Healthcare Manager Winter 2012

issue 16 winter 2012

healthcare manager

PAULA VASCO-KNIGHT BREAKING BARRIERS plus

THE CASE FOR INVESTING IN MENTAL HEALTH NHS FINANCE: THE REAL DEAL

helping you make healthcare happen

issue 16 winter 2012

healthcare manager inside

heads up:2

What you might have missed & what to look out for Leading edge: Jon Restell inperson: Sîan Richards, mental health strategy lead, Welsh Government inpublic: Gartnavel Royal Hospital, Glasgow

letters & comment:8 Richard Vize: empowering managers

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 2012 Conference in Birmingham Interview: Paula Vasco-Knight, chief executive of South Devon Healthcare Trust Finance: Noel Plumridge busts a few myths about NHS money matters Mental Health: save money by spending more says Professor Richard Layard

regulars:20

Legal Eye: the government’s latest assault on employment rights Tipster: using acting skills to make an impact MiP at Work: with Archbishop Desmond Tutu

backlash:24

healthcare manager | issue 16 | winter 2012

Welcome to the winter issue of healthcare manager, the magazine from MiP, the specialist trade union for health and social care managers.

In this issue we hear from Paula Vasco-Wright, the only black female chief executive of an acute trust. We hear about her journey to the top and the great things she is doing to make a difference in healthcare in South Devon and in promoting diversity on the national stage. We also hear about the Conversations for Change with Archbishop Desmond Tutu and his daughter, supported by MiP, promoting equality in the health services.

There is a strong focus on mental health in this issue. Richard Layard argues that the NHS must invest in improving access to psychological therapies. Sîan Richards is developing the mental health strategy for Wales. And Gartnavel Royal Hospital in Glasgow has been designed both physically and culturally to break down the barriers between a mental health hospital and the community.

And Noel Plumridge is back to bust a few myths about NHS finances.

I hope you enjoy this issue. Do let us have your views and news.

Finally, I’d like to wish you all the best for a happy new year.

Marisa Howes Executive editor

1

HEADS UP

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

Disability

Mental health in the workplace The TUC has published a resource list for dealing with mental health in the workplace, aimed at helping local reps to represent members, negotiate effective policies with employers and inform and educate members about mental health issues.

People with mental health problems have one of the lowest employment rates among all disabled people and ignorance and prejudice – from employers and fellow workers – are probably the most significant barriers they face, and also the most difficult to challenge. The resource list includes a variety of publications from trade unions and mental health charities such as MIND, together with advice for employers and individuals needing help.

NHS England

Unions consult on proposed changes to Agenda for Change

4-10

2013

After lengthy discussions, the NHS Staff Council has agreed proposals on changes to the terms and conditions for staff on Agenda for Change in England only.

The trade unions, including MiP, are consulting their members before further discussions in February. Any changes will apply from April 2013.

At a time when the Agenda for Change grading system is increasingly under threat, these proposals aim to help ensure that the NHS Staff Council’s terms and conditions handbook remains sustainable for the future, fit for purpose, fair to staff and continues to be used by NHS organisations.

MiP has serious concerns about some of the proposals

and the risks they pose to a fair and equitable pay system, which are set out in a briefing posted on the MiP website.

A summary of the proposed changes is available on the NHS Employers website at: www.nhsemployers.org/PayAndContracts/AgendaForChange.

healthcare manager

Executive Editor

Marisa Howes m.howes@miphealth.org.uk

Contributors

issue 16 | winter 2012

healthcare manager is sent to all MiP members.

ISSN 1759-9784 published by MiP

Associate Editor

The resource list is available on the TUC website at: www.tuc.org.uk/equality/ tuc-21516-f0.cfm.

All copy © 2012 MiP or the author.

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

Craig Ryan editor@healthcare-manager.co.uk

Art Director

James Sparling

Design and Production

Lexographic production@healthcare-manager.co.uk

2

Thousands of events and activities are being planned by organisations from every part of society for Climate Week, Britain’s biggest climate change campaign, taking place from the 4-10 March 2013.

Showcasing real, practical ways to combat climate change, the week aims to renew our ambition to create a more sustainable, low-carbon future.

As a huge emitter of greenhouse gases, the health sector is crucial to cutting emissions both from its own estates but also through its outreach function highlighting the detrimental effects of carbon-intensive lifestyles on health and community well-being. Indeed, climate change is one of the biggest threats to global health that we currently face.

To find out how you can involve your organisation in Climate Week go to www.climateweek.com where you can discover a multitude of activities and events that you can host and get involved in. You can also email Climate Week on info@climateweek.com or telephone 020 3397 2601.

Iain Birrell, Marisa Howes, Richard Layard, Helen Mooney, Alison Moore, Noel Plumridge, Jon Restell, Craig Ryan, Richard Vize.

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

Advertising Enquiries

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

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

healthcare manager | issue 16 | winter 2012

HEADS UP

leadingedge Jon Restell, chief executive, MiP

T

he energy released by our annual conference still has me buzzing. Our inspiring speakers and the values and calm voices of our members have recharged my batteries. I feel ready to face the challenges of 2013.

I learnt much from the people I spoke to at our conference. Most important I was reminded about the skills, dedication and goodwill of the managers throughout the UK who are keeping the NHS on track at a moment of great danger.

This point was also punched home: There are practical things to be done to maintain my own health and well-being and to contribute to the effectiveness of MiP. Of course, given the time of year, I am turning that energy and those lessons into new year resolutions.

I’ve made a short (and thus more achievable) list. Three resolutions concern my own health and wellbeing and three a healthy organisation.

I will:

“I am turning that energy and those lessons into new year resolutions.

I’ve made a short (and thus more achievable) list.”

1 Spend more quality time with the people I love and who love me. And by quality time, I mean being present, not sitting in the same room as I tap out tweets.

2 Exercise more. (I could hardly exercise less.) This will help shed [cough] a few pounds but also benefit my mental faculties and energy levels.

3 Learn something new. Yoga sounds too strenuous. Perhaps I’ll learn Italian – as I’ve been meaning to for years.

4 Make more time for reflection:

on my own, with the MiP team and with our committee. We are all gripped by ‘a pathology of working harder and harder’.

We need to stop and think about what we are doing and why we are doing it.

5 Nurture trust in our organisation.

I will avoid micro-management and delegate well. (You read that last sentence right, head office colleagues.)

6 Invest even more in partnership working. Everyone who works in the NHS shares values – compassion, community, kindness, fairness – and a commitment to the health services. Next year we face tough problems (including endless reorganisation, Francis, and terms and conditions), which we can only solve through partnership working with the rest of the healthcare team and with our employers.

Buon Natale!

New standards for top managers Standards

Professional standards for members of NHS boards and clinical commissioning group governing bodies in England have been published by the Professional Standards Authority for Health and Social Care (PSA). The standards developed by the PSA, for-

merly the Council for Healthcare Regulatory Excellence, set out the skills and personal standards expected of all executive and non-executive leaders in the NHS in England.

The standards cover personal behaviours, technical competences and business practices

healthcare manager | issue 16 | winter 2012

and, according to the PSA, ‘aim to put care and compassion at the heart of leadership and governance’.

NHS leaders will be required to commit to the values of the NHS Constitution, to ‘equality and human rights in the treatment of patients and service users’, to promote ‘excellence

in clinical care’ and ‘long-term financial stability. Leaders must also ‘be ready to be held publicly to account for their organisation’s decisions and for its use of public money.’

Full details of the new professional standards are available from the PSA’s website: www.chre.org.uk.

3

HEADS UP

NHS Constitution

MiP 2013 subscriptions Members who joined MiP after 1 June 2005 pay MiP subscriptions, as set out below. Members who transferred into MiP from FDA or Unison when it was launched on 1 June 2005 (founding members), pay the relevant rate of the partner union from which they transferred.

MiP subscriptions are proposed

by MiP’s management board, in consultation with MiP’s national committee, and approved by the FDA annual delegate conference.

All subscription enquiries should be made to MiP. All subscription rates shown in the table come into effect on

1 January 2013.

Management trainees MiP now has a special introductory subscription rate for management trainees. They pay just £10 per year for the two years of their course.

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

Annual basic salary

Subscription

A

up to £25,750

£20.75

B

£25,751-£38,850

£22.80

A

£38,851-£61,800

£25.50

B

£61,801-£72,100

£28.75

C

£72,101-£82,400

£30.95

D

Over £82,400

£33.50

Management trainee

£10 pa every year of the two-year course

Band

DH proposes new pledges for staff and patients

Part Time

Full Time

FDA founding members A

£15,500-£33,500

£13.05

B

£33,501-£47,000

£25.30

C

£47,001-£70,500

£27.60

D

£70,501-£88,000

£29.95

E

Over £88,000

£32.70

Over £35,000

£22.50

UNISON founding members BAND K

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The Department of Health is consulting on several proposed changes to the NHS Constitution, which sets out the rights and responsibilities of patients, staff and the public, and the values and aims of the NHS. The changes include extending the staff pledges to everyone who provides NHS services, regardless of whether they are employed by the NHS or not. Staff will also be encouraged to raise concerns about services and suggest ways in which they can be improved, and a new pledge has been added that employers will ensure staff feel ‘supported’.

There would also be a new

duty on patients to treat staff and other patients with respect and to ‘recognise that violence, causing a nuisance or disturbance on NHS premises could result in prosecution and that abusive or violent behaviour could result in you being refused access to the NHS.’ The constitution will also be extended to local councils in respect of the public health duties they take on following the 2012 Health and Social Care Act. The consultation is open until 28 January 2013 and the consultation document is available from the consultations section of the DH website: www.dh.gov.uk.

healthcare manager | issue 16 | winter 2012

HEADS UP

inperson Sîan Richards, mental health strategy lead, Welsh Government In leading the development of a new 10-year mental health and wellbeing strategy for Wales, entitled ‘Together for Mental Health’, Sîan Richards co-ordinates and develops the strategy across the Welsh Government, the NHS, local government and the third sector.

She says the strategy is ‘very explicit’ in being about ‘mental wellbeing for everyone’ – that it is about ‘improving and sustaining’ mental wellbeing for the people of Wales, as well as ensuring good quality care and services for people with mental illness.

‘In the past policies have tended to focus on the severe and enduring mental illness agenda,’ she says. ‘This of course remains a priority, but we must also recognise mental health as being about everybody’s wellbeing too. This is very much a cross-governmental strategy. Improving mental health and wellbeing is not just about the NHS and social services, it’s about all areas of government and cross-sector activity.’

Coming from an NHS management background – she was recently chief executive of Cardiff Local Health Board – Ms Richards says that one of things that strikes her when speaking to mental health service users is that the care and treatment they receive from the NHS or social services is not always their top priority.

‘Of all the areas raised in consultation, housing appeared to be priority number one, because if people are in a safe home it makes so many other areas of their lives easier to manage and is critical to independence.’

This new strategy is also different

healthcare manager | issue 16 | winter 2012

because it covers all age groups.

‘Where services can break down is at the points of transition – between child and adult services or adult to older age,’ says Sîan. ‘Transition between services needs to be about individual need and not artificial age boundaries.’

She believes Wales is heading for a ‘real change’ in how it delivers mental health care and services, as a result of embedding the groundbreaking Mental Health (Wales) Measure 2010 into the Cardiff government’s approach.

With its focus on recovery and enablement, the measure puts new statutory responsibilities on local authorities and the NHS, including a requirement that all users of secondary care mental health services should have a care and treatment plan that looks at their wider needs and is developed in partnership with them wherever possible.

Sîan says that she has built on her experience of managing and commissioning mental health services to ensure wide-ranging ‘involvement and engagement’ in putting together the strategy even prior to the formal consultation process to ensure that it was ‘meaningful for the people of

“Housing [is] priority number one, because if people are in a safe home it makes so many other areas of their lives easier to manage.”

Wales’. She adds: ‘We have also published a detailed delivery plan alongside the strategy so that from day one we are starting to deliver real changes on the ground.’

The strategy’s title, ‘Together for Mental Health’, is also important, says Sîan. It reflects the fact that, while the NHS and social service provision of mental health services is ‘vitally important’, we must also recognise the ‘wider agenda’ across all government departments, and all sectors and agencies in ‘enabling people to live as fulfilled and independent lives as possible’.

Helen Mooney The strategy can be downloaded from the Welsh Government website: wales.gov.uk.

5

HEADS UP

HSJ Awards 2012

Sandwell and West Birmingham Hospitals Trust scooped the staff engagement prize at the Annual HSJ Awards, held at the Grosvenor Hotel in November. The award, sponsored by MiP and Unison, was won by the trust for its Listening into Action programme launched in 2008.

The award was presented to the trust chief executive John Adler by MiP chief executive Jon Restell and Unison’s head of health Christine McAnea (pictured above).

Jon Restell said: ‘This is a great example of how effective staff engagement can not only improve staff morale but also improve health outcomes for pa-

tients. This radical culture change owes much to the enthusiastic support of chief executive John Adler who has embraced staff engagement wholeheartedly.’

The HSJ awards ceremony was hosted by Huw Edwards and attended by 1,400 guests including health secretary Jeremy Hunt.

Northern Ireland

Cut hospitals by half, says government review A major review of the health service in Northern Ireland has proposed reducing the number of acute hospitals from ten to five, and substantially cutting the number of care homes for older people, as more people are cared for in their own homes.

The department said some of the five acute hospitals which are no longer required may remain open to provide other NHS services.

The review, Transforming Your Care, was published by the Northern Ireland Department 6

of Health, Social Services and Public Safety in October and is out for consultation until 15 January.

The review also proposes that ministers should consider a greater role for the state in affecting health outcomes, including possible regulation of the pricing of alcohol and junk food.

The department is also proposing a major drive to improve health and social services for the youngest children, including a restructuring of services to develop

a ‘headstart’ programme for 0-5 year olds. It claimed that early intervention to support the devel­­opment of young children was one of the most cost-effective aspects of social care. The headstart programme would be funded by diverting £83m from hospital services into community care.

The report also says Northern Ireland’s 353 GP practices should form 17 federations based on the already established Primary Care Partnerships.

Transitional funding of £65m

would be needed over the next three years to allow the changes to take place, said the department.

The review document is available from the consultation website: www.tycconsultation.hscni.net.

healthcare manager | issue 16 | winter 2012

HEADS UP

inpublic

“One of the first things people say when they visit the hospital is how it doesn’t feel like a mental health hospital.”

Gartnavel Royal Hospital, Glasgow The marketing blurb for Gartnavel Royal Hospital, part of NHS Greater Glasgow and Clyde, claims it is ‘the most modern and innovative mental health hospital in the UK’.

It says that ‘the state-of-theart £19m hospital has transformed inpatient care and made Glasgow a centre of excellence in the delivery of mental health care.’

It’s certainly true that Gartnavel is a bright, modern, attractive building which is light, airy and spacious. Imaginative use of windows and landscaping connect the inside of the hospital with attractive external garden and courtyard areas. All 117 beds are provided in single en-suite bedrooms and a community café has been created in a bid to help break down barriers by giving local people an opportunity to mix with patients and staff.

Patients and their families were involved in shaping the layout and design of the building from the beginning, and staff also visited mental health hospitals in other parts of the UK as part of the design process.

Opened in 2008 by former Scottish health secretary Nicola Sturgeon, Gartnavel is the product of a 25-year private finance initiative contract. Colin McCormack the hospital’s head of mental health services claims that what has been created in terms of both the quality of the accommodation and the services that the hospital provides is ‘very positive’.

‘There is a strong belief in bringing the outside in,’ he explains. ‘There are massive areas of glass and light, the rooms are very light and very airy and since the hospital opened there has been a significant healthcare manager | issue 16 | winter 2012

reduction in the number of adverse incidents we have had.

‘One of the first things people say when they visit the hospital is how it doesn’t feel like a mental health hospital. People talk about how calm and quiet it is.’

McCormack says that, through listening to patients and learning from experience elsewhere, a revolutionary new hospital fit for the 21st century has been created.

The Ministry of Defence were sufficiently impressed with the hospital that they signed a contract with Gartnavel to guarantee a number of in-patient beds for serving military personnel. The hospital managed to beat off rival bidders Virgin Health and The Priory to win the MoD contract.

The hospital has six wards – three adult,

two elderly and one intensive psychiatric care unit, which includes an extra-care suite if a patient needs to be segregated from other patients.

‘I think the combination of an excellent environment in terms of the hospital design which is fresh and clean, mixed with happy staff who are pleased to work here means that we are really as good as we can be,’ says McCormack.

‘I also think that with lots of theatre, art, drama and physical activity programmes, and the fact we are trying to engage with the wider local community, we are beginning to de-stigmatise mental health and the hospital, and make the site part of and for the community.’

Helen Mooney 7

LETTERS

letters

Letters on any subject are welcome. Please send to editor@ healthcare-manager.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

It’s time we all looked in the mirror Many of you may have seen the You Tube hit of the Australian premier, Julia Gillard condemning the opposition leader for sexism and misogyny (www.youtube.com/ watch?v=ihd7ofrwQX0 – highly recommended viewing if you haven’t seen it). She suggests quite firmly that the opposition leader should look in a mirror at his own behaviour, after throwing a member of his own party to the wolves for inappropriate comments.

In the current NHS reorganisation, the equalities agenda seems to have been thrown out of the window and BME staff have been hit particularly hard. I have come across cases where a person of BME origin

suddenly finds themselves being managed by the nonBME person they managed the day before! The criteria for BME staff seem to constantly shift, are applied inconsistently, and are much more rigorous than for their white counterparts. For evidence of this: just take a look around your own departments and ask your BME colleagues.

The truth is, a lot of us have behaved quite badly In this scramble for jobs.

Rumours abound of those with access to people with influence securing themselves posts of their choice, whilst others who work very hard and play by the rules are left by the wayside.

HR departments have been practically silent on this matter, citing ‘difficulties’ in collating data because staff do not wish to disclose sensitive details about race or sexual orientation when applying. I would argue

that this is because many already assume that such data would be used against them. This is what many tell me privately.

It is not too difficult to get empirical data: just talk to a random sample in private.

Although not scientific, it ought to provide enough to begin a meaningful discussion. I also know that HR departments have been issuing ‘trackers’ to show where staff are being posted, which should provide enough data to indicate whether there is a race or gender bias at particular levels and/or in particular departments.

Whilst women have done reasonably well in the public sector, certain departments, finance in particular, remain traditionally male.

This hinders the progress of women because ‘high finance’ is generally seen as a route to the very top. This is not merely a moral argument. Evidence

suggests that a homogenous leadership by definition fails to take into account the thoughts and experiences of people from different groups, and ultimately the public suffers as a result.

Solutions? I can’t say I have all the answers, but I believe it’s time either for HR departments to have much more power (a bit like ‘internal affairs’ in police services around the world) or for recruitment to be completely taken away from local level, to reduce the risk of ‘arrangements’ being made between friends (‘networking’ can be positive, but it also means by definition that many are excluded). As long as the current traditional structures remain, absolutely nothing will change.

Time for us all to look in the mirror, be honest with ourselves and check our own behaviour.

MiP member Name and address supplied

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.

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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 16 | winter 2012

comment

COMMENT

Richard Vize

Guardian columnist and former editor of the Health Service Journal.

A mandate to empower managers?

The mandate for the NHS Commissioning Board, which sets out the government’s expectations of the NHS, marks the beginning of both more operational freedom and greater accountability for managers – which could morph into a greater risk of being blamed for the service failures of a system under stress.

The Commons’ debate on the mandate reinforced the perception of managers as a species of NHS staff which is tolerated rather than celebrated. Health secretary Jeremy Hunt trumpeted the stripping out of 17,000 managers as one of his government’s great achievements, while his shadow, Andy Burnham, bemoaned the fact that over 1,000 managers have received ‘six-figure payouts’ for losing their jobs. It’s scandalous, apparently; nurses should have had the money instead.

The mandate is heavy with references to staff. It prepares the ground for the recommendations of the inquiry by Robert Francis QC into Mid Staffordshire Foundation Trust by promising that managers will be ‘better held to account’ for such failures. It is striking that it is only managers – not clinicians – who are lined up to take the blame in this context.

The mandate says the government’s response to the Francis Inquiry will be ‘comprehensive, effective and lasting’. Sadly, it does not say it will be proportionate, balanced and realistic in what can be achieved by regulation and central prescription. In the wake of healthcare manager | issue 16 | winter 2012

what will no doubt be a horrific report for the health service, there is a severe risk that any additional freedom to exercise professional judgment that emerges from the NHS reforms will be undermined by new layers of control as the health secretary tries to win the media battle to be seen to be tough on failure.

The best news in the mandate is that Hunt has dumped the targets Andrew Lansley proposed in the consultation document. It is tempting to believe this was simply because Hunt wanted to avoid the tedium of wading through the sort of operational detail that gave his predecessor so much pleasure. But the consequences of this change are significant.

If Lansley had got his way the potential prize of the new system – greater local autonomy for managers and clinicians – would have been lost.

The Commissioning Board would have been almost compelled to impose tighter central control, greatly harming the longterm interests of the service.

Instead Hunt, in his first big decision as health secretary, has decided to focus on improvement as the key measure of success, which will avoid the serious operational distortions which inevitably result from targets. It will, of course, also avoid handing the opposition easy opportunities to attack the government on the NHS. The priorities he has set, such as better dementia care, reducing avoidable deaths and improving the patient experience, are

already objectives around which staff are uniting. The promise to use data more effectively and to be more transparent about services will provide further incentives to deliver better care.

The mandate does its best to ram home the message that the Commissioning Board is committed to promoting local freedom, and promises ‘comprehensive feedback for assessing the board’s performance’ in achieving it. This at least opens up the possibility that managers could push back against excessive central interference. At the moment, trying to override central directives amounts to signing a career death warrant. The Commissioning Board system might allow local leaders to exert more influence over how services are run.

This opens up a role for organisations, including MiP and the NHS Confederation, in ensuring the Commissioning Board stands by its rhetoric. They need to articulate the extent to which the culture of central control is finally giving way to more respect for professional judgment, and to press for firm action if little is changing.

If the long promised decentralisation is not embedded in the first few months of the new structure it will never happen, and the first real opportunity in more than six decades to empower clinicians and managers in leading the NHS will have been lost.

Views expressed are those of the author and not necessarily those of healthcare manager or MiP. 9

MiP ANNUAL CONFERENCE 2012

MiP national conference Photos show (clockwise from top left): Victoria Macdonald; Rob Gee; MiP vice chair Zoeta Manning; MiP chief executive Jon Restell; Liz Kendall MP, shadow health minister; Andrea Sutcliffe, Social Care Institute for Excellence; Christina McAnea, Unison; Prof Michael West; Dr Andrew Goodall, Aneurin Bevan Health Board and Mike Farrar, NHS Confederation; Jo-Anne Wass, NHS Commissioning Board; delegates in the Network Café; Vicky Phillips, Thompsons Solicitors and Dean Royles, NHS Employers with Victoria Macdonald.

all pictures © Timm Sonnenschein, Roy Peters Photography

A great line up of speakers and enthusiastic delegates generated great ideas at this year’ MiP conference. Comedian Rob Gee from Big Difference set the tone with a poem specially for healthcare managers, and he rounded the day off with a poem based on the day’s proceedings. A host of speakers, headed by Professor Michael West of Lancaster University and chaired

by Channel 4 health correspondent Victoria Macdonald spoke about the values and commitment that managers bring to the table.

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healthcare manager | issue 16 | winter 2012

MiP ANNUAL CONFERENCE 2012

healthcare manager | issue 16 | winter 2012

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INTERVIEW

Paula Vasco-Knight, chief executive of South Devon Trust, is the only black woman to lead an acute trust and has just taken charge of equality at the National Commissioning Board. She found time to talk to Alison Moore.

Paula Vasco-Knight is a challenge to the stereotypical view of senior NHS managers as middle-aged men in grey suits.

The only black woman acute chief executive in the UK, the 47-year-old was nicknamed ‘Tigger’ by staff at a former hospital and now leads South Devon Healthcare Foundation NHS Trust. ‘I was once told I had naïve enthusiasm – I think it has served me well,’ she says. That enthusiasm is increasingly being shown on a wider stage as she takes on a national role as the NHS Commissioning Board’s lead on equality.

The daughter of a Nigerian father and a Scottish-English mother from a working class background in Liverpool, Vasco-Knight left school with O-levels intending to become a registered general nurse. ‘When I went for interviews I was very focused on patient care and they said I would be best suited to be a state enrolled nurse.

Within about a week I realised that it meant I could not progress,’ she says.

‘I remember feeling frustrated early on that I could only influence the patients in front of me. I was always interested in leadership and management and processes, and systems of management and governance.’

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Seeing the wider impact nurses in management positions could have on patient care inspired her to plan to become a director of nursing and to gain more academic qualifications – especially when she was told she could not take on additional responsibilities because of her SEN status. She became more involved in leading change and innovation. ‘I have always tried to get people to think innovatively and push the boundaries of what is possible.’

She went on to gain a BSc in health, and then a BPhil and an MBA – all gained part time while working. And along the way she had three daughters – now 23, 16 and 11 – spending some time as a single mother before remarrying.

And her career progressed rapidly, working in the Liverpool and Southport area, before moving to Nottingham and then Leicester – where she took on a general management role alongside being the senior nurse in surgery. The management role gave her ‘huge insight into aligning clinicians and management. My nursing skills felt quite precious in terms of helping me make the right general management decisions,’ she says.

‘I always looked up to the managers because I felt they had a tough job. It’s a tough job when you are a clinician –

but tougher still when you aren’t.

Clinicians taking leadership and management roles has been a key theme throughout my career.’

But she was also aware that the management experience was essential to enable her to make the leap to a director of nursing role. In 2001, she was appointed director of nursing at Plymouth Hospitals NHS Trust, moving south into an area with a much smaller black and minority ethnic population.

Seven years later she was appointed chief executive at South Devon.

Has she personally encountered racism? Yes – though she does not want to dwell on it – there were incidents early on in her career of inappropriate name calling. She prefers to stress the positive memories she has of being taken under the wing of some wonderful nurses who exemplified good patient care.

But Vasco-Knight says that she has been told that appointing her to some jobs was ‘a risk’. She had two days of tough interviews – including presenting to a large group of senior consultants – before she got the job at South Devon. In the final interview, she had to address the question of how she would overcome the challenge of being perceived as ‘different’.

She says: ‘I took a deep breath and healthcare manager | issue 16 | winter 2012

INTERVIEW

‘I’m different and my style is very different. I see difference as great and good, and I love it – but some people fear it. ”

answered from the heart. I was saddened the question had to be asked but believe that my chairman Peter Hildrew was correct in asking it. He has always been extremely supportive and really appreciates diversity.

‘I’m different and my style is very different. I see difference as great and good, and I love difference – but some people fear it.

‘You have to ask people to give you a chance and not to make a judgement because you are different. It does not take long for people to see you for who you are and your value base and your ability. I have always been passionate about equality and inclusion and diversity and difference.’

She puts a lot of this approach down to the strong mutual respect between her grandfathers that transcended cultural and linguistic boundaries: she now uses their photographs during presentations on diversity. ‘They had a wonderful respect for each other and what they had done for the families. ….it had a huge impact on me and I found it difficult when people did not value difference.’

If there were any qualms about her appointment among the staff, they seem to have long since dispersed.

Part of this may be down to her desire to be visible, accessible and inclusive healthcare manager | issue 16 | winter 2012

– making a point of meeting staff from every area in her first few weeks and regularly working on the wards.

She was nominated for HSJ chief executive of the year by her own medical directors, for which she was highly commended, and at the time of going to press is awaiting the outcome of her shortlisting for the NHS Leadership Academy’s inspirational leader award. Last year South Devon was named HSJ acute healthcare organisation of the year.

Vasco-Knight says her organisation lives and breathes the values enshrined in the NHS Constitution, embedding them in its recruitment as well as its everyday work. The benefits of these values are felt not just by staff but ultimately by patients in the care they receive. ‘The impact of having a happy workforce on patient care is something you learn so quickly when you are on the frontline. Ultimately it is what happens to a patient that is important.’

The area served by South Devon is not the homogenous affluent retirement spot it is sometimes portrayed as.

Within Torbay, there are some of the most deprived areas in the country and there is a relatively high level of drug and alcohol abuse and children at risk.

Meeting the needs of this diverse population is a real challenge, she says.

An integrated approach is one of the ways of doing this – like many managers she is enthused by health minister Norman Lamb’s recent comments on integrated care. The catchment area offers a chance to put this into action: Nearby Torbay and Southern Devon Health and Care NHS Trust is one of the most celebrated examples of integrated care. It has now decided to enter into partnership with another organisation, and Vasco-Knight’s trust has already taken the first steps in this process.

Like many acute chief executives, Vasco-Knight has considered how the acute sector can continue to provide the specialist care required while inevitably shrinking as more care moves into the community. Sometimes providing the right care means that the interests of her own organisation have to be put aside in favour of what is right for the system as a whole.

‘I would rather invest in a patient staying at home and keeping them well than them coming into hospital,’ she says. Incentivising the right behaviour across both health and social care is important, she suggests, and that means finding ways of funding community placements and re-enablement.

So what does being the only black woman acute chief executive mean to 13

INTERVIEW

Paula Vasco-Knight with interns from Project Search, a scheme to boost employment opportunities for people with learning difficulties, launched in South Devon in September.

her? Not having a peer group is one issue she mentions, but she hopes that she has changed things for those who come after her. She also points to how her own organisation looks different: the trust has a higher proportion of black and minority ethnic staff than the 4% in the local population.

But equality and inclusion does not just mean colour or race. South Devon has a high proportion of people with learning disabilities and Vasco-Knight has been determined to try to offer them opportunities for paid employment within the trust. A half-hour presentation to managers by some of the potential employees led to an offer of 48 work placements as a first step.

‘We are confident we will get 100% of them into jobs,’ she says. The trust is also trying to work with young ex-offenders, another marginalised group who find it difficult to get on the jobs ladder.

As well as leading her organisation, Vasco-Knight is the NHS Commissioning Board’s national equalities lead for one day a week, working with health inequalities lead Professor Steve Field.

‘Our aim is to bring inequalities and equalities together into one cohesive 14

strategy that really has an impact,’ she says. ‘How do you have a robust strategy that achieves equal services and access and experience for all members of society, and reduces the gap in health inequalities – and has a workforce that reflects the community it serves?

As well as the importance of ‘mainstreaming’ the equalities agenda, she highlights the top level support and commitment – from Sir David Nicholson downwards – for the drive towards equality and diversity. This commitment and other factors mean that this is the ‘best opportunity’ to bring about change.

But, in common with many people working in equality, she is concerned that the current changes may result in a less diverse workforce at the top. Former Commission for Racial Equality chair Trevor Phillips once described the NHS as ‘snow capped’ and – although Vasco-Knight may be the exception that shows it can be changed – it’s probably still a largely accurate description.

The massive changes in PCTs may have had a negative effect, she agrees, affecting the many senior BME staff members who worked in them. ‘It is not

too late for us to address that. There are 600 posts being advertised at the minute,’ she says. The NHS Commissioning Board has been working with interview panels to ensure that there are equal chances to be shortlisted and appointed.

She fears the boat may have been missed in terms of CCG leaders reflecting the wider GP community, including women. ‘We should have proactively managed the process,’ she says. But the equality delivery system has now been put into the CCG authorisation process so they have to demonstrate how they are ensuring they are delivering and commissioning for equality.

Ultimately, Vasco-Knight is hopeful that the NHS will have a more diverse leadership, reflecting both its staff and the communities it serves. ‘Change does not happen overnight, it is a journey, but I hope we could see tangible change within a couple of years,’ she says. ‘In all honesty we have come a long way. We need to recognise that and learn from it.’

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Alison Moore is a freelance journalist. healthcare manager | issue 16 | winter 2012

MONEY MYTHS

In the wild new landscape of NHS finance, nothing is quite what it seems, says Noel Plumridge.

Having taken a momentous restructuring in its stride, a cashstrapped English NHS continues to make steady progress towards its savings target, the £20 billion ‘Nicholson challenge’. Meanwhile, private sector competitors are circling, waiting to cherry-pick the simpler surgical cases and take over failing acute hospitals.

If this vision of the NHS financial landscape looks like a reasonable summary to you, take a closer look. It’s almost entirely based upon myth and spin. So let’s examine what’s really happening. Let’s bust a few myths.

1. The English NHS is strapped for cash No, it isn’t. Fact: in 2011-12 the English NHS reported a ‘surplus’ of £2 billion. It may not feel like it in the average hospital, and it’s hard to square with the remorseless grind of annual cost improvement targets, but the NHS is awash with cash.

What’s more, the £1.6 billion ‘surplus’ reported by primary care trusts and strategic health authorities – that’s most of the £2 billion total – is nothing unusual. Each of the three previous years saw ‘surpluses’ in healthcare manager | issue 16 | winter 2012

excess of £1.3 billion.

So why not, managers are starting to ask, fund the wretched savings targets with last year’s surpluses?

How can one reconcile an NHS billions of pounds in the black with this continuing and near-obsessive pursuit of savings?

But the term “surplus” is misleading. Trading organisations make surpluses. NHS commissioners and regulatory bodies, for all their boasts of robust independence, remain an arm of government. Their role is to prioritise and direct the resource voted by Parliament.

So, they underspend. Their motives may be transformational (funding strategic change), practical (paying for redundancies arising from PCT abolition), or simple compliance with orders from above: the outcome is the same. In a climate of austerity, not spending money has become virtuous.

Health needs investment. France and Germany each spend over 11.5% of

their GDP on health care. Despite all the growth of the Blair and Brown years, the UK still spends just 9.6%.

The NHS is not overfunded. But its money is being deliberately withheld.

And underspending, year after year, hints that the NHS perhaps didn’t need the money in the first place. Recent analysis suggests nearly £3 billion of unspent NHS funding has been returned, intact, to George Osborne.

15

moNEY MYTHS

That’s money the NHS will never see again. The Commons health select committee is asking pertinent questions.

Nevertheless, with economic recovery still a distant dream and the national tax take stalling, the Treasury will be sizing up the £5.1 billion cash reserve currently held, unspent, by NHS trusts and foundation trusts. Most (£3.9 billion) is a by-product of the arcane foundation trust financial regime. The 144 foundation trusts sing a song of independence and freedom to invest; Monitor, their regulator, demands strong balance sheets. But now it’s another opportunity for the Treasury to withdraw funds.

For the Treasury has little interest in the internal workings of the NHS or its transient quangos. For two years Westminster observed a growing tension between Andrew Lansley, a Secretary of State pursuing deep structural reform, and pragmatists who viewed the resulting instability as a threat to the broader economy. Now, with the Act passed and Lansley gone, the gloves are off in Whitehall: the focus is once again firmly on savings.

2. The problem is £20 billion; the answer is QIPP If only it were so simple. Sadly the vision of a huge, heroic push for productivity and efficiency, followed by a well-earned rest, was always an illusion.

Between £15 and £20 billion – quickly redefined as the higher figure – was the McKinsey consultancy’s 2009 estimate of how much the NHS would need to save, once funding growth ended, to absorb unavoidable cost pressures.

Savings would finance reinvestment, especially in three pressing areas: the 16

costs of an ageing population, costs arising from population growth, and better drugs and medical technology.

Together these amount to between four and five per cent per year.

Not everyone accepted the scale of what’s become known as the ‘Nicholson challenge’. In the spring of 2010, the King’s Fund suggested a pay freeze might save £3.5 billion, while a further £3 billion might be saved by retaining existing patient access standards and scaling back capital investment plans.

This was not outlandish. The pay freeze soon came to pass, and Monitor’s financial regime was already curtailing foundation trust capital spending plans.

A ‘challenge’ of £13.5 billion would be less forbidding and more achievable than £20 billion.

The unavoidability of some cost pressures has also been questioned.

Population growth, largely driven by migration, was always hard to quantify, and in poorer times the UK might well become a less attractive destination.

And why should scientific advance always be a net cost? Pharmaceutical companies need to recover their research and development investment, but what about the impact of better treatments? What about the gains to public health and NICE’s insistence on a coherent business case for new drugs?

But NHS providers have risen to the task.

Many acute hospital finance directors report actual cost improvement programmes of six or seven per cent, and sometimes more, allowing for amendments to the tariff regime and commissioners’ ‘demand management’ initiatives.

Yet where is the reinvestment? Last year’s total savings amounted to £5.1

billion, says the Department of Health, plus an additional £0.7 billion of ‘cost avoidance’. However, one searches in vain for such sums being channelled back into geriatric medicine, or into GP practice budgets.

And the reality is dawning that 2014-15 isn’t the finishing line.

The UK economy remains flat.

Even if economic growth were to return, no credible political party is suggesting material year-on-year growth for tax-funded healthcare.

Conclusion: an annual savings regime of four per cent or more appears likely for the foreseeable future.

3. The private sector’s waiting to muscle in on failing hospitals Meanwhile, as the private sector scans money-making opportunities in the NHS, it’s tempting to see failing hospitals as the prime target. Perhaps a private company might step into the financial morass that is South London Healthcare. Or into Mid Yorkshire, or Epsom and St Helier.

Actually the private sector is wary.

Why take on struggling NHS hospitals?

Such takeovers might please a government intent on hacking back the public sector workforce, and a health secretary encumbered with dozens of NHS hospitals too indebted to become foundation trusts.

Firms see a health sector starved of growth and an oppressive tariff system.

They worry about their reputations. And they watch what’s happening to Circle, which took over Hinchingbrooke Hospital in Cambridgeshire in February.

The deal is that if Circle generates healthcare manager | issue 16 | winter 2012

MONEY MYTHS

surpluses of £70 million over a decade, it keeps 44%. But Hinchingbrooke hasn’t made a million-pound surplus this century. Aggressive costcutting looks inevitable. And staff morale and patient satisfaction are falling.

According to NHS Midlands and East’s measure – would you recommend this hospital to your friends and family? –

by August, Hinchingbrooke had already dropped from sparkling to average.

To lure commercial operators, steadily withdrawing since the high tide of independent sector treatment centres, most NHS hospitals would need sweeteners: subsidies, income guarantees, a fix for PFI, a material undervaluing of the assets. All are possible, but none appears imminent.

For the present, the non-acute sector of the NHS – worth an estimated £15 to £20 billion – is more attractive. And the principal predators aren’t private health providers but multinational outsourcing companies.

Serco and Virgin are prominent. Their business model is simple enough: win the tender, take on the staff, shred the management structure, and cut costs.

It’s privatisation fuelled by the ‘any qualified provider’ regime which, since April, forces NHS commissioners to offer whole services to competition. If there’s one field where the outsourcing companies have special expertise, it’s competitive tendering.

In 2012, Virgin has already won the £650 million contract to run community services in western Surrey, and is pursuing a £140m contract for children’s services in Devon. Serco, meanwhile, captured a £140m contract to run community services in Suffolk.

Why community health services? healthcare manager | issue 16 | winter 2012

Crucially, unlike acute hospitals, there’s no effective tariff system. Measuring what a health visitor or a speech therapist actually does is more complex than counting hospital ‘spells’. Pruning a community team is less visible and less controversial than closing a hospital. The risks are lower, the profit margins higher.

The trend seems set to continue.

Virgin’s success in Surrey followed overt pressure from the local MP to expedite the deal. That MP is Jeremy Hunt, now Secretary of State for Health.

And the Government’s happy. To smooth Virgin’s path into Surrey, it found a device to safeguard the prized NHS pension rights of 2,500 staff.

Rather than working directly for Virgin Health, they have transferred instead to the employment of VH Doctors – a social enterprise.

4. The NHS has taken restructuring in its stride The final myth is that the recent reforms are now essentially complete.

Perhaps some lingering uncertainty surrounds the respective roles of clinical commissioning groups, commissioning support units and the new Commissioning Board’s local structure. Perhaps there will be one or two local wobbles as the new commissioning arrangements take shape. And somehow, once again, financial control has remained intact. By and large, quality and safety have not been compromised. Despite so much potential for chaos, the NHS show is still on the

road.

Hmm. That corporate sigh of relief may prove premature. On patient care, the Francis report on mid-Staffordshire is overdue, and is likely to make uncomfortable reading indeed. And financially, there’s more to success than staying within one’s budget. The scandal at NHS Croydon, for instance – a £20 million ‘black hole’ in the accounts – is prompting hard criticism from local councils, using the scrutiny mechanisms to probe NHS stewardship and accountability.

So perhaps at last the NHS can return to ‘business as usual’? Perhaps a period of stability, with a 2013-14 Operating Framework focusing on the treatment and care of patients?

Emerging themes appear to include dignity in old age, dementia care, reducing infant mortality, and improving outcomes for heart and respiratory illness.

However, Lansley’s Act was never simply about commissioning. The Government’s other main concern – arguably the greater – has consistently been to reduce the scale of direct NHS provision and employment.

It’s been a consistent enough desire, from the early rhetoric of ‘small government’ to talk of foundation trusts becoming the world’s biggest social enterprise sector, and more recently to the NHS itself being repositioned as a ‘brand’.

Whatever its health priorities, the main ministerial field of action over the remaining life of the coalition is likely to be competition and privatisation.

The final myth is that the reforms are now over.

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17

MENTAL HEALTH

Cutting access to mental health services is not only unfair, but self-defeating for managers who need to save costs, says Professor Richard Layard.

Crippling depression and chronic anxiety disorder account for over a third of all morbidity in Britain. But under a third of these people are in treatment. This is deeply shocking and by far the greatest health inequality in Britain.

‘It mainly reflects unfair and shortsighted behaviour by commissioners.

The unfairness is obvious. NICE guidelines say that people with depression and anxiety should be offered modern evidence-based psychological therapy. In huge areas of the country this still does not happen.

There is simply no parity of esteem in commissioning.

The short-sightedness is less obvious, but it is even more striking.

Mental illness adds some £10 billion to the cost of physical healthcare for commissioners. If we take people with the same chronic physical illness of the same severity, people who are also mentally ill get 50% more physical healthcare. They are less good at managing their condition, and their low mood adds to their physical dysfunction. That is why spending on psycho18

logical therapies saves more money on physical healthcare than it costs in psychological therapy.

There is plenty of evidence that this is true. In 26 of 28 randomised trials of cognitive behavioural therapy (CBT) where costs have been studied, the savings on physical healthcare exceeded the cost of the CBT. And where the CBT is specifically targeted at the person’s physical condition, the savings can be even greater.

The implications for commissioners are clear: the expansion of the Improving Access to Psychological Therapies (IAPT) programme has to be one of their top priorities. The programme began from scratch in Autumn 2008. By 2011-12 it was reaching 10% of the 6 million adults with depression and anxiety. NHS commissioners have been given enough money in their baseline budgets to treat 15% of that need in 2014-15. That money must be spent. In a typical area, this means some 40 therapists for every quarter of a million population. Very few PCTs have yet reached that level, yet many PCTs are already marking time or even

using IAPT as a place to find cuts.

This is a false economy. CBT and other evidence-based psychological therapies are among the most costeffective treatments the NHS has to offer. Recovery rates are nearly 50% and costs per quality-adjusted life year gained are well below £10,000. But the effectiveness depends on the therapists being well-trained and supervised.

Recovery rates differ sharply between IAPT services, ranging from 22% to 71%. They only reach the government’s 50% target where there are enough senior staff, and enough sessions are provided to each patient.

Reducing expenditure per patient is a false economy – it will simply lead to patients coming back again and again.

These are conditions which are in many cases curable on a long-term basis, and a good IAPT service can secure those outcomes. We know this because psychological therapy has the most rigorous monitoring of outcomes on a session-by-session basis of any treatment within the NHS. But the training received by the healthcare manager | issue 16 | winter 2012

© Linda Nylind/Guardian News & Media Ltd

MENTAL HEALTH

therapists is crucial. For example, in one South London service less-trained staff were achieving 20% recovery rates for panic disorder, but after training they achieved the standard rate of 80%.

When IAPT began there was an acute shortage of therapists trained in NICE-recommended therapy. So in parallel with service expansion goes a major one-year training programme for each trainee. In its first three years the programme produced an average of 1,200 new therapists a year. The trainees spent two days a week in college and three in the service which employs them – all financed out of the Multi-Professional Education and Training (MPET) budget.

In the first three years of the programme, most of the newly trained staff were kept on as therapists in the same service where they trained. But in 2011-12 trainee numbers are well down and trainees can no longer be confihealthcare manager | issue 16 | winter 2012

dent of being kept on. The pressures are all towards providing cheaper, shorter treatments by less well-qualified people. But that is a formula for lower value-for-money. All the evidence favours well-trained people providing enough sessions to produce permanent change.

Cost-cutting in IAPT would be reasonable if we were starting from a position where psychological therapy was as readily available as most types of physical therapy. But it is not. IAPT started from a zero base and is still less than half the size it needs to be. The Nicholson cuts are not meant to be cuts all round. They are meant to be savings on existing well-established services, to make room for new needs, unmet needs and technological progress. Psychological therapy is a clear case of unmet need, and of technological progress not yet reflected in provision. It is a prime candidate for the expanded funding financed by the

Nicholson cuts.

So here are three things we should expect from local commissioners.

They should continue expanding IAPT to meet 15% of need by 2015, as promised by the government. This would require by then some 40 full-time therapists (or equivalent) per quarter of a million population – with the majority trained in ‘high-intensity’ work. Trainees should normally be retained after this training is complete. Commissioners should also adopt a waiting time target for psychological therapy – ideally 28 days.

Beyond 2015, commissioners should envisage a further round of moneysaving expansion of IAPT to cover people with co-morbid chronic physical illness. Models of how to do this are now being piloted within IAPT. If IAPT was expanded to meet 25% of need, this would cost about £300 million a year, but save about £500 million a year in reduced costs of physical healthcare.

There should be no cuts in children and adolescent mental health services.

This is the most short-sighted of all developments. Even if local authorities ‘ought’ to be doing their bit, it is in the interest of the NHS to make sure that children’s problems are treated as early as possible.

The final need is for much better mental health training for GPs. They are vital partners in this drive and every GP should do a rotation in common mental illness during training.

The Health and Social Care Bill promised parity of esteem for mental and physical healthcare. At present we are far from that. But one shift in commissioners’ priorities would make all the difference: back IAPT! Nature, the world’s top science journal, recently called IAPT ‘world-beating’. But it requires the backing of every manager in the NHS.

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Prof Lord Layard is Director of the Wellbeing Programme at the LSE Centre for Economic Performance, National Adviser to the IAPT programme and co-author of the report How Mental Illness Loses Out in the NHS. 19

LEGAL MATTERS

legaleye Iain Birrell describes the government’s latest assault on employment rights.

If there was ever a case of a government trying to use one piece of legislation to sweep away huge chunks of employment rights law it doesn’t like, it’s the coalition’s Enterprise and Regulatory Reform Bill (ERRB).

The bill was significantly amended during the Commons report stage.

This included repealing sections of the Equality Act, repackaging the controversial protected conversations proposed by Conservative Party donor Adrian Beecroft as ‘pre-termination negotiations’, some apparently small but significant changes to tribunal powers, and the removal of strict liability for breach of health and safety duties.

George Osborne’s widely-derided plan for workers to trade their employment rights for shares is being added to another bill after an unseemingly short consultation. A recent YouGov poll showed just 20% of the public supports the idea.

In a move that brings into question the whole basis of government consultation with interested parties, the government didn’t consult at all on removing strict liability in health and safety – a move that takes us back to 1898 in terms of the regulations. And its response to the consultation on repealing the Equality Act provisions shows the contempt in which it holds the consultation process: ‘Of [the 157 responses], 12% were in favour of repealing the wider recommendations provisions and 79% were 20

opposed,’ the Government Equalities Office said. ‘15% were in favour of repealing the obtaining information provisions and 83% were opposed. All business representative organisations supported repeal.’

For the repeal of the third party harassment provisions, 80 responses were received, 20% agreed with repeal and 71% opposed it.

The government’s conclusion?

‘Taken as a whole, this response has not persuaded the Government that there is a need to re-think the proposals on which it consulted.’

The third party harassment provisions are intended to protect employees under the Act from harassment by customers, service users and contractors, but only as a last resort when employers ignore their responsibility to those employees.

The government’s justification for repeal is that the provisions are rarely used. The fact that you don’t have to use your biggest stick isn’t a reason to chuck it away. Remove it and you leave employees vulnerable to harassment and embolden rogue employers to ignore their complaints.

So who were the respondees the government is choosing to ignore?

‘Responses which agreed to the proposed repeals came mostly from private and not-for profit sector employers and business representative organisations. Responses which disagreed with our proposals were mainly on behalf of unions, equality lobby groups, staff associations, the judiciary and members of the public.’

So the views of the public and judges are as worthless as those of trade unions and equality groups.

Repealing the wider recommendations provisions of the Equality Act – which, for example gives an employment tribunal power to order equal opportunities training for a recalcitrant employer – benefits no one.

Again, this power may not be widely used, but if it is a useful tool for tackling discrimination in the workplace and if (as in our experience) employers might benefit if it were used more often – why make it unavailable? It’s got to be good not just for employers, but for wider society.

Clearly employers didn’t think the power was a problem. Even the 12% who supported repeal offered no evidence for why they opposed it.

The one bright spot is the introduction of a discretionary power to require an equal pay audit where an employer loses an equal pay claim. But it’s unlikely to have much impact. In 2011-12 only 32 equal pay cases were successful, down from 280 the year before.

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Iain Birrell 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 16 | winter 2012

TIPSTER

Making a personal impact Since 2010, Central Connects, part of the Central School of Speech and Drama at London University has delivered the very successful Personal Impact: Stand and Deliver masterclasses for MiP members using actor training techniques to improve presentation skills. Lizzie Yirrell gives some top tips from the programme.

 Motivation You may have heard actors ask, ‘What is my motivation?’ Actors will often have a clear motivation, objective or goal, that drives all their action and words, and motivates them throughout the play.

This also helps actors to focus on their characters, on those around them and the immediacy of the circumstances (rather than on themselves). An objective liberates actors from negative thoughts such as ‘the audience hate me, no one laughed!’ so they can focus on the effect they want to have on the other characters. What is your motivation? What is the objective of your presentation?

2 Practice By being prepared, you will feel more confident and communicate more effectively. How often do you write your presentation but don’t practice it? Practice must be done on your feet and using your voice. Why not rehearse in front of a mirror so you can observe your own habits? Practicing a presentation in your head on the way to work won’t help you to speak in public.

3 Breathe Deep, diaphragmatic breathing helps to manage stress and supports your speech. If you get flustered, nervous or loose your chain of thought, use some deep breathing to relax you back into your flow.

4 Grounding & Presence Good speakers do not need to move around. Make sure you feel comfortable standing still. If you feel the need to move, make sure it’s for a reason. Unnecessary movement can be distracting.

5 Clarity Use articulation exercises to make sure you are clear with your words. The more you commit to your consonants, the more enthusiastic you will seem

healthcare manager | issue 16 | winter 2012

about your message.

Make sure you speak at a suitable pace so the audience can follow your speech.

Take time to breathe between thoughts and changes of subject to prevent you from speeding up.

6 Eye Contact Remember to establish eye contact with members of the audience at key points in your speech. Try to make sure you look at everyone during the presentation so the whole audience feels included and engaged.

7 Gesture Gestures that show how strongly you feel about topics in your speech will help to engage the audience, but too much gesturing can be distracting. A very simple technique is to release one hand at a time to underline key words and messages. Then place your hands back together.

8 Rhythm and Pause Pick out key words or phrases that you want to emphasise and practice delivering these sections. Divide the content into separate sections and make sure you pause between them. This will signal to the audience that they should listen carefully for the next ‘thought’ and give you variety of rhythm.

9 Range Make sure your presentation is not all at the same pitch, otherwise it will sound monotonous. In conversation, we tend

to use a variety of pitch, pace and volume. Consciously trying to include this vocal variety in your presentation will make it more interesting for the listeners and develop impact.

 Volume & Projection Try to practice your presentation in the space you will be using (or a similar sized room) to make sure you have the right volume. Remember to speak loud enough so that people at the back can hear you clearly.

For further information email ccadmin@ cssd.ac.uk telephone 020 7559 3960 or visit www.cssd.ac.uk Lizzie Yirrell, Business & Enterprise Manager, Central Connects.

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MiP AT WORK

NATIONAL

MiP backs Tutu Foundation work for equality in the NHS To celebrate Black History Month in October, MiP supported a number events with the Tutu Foundation, the community-building charity inspired by the work of South African peace campaigner Archbishop Desmond Tutu.

On 22 October, Archbishop Tutu himself attended a ‘Conversations for Change’ workshop hosted by Ashford and St. Peter’s Hospitals NHS Trust and the Tutu Foundation UK, as part of a joint initiative to promote equality in the trust’s work.

MiP chief executive Jon Restell and vice chair Zoeta Manning also attended the event. Jon gave a short speech comparing the Archbishop to a cake and explained why monitoring, leadership, networks and mentorship make the difference for MiP’s BME members. The day closed with

REGIONS: SUFFOLK

An engaging recipe for success in Suffolk Good news from NHS Suffolk, where all but one of the current workforce have secured jobs in the two new CCGs – with the only redundancy so far made by mutual agreement.

MiP national officer George Shepherd says much of this success is down to

22

MiP chief executive Jon Restell and vice chair Zoeta Manning with Desmond Tutu.

Amanda Lyes (pictured), Director of HR and OD. ‘She’s done a fantastic job in achieving real staff engagement at a difficult time. It’s a shining example of what can be achieved through effective partnership working.’

When MiP member Amanda joined the PCT in March, staff morale was at an all-time low. ‘There was no staff engagement and no consultation with the trade unions,’ she says. ‘We now have a vibrant staff side committee and good relations with the trade union full-time officers and local representatives. We are now working in partnership to refresh our HR policies ready for the establishment of the new organisations in April.’

Amanda says ‘buy-in’ from top management is essential for engaging staff in

this way. ‘We had a new chief executive in post. He is very supportive and flies the flag for engagement with staff and their unions.

‘Then you need good communications – you have to be open and transparent with staff about what is happening. Staff need to know they are being listened to and they have a say in the organisation’s development. Finally, you need to build mutual trust between management, staff and trade unions. You need to make sure things are done honestly and fairly, and that there are no hidden surprises.’

As East Suffolk CCG’s chief corporate services officer, Amanda is extending this approach into the new organisation and is working closely with Ed Garrett, chief

healthcare manager | issue 16 | winter 2012

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MiP AT WORK

an inspirational keynote speech from the Archbishop on health inequalities, discrimination and reconciliation.

‘Archbishop Tutu is a beautiful, funny and inspiring man,’ said Zoeta. ‘His intelligent, emotional exposition of his philosophy of intrinsic human worth and our interconnectedness appeals both to those of faith and those with none.’

On 23 October, MiP explained the union’s approach to partnership working at a lunch with the board of Ashford and St. Peter’s Hospitals and members of the Tutu Foundation UK. That evening a Concert 4 Change, including conversations, dance and music was held at the Fairfield Concert Halls in Croydon, Surrey, as part of a historic national conversation for change with Archbishop Tutu and his daughter, Reverend Mpho Tutu.

On 24 October, MiP supported an event at West London Mental Health NHS Trust, where Mpho Tutu spoke on the vision of the Tutu Foundation: to live in a world in which the lives of individuals and communities in, or at risk of, conflict are transformed through ubuntu – an ancient African philosophy emphasising our common humanity. Zoeta Manning spoke on behalf of MiP, highlighting the importance of diverse leadership, particularly in improving health outcomes.

‘It was a full three days, but very enjoyable and worthwhile in raising the profile of equality,’ added Zoeta

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operating officer for West Suffolk CCG, a fellow staff engagement enthusiast.

They already have a partnership agreement and the staff side committee will transfer.

‘There’s a definite feeling that the workforce are motivated and up to the challenge of setting up the new structure.

It’s an exciting place to be,’ says Amanda.

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healthcare manager | issue 16 | winter 2012

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

23

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

backlash

by Celticus

Careful what you wish for

J

eremy Hunt ruffled feathers with claims about the ‘normalisation of cruelty’ in ‘some parts of the health and social care system’ (or ‘the NHS’ as the Mail and the Telegraph put it). Hunt didn’t say that two of the examples of appalling care he cited in his King’s Fund speech – at Winterbourne View and Ash Court care homes – have nothing to do with the NHS at all (Castlebeck Care and Forest Healthcare Ltd, since you ask). These are the ‘any qualified providers’ Mr Hunt wants to see a lot more of. No mention either of Woking Community Hospital, recently castigated by the CQC for leaving its patients ‘in a soiled condition’. Virgin Care won the contract to run Woking after lobbying from, among others, a local Surrey MP named Jeremy Hunt.

Credit worthy?

S

ome naughtiness with numbers during a Commons row between Jeremy Hunt and his Labour shadow Andy Burnham over nurse numbers in the NHS. Hunt admitted there were 7,000 fewer nurses than in 2010, but claimed the nurseto-bed-ratio has improved – which is just a polite way of saying he’s cutting beds even faster than nurses. The SoS also tried to claim credit for 7,000 extra doctors and

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1,000 more midwives. But as it takes upwards of five years to train a doctor and three for a midwife, the credit for that belongs more to Mr Burnham than to Mr Hunt.

Public health sub-committee, Prime Minister!

Skeletons in the cupboard

V

ery much a case of poacher-turnedgamekeeper with the new head of the CQC, David Prior, chair of Norwich and Norfolk NHS Trust. Prior’s trust has been inspected by the CQC no less than five times since March 2011 – so he should be at least on nodding terms with some of his new team. Last year, the hospital hit the headlines for renaming 27 store cupboards as ‘treatment rooms’ and using them to house patients.

Prior worked for the nowdefunct merchant bank Lehman Brothers before becoming a Tory MP in 1997 and (briefly) Tory Party Chairman. Ironically, his political career ended in 2001 when he lost his North Norfolk seat to Lib Dem Norman Lamb – now one of his political bosses at the Department of Health.

Whitehall washout

A

ndrew Lansley may have failed to turn his Whitehall fiefdom into a Department of Public Health, but he did secure a cabinet sub-committee, which should have catapulted

public health to the top of the political agenda alongside banking reform and national security. And he even managed to ring-fence the £2.2 billion public health budget for local councils.

Alas, the new SoS doesn’t share Lansley’s enthusiasm.

The cabinet sub-commitee has been replaced by a ‘group of officials’ because, Celticus understands, other ministers were reluctant to turn up and very few meetings were actually held. As for the ring-fenced money, health minister Anna Soubry recently told the Commons that ‘decisions on whether to maintain or remove the ringfence... will be taken in due course.’ Doesn’t sound too hopeful.

All ears

E

ver wondered who the Government were listening to during

last year’s ‘pause and listen’ exercise on the Health bill?

It seems it might have been David Worskett, head of the NHS Partners Network, the lobbying group for private healthcare firms – at least according to Mr Worskett himself. In an embarrassing leaked memo, Worskett boasted to his clients about his access during the pause.

‘I did brief the new No 10 health policy adviser very fully, and indeed “cleared” our materials with him. I have had several other “stock take” phone conversations with him.’ Worksett goes on to explain his influence over Sir Stephen Bubb’s independent review of competition in the NHS. ‘We agreed on the approach he would take, what the key issues are, and how to handle the politics.

He has not deviated from this for a moment throughout the period.’

healthcare manager | issue 16 | winter 2012

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