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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 11 autumn 2011
healthcare manager inside
heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Brenda Bellando, West of Scotland Screening inpublic: Probus Surgical Centre, Truro.
letters & comment:8 Paul Hodgkin public voice will transform the NHS
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.
Breast cancer: Digital screening - the next big breakthrough Interview: Monitor chief Dr David Bennett. Social care: Human rights for older people Regulation: Harry Cayton on professional standards for healthcare managers.
regulars:20 Legal eye: New rights for older workers. Tipster: How to find good ideas. Careers: self knowledge and management practice. MiP at Work: Our part in remaking the Health Bill.
backlash:24
It’s autumn again and I’m delighted to present another issue of healthcare manager, the magazine from MiP, the trade union organisation specifically for managers working in health and social care. In the MiP office we will be going pink in October to support Breast Cancer Awareness month. In this issue, Maggie Alexander at Breakthrough Breast Cancer makes the case for digital screening, and we hear from Brenda Bellando, a fantastic manager who keeps the West of Scotland breast screening service on the road. Quite literally – getting the mobile units across to the islands by ferry is quite a logistical feat! Brenda is a great example of what good management is about. Something Harry Cayton might be interested in. He’s working for David Nicholson, revisiting the perennial topic of professional standards for healthcare managers, and he wants your views. We also interview Monitor’s David Bennett, who wants to set the record straight about his views on the regulation of health services and how Monitor will use its new powers. And Jon Restell sets out his strategy for dealing with the government’s attack on public service pensions. Marisa Howes Executive editor
issue 11 | autumn 2011 | healthcare manager
1
HEADS UP
heads up what you might have missed and what to look out for
Equality
Improving representation London, 10 November As the budget squeeze begins to bite across the public sector, the progress made in improving the representation of black and minority ethnic (BME) staff at senior level is slowing, and in some cases, going into reverse. MiP has joined with FDA to host this conference to bring together BME staff from across the public sector to share experience and develop strategies to maintain their motivation and wellbeing despite the tough climate. The conference will hear from senior policy makers and draw on personal experiences to review the current challenges
facing BME staff and consider how we can encourage diversity and promote smarter working. Delegates can identify leadership opportunities and develop strategies to put policy into practice. MiP members get a £50 discount off the registration fee. For further details check out the conference website at www.bmeintoleadership.co.uk.
MiP elections
Choosing MiP’s national committee
If you would like further information, talk to your national officer, visit miphealth.org.uk or contact Martin Furlong on 020 7121 5438.
Pensions
Speak up for NHS pensions
Nominations for candidates for MiP’s national committee close on 23 September. If you are interested in standing for election, or you want to nominate a colleague, check out the MiP
Readers working in the NHS will be well aware of the Government’s proposals to radically alter public service pensions. These pensions are being attacked on a number of fronts and the unions are
healthcare manager
Executive Editor
Contributors
issue 11 | autumn 2011
Marisa Howes m.howes@miphealth.org.uk
ISSN 1759-9784 published by MiP
Associate Editor
Maggie Alexander, Harry Cayton, Paul Hodgkin, Marisa Howes, Helen Mooney, Alison Moore, Gareth Morgan, Jon Restell, Craig Ryan, Jo Seery, Jenny Sims
All copy © 2011 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
Craig Ryan editor@healthcare-manager.co.uk
Art Director
Print Warners Print, Bourne, Lincs
James Sparling
Design and Production Lexographic production@healthcare-manager.co.uk
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website where you will find details about the role of the committee and how individual committee members can contribute to MiP’s policy development and influence. The nomination form can also be downloaded from the website. Where seats are contested, we will send election materials and ballot papers to members in those constituencies by 10 October, and voting will close on 7 November.
issue 11 | autumn 2011 | healthcare manager
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united in their defence (see Jon Restell, Leading Edge, opposite). Despite the fact that discussions are continuing, the Government is now consulting on its proposed increase in contributions to public sector pensions to take effect from April 2012. As many MiP members have pointed out, this amounts to a tax on public sector workers and they have made their opposition to the proposals clear. Feedback from MiP members has been posted on the website and will form the basis of the union’s official response to the consultation. We also want individual members to let the Department of Health know their views. The consultation runs until 21 October and the document is available on the DH website at: www.dh.gov.uk. The proposals affect the NHS pension scheme in England and Wales. We are waiting to hear what is proposed for Scotland and Northern Ireland.
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. COVER IMAGE: © The McGrath Foundation
HEADS UP
leading edge Jon Restell, chief executive, MiP The government is proposing to push up employee pension contributions by as much as 2.4% next April, with more rises planned over a further two years. Its latest attack on NHS pensions has provoked an angry but typically thoughtful response from MiP members. Many were prepared to take a hit over pensions, but this is unacceptable. Pay may be rising by 2.5% in the private sector, but it is frozen solid in the public sector. And at a time of rising inflation a pay freeze is a pay cut (taken with other changes to taxes and benefits, one member calculates that his reward package has already been cut by 20% in three years). Alongside widespread job cuts, massive change in the NHS and Hutton’s long-term pension proposals, this unjustified tax on health workers’ pensions is a step too far by this government. If we are going to get anywhere defending NHS pensions, two things are crystal clear. First, health unions must stand completely united if they are going to take on one of the most radical governments ever and win. Secondly, NHS staff must win public sympathy and support if their pensions are to be defended. Only with the
“The pension scheme reflects the demanding nature of NHS work. The public won’t want 68-year-old paramedics carrying patients down stairs.” public massively on our side will the handful of politicians who call the shots in this government change position. This is why the health unions, including MiP, have set up a pension campaign group to co-ordinate the response to the government’s attack on NHS pensions. The public must be helped to see what’s at stake here for their health services. The public always respond to an appeal to fairness. Health workers have already accepted a revised pension scheme with employers’ contributions capped at 14%, new costs met by the employees and higher paid staff paying more. Nothing has changed since this new scheme was introduced in 2008; there’s no new evidence.
Furthermore, working for the health service is rewarding but it is also demanding – physically and mentally. The NHS pension scheme and the retirement age in particular reflect the demanding nature of this work. The public won’t want 68-year-old paramedics carrying patients down stairs. What the public wants is the best people providing its care, over long and committed careers. It will not want talented and caring people leaving the NHS for less demanding work elsewhere, and, just as bad, not joining the NHS in the first place. Finally, taxpayers will not want to pick up the bill now if tens of thousands of health workers suddenly leave the scheme, destabilising the funding of NHS pensions. And it will certainly not want to meet the costs later of pensioner poverty if the value of NHS pensions is slashed. Our campaign, including any industrial action, must always keep in mind the public. The goal is not to have a strike but to win over public opinion and force a shift by politicians. I hope you will support the campaign as it unfolds in every way you can.
Update your details MiP members should have received new membership cards and a request to check and update their details. We need an up to date membership record so we can keep you informed and identify your employer, job title and workplace. And depending what happens in the pensions negotiations, we may need to contact you urgently about a possible ballot for industrial action. So
please take a few moments to check your record and make any necessary changes. You can do this online by logging into the members’ area of the MiP website at www.miphealth.org.uk/MembersArea/mip_myMIP.aspx and following the prompts to update your details. If you haven’t received a new card, please contact us on info@ miphealth.org.uk.
issue 11 | autumn 2011 | healthcare manager
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HEADS UP
Flu prevention
Leadership can save lives The NHS has launched a campaign to encourage more staff to have the flu vaccination to reduce the risk of flu spreading through hospitals and other NHS sites this winter. The ‘flu fighters’ campaign, to be run by NHS Employers on behalf of the national Social Partnership Forum, urges managers to show leadership in encouraging as many staff as possible to have the jab. The campaign also aims to dispel myths about the flu jab. These include rumours that a ‘huge’ needle is used and concerns about significant and widespread side effects. In fact, the needle is only a few millimetres long, the jab takes only
HIV
New moves to tackle £1bn epidemic Britain’s leading HIV charity, the Terrence Higgins Trust has launched a plan to reduce HIV transmission in the UK and ease the growing burden on the NHS. The trust believes the cost of lifetime treatment for people with HIV infection, now over £1 billion a year, could be cut substantially through better diagnosis, more widespread treatment and improved prevention and information services. With 7,000 people diagnosed with HIV 4
issue 11 | autumn 2011 | healthcare manager
Staff survey
Have your say
two seconds, and the risk of serious side effects is less than one in a million – far less than the risk of getting seriously ill from the flu virus itself. Dean Royles, Director of NHS Employers, said: ‘It’s vital to the health of our patients that managers provide top notch leadership in getting frontline staff to protect themselves, their families and their patients.’ MiP chief executive Jon Restell, urged managers to set an example by having the jab themselves. ‘Management cuts and restructuring are taking their toll on staff resilience. Let’s get this message about fighting flu out there and get staff vaccinated. And that includes managers!’ NHS trusts will receive campaign posters, leaflets and stickers in September. The campaign will also use social media to spread information, including a Facebook page (facebook. com/nhsflufighter) and a Twitter account (@NHSflufighter).
The 2011 NHS staff survey, launched at the end of September, is an excellent opportunity for NHS staff to express their views about what is happening in their organisation and report their experience in areas such as access to training, appraisal and job satisfaction. The survey also allows organisations to get feedback from staff on these vital issues. The staff survey shows the link between good employment practice and health outcomes. Recent research by Aston Business School concluded: ‘Good management of NHS staff leads to higher quality of care, more satisfied patients and lower patient mortality. Good staff management offers significant financial savings for the NHS.’ The report NHS Staff Management and Health Service Quality is available on the DH website at www.dh.gov.uk. Details of the 2011 survey are available online at www.nhsstaffsurveys.com.
each year, the report, Tackling the Spread of HIV in the UK, says key to reducing costs is to bring down long-term infection rates, by halving the number of people with undiagnosed or late-diagnoses HIV and increasing the number of people with HIV receiving treatment from 50% to 66%, within three years. People receiving HIV treatment are significantly less likely to pass on HIV to other people, the report says. ‘Rising HIV infections are placing an increasing yet avoidable burden on the NHS which hard-pressed budgets can ill afford,’ said Paul Ward, deputy chief executive of the trust (pictured left). ‘There is no cure for HIV and it is the fastest growing serious health condition in the UK, but we do not have to accept rising costs as inevitable. By renewing our approach to HIV prevention in the UK, by properly involving communities, businesses, charities, individuals and the state we can turn this epidemic around.’
HEADS UP
inperson Brenda Bellando, business and service manager, West of Scotland Breast Screening Service
‘We provide a breast screening service which covers 40% of the Scottish population, that’s 240,000 women who are screened over a three year cycle,’ explains Brenda Bellando, business and service manager for the West of Scotland Breast Screening Service. Set up in 1988, the service is part of the government’s national breast screening service, and provides a dedicated asymptomatic breast screening and follow up service in Glasgow as well as seven full-time mobile breast screening units covering the whole of the West of Scotland. Brenda has worked on and off in the NHS for over 40 years and has been in her current job for over a decade. Her role is to co-ordinate, manage and oversee the service, including ‘planning programming and managing budgets and dealing with the overview of the IT needed to provide the service’. She says her job is about making sure that the right processes and procedures are in place to ensure the service is working effectively as well as ‘keeping an eye on things in terms of performance management’. Brenda must also make sure the service is both hitting current breast screening targets and constantly trying to improve screening rates and outcome rates for people with suspected breast cancer. ‘The importance of management is that although things can be set in motion, if they are not managed they can easily grind to a halt when there is a glitch.’ With over 100 staff, including consultant radiographers, mamographers, breast care nurses, managers and transport liaison staff, ‘there is a lot of teamwork and logistics involved in the service we provide,’ says Brenda. The mobile service travels as far as the Isle of Mull and Campbeltown on the Kintyre peninsula. Transporting the mobile equipment and scanners across to the islands by ferry can be a huge operation.
Brenda says that the team are constantly involved in contacting women for screening and advertising and publicising the service not just in GP practices, but in supermarkets and health centres across the region. She admits that in the current financial climate the service has to work to be as efficient as possible to justify its £4m budget. The breast screening service across Scotland is currently subject to a government review. ‘Like everyone else we have to be efficient with the things we provide. Within the budget, we have to provide information about our costings and submit business cases, especially because the
“The importance of management is that although things can be set in motion if they are not managed they can easily grind to a halt when there is a glitch.”
equipment we use is very expensive,’ says Brenda. Healthcare managers play a vitally important role within her team. ‘It’s about helping to co-ordinate a team to work together to make things more efficient and more effective for patients,’ she says. ‘I might plan a mobile unit screening programme but if we don’t have a rota for the clinicians, radiographers and the transport workers nothing will happen and no services will be provided. If we all do our bit the outcome is better for the patient.’ Helen Mooney
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HEADS UP
NHS reform
Trust plans ‘chain’ of cancer clinics
One of the NHS’s leading specialist cancer hospitals, the Christie in Manchester, is planning to open ‘branded’ NHS cancer treatment centres across England in partnership with private hospital group HCA. Caroline Shaw, chief executive of The Christie Foundation Trust, told the Health Service Journal in August that the government’s NHS reforms could allow the Christie to become ‘the first national chain of providers of cancer services within the NHS’. The joint venture with HCA would provide capital for The Christie to build ‘stand-alone’ cancer centres outside its current catchment area of Manchester and Cheshire. Shaw said provisions in the Health and Social Care Bill to allow ‘any willing provider’ to offer NHS services ‘gives us the opportunity to manage care in different parts of the pathway. We can get into diagnostics; we can manage satellites all over the country.’ The Christie is Europe’s largest specialist cancer hospital, treating more than 40,000 patients annually, with a staff of 2,500 and a turnover of £180m. American-owned HCA is the largest private hospital group in London and already operates a private cancer clinic in partnership with the Christie on the trust’s Manchester site.
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issue 11 | autumn 2011 | healthcare manager
NHS reform
MiP in talks on public health transfers MiP is working closely with the other health unions to secure the best possible outcome for members working in public health, who are facing transfer to Public Health England or local authorities. National officer Jim Keegan (right) is representing MiP in the partnership discussions to develop a ‘concordat’ for the proposed transfer of staff. The talks involve all the health unions, including RCN and BMA, and employer representatives from the Department of Health, local authorities, PCTs, and the Faculty of Public Health. ‘The concordat will be a high-level overarching document setting out the key principles and protocols for the process. We expect further HR framework documents governing the detail of any transfers to flow from this concordat,’ said Keegan. The unions argue that all public health staff should be employed by Public Health England and seconded to local authorities on a ‘Retention of Employment’ basis. Unions have highlighted inherent difficulties with supervision, CPD and the future of public health trainees if part of the service were to operate outside the NHS. As we went to press, the unions are awaiting the first draft of the concordat for comment. It remains unclear exactly how many
public health staff would be affected by the transfer proposals. To date, some 5,500 staff have been identified for possible transfer to about 150 local authorities, but this excludes public health staff working in provider organisations who provide such services as sexual health, and alcohol and drug addiction. Opinion is divided on whether these staff should remain in these organisations or transfer. Jim Keegan added: ‘MiP has had some valuable comments about the White Paper from members which have helped to shape our policy. We are keen to hear members’ views about these proposals and what your concerns and aspirations are, and how you think MiP can best represent your interests.’ Email your comments to Jim at j.keegan@ miphealth.org.uk
Health bill
Still listening The government has extended the life of the body which conducted the so-called ‘listening exercise’ set up in the wake of the widespread backlash against the NHS reforms in the Health and Social Care Bill. The NHS Future Forum, led by GP Professor Steve Field, will continue its consultations with patients, NHS staff and the public in four areas: education and training, health information, integrated care, and public health. Prime minister David Cameron said the forum’s feedback had been ‘invaluable’ and the government’s plans for NHS reform were ‘stronger as a result’.
Field said the forum would particularly be listening to the views of ‘clinicians and importantly, patients and service users’ as part of the second phase of the listening exercise. ‘With a broader membership across health and social care and a defined focus, I believe the NHS Future Forum will stimulate important debate on issues that really matter to people,’ he added. The forum will report back to ministers before the end of the year. For further information visit: healthandcare. dh.gov.uk/category/conversations/futureforum/miphealth.org.uk
HEADS UP
inpublic
“Patients can be treated within three weeks of referral from their GP. Our waiting times are ridiculously short,”
Probus Surgical Centre, Truro, Cornwall Probus Surgical Centre near Truro in Cornwall was established four years ago to expand on the surgical services already being performed at the Probus Surgery general practice. The centre, which has two theatres, a treatment room, and a surgical administration department had also recently been awarded a community services contract by Cornwall and Isles of Scilly primary care trust to treat patients needing minor surgery from across the county. In the last few years the centre has been treating up to 2,000 patients annually and has been recognised by the Department of Health as a leader and pilot for the government’s programme of delivering care closer to patients’ homes. But in November 2010 the PCT dealt what Chris Gendall, the centre’s surgical general manager, describes as a ‘bitter blow’ to the organisation. ‘The PCT asked for bidders for an elective surgery services contract under any willing provider,’ he explains, ‘and in order to bid the centre would have needed to be registered with the Care Quality Commission. But our problem was that GP practices are not eligible to register with the CQC until 2013.’ The centre was forced to become a limited company in order to be able to register with the CQC and bid for the contract which it won back from the PCT. ‘We are now Probus Surgical Centre Limited and the GP surgery partners are the directors and shareholders.’ While Gendall says that setting up the company was ‘quite a good solution’ it was
a ‘bitter pill’, because at the same time it meant that full time staff lost their right to an ongoing NHS pension and the centre lost out on preferential procurement rates with Royal Cornwall Hospital Trust. He says that the centre may well go back to its original set up once GP practices are allowed to register with the CQC. Despite these issues, the centre has performed well over the last year, treating around 4,500 patients mainly from Cornwall, but with patients coming from across England for the centre’s renowned hernia surgery. The centre is able to operate using local anaesthetic on patients with co-morbidities, a procedure which is not widely on offer in England. The centre also delivered its contract at 90 per cent of the national tariff, saving the PCT approximately £100,000, has achieved a £2m turnover per annum, and is MRSA and infection free. Gendall is hopeful that the introduction of a central referral management system across the region will also mean that more patients will choose the centre. ‘Patients can be treated within three weeks of referral from their GP. Our waiting times are ridiculously short,’ he boasts. Future plans include expanding the centre to include endoscopy for upper and lower GI and ophthalmology. Gendall says the centre has got a ‘bright future’ ahead of it, although he warns against it becoming too much like a hospital. Helen Mooney
issue 11 | autumn 2011 | 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
A deal is a deal! I would like to take this opportunity to comment on the doctrinal changes to pensions this government intends to impose. I will keep my comments short as, to some extent, I think it is unwise to fall into the trap of arguing whether we will be hung, shot, electrocuted or poisoned! This is a fundamental breach of a contract; an agreement was reached and as such should only be changed by agreement not imposition. Clearly this Tory government’s opinion of public sector workers and managers in particular is at best extremely low and it is deceitful to pretend otherwise: the actions they take belie the words they speak. We are not the venal, stupid or idle people the government believes us to be. Not venal, as we recognise that our pensions need to be adequately funded and have agreed to do so. This is different to bailing out successive governments’ “spiv economics” – running a country on the premise greed and short termism is good or, worse, effective. As 8
the current slump evidences it doesn’t work and shortly neither will a lot of us. Not stupid, we can read (in fact read so well that we can read between the lines), we are capable of critical analysis and of suggesting a route to adequately fund public sector pensions, even to engage in reasoned argument in a consultation process however bad the faith demonstrated by the Government’s contribution. Not idle, we are a hard working cadre of professional managers whom the Kings Fund and others have widely recognised as efficient when benchmarking our service. Very few managers work only contracted hours. Many of us have worked our way up and are no strangers to the many aspects of work within the NHS. I am proud and pleased to say there is still enough of a battered concept of public service and pride in being a manager left to enable us to provide a service that responds without the need for a Fat Cat bonus to motivate it. The Government must recognise we have an interest in sustainable reasonable pensions and, dare I say it, so should colleagues in the
issue 11 | autumn 2011 | healthcare manager
private sector: reasonable pension should be for all, not just fat cats and MPs. A race to old age penury won’t help the individual, society or the economy – even John Hutton recognised this. In short we made a deal, shook hands and it should stick until we all agree the change. Andrew Cole by email
NHS birth partners wanted Leading midwives agree that good antenatal education can have a positive impact on a woman’s birth experience and birth outcome. At Antenatal Online, we are looking for an NHS partner to pilot a new concept in antenatal classes which would deliver quality antenatal advice and support direct to your mums-to-be and their birth partners. Ultimately we believe that if women are prepared for birth the chances of intervention are
lessened, potentially giving significant cost savings at a time when services are struggling. Antenatal Online has been developed with NHS midwives and offers high quality, flexible antenatal tuition, delivered via the web. Preview videos and further information can be found at www. antenatalonline.co.uk. If you are interested in discussing working in partnership with us to pilot the classes in your area, please get in touch. Our classes can be cobranded for your NHS Trust and could easily be supplemented with other local information. We believe this is an exciting step forward for antenatal education and look forward to hearing from you. Louise Morrison Founder Antenatal Online louise@antenatalonline.co.uk 01622 205975
COMMENT
comment Paul Hodgkin
Chief executive of Patient Opinion.
Get with the programme The recent riots carry many messages but one of the most important is about that favourite NHS word, ‘engagement’. Engagement can mean many things – a prelude to marriage, for example. And for busy staff, the metaphor involves gears engaging, with patients as handy cogs turning smoothly, playing their natural part in the great machinery of healthcare, while other, wiser hands do the steering. For those rioting on the streets, of course, engagement was about clashing with the police, looting and pillaging. However, one thing about engagement is certain – quick, cheap, many-to-many messaging has shifted the balance of power from the state to the crowd. This is true whenever citizens rub up against hierarchies. News International’s crucifixion was partly due to the power of Mumsnet in mobilising parents against advertisers using the News of the World. Put this technological transfer of power next to disgraced bankers, politicians, police and the press, and you begin to see the rioter’s crooked sense of entitlement and immunity staring out at you from the next crazed shop front. So what can the NHS learn from all this? First, that ‘engagement’ as practiced by the NHS has now been left so far behind by the street that it needs those quote marks around it. The way people actually engage with each other – with friends, brands and authority – now bears almost no relation to the quaint top-down, antiquated tools
the NHS has in mind when it talks about ‘engagement’. Secondly, just as in the wider world, public voice is transferring authority to citizens and patients within the NHS. Power is leaking from one side of the consultation desk to the other. Not all power, but significant amounts. That’s why the Cabinet Office’s recent paper on open data was so important, and why it included a commitment to independent online feedback for all public services. So expect the unexpected once citizens really grasp this new, less-fettered way of doing business. Finally, social media has grown up. It’s no longer a fluffy toy and can now be seen for what it is: a transformative, disruptive technology that is as much snarl as social. And like all technologies it can be used for good or ill. Twitter facilitated the clean up just as easily as the preceding riot. So bad outcomes from technologies are not pre-ordained, we make our own weather. The NHS does not have to sit passively and wait for a Facebook hate campaign against a clinician to claim its first victim. We can and should be out there building tools that actively shape the dialogue, that enable the good stuff to happen and make the bile less likely to spew. This will only happen if we grasp the opportunities early and develop platforms that inspire and delight citizens. What patients want – and we know from the evidence – is to be heard, to feel listened to and involved, and to know that difficult decisions will be shared with them. Social media is ideal
“Public voice is transferring authority to citizens and patients. Power is leaking from one side of the consultation desk to the other. ” for them because it means everyone now has a public voice. And people who think they are starting a conversation naturally want a response. Which is tough for busy staff, who are expecting engaged cogs not animated conversations. But, hey, who ever said the future was easy? But once we make that transition, a million conversations really can bloom. Unrealistic? At Patient Opinion we’re not setting our sights quite that high, but we do want 100,000 stories per year, answered by 10,000 staff (that’s about one response per month for each staff member). With many thousands of stories already published, it’s clear that patients don’t want to be ‘data’ or ‘feedback’. They want to be part of the solution. They want to be involved, to help – and what’s not to like about that? The question is – what do staff want?
.
Patient Opinion is the UK’s independent non-profit feedback platform for health services. For details, visit: www.patientopinion.org.uk
Views expressed are those of the author and not necessarily those of healthcare manager or MiP.
issue 11 | autumn 2011 | healthcare manager
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SCREENING
The benefits of digital screening for breast cancer are clear and compelling. Britain’s world-class breast screening service needs to implement the new technology with urgency, says Maggie Alexander.
Digital technology has transformed the world we live in. Our mobile phones now allow us to check emails, surf the internet and even watch videos on the move. It means we can do more, faster. In the NHS, digital technology has improved the way information is collected and handled. It means that imaging has become faster, more efficient, and gives clearer results. Digital imaging has been replacing photographic film in medical and dental applications for years. A commitment to roll-out digital breast screening across the NHS Breast Screening Programme was made in the Cancer Reform Strategy of 2007, but four years on, progress has been patchy and slow. We are aware of a number of challenges that have impacted on this for example the recent health reforms and lack of capital. While digital screening has been rolled out in some parts of the country, it is nowhere to be seen in others. It means that while some patients, and indeed healthcare professionals in breast screening units, enjoy the benefits of digital, others do not. Breast screening is actually one of the very few areas of imaging in the NHS where film is still routinely used. The truth is that using film is some10
issue 11 | autumn 2011 | healthcare manager
thing that has worked well for many years and many women have benefited from that technology. Now, however, we have something that is clearly better, a fact which has been recognised by the Government and many across the NHS. We know there are challenges in the roll-out of this technology, but we should be focussed on making digital happen. We can’t have screening technology more suitable for a bygone era any longer. Healthcare professionals who use digital tell us that the differences are huge and when they have started using digital screening they would never want to go back. So, what are the benefits of digital imaging technology for breast screening? reduced radiation dose through improvements in technology ■■ fewer repeat mammograms needed as technical errors can be seen immediately ■■ easier analysis of the image through the use of high quality computer monitors and image manipulation tools ■■ Improved access to expert opinion as images captured at one location can be viewed simultaneously by a radiologist in another ■■
■■
images can be produced quicker and experts have reliable access to previous digital images
It’s a pretty compelling list of benefits, and that is before you start thinking about the potential cost savings. Digital breast screening is clearly one of those examples where the NHS can, and should, invest to save. In fact, the NHS has already stated that digital mammography implementation is costeffective over film screen mammography. In July 2008 the NHS Purchasing and Supply Agency published a report outlining the cost effectiveness of full field digital mammography versus film screen imaging for mammography. They concluded that although digital mammography will be more expensive in the initial phase, other factors show it to be a more cost-effective option as a result of: ■■ reductions in consumables used (e.g. x-ray film, printing solutions etc) ■■ reductions in recall appointments (it is possible to see straight away if the X-ray has worked avoiding the need for repeat appointments) ■■ reductions in staff costs by removing the need to spend time processing images It should also be added that while
SCREENING
“We don’t want a situation where women in different parts of the country feel they are getting a different quality service to each other.”
annual maintenance costs are currently greater for digital mammography these costs are likely to be reduced as component parts become cheaper. The challenge is to get digital fully rolled out across the NHS. We know this isn’t easy. However, we also think that the benefits of this technology are so great that we cannot delay. We don’t want a situation where
women in different parts of the country feel they are getting a different quality service to each other. A two-tier breast screening service is something that none of us wants. While I hope this expresses the urgency with which we at Breakthrough Breast Cancer feel this issue must be addressed, we must reflect that we, in the UK, are starting from a position of
strength. The NHS Breast Screening Programme, now running for more than two decades, is a world-class service and has made a huge difference in the early detection of breast cancer. This is because breast tumours can be identified before other signs and symptoms are apparent and before they can be seen or felt, which means treatment is more likely to be successful and less invasive than if it was picked up at a later stage. I, personally, am a huge supporter of the work the NHS has done within the breast screening programme and the improvements we have seen over the years. That said, the case for the roll-out of digital technology is one that cannot be ignored. Just as someone who uses a 3G smartphone would not wish to revert to using a phone from the last century, those working in the breast screening programme should not be forced to use outdated technology. Let us seize the opportunity to adopt change and make sure our breast screening programme remains an exemplar service for many years to come
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Maggie Alexander is Director of Policy and Campaigns at Breakthrough Breast Cancer.
issue 11 | autumn 2011 | healthcare manager
11
INTERVIEW
In an exclusive interview, Dr David Bennett, head of NHS ‘superregulator’ Monitor, talks to Healthcare Manager’s Alison Moore.
In NHS mythology, Monitor chair and interim chief executive David Bennett risks being remembered as the man who compared the service to a utility company and suggested it should be dismembered. But the man himself almost jumps out of his chair to protest. He says he never used the word ‘dismemberment’ in his interview with The Times in February and it was ‘an unfortunate misstatement of what I really think’. It’s true that the word seems to have been tagged on later in second-hand reports and was not used in the interview. But he did suggest in the UK there was ‘20 years of experience of taking monopolistic, monolithic markets and providers and exposing them to economic regulation’, that he was convinced ‘choice and competition will work in the NHS as it did in those other sectors’ and even that ‘over time an element of price competition would be appropriate’ – though he added care would be needed because of the risk to quality. Six months, a listening exercise and a revised bill later, his message is more nuanced. ‘It‘s true that other complex sectors, like healthcare, have been restructured. In a number of cases economic regulators have been introduced,’ says the former non-political 12
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chief policy adviser to Tony Blair, who was appointed as interim chief executive at Monitor before last year’s election and then as chair this February. Sectors such as gas, electricity, telecoms, rail and water are different to the NHS, he swiftly adds. But there are lessons which can be learnt from them. ‘For example…where we have a health service that is essential, we need to make sure that there are mechanisms in place to protect the service even if the hospital does get into difficulties,’ he says. In that respect – continuity of service – there are some similarities between the NHS and other sectors, he suggests. And as a regulator Monitor will have to change its focus towards patients – in the same way that regulators in other sectors have had to switch from being institution-oriented to thinking more about the service users. ‘We need to change our orientation – it’s a big jump,’ he says. ‘One of the things is just who we think of as our stakeholders. At the moment they are the obvious ones like Parliament and then the foundation trusts. Although this is not going to go away, just recognising that patients and their representatives are our stakeholders will be a change. ‘I know one other regulator who has tried to recruit people from a more con-
sumer-oriented background. We must not slip into the trap of thinking that consumers of healthcare are like consumers of other sectors, but nonetheless that is something that another regulator has done that we need to think about. Do we need at least one key person here with a real understanding of how consumers are thinking?’ The reaction to his Times interview has obviously stung him: several times, he is at pains to point out how healthcare is different to other areas. Other pronouncements suggest he has an independent turn of mind which will ensure he is no political puppet. The impact assessment carried out by the Department of Health on the health bill suggested that the NHS enjoyed a whopping 14% cost advantage over the private sector when providing services. The figure sent a shiver down many NHS organisations’ spines, as it seemed to make a case for differential tariffs. Dr Bennett, however, rubbished the figures at the Health and Social Care Bill’s committee stage in February, saying, ‘I don’t think it represents a complete analysis’. Monitor needed to examine the issue in more detail and ‘may well discover it’s the public sector
INTERVIEW
“We must not slip into the trap of thinking that consumers of healthcare are like consumers of other sectors.”
that’s disadvantaged’. This may not have won him many friends in the Department – he may have learnt a lesson himself, he says wryly – but it did offer the NHS some comfort. Looking back, he points out there was a list of advantages and disadvantages on both sides – NHS pensions being one of the most significant ones – but only some of them could be priced. His objection was more that the figures presented an incomplete picture, rather than with making the comparison itself. ‘What I said was I will believe these numbers when we have had a chance to assess them properly.’ There were also some muted cheers for the slight revision of Monitor’s role after the listening exercise on the bill. From ‘promoting competition’ it is now charged with preventing ‘anti-competitive behaviour’. He sees some of the changes to the bill being designed to clarify what was originally intended. The interests of patients were always the core duty, he says, but people were concerned that competition might be promoted over and above the interests of service users. The change of emphasis pleased him, but he has always seen the job as using whatever tools are available to promote and protect the interests of the user. ‘I think in the original wording they have the impression there could be competition on price. It was never clear to us how that would work,’ he says. The new emphasis on integrated care is also important, although he argues that integrated care does not always need integrated organisations.
This leaves open the possibility that alternative providers could provide part of a care pathway as long as the patient still receives an ‘integrated’ experience. So was he at one with the health secretary over visions for the future and changes to the bill? He certainly seems close to Andrew Lansley – always referring to him by his first name – and says ‘we were in complete agreement that the way in which language was used…was very important and some of the wording of the original bill caused people to be concerned.’ He says he would not have used the greater powers that the original bill appeared to give Monitor, but he con-
cedes that things change and his successor might have. Dr Bennett will be guiding Monitor through a period of immense change as it expands its current role to encompass that of economic regulation. Bennett puts the government’s enthusiasm for Monitor’s expansion down to seeing some efficiencies in combining the regulatory roles and the organisation’s good reputation for acting professionally. With a large number of acute trusts still to attain foundation trust status, there is widespread concern within the NHS about what the future holds for organisations who are struggling. But he points out that it is for the DH to put forward trusts for issue 11 | autumn 2011 | healthcare manager
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INTERVIEW
“We only ask very simple questions – are trusts well governed, delivering safe care and financially strong? If we have trusts which struggle to demonstrate that, then we all have a problem.” foundation status and that the changes needed to make some of these trusts viable candidates are really issues for the department: Monitor sets the bar that trusts need to reach. ‘We only ask very simple questions of trusts – are they well governed, delivering safe care and financially strong? If we have trusts which are going to struggle to demonstrate that, then we all have a problem,’ he says. ‘Do I think that every trust will pass that barrier? No.’ He doesn’t say it explicitly but the message is clear: there won’t be any slackening of the requirements for prospective foundation trusts, even if the consequence is that some trusts won’t make it. He has warned, however, that creating a rush for authorisation at the last minute will create an ‘almost impossible challenge’ for Monitor in terms of processing applications. And Monitor’s recent messages for existing FTs have been just as blunt. In addition to finding some trusts in breach of their authorisation, it sent out a letter in April warning that 4% cost savings would not be enough; they could need to find up to 7%. The need for tougher cost savings would be reflected in assessments of both new applicants and existing trusts. The figures have caused some sharp intakes of breaths around board tables, but Dr Bennett is unrepentant. ‘If you look at our projections over the next few years they are showing a tougher environment. That is only a reflection of 14
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what is going on around us. There does not have to be a trade off between quality and cost and there should not be.’ Many foundation trusts recognise they need to be more energetic in their cost improvement plans, he says. But he has a message for them: ‘When you are under pressure to reduce costs in the first instance you can make savings by just good housekeeping. But there is a limit to what you can do in that way. ‘The danger is that you keep searching for more savings of the same kind rather than saying...we have to think much more fundamentally about how we do things. For some organisations it might mean asking if all the things that we do are necessary. Typically for us [in the NHS] that’s not a choice. They have to think about the ways in which they do things and may improve the quality of care as well.’ The example he uses is reducing the length of hospital stays, which can yield significant savings for trusts but is also better for patients. It also links into the need for integrated care – patients seamlessly moving into the right setting as they leave the acute sector and information moving with them. Monitor could work with the National Commissioning Board to define some of this, he says. ‘There is nothing around competition that should get in the way of that.’ If the size of the task ahead is daunting, Dr Bennett – a former McKinsey’s senior partner – shows little sign of being fazed by it. He will continue to com-
bine chief executive and chair roles – a new chief executive is not expected to be appointed before 2012 – as the bill progresses and the details of how the new system will work become clearer. Bennett does not come across as being wedded to competition for its own sake, but more as someone who sees it as a means to the end of improving quality for patients in some situations. But the future road for foundation trusts looks hard: more competitors, the demands for still greater cost savings and a regulator who is not afraid to shine a light on trusts who are off the mark and demand they raise their game. On the positive side, he is unlikely to be any politician’s lapdog and is swayed by evidence rather than ideology. And he does have some good news for NHS managers. As Monitor’s role expands, so will its headcount – from around 150 staff to 400 or more. Dr Bennett has also suggested the collapse of Southern Cross could lead to Monitor becoming involved in regulating social care ‘sooner rather than later’, which could increase its need for staff. As Monitor takes on the job of price setting, he wants to recruit more people with health service experience. ‘It’s important to have people who have been there and done that, and understand it. I would have to say that I see managing a health care provider in particular as one of the most difficult management jobs I have ever come across.’
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ELDERLY CARE
Older people’s basic human rights are being overlooked in the provision of care at home, according to new research. Jenny Sims examines the issues.
“Leaving someone in soiled beds or clothing for a long time or failing to ensure that an older person is able to eat or drink is serious neglect and should be treated as such.”
This autumn and winter will see a number of reports published on human rights and older people. Among them will be the results of a major inquiry into home care by the Equality and Human Rights Commission (EHRC), and how the support system in England is protecting the rights of people over 65. An interim report*, based on more than 500 submissions from care organisations, older people, families and care staff, has already uncovered ‘major problems’. These include neglect, lack of staff training, inadequate time to deliver care, and the emotional impact on older people of high staff turnover and large numbers of different carers performing intimate tasks such as washing and dressing. In one case a woman recorded having 32 different carers in two weeks. Other examples of poor care include: people being left in bed for 17 hours or more between care visits; failure to wash people regularly and provide them with the support for eating and drinking; and people being left in soiled beds and clothes for long periods. ‘This is placing older people’s human rights to privacy, autonomy and dignity at risk, sometimes in very serious ways,’ said Baroness Sally Greengross, a
Michelle Mitchell Charity Director AgeUK commissioner at the EHRC. And Michelle Mitchell (pictured), charity director at Age UK, responded: ‘Let’s not mince words about what the findings show – leaving someone in soiled beds or clothing for a long time or failing to ensure that an older person is able to eat or drink is serious neglect and should be treated as such. ‘But more than that, providing personal care for older people should not be about completing tasks in whatever is the quickest or cheapest way. Decent care is about looking after a fellow human being in the way that we would like to be cared for when we are older.’
One in five older people who responded to the EHRC call for evidence said they would not complain themselves, either because they didn’t know how to, or for fear of repercussions. The report’s authors say they be examining this fear of complaining as well as what protection and support is currently in place for care worker whistleblowers who want to expose poor or abusive practices. They will also look at the reasons for high staff turnover. Overall, the EHRC inquiry aims to find out whether homecare services promote the dignity and independence of older people and how people’s home issue 11 | autumn 2011 | healthcare manager
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ELDERLY CARE
“Our treatment of elderly and indeed all vulnerable people reflects the type of society that we want to live in.” Gwenda Thomas Welsh social care minister
and family life is respected. This includes ensuring correspondence and personal information is kept private, whether people are provided with information with which to make an informed choice about their care, and whether people are listened to and have their opinions acknowledged, accepted and acted on. Ultimately, their recommendations will be fed into the Independent Commission on social care reform. Following publication of the interim report, Baroness Greengross said: ‘Many older people up and down the country receive good quality care from committed, respectful care workers. But our evidence suggests that in some places care workers are faced with too much to do, in too little time, sometimes without proper training.’ The inquiry has been backed by a wide range of health and social care organisations including the unions, all of whom have encouraged their members to report both their positive and negative experiences. ‘Tell it like it is, be as open and honest as possible – we need the real story,’ Martin Green, chief executive of the English Community Care Association, told members. ‘The protection of human rights is central to good quality care, and anything that enhances quality of care and promotes good practice is of interest to us.’ Allison Roche, Assistant National Officer at Unison, said the union constantly encouraged its members to participate in surveys and had urged them – whether they were social workers, 16
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domiciliary care workers, or had friends or family who were unpaid carers – to participate. ‘The workforce is very important to the delivery of good social care, and we all have a story to tell,’ she said. Home care for elderly people may involve assistance with washing, bathing and getting dressed, meal preparation, laundry and housework, attending day activities, shopping, and administering medication. Inadequate time to deliver adequate homecare was a key problem, according to the survey. Staff sometimes only had 15 minutes for each visit, resulting in older people sometimes having to choose between having a cooked meal or a wash, and staff having to rush tasks like washing and dressing. It’s an issue that frustrates and dissatisfies both older people and staff alike. The Social Care Association has been involved in human rights issues in a variety of care settings. Nick Johnson, its Chief Executive, said they would ‘do anything’ to support the promotion of good practice, and he hoped the enquiry would lead to an improvement in access to services for older people. But whatever the Commission’s final recommendations, they may prove difficult to implement against a background of cuts in funding. Only one week after the commission’s interim report, AGE UK research predicted likely cuts to older people’s social care of 8.4% this year. ‘This could hasten the collapse of an already crumbling social
care system in England,’ warned Mitchell. She added: ‘The biggest threat to the human rights of older people receiving care at home is from cuts to adult social care budget. And it’s very unclear whether tightening eligibility criteria for care will allow local authorities to continue to meet their human rights obligations. ‘We all share a responsibility to ensure that we respect and care for those in the last years of their lives. We need to ensure that the funding, training and systems are in place to ensure that every single older person is allowed to live safely and with dignity’. She said the Dilnot commission should be a clarion call to government to create a social care structure that ensures a sustainable and fair provision ‘for this generation of older people and those to come’. The EHRC inquiry is only looking at home-based care because this accounts for two-thirds of all expenditure on social care for older people and, in the past, much greater attention has been paid to the human rights of older people in hospitals, residential and nursing care homes, including the recent inquiry by the Joint Committee on Human Rights into the human rights of older people in healthcare. The EHRC’s work applies only to England. But Wales, too, is pushing forward on the dignity and human rights agenda. The National Assembly, flexing its muscles since a referendum in February gave it greater law making powers, is currently looking to see if it can make legislative changes ‘to strengthen adult safeguarding’. ‘Our treatment of elderly and indeed all vulnerable people reflects the type of society that we want to live in,’ said Gwenda Thomas, deputy minister for children and social care, who has made a personal commitment to protecting older people. Last year the Welsh Government published three reports on how adult protection arrangements in Wales
ELDERLY CARE
Attempts to build similar human rights policies into their health care systems are being made by national governments throughout Europe. A recent conference, ‘The Rights and Needs of Older Patients’, held in Warsaw and organised by the European Patients’ Forum and the Polish Patients Forum, reported that ‘urgent action’ was needed at EU and national levels to tackle a potential crisis stemming from the growing health and social care needs of older people in Europe. Top EU policy makers, healthcare specialists and patients’ leaders laid bare problems for older people ranging from poverty, ageism and inequity of access to health services, to inappropriate prescribing of medicines. Speakers drew a graphic picture of healthcare professionals not understanding older patients’ needs, and of many older patients not knowing their rights to services and care. And the EU’s pilot Innovation Partnership goal of adding two healthy life years for all European citizens by 2020 does not look like it’s going to be easy to achieve. A key message was that innovative policies and practice were essential in dealing with the multiplicity of challenges posed by an ageing population, the increase in chronic diseases, and the shortage of healthcare professionals and financial resources. Proposed solutions included e-health and personalised medicine, but more partnerships between all stakeholders – doctors, carers and older patients themselves – was seen as the cornerstone for change, along with a greater focus on human rights of older people.
John Birdsall/John Birdsall/Press Association Images
could be strengthened, including those for vulnerable older people. This year, after announcing that spot checks would be carried out ‘to ensure dignity in care’, it published Sustainable Social Services in Wales: A Framework for Action. This stated that it’s ‘a basic right for everyone to be free from exploitation, abuse and neglect regardless of age.’
There will be a lot of European interest when the EHRC’s full report is published in November, and hot on its heels will follow a review of the state of human rights in England and Wales – due out on Human Rights Day, 10 December 2011. No doubt health and care managers will be urged to pick up and run with these recommendations next year by many stakeholders. 2012 isn’t just the year of the London Olympics, but the European Year for Active Ageing and Solidarity between Generations. And healthy ageing and human rights will again be hot topics. Bridget Warr, chief executive of the UK Home Care Association, says: ‘There can’t really be anything more
important than protecting and promoting people’s human rights and helping them lead the independent lives they want.’ The EU Patients Forum and many other organisations will agree with her
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Jenny Sims is a freelance writer and editor *EHRC Interim Report of Formal Inquiry into older people and human rights in homecare in England, published 20 June 2011. Available at: www.equalityhumanrights.com/homecareinquiry For more information on The Rights and Needs of Older Patients, Warsaw Conference, visit: www.eu-patient.eu
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professional regulation
NHS chief Sir David Nicholson wants to introduce professional ethical standards for healthcare managers. Harry Cayton, who heads the body charged with developing them, explains their initial thinking.
“I believe that management is an honest trade, open to those with the necessary skills and aptitude. It is not a profession closed to those without specific qualifications and subject to regulatory discipline.” Many have tried; few have succeeded. The NHS is, some might say, already over supplied with various forms of standards for managers. Most of them are, it seems, more honoured in the breach than in the observance. There is the NHS Code of Conduct as well as standards and advice from the Institute of Healthcare Management, the National Leadership Council and the now closed British Association of Medical Managers, among others. It’s not surprising then that some scepticism greeted David Nicholson’s announcement, at the NHS Confederation conference in July, that I and colleagues at the Council for Healthcare Regulatory Excellence (CHRE) had been asked to develop ethical standards for NHS executive and non-executive board members. I’m fairly sceptical myself. So what is it that CHRE is setting out to do and how are we going about it? We need to separate out, in this blizzard of good intentions, the numerous different approaches. There 18
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are competency frameworks, leadership programmes, standards of performance, voluntary accreditation and licensing schemes and proposals for statutory regulation. Some focus on technical skills, some on ethics, some on leadership. They may be linked but they serve different purposes. We also need to bear in mind the numerous obligations that senior managers are already under, either by virtue of being in a position of responsibility in a public sector body and in the NHS, or because they are registered professionals – doctors, nurses, lawyers, and accountants. In its recent report, No More Heroes: The Future of Leadership and Management in the NHS (2011) the King’s Fund argued that ‘the current proposals for reform [of the NHS] raise serious issues around governance, leadership and management’. Sir David Nicholson is indeed aware of this; that is one of the reasons why he has put his personal commitment behind this work. In particular, the creation of new local commissioning arrangements, with a great deal of financial power and
responsibility being vested in GPs, requires clarity about the proper use of public money and avoidance of conflicts of interest. In the new world, qualities such as integrity, honesty and probity will be more central to good management than ever before. I believe that management is an honest trade, open to those with the necessary skills and aptitude. It is not a profession closed to those without specific qualifications and subject to regulatory discipline. But that does not mean that managers cannot be professional or that we cannot expect high standards from ourselves. Much has been written about the nature of professionalism and its expression in the regulated professions. The Royal College of Physicians published a thoughtful report in 2005, Doctors in Society: Medical Professionalism in a Changing World, suggesting that professionalism could no longer be defined through personal qualities but rather as a set ‘of values, behaviours and relationships’. It is indeed values, behaviours and relationships that will form the basis of these ethical standards for managers.
Professional regulation
Given the confusion surrounding standards for managers we need to be clear about our intentions. Our publication Right-Touch Regulation (2010) describes the approach we adopt in our work. It reminds us that we should use existing regulatory and improvement mechanisms properly before inventing new ones. There are already many ways of ensuring high quality management; proper recruitment and due diligence by employers, personal development plans, training, supervision, appraisal and effective oversight by nonexecutives. CHRE’s work will aim to support existing mechanisms not to substitute for them.
We will develop these high-level ethical standards for NHS board members through extensive consultation across the healthcare sector, and building on work already done in this area. They will be consistent with the Nolan Principles on Public Life and other legal frameworks that apply to professionals and senior managers in the NHS. The standards will cover three domains: Competence and ability to carry out the job ■■ Personal behaviours and accountability ■■ Business practices, including financial probity ■■
We have started with a literature review which will be completed by September. We have also embarked on a series of interviews with key individuals. These will continue through the autumn. The NHS Confederation has offered to help us engage with groups of managers and we will also be visiting a small number of trusts and PCTs to speak directly to those with day-to-day responsibility for decisionmaking. We will also be talking to patients and the public about their views of NHS management. We hope to build a picture of what good management looks like to all these groups, so that we can pin down the values, behaviours and relationships that make NHS managers excel at their job. We want the standards to be a useful aid to board members, to help them make difficult decisions in a way that is ethically sound and publicly defensible – so we’ll be asking managers for specific examples of dilemmas they have faced at work where they feel they could have done better. We hope to have draft proposals available in November and will consult formally on those. In early 2012, a revised version will be tested with a small reference group and our final product will be delivered to Sir David Nicholson by the end of March. We welcome the engagement of anyone who works in or uses the NHS. We will keep you up-to-date with progress via our website and you can register your interest in it by emailing policy@chre.org.uk. An email questionnaire will be available as part of the development and consultation processes.
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Harry Cayton is Chief Executive of the Council for Healthcare Regulatory Excellence. For more information contact the CHRE project manager, Dinah Godfree by email to: dinah.godfree@chre.org.uk.
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LEGAL MATTERS
legaleye New regulations will make it harder for employers to dismiss people reaching ‘retirement’ age, says Jo Seery. The Employment Equality (Repeal of Retirement Age Provisions) Regulations 2011, which came into force in April, made dismissal for retirement unfair. Such dismissals will also amount to discrimination on the grounds of age unless the employer can establish that they were objectively justified under the terms of the Equality Act 2010. However, under the transitional provisions, an employer may still fairly dismiss an employee who reaches the age of 65 before 1 October 2011, provided they have issued notice of retirement by 5 April 2011 and complied with the strict notification procedure. Transitional Provisions Even where transitional provisions apply, the employer must still comply with the statutory retirement procedure under the Employment Equality (Age) Regulations 2006. This means the employer must: ■■ Give the employee six or 12 months notice of the intention to retire them ■■ Notify the employee of their right to request not to retire and the conditions for making a valid request (in particular, the employer must have informed the employee that any request must be in writing and cite Paragraph 5 of Schedule 6 to the Age Regulations) ■■ Consider the employee’s request, which means they must meet the employee with an open mind and genuinely consider their representations as to why they should be allowed to continue 20
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working beyond retirement age Give a written response and if the employee’s request was accepted, say whether employment will continue indefinitely or for a fixed period ■■ If the request was not granted, hold an appeal hearing, if the employee wishes to appeal, and give a written response to the appeal ■■
Employer Justified Retirement Age The abolition of the Default Retirement Age does not mean that the employer cannot retire an employee. Many trade unions have negotiated collective agreements which allow employees to be dismissed for retirement at a particular age. Even without a collective agreement, union members may have employment contracts which allow an employer to do this. The issue then will be whether dismissal at a certain age can be objectively justified. This will depend on whether the dismissal is a proportionate means of achieving a legitimate aim. Legitimate aims could include dealing with diminishing performance and allowing people to retire with dignity, enabling candidates to be appointed to senior positions and enabling the employer to plan the workforce. However, it is not enough for an employer simply to state a legitimate aim. They must provide evidence that both the aim was legitimate and that the measures taken were proportionate. That will depend on the balance between the discriminatory effect and the reasonable needs of the business. Relevant factors will
include: whether the retirement age was collectively negotiated with a union (with the agreement of members); whether the employee will receive financial compensation such as an occupational pension; and whether compulsory retirement has been widespread in the organisation without having any effect on recruitment. Unfair dismissal Where the contract provides for compulsory retirement at 65 or normal retirement age, this will amount to a dismissal under the Employment Rights Act 1996. In those circumstances, the reason for dismissal may be on one of the following grounds: redundancy, some other substantial reason, capability and/or ill health. Whether such dismissals are fair will depend on whether the employer acted reasonably in dismissing on one of those grounds taking into account established case law. Recruitment Finally, employers cannot refuse a prospective worker a job simply because they are within six months of retirement age. Employers’ recruitment policies need to be revised and if necessary renegotiated to reflect this.
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Jo Seery 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
Staying true Developing self-knowledge and awareness can improve management practice, says Dr Gareth Morgan. In the light of forthcoming pension reforms, my 17-year NHS career makes me a professional approaching the middle part of my career. Potentially, this is an exciting time professionally, as I have much experience to draw on while also having more senior colleagues to learn from. Recently, I became interested in offering something back to colleagues and one thing I can offer, from my accumulated experience and observations, both positive and negative, is a viewpoint on authentic management practice. For me, the starting point is selfknowledge and awareness. There is plenty of literature on this, including some of my own work; there is a danger that one can spend more time reading about self-knowledge and awareness
than actually cultivating the qualities they seek to enhance. Often similar topics may be given slightly different names or there may be differences of opinion. While this illustrates the inexact nature of these concepts, it is easy for people to become confused on a technical point. The most important principle is to find an approach to achieving self-knowledge and awareness that suits your specific personality and circumstances. Our approach to getting fit will depend on our potential and how we want to use the ‘fitness’ we achieve: a swimmer will have a different regime to a tennis player. To take the sporting analogy further, a good coach can help by providing support, observations and feedback. My approach involves ‘reflective practice’, a discipline that requires me to set aside time at the start and end of each
day to prospectively and retrospectively review activity. In the morning, I do this as part of a structured exercise regime, while at the end of the day, I take a more opportunistic and flexible approach, depending on circumstances. My coach, a ‘critical friend’, offers observations and feedback every quarter. With due consideration to timing and tact, authentic management practice is basically about being true to oneself and delivering an honest message. Experience teaches me that the way we deliver the most difficult messages is what truly defines our authenticity as a manager.
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Dr. Gareth Morgan is project manager for the National Service Framework for Older People, NHS Wales.
Tipster: Generating ideas Blue-sky thinking is all very well, but will you get the ideas you need? Here are a few simple tips to get the most from group discussions:
Planning Be clear about what you want and the timescale for delivery. Be clear about key criteria, especially the budget.
2 Scoping What is up for discussion and what is not? There’s no point in your group generating fabulous ideas which you can’t implement.
3 Get the right participants Bring together a mix of people with the experience you need. Don’t choose people just because of their place in the hierarchy.
4 Focus the discussion Ask the right questions to generate useful ideas. There’s no point in having a free-flowing discussion that takes you nowhere.
5 Make your expectations clear Take time at the beginning to explain the purpose of the discussion and what the follow up will be. With ideas, it’s quality rather than quantity that counts two or three gems from each group is more than enough.
6 Use sub-groups to discuss specific questions. Have multiple, discrete, focused idea generation sessions in sub groups of three to five people, focussing on one question for about 30 minutes.
8 Explain the next steps Your participants need to know how you will follow up the ideas generated.
9 Follow up Be quick and thorough. Take forward the usable ideas and be clear about why some are rejected.
Feedback Communicate decisions quickly to participants. People want to know that their ideas have been heard and the reasons for rejection, rather than hearing nothing.
7 Wrap it up Get the subgroups to narrow down to their top two or three ideas and share with the larger group.
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MiP AT WORK
Putting a brake on manager-bashing MiP’s parliamentary campaign on the Health and Social Care Bill MiP has been lobbying hard on the Health and Social Care Bill, in particular bringing the Government to book for its anti-management rhetoric. Of course we cannot claim all the credit for the change following the listening exercise, but we clearly had an influence and our proactive communication campaign aimed at policymakers has certainly made a major contribution. We met with a wide range of influential MPs including Stephen Dorrell, chair of the health select committee and many of its members, the Labour health team, members of the Health and Social Care Bill committee, key backbenchers and peers including Baroness Shirley Williams as well as the health secretary, his ministers and officials. We also circulated briefing papers at second reading, and when there were debates in the Lords, and provided evidence to the bill committee and the select committee. We also provided a proforma letter to assist MiP members to contact their local MP. We had two sets of arguments. The first concerned the proposals in the bill itself – most notably issues concerning probity, accountability and the introduction of competition. The second concerned the role of managers as part of the healthcare team. We made it clear that the negative rhetoric about managers was not only offensive and unsubstantiated, but also destabilising and counterproductive. And we emphasised that without talented and skilled management the changes proposed in 22
issue 11 | autumn 2011 | healthcare manager
the bill would founder – that managers were part of the solution not the problem. We worked closely with other organisations lobbying for changes to the bill to ensure that managers were not ignored, notably the other health unions, but also with Dr Clare Gerada, chair of the Royal College of GPs, who made frequent helpful statements about managers’ skills, as did Richard Vautry of the BMA and Mike Farrar at the NHS Confederation. The intervention of the Kings Fund – who released a report The future of leadership and management in the NHS: No more heroes – was crucial. The report concluded that there was no ‘persuasive evidence that the NHS is over-managed’ and recommended that it was time to stop using management as a ‘pejorative’ term and, most helpfully, that the target for reducing the number of managers should be revisited. Of course it is easy to be cynical
and to explain the change in terms of arguably the biggest lesson learnt by the coalition during the ‘pause’ – that a great deal of the opposition flaring up against their reforms was due to the combative language they had used. But the listening exercise did amount to a real and welcome retreat on a number of policy issues and the changing tone of rhetoric is leading to improved negotiated outcomes in the realities of redeployment, insecurity and redundancy facing MiP members. It is now clear, from ministerial speeches and David Nicholson’s transition plan, that the terms of the debate have shifted, although it is equally clear that this is not the end of the story. Unfortunately, managers will continue to be in the firing line and we still have significant concerns about the Health and Social Care Bill. But at least there is now more widespread recognition of managers’ worth and MiP will continue to argue their case on behalf of our members
.
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Making an impact – MiP masterclasses MiP has developed a programme of masterclasses which it is rolling out around the regions. Following our successful bid for funding from the Union Learning Fund, we have been able to develop these sessions tailored to the needs of healthcare managers. Stand and Deliver is a half day event delivered by actors from the Central School of Speech and Drama. This course shows you techniques to get your message across – to your staff, your Board or the general public. – covering areas such as the impact of body language and how to produce a powerful and effective speaking voice, as well as sharing some of the secrets of the acting profession. The course has been very well received so far with comments such as ‘an excellent opportunity to learn some techniques which can and will make an impact on any future presentations I have to give’ and ‘an excellent course delivered in a non-conventional style – made it all the better’. They have been held in London and Birmingham with more dates to be added over the autumn: Manchester on 3 October, London again on 17 October and Essex on 7 November. We have added another masterclass focussing on the content of presentations which we are now piloting: Storytelling for Leaders, which helps participants to develop the technique of storytelling to deliver a memorable message and inspire audiences. Attendance at these masterclasses is free, with just a small administrative charge. For information about these and free places at conferences, keep an eye on MiP’s website at www. miphealth.org.uk If you would like us to bring an event to your area, contact Liz McCarten at l.mccarten@miphealth.org.uk
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 11 | autumn 2011 | healthcare manager
23
backlash
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
by Celticus
Hearing but not listening
H
e listened, and now ‘the whole health profession is on board’ for the government’s NHS shake-up, PM David Cameron told an audience at the Royal Cornwall Hospital last month. But who has he been listening to? Not doctors: the BMA said the revised bill posed an ‘unacceptably high risk to the NHS, threatening its ability to operate effectively and equitably, now and in the future’. Not nurses either: the RCN said it would have ‘a seriously detrimental effect upon the NHS and the delivery of patient care’. And certainly not managers: MiP said ‘the listening exercise has been a failure… the things that remain fundamentally wrong and dangerous about the bill are all still intact’.
Trust me, I’m a doctor
N
ews from our friends at pollsters IPSOS MORI that doctors are once again our most trusted profession (Mr Cameron take note). 88% of the public trust medics to tell the truth, placing them ahead of teachers (81%) and even clergymen (68%). Social workers fared surprisingly well, with 60% trusting them. NHS managers? Mid-table, I’m afraid with 40% trusting and 45%
24
not. Still, could’ve been a lot worse. Politicians came rock bottom, only trusted by 14%, behind even journalists (19%) and bankers (29%).
Lansley’s private office with £21,000 before the election, while Mrs Nash stumped up £60,000 for the Conservative Party in September 2010.
Big Bucks
Sorry Saga
T
rouble in Buckinghamshire, where the PCT’s practice-based commissioning arm is headed by Dr Johnny Marshall (pictured), who also leads the pro-Lansley National Association of Primary Care. Buckinghamshire’s outsourcing of diagnostics and musculoskeletal care isn’t going as smoothly as hoped. Even Marshall admits ‘there have been a few headaches’ and waiting times have risen, while in August the prison inspectorate, in a report about two local prisons, found ‘serious concerns about the healthcare provision which NHS Buckinghamshire has commissioned from Care UK’. Still, the firm has friends in high places: Care UK chairman John Nash bankrolled Andrew
issue 11 | autumn 2011 | healthcare manager
C
elticus is grateful to a Dr Grumble (perhaps not his real name) for passing on a helpful leaflet from Saga, the lifestyle conglomerate for the over 50s. The NHS Reforms: how they will affect you does indeed make grim reading: upheaval, teething troubles, rising waiting lists and so on. So bad in fact, that it recommends taking out private health insurance – from Saga of course – so ‘you can have the reassurance of private treatment and care’. Could these be the same terrifying NHS reforms that Saga chief executive Rachel Altman (picutred) said ‘must not be derailed by vested interests’ and without which she told the Daily Telegraph in May, ‘the whole system will collapse’?
Big mouth
L
ow-profile ‘policy’ minister Oliver Letwin put his head above the parapet, helpfully telling hospital and school staff they needed ‘some real discipline and some fear’ to improve their perfomance. Letwin himself knows no fear. He once successfully chased – in his pyjamas – two thieves who had stolen his wallet after persuading Letwin to let them use his loo. Discipline is not his strong suit either. In 2001, he derailed the Tories’ election campaign by talking about secret plans to slash public spending by £20bn a year, before going AWOL for the rest of the campaign. And this April, he attracted the ire of deputy PM Nick Clegg after reportedly shooting his mouth off about ‘not wanting families from Sheffield flying away on cheap holidays’. Best keep it zipped, Ollie.
Impressing no one
F
inally, congratulations to NHS chief Sir David Nicholson, voted ‘most impressive public sector leader’ in a MORI poll of senior public sector managers, beating Cabinet Secretary Sir Gus O’Donnell into second place. Mike Farrar of the NHS Confederation came fifth. But least impressive was that 53% of NHS respondents couldn’t think of anyone ‘impressive’ at all.
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)
Advance your career www.openuniversity.co.uk/mip
0845 300 8846 Quote: GAMAEG
INSPIRING LEARNING
The Open University is incorporated by Royal Charter (RC 000391), an exempt charity in England and Wales and a charity registered in Scotland (SC 038302).
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18/02/2011 10:10
EE i P S FR R M ER B FO EM M
MiP national conference 2011
Managing the squeeze: what good leaders can do for patients, staff and themselves Wednesday 23 November • Congress Centre, London WC1B 3LS keynote speakers include conference chair
Ben Page Chief Executive, Ipsos MORI
Joan Saddler, National Director, Department of Health
Rt Hon Stephen Dorrell MP Chair, Health Select Committee
Christina McAnea Head of Health, UNISON
Despite the rhetoric of protecting health services, the reality is that managers are under pressure to deliver more with less. MiP’s fifth annual conference will discuss the impact of the public sector spending squeeze on managers’ lives. The annual MiP conference gives you the opportunity to join managers, policymakers and other decision makers to debate the challenges we face. Other speakers include: • • • •
Jon Restell, Chief Executive, MiP David Nicholson, Chief Executive, NHS Lord Bichard, Senior Fellow, Institute of Government David Brindle, Public services editor, The Guardian
• • • •
Dean Royles, Director, NHS Employers Sophie Corlett, Acting CEO, MIND Rosie Ilett, Deputy Director, Glasgow Centre for Population Health Elisabeth Paice, NHS Mentor of the year
places are limited: for more information and to register online go to
mip-conference.co.uk or telephone 020 7592 9490 sponsored by
helping you make healthcare happen