Healthcare Manager Spring 2012 by lexographic

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issue 13 spring 2012

healthcare manager inside

heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Lizzie Smith, Assistant Service Manager, Barts & the London inpublic: National Procurement Scotland

letters & comment:8 Gerry Hassan: social justice and health inequalities

features:10 published by

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

MiP conference – autumn 2011 Managing the Squeeze Interview: Mike Farrar, Chief Executive, NHS Confederation NHS commissioning: charting the new landscape Climate change: what trusts are doing to drive down carbon emissions

regulars:20 Legal eye: implications of the data protection act Careers: why training still matters in tight times MiP at Work: results from our annual survey

backlash:24

healthcare manager | issue 13 | spring 2012

Welcome to the Spring issue of healthcare manager, the magazine from MiP, the trade union organisation specifically for health and social care managers. As we go to press the health bill is still lurching through Parliament, and there are still a lot of unknowns about how the NHS will look in a year or so. We ask Mike Farrar, at the NHS Confederation, how he sees things panning out. We also present our own rough guide to the way things are shaping up… we think. March sees activities to mark Climate Week (12–18 March) and for the first time, NHS Sustainability Day, on 28 March. We are again supporting these activities, and Alison Moore gives a round up on how NHS organisations are addressing the challenge to reduce carbon emissions. And we have some hot tips on how you can help. We also have our regular features, including inperson, featuring Lizzie Smith, who is building networks between management trainees and junior doctors to foster good working relations. And inpublic shows how the backroom staff at National Procurement Scotland keep the whole NHS show on the road. Enjoy the magazine, and do write to us if you have any comments. Marisa Howes Executive editor

HEADS UP

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

Delivering better health services Health Services Research Network Symposium 19–20 June 2012, Manchester Central

Now in it’s fifth year this symposium will take place immediately before the NHS Confederation annual conference, which brings together researchers, practitioners, senior managers and policy makers. At the symposium you can engage with the latest health services research, connect with colleagues in research, policy and practice and build new partnerships across research and service boundaries. Delegates include leading researchers, senior managers and decision makers from a broad range of NHS and social care bodies, central and local

government, industry and the third sector. Day one highlights new and emerging health services research and considers the research landscape. Day two explores the application and spread of knowledge and innovative practice. To book your place online visit the NHS Confed website at: www.nhsconfed. org/events.

Facility Time

Union reps save employers cash

and £9 was returned to employers through more productive workforces. Written by Gregor Gall, professor of industrial relations at the University of Hertfordshire, the report demonstrated the overall value of union reps to the UK economy, not only helping improve workplace conditions but also enabling private and public sector employers to keep costs down and deliver huge savings to the taxpayer. The report was commissioned following the government’s announcement in November 2011 that it would review the provision of funding for trade union facility time in the public sector. The report is available on the TUC website: www.tuc.org.uk

Learning

in the health sector encourage more colleagues to take advantage of learning and development opportunities at work. Going live in April, the Health Sector Climbing Frame brings together a vast amount of information about learning opportunities in one place for the first time. It is organised under five separate ‘learning themes’: ■■ an overview of learning and development in the health sector ■■ appraisal in the NHS ■■ career development ■■ apprenticeships ■■ workforce development It includes a number of case studies of staff who have developed their careers through learning, ranging from domestic staff who have become supervisors, to MiP member Patrick Geoghegan, who started his career as a porter at the age of 17 and is now chief executive of South Essex Partnership NHS Foundation Trust.

Union reps could be saving employers £2m a day, according to a report published recently by the TUC. The report Facility Time for Union Reps: Separating fact from fiction, found that for every £1 spent on union facility time in the public sector, between £3

The health sector unions, including MiP, are to launch a new online service to help union learning reps (ULRs)

The HSCF goes live on 24 April at climbingframe.unionlearn.org.uk/Home

healthcare manager

Executive Editor

Contributors

issue 13 | spring 201

Marisa Howes m.howes@miphealth.org.uk

healthcare manager is sent to all MiP members.

ISSN 1759-9784 published by MiP

Associate Editor

Susannah Fields, Gerry Hassan, Karl Heidel, Marisa Howes, Liz McCarten, Helen Mooney, Alison Moore, Colin Moore, Noel Plumridge, Jon Restell, Craig Ryan, Jo Seery.

Craig Ryan editor@healthcare-manager.co.uk

Art Director

Lexographic production@healthcare-manager.co.uk

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.

Print Warners Print, Bourne, Lincs

James Sparling

Design and Production

Climbing Frame for healthcare skills launched

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

Cover picture: Linda Nyland

healthcare manager | issue 13 | spring 2012

HEADS UP

leadingedge Jon Restell, chief executive, MiP Our annual survey (see page 22), shows a marked drop in the percentage of managers who would recommend their career to family and friends. This suggests the deal for managers no longer looks as attractive as it did. Alarm bells should ring in a service not noted for worrying much about its managers. At MiP we are taking stock of the package and where we go next with it. Employers are doing the same. You can see the package as broadly comprising pay and conditions, quality of work and respect. MiP members in the public sector are half way through a four or five year pay freeze. Higher pension contributions and major changes to pension benefits begin in April. Many members will see something like a 30% real terms cut in their overall remuneration. Most members are realists. They know there will be limits to how much ground can be made up. But employers must think creatively about how they maximise the financial elements of the package. Oth-

“The Prime Minister lazily dismisses managers as bureaucrats. He has no idea what managers do in the real world of the NHS.” erwise people will walk as soon as economic conditions improve elsewhere – and desperate employers will start cutting the wrong sort of deals. Fairness will be vital. The NHS has always had a good story to tell on flexible working – it could do more to help managers balance work and home. NHS managers are vocational just like other healthcare staff. They value high quality, interesting work. There is huge potential in simply working out how to deliver the staff rights and pledges in the NHS Constitution to managers. The pledges concern clear roles and responsibilities and rewarding jobs that

make a difference to patients, their families, carers and communities; personal development, training and line management support; opportunities to maintain staff health, wellbeing and safety; and engaging staff in decisions that affect them and the service they provide. Another issue is straightforward respect for what managers do. The Prime Minister lazily dismisses managers as bureaucrats. He has no idea what managers do in the real world of the NHS. Managers keeps patients safe from infection, stop the taxpayer being defrauded, and make clinicians’ great ideas happen. Turning off the tap of denigration and seeing managers as a resource, not a cost, would make a huge difference. We need managers to perform as never before. We hope others will agree that overhauling the deal for managers would be energy well spent. If it gets this right, in hugely difficult conditions, the NHS will deliver a massive boost for managers and healthcare.

Pensions

Final pension offer expected soon A final, detailed offer on the future of the NHS Pension scheme is expected soon. When MiP receives it, the union will write to all members to consult them on the offer. Meanwhile, separate from these discussions, the Government-imposed public service pension contribution increases come into effect from 1 April. NHS staff in England will have received a healthcare manager | issue 13 | spring 2012

leaflet with their February pay slips notifying them of these increases. This is intended to be the first of three annual increases, but any proposals for 2013 and 2014 will be subject to further statutory consultation. MiP will continue to voice our concerns about the justification for tiered contributions in a career averaged pension scheme. The Department of Health has published updated pension calculators for

staff on Agenda for Change and for medical and dental staff to enable them to estimate their future benefits under the Government’s proposals as set out in the Heads of Agreement document. You can access the calculators and the Heads of Agreement from the pensions page on the MiP website (www. miphealth.org.uk). We are posting updates about the discussions on the website so do check it regularly. 3

HEADS UP

NHS shake-up

More big chiefs named Eight of the ten directors who will lead the new NHS Commissioning Board have now been appointed by the Department of Health. They are: ■■ Chief Executive: Sir David Nicholson

(currently NHS Chief Executive) ■■ Medical director: Bruce Keogh (cur-

rently chief medical officer, Department of Health) ■■ Chief operating officer: Ian Dalton (currently chief executive of NHS North of England SHA cluster) ■■ Finance director: Paul Baumann (currently finance director, London SHA) ■■ Commissioning development: Dame Barbara Hakin (currently DH managing director of commissioning development) ■■ Improvement and transformation: Jim Easton (currently DH director for improvement and efficiency) ■■ Policy, corporate development and partnership: Bill McCarthy (currently managing director, NHS Commissioning Board Authority) ■■ Chief of staff: Jo-Anne Wass (currently NHS chief of staff)

At the time of going to press, the appointment of a chief nursing officer and a director of patient and public engagement, insight and informatics had yet to be made. Dalton’s is widely seen as the key appointment, as the chief operating officer will oversee the board’s four sector offices and 50-odd local outposts, and handle day-to-day relations with CCGs. Announcing five new appointments at the beginning of February, NHS chief executive Sir David Nicholson said: ‘Each individual brings a wealth of experience and professional knowledge that, combined together, gives us a truly outstanding team to take the NHS forward.’ Meanwhile, Deputy NHS chief David Flory (pictured) has been named as first Chief Executive of the NHS Trust

Development Authority (NTDA), the body that will support trusts moving towards foundation status. Flory is set to continue as number two to Sir David Nicholson until the NTDA is fully established in April 2013.

Sustainability

NHS Sustainability Day 28 March 2012 The NHS is holding its first Sustainability Day on 28 March, giving all NHS organisations a chance to show what they are doing and could be doing to reduce carbon emissions and make the NHS more sustainable. Co-ordinated by UCLH in London, NHS Trusts are encouraged to organise their own events on the day, which might include: ■■ A sustainability awareness day

■■ Pledges to change actions

to become more sustainable ■■ Non clinical and clinical

actions on the day so that all aspects of healthcare delivery are considered involving all stakeholders ■■ Initiatives focussed on clinical practice, local sourcing of food, low carbon menus, procurement, travel ■■ Walk to work days ■■ A day of education, participation, action and fun ■■ Patient, community, sup-

ply chain and partner engagement David Pencheon (pictured), director of the NHS sustainable development unit, said: ‘We really need everyone to use this day to share what they are doing and listen to

what others are doing. Let’s make it a productive and inspiring day so we can help make this an annual event. This opportunity is happening on our watch and will be our legacy.’ Writer and broadcaster Stephen Fry, one of the sponsors of the event, added: ‘The NHS is one of the greatest institutions in the world – helping to look after us while doing no harm. But its very size means it can harm the world it shares with us. So it needs to be more sustainable. Support the NHS and participate in NHS Sustainability Day on 28 March. It’s a fabulous opportunity to make a difference and make healthcare more sustainable.’

healthcare manager | issue 13 | spring 2012

HEADS UP

inperson Lizzie Smith, assistant service manager at Barts & the London Lizzie Smith is a former NHS management trainee and is currently working as assistant service manager at Barts and the London NHS Hospital Trust. Last year, Lizzie was instrumental in setting up a new buddying scheme for junior doctors and management trainees. ‘It is insane that doctors go through medical school yet most go into an NHS organisation without the knowledge of how it is managed or its finances,’ she says. As an NHS management trainee in the ‘Leading for Health’ programme at NHS London, Lizzie helped set up the scheme alongside Dr Alice Roueché, who was at the time working as a Darzi fellow at the London Deanery. The programme, ‘Learning Together, Leading Together’, which started in September 2011, pairs up trainees with Foundation Year two doctors in 16 acute, primary care and mental health trusts across London. ‘We were inspired by the paired learning programme at Imperial College set up by Bob Klaber, which teams up mid-level managers with specialist registrar doctors, and we thought it would be great to have something at a more junior level,’ she explains. She and her team contacted each of the 16 London NHS organisations to which an NHS management trainee had been assigned and asked them to put forward a junior doctor to be ‘paired up’ with the trainee. ‘We were overwhelmed by the response,’ she admits. ‘We were massively oversubscribed and had doctors from around the country contacting us because they wanted to get involved.’ healthcare manager | issue 13 | spring 2012

The programme, which runs until July, is ostensibly about pairs of junior doctors and trainees meeting up for coffee and a chat in order to share their thoughts about their jobs and the experiences of their day-to-day working lives. However, the scheme also sets them three tasks to complete by the end of the year. Firstly, pairs have to shadow each other through half a day’s work. Secondly, working together, they shadow a patient for a day, offering their expertise and different perspectives to help the patient on their healthcare journey. Finally, they are each asked to interview a senior leader in their organisation about an issue on which they are interested in putting forward their own ideas. Several workshops are also planned throughout the programme giving those involved the chance

“The scheme was set up with very limited resources which shows that leadership development does not necessarily have to incur high costs.”

to discuss issues with senior NHS leaders. ‘The pairs have found it really helpful to shadow each other during their day-today work,’ says Lizzie. ‘The [management] trainees have found doing the ward rounds interesting and the junior doctors have said that many of them have attended their first ever management meeting.’ The scheme was set up with very limited resources, which shows, Lizzie says, that leadership development does not necessarily have to incur high costs. She is hopeful that the scheme can continue although nothing is yet in the pipeline. ‘We will be thoroughly evaluating the scheme and sharing the results widely. Ultimately our philosophy in this is to drive change from the bottom up.’ Helen Mooney

HEADS UP

Commissioning

TV Triumph

Former MiP vice chair beats Eggheads Lansley and Nicholson lead Commissioning show line-up Commissioning 2012: 27-28 June, London Olympia

The Five a Day team was Rosie Ilett, Ricky Fleming, Rebecca Lenagh-Snow, Pete Seaman and Martin Taulbut. The Eggheads were CJ, Kevin, Barry, Pat and Judith. Jeremy Vine was the quiz master.

MiP has again secured a number of free places for our members at Commissioning 2012. Health secretary Andrew Lansley and NHS chief executive Sir David Nicholson have been confirmed as speakers for the 2012 Commissioning Show. Also due to chair and speak is Dr Michael Dixon, chair of the NHS Alliance. Nearly 100 experts, including CCG leaders across the country, will address delegates on: ■■ the future challenges of CCGs in the run up to authorisation ■■ managing long-term conditions ■■ integrated care ■■ productivity through technology ■■ building relationships with Health and Wellbeing Boards. Facilitated workshop sessions will allow small groups to explore issues in more detail. Delegates will also be able to propose and chair their own roundtable sessions, tailoring the event to their own ‘hot topics’. 3,000 delegates are expected to attend Commissioning 2012 on 27-28 June, building on the success of the inaugural show last year. This year’s event has moved to the larger national hall at London Olympia. Registration is now open. To guarantee your free MiP place register now. Visit www.commissioningshow.co.uk to find out more.

A team of NHS managers lead by former MiP Vice Chair Rosie Illet, beat the mighty Eggheads in the cult BBC2 quiz programme, becoming the 76th group of challengers to triumph over the show’s quiz experts. In an episode screened on 23 February, the team, ‘Five a Day’ from the Glasgow Centre for Population Health, clinched the £27,000 prize despite despite losing two rounds to the Eggheads, after the experts crumbled on the final question.

‘It was a brilliant experience’ said team captain Rosie. ‘‘We entered it for a bit of fun, and had no expectation of getting filmed, let alone winning.’ The team took annual leave to attend the audition and filming and have donated some of their winnings to charity and some to create a social fund for their work colleagues. ‘We couldn’t have done it without their support,’ added Rosie. ‘Everybody backed us all the way, and they deserve being treated too!’

Partnership

Social partners renew joint working agreement The Social Partnership Forum in England (SPF) has re-endorsed the national partnership agreement setting out arrangements for joint working between the Department of Health, NHS Employers and NHS trade unions. The agreement, endorsed by the Minister of State for Health, sets out guiding principles for effective partnership working at national, regional and local level. It reaffirms the SPF’s shared commitment to meet the workforce challenges facing the NHS in a supportive and constructive way.

MiP chief executive Jon Restell is a member of the national SPF. Welcoming the new agreement, he said: ‘Partnership working is the most effective way to deliver a better experience for staff and for patients, including better health outcomes. Now we have this renewed commitment by the SPF we need to make sure it is embedded in NHS organisations at national, regional and local level. MiP will be working to make that happen.’ The full agreement is on the SPF website at www.socialpartnershipforum.org

healthcare manager | issue 13 | spring 2012

HEADS UP

inpublic National Procurement Scotland

The week before Christmas deliveries of vital supplies to hospitals across Scotland reached a record 100,000 products, with National Procurement Scotland working 24 hours-a-day to make sure that hospitals were well stocked with everything they needed from syringes to surgical gowns. ‘What having a national distribution has allowed us to do is deliver daily to all major acute trusts across Scotland. So, from 10pm on Sunday until 10pm on Friday deliveries are made and they are ‘silent deliveries’ so they are

made between 5pm and 8am,’ explains Gordon James, logistics director at National Procurement Scotland. Established in 2006, following the McClelland review of public procurement in Scotland, National Procurement markets itself as ‘the centre of procurement expertise for health’. Director of National Procurement Colin Sinclair says that ultimately the organisation saves NHS Scotland time and money. ‘As last year’s National Audit Office report pointed out, central buying and delivery of

healthcare manager | issue 13 | spring 2012

“Prior to the establishment of National Procurement service levels were anywhere between 65 and 95 per cent... now it’s at 98 per cent.”

supplies can save the NHS and the taxpayer hundreds of millions of pounds,’ says Sinclair. ‘Since we were set up in 2006, we have secured savings of over £200 million for NHS Scotland. This is money which can then be reinvested in the frontline – treating patients.’ The organisation works across four areas: strategic sourcing; logistics; eProcurement and programme management and support services. National Procurement tenders for contracts on a pan-Scotland basis and has a portfolio of

around 200 contracts worth approximately £750 million. ‘Contracts with suppliers normally last for four years and in any one year we will have about 80 contracts out to tender,” says James. National Procurement’s Ward Procurement Management tool also means that hospitals can now use a simple barcode system to keep supplies at optimum levels. Once the number of supplies available has been scanned and the numbers fed back to National Procurement, the organisation can immediately respond to demand for new stock. ‘One of the biggest changes has been in the availability of products and in service delivery,’ says James. ‘Prior to the establishment of National Procurement service levels were anywhere between 65 and 95 per cent, now the availability and delivery of products is consistently at 98 per cent, the system has been hugely beneficial to NHS Health Boards in Scotland,’ he adds. The organisation also has a sophisticated system of product tendering which ensures clinicians are involved in procurement decisions. For each new product and supplier a commodity adviser panel, which includes doctors and nurses, is set up; this panel decides the specification for each product along with a scoring mechanism to evaluate its quality. Helen Mooney 7

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

PM should mind his PMQs Mr Cameron’s recent comments (at Prime Minister’s questions on 8 February) on the Welsh NHS were interesting to say the least. Quoting some dubious statistics, he claimed the NHS in Wales shows what happens when you ‘don’t do the reform.’ However he really needs to remember that the NHS is a devolved matter and the people of Wales have elected a government which has a larger proportion of seats than his own party and potentially a greater mandate. The structure for the NHS in Wales is different to say the least from the current and proposed new structures in England. However an interesting common fea-

ture to both is commissioning which includes clinical leadership and GP involvement. In Wales, management structures including clinical leaders are already in place in some Health Boards and will be implemented in others following a recent ministerial policy announcement. As Health Boards in Wales are combined commissioners and providers this means that there is clinical and GP involvement in commissioning for both internally and externally provided services. All achieved without the high risk, unilaterally opposed, apocalyptic health bill currently cruising its way through the Parliamentary system like the Costa Concordia. Who will pick up the survivors in the new world of extra lean public services? Name and address supplied NHS Wales public servant

Tweet Box

A selection of tweets on issues covered in healthcare manager

Looked at Lansley visit to Royal Free. Can he do job if he needs a police escort everytime he visits NHS place? 1st SoS needing bodyguard? @GlenysThornton The best I can say about the Health Bill is that GPs are harder to gag than the rest of the NHS so if it goes tits up, we’ll here about it. @drphilhammond Given the amount of vaccination the NHS has carried out it’s highly likely the NHS has saved your life without you even knowing it. @MitchBenn Already spent most of the turning off all the PatientLine TVs so I (and the patients) don’t have to look at or listen to @Lala_Lansley … It’s actually quite Orwellian how the TV sets all turn themselves on automatically every morning and then @Lala_Lansley appears. @northern_doctor

Lansley linked with Chelsea job after Abramovich calls for top-down reorganisation at the club @MartinShovel He’ll dismiss 46% of backroom staff (bye kit man - u waste of space) & empower frontline professionals #playerpower @Jon_Restell Today’s opinion poll in Le Monde on [French] presidential election shows health system doesn’t even register among voter concerns! @martinmckee Telehealth lessons: need inspiring vision, clinical engagement, change management. Bread and butter for improvers @nhsinstituteuk @robertvarnam For everyone wondering where DH/ NHS statistics has gone - it’s hived off to ironically named ‘transparency.dh’ @jappleby123

Update your details Do we have your correct home address, work address, employer and preferred email address? We need this information to keep you informed about our activity and negotiations on issues such restructuring and pensions, and to consult you on the direction we should take.

So please take a few moments to check your membership records and make any necessary changes. Simply log in to the Members’ area of the MiP website and follow the prompts to update your details. Alternatively, please email us at info@miphealth.org.uk.

healthcare manager | issue 13 | spring 2012

COMMENT

comment Gerry Hassan

Writer and commentator

What do we do about health inequalities and social justice? The Scottish and the UK Governments find themselves at a crossroads on the question of Scottish independence, with the former committed to a referendum in autumn 2014. This debate is about more than constitutionalism, but reflects the growing policy divergence between Scotland and England on public services and most notably health. The NHS Bill for England being pushed through by Andrew Lansley advances competition, marketisation and the use of private sector providers. His Scottish counterpart, Nicola Sturgeon, instead emphasises greater integration and partnership between health and social care. The Scottish Government is also promoting the ‘assets approach’ as a way of improving health and addressing lack of capacity and empowerment. However, some see this as a move away from tackling the link between health and social inequalities. Thinking about health inequalities seems to have shifted since the first Scottish post-devolution administration. In 2000, the then Health Minister, Susan Deacon, said: ‘Tackling inequalities in health is central to our commitment to social justice. The health gap between rich and poor in Scotland is stark.’ Although this commitment was initially retained by the incoming SNP administration, more recently it seems healthcare manager | issue 13 | spring 2012

to be placing less emphasis on tackling inequalities as a cause of poor health. The health section of the Scottish Government’s website (www.scotland.gov.uk/ Topics/Health) in February 2012 opens with the statement, ‘The Government aims to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.’ The recent Christie Commission on Scottish public sector reform stressed this need for the population to recognise its own role in promoting health. This is also at the heart of the assets approach to health improvement, currently championed by Sir Harry Burns, Scotland’s Chief Medical Officer, who wants to shift thinking from deficit models to assets, where communities and individuals, however disenfranchised and unequal, are valued and encouraged to make their contribution. While the assets approach contains worthwhile elements, for many people it sits within the tradition of Scottish public bodies looking for one-stop shop solutions to complex and what have been so far intractable problems. Scotland may be a wealthy country, but has some of the worst concentrations of poverty and health inequalities in Western Europe. The assets approach is also silent on structural issues of who has status, voice and power, and refuses to address who has gained most from the rich web of

networks, organisations and public patronage which have been built both before and during the devolution era. These tend to exclude those in the greatest need, benefitting mainly the insiders and interest groups who know how to work the channels of power and influence. Scotland’s First Minister, Alex Salmond, sees one of his main tasks over the next two years as building up Scotland and its people’s energy and capacities to bring about a positive outcome in an independence referendum. There seems to be no intention to address hard questions about social injustices and inequalities, and some critics think the generalist nature of the asset outlook suits this just fine. Scottish self-government and independence could bring a renewed purpose and vigour to addressing these problems. However for this potential to be realised and for a wider, more radical coalition to get behind constitutional change, some difficult questions are going to have to be addressed. How can we best empower Scotland’s disadvantaged communities? What is the best way to reduce long standing health and social inequalities? And are those with power and status in the system really the best placed to tell others what kind of social change works best?

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

MiP ANNUAL CONFERENCE 2011

MiP national conference Over 250 delegates came to MiP’s fifth conference to hear from a great line-up of speakers on the big issues facing healthcare managers, including the leadership challenge and the attack on NHS pensions. Pictured centre are some of the delegates, surrounded by, clockwise from top left: Ben Page, from Ipsos Mori; Lord Bichard, the Guardian’s David Brindle and Stephen Dorrell MP, Chair of the Health Select Committee; David Nicholson does some research; actuary Hilary

Salt and MiP’s Jon Restell talk pensions; MiP vice chair Rosie Ilett and commentator Roy Lilley; Joan Saddler, DH Director for Patient and Public Affairs; TUC General Secretary Brendan Barber chats to MiP chair David Amos; MiP national committee member Sam Crane; delegates speed networking and NHS Employers’ Dean Royles, Unison Head of Health Christina McAnea and Sophie Corlett from Mind. All photographs by Susannah Fields.

healthcare manager | issue 13 | spring 2012

MiP ANNUAL CONFERENCE 2011

healthcare manager | issue 13 | spring 2012

INTERVIEW

Noel Plumridge talks to NHS Confederation chief executive Mike Farrar about the challenges ahead for the NHS and the ‘assertive and constructive’ role of the Confed.

Mike Farrar took over as chief executive at NHS Confederation in May 2011, having been chief executive of the North West SHA for the five years of its existence, and previously in West and South Yorkshire SHAs. Now he has settled in, he spoke to us about how he sees the NHS shaping up, and how the role of the Confederation will develop. HCM: You’ve moved from being a high-profile mainstream NHS leader into a very different job. How does it feel? MF: After eleven years in the intermediate tier, anyone’s entitled to be released! There are different pressures. At the Confederation you’re accountable to your members rather than through a hierarchy, so there’s a constant need to reassess. And you’re responsible for saying things that others can’t say. It’s not a reduction in power or authority. You speak on behalf of such a lot of people. I find that I’m saying the same things I said previously, and now people are listening. HCM: You’ve described some of the radical changes needed to the way we provide healthcare in England if we’re going to come near achieving the ‘Nicholson challenge’. Is £20bn in four 12

years achievable? MF: Well, it’s not really a four-year trip. It’s better to think about what a decade of change might look like… Our only route is to spend our money differently. We need to reconfigure and consolidate, looking at our fixed costs and our asset base. And we need to work differently, reducing either the unit costs of labour or the number of people involved in certain areas of care. Actually we’ve been lucky to get the cost of inflation covered so far. This is going to need political support. We need to build a public appetite for getting out of hospital as soon as one’s fit, and for care in one’s own home. And we need to address variations: the variations in cancer outcomes, for instance, are ridiculous. On the pay front, we need either to influence the national contracts or build a reward system we actually own. That’s not to say national collective bargaining is wrong, but we must apply ourselves sensitively and intelligently to this issue. HCM: In other industries, such as banking, technology has been at the core of radical change. You’ve suggested that medical technology and telehealth are central to NHS service improvement. Are we geared up for this kind of redesign?

MF: Technology is massively important, and will help us. But we need to adopt changes quickly. We can’t spend 25 years over it, like we did with antipsychotic drugs. This is a real opportunity for the Confederation to step up its game. Using our membership model to pool and share work, we should be able to collapse adoption timeframes. Then you can move from one adopter to thirty very quickly and offer suppliers a return on their investment. The process needs to be of the NHS and for the NHS, exposing people to promising ideas. We’re already working with the Association of British Healthcare Industries and the Association of British Pharmaceutical Industries on showcasing promising innovations sooner. And we’re hoping to announce a big equitydriven fund for innovation in the summer. You can’t impose innovation. You need both top-down and bottom-up processes; you need clinical buy-in. And the NHS needs “skin in the game” when it comes to promoting best practice. HCM: In the pursuit of greater efficiency, we’re starting to see provider mergers and “integration”. Is “integration” the answer to greater productivity? healthcare manager | issue 13 | spring 2012

INTERVIEW

Linda Nylind

“The biggest determinant of quality is the extent to which individuals feel valued by their organisation.”

MF: There are different levels of joint working, ranging from collaboration to outright merger. I think there’s a lot of mileage in joint ventures like the academic science networks. People say they’re anti-competitive but they’re not: bigger groups of providers offer genuine, helpful competition and can afford to lose a service occasionally. It’s worth seeking out the North West’s and Yorkshire and Humber’s experience of the steps to collaboration. Such groups can include community, primary care and the independent sector. Monitor won’t necessarily stand in the way. We’re still trying to interpret what a “duty of integration” actually means. There’s only so much gain to be made within individual organisations. The big savings are to be had around organisational inter-relationships, for example in medicines management across the whole system. But not just savings: that’s also the key to better quality for patients. HCM: We already have numerous social enterprise providers, employing ex-NHS and ex-local authority staff. Are they here to stay, or a transitory healthcare manager | issue 13 | spring 2012

phase as a predatory market takes its course? MF: I’m a fan of social enterprise, subject to it being fair for staff. It has a different philosophy around the creation of social value, and offers a different way of connecting with our community. It also gives us the flexibility to motivate staff differently. So let’s support social enterprises. Let’s back them and see how they work. We should see the early examples given a real opportunity to succeed, a fair chance. And let’s see government back that up with care and attention. HCM: Do you think the NHS has learned from what happened in Mid Staffordshire? MF: It remains to be seen. I’m interested in the balance between organisational and professional regulation that will emerge. Mid Staffordshire showed that quality has to be owned, bottom up: there’s a responsibility falling on the individual. And the biggest determinant of quality is the extent to which individuals feel valued by their organisation. If we just shout at organisations and

rely on inspection, we haven’t learned. HCM: You’ve recently suggested that the scale of reduction in management resource for commissioning and planning could harm patient care. Do commissioners really have that much impact? MF: Yes, at a macro level. If we get the level of investment wrong in, say, the early identification of cancer, even the best clinicians will have worse outcomes. So we need to spend money on organising care. Actually it doesn’t matter whether a GP or an administrator does it, but organisation is crucial. Cut it and patient care suffers. HCM: Is the new NHS regulatory regime adequate, given the expectations placed upon it? MF: The evidence I gave to the Public Accounts Committee is that, while we don’t want another reorganisation of regulation, we need regulation with a clear scope and purpose, that’s proportionate, consistent, and aligned to public expectations. Not more inspection but a balanced approach, ensuring standards are right and consistent. We 13

INTERVIEW

HCM: What strategic issues should NHS leaders be paying more attention to? MF: We’re not transparent enough. Rather than always trying to solve our own problems, we need to develop a more open culture. Engaging the customer is always valuable. You get new information, new ideas, maybe even support. Look at what transformed the IT industry: not just technology but interaction with users which helped to establish the internet as the force it is today. That’s the way to create exponential change. Engaging people with their own health will bring real benefits. We have a chance to create a new public health that’s neither about the nanny state nor about being victims. It’s about the “care footprint” of the individual. At the Confederation we’re looking at individuals’ use of resources, though we still need a way to operationalise it. HCM: Defending its Bill, the government seems to be suggesting it’s about doctors replacing bureaucrats in leading the NHS. Are we in for another round of manager-bashing? MF: The political narrative about “bureaucrats” is cheap. It should stop. Clinical commissioners don’t see themselves as somehow superior to good quality managers. It’s pointless and scandalous, a distraction. The NHS is neither over managed nor poorly managed. It would be nice if senior government figures could acknowledge the quality of management’s contribution. HCM: How do you see clinical commissioning groups developing? MF: I’m a big fan of the principle of clinical commissioning. But although GPs will micro commission very well, 14

Linda Nylind

don’t need heads on plates; we do need a better system. Look at the extension of CQC’s remit into the regulation of GP practices. GPs are already heavily regulated as individuals, so will we see much of a return on the extra effort?

“Trust your emotions as well as your rationality. And speak truth to power. Don’t be frightened to express your views. ” improving individual pathways and challenging referrals, can they convert small pockets of gain into “right-sizing” of the providers? It could all cost more. So the challenge for CCGs is: can they federate to achieve strategic change? Will they be able to work collaboratively with the NHS Commissioning Board? We want to support them. HCM: So maybe the skills of people who’ve been leading PCT commissioning for the past decade will be in demand? MF: NHS commissioners have built up a huge amount of experience. Under World Class Commissioning they became especially strong on partnership working with social care for example, though less strong in other areas such as predictive modelling. I’d expect CCGs to value their experience, though they’ll also be clear on what they want to bring in from outside.

HCM: Amid all the noise around the Bill, it’s worth remembering that Northern Ireland, Scotland and Wales aren’t following England. Slow adopters or wise birds? MF: Across the United Kingdom we have a fantastic opportunity to look at the strengths and weaknesses of different models. We need to invest in this and learn from it. It’s like a large randomised control trial. And let’s not limit ourselves to the UK. I was recently the keynote speaker for a conference of Dutch insurers, and they’re a group from whom we could learn a lot. The Dutch system allows price competition, but it’s far from being a free market. HCM: What advice would you offer to young health managers wondering how to build their careers? MF: The health system is a wonderful place to work. Look to spend time in the different sectors of the industry, and be sure to allow yourself to think as well as do. Trust your emotions as well as your rationality. And speak truth to power. Don’t be frightened to express your views. If you don’t, we’re all the poorer. HCM: Finally, in a world of GP-led commissioning and growing provider diversity, how do you see the role of the Confederation developing? MF: With the whole host of separate national bodies that’s emerging, there’s massive value in an organisation that can pull together the various elements within healthcare. To add that value, Confederation needs to be clinically relevant, meaningful to patients and to the public, and needs to add value to the supply chain. We need to be both assertive and constructive. That’s our vision of how Confederation will develop. So we’ll be talking to the Royal colleges, to young leaders, and to CCGs. The health system desperately needs an organisation that can fulfil that role. to involve public and patients. Health and wellbeing boards will, of course, have an important part to play.

healthcare manager | issue 13 | spring 2012

NHS COMMISSIONING

As the Health Bill emerges from its tortuous progress through parliament, Healthcare Manager’s Craig Ryan presents a rough and ready guide to the big beasts set to roam the new commissioning landscape of the NHS.

Here’s how we think the new commissioning structures are shaping up. With so many new bodies, it’s still far from clear how they will relate to each other or where current functions will fit. Let’s just hope the NHS has the HR capacity to deliver the transition in a fair way that maximises skills retention and minimises redundancies. MiP believes the Health Bill is unnecessary, costly and risky, but if it is passed, MiP will do what we can to make the new system work in the interests of staff and patients.’ Clinical Senates The job: An ill-fitting component bringing together clinical chiefs across a region to give ‘strategic advice’ to commissioners. May get involved in scrutinising plans for large-scale reconfiguration. Set up: the Health Bill envisages around 15 senates, which will not be statutory bodies or formal organisations. Staff: Clinical senates will be supported by the local or sector offices of the NHS CB. Risks: If it has clout, it could interfere with CCGs too much. If it doesn’t, will anyone turn up?

NHS Commissioning Board (NHS CB) The job: The mission control of the new NHS will support CCGs and hold them to account for their performance, while directly commissioning primary services (GPs, dentists, opticians etc) and some specialist services. Default host for other bodies with no home to go to. Set up: ‘Hourglass’. A big headquarters, four ‘sector’ offices based on SHA clusters, and around 50 local offices based on PCT clusters. Becomes a quango in October 2012 and assumes full powers in April 2013. Staff: 3,600 – around 900 at headquarters, 2,500 in local offices, and 200 in sectors.

Off message: Andrew, did you leave this spanner in here?

Who goes there: Policy, legal and admin staff from DH and arms-length bodies like the Institute for Innovation and Improvement, plus CQC staff assessing commissioning. Some SHA staff transfer to sector offices, while PCT cluster chief execs are ‘encouraged’ to apply to head their local NHS CB office. Recruitment begins in spring 2012.

Risk Rating: A+ (Slovenia)

Pay and conditions: Very Senior

On message: They will have an enabling role for both CCGs and the NCB… They are not intended to be another layer of bureaucracy or...to ‘interfere’ with or constrain clinical commissioning groups. (DH)

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Managers Pay structure for top officials, Agenda for Change for most others, with clinical pay structures where appropriate. The buck stops with: A ten-person board headed by NHS chief exec Sir David Nicholson. Heads of local offices accountable to the chief operating officer at NHS CB. Money: Running costs of £492m represent a 50% cut over present levels. Will spend £21bn on directly commissioned services. Risks: Loss of senior staff during transition and a shortage of commissioning staff. Budget cuts mean clashes with the DH over functions are likely. Risks getting dumped on by both DH and CCGs and thus becoming the whipping boy for NHS failures. On message: ‘Will ensure the new architecture is fit for purpose and provides clear national standards and accountability – it will put the ‘N’ in NHS.’ (Sir David Nicholson) Off message: an NHS politburo with regional and local outposts, telling GPs how to run a supposedly GP-led service. Risk rating: AA (Belgium)

NHS COMMISSIONING

Commissioning Support Services (CSS) The Job: local workhorses supporting CCGs with specialist skills for the ‘non-clinical elements of commissioning’. CSS will provide “business intelligence” for CCGs, such as collecting and organising data, “major clinical procurement”, back office functions such as IT, estates management, human resources, finance and communications services. set up: Carved out of PCT clusters, around 20-25 CSS units are expected to survive. Will be ‘hosted’ by the NCB from April 2013, but must become ‘standalone’ organisations flogging services to CCGs by 2016. Some large CCGs may host their own CSS; others may become social enterprises, joint ventures with local councils or private businesses. Who goes there: PCT cluster staff in CSS units will transfer to the NCB from April 2013, pending eventual transfer to a freestanding body. Existing terms and conditions likely to be retained while hosted by the NCB. The buck stops with: managing directors, picked for their ‘commercial acumen’ who will be accountable within a governance framework agreed with local CCGs. Risks: haemorrhage of staff and expertise during transition; lack of ‘buy-in’ from CCGs leading to financial failure; persistent uncertainty about long-term future. On message: ‘An attractive sector for talented staff who will be able to develop expertise and skills as they innovate and have rewarding careers.’ (DH) Off Message: Remind me, why are we getting rid of PCTs again? Risk rating: A- (Spain)

Health and Wellbeing Boards (HWBs)

The job: The ‘Lib-Dem component’, HWBs will ‘drive local integration of services’ and give democratic legitimacy to commissioning decisions by scrutinising CCGs. Set up: Shadow boards already set up for most 152 ‘top tier’ local authorities. Councils decide their composition, but must include: a rep from each CCG, at least one councillor (a majority of councillors is possible), the directors of children’s services and public health, and a local Health Watch rep. Staff: As committees of the local authority, HWBs will be supported by local government staff. The buck stops with: a board whose

Risks: lack of clinical and patient clout (especially if boards are packed with councillors); clashes between councillors and CCGs, especially over difficult reconfiguration decisions. On message: ‘HWBs...can bring together the full range of local bodies to agree on co-ordinating services more effectively.’ (NHS Confederation) Off message: a talking sop to localism, where councillors can grandstand in front of tired CCG reps hurrying from one meeting to the next. Risk Rating: AA+ (France)

Health Education England (HEE) Local Education & Training Boards (LETBs) The job: Oversees the new education and training system and allocates cash nationally. LETBs will set local priorities and commission education and training on behalf of local providers. Set-up: Established as a Special Health Authority, HEE will eventually become an agency of DH. Shadow LETBs set up as committees of SHAs, but their eventual make-up and legal basis has yet to be decided. Who goes there: Education staff from SHAs, including postgraduate Deaneries, and policy staff from the DH. LETBs may eventually contract out their functions. NHS conditions retained at least until HEE becomes a civil service body. LETB staff will be ‘hosted’ by HEE. TUPE expected to apply to transfers from SHAs. The buck stops with: the HEE chief exec will answer to an independent board with five non-executive members, in turn accountable to the DH. LETBs will include

main job will be managing conflicting mandates as members will be accountable to their own organisations.

reps from both service providers and education have a board accountable to HEE, on which both healthcare and education providers will be represented. Money: The 2012 central budget for education and training is £4.9bn. LETBs will introduce tariff-based funding, with a levy on healthcare providers further down the pipeline. Risks: shortages in specialities due to fragmentation of education system; insolvency of providers through squeeze on tariffs; conflicts of interests for provider reps on LETBs. On message: ‘A unique opportunity to strengthen partnerships between all providers of services and the professionals who deliver them.’ (Andrew Lansley) Off Message: Bloated Workforce Development Confederations being sat on by another overweening national bureaucracy. Risk Rating: A- (Slovakia)

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NHS COMMISSIONING

Public Health England (PHE) The job: A mini NHS CB for public health, supposed to improve health and wellbeing in England and reduce health inequalities. Will commission national public health services and support local public health directors and HWBs.

flexibility’ of NHS arrangements.

Set-up: An agency of the DH, with a national office in London, four regional ‘hubs’ based on SHA clusters, and 25 local ‘units’ based on existing local outposts of the Health Protection Agency.

Risks: cost and complexity of transferring staff from many different organisations; erosion of public health budget; conflicts with local authorities.

Who goes there: Approximately 5,000 staff from the Health Protection Agency, National Treatment Agency for Substance Abuse, NHS screening programmes, National Cancer Intelligence Network, and public health units of the DH, PCTs and SHAs. Pay and conditions to be negotiated within civil service structures ‘while retaining the

The buck stops with: a chief executive (to be named in April 2012) supported by an advisory board, accountable to the Secretary of State. Budget: not specified, but existing functions have a combined budget of around £4bn.

On message: “A service that gives more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics.” (DH) Off message: A new super quango forged in the white heat of Andrew Lansley’s ‘bonfire’ of the health quangos. Risk rating: AA+ (Austria)

Local Authority Directors of Public Health The job: Local health tsars, co-ordinating and commissioning local public health services (except those reserved to the NHS CB). Set up: under the wing of ‘top-tier’ local authorities – county councils, London boroughs and unitary authorities – which assume public health duties from 2013. Who goes there? Some existing NHS directors of public health; local PCT staff involved in public health work; councils staff from social care, housing, environment, education etc with public health responsibilities. Local authority pay and conditions will apply with protection for NHS staff transferring under TUPE. The buck stops with: one director, two guv’nors – the local director of public health will accountable to (and appointed by) both the

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council and the Secretary of State (via Public Health England). Budget: unspecified, but ringfenced within overall local authority budget. Risks: conflicting lines of accountability; conflicts over priorities and budgets with CCGs; lack of commissioning expertise; conflicts between PHE and councils; risk of failure of private sector providers; fragmentation of public health expertise; loss of public health influence within NHS. On message: ‘Democratically accountable bodies... ideally placed to shape services [and] develop holistic solutions to health and wellbeing embracing the full range of local services’. (DH)

Clinical Commissioning Groups (CCGs) The job: The (potentially destructive) nuclear core of the system, CCGs will commission most services locally. With membership based on GP practices and other healthcare professionals, they are supposed to embody the principle of clinical leadership in the NHS. Set up: CCGs decide their own boundaries (50,000 is thought to be the minimum viable population) but many are based on existing PCTs. At February 2012, 244 CCGs were being formed, but some smaller groups are expected to merge. Staff: Will vary widely according to CCG size and extent of contracting out. Some may employ no staff and hire consortiums of managers or consultancy firms instead. Who goes there? Where a CCG function is sufficiently similar, PCT staff may transfer to CCGs (or sub-contracting firms) under TUPE regulations. PCT staff already ‘assigned’ to CCGs are not guaranteed a permanent job in the new set up. CCGs set their own pay and conditions, but many may stick with NHS terms. People transferred under TUPE retain their existing terms. The buck stops with: a ‘governing body’, made up of reps from constituent GP practices, at least two lay members and two ‘other clinicians’, chaired by an ‘accountable officer’. The NHS CB will authorise CCGs and assess their performance each year. Money: In total, CCGs will commission services worth £65bn per year. Estimated individual budgets range from £18m for Red House, a Hertfordshire GP practice trying to go it alone as a CCG, to £835m for Cambridgeshire and Peterborough CCG, which covers two PCT areas. Risks: Legion. Disagreements between GP practices over structures; lack of GP interest; loss of key staff during transition; lack of expertise in commissioning and budgeting; loss of accountability and budgetary control due to contracting out; political rows over pay; heavy-handed supervision by the NHS CB; botched funding allocations; lack of clarity over failure regime. We could go on... On message: “Will put healthcare professionals in the driving seat so that they are free to deliver better quality and integrated care, closer to the patients.” (Health minister Simon Burns)

Off message: The unaccountable in pursuit of the unattainable.

Off message: If you think this will work, you need to see a doctor.

Risk rating: BBB+ (Italy)

Risk rating: CC (Greece)

SUSTAINABILITY

Ahead of the NHS’s first day of action on sustainability on 28 March, Alison Moore assesses the deeper changes needed to achieve a low carbon NHS.

“‘This is a bit of a ticking time-bomb in terms of what is going on in the future – there are some very stringent targets... people really need to take it seriously.”

Does your NHS organisation try to cut its energy use, recycle paper and reduce waste? Increasingly the answer is likely to be yes. These are all potential money savers – very welcome for the NHS at the moment – which are relatively easy to do and similar to what many of us are doing at home. But the challenge now is to embed these ‘easy wins’ into the everyday practice NHS organisations and then move onto areas of sustainability which are less familiar.

remains admirably committed to driving forward the green agenda, recognising that cutting carbon emissions is an effective way of saving money.’ But Stephen Heard, an MiP executive member who leads on sustainability issues, believes some parts of the NHS have still to hear the message. ‘This is a bit of a ticking time-bomb in terms of what is going on in the future – there are some very stringent targets,’ he warns. ‘People really need to take it seriously.’ Many organisations are at an early stage and have not even calculated what their carbon footprint is, says Heard. Their thinking tends to concentrate on energy, water and waste to the neglect of other important areas, such as procurement. Mr Heard points out that carbon savings can be incorporated into business plans – those for moving services into the community, for example – and can make some marginal projects worth doing. Money talks, and carrying out whole-of-life costings for green investments can have a big effect on whether they look

‘This is a long journey to get to what a sustainable health service will look like,’ says Sonia Roschnik, operational director of the NHS Sustainability Development Unit. ‘But if we get it right not only does it benefit the health of the public but also the health of the organisation.’ The NHS has a legally-binding target to reduce carbon emissions by 10% by 2015, compared with a 2007 baseline. It’s probably nearly halfway now – probably helped by the slower growth it is experiencing – but a substantial challenge remains. 18

There have been some striking successes. Musgrove Park Hospital, for example, wants to see reduce emissions by 43% per cent by the end of this year, and calculates it will save £17m over the next 20 years. The University Hospital of South Manchester reduced its emissions by 26% 2010, saving £120,000 on its energy costs. Last year, University College London Hospital reduced its carbon footprint by 14% per cent and energy costs by 6%. The demand for financial savings has encouraged energy saving and, for larger NHS trusts, the introduction of a carbon emissions payment, is acting as another driver (see below). The Carbon Trust recently said that the 100-plus trusts signed up to their NHS carbon management programme were finding that ‘the most cost-effective projects – those with the quickest payback periods – are being implemented first.’ The savings are often worthwhile – trusts were identifying savings of over £1m each per year. Kevin Steele, chief executive of Climate Week, says: ‘Despite the difficult economic climate, the NHS

healthcare manager | issue 13 | spring 2012

SUSTAINABILITY

Terry Robertson chief of Colchester HUT showing visitors from Bolton NHS Foundation Trust the new efficient gas boilers at Colchester General Hospital.

worthwhile. ‘Where I have most traction is where I can talk to finance directors,’ says Heard. One of the most important issues for the future will be ways of making NHS care pathways more sustainable, an area where there are clear overlaps between the sustainability agenda and the direction of key policies. Telehealth projects and moving healthcare closer to patients’ homes are key objectives for the NHS, which also have the potential to be more energy-efficient. But avoiding illness in the first place will have a part to play. ‘It’s another opportunity to revisit the question of what are we about – are we about promoting health or preventing sickness?’ Roschnik. The SDU’s route map for sustainable healthcare offers a vision which encompasses change in society as well as change in the NHS. Reducing reliance on medications could mean major savings for both budgets and carbon emissions: around 20% of the NHS’s emissions are due to pharmaceuticals. A more holistic approach – rather than a ‘pill for every ill’ approach – could help. And essential services can be greened without adversely affecting patient care. The Campaign for Sustainable Healthcare is looking at healthcare manager | issue 13 | spring 2012

Bee keeping: just one of the sustainable projects at University Hospital of South Manchester

health services themselves, rather than just the facilities and estates they use. One project, involving retrofitting heat exchangers to dialysis machines, reduced energy use by 20 per cent – there is now a network of green representatives in nephrology centres. Surveys carried out for the NHS’s Sustainable Development Unit shows there is strong support for moving the NHS to a more sustainable pathways. 90% of NHS leaders who responded believed sustainability was important while 60% thought it was essential to the running of their organisations. One third of the public said the NHS should act in a more sustainable manner even if it was more expensive. But, as Ms Roschnik points out, ‘We’re still too early in the journey to know what a truly sustainable system will be like.’ It is still hard to grasp what will be involved in achieving such long term goals as an 80% reduction in carbon emissions by 2050. But it will almost certainly be a model of healthcare significantly different from the one we have now. Many large NHS organisations now have an added incentive to reduce their energy costs: from this year they face bills of of up to £250,000 for their emissions. Some 159 organisations – mainly big

acute trusts – registered under the carbon reduction commitment scheme will have to pay £12 per tonne of carbon dioxide emitted. Among those already tackling the issue is Colchester Hospital University Trust, one of the highest rated trusts in England for its commitment to reducing energy consumption. Colchester’s energy reduction programme – which also includes a green transport strategy – has been going on for several years. The trust spent £1.6m (mainly funded by the government) on converting its boilers to natural gas with 30% lower emissions. It has also moved towards lower energy lighting and has introduced better monitoring its gas and electricity use. Continuing to reduce energy will be a challenge, especially as Colchester has a major major development programme including a cancer centre which will potentially increase energy use. But with the arrival of carbon allowances in the NHS it will have an added reason to keep on trying.

Alison Moore is a freelance journalist. More information about Climate Week (12-18 March) is at climateweek.com. The NHS Day of Action on Sustainability is on March 28: www.nhssustainabilityday.co.uk 19

LEGAL MATTERS

legaleye Jo Seery explains the obligations that the Data Protection Act places on health care professionals. The Data Protection Act 1998 (DPA) gives certain rights to individuals about information held about them, and the right to request that information about them is not processed if it could cause substantial unwarranted damage or distress. The act contains eight ‘data protection principles’. These specify that personal data must be: 1. Processed fairly and lawfully. 2. Obtained for specified and lawful purposes. 3. Adequate, relevant and not excessive. 4. Accurate and up to date. 5. Not kept any longer than necessary. 6. Processed in accordance with the data subject’s rights. 7. Securely kept. 8. Not transferred to any other country outside the European Economic Community without adequate safeguards. In healthcare, the DPA applies to personal data held by both the NHS and the private sector. The act covers information held on, or awaiting entry into, computer systems, as well as manual records if these ‘form part of a relevant filing system’. Case law has established that ‘a relevant filing system’ means the file must be organised in such a way that the information can be found directly. A personnel file which simply files information in chronological order does not necessarily fall within this definition. However, a structured file in 20

which information regarding holidays, absences, disciplinary action and grievances is separated, is more likely to be covered because the information to which access may be requited is readily identifiable. Personal data includes information relating to the physical or mental health of individuals. It also includes opinions about patients, so any notes taken in conversation with patients, during appointments or on the phone, any assessments and any other records about their care can be disclosed. It is therefore vital to keep information in accordance with the eight DPA principles. Patients personal data cannot be disclosed to third parties under any circumstances – not even to family members – without their consent. A request for disclosure from a patient for their own health records should be accompanied by a signed consent form. Because health professionals must treat information about patients confidentially and use it only in relation to the care given, papers about patients must never be taken home. Section 7 (5) provides that where complying with a patient’s request for information would reveal the identity of another individual – such as a health professional – the data controller should seek their consent before disclosing the information. Exemptions Some information is exempt from access. This includes: ** where disclosure would be likely to cause serious harm to the mental

health or condition of the individual concerned **

where disclosures relating to disabled people or children is prevented by someone with parental responsibility or someone appointed by the court to manage their affairs, if they believe the individual concerned expected or expressly requested that the data would not be disclosed

confidential employment references

Employer’s obligations Employers are obliged to manage data held on employees as well as patients. This could include information on performance appraisal as well as, for example, information on training needs or selection for redundancy. Employers must designate somebody with responsibility for ensuring compliance with the DPA in respect of employees and patients, and should ensure that line managers and workers understand their responsibilities in complying with the act. The organisation should also have a valid notification and a register of data controllers. For more information about this and the DPA go to the Information Commissioner’s Office website at: www.dpr.gov.uk.

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. healthcare manager | issue 13 | spring 2012

CAREERS

Take control of your career Budgets are tight, but now isn’t the time to neglect your training needs, says Liz McCarten. Have you thought recently about training and development? It’s a fair bet that, with all the uncertainty around you, your workplace is not functioning at its best. Even if your employer used to be great, you are probably finding there isn’t the the money or the will to do much about employees’ skills. However, now is the time when you need to feel confident and marketable to face the future. So the first thing to do is to take yourself off for a quiet coffee and a think. Is there some area of development that you were promised, but which never quite happened? Is there a practical skill you really need just to

keep yourself at the same level? Is there something you need to do to help you change direction? Once you have identified what might be needed, ask your line manager if there is actually any money for training in the next few months. Something might be available if you push. Remember, you need to make a good case for why your plan will benefit the employer. And employers going through restructuring probably have a fund to help staff find suitable alternative employment, including training in areas such as interview techniques and CV writing. If you draw a blank, maybe you should

look elsewhere for your training. If you really need new skills, you should weigh up the relative cost of paying for training against waiting to see what happens to your current job. MiP is clear that employers should make provision for your continuing professional development, but these are not normal times and you need to safeguard your future. MiP regularly hosts half day masterclasses to help members enhance their skills in areas like public speaking and presentations. There is a small administrative charge, but otherwise all you need from your employer is the time off to attend. Keep your eye on our website for details.

Tipster: Reducing your carbon footprint Karl Heidel of the NHS Sustainable Development Unit shows how every manager can play a part in giving the NHS a sustainable future.

 Don’t reinvent the wheel The NHS is so large that there is always somebody, somewhere doing something good. The NHS SDU website includes a list of case studies so you can learn how others have succeeded.

2 Make an Impact Show some quick wins such as improving recycling of hospital waste or work with your estates department to reduce energy consumption. Show that sustainability saves money.

3 Have a plan The old business adage ‘you can only manage what you can measure’ is spot on. Develop a Sustainable Development Management Plan and get the

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board to approve it, so they ‘buy into’ the process. Be sure to measure energy use and carbon reduction so you have a benchmark to compare against over the years.

4 Be a good corporate citizen Use the NHS Good Corporate Citizenship Assessment Tool. It gives a score which you can compare to other NHS organisations and against which you can assess your organisation’s levels of sustainability.

5 Carbon Champions A lot of NHS organisations have voluntary carbon champions: people who are interested in helping their organisation

be more efficient. The more hands on deck, the greater impact you will have across your organisation.

6 Campaign Get your Comms team to help develop a recycling/sustainability/low carbon campaign. This will help build awareness across the organisation and with the public. It will also make it visible to your CEO.

7 Help The NHS Sustainable Development Unit is only a phone call away and we are happy to help wherever possible. Phone: 01223 597792. For more details, visit the website: www.sdu.nhs.uk

MiP AT WORK

Life as a healthcare manager in 2011 Marisa Howes reports on the results of MiP’s annual survey to test the mood among healthcare managers. After a year of unprecedented manager-bashing by politicians and the media, we asked healthcare managers how life in the health service is treating them. Their responses reflect the management cuts across the UK, and the chaos caused by the Health Bill in England. ‘This is the worst reorganisation I’ve been through in 30-plus years in the NHS,’ said one respondent. ‘I hold on to a belief that David Nicholson is trying to make a silk purse out of Andrew Lansley’s sow’s ear.’ We had responses from 349 managers – about 6% of our members. Not surprisingly, they are not nearly as happy or optimistic as last year, with many just looking forward to retiring

Public? Private? If it’s healthcare, MiP is there for you Colin Moore, associate national officer, explains why MiP membership is good for you even when you move on from the NHS.

or being made redundant. ‘In my 38 years service I have never felt so much under pressure to deliver an impossible agenda that has nothing to do with improving healthcare,’ said one. ‘Given the chance I would retire now.’ At least managers feel appreciated by their colleagues: 49% felt their work was very positively valued by their team. But just 2% felt very positively valued by the Government, and just 1% by the media. ‘I feel completely demoralised… I feel that the NHS is being torn apart and that my professionalism is neither understood nor valued by government or media,’ was one manager’s comment. A worrying – but not surprising – trend is declining morale. Just 46%

were very or fairly happy in their job, compared to 55% last year and 57% in 2009. This year, only 55% would recommend a career in healthcare: not bad, but compare it to 62% last year and a whopping 79% in 2009. ‘Five years ago, I would have recommended an NHS career, but not sure I could now due to the Government’s continual use of the NHS to try to score public

Upheaval in the NHS means many senior staff are moving to new jobs in the private and voluntary sectors. Members often ask if MiP can still represent them when they move outside the NHS, and the answer is definitely yes! Everyone has the right to trade union representation, and even if MiP is not recognised for bargaining purposes, we can still represent you and give expert advice. Take John (not his real name), an NHS Human Resources Director, who was invited to join the UK arm of one of the biggest and best global consultancy firms. They offered fantastic prospects, so John took the offer and prospered for three years, winning appraisal plaudits, promotion promises and bonuses to match. Then a new senior manager brought in

a new world order. John was invited to a meeting with his new divisional boss – ‘at which Human Resources will be present.’ John was told he would be suspended and investigated for breaches of expenses policy, even though his expenses had all been approved by his manager. Taxi fares were somtimes approved because they increased productivity – a practice accepted by John’s grateful line manager. But now the boundary of acceptability had moved. Thankfully, John kept his MiP membership and help was at hand. Although convinced he had not acted inappropriately, and certainly not fraudulently, a disciplinary hearing, whatever the outcome, could be disastrous for his career. He needed MiP to stop the issue going to the formal process. After the employer first refused to

healthcare manager | issue 13 | spring 2012

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brownie points,’ said one. Asked about the future of the health service, 72% felt very or fairly negative, compared to 64% last year and just 29% two years ago. One respondent summed up the mood: ‘Very depressing what is happening to the NHS in England… The speed and size of change is a huge risk and undermining previous achievements… Commissioning decisions are more short term than I can remember which is another risk in itself, especially in times of reduced budgets.’ Finally, completely unprompted, many respondents thanked MiP for standing up for healthcare managers in individual case work – ‘I could not have done without the support provided by [MiP]… I am well represented, maintaining my dignity and self esteem’ – and by contributing to national debates: ‘I do feel that other than MiP, managers in the health service have no-one at their backs,’ said one. ‘Thank you for being there and being our voice.’ Ministers take note: it’s time to stop denigrating managers and start treating them as a valued part of the healthcare team.

engage in informal discussions to achieve a solution, MiP escalated the request to partner level, pointing out that a formal hearing would raise concerns about breaches of working time regulations, and would involve a detailed examination of John’s previous manager, as well as calling clients as witnesses to verify meetings attended and work done. Eventually, we got the meeting at partner level and with careful and extensive preparation, common sense prevailed. John’s suspension was lifted the day before Christmas Eve and the remaining issues are being sorted out informally, without any formal process.

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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

If you are changing employer, just let us know on info@miphealth.org.uk

healthcare manager | issue 13 | spring 2012

helping you make healthcare happen

backlash

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

by Celticus

Royal flee

resh from his ‘codswalloping’ outside Downing Street by angry health protester Jean Hautot, Andrew Lansley bravely turned up on 5 March at the Royal Free in Hampstead, to be hustled in to meet handpicked staff, surrounded by his usual retinue of police and security guards (some, rumour has it, disguised as paramedics). But even they couldn’t prevent him from being pursued through the Royal Free’s corridors by the irrepressible Hautot and an angry doctor shouting ‘the bill is rubbish, and you know it’. Local hacks were banned from the visit and, although the BBC were on hand, they chose not to broadcast the SoS’s embarrassment. At HCM, we have no such scruples: www.youtube.com/ watch?v=KZCdJSHTf3I

Feel the quality

e’re grateful to Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, for kicking away another rickety strut from

under the Health Bill, namely those ministerial claims about falling NHS productivity. A study by Black published in The Lancet poured a bucket of cold water over the figures touted by ministers allegedly showing that productivity fell by 15% in the ten years from 2000. Black found the research, by the Office for National Statistics, completely ignored improvements in the quality of care in favour of measuring only quantity. In fact, such was the improvement that a baby born in 2009 could expect to live three years longer than one born in 2000. Professor Black is no opposition stooge: he’s an adviser to Lansley’s own Department of Health. ‘Many high-ranking Department of Health officials were very surprised by my data,’ said Black.

Could do better

ore red faces at the Department after a stinging rebuke from the Regulatory Policy Committee, an independent panel set up by ministers to vet the quality of Whitehall policy making. The RPC ran the rule over the government’s ‘impact assessment statements’ (IAPs) for the Health Bill and found them wanting. The Department’s assessment of the impact on GP commissioning and public bodies were ‘redrated’ as ‘unfit for purpose’ by the experts even after

Not a pretty sight Ever wondered what £1,300,000,000 looks like? The sleek lines of the post-Lansley NHS became a little clearer when the ‘Future Design’ of the NHS in London was leaked to investigative journalist David Hencke (see above). Now we can see what the Prime Minister means by ‘getting rid of a whole load of bureaucracy’. Look closely and you can just see ‘Patients and the Public’ crammed in at the bottom. Spare a thought for NHS Education London, marooned without funding and apparently accountable to no one, and GP practices which are missed off altogether (maybe they wanted to keep things simple) Still, give it time, it’s only version 0.4. Download your own copy to stick on your wall: http://davidhencke.files.wordpress.com/2012/03/ nhs-structure-2.jpg

being sent back once for revisions. ‘They did not provide reliable estimates of the costs and benefits of the regulatory proposals being considered, including those of unintended consequences and potential risks and uncertainties,’ said the RPA.

Pot of gold

roblems too, with with the Department’s sums. DH figures show the total running costs of

the NHS as £3bn in 2014-15, with £492m expected to go on running the new NHS Commissioning Board. With CCG running costs fixed at £25 per head of population (around £1.25bn in total), this would appear to leave a massive £1.3bn for running public health services and, of course, the DH itself. We knew there had to be a winner in this somewhere.

healthcare manager | issue 13 | spring 2012

insuranc

holidays

The added va lue of membership

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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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.