issue 25 spring 2015
healthcare manager
UMESH PRABHU
HAPPY STAFF HAPPY PATIENTS plus SAFE IN WHOSE HANDS? The NHS and the general election A SOCIAL MOVEMENT Lis Paice on integrating health and social care
helping you make healthcare happen
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Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus. More often than not, these benefits will be on an exclusive basis with leading companies. But it isn’t only excellent terms and value for money we look for in a potential Partner. The products or services they offer have to be among the ‘best in class’. They must share our values and deliver a high quality service, including straightforward call-handling and easy-to-navigate websites. On the UNISON website you’ll find full details of all the criteria we look for, before we award companies with our official Partner accreditation. All you have to look for when you are looking for a name you can trust is the UNISONplus logo. For more information visit www.unison.org.uk and click on the UNISONplus logo or call MiPLink tel 0845 601 1144. You could save the cost of your subscription many times over and guarantee yourself the value for money that you and your family deserve.
issue 25 spring 2015
healthcare manager inside heads up:2 Leading edge: Jon Restell inperson: Geoff Underwood, North Bristol NHS Trust inpublic: City Care Centre, Peterborough
comment:9 Christina McAnea: Harsh treatment of NHS managers is storing up trouble for the future.
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.
Integrated care: Lis Paice on joining up services in north-west London Interview: Dr Umesh Prabhu, Wrightington, Wigan and Leigh Foundation Trust. Election 2015: Where next for the NHS? Race equality: New standards to improve diversity at the top
regulars:20 Legal Eye: The perils of informal meetings Tipster: How to navigate social media safely MiP at Work: Sandie Belcher on speaking up for managers in south-west London
backlash:24
Welcome to the spring issue of healthcare manager, the magazine from MiP, the trade union for health and care managers. Our campaign for Respect for NHS Managers is striking a chord with managers, clinicians and all the healthcare team and we will keep it up during the general election campaign and beyond. In this issue we hear from Dr Umesh Prabhu, medical director at awardwinning Wrightington, Wigan and Leigh FT. He is a tireless campaigner for patient safety and effective staff engagement and explains why managers and clinicians must work together to achieve this. We talk to MiP member Geoff Underwood about his role working with clinicians to improve services for patients in Bristol and Lis Paice describes why managers need to fully involve patients in service design to achieve effective integration. Rachael Ogden from EW Group outlines what managers will need to do to meet the requirements of the new NHS Workforce Race Equality Standard. As the general election approaches our associate editor Craig Ryan gives his views on what’s in store for the NHS and managers. I hope you enjoy this issue. Do let us have your views on these and other topics. Marisa Howes, Executive editor
healthcare manager | issue 25 | spring 2015
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HEADS UP
heads up what you might have missed and what to look out for
Putting theory into practice: How to empower patients through high-quality health information and support
Scotland
Staff shortages hit NHS advice line
Wednesday 1 July 2015, The Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PE
MiP is delighted to support the Patient Information Forum’s tenth annual conference for people working in patient and health information. The need for top-quality consumer health information has never been higher, and managers must find practical solutions to make information more
To register or for more information, visit: pifonline.org.uk/2015-conference
healthcare manager
Associate Editor
issue 25 | spring 2015
Craig Ryan craig@lexographic.co.uk
ISSN 1759-9784 published by MiP
Design and Production
All copy © 2015 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
Executive Editor
Marisa Howes m.howes@miphealth.org.uk
2
usable, accessible and patient-led. This conference will help you discover practical ways to help patients feel informed and engaged in their healthcare, with opportunities to be inspired, discover good practice and find solutions on topics such as behaviour change, measuring the impact of information, targeting your audience, health literacy, producing health information on a budget and much more.
Scotland’s telehealth advice line, NHS 24, is struggling to cope with demand from patients due to staff shortages, one of its own directors has admitted. According to board minutes, NHS 24 medical director Prof George Crooks (pictured above) told fellow directors that patient care standards
Lexographic www.lexographic.co.uk
Contributors
Iain Birrell, Marisa Howes, Helen Mooney, Alison Moore, Christina McAnea, Lis Paice, Rachael Ogden, Jon Restell, Craig Ryan, Corrado Valle.
healthcare manager | issue 25 | spring 2015
were being hit by a shortage of clinical staff. “The service and staff were at times under pressure which was not sustainable in the longer term,” he said. Crooks also warned that “staff rapport with patients may at times suffer due to time restraints”. The board papers revealed that NHS 24
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– Scotland’s equivalent to the 111 service in England – has 33 unfilled clinical posts – around 10% of the total. At the same time the volume of calls has risen by 20% since NHS 24 switched to using the 111 telephone number in April 2014. In a statement, Crooks urged patients not to be deterred from calling NHS 24. “We can absolutely assure the safety and effectiveness of NHS 24 services to the patients who call us,” he said. “NHS 24 staff perform a high quality role in delivering support to thousands of patients every day.”
healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.
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.
HEADS UP
leadingedge Jon Restell, chief executive, MiP
I
love the NHS. I love what it does. I love what it stands for in society and the world. I love its staff. I love the public who support it and the politicians who fund it. Most of all I love the managers who work as hard as anyone else to keep the show on the road. People who protect patients, nurture the staff and make resources stretch as far as they can. People who believe the NHS exists to provide universal and comprehensive health care, free at the point of need. People who know the parts of the system, how they fit together and how and when to shift things. An NHS without expert, specialist, public service managers would not be the NHS, and I fear for my family and friends in a system without those people working in it. This is why I am worried about recent failures to value the important role of NHS managers. I know these failures to value you are hurtful, and I know you know
“Reaction to the ridiculous infographic from the DH, crowing about the numbers of managers who have been made unemployed, was heartening. It should encourage us to fight back.” your own worth and the importance of your job. Your rejection of the pay offer in England, with 92% against it on MiP’s highest ever turnout for a member consultation, shows your strength of feeling. It’s not that you didn’t want other staff to get a rise and their increments, and it’s not that you didn’t want the lowest paid to get proportionately more, but that you did want something that acknowledged your worth. Then there have been episodes like the ridiculous infographic from the Department of Health, crowing about the numbers of
managers who have been made unemployed during unnecessary changes – changes already sliding into the bin after less than two years. It drew howls of protest from people from all walks of life. This reaction was heartening. It should encourage us to fight back. Join me and your colleagues to start that fight back. Tell people the story of what you do and why it is important – and ask your friends and family to do the same. Paint pictures for them. Deal with misinformed views, scapegoating and stereotyping wherever and whenever you find them. Help us to challenge politicians and the media in the general election campaign. Tell us when you see manager-bashing, so we can push back, and do so yourself whenever you can. Use our briefings and hit social media. Keep the pressure on your employer about pay. The people need the NHS, the NHS needs you, its managers, and you need respect. Let’s get to work.
Equality
UK slips down gender equality league To mark International Women’s Day on 8 March, the TUC has published a report on how the recession and austerity policies have affected women in the UK. The report, The Impact on Women of Recession and Austerity looks at how women have fared over the last seven years. It finds that while progress on
some headline measures of gender equality has continued – the employment and gender pay gap have continued to narrow, for example – some women are facing new hardships and barriers to equality, and the UK has dropped to 26th place in the World Economic Forum’s gender gap index, down from 13th in 2008. The report shows how cuts in benefits
and public services have a particular impact on women, both as users of services and as employees. It shines a light on how women have been affected by changes in the labour market and the cuts in public spending in the past seven years, and is available from the TUC website at: bit.ly/hcm2512.
healthcare manager | issue 25 | spring 2015
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HEADS UP
NHS staff survey
Staff wellbeing
The fruits of labour
As part of their commitment to supporting staff health and wellbeing, NHS Ipswich and East Suffolk and NHS West Suffolk clinical commissioning groups began a monthly fruit drop last month. A supply of fruit is delivered and distrib-
uted to the offices in Bramford and Bury St Edmunds, with the aim of encouraging staff to eat more fruit and to swap fruit-based recipes to further raise awareness of how good fruit is. The first drop was
Wales
NHS staff give warning over pay
extremely well received by staff, who enjoyed the delicious taste of fresh fruits and are eagerly awaiting the next drop! The initiative is sponsored – currently by social enterprise SoActive – so there is no cost to either CCG.
MiP has welcomed the publication of the 2014 NHS staff survey in England as an invaluable barometer of staff experience. “The report shows that despite the pressures building on everyone in the NHS, the level of support given to staff by line managers has improved,” said MiP chief executive Jon Restell. “This is good news and we need to build on it by providing high quality training to support managers.” The survey also shows a big drop in satisfaction with pay and a fall in the number who would recommend their organisation as a place to work. “This is a warning the government should heed,” said Restell. “Staff are working under enormous pressure to provide quality services to patients and this must be recognised in fair pay independent review of workforce needs awards that compensate all staff for cost for the future. of living increases. Trusts are already exSpeaking about the workforce review, periencing staff shortages and having to MiP national officer Andy Hardy said: employ costly agency staff. This can only “MiP will ensure that managers’ voices get worse if the government continues to are heard in this review. We will emsqueeze NHS pay.” phasise the need for managers to be While the survey found that 98% of staff supported through any change process know how to report concerns about unsafe with effective training and adequate clinical practice, only 57% were confident resources.” their organisation would address their The conference will take place on 9 July concern. Two thirds are satisfied with the at Cardiff City Hall, and will be opened by support they receive from their immediFirst Minister Carwen Jones. It will involve ate manager, up from 65% in 2013, but speakers from the prudent healthcare satisfaction with pay levels fell from 38% movement worldwide, as well as health in 2013 to 33% in 2014. The proportion of boards, NHS trusts, Royal Colleges and staff who would recommend their organithe National Institute for Health and Care sation as a place to work has fallen from Excellence. 58% to 56%.
Putting prudent healthcare into practice in 2015 Wales is to hold its first prudent healthcare conference as part of the Welsh Government’s drive to redesign health services according to prudent principles. The prudent health programme was unveiled twelve months ago at the Welsh NHS Confederation and involves remodelling NHS services around four principles drawn up by the Bevan Commission, chaired by Sir Mansel Aylward, on the future of the NHS in Wales: partnership between patients and healthcare professionals, priority according to need, “do only what’s needed”, and using evidence-based best practice. Health and social services minister Mark Drakeford has announced plans to remodel the NHS workforce in Wales as part of the initiative, including the launch of a primary care workforce strategy and an
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healthcare manager | issue 25 | spring 2015
Further information is available on the Making Prudent Healthcare Happen online resource: prudenthealthcare. org.uk.
The report is available on the NHS England website at bit.ly/hcm2510.
HEADS UP
inperson
“We help clinical staff to make lots of small changes which add up to having a massive effect on the whole organisation.”
Geoff Underwood, deputy head of the programme management office, Southmead Hospital, North Bristol NHS Trust.
Geoff Underwood joined North Bristol NHS Trust four years ago to work with the trust’s clinical staff in developing and planning new ways of working at the hospital. He now heads up what he calls the trust’s change management team, which helps the trust to get long-term projects off the ground. “Over the next two or three years it’s important that the trust improves its quality, productivity and efficiency for patients and implements new ways of working that will also save money,” he explains. “If you’ve got really efficient patient flow systems, for example, then patients are not waiting unncessarily for days and days to leave the hospital.” Geoff says that his and his team’s job is to analyse and improve on current ways of working and create the “headspace” clinicians need to do the same – with the end goal of improving services for patients. “We do a range of things to get clinical staff to engage in forward planning. We work in different departments, organise events for staff to attend, sort out problems and issues around excess paperwork, and generally help clinical staff to make lots of small changes to the way they work, which in turn add up to having a massive effect on the whole organisation.” Without his team, Geoff says clinical staff would not have enough time and resources to focus on long-term planning and examine better ways of working, because they would have to concentrate on trying to meet weekly and monthly targets. Geoff is also responsible for bringing in extra support from outside
agencies when needed. “We’ve got a company in at the moment to look at our coding and how we can make it more efficient. We try and connect all the dots and spot where problems lie,” he says. Currently, the team are examining ways to streamline appointment systems so patients coming in for a scan can have their other follow-up appointments scheduled at the same time, so they only have to visit the hospital once. “One of my team is reviewing this, looking at processes and thinking about how we can make it better for patients by reducing waiting lists, but also balancing this efficiency with safety,” says Geoff. He says having a dedicated team to examine and plan new ways of working, means clinical staff can concentrate on treating patients. “We work with all our doctors, nurses, clinical teams and managers to help them deliver the long term developments and projects that the trust needs, we help them to do the long term planning and do the team work for them, the things they would not ordinarily have time to do. “Ultimately the programme management office was set up to overcome the obstacles to achieving change and making things better for patients. We do a lot of organising for
busy clinical staff by providing the expertise for them so they can make informed decisions about what happens and how it happens in their departments. “I am here because I am passionate about the NHS and want to show that it can work as efficiently and effectively as possible for patients,” Geoff adds. Helen Mooney
healthcare manager | issue 25 | spring 2015
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HEADS UP
Regulation
False data could land managers in the dock NHS managers who provide false or misleading information to regulators or the public will face criminal charges under new regulations to be introduced by the government before the general election. From April, it will be a criminal offence for providers of NHS funded care “to publish or submit to regulators false or misleading information” on issues such as mortality rates, waiting list targets, complaints data and nationally audited services such as diabetes and maternity. Senior managers and directors may also be personally prosecuted if they are suspected of having “consented or connived in the provision of false or misleading information”, and could face unlimited fines or a maximum of two years in prison. The government accepted the recommendation by the Mid-Staffs inquiry that a new criminal offence was required, after Sir Robert Francis found that false and misleading information had been published and given to the CQC about the performance of Stafford Hospital. From April, trusts will also face fines of £10,000 for each clinical negligence claim in which hospitals are found not to have been open and honest about clinical failings. This move follows the introduction of the “duty of candour” introduced in November, under which trusts can be fined £2,500 each time they fail to deal with complaints properly. The Department of Health’s guidance is available online at: bit.ly/hcm2509.
Overseas visitors
Government claims new visitor rules will save £500m
The Department of Health has announced new restrictions on free healthcare for visitors to the UK, which it says will save the NHS £500m a year by 2018. Under new rules taking effect in April, people living in another European Economic Area (EEA) country will have to pay for care if they cannot produce a European Health Insurance Card and don’t have private health insurance. Some EEA countries do not issue cards to people who are not working and don’t pay social insurance contributions.
MiP’s 10th anniversary conference 18 November 2015, London
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healthcare manager | issue 25 | spring 2015
People living outside the EEA must have private health insurance or pay 150% of the national NHS tariff for any care they receive. The department said the new restrictions will apply to pensioners and other former UK residents who are now living abroad, but there are a number of exemptions, including members of armed forces, UK government employees and people who are returning permanently to the UK. GP and A&E services will remain free to visitors to the UK, the department added. Put the date in your diary and join us at our tenth anniversary conference. It should be an interesting event, not only because we’ll be celebrating our anniversary, but also because it takes place just a few months after the election. Whichever party or parties form the next government, the future of the NHS will be high on their agenda. We’ll invite them to come and talk about their plans, along with other key players. Register your interest by email to info@mip-conference.org.uk
inpublic
HEADS UP
“It’s brilliant because the person gets someone in to help them immediately, and we can crack on working with other co-located services.”
City Care Centre, Peterborough Six years ago Peterborough gained a valuable addition to its NHS services in the form of the City Care Centre, developed by the local PCT. The £25m PFI-funded centre, situated in the heart of the city, brings together a number of NHS services outside the traditional hospital setting with the aim of providing a onestop shop for many of Peterborough residents’ health and social care needs. It is part of the £335m Greater Peterborough Health Investment Project (GPHIP), which has seen the construction of three major new healthcare facilities in the city. The PCT’s idea, now inherited by Cambridgeshire and Peterborough CCG, was to provide its local population with easier and quicker access to services and stop the need for numerous visits to different NHS buildings. The City Care Centre hosts an intermediate care unit and a musculoskeletal assessment and treatment service run by Cambridgeshire Community Services (CCS) NHS trust, and a minor injuries and illness unit run by Lincolnshire Community Health Services NHS trust. The centre also houses the out-of-hours medical service for Peterborough, commissioned by the CCG, the NHS 111 phone service, and a raft of other out-patient services including dermatology, rheumatology, neurology, audiology, pain management and child development. The intermediate care unit reflects the CCG’s decision to give higher priority to its older people’s programme and to end of life care. The unit cares for people who are well enough to leave or avoid hospital, but who need extra help before they can return home. It is staffed by a team of nurses, physiotherapists, therapy
support workers, social care workers and healthcare assistants. The centre includes 34 en-suite bedrooms, which meet the latest national standards, and four rooms with specialist equipment, such as hoists, and rehabilitation facilities, including a gym and a therapy garden. Christine Cooper, operational lead for the CCS trust in Peterborough, who is based in the unit, explains that it mainly functions as a “step down” facility for the local Peterborough and Stamford NHS Foundation Trust. “We provide services for people with complex needs who are not well enough to be at home but don’t need to be in hospital. We also work to stop people in crisis needing to go into hospital,” she says. “The great thing about being located in the City Care Centre is that we have access to, and are colocated with, other specialists like occupational therapists from the community rehabilitation team. In the main, we’re working with people who are very frail and elderly. The community district nursing team and the call-centre triage team are also located in the building, so we can make quick contact with them when we need to,” she adds. Cooper says the Centre is a “huge resource with lots of expertise” housed in the same location, including the local council’s social services intermediate care team. “It’s brilliant for the person at the centre of the services because they get someone in to help them immediately, and because we are working in a hub we can crack on straight away working with other co-located services.” The charity Hospital at Home, which employs specially-trained staff to work with people who need
rehabilitation or end-of-life care is also based on the same site. Before the City Care Centre opened, Cooper says that all the resources and services on offer were scattered about Peterborough and all tended to work separately. “Of course, we had formal meetings but the OTs, physiotherapists and nurses didn’t necessarily know each other. It’s just a positive environment to work in,” she says. Helen Mooney
healthcare manager | issue 25 | spring 2015
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HEADS UP
Leadership
Celebrating great NHS mentors
letters to the editor
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.
The final straw
George Shepherd, MiP national officer (left) with Chris Birbeck.
MiP was pleased once again to sponsor the NHS Leadership regional awards for mentor/coach of the year to celebrate the great work being done in the NHS. The award in the East of England went to Chris Birbeck, head of quality improvement at Health Education England in the region. “Chris has extensive experience and is now applying this experience in teaching others to coach and mentor,” said the judges. “He has a strong sense of reflective practice and powerful outcomes have been delivered for his coachees.” After presenting the award, MiP national officer George Shepherd said: “I was delighted to present the award to Chris, a worthy winner. The NHS can be proud of its tradition of mentoring its staff and it can be proud of Chris and the other finalists in the East of England.” Chris and the other winners were automatically put forward for the national awards which will be announced at a ceremony at the end of March.
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healthcare manager | issue 25 | spring 2015
Anger doesn’t come close to describing my reaction to the government’s pay offer for staff on Agenda for Change in England. Speaking as a 36year veteran of Family Health Services and Primary Care Support, this really is the last straw. The government has messed the service about for nearly two years. Firstly, by “lifting and shifting” us reluctantly into NHS England because they did not know what else to do. Only then to immediately label us with an “affected by change” tag. This was more burden than boon, as it created much uncertainty and anxiety but was insufficient to allow us to access jobs in the same manner as PCT/SHA colleagues labelled “at risk”. While we were in limbo, NHS England wasted vast amounts of time and resources asking the service to look at an “at scale” provider option, only to accept an unsolicited proposal from the commercial sector. Only then to get caught out by their poor judgement and their own lawyers, who advised it would be more prudent if the service were to go out to national procurement. Suffice to say, during all this time, PCT/SHA and Area Team staff were able to access the full range of “at risk” benefits: one month’s pay
for each year of service up to a maximum 24 months and, if aged over 50, allowed to draw their pension unabated. After dragging PCS staff left, right and centre for nearly two years, NHS England now wish to move the goal posts… off the darn pitch! This surely cannot be morally or legally upheld. I have paid my UNISON/MiP subs for longer than I care to remember. I don’t believe I have ever called upon your support. Well I am now. I hope MiP come out all guns blazing. I find it impossible to believe that, through absolutely no fault of our own, PCS Agenda for Change officers are being so unfairly and unjustly treated. There must surely be an acceptable middle ground whereby an appropriate solution can be reached. Pay rises arbitrarily cut at random spine points; non-consolidated pay rises; increased pension contributions with nil return; reduced redundancy payments – these will all largely impact on those left behind by the recent change programmes due to no fault of their own. Needless to say, this member rejects this insult of an offer. In fact, I would welcome, on behalf of MiP members in PCS, an individually-focused opinion on the legality of this position and any challenges that can be made against it.
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COMMENT
comment Christina McAnea
Head of health, UNISON
A lazy and cynical attack on managers By ignoring the recommendations of the NHS Pay Review Body for England last year, the government forced health workers to take strike action over pay for the first time in 34 years.
No member of NHS staff ever takes strike action lightly, but for many staff, they had simply had enough. Healthcare assistants, porters, catering staff, as well as managers, all know that NHS staff care about patients, they care about the service that they provide and they care about the NHS as a whole. It was only following the threat of further strike action this January that the government was forced to come to the negotiating table and finally produced a pay offer. The offer falls short of what NHS staff deserve; most starkly it fails to reward managers, who are most often the first in the political firing line. The offer though does go some way to addressing some of UNISON’s key concerns about low pay in the NHS, and over 250,000 of those on the lowest pay bands in the NHS will receive an improved pay rise. The government’s revised pay offer was a cynical move, holding out the prospect of lifting the lower paid up but only at the expense of those on the higher pay bands in Agenda for Change. Our members were faced with a very difficult decision, but they have now voted to accept the pay offer as
“Penalising those at the top of the pay scale is not a sustainable pay solution and will make it even more difficult for the NHS to attract high quality managers.” the best we can achieve without taking further industrial action. This revised offer was forced upon us by a government pursuing a political agenda to squeeze public sector salaries. This blatant attack on managers’ pay was not negotiated by the trade unions and it is not something that UNISON agrees with. We know that MiP members, understandably, rejected the pay offer. Penalising those at the top of the pay scale is not a sustainable pay solution and cannot be allowed to continue. It will only lead to managers feeling undervalued and unrewarded and make it even more difficult for the NHS to attract and retain high quality staff willing to take on management responsibilities and all that that entails in such a high profile sector. It is not right that only non-medical senior staff have to bear the brunt of these cuts. UNISON values the role good
managers and senior leaders play in the provision of quality clinical care and this needs to be recognised by the government if we want to avoid a mass exodus of managers from the NHS. We want to play our part in highlighting the amazing job so many senior staff do in the NHS. Too often NHS managers are an easy scapegoat for any problems in the NHS, when we know the underlying difficulty has been the systematic underfunding of the NHS over the past five years. It’s an easy and lazy political complaint that the NHS is over-managed when, compared to many sectors, you could argue if anything the NHS is under-managed. The government’s harsh treatment of NHS managers is not only unfair, it is storing up problems for the future as it will become more and more difficult to recruit and retain good managers. UNISON is proud of its partnership and ongoing work with Managers in Partnership and this will continue through this difficult time and in the future. Although UNISON members have voted to accept the offer, UNISON’s campaign for fair pay for all NHS staff continues. We need a sustainable pay system that fairly rewards all members of the healthcare team and this will be a central plank of our ongoing campaign.
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Views expressed are those of the author and not necessarily those of healthcare manager or MiP. healthcare manager | issue 25 | spring 2015
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INTEGRATED CARE
Integrated care is a social movement not just another reorganisation. And the benefits can be surprising even for seasoned healthcare professionals, says Lis Paice.
All the main political parties accept that integrated care is the only way to bring about the improvements we want in patient care within the limited financial resources available. The concept – co-ordinating care around the needs of the patient – is appealingly simple. But designing and implementing a system to deliver integrated care is neither simple nor free of risk. In North-West London we have been on this journey over the last four years and learned many lessons that may help others who will be implementing integrated care programmes in the years to come. North-West London covers eight boroughs and two million people. After health, social care, third sector and patient organisations decided to work together, North-West London was selected as one of 14 national integration pioneers. Rising healthcare demand, changing patient expectations and limited resources have led to ambitious plans to move care out of hospitals and create a high-quality and sustainable health economy. “Whole systems integrated care” is a vital element of a wider programme that includes reconfiguring hospital services, transforming primary care services and enhanced support 10
healthcare manager | issue 25 | spring 2015
“The patient group really came into its own at the end of the first year. They gave everyone the heart to carry on.” for mental health and wellbeing. At the outset, it was important to find a way of describing what integrated care was supposed to deliver in simple but compelling terms. Common reactions to the initial proposals included: “We’re already doing that”, “We tried that and it didn’t work” or “This is just about saving money!” The case for change was made by sharing real local stories which brought to life the recent consequences of fragmented care,
especially when data showed that the issue was genuine and widespread. We wanted care to be co-ordinated around the individual’s needs, not historic organisational structures. Health and social care would be joined up and one set of records would be shared across organisations and with patients themselves. The North-West London Integrated Care Pilots began in 2011 and focused first on adults with diabetes and people over the age of 75 – two groups with high levels of need. Clinicians devised a multidisciplinary system for registering patients, assessing risks, developing care plans with them, and discussing complex cases in multidisciplinary group meetings. Around 40 of these groups were set up, chaired by a GP and supported by a co-ordinator from the pilot’s team. Local GPs, specialists from the local hospital and mental health services also attended, and the rest of the group typically included a district nurse, a social worker, and a community pharmacist. Some GPs complained that a threehour meeting, where maybe only one or two of their own cases were discussed, was not a good use of time. They would rather have phoned or emailed a consultant if they had a problem. But unplanned benefits emerged from
INTEGRATED CARE
Cath Atlee, head of integrated commissioning at Ealing CCG, lay partner Angeleça Silversides and Ethie Kong, chair of Brent CCG, at the launch of the NW London Integration Toolkit.
these meetings. People became more aware of each other’s roles. The groups began to compare data and plan joint innovations. Many of the group chairs became clinical leaders. When the time came to launch the more ambitious Whole Systems Integrated Care programme, a culture of collaboration and a network of relationships was already in place. When we launched the pilots, it took months before we had a strong patient group, with representatives on the programme board and its committees. It was a bit of a culture shock for the professionals. Early on, a committee chair asked patient representatives to leave the room while matters of commercial sensitivity were discussed. The patient group really came into its own at the end of the first year when, despite all our efforts, non-elective admissions had not fallen and money had not been saved. It would have been tempting to give up and move on. The patient group would have none of that. They told us in no uncertain terms that we were doing the right thing, pointed to evidence that patient experience was improving, and gave everyone the heart to continue. Patient involvement proved so useful that it was built into the Whole Systems
Integrated Care programme from the start. A small group of patients, carers and service users, who decided to call themselves “lay partners”, advised how we might recruit others and described the sort of support we should provide. We arranged a training day and devised role profiles so they could understand what they were being asked to do. By the time the first working groups were set up, we could ensure that each one had two lay partners able to attend the first meeting. After some initial discomfort, the professionals quickly discovered the benefits of working with lay partners, and involving them in every aspect of the work became the way things were done. The lay partners became the guardians of the vision, making sure the working groups never lost sight of what we were trying to achieve in terms of better, safer patient care. They were less risk averse than the professionals, encouraging ambition and innovation, and were acutely aware of language and quick to point out implied dependency or condescension. They were willing to work extraordinarily hard, provided they were listened to and treated as equals. The international evidence is that it takes three to five years for the first
financial and clinical benefits to be realised. A degree of faith is needed to keep working through the “enablers” that will support the changes, or at least prevent them from derailing at an early stage. We wanted fewer people treated in hospital and those who were treated there to leave sooner. More care would be provided via multidisciplinary home teams and specialist support in the community. Funding would flow to where it was needed, with more investment in primary and community care. Social care and mental health needs would be considered together with physical health and care needs, and there would be less spent on acute hospital care. More support would be offered for self-management and informal carers. To support this we put a lot of effort into co-producing a toolkit of resources to support partners in each of the boroughs to design, plan and implement the changes required. The toolkit addresses difficult issues such as analysing population need, designing outcome measures and payment systems, drawing up contracts to support joint commissioning and using readyto-implement best practice. All of this was developed, with consultancy support, by managers, clinicians and lay partners from commissioner and provider organisations working together. It is freely available on the North-West London website at: bit.ly/hcm2502 For integrated care to work, we need to change the way we think about care and the roles individuals play. In NorthWest London huge efforts have gone into communicating the vision and engaging clinicians, frontline staff and patients. It still isn’t enough. The main lesson we’ve learned is that it needs everyone – policymakers, managers, frontline staff, patients and carers – to understand what it’s all about and play their own part. Integrated care needs to become less a project and more a culture, a mindset, a social movement.
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Lis Paice is chair of the North-West London Integrated Care Pilot. healthcare manager | issue 25 | spring 2015
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INTERVIEW: UMESH PRABHU
Umesh Prabhu, medical director at the award-winning Wrightington, Wigan and Leigh Foundation Trust, tells Alison Moore how a passion for safety and caring for staff turned the trust around. And how he wants to do it all again.
When Umesh Prabhu had been a consultant for just four weeks, he sent home a baby with 26 rib fractures who was later left brain damaged by its father.
It was a simple error – there were two babies with the same name on the ward and X-rays had been taken of the wrong child, revealing no problems and leading to Prabhu’s decision to discharge. But it was a decision he has never forgotten. “I felt unfit to be a doctor, let alone a consultant paediatrician,” he says, With the help of a mentor, he turned the mistake into a positive which inspired his lifelong concern for patient safety. “After this error, I put systems in place so that this type of mistake could never happen again to a patient.” His commitment to patient safety, openness and supporting doctors to improve safety and report concerns has had national impact. The trust where Prabhu is medical director – Wrightington, Wigan and Leigh Foundation Trust (WWL) – has won a string of awards and been praised for its staff engagement, culture and commitment to safety. Last year it was named by the Health Service Journal as the provider 12
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trust of the year. The results go deeper than winning industry accolades. Since 2008, the trust’s mortality rate has plummeted, with 450 fewer people a year dying in the trust’s three hospitals. “We had 46 patients with serious falls leading to fractures five years ago; this year [2014/15], we’ve had eight,” he says. Hospital infections, pressure ulcers, hydration and nutrition, neck of femur fractures and strokes have all been targeted for improvement. This work is backed up by rigorous examination of what has gone wrong: each death in hospital is reviewed, with staff given a digest of what could be improved. Prabhu thinks this robust governance does more to improve care than revalidation of doctors, which happens only every five years. On top of all this, the trust is also one of the few in surplus – £4m in 2013-14 and around £1.8m this year. How has it achieved all this? One answers has to be the remarkably good working relationships within the top team – especially between Prabhu and chief executive Andrew Foster. “I came here in 2010 because of Andrew Foster,” he says. “I saw a man with the same vision and passion for patient safety as I have – but also the
respect for staff. There’s a link – look after your staff well and they will look after patients. “Most places there are no plans to bring managers and clinicians together. This creates a ‘them and us’ culture. Most medical managers are either self-selected or selected by the trust. Many do not have any training in leadership and many do not have any feedback about their leadership style. Many are poor. I always say MD stands for medical director, medical dictator and medical deadwood! We need truly good leaders and medical directors are the key.” When Prabhu was appointed, he felt the culture of the organisation needed to change. He and Foster met around 1,000 staff in small groups. While the majority of consultants were doing a great job, there was a minority who were rude and bullying. “That was very painful but the feedback defined what we needed to do,” he says. “80% of consultants have never given me a headache”. Of those who did – for whatever reason – some have left the trust and others have changed their ways. Local GPs have been a useful source of feedback – naming consultants who were rude or didn’t return calls, Prabhu says.
INTERVIEW: UMESH PRABHU
“I’m now confident that most consultants will come to me and say they’ve made a mistake. It’s not about punishment or humiliation, it’s about making all our staff better.”
In many cases telling consultants about concerns is enough to prompt better behaviour, but continuing problems meant pursuing a disciplinary route. “In the last two years, I’ve not had any complaints about doctors’ rudeness,” he says. “It’s most important for doctors to have humility, insight and to learn to take feedback.” But while the NHS has to move away from “blaming, humiliating, and disciplining” towards supporting staff to improve, he adds, “patient safety is not for negotiation.” Over the years he has been
approached by many staff raising concerns about their colleagues –including nurses who believe patients have been misdiagnosed and junior doctors unhappy with what they’ve seen. One consultant was observed seeing nine patients without washing his hands once. Handling these cases is walking a tightrope; while patient safety cannot be compromised, demonising doctors or nurses doesn’t help either. Sometimes complications will be a recognised risk of an operation but may
still be hard for a young doctor to deal with — Prabhu says he has had doctors ringing him in the evening in tears because a patient has suffered. “Unfortunately, we don’t have a learning curve – we deal with human beings. I always tell the story of my own mistake.” It’s this passion for patient safety and experience which has propelled him onto the national stage – working with the National Patient Safety Agency, Action against Medical Accidents and as an adviser for the National Assessment Service. He is also in demand as a conference speaker. Prabhu is due to meet Simon Stevens after approaching the NHS England chief executive by email. So what will he say to Stevens and other policy makers? First, that the NHS still has a mixed record on patient safety and needs to think about robust governance procedures. “I think many things have been achieved but still many things are a hotch-potch,” he says. And the NHS still needs more openness. WWL is open with patients and families as soon as it realises something may have gone wrong, sharing reports and meeting with them – and admitting if care could have been better. The week of our interview, Prabhu was meeting the family of a woman who died in 2006, to explain changes which had been made and apologise for any failings in care. “I’m now confident that most consultants will come to me and say they’ve made a mistake. We tell the staff it’s not about punishment or humiliation, it’s about making all our staff better.” healthcare manager | issue 25 | spring 2015
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INTERVIEW: UMESH PRABHU
But this requires board-level leadership, he says. “That’s why I spend a lot of time giving lectures. What is valuesbased leadership? Values are what the staff can observe in us. You say you put people at the heart of what you do – but what do your staff say? “If the chief executive is a bully, what hope is there for an organisation? The first thing is to get the board-level leadership right and get in people who uphold the values. Everyone knows who are the bad doctors, but they don’t do anything about it. It becomes a habit. It’s as if you pass the driving test, jump an amber light, and nothing happens. Then you jump a red light. Ten years later, you think that’s how to drive. “A good leader is the one who works with each and every one of the staff. It’s the one who takes the whole team with them,” he adds. Half of his key leaders are from black or minority ethnic (BME) backgrounds and the trust’s surgical clinical director is a woman. “I appointed them for their values and nothing else,” he says. But he believes passionately the NHS needs to do more to ensure that good people are promoted, regardless of background, and to encourage them to step forward for leadership jobs. “The NHS fails to appoint good BME and women leaders because of a club culture, an old boy’s network and discrimination. Patients, staff and the NHS suffer. BME staff are three times more unhappy in the NHS as they are bullied, harassed, victimised, not supported to do a good job and not promoted.” In some cases, he says, “they lose kindness, caring and compassion. They are isolated so they don’t become good team players and the team suffers.” He wants to see more and better leadership training, and urges the NHS to “role model” the behaviours it wants to see all the way to the top of the organisation.“We have 60 consultants ready to be leaders. Each year we provide leadership training which is multi-disciplinary. The Leadership 14
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“A good leader is the one who works with each and every one of the staff.”
Academy needs to look at the leadership strategy. I think we are wasting a lot of money. What we have done in Wigan is the right approach.” Prabhu is also critical of targets, such as the four-hour A&E target, which he warns creates a danger that corners will be cut and people admitted who don’t need to be – or not admitted when they should be. “When you focus on targets by hook or by crook, people do all the wrong things,” he says. “I always say don’t punish, but support.” He thinks that doctors from the Indian sub-Continent could help to resolve Britain’s current shortage of doctors, but the contracts which many are offered, lasting two years or less, may not be enough to attract them in sufficient numbers. Instead, he suggests four year contracts, including a period of advanced training in their chosen specialty. While there can be language difficulties with doctors from other EU countries – who are free to work in the UK – Indian doctors almost always speak good English. Prabhu’s trust is talking to Health Education England about bringing in doctors on this sort of contract – but the need is probably more pressing in other trusts. He points out that trusts like North Cumbria University Hospitals – which
WWL has been advising informally – are spending a fortune on locums because they can’t recruit permanent staff. (North Cumbria’s board papers show that in the first nine months of 2014-15 it spent nearly £15m on agency staff.) “My plea to Simon [Stevens] is to help the trust to get in doctors from overseas. If they got in 100 doctors from India and Pakistan it could reduce the cost by £5m because they are paying so much for locums,” he says. He sees the next three or four years as crucial for the NHS. On a practical level, he wants to create a different pathway for the “at risk” elderly in the area, who are likely otherwise to be admitted to hospital. Elderly care is crucial and many would be better cared for out of hospital. Shadow health secretary and local MP Andy Burnham joined a grand round at the trust and saw the problems for himself, Prabhu says. At 59, he is not ready for retirement yet. He says in a year or two he and Foster may go off together and try to turn around a failing trust, using the approaches which have been so successful in WWL. He even has a couple in mind. But whatever he ends up doing, patient safety and supporting staff will remain the twin pillars of his success.
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GENERAL ELECTION
The 2010 election settled nothing for the NHS. This time, despite a record number of parties jostling for power, there’s still no compelling vision for health and social care, argues Craig Ryan.
It’s already become a cliché to describe the 2015 general election as the “NHS election”. But clichés are often just things that are true. Polls show the NHS is the most important issue for voters, ahead of the economy, immigration or Europe. The papers are full of NHS stories – at the time of writing, there has been one on the front page of at least one national for eight days. Which party gets the first go at forming a government on 8 May may well depend on who voters mistrust the least on the NHS. Don’t expect a sophisticated debate. This election may be novel in featuring at least seven parties in with a chance of Cabinet seats, but the campaign already has a decidedly retro feel, with Labour claiming the Tories will privatise the NHS and the Conservatives saying Labour will wreck the economic recovery on which its funding depends. But their polarised rhetoric disguises NHS policies which have rarely been so alike. Everyone agrees the NHS needs more money. As the Nuffield Trust’s Andy McKeon says, “how we fund the NHS is going to be the single largest and most difficult domestic policy issue in the coming Parliament”. The
sums notionally promised by the parties vary only slightly, and whether they are affordable will depend more on the recovery of tax receipts than GDP growth or the modest tax changes proposed to fund them. Only the Lib-Dems and the Greens have explicitly promised to meet Simon Stevens’s £8bn funding requirement, but neither have very convincing plans to pay for it. Labour, Tory and UKIP promises fall well short. All parties are tacitly relying on economic growth to fund the NHS, but daren’t say so out loud. Growth is likely but not certain, and no one wants to have the dreaded “black hole” spotted in their finances. One thing is clear: there will be very little for pay. At MiP’s conference in November, Labour’s Andy Burnham promised not to renege on review body recommendations but, in reality, all the main parties are counting on pay restraint continuing for the foreseeable future. Their sums simply won’t add up without it. “Only the stingiest pay awards will be possible,” said McKeon. “The next five years for pay are going to look like the last five.” Warnings from unions and Simon Stevens, among others, that staff shortages and spiralling agency bills make the policy unsustainable will
be politely ignored, at least until after polling day. Everyone also agrees that joining up health and social care is a good thing. But until George Osborne lobbed his Manchester hand-grenade into the debate, the parties seemed wary of the costs and of foisting another “topdown” reorganisation on the NHS. A range of cautious and piecemeal initiatives were offered, which simply dodged the issue of whether local councils or the NHS would be responsible for pooled budgets and the wider question of how to reconcile local autonomy with national accountability. The Greater Manchester devolution plan changed all that. The slow shift in the tectonic plates towards more local authority involvement in the NHS turned into an earthquake. With a Tory mayor in place until at least 2016 – and trailing Labour badly in London – the Conservatives may well include a similar devolution plan for the capital in their manifesto, which could even be extended to anywhere in England that wants it by 2020. Bringing health and social care together under the ultimate control of an elected metropolitan mayor raises all sorts of questions about accountability and the NHS’s status as a national service. And an insurgent healthcare manager | issue 25 | spring 2015
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GENERAL ELECTION
reorganisation from below could prove just as disruptive as a top-down one. “It will be important to avoid the distraction of further organisational change and to clarify how the health secretary’s accountability for the NHS as a whole fits with the greater responsibility given to local government,” says the King’s Fund’s Richard Humphries. Nevertheless Osborne’s political coup has wrong-footed Labour, whose Ten Year Plan for Health and Care now looks timid by comparison. Andy Burnham has warned the devolution plans could lead to another destablising reorganisation and a “Swiss cheese NHS”, but says “the principle behind [them] is a good one”. Eight of the ten councils lined up behind “Devo-Manc” are Labour controlled and, in any case, Burnham himself was already moving in the same direction. Labour’s plans for “Year of Care” budgets for health and social care, with “accountable” providers liable for the hospital treatment costs if patients deteriorate, look like an inchoate version of the Manchester plan. And Burnham had already floated the idea that CCGs could become the “operating arm” of local government controlled Health and Wellbeing Boards. All this means the Lansley reforms are already history, although the new structures will somehow have to stagger on until the new post-Manchester landscape becomes clear. For the reforms to be unpicked by the same government that introduced them – before the end of the same parliament – should be an acute political embarrassment for the Conservatives. Opposition parties will seize on a timely report from the the King’s Fund, The NHS under the Coalition Government which said the reforms were “a strategic error” that “wasted three years on organisational changes” and contributed to the NHS missing patient care targets. Weak claims from ministers that the reforms have saved £6bn don’t stand up. They seem to attribute all savings in the NHS since 2010 to Lansley’s reforms – doubly galling for 16
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“In this game of pass the blame, the blame usually ends up in managers’ laps. With no money to spend and identikit policies, politicians can’t find anywhere else to put it.” NHS staff trying to cope with the fallout, since most of the savings come from freezing their pay. In turn, the Tories will make hay out of Burnham’s role as health secretary at the time of the Mid-Staffs scandal, and will use the PFI and the spate of private contracting under Labour to imply that they can’t be trusted with the NHS either. In good old-fashioned Liberal tradition, the Lib-Dems will blame both Labour and Tories for ideological meddling with the NHS, while making – probably futile – attempts to distance themselves from the Lansley reforms by saying they tried to make the best of a bad job. In this game of pass the blame, the blame usually ends up in managers’ laps. With no money to spend and identikit policies, politicians simply can’t find anywhere else to put it. The King’s Fund’s wise call, in its pre-election wish list Priorities for the Next Government, for politicians to “resist the temptation to slip into lazy rhetoric about NHS bureaucrats”, will probably fall on deaf ears. Managers should brace themselves for the usual avalanche of negative stereotypes and wilful ignorance during the campaign. Both health minister Dan Poulter and Andy Burnham pledged at MiP’s conference to refrain from “manager bashing”, but in a tight financial corner all parties will fall back on “cutting bureaucracy” and eliminating “waste”, and equate this with reducing management costs. It doesn’t matter that the King’s Fund and the Commonwealth Fund, among many others, have found the NHS to be one of the most efficient health
services in the world, or that dictating management structures from Whitehall is exactly the kind of micromanagement that politicians say they want to get away from. UKIP spokespeople still routinely repeat deputy leader Paul Nuttall’s ludicrous claim that there are two NHS managers for every nurse (the actual figure is eleven nurses for every manager). Indeed, UKIP seems to have a particular beef about “middle managers”, with Nigel Farage claiming recently – without any evidence – that “hundreds of millions of pounds are wasted on middle managers”. UKIP’s proposal for a “GMC for managers” – basically a negative licensing scheme under which “incompetent” managers will be “struck off” and prevented from returning to work in the NHS – has also attracted some support in Conservative circles. The government is already clawing back redundancy payments from some managers who rejoin the NHS within a year, and Treasury minister Priti Patel says the Tories will cap entitlements for NHS managers at £95,000 if re-elected. Patel has not explained why NHS managers who have lost their jobs deserve less protection than any other worker in the UK, nor that most of the people affected by the redundancy cap would actually be doctors. The NHS has never needed professional and experienced managers more than it does now. As well as intractable problems and day-to-day crises to be managed, there are breathtaking opportunities. There is genuine enthusiasm for the Five Year Forward View, and excitement and trepidation in equal measure about the Manchester devolution. As the columnist Rafael Behr recently pointed out, the 2010 election seems to have settled nothing: “things that were meant to be fixed stayed broken”. No one knows what’s going to happen, in the NHS or anywhere else. Fasten your seat belts – it’s going to be a blast.
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Craig Ryan is a freelance writer and associate editor of Healthcare Manager. Visit craigryan.eu for more.
GENERAL ELECTION
WHAT THE PARTIES SAY CONSERVATIVES GREENS
LABOUR
LIB-DEMS
SNP
UKIP
You can’t have a strong NHS without a strong economy
Private profit will have no place in our publiclyowned, locally-run NHS
We will reset the NHS as a national health and care service, increase investment and halt privatisation
The NHS needs more stability, more local control and more longterm planning
A threat to the NHS in England is a threat to the NHS in Scotland
The NHS has too many middle managers, and too many doctors, nurses and patients who don’t speak English
Ring fenced NHS budget with real terms spending increases every year
£12bn extra “core” funding for the NHS, paid for by a dedicated NHS tax
£2.5bn extra NHS funding as a “signal of commitment” to the Five Year Forward View
Meet the £8bn funding requirement by 2020 through tax changes and “efficiencies”
Scrap Trident and invest the savings in the NHS and childcare
£3bn extra NHS funding for “frontline” services
Integrated “Year of Care” budgets for health and social care, with “whole system leadership” invested in HWBs
All health and social care budgets to be pooled by 2018, with a single health and social care Whitehall department
Oppose any measures which reduce public funding for the NHS in England because of the knock-on effect on Scottish funding
Invest £500m extra in mental health services with a dedicated mental health minister
Restore the English health secretary’s duty to provide a universal healthcare service in England
info: bit.ly/hcm2504
info: bit.ly/hcm2506
info: bit.ly/hcm2508
info: bit.ly/hcm2505
ANDY BURNHAM
NORMAN LAMB
SHONA ROBISON
LOUISE BOURS
GP surgeries to open sevendays-a-week “for hardworking people” by 2020 Devolution of health and social care to the Greater Manchester Combined Authority
info: bit.ly/hcm2503
Abolish foundation trusts and wind-up the NHS internal market GP practices to become local patient-owned co-operatives
info: bit.ly/hcm2507
Abolish competition rules and make the NHS services and charities “preferred providers”
A statutory “licence to manage” for NHS managers, to be overseen by a professional regulator Visitors and migrants to be refused NHS treatment for five years and required to have private health insurance
HEALTH SPOKESPERSON
JEREMY HUNT
JILLIAN CREASY
healthcare manager | issue 25 | spring 2015
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RACE EQUALITY
New standards for race equality in the NHS are based on a simple business case for improving care and saving costs, says Rachael Ogden.
Diversity is at the heart of Simon Stevens’s five-year vision for the NHS. And although it would be no surprise if NHS managers see the incoming Workforce Race Equality Standard (WRES) as another case of “been there, tried that”, the need for accountability and action on race equality in health care has never been more pressing. The Kings Fund recently said: “Ten years ago the NHS Race Equality Action Plan was launched with ministerial support, yet a decade later no progress appears to have been made on any measure.” The disparities today are as stark as they are dispiriting. In England, 17% of NHS staff are from black and minority ethnic (BME) backgrounds, but there is only 3.6% BME representation on the boards of NHS national bodies. And whereas over 40% of hospital doctors come from BME backgrounds, this falls to less than 3% at medical director level. According to the 2013 NHS national staff survey, BME staff are almost three times more likely to have experienced discrimination at work, and more than twice as likely to believe their trust does not provide equal opportunities for career progression. For the proposed combination of productivity increases and illness prevention to work, we need better (i.e. more 18
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“In England, 17% of NHS staff are from black and minority ethnic backgrounds, but there is only 3.6% BME representation on the boards of national bodies.” diverse) engagement with both the staff who deliver services and the communities who use them. The WRES framework of nine metrics may appear to be more carrot than stick. Yet one critical difference is the proposal to compare performance across organisations. From conversations with HR leads in NHS organisations, we believe such sector benchmarking will give impetus to the development of innovative approaches to equality, diversity and inclusion. Equality and diversity professionals in the NHS are some of the most competent and committed people working in this field. Their efforts will be strengthened by this new framework, which will provide even greater benefits to staff and patients when leaders work on their own unconscious biases – after all, we all have these. This will help them ensure that E&D professionals have the profile and the
support they need to work with others in embedding equality and human rights into every aspect of NHS organisations. At the MiP conference last November, we spoke about how managers could drive a step change in race equality. There is a simple business case for diversity in healthcare: it encourages improved staff performance and engagement, enables the recruitment and retention of the best clinical and administrative talent, and contributes to the building of world-class organisations. Clearly there is advantage in the labour market for organisations that offer an attractive, inclusive employment proposition. For patients, too, the benefit of a more representative workforce makes intuitive sense. As patient expectations and choices become more aligned to cultural identity, organisations must “match the market” or risk languishing behind the times. Yet achieving race equality often requires those appointing to senior positions to recruit people who are not in their own image. We all unconsciously favour people who are “like us”. Roger Kline’s Snowy White Peaks report last year criticised NHS recruitment processes for not addressing the lack of BME people at senior level. However, at EW Group we have seen how talent development programmes can bring
RACE EQUALITY
The Workforce Race Equality Standard (WRES) ■■
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The WRES will be inserted into the NHS standard contract from April 2015 and the CQC will inspect against it, as part of its “Well Led” domain, from April 2016 – giving organisations a year to prepare. Organisations will have to demonstrate they are closing the difference in metrics between the treatment and experience of white and BME staff. The WRES will apply to providers (except “small providers” with contracts worth under £200,000), NHS commissioners and other national arm’s length bodies. The metrics are designed to encourage organisations to conduct root cause analyses of the causes of existing inequalities, with the intention of driving change rather than compliance. Work on the WRES will complement and contribute to work on the revised Equality Delivery System (EDS2) but will be undertaken and published separately.
about genuine cultural change. The programmes we are running at the BBC and in Harrow Council are simple, quick and cost-effective to run. Both can be piloted on a small scale and measured for success almost immediately. Four of the nine WRES metrics are designed to highlight – and help close – the gaps between the experiences and treatment of white and BME staff in the NHS. Metric 2, for example, measures the relative likelihood of BME staff being appointed from shortlisting compared to that of white staff across all posts. We are currently helping to address BME under-representation in recruitment at the BBC, where we deliver bespoke training as part of a positive-action mentoring programme. We help both mentors and mentees to push back against the traditional models of power and selection that often bar BME advancement. After just three months, 38% of the cohort had already undergone recognised career development moves. At Harrow Council we recently devised a bespoke one-day workshop on tackling unconscious bias. The workshop centres on a true-to-life interview. With a real candidate in the room, managers’ behaviour is put under the microscope in a safe and constructive environment. In turn, delegates begin to understand the very subtle ways in which bias and disadvantage operate,
“Research shows that if staff lack support and respect, the impact on patient care and safety can be extremely damaging.”
and how they can be checked and challenged. Feedback from a pilot in the Council’s legal services department was extraordinary: many had never experienced a training event like it, and we now run monthly workshops across the local authority. Research shows that if staff lack support and respect, the impact on patient care and safety can be extremely damaging. Metric 6 measures the proportion of staff experiencing harassment, bullying or abuse from fellow staff over a year, while metric 8 measures incidents of personal discrimination by managers, team leaders or other colleagues. Bullying affects staff health and costs employers in sick pay and turnover. Crucially, it is also bad for patient care. In a culture of blame and bullying, staff are less likely to raise concerns and admit mistakes. Intimidating and disruptive behaviour can result in clinical and clerical mistakes, preventable adverse outcomes and poor patient satisfaction – all of which increases the costs of care. Mitigating these too-often-seen tendencies requires teamwork, communication, and fostering a collaborative work environment. Our training focuses on empowering managers when it comes to intercultural competence and dialogue at a local level, allowing them to enter into the most difficult
conversations with confidence. At a strategic level, this recasts the performance management process and reiterates the accountability of managers for their actions on diversity. In other words, the higher the salary, the greater the responsibility and senior management buy-in required. Significantly, the last WRES metric states that “boards are expected to be broadly representative of the population they serve”. We have long believed that diversity management is not a box to be ticked, but a skill that can be taught, learned and developed over time, and senior level engagement in WRES will be crucial to its success. The key will be the plans that lie behind the standard and how those plans and the outcomes are monitored. If the leaders understand that the standards offer a renewed opportunity to address systemic discrimination on the one hand, and a fantastic opportunity to recruit and retain the best people and deliver the best healthcare possible, on the other, the standards will result in real change.
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Rachael Ogden is managing director of EW Group, which works with leaders in all sectors to identify the opportunities for growth that diversity can bring to their organisations. For more information email rachael.ogden@theewgroup.com or visit www.theewgroup.com/health/. healthcare manager | issue 25 | spring 2015
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LEGAL MATTERS
legaleye Iain Birrell explains how some employers are using “informal” meetings to deny an employee’s right to be accompanied at crucial discussions about their job. The right to be accompanied is an important right for employees. It allows workers to be accompanied to disciplinary or grievance hearings by a trade union official, union representative or fellow worker. It helps level the balance of power between employers and employees by ensuring that workers have someone who can advise and support them during important meetings which could decide the future of their job. Section 10 of the Employment Relations Act 1999 states that the statutory right to be accompanied applies where a worker is invited to attend a grievance or disciplinary hearing and asks to be accompanied by a trade union official, certified union representative or fellow worker. In the case of Toal v GB Oils, where two workers were refused permission to be accompanied at a grievance hearing, the Employment Appeal Tribunal ruled that employers have no right to a veto over the choice of companion, under either the Act or the ACAS Code. However, some employers are taking advantage of the right’s limitations. More and more bosses are holding so-called “informal” meetings with employees about their performance. Technically, these meetings aren’t covered by the right to be accompanied, because they are not formal disciplinary or grievance hearings. But what goes on in these “informal” meetings can nevertheless be key factors in later decisions about an employee’s capability or discipline. 20
healthcare manager | issue 25 | spring 2015
In fact, employers can later use what was said in these meetings against the employee. Even so, for the sake of fairness and clarity, it is good practice for employers to accept an employee’s request to be accompanied at all stages, including at “informal” meetings. Often, employees can be placed at a disadvantage when they attend meetings alone. This can especially be the case when they turn up expecting a casual chat, but the discussion turns out to be much more serious than they thought, and they are unaware that what they say could possibly be held against them later on. Being accompanied, especially by a trade union representative, means that an employee has someone who has extensive experience of employment practices who can speak for them and support them. They can also act as a witness should the meeting be conducted in an inappropriate way. In a high pressure environment some employees can say the wrong thing, or
“Even if a meeting is described as ‘informal’, what is said can still be used against you later down the line.”
express themselves badly. This is especially the case when they are by themselves and their boss may be confronting them with difficult questions. It is not surprising that some people panic. Not everyone is very good at responding under such pressure, with only seconds to answer tough questions about their work. These “informal” meetings therefore hold various traps for employees. For example, they may say one thing at the meeting, but after the meeting reflect and wish they had answered differently. When they say something different at a disciplinary or grievance hearing then this is used as evidence of them supposedly “changing their story”. Employers should respect the working relationship by ensuring that no one is placed at a disadvantage at any stage of the disciplinary or grievance process – this includes meetings which are allegedly “informal” but could have a major impact later on. Employees should also be aware of the law around the right to be accompanied and to request a companion to important meetings. Remember: even if a meeting is described as “informal”, what is said can still be used against you later down the line. Anyone with particular queries or concerns should speak to their union representative.
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Iain Birrell is an employment rights lawyer at Thompsons Solicitors. Legaleye is not intended to offer legal advice on individual cases. MiP members in need of personal advice should immediately contact their MiP rep.
TIPSTER
Staying out of trouble on social media Healthcare organisations need to communicate and engage like never before, and social media have a huge role to play. So don’t be put off by the pitfalls – follow these tips from Craig Ryan and you won’t go far wrong. 1 PERSONAL DOESN’T MEAN PRIVATE
7 OWN UP TO MISTAKES
It’s not essential to have separate “work” and “personal” social media accounts, but if you use personal accounts to talk about work, put a disclaimer in your profile. Your employer could still take action against you if you say something that causes the organisation “reputational damage”, breaches staff or patient confidentiality, or is racist, sexist or otherwise so generally offensive that it brings into question whether you should be in the job at all. Use common sense and, if in doubt, don’t post it.
8 TAKE AN INTEREST
If you or your organisation make a mistake on social media (and you will), own up and apologise. Don’t try to blame other staff and never claim your account has been “hacked” unless it really has. No one will believe you.
Too often social media is left to junior staff on the spurious grounds that only young people understand it. This can quickly lead to a disconnect between the people doing the social media and the organisation’s wider objectives and functions. The best way to get involved as a manager is to use social media yourself.
2 A BIT OF POLITICS IS FINE It’s okay to get political on your personal account (subject to the points above) but take care when using a work computer. Make sure you read your employer’s social media policy, and avoid using specific examples from your workplace to make political points, especially if the information is confidential or isn’t being made public otherwise.
3 SOCIAL MEDIA ISN’T PART OF THE GRIEVANCE PROCEDURE Social media isn’t the place to air workplace grievances. General gripes about work and the NHS are fine, but be careful what you say about your employer and never use social media to attack other staff, however justified you feel your complaint is. If you don’t want to talk to your manager, go to see your MiP rep.
4 THINK BEFORE YOU POST Pause for a moment before you click send. If you have any doubts about what you’ve said, leave it for half an hour. The world can probably wait that long. And
9 LEARN FROM THE BEST never post when you are angry about something at work. Wait until you’ve calmed down a bit.
5 READ YOUR OWN POST Social media is fast and it’s easy to slip up, especially with autocorrect functions. Remember how Wrexham council’s Executive Board became its “Pathetic Board”? And we all know what can happen to the word “public”. Read through your post at least once before sending – aloud if you can.
CLICK AND CHECK Make sure the links in your posts work and lead to where you think they do, especially when sharing links from other people. This isn’t just a courtesy to your readers – spammers and porn merchants often attach dodgy links to otherwise innocuous posts. One quick click can save a lot of embarrassment later on.
Look at what other people are doing to see how you can keep your social media work interesting without slipping up too often. Among the most effective social media users in the NHS community are: @ManchesterCCGs, @DrUmeshPrabhu, @LDN-Ambulance, @helenbevan, @stuartberry1, @nurse_w_glasses, @LisaSaysThis and, of course, @Jon_ Restell.
DON’T BE PUT OFF There are pitfalls in all forms of communication and social media is no different. Just ask yourself: “Would I say this to colleagues at a conference?” Social media is becoming mission critical in the NHS, so you might as well like it as lump it. Get stuck in! Craig Ryan (@CraigA_Ryan) is associate editor of Healthcare Manager.
healthcare manager | issue 25 | spring 2015
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MIP AT WORK
TUPE
Getting a good result for transferred members MiP national officer Corrado Valle explains how he helped one MiP member protect her professional status during her transfer. I’ve noticed an increase in the number of members needing representation during transfer of employment. Contracts for NHS services are now more regularly put out to tender, often resulting in staff being transferred from one employer to another – either between NHS employers or from the NHS to a private company. Employee’s rights during and after the transfer are set out in the Transfer of Undertakings (Protection of Employment) Regulations, known as TUPE. These regulations are highly complicated and difficult to navigate for anyone not familiar with them. As an MiP officer I am dealing with them on a regular basis and have the expertise to help members who are being transferred. One such member is Jenny, who was transferred to a private company. Jenny came to MiP for help when her trust lost the contract to provide healthcare for the prison service (HMP) in their area. Most of the trust staff working at the prison were subject to TUPE transfer and were eventually transferred to three different organisations providing different elements of the overall contract with HMP. Under the TUPE regulations, Jenny would transfer on her existing terms and conditions, but the letter setting out the terms of the transfer (the measures ) identified some changes that would take place post-transfer; changes that would be detrimental to Jenny. I was involved in the negotiations concerning the transfer of the NHS staff with the receiving organisation and we reached an agreement relating 22
healthcare manager | issue 25 | spring 2015
“Jenny retained her professional status and her level of income during this complicated series of events, and the transfer went smoothly.”
to possible post-transfer redundancies. We agreed that there should be an organisation-wide consultation about the changes anticipated post-transfer. We also negotiated an agreement to retain the recruitment and retention premium paid to Jenny and other staff which the receiving organisation wanted to cut. I ensured that Jenny retained her professional status and her level of
income during this complicated series of events, and the transfer went smoothly. Jenny was then able to successfully apply for a different job, back in the NHS. Her career has progressed to new heights, and her experience during this complicated transfer process persuaded her to become an MiP representative. Good news for her – and good news for MiP.
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You never know when you may need support in dealing with a problem at work. If you are a member and need help, you can contact your MiP national officer directly. If you are not yet a member, don’t delay – join online via our website, miphealth.org.uk/ joinus or ring 020 7121 5146.
NEW MIP NATIONAL OFFICER IN MIDLANDS Helen Russell has joined the MiP team to support members in the Midlands. Helen will be covering for Pete Lowe while he takes leave of absence to pursue his ambition to be elected as MP for Stourbridge in May. If you work in the Midlands and need advice or representation, contact Helen on h.russell@miphealth. org.uk or telephone 07984 292 905. Welcome to the team, Helen, and good luck Pete!
MIP AT WORK
LINK MEMBERS
Speaking up for managers in South West London MiP has a great network of representatives around the country helping us to make sure managers’ voices are heard at local level. We spoke to Sandie Belcher, MiP rep at South West London St George’s Mental Health Trust about her role. What is your day job? I’m the Acute Care Co-ordination Centre manager, supporting the safe and timely discharge of patients and finding beds for people needing admission. It’s a new service, built up over the past three months. It’s challenging: no two days are the same and it’s never boring.
concerns were addressed. As a manager and trade union representative, I can act as a bridge between the two sides to keep the conversation going. I’m also representing individual members now, with support from Jo. What skills do you need for the role? They’re similar to those in my day job – effective communication, negotiating and interpersonal skills and the ability to see other people’s perspective. All the union reps are committed to patient care, so we work well together.
Tell us something about your trust South West London St George’s covers five boroughs in south London, serving about 20,000 people. It’s multi-site, with three in-patient hospitals and numerous community facilities. There’s a strong commitment to partnership and engagement with staff and patients. What are the key issues affecting staff in the trust at the moment? The big issue at the moment is our application for foundation trust status, which will give us greater autonomy. We’re also looking at the way we deliver services and how we can improve things at the moment, which can be unsettling, but the unions work together to help ensure changes are fair and to support our members. Why did you become an MiP rep? I’ve always taken an interest in staffing issues and was persuaded to take on the role at an MiP conference. Major transformation is inevitable in the NHS and hard decisions have to be made. Partnership working is essential to ensure that staff are listened to and kept informed, and change is applied consistently and fairly. I can help by representing managers.
“It’s a great opportunity to get more involved in the bigger picture and help get the best possible outcome for staff and patients.” What support do you get from MiP? I went on MiP’s Principled Negotiations course, which was brilliant. I also get great support from our national officer, Jo Spear, and the rest of the MiP team. What role do you play in the trust on behalf of MiP? I’m on the Joint Consultative Committee (JCC). I got involved when we went through a management restructure to make sure managers’
How has being the MiP rep affected you relationship with the trust? I’ve got to know senior managers I wouldn’t necessarily have known before. This has proved very useful for getting things done in my day job as well as in the JCC. Any advice for members about getting more involved in MiP? It’s a great opportunity to get more involved in the bigger picture in your trust and help get the best possible outcome for staff and patients. You also develop new skills, like negotiating, which I use a lot – as a trade union rep, as a bed manager, and as the mother of two young adults!
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If you would like more information about becoming an MiP representative in your workplace, speak to the national officer for your area – listed on our website (miphealth. org.uk) – or ring us on 020 7121 5146.
healthcare manager | issue 25 | spring 2015
23
BACKLASH
backlash
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
by Celticus
A Rose in the long grass
Sign of the times
uses BT Broadband, travels on Virgin Trains or has been swindled out of PPI or pension money by a bank. Celticus feels bound to point out Ridley’s own considerable expertise in failure: he was chairman of Northern Rock when the mismanaged bank collapsed in ignominy in 2007, leaving taxpayers to find £27bn to ensure its survival — and eventual sale to Virgin Money.
If you fancy putting up a sign in your front garden to oppose privatisation in the NHS, make sure you don’t live in southwest Surrey. In a clumsy move which generated as much publicity as the signs themselves, Waverley council banned residents from displaying placards from campaign group The People’s NHS, which bore the slogan “Cameron and Hunt: Stop the Sale”. The council says the signs constitute “illegal advertising” and sent officials round in a van to remove them. Might Waverley’s zeal have something to do with the identity of the local MP? Yes, it’s Jeremy Hunt, of course. We wonder if the council will be so zealous when other signs bearing Mr Hunt’s name start appearing in front gardens over the next few weeks.
Lancashire hotchpotch
T
he fate of Stuart Rose’s report on NHS management remains a mystery at the time of going to press, with even the Tory chair of the Commons health committee, ex-GP Sarah Wollaston, accusing the government of withholding “uncomfortable information”. The report is known to be highly critical of NHS management structures, but the former M&S boss is also believed to have pointed the finger at the ill-fated Lansley reforms for making things worse. Officially, the Department of Health claims “further work is required” following the Five Year Forward View (which was, after all, only published six months ago) – presumably something Rose could readily confirm. Alas, the Tory peer has been “unavailable for comment” for weeks. Perhaps he really is hard at work revising his report but we wouldn’t advise holding your breath. Roses come out in June, remember.
Hot property
N
HS Property Services, popularly known as “Propco”, has a new face on the board in the shape of ex-Sainsbury’s and ex-Tesco property director Neil Sachdev. Sachdev has added Propco to the impres-
24
sive portfolio of part-time directorships he’s built up since leaving Sainsbury’s last spring. These include property developers Martin’s Property and the land-hungry shopping mall conglomerate Intu, owners of the giant Arndale Centre in Manchester among many others. With Propco due to put at least £250m worth of NHS land up for sale (not to mention the £7.5bn worth of CCG land Jeremy Hunt wants to sell off), Celticus has to ask if anyone at the Department of Health knows what a conflict of interest looks like.
healthcare manager | issue 25 | spring 2015
Banker’s daft
T
he prize for the silliest own goal of the season has to go to Matt Ridley of the The Times for his 3 March assault on the NHS. Under the headline, “It’s a scandal that the NHS is too big to fail”, free-market ideologue Ridley (the 5th Viscount Ridley to give him his full title) took aim at public bodies like the NHS and the BBC. When they “fail miserably, they still survive. That wouldn’t happen with private companies,” he fumed. Which will come as a surprise to anyone who
D
evo Manc is a funny kind of devolution. What’s actually being devolved? Of the NHS services to be commissioned by the new Greater Manchester Joint Commissioning Board, only “specialised services” are currently commissioned nationally, and they make up less than 10% of the budget. Acute care, primary care, and community and mental health services are all commissioned, or soon due to be, by 12 local CCGs. Social care and public health are run by ten local authorities, so “devolving” these to the Greater Manchester authority actually means centralising them too. Devo Manc has its merits, but simplicity isn’t one of them. Part devolution, part centralisation, part merger – is there a word for that? Oh, yes, reorganisation.
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It’s not just doctors who make it better.
Managers are an essential part of the team delivering high quality, efficient healthcare. MiP is the specialist trade union for healthcare managers, providing expert employment advice and speaking up on behalf of the UK’s healthcare managers. Join MiP online at miphealth.org.uk/joinus
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