg. ‘We can talk about that further down the line’).

7 Know Why you want the job If you’ve prepared properly you will know what attracts you about the organisation. If your reason is too pragmatic (‘it’s near my house’, ‘it will do for a while’), find something else to get enthusiastic about, so that you can be truthful about the positives. Try your reasons out on a friend in advance if you’re not sure how they sound.

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MiP AT WORK

Tackling genderbased violence Marisa Howes reports on a Scottish initiative to support staff facing abuse in and out of work Gender-based violence costs the NHS over £1.2 billion a year, and one in five women in Scotland experience domestic abuse at some stage in their lives. The UK’s health services are responding by developing training for frontline staff to help them understand and respond to patients who may have been subjected to gender-base violence.

The NHS in Scotland has gone a step further. It has developed a draft policy for its own employees. A genderbased violence employee partnership information network (PIN) policy has been developed in partnership with trade unions and should be out for full consultation in November.

The policy identifies that the impact of gender-based violence on the health and wellbeing of NHS staff is a recognisable and preventable problem like many other health and safety issues that affect NHS Scotland employers. Given its prevalence within the wider population, and the size of the NHS workforce in Scotland, it is inevitable that some NHS employees will have experience of some form of abuse and that a small number will be perpetrators.

The increased focus on the NHS’s role in relation to gender-based violence – particularly implementing routine enquiries of abuse in key services – may result in a greater number of staff disclosing their own experiences of abuse.

In light of these considerations, the policy aims to promote the welfare of staff affected by current or previous experience of abuse, and to ensure that health boards respond effectively to staff members who may be perpetrators of abuse.

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The creation of a specific policy on gender-based violence demonstrates a commitment from NHS Scotland boards to improve the safety and welfare of staff affected by abuse by: ** Raising awareness of gender-based violence as a serious health and social issue, highlighting its hidden nature and the impact on those affected by it ** Sending a positive message to employees with experience of abuse that they will be listened to and supported ** Projecting a clear signal that the behaviour of employees who perpetrate abuse, within or outside the workplace, is unacceptable.

MiP members will have a key role to play in implementing this policy effectively. As line managers they will be responsible for ensuring that any staff who are affected by abuse feel confident that they will be dealt with sensitively and in confidence.

‘The statistics about gender-based

“The statistics about gender-based violence are stark... it is inevitable that some of our members will have been touched by it in some way or another.”

Claire Pullar, MiP national officer, ScotlAnd

violence are stark, and it is inevitable that some of our members will have been touched by it in some way or another,’ said Claire Pullar, MiP national officer for Scotland. ‘It’s good that NHS Scotland has recognised that it’s an important workplace issue that needs to be handled sensitively by employers.

Managers need to be aware of the extent and effect of gender-based violence and try to provide a supportive environment. It is good management practice to be aware of any changes in behaviour in staff members, such as sudden increases in sick leave, or an inexplicable drop in peformance.

‘We’re not talking about managers becoming informal counsellors, but they can pass on contact numbers for welfare advice services and organisations like Women’s Aid. There are steps that can be taken that give practical support to staff in these circumstancces, such as allowing time off for court appearances and visits to their children’s school, as well as maintaining confidentiality.’

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WHITE PAPER RESPONSE

Managing together Marisa Howes spells out MiP’s response to the white paper Liberating the NHS The white paper, Liberating the NHS, proposes the biggest shake up of the NHS in England in decades. It will fall to NHS managers, many of whom are MiP members, to implement the changes, ensure a smooth transition and maintain service standards.

MiP’s response flies the flag for managers, emphasising the crucial role they play in the healthcare team. It reflects our members views, gathered through meetings, surveys and emails.

Some of the white paper’s aims are laudable and long-supported by MiP, especially for a patient-centred service.

But its main proposals are risky and MiP has called for a slower pace of change to protect patients and ensure value for money.

We take issue with the constant denigration of managers. The confusion between bureaucracy and management means managers are undervalued and there is a risk of losing the skills, knowledge and expertise they bring to the healthcare team.

Good management and effective leaders are critical for good healthcare, particularly in times of change. None of the white paper’s ambitions will happen without good management by clinicians, managers and other healthcare staff working together.

The Government should give serious thought to the management resources needed to deliver such an unprecedented reform programme.

Key points from MiP’s submission 

The future of PCTs and SHAs

There is still a need for a strategic tier between GP consortia and the national level. Abolishing PCTs completely would

Information Greater choice and control and Choice Proposals for implementing the white paper’s commitment to ‘no

The latest decision about me without me’. It seeks views on: consultations  Proposals for offering more choice for patients and service users linked to the white  How shared decision making can become the norm paper, relating  How it can happen: information, ‘any willing provider’ & other tools to patient choice  Making safe and sustainable choices and information, are significant for An information revolution managers. Proposals to give people more control over their care records, and more information about care quality so they can make informed choices. It sets out government thinking on:  universally applied standards for the recording of care  the need for high quality evidence - from clinical audit, staff feedback, research and other sources  the key role of informatics The closing date for submissions is 14 January 2011 The documents are available from www.miphealth.org.uk/hcm. divert energies to managing people out of the NHS rather than managing reconfiguration and supporting GP practices in realising the white paper’s vision. 

GP consortia

Effective consortia need a multi-professional commissioning team, bringing together GPs, managers, nurses, allied health professionals and non-clinical support staff. 

Mental health commissioning

Responsibility for mental health commissioning should be carefully considered. Many GPs do not have the day-to-day experience of the full range and complexity of mental health issues outside primary settings to be able to commission services effectively. 

Public health

The lack of guidance to support both the move to local authorities and the introduction of a Public Health Service could lead to the loss of public health expertise and reduce the NHS to being solely a sickness service.



The future of acute services

The white paper proposes that all NHS trusts should become foundation trusts.

What will happen to trusts that don’t make the grade but whose services are still required? 

Workforce

We welcome the ambition to value and increase NHS staff engagement and influence. All providers of NHS services should commit to uphold the NHS Constitution and MiP wants to see a workforce standard included in all contracts. 

Pay and conditions

The white paper overestimates the potential savings from local pay determination, which would be relatively small compared to those set out in the QIPP figures. Any savings could be wiped out by the additional costs of administering a pay system which is fair and equitable at local level. MiP has also made a submission to the Fair Pay Commission about managers’ pay and to Lord Hutton’s review of public service pensions The full response is on the MiP website: www. miphealth.org.uk/hcm.

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issue 8 | winter 2010 | healthcare manager

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MiP AT WORK

Partners for Dignity in Brent New project aims to curb bullying and promote a respectful workplace NHS Brent and Brent Community Services have joined with MiP, Unison and the Royal College of Nursing to form ‘Partners for Dignity’.

The group’s remit is to create a better culture for staff, drawing on the skills and expertise of the partners to address key issues that are important to staff and which will promote a more respectful working environment.

The Partners for Dignity project group was set up to develop respect and dignity at work between managers and staff following the results of the staff survey in 2009, which

showed that 25% of respondents said they had experienced harassment, bullying or abuse at the hands of colleagues or managers.

They have already been successful in launching a new exit questionnaire process, to ensure that all members of staff have a confidential mechanism for providing feedback, whether positive or otherwise. The next step is to recruit dignity at work representatives – or ‘Respect Reps’.

Respect Reps will receive training on the Dignity at Work policy so that they can provide confidential and up-to-date support to staff who wish

to talk to someone other than their manager, union rep or HR about their experiences on an informal basis.

Scottish managers get interactive

MiP had a high profile at the annual conference of the Institute of Healthcare Mangers in Scotland.

Having been regular visitors to this event over the years we thought we would use our slot on the timetable for something a bit different and more interactive. So MiP teamed 22

issue 8 | winter 2010 | healthcare manager

up with our training partners goodthinking2 to facilitate a ‘fly on the wall’ interactive session to help delegates think about the challenges they face in an increasingly difficult environment, and what the healthcare landscape will look like when change arrives.

Like the rest of the UK, health services in Scotland are facing a period of uncertainty and intense pressure on budgets. Healthcare managers will be at the forefront of dealing with these challenges and will need to gear themselves up for

difficult conversations with staff about the future. Our session allowed them to think through these challenges and how they might handle them.

Well over half the conference

16332 MIP ad 213(h) x 110(w):Layout 1

“In a 2009 staff survey, 25% said they had experienced harassment, bullying or abuse at the hands of colleagues or managers.”

Gemma Davies, Head of HR at NHS Brent, said: “The success of this project rests not only with HR and staffside but with the whole organisation. This is a positive project both for the organisation as a whole and for the progression of partnership working.”

Marco Inzani (pictured), MiP link member at NHS Brent, said: ‘It is important that we follow up on this initiative to see what impact it has had on staff satisfaction and experience of harassment and bullying particularly in these changing and challenging times.”. delegates attended the session and were able to use the innovative training techniques which MiP and goodthinking2 have developed.

Delegates were shown how their behaviour could affect the performance of others and how to manage proactively in times of change. The feedback about the session from delegates was overwhelmingly positive MiP also sponsored the IHM Scotland Top Healthcare Manager Awards 2010, which were presented at the conference. The runners up were Joan Wilson, Head of Nursing & Public Health, Dundee CHP, and Roslynne O’Connor, Practice Manager, Dollar Health Centre.

The winner was Dr Alison Bigrigg (pictured), Director of the Sandyford Initiative and Sexual Health Services, NHS Greater Glasgow and Clyde .

31/8/10

13:11 Page 1 MiP AT WORK

These are uncertain times.

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 8 | winter 2010 | 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 department of health

Blithe spirit

Howe’s that?

E

ven ministers seem to be confused by coalition plans to curb NICE’s powers to decide which drugs and treatments are available on the NHS. Plenty of questions for health minister Earl Howe in the Lords: will every GP practice be sitting to down haggle with the pharmaceutical multinationals? Who was consulted? What will NICE do now? Unfortunately, no answers from the minister, who seemed to think he was introducing the system rather than abolishing it.

‘We want to change that so that the price of a drug to the NHS is based on an assessment of its value, rather than pharmaceutical companies being free to set whatever price they choose and expecting the NHS to pay.’ Which is about as succinct a summary of what NICE does as you can get.

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The grim choice at Hairmyres Hospital in East Kilbride.

A

dmirable optimism from health minister Paul Burstow in the Commons. On 2 November, Burstow assured Labour’s new health spokeswoman Diane Abbott that there would be no widening of health inequalities under the coalition government.

This was because ‘the Office for Budget Responsibility identified that there will be growth in employment during the spending review period, and this Government are determined to make sure that we see that growth take place.’ Celticus is reminded of similar blithe optimism from Mr Justice Hinchcliffe in 1969, when he ruled that inflation should be ignored in calculating damages for thalidomide victims. His grounds? ‘The government had promised to control inflation’. In the following five years inflation averaged almost 20%.

Careful who you praise

W

ith doctors’ leaders almost on bended knees begging managers to stay in the NHS, the Audit Commission recklessly joined in the lovein for our much-maligned PCTs. ‘The NHS is mostly in good shape to face the certain tough times ahead,’ says the commission’s latest report, thanks to ‘strong financial management and

issue 8 | winter 2010 | healthcare manager

resilience’ by PCTs and SHAs, which delivered a £1.5bn surplus for the last financial year. Not exactly music to ministers’ ears, and communities secretary Eric Pickles wasted no time in sending the Audit Commission the same way as PCTs.

The signs are not good

H

ospitals are full of signs and notices and the scope for faux pas is wide. There are plenty of greengrocer’s apostrophe’s around,

and how many doors to maternity units bear signs exhorting us to ‘Push’?

There is, or was, a sign at Northampton General Hospital, which read: ‘Family Planning Advice – Use Rear Entrance’ (don’t try to deny it – we have photographic evidence!) We also enjoyed the sign fixed to the wall of Virginia Mason hospital in Seattle: ‘You are now entering an injury free environment.’ That should save a few bucks. Send your examples of silly signage or nonsense notifications to backlash@healthcaremanager.co.uk

LESSONS FROM HISTORY: PART II Celticus is grateful to readers with a superior classical education (there are one or two) for pointing out that the quotation attributed to the Roman satirist Gaius Petronius Arbiter in my last column (‘We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganized…’) actually comes from the American journalist Charlton Ogburn (1911-1998), writing in Harper’s Magazine in 1957. Thanks to Linda Semple from NHS Ayrshire and Arran for suggesting an alternative take on our current situation, from Tacitus: Ubi solitudinem faciunt, pacem appellant.

Which as all readers will know means, ‘they created a desert, and called it peace’.

e

insuranc

holidays

The added va lue of membership

s

mortgage

savings

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.

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MiP Ad 250x200 NEW:Layout 1

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It’s not just doctors who make it better.

Healthcare managers are passionate about delivering effective healthcare. In fact, it couldn’t happen without them. That’s why they deserve specialist representation.

MiP is the only trade union organisation dedicated to providing personal support and employment advice, management skills and networks, and an influential voice for the UK’s healthcare managers.

helping you make healthcare happen.

www.miphealth.org.uk