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THE ADDED VALUE OF MEMBERSHIP

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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 3 autumn 2009

healthcare manager inside heads up:2 What you might have missed & what to look out for

Leading edge: Jon Restell inperson: Zoeta Brown, Birmingham Cancer Network inpublic: Royal Manchester Children’s Hospital

letters & comment:8 Emily Holzhausen from Carers UK on how carers are missing out on government funds

published by

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

features:10 Partnership through service pledges Party lines: what’s in store for the NHS Fund of all knowledge

your job:19 Legal eye: lack of progress on ageism Tipster: setting up a partnership forum MiP at work: healthier staff, better services MiP around the UK

backlash:24

I am pleased to introduce the third issue of healthcare manager, the magazine from Managers in Partnership.

October is breast cancer awareness month, when thousands of us go pink to support the cause and raise money for organisations like Breakthrough Breast Cancer. We invited Maggie Alexander from Breakthrough to write a feature for this issue explaining how some of that money is spent. She talks about the Service Pledge, which Breakthrough have implemented in breast care units in partnership with the healthcare team. It is simple and inexpensive and we hope more organisations will sign up to it.

The service pledge is a great example of partnership working, which is going from strength to strength in the health services. And in this issue we report on other partnership work, including the London NHS Partnership’s initiative to support and encourage partnership working at local level.

The magazine also brings you information about key events, including MiP’s conference on 24 November. You can register now; see the back cover for details. I do hope you can join us at the conference, and enjoy this issue of healthcare manager.

Marisa Howes Executive editor

issue 3 | autumn 2009 | healthcare manager

1

HEADS UP

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

Equality Council

Taking equality to the top The Department of Health has set up a new NHS Equality and Diversity Council to ‘provide clear leadership on equality and diversity issues at the highest level’.

The Council, to be chaired

by NHS chief executive David Nicholson, will report to NHS Management Board on equality and diversity issues in the NHS, including ‘championing improvement and campaigning for change’.

Lay members are being recruited to the Council, which will include representatives from patient groups, NHS staff, and social and voluntary groups.

MiP chief executive Jon Restell welcomed the initiative, which the union hopes will drive forward the equality agenda in the NHS. ‘It definitely shows promise; having the chief executive in the chair is a

healthcare manager issue 3 | autumn 2009 published by MiP All copy © 2009 MiP, or the author. Opinions stated are not necessarily those of MiP.

The Improving Working Lives standard has been

revised and updated by the NHS Staff Council and published as a framework for partnership working.

The Improving Working Lives Standard (IWL), developed in 2001, aimed to ensure all NHS employers were committed to improving the working lives of all their staff. It was developed in the light of evidence that good HR practices have a direct and measurable positive impact on health outcomes for service users.

The IWL standard enshrined the principles of partnership working in the development of workforce strategies and ensured that HR strategies and practices were a central part of the business planning of organisations, not just an add on.

In the revised framework, the Staff Council have stripped out unnecessary duplication and focused on the key elements of each strand in the IWL framework. It also provides

Executive Editor

Contributors

Marisa Howes m.howes@miphealth.org.uk

Maggie Alexander, Mark Gray, Emily Holzhausen, Marisa Howes, Helen Mooney, Ray Phillips, Jon Restell, Craig Ryan, James Sparling

clear signal that this is not an optional extra but is part of the NHS’s core business,’ said Restell.

‘Now we want them to deliver, by setting and achieving some clear goals in melting those snowy white peaks at the top of NHS organisations.

‘It’s good news that they have a broad membership on the council, including a member from the staff council, and that they will be inviting applications from a wider pool of interested parties. We will be watching and contributing and wish the Council every success.’

The new council is expected to meet for the first time in October.

Partnership

Improving Working Lives – still going strong

Associate Editor Craig Ryan editor@healthcare-manager.co.uk

Print Art Director

Broglia Press, Poole

James Sparling

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

2

issue 3 | autumn 2009 | healthcare manager

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

updated information about relevant legislation and examples of good practice.

The Framework is now provided as guidance rather than a performance measure, but other things have moved on since 2001.

Partnership working is now firmly embedded at national level and is thriving in most regions. The IWL framework provides an excellent outline for a programme of work for partnership working at local level.

More information, including the full Framework, is available on the NHS Employers website, see www.miphealth.org.uk/hcm for full link.

Cover picture: Naomi Campbell and her mother Valerie, opening the Breakthrough Breast Cancer Research Unit at Kings College London, photographed by Richard Young. healthcare manager is sent to all MiP members. If you would like to join see page 23.

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

HEADS UP

leading edge Jon Restell, chief executive, MiP I was reminded yesterday about the power of future scenarios to get your mental juices flowing. On the heels of its Carbon Reduction Strategy earlier this year, the NHS Sustainable Development Unit published four scenarios for low-carbon healthcare in 2030 (www.sdu.nhs.uk). They are all interesting and thought-provoking, and at least one is unsettling. The scenarios can be used to develop new strategies, test current plans, form your own vision of the future, stimulate partnership working and kick-start innovation and development.

‘What if’ scenarios are not predictions, especially when they are looking 20 years down the road, but they do help individuals and organisations prepare for a range of possible futures.

MiP’s national committee, which you will shortly elect, also has to prepare us

Pensions

Time to choose Your NHS Pension Choice is a scheme allowing all eligible members of the NHS Pension Scheme the one-off option to transfer all of their membership from the 1995 Section into the 2008 Section.

Eligible members will receive a choice pack which includes an explanatory booklet, a choice statement, comparing benefits between the 1995 and 2008 Section, and a DVD. The choice exercise will be carried out as a rolling

“We need to be ready for whatever comes our way, both as a trade union and as a professional community...” for a range of possible futures – albeit for a timescale of five to ten years – which can’t be confidently predicted either.

The upcoming general election and expected spending cuts suggest several scenarios, some of which we might face sooner rather than later: ■■ Massive public spending cuts, including, despite assurances now, in health care, and huge reductions in both the numbers and employment costs of public servants.

■■ As the Conservative government

programme across the NHS regions from October 2009 to March 2012, with the South West region going first. The full timetable is shown in the table on the right.

Strategic Health Authority region

NHS Pensions are providing useful guidance and information on special pages of their website at: www.nhsbsa.nhs.uk/ Choice.aspx

We will be doing a special feature on NHS pensions in the next issue of healthcare manager, so let us know if you have any specific questions you’d like addressed.

South East Coast

radically reduces the role of the state (in England) in favour of civil society, the NHS becomes a brand, a commissioner and a regulator, with private and third sector provision the ideal.

■■ Personal choice explodes, with citizens as customers first and foremost and individual payment for public services the norm.

■■ Service provision becomes evermore localised with voluntary cooperation encouraged and the postcode lottery tolerated.

Please feel free to fire in your own ‘possible futures’ for the committee to sink its teeth into. We need to be ready for whatever comes our way, both as the trade union for managers and a professional community that believes in the pivotal role of management in safe, effective and dignified health and social care. It will be interesting work.

Anticipated choice pack distribution Members aged 50 or over on 1 Oct 2009

South West South Central

Members aged under 50 on 1 Oct 2009 Oct 2010-Dec 2010

Jan 2010-Mar 2010

Jan 2011-Mar 2011

London East of England

Apr 2010-Jun 2010

Apr 2011-Jun 2011

Jul 2010-Sep 2010

Jul 2011-Sep 2011

Oct 2010-Dec 2010

Oct 2011-Dec 2011

West Midlands East Midlands Yorks & North Humber North West North East Wales

issue 3 | autumn 2009 | healthcare manager

3

HEADS UP

Communication

Why words matter It’s an oft-quoted piece of ‘wisdom’ that words account for only a tiny fraction of the meaning of a spoken message, with the rest being accounted for by tone of voice and body language. This myth is usually attributed to the American psychologist Albert Mehrabian whose ‘rule’ states that 55% of meaning is conveyed by facial expression, 38% by tone of voice

Scrutiny

Two new regulators for Scottish services The Scottish Government is planning to streamline the scrutiny of health and social care standards under new legislation introduced into the Scottish Parliament in May. The Public Services Reform (Scotland) Bill will establish two new improvement and scrutiny organisations – Healthcare Improvement Scotland (HIS) and Social Care and Social Work Improvement Scotland (SCSWIS).

Survey

Life as a healthcare manager This summer, MiP has again carried out an online survey of healthcare managers.

There has been a great response to the survey, which we will report in the next issue of healthcare manager. Jon Restell, MiP’s chief executive, told us: ‘Healthcare managers are certainly keen to tell us what it’s like out 4

The two new bodies will bring together the work currently done by: ■■ HM Inspectorate of Education (integrated children’s services functions only) ■■ NHS Quality Improvement Scotland ■■ The Social Work Inspection Agency ■■ The Care Commission.

HIS will take over responsibility for regulating standards of NHS care from NHS Quality Improvement Scotland and the regulation of independent healthcare organisations from the Care Commission.

SCSWIS will absorb the remaining responsibilities of the

there. I was particularly impressed by the suggestions for changes to reduce the bureaucratic burden: some are very imaginative!’

The responses to the survey will inform MiP’s evidence to the Senior Salaries Review Body on very senior managers’ pay, which is being prepared as we go to press. The evidence will report to the Review Body about morale among healthcare managers, their views about the fairness of the current

issue 3 | autumn 2009 | healthcare manager

and only 7% by the words used.

Although probably unfair to Mehrabian, whose experiment referred only to communications of like and dislike, the idea has stuck.

In their video ‘Busting the Mehrabian Myth’, which features Mehrabian, CreativityWorks have produced a neat and funny threeminute explosion of this idea, showing us how the words we use do matter. And the ‘animated whiteboard’ is pretty cute too. View it on YouTube by clicking on the link at www.miphealth.org.uk/hcm.

Care Commission and the Social Work Inspection Agency, along with responsibility for inspecting services to protect children and integrated children’s services.

The Scottish Government claims the new bodies will work more effectively with each other and with other scrutiny bodies.

‘Healthcare managers will be interested that creating the new bodies is intended to lead to reduced administrative burdens on public bodies and a better focus on the greatest risks,’ said a Scottish Government spokesman.

‘This will free time to concentrate on improving services and delivering better outcomes for people who use

system for determining very senior managers’ pay and how it compares to pay for comparable jobs in other sectors.

BME staff

Getting together for race equality Following the hugely successful MiPsponsored conference in June, MiP members have joined with others to set up an independent national

services. To achieve this, there will be robust and effective self-assessment coupled with effective public reporting and proportionate external scrutiny,’ added the spokesman. ‘To be effective these processes will be supported by powers to intervene and address shortcomings, where they arise, in service performance.’

MiP’s national officer for Scotland Claire Pullar welcomed the reform saying ‘this should simplify the process for our members and lead to more effective regulation’.

More information on the scrutiny bodies can be found by clicking on the relevant link at: www.miphealth.org.uk/hcm.

network for BME staff working in the NHS. One of its main aims will be to work in partnership with relevant stakeholders to ensure the NHS starts to deliver on its statutory duties under the Race Relations (Amendment) Act 2000.

As a first step, they have set up a national transitional committee to get the network established. They organised regional meetings in Birmingham, Bristol, Leicester, Leeds and London in

August and September, sponsored by the Care Quality Commission.

Among other things, the participants were able to discuss their concerns about the regulation of the NHS with representatives from the Commission.

If you would like more information about how you can become involved in the network, contact John Petley at johnpetley@yahoo.co.uk.

HEADS UP

inperson

“MiP is quite refreshing because it’s easy to contact national representatives.”

Zoeta Brown: Service improvement facilitator – primary and palliative care, Pan Birmingham Cancer Network

MiP member Zoeta Brown works as service improvement facilitator for primary and palliative care at Birmingham’s Cancer Network.

Her job is to help improve the services people receive when they are nearing the end of their lives, and she also co-ordinates services for children and young people across the Birmingham region.

Zoeta will soon be joining Birmingham East and North primary

care trust as a pathway systems facilitator, helping ensure patients flow through the NHS system, and looking for blockages or waiting lists that are building up across Birmingham.

Zoeta has been an MiP member for a year, after being introduced to the union through her sister, an NHS human resources manager also based in Birmingham. Before joining MiP, Zoeta was a member

of UNISON. She says it is important to be a union member, ‘as much for an insurance policy as anything – when you need help from a union it is well worth the investment’.

In May, Zoeta decided to become an MiP link member, and having been accredited she is now actively seeking to recruit members across South Birmingham. ‘Being a black manager myself I have had good and bad experiences of managers within the NHS, where I have worked for the last 24 years,’ she explains. ‘People have discriminated against me in the past and I recently had to seek help from MiP in a case.’

Zoeta says she found MiP ‘quite refreshing’ because it was easy to contact national representatives to seek help and advice. She says she is also now ‘very, very keen’ to get involved in the national black and minority ethnic network which MiP is supporting (see article on page 4). She believes that networking is an important part of MiP’s work and that the ability to speak to someone within the union ‘independently’ and get the right advice is invaluable. ‘I would encourage people to think about the issues that are affecting them and talk to their MiP link and representatives because the help and advice is there,’ she says. ‘Ultimately, it is important to be an MiP member so we are not on our own as managers in this politically complex and changing environment. Often managers are used as scapegoats and leave or are paid off, but they should be entitled to the same rights in a fair way as everyone else.’

Helen Mooney

issue 3 | autumn 2009 | healthcare manager

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HEADS UP

New Horizons

Making mental health ‘everyone’s business’ The Department of Health has launched a major new consultation exercise on the future of mental health services in England, with the aim of creating ‘a powerful alliance that can target the root causes of poor mental health’.

Ministers say the ‘New Horizons’ consultation will build on the success of the national service framework introduced in 1999.

‘Our aim is to build on recent achievements, whilst simultaneously taking the next logical step – helping to prevent mental health problems from developing in the first place,’ said care services minister Phil Hope.

‘We want to involve everyone in building mentally healthier communities, which is why it is important that people tell us what they think about the ideas in New

Horizons,’ he added.

Steve Shrubb, director of the NHS Confederation’s mental health network, said the consultation had been developed by a wide-ranging ‘coalition’ of organisations involved in mental healthcare.

‘We know there can be no health without mental health. Fostering good mental well-being will be a vital part of how we respond as a society to the challenges of the recession.’

The consultation exercise will cover a number of key themes including prevention, tackling stigma and social exclusion, personalised care, multi-agency collaboration and value for money.

To take part or for further details, find the link at: www.miphealth.org.uk/hcm

MiP conference 2009:

Quality through Partnership

MiP’s third national conference will take place on Tuesday 24 November 2009 at the Congress Centre, London WC1. Join delegates and guest speakers to debate topical questions about healthcare management, MiP policy and hear from the political parties about their manifestos for health. The conference will be chaired by Polly Toynbee of The Guardian and the keynote speaker will be Mike O’Brien MP, minister of state for health.

For more details see the back cover of this issue of healthcare manager.

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issue 3 | autumn 2009 | healthcare manager

“There can be no health without mental health.”

Steve Shrubb Mental Health Network NHS Confederation

MiP committee elections

Don’t miss the chance to have your say!

The first elections for MiP’s national committee take place this autumn. The committee will decide on MiP policy concerning healthcare, the organisation

and representation of members and the conditions of their employment. Members will vote in constituencies with one seat for each English NHS region (except London) and Northern Ireland, and two seats for London, Scotland and Wales.

You should have already received a nomination pack and a guide to the election process.

Nominations close on 28 September, and ballot papers will be sent out between 20 October and 17 November. The results will be announced at the MiP conference on 24 November.

For further information on the elections contact Martin Furlong on 020 7551 1438 or email election@miphealth.org.uk.

HEADS UP

inpublic

“This hospital is the ‘star on the horizon’ for the trust.”

Royal Manchester Children’s Hospital

The new Royal Manchester Children’s Hospital opened on 11 June and is part of Central Manchester University Hospitals foundation trust. With 371 beds, it is the largest children’s hospital in the UK. Services have moved to the new site on Manchester’s Oxford Road from cramped Victorian buildings at Booth Hall and Pendlebury hospitals, which have now closed, while both the new hospital and North Manchester General Hospital boast new children’s Accident and Emergency departments.

The new hospital is the largest of its kind in Europe

and, according to chief executive Mike Deegan, something to be proud of.

‘As anyone who visits can see, its scale is simply breathtaking. It will unquestionably provide patients and staff with some of the best healthcare facilities in the world.’

Built as part of a £500m private finance initiative scheme, the hospital will treat all paediatric illnesses and receive referrals from across the North West region. The hospital houses a high-resolution chip analyser for scanning and detecting genetic abnormalities in children, and has 17 beds for patients in intensive care – two more than the region’s current emergency provision – and

12 high-dependency beds.

It also includes an area specifically designed for adolescents, children’s play areas and its own hydrotherapy pool.

The new hospital will also be home to teams carrying out pioneering research through its existing partnership with the University of Manchester. The hospital is also leading the North West region’s Medicines for Children’s Research Network. It is one of six such networks nationwide which work to research and test new medicines and treatments for children.

The Network uses clinical trials to detect possible reactions to certain types of medicines, and then tests treatments to confirm they

will provide the best possible care for children. The hospital has specialist consultants in all aspects of patient care, which should ensure it gains an international reputation as a centre for medical innovation.

Consultants focus on a number of specialisms including cancer, growth and endocrine disorders, mental health, inherited metabolic disease and kidney disease.

Deegan describes the hospital as the ‘star on the horizon’ for the trust. ‘Providing medical care for children is hugely important. Distinctive pieces of medical equipment, doctors with particular expertise and a child-friendly and warm environment, are fundamental expectations of paediatric care,’ he explains.

The trust worked with PFI consortium Catalyst Healthcare to establish the new hospital. The hospital’s A&E department has been expanded to treat children with the most urgent care needs quickly rather than transferring them across Manchester. ‘Along with its state-of-the-art design, the hospital is also fully equipped with impressive modern technology,’ says Deegan. ‘Our job will be to ensure that the north-west’s healthcare standards remain extremely high and continually improve for future generations.’ HM

issue 3 | autumn 2009 | healthcare manager

7

YOUR OPINION

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 to not be published.

to the editor

China Trek: done!

basic and a challenge but on the whole I am really proud of myself for completing the challenge. The evidence is in the photograph – I was not looking my best though! I collected the £2,700 required but it was really difficult and I had to put in a small amount myself.

Thanks to all for their support.

Kath Ackah UNISON Worcestershire Acute Hospitals NHS Trust Branch

Behind the curtain Reporting back from my intentions in the last issue, the trek in China was amazing but the hardest thing I have ever done.

The temperature was in the 90s every day and we had 7.30am starts and 5pm finishes. There were 60 of us and we all started and finished, though there were a few casualties along the way. I did lose a couple of toenails and injured my knee – but not seriously and carried on strapped up.

The food was interesting, eggs and noodle soup for breakfast, but the evening meals were lovely. Some of the ‘amenities’ were very

8

On 8 July 2009 I decided I would attend the MiP parliamentary reception.

So off I went, meeting up with my Regional Rep. We arrived and after all the security checks we walked into the Great Hall at Westminster. Having studied history to a reasonably high level, when I walk into an area like this I become inspired. To breathe in the smell of history and to see what others have seen before me, to walk the path of major historical figures, truly moves me. I had stopped wondering why I was there at this point.

As I stood on the step where Elizabeth I delivered

issue 3 | autumn 2009 | healthcare manager

her speeches and where William Wallace addressed parliament, I could only begin to wonder how and what history I would make.

I started talking to a security guard who noted my obvious interest and he asked if I would like to see the private chapel. I jumped at the opportunity. He showed me down a stairway which lead eventually into the chapel. In this stunning church employees of Westminster and MPs can be married and christened.

But that wasn’t the end of the tour. I was then shown a door to what appeared to be a heating boiler cupboard.

A few concerns were going through my mind as he grinned at me. But in I went to this tiny room. To shut the door you have to get by the side of the boiler and then step out again, very much like modern toilet facilities.

On the back of the

door was a brass plaque, commemorating the night of 13 July 1911 when Emily Wilding Davison was hiding in this cupboard, so that she could claim her residency on the night of the census as living in the House of Commons.

I only knew that she was famous for throwing herself under the King’s horse! This plaque, I discovered, was illegally placed there, by Tony Benn, with his own screwdriver.

After this thrilling moment, I then went on to the MiP reception, which was a great night for networking, listening and getting to know people. All in all a very uplifting evening. I now know what my part is in supporting this union working so hard to help make the NHS the organisation it is.

So I took away from the evening a new perspective on small steps – the significance of one person making a stand. Although Emily never saw the outcome, she left a legacy of standing up for what she believed was right. Breaking a few rules on the way, despite the adversity of the day, she made a little-known stand that helped to make history.

PHILLIPA CHAPMaN Royal Berkshire Hospital

OPINION

comment

“The evidence is that the funding for breaks for carers is not reaching them on the ground.”

Emily Holzhausen

Director of Policy and Public Affairs for Carers UK

How carers are missing out Last year the Government announced an additional £150m to fund breaks for carers. But many PCTs do not know about the money and carers are still waiting to see the results.

There is no doubt that caring for an ill, frail or disabled friend or family member can have a huge impact on carers’ health. Carers are twice as likely to suffer ill health as the general public and research by Carers UK shows that as many as 95% of carers cover up their own ill health to continue caring. The need could not be greater for them to get additional time off to look after themselves. If carers cannot get a break, they often run themselves into the ground, and health and social care services have to pick up the pieces.

New funding of £150 million, allocated over two years to PCTs in England, was designed to meet some of this need and to get PCTs and local authorities working together to support carers. The NHS Operating Framework made clear that the two services would be expected to draw up joint plans, looking at how their combined funding could be used to combat carers’ isolation and mental and physical ill-

health. According to the government’s Carers Strategy, these joint plans should be part of the Joint Strategic Needs Assessments and will be be published following local consultation with relevant parties, including the third sector and carers themselves.

However, the evidence is that the money is not reaching carers on the ground. The funding appeared in PCT budgets for 2009-10, but PCTs received no specific guidance from the department on how they should spend it. Many heard about it too late to make plans in this budget year. Also, the money is not ring-fenced, forcing PCTs to make decisions based on their many priorities. Some PCTs have not even heard about the funding and others denied its existence even after Carers UK alerted them to it.

Carers UK has produced a briefing outlining the requirements on PCTs, and have estimated the amount each PCT has received based on their overall funding allocation. Along with the Princess Royal Trust for Carers and Crossroads Care, we have also written to NHS Chief Executive David Nicholson to ask him to issue additional guidance to PCTs and asked all our

local networks to contact their trusts to ask about their plans and how they are going to spend this money.

Some PCTs are already delivering innovative and life-changing carers’ services, ranging from providing specialist replacement care for carers looking after someone with complex needs, to GPs prescribing courses of learning and development to improve carers’ mental health and well-being.

These sorts of services can make all the difference to carers and we are calling on PCTs to now take a lead in making this commitment a reality.

.

Carers UK supports health and social care professionals by publishing briefings on policy changes, carrying out research, promoting good practice and providing training.

More information can be found at www.carersuk.org/Professionals.

issue 3 | autumn 2009 | healthcare manager

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SERVICE PLEDGE

The layout of a hospital waiting room may not make headline news, but it can make a huge difference to a breast cancer patient’s experience. Maggie Alexander, director of policy and campaigns at Breakthrough Breast Cancer explains the principles behind the charity’s innovative Service Pledge for Breast Cancer.

Established over five years ago, Breakthrough’s Service Pledge was developed as a tool to help patients and health professionals to work in partnership towards better local breast cancer services.

A total of 26 hospitals across the UK now work with Breakthrough, developing their own local Service Pledges, asking breast units to make an explicit written promise to people diagnosed with the disease and informing patients about what they should expect from their hospital.

Patients are experts in their own condition and there’s no better source of

“Patients are experts in their own condition and there’s no better source of insight than the personal experience of what it feels like.”

Maggie Alexander, Breakthrough

insight into improvements that are needed than those who know from personal experience what it feels like in the waiting room before diagnosis or what changes to hospital information might reassure future patients. Using the Service Pledge enables healthcare professionals to consider how to offer an even better service to their patients, while consulting patients about what improvements matter most to them. It empowers patients to ask for information and gives health professionals the confidence to implement changes to improve services.

Benefits for health professionals and patients. “User involvement” is a

familiar phrase for NHS professionals, and listening to what patients have to say and working to improve areas highlighted for change is a key requirement for everyone working in the sector. Putting this theory into practice, while balancing the immediate clinical needs of patients, can pose challenges, but one of the key benefits of the Service Pledge is that it can help give real substance to the many references to “user involvement” in healthcare guidelines. Developing the Service Pledge in direct response to patient suggestions demonstrates that health professionals have listened and responded to feedback. The Department of Health’s Cancer Reform Strategy emphasised the importance of local implementation and decision making and Breakthrough’s Service Pledge is an ideal tool to support this.

How it works Each Service Pledge hospital commits itself to: ■■ Producing a local Pledge, outlining the standards patients can expect from its breast unit, to be given to patients at the point of breast cancer diagnosis. continued on page 12

10

issue 3 | autumn 2009 | healthcare manager

SERVICE PLEDGE

Pilgrim Hospital Breast Unit, Boston

Pilgrim Hospital in Boston, Lincolnshire, signed up to Breakthrough’s Service Pledge for Breast Cancer in 2007. Patients were interviewed about the breast service they received at the hospital and asked for any improvements they would like to see. As a result, a local Service Pledge for Breast Cancer was developed outlining the improvements suggested by patients themselves.

A copy of Pilgrim Hospital’s Service Pledge is given to every person diagnosed with breast cancer to let them know the services they can expect to receive at the hospital, how the unit intends to improve its service and how patients can let them know if they think that something can be done better. Patients wanted to see a dedicated breast unit at Pilgrim Hospital and a key component of the hospital’s Service Pledge was a new £2 million purpose built breast care unit which opened in April 2008.

In the meantime, patients will also be benefiting from Pilgrim Hospital’s commitment to other significant improvements including: ■■ Ensuring that all patients are aware of the hospital’s counselling service and have the opportunity to gain emotional support from a trained counsellor.

■■

■■

Revitalising the waiting room to make it more comfortable and relaxing.

■■

Establishing a discussion group and drop-in service offering patients the opportunity to talk about breast cancer issues.

Breast Care Nurse Doreen Macaskill-Refaat, who is leading the project at the hospital, said: “It has been empowering and satisfying to work on the goals of our local Service Pledge as it helps us to focus on what patients tell us they want. Changing the way we think about the care we give to our patients is a significant step towards providing the best possible breast cancer services – something all women should have access to. We are very excited to be working with Breakthrough and our patients to achieve this.”

Consultant Radiologist Robert Jones said: “The new breast unit at Pilgrim is a huge improvement to the facilities we are able to offer our breast care patients. All breast care investigations, examinations and advice can be given in one place, with suitable private areas for things like counselling and prosthesis fitting. Our staff will benefit from more space, new equipment and centralised working.”

The Breast Unit at Pilgrim Hospital is featured in one of MiP’s ‘making healthcare happen’ videos which showcase innovative projects. The video is available at www.miphealth.org.uk/makinghealthcarehappen.

Ensuring that the unit’s reception and waiting room are staffed and that patients are greeted as they arrive.

issue 3 | autumn 2009 | healthcare manager

11

SERVICE PLEDGE

Selecting a minimum of three standards from the Pledge which its breast cancer unit is not meeting, and developing an action plan explaining how and when these standards will be met.

■■ Involving patients throughout the project.

■■

At each participating site a Breast Care Nurse takes on the role of “Pledge Lead”, getting colleagues on board, recruiting patients to take part in interviews, and putting together action plans to meet improvement goals.

Patients are encouraged to get involved via questionnaires or face-to-face interviews. Everyone diagnosed with breast cancer at the hospital receives a copy of the final Pledge, letting them know the services they can expect, how the unit intends to improve and how patients can let them know if they think something can be done better.

Often it’s the small details that make the most difference – appointment letters that encourage patients to bring a friend with them and waiting rooms without regimented rows of chairs are some of the simple suggestions that have been made by patients. Many important improvements don’t need to cost much but make a huge difference to the patient experience at what is already an anxious time.

Breakthrough provides support throughout to Pledge Leads via training, which includes project management skills, developing a questionnaire and the final Service Pledge itself.

Challenge or opportunity?

Breakthrough has found that patients are realistic about what can be achieved and can suggest imaginative ways to overcome problems. They value an explanation of why things are run the way they are. Breakthrough has also found that it can be difficult for trusts to commit to large-scale, ambitious improvement goals.

However, breast units have found that patient feedback is a valuable lobbying tool in securing funding for these changes.

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Service success Service Pledge successes so far include: ■■ Patients at Friarage Hospital were concerned that women found it difficult to access the hospital due to poor public transport links. They suggested a drop-in clinic in the community to address the problem and this has now been established at the Duchess of Kent Military Hospital in Richmond. It has had a real impact on women in the area as well as demonstrating the breast care team’s commitment to meeting local needs.

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The Pledge helped staff at Pilgrim Hospital in Boston to get a new breast unit. As the unit was previously based in a portakabin, the contrast is enormous because care has been taken to find plenty of space for everything (see box on page 11 for more details).

The letter that breast cancer patients at Trafford General Hospital receive in advance of their first appointment was revised to include more information about likely waiting times and reasons for delays. The new letter also included practical details such as where to park the car. As a result there was a reduction in the number of patients who failed to attend their appointments and patients were visibly less anxious when they arrived at the hospital for the first time.

Of course, not all recommendations can be implemented quickly.

Establishing a dedicated breast cancer ward or cutting waiting times takes time and money. Yet as long as these aspirations remain dreams on a “wish list” rather than goals with a timeline, it’s unlikely that they will materialise.

Hospitals taking part in the Breakthrough Service Pledge sign up to both long and short-term goals, ensuring that patients see both immediate changes and a commitment

to big improvements in the future.

Patient involvement is vital if the NHS is to provide a truly world-class service, sensitive to the needs of the people it cares for. Breakthrough’s Service Pledge demonstrates that patients can be successfully involved where they are properly supported and there is a willingness to listen.

The approach set out here is not exclusive to breast cancer and could apply to other conditions. Ultimately the Service Pledge is about senior managers within the NHS having the courage to listen to someone from outside about what service improvements it could make to the services it offers patients. Breakthrough hopes it acts as a good model of how a patient group can help hospitals become more patient-focused

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For more information please visit www.breakthrough.org.uk Have you implemented the Service Pledge for Breast Cancer or a similar scheme at your trust? Write to healthcare manager at editor@ healthcare-manager.co.uk or by post to MiP head office.

NHS PARTY POLICIES

With the party conference season upon us, Craig Ryan finds little clear water of any colour between the health policies of the three main parties.

The general election looms, and rows about the NHS are breaking out all over the place. But look closer and there is a considerable consensus about the future. On health, the differences between the parties are narrower than at any time since the 1970s.

All three parties remain committed to funding the NHS out of general taxation, although the Liberal Democrats would allow some additional funds to be raised locally.

David Cameron’s ‘unequivocal commitment’ to this cardinal principle of the NHS has not gone down well with the party’s right, though dissent has so far been confined to the grass roots, the Conservative blogosphere and some ‘eccentric’ MEPs. The Tories, mindful of previous public mistrust, have offered a ‘guarantee’

that NHS spending will increase in real terms for the years 2011 to 2014. In August, Cameron specifically rejected right-wing calls for a spending freeze.

‘Spending on the NHS cannot stand still because standing still would be a step backward,’ he said.

Labour and the Liberal Democrats have also promised to protect the NHS from the expected heavy cuts in overall public spending. But don’t expect anyone to commit to numbers, especially since the Government has postponed the 2009 spending review, which would have set funding for the next three years, until after the election.

The straws in the wind are not good.

In June, health secretary Andy Burnham told the NHS Confederation that ‘we should not and cannot expect to see the dramatic leaps in investment of recent years’. In September, shadow

health secretary Andrew Lansley followed suit, saying NHS funding increases under the Conservatives would only be ‘a tiny fraction’ of those in recent years and could be lower than under Margaret Thatcher. Like Labour, the Tories want to make efficiency savings even within the envelope of overall funding increases.

‘Even with small increases, NHS services everywhere will have to tighten their belts just to meet demand,’ said Lansley. ‘A real-terms increase in expenditure has to got to go hand-inhand with real savings, which can be ploughed back into frontline services to meet the needs of an ageing population and drag up our healthcare results.’

All three parties noisily rejected the recently-leaked McKinsey report, which called for cuts of up to £20bn in NHS spending and the axing of 137,000

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NHS PARTY POLICIES

“A real-terms increase in expenditure has to go hand-in-hand with real savings... ploughed back into frontline services.”

Andrew Lansley Conservatives

jobs. But you can bet your life they will be studying the details, not least the claim that 40% of patients in a typical hospital do not need to be there and that £2.4bn could be saved by raising the productivity of inefficient services to the NHS average. A resort to the crude device of reducing the tariffs for hospital services to force ‘efficiencies’ on providers is likely, whoever wins power next year.

Following the permanent revolution of the last 25 years, there is less little appetite for major restructuring.

Tinkering is more the order of the day, with the Conservatives and Liberal Democrats emphasising their ‘localist’ credentials more than Labour.

The Government proposes little more than an extension of existing reforms, such as more foundation trusts and greater freedoms for some PCTs. Ministers believe their NHS reforms are finally working and will want to portray Tory plans as a threat to the progress they’ve made. Burnham has gone big on the ‘N’ in ‘NHS’, stressing that Labour stands for ‘national standards, national pay and national accountability’ and raising the spectre of a ‘postcode lottery’ of services under ‘Tory localism’.

‘Our commitment to national standards and structures in health remains strong. Without them, the poorest areas tend to get the poorest services,’ he says.

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In turn, the Tories have portrayed Labour as centralist and obsessed with imposing reform from above. But while certainly more localist, Conservative plans are relatively modest. They would move most of the responsibility for commissioning services from PCTs to GP practices (or consortiums of practices), which would get more freedoms – ‘real opportunities to save and invest, and real control over contracts,’ says Lansley. Where that leaves PCTs is unclear. Lansley says they would continue to play a coordinating role between commissioning consortiums and provider trusts. The party has denied it plans to merge PCTs with SHAs, although it has not ruled out cutting the number of PCTs to create larger bodies with more power to negotiate with acute providers.

The Tories are also notably more enthusiastic about using the private sector to provide NHS care, though this hardly constitutes a major dividing line between the parties now. The Tories want to give Foundation Trusts more independence, such as the power to borrow against their assets, but Lansley has insisted he has no plans to allow them to become independent charities outside the NHS, despite strong interest in some Conservative circles.

The Tories argue that Labour has failed to level the playing field for private hospitals wanting to provide NHS treatment. ‘When extra capacity was needed, private providers were waved in – but then pushed out again later on,’ says Cameron. The Tories say private providers should be able to compete freely for all NHS services provided they can match the NHS tariffs and quality standards.

The Conservatives also want to hive off the running of the NHS from the Department of Health to an independent board, with members appointed on the advice of the Appointments Commission. The board would oversee the provision of services, set guidelines for commissioning and agree with the health secretary a set of objectives for health outcomes ‘which are consistent with the level of resources for the NHS determined by ministers and approved by parliament’.

Burnham has described this policy as ‘a dangerous gamble with a structure that broadly works’ and claims it will turn the NHS into ‘the world’s biggest quango’. But the Tories insist removing the NHS from political control will ensure long-term stability and allow professionals rather than politicians to set priorities. Sceptics doubt that taking the NHS out of politics is possible (or even desirable), and much would depend on how tightly the board’s statutory freedoms are drawn in the legislation. Cameron says the rump of the DH would become a Department of Public Health concentrating on the prevention of illness and tackling the root causes of poor health.

As the most avowedly localist of the parties, the Lib Dems say Labour and the Conservatives are only interested in devolving the administration of health services to

NHS PARTY POLICIES

local level, not the actual decision making. The party wants to replace PCTs as the main commissioners of services with elected local health boards, and abolish SHAs altogether. These boards will be able to raise some of their funds locally, as part of long-standing Lib Dem plans for local income taxes. But the party remains committed to the purchaserprovider split: ‘As a Liberal I do support the case for a diversity of providers, provided they meet quality standards, for patients being able to exercise choice, as these economic drivers can bring down cost and improve quality,’ says health spokesman Norman Lamb.

The gap between the parties on targets and standards has also been narrowing. The

“Our commitment to national standards and structures remains strong. Without them, the poorest areas tend to get the poorest services.”

Andy Burnham Labour

Conservatives say they would phase out Labour’s ‘top-down process targets’ and replace them with a series of ‘outcome objectives’ measuring things like the success of NHS treatments and patient satisfaction. The party says these objectives differ from existing targets because they allow health professionals to focus on ‘the result itself, not how it is achieved’. But whether Lansley will really scrap, for example, the 18-week target for waiting times, or simply re-brand it as an ‘objective’ or ‘standard’, remains to be seen.

Labour says it has already changed tack by pushing power and control downwards through foundation trusts, widening private sector treatment provision, practice-based commissioning and payment by results – all areas where they are trying to cramp the Tories for room. Burnham argues that a top-down approach was needed ‘to impose order on a failing system’ before moving towards a more flexible system based on patient empowerment, local control of funds and the ‘Darzi approach’, emphasising quality care and prevention.

When it comes to NHS pay and staffing, all three parties seem to agree that the best policy is to have no policy. But Lansley has hinted at some sort of NHS pay policy, as well as the possible re-introduction of local pay bargaining, something many Tories still favour.

In July, his office told Sky News: ‘The problem in recent years has been that staff pay has simply increased in line with the huge rises in the NHS budget.

In these times of increasing financial pressure we need to ensure that we move to a situation where pay is

“I support the case for a diversity of providers, for patients being able to exercise choice... these drivers can bring down cost and improve quality.”

Norman Lamb Liberal Democrats instead defined by what is necessary to recruit, retain and motivate the staff, and also what is affordable for local healthcare providers. Future NHS allocations will not be able to accommodate inflationary staff costs.’

This is not exactly a real-terms pay freeze, as it leaves open the possibility that staff could receive increases above inflation but below the rate of growth of overall NHS spending. But it’s about as close as he can get without saying so.

Labour has remained silent on future pay settlements, but has attacked the suggestion of a return to local pay deals, arguing that ‘national pay structures bring a stability to the system in terms of recruitment and retention’.

The pre-election debate on health is set to be a narrow, scrappy and noisy one. With so few ideological differences between the parties’ declared policies, arguments about management indicators, funding mechanisms and corporate structures may leave the public cold, forcing the parties to turn up the rhetoric further. The NHS has always been at or near the centre of election campaigns, and it will be again in 2010. But don’t expect to get much idea about what the future will really look like until long after the votes have been counted.

Craig Ryan is a freelance writer and associate editor of healthcare manager.

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INFORMATION Services

The King’s Fund has recently overhauled its information and library services to make them more user-friendly for those involved in service delivery, including managers.

Healthcare manager asked Ray Phillips, their head of information services development, to give us an overview of the new service and what it can do for you.

If knowledge is power then information overload is paralysis.

Healthcare managers need to make decisions based on the best information, retrieved with minimum fuss from reliable sources and in manageable quantities.

The King’s Fund Information and Library Service (ILS) can help the busy manager satisfy those needs.

The ILS is part of the King’s Fund’s broader mission to understand

“No single service can serve all the needs of healthcare managers. If we can’t help, then we will find someone who can.”

Ray Phillips King’s Fund

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how the health system in England can be improved and work with individuals and organisations to shape policy, transform services and change behaviour.

‘Information’ means items organised and stored in a variety of formats, so that ideas and data can be conveyed.

Barriers, real or perceived, can prevent managers making regular use of information to support their practice.

These include: lack of time to find

information; lack of knowledge or confidence about where and how to find high-quality information; and political and organisational constraints on decision-making which can mean that solutions rely more on expediency and less on evidence. Using information, particularly where it is mediated for quality and relevance by information professionals, will help to circumvent some of these barriers.

Benefits of using information include: ■■ Being supported by evidence – ensure your decision-making is supported by facts ■■ Fostering innovation – be stimulated by the ideas and experiences of others to produce something new ■■ Enabling benchmarking – compare your services to others; take opportunities to learn about and adopt high-value practices ■■ Providing perspective – broaden your point of view ■■ Enabling professional and personal development – keep your career and skills on track

INFORMATION Services

90,000 records. If you work for the NHS in England, this database is available to you through NHS Evidence Health Information Resources, where it is combined with a Department of Health database known as HMIC. The King’s Fund database is also available to NHS Scotland.

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Specialist collections – the King’s Fund ILS works with NHS Evidence to produce four web-based collections containing focused, high-quality information resources targeting four key areas: health management; commissioning; innovation and improvement; and patient and public involvement.

Key features on the four sites include:

“What are the annual training budgets for the NHS…?”

“I’ve got a job interview next week and I’d like some information on the role of a senior specialist nurse in the present health economy.”

King’s Fund Services Working alone or in partnership, the King’s Fund ILS provides free, open-toall services that make high-quality information easier to find. These include: Enquiries services – we encourage healthcare managers to make enquiries on healthcare policy, management and leadership by email, phone, via our website or in person. Examples of recent enquiries include: “Has any work been done to measure the realisation of benefits from the world class

News alert/subject-based RSS feeds providing targeted, succinct information on key topics

EE

Twitter – see the latest RSS feeds and other news from the collections, and easily pass on useful information to colleagues or feed back comments

EE

Key topics – regularly updated pages providing guidance, tools, reports and news on key areas of health and social care

EE

“Focus On” – concise collections of resources on current issues and policy, including organisational responses and press coverage

EE

Dedicated information specialists for each collection who are contactable by email to deal with subjectspecific enquiries or help with accessing resources

EE

Events listings – relevant courses and conferences for each specialist area available on the site or as an RSS feed

commissioning programme?”

Keeping up to date – know what’s going on in your area ■■ Facilitating “horizon scanning” – keep a few steps ahead and don’t be caught out by professional or political developments.

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EE

“What evidence is there of the impact of personalised healthcare and outcomes for patients with long term conditions?”

As well as free short enquiries and brief literature searches, the ILS team will also perform detailed literature searches at a reasonable cost.

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King’s Fund Database – The ILS team build and maintain a bibliographic database of resources on healthcare systems, policy and management, containing nearly

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Current awareness services – The ILS keeps users abreast of new developments through a twicemonthly email current awareness bulletin containing any books, issue 3 | autumn 2009 | healthcare manager

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INFORMATION Services

reports, official Department of Health documents and abstracts of articles added to the King’s Fund database in the previous two weeks. The bulletin is currently free while its future development is under review.

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Website services – On the King’s Fund website you can retrieve many of our resources by directly searching the library database and review our current reading lists on a wide range of healthcare management topics. The ILS also provides web resources to support King’s Fund networks: for example, the Global Emerging Leaders network, an international community of people building careers in the health sector, run by the King’s Fund and the European Health Managers Association.

Information Centre and Friends’ Lounge – The King’s Fund has recently opened its new Information Centre, which has a broader remit than the previous library. The opento-all section offers: EE

Browsing and purchasing of reports and other products

EE

Newspapers, up-to-date journals, briefings etc

EE

A sizeable book and journal stock

EE

Study spaces

EE

Access to our enquiries team

EE

Displays showcasing the King’s Fund’s work

EE

Access to computers

The Information Centre also contains our new Friends’ Lounge (pictured right), a dedicated space for Friends of the Fund. The Friends scheme is open to everyone involved in health and social care and is free to join. The Friends’ Lounge provides members with a comfortable and informal central London location to meet with colleagues or to work, with WiFi access, newspapers books journals, light refreshments and 18

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King’s Fund key The King’s Fund ILS team: contacts Tel. 020 7307 2568, enquiry@kingsfund.org.uk www.kingsfund.org.uk Commissioning specialist collection

www.library.nhs.uk/commissioning/ Health management specialist collection

www.library.nhs.uk/healthManagement/ Innovation and Improvement specialist collection

www.library.nhs.uk/improvement/ Patient and Public Involvement specialist collection

www.library.nhs.uk/ppi/ Health Library and Information Services Directory (for your nearest NHS or Independent Health Library Service)

www.hlisd.org

access to our enquiries team.

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‘Meet the expert’ events – discussion sessions with authors of topical reports, books and papers – are also held in the Friends’ Lounge.

Working in partnership No single service can serve all the needs of such a diverse and complex group as healthcare managers. The King’s Fund ILS works with our NHS librarian colleagues to ensure there are no information dead-ends for our users.

If we can’t help, then we will do our

utmost to refer them to resources or colleagues who can.

The King’s Fund aims to be the hub of health and social care management and policy, and the ILS seeks to be equally central in providing information resources to healthcare managers. Be it online, over the phone, or in person, contact us and see how high-quality information, reliably retrieved, can enhance and empower your practice

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Ray Phillips is Head of Information Services Development at the King’s Fund.

YOUR JOB

legaleye Age discrimination regulations three years on

Court blow for older workers Less than three years after the age discrimination regulations came into force, the European Court of Justice (ECJ) has already demonstrated that they are unlikely to be effective in preventing older workers in the UK being unfairly forced out of work at 65.

The ECJ’s judgement earlier this year in Age Concern’s challenge to the UK Age Discrimination Regulations, which permit employers to retire employees compulsorily at 65, shows the regulations are not quite the claimed biggest overhaul in discrimination law for 30 years.

It held that retirement provisions are covered by the Equal Treatment Directive, the UK regulations did not have to give a precise list of the circumstances in which discrimination is justified, but the UK’s compulsory retirement provisions would have to be justified to a ‘high standard of proof’.

Whether the compulsory retirement provisions are justified will have to be determined by the High Court, because the case referred to the ECJ related solely to whether the UK regulations were a permissible way of transposing the requirements of the EU directive into UK law.

While the ECJ ruled that the method adopted by the UK is, in theory, permissible, the government will

still have to show that compulsory retirement is ‘objectively and reasonably justified by a legitimate aim’, and that the means chosen are ‘appropriate and necessary’. A legitimate aim has to be grounded in social policy and not ‘purely individual reasons particular to the employer’s situation’.

It seems that while the ECJ was reluctant to criticise law-making in the UK, it was also sceptical about whether the UK government could show that there was a legitimate aim, and that the means of achieving it were proportionate and necessary.

Predictably, employers welcomed the ECJ’s decision. They claimed the new age laws would harm business and deter bosses from employing older people. Indeed, during the runup to the introduction of the new regulations in 2006, there were reports of employers dismissing older workers for fear it would become more difficult after they came into effect.

It is ludicrous, at a time when it so hard to make adequate retirement provision and the value of savings has plummeted that employers can be given a licence to discriminate against older workers. The UK’s age discrimination laws have a long way to go before they have any serious impact on ageism at work, although the government has promised to review the rules in 2011.

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Mark Gray Thompsons Solicitors

NHS casebook: Successful age discrimination case in Cornwall One of the first successful age discrimination cases related to events prior to the age discrimination legislation becoming effective in October 2006.

One day before the new laws came into effect, UNISON member Annette Southcott, 67, and 30 of her colleagues were dismissed by the Royal Cornwall NHS Trust because of their age.

Thompsons began legal proceedings on her behalf on the basis of existing European Case Law, which suggested that age discrimination may already have been unlawful. The regulations allowed for cases of age discrimination for the first time. Prior to this, Annette and her colleagues would have been unable to take action.

Annette and all her colleagues were reinstated during the course of the proceedings – the first successful outcome to an age discrimination case in the UK. Since then, ACAS has reported that age discrimination claims are rising. In 20078, there were 2,652 employment tribunal claims compared with 739 the previous year. Although the outcome of tribunal claims has been predictable rather than groundbreaking, they do show how the employers’ justification defence, confirmed by the ECJ, will be interpreted by tribunals.

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YOUR JOB

Is this the solution to every committee secretary’s nightmare?

Well, it just might be! NHS South East Sussex have recently signed up to a new piece of software that promises to make planning meetings as simple as using an online diary. eShare’s eMeetings application allows participants to organise their meetings all in on place. Every potential participant can have access to the details, the relevant papers for the meeting, the agenda and see who

AGENDA

ATTENDEES

else is coming. The software allows the attendees to update in real time information about the meeting as well as making sure they are fully prepared and equipped for the event, with maps

Tipster: PARTNERSHIP 1 Board level support Yes, it’s that old favourite. If you want to succeed, you need that commitment from the top, including adequate resources.

2 Diverse membership The partnership forum needs to represent the broad range of occupational groups and the geographical spread of your organisation.

3 No more them and us Make sure members of the forum understand the concept of partnership. Encourage group work and problem solving. This is a new way of working for many people – take time at the beginning to make it happen. Consider getting an external facilitator to build the team; it’s worth the effort and helps to break down pre-conceived ideas and “silo” working.

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LOCATION MAP

MEETING DETAILS

ASSOCIATED PAPERS

TASKS/NOTES/CONFLICTS

of how to get there, and an idea of how long the meeting will last. There’s even a place to make your excuses – that you can’t, after all, make the meeting. JS

Our guide to setting up a successful social partnership forum.

4 Don’t re-invent the wheel Check out the website for your social partnership forum: www.socialpartnershipforum.org for England www.sehd.scot.nhs.uk/psu/spf.htm for Scotland, wales.gov.uk/topics/health/nhswales/ partnershipforum for Wales.

5 Ground rules When the forum is being set up, make time to agree ground rules about the way the group will work together and how you will manage disagreements.

Make sure everyone understands the commitment required and their responsibilities as part of the team.

6 SMART objectives Make sure the forum’s programme of work has clear objectives, including measures of success and timeframes. Be clear about what is within the scope for this group and what isn’t.

7 Quick wins Another favourite for effective working. Some quick wins will boost morale for the forum and win you friends in the wider organisation.

8 Manage disagreements Disagreements are bound to occur but managed effectively they can produce positive results.

9 Communication Obvious but often forgotten in the rush to get things done. Good communication is essential to build and maintain support for partnership working. Promote the forum as well as consulting and reporting on its work.

10 Celebrate success Make sure everyone knows about your achievements.

MiP At WORK

All’s well in Wales’s BSC Marisa Howes finds out how promoting staff health and wellbeing has helped improve services at one award winning NHS organisation.

Judith Paget, Chief Executive of Powys Teaching Local Health Board, being presented with the Customer Services Excellence Award, by Paul Williams, Chief Executive, NHS Wales.

The interim report from the Boorman Review, published in August, throws up some interesting insights into the health and well-being – or lack of it – of staff in parts of the NHS. It calls for NHS organisations to ensure that managers are ‘properly equipped’ to support the health and well-being of NHS staff. They could do worse than to take their cue from NHS Wales’s Business Services Centre (BSC).

The BSC has just become one of the first NHS organisations in the UK to be awarded the government’s Standard for Excellence in Customer Service.

The award is a welcome recognition for the staff at BSC who have been through several bouts of re-structuring in recent years and have sometimes felt that their work has been forgotten.

‘This award is a great accolade for the staff,’ said Andrew Aston, MiP member

and BSC regional head of finance for South East Wales. ‘It helps to raise our profile and remind people that we may be back office support, but we are an essential part of the healthcare team.’

Judith Paget, chief executive of Powys Teaching Local Health Board, which hosts the BSC, agreed. ‘The BSC team does a vital job for the whole of the NHS. Working behind the scenes, they are some of the many hidden heroes of the NHS. I’m delighted that this award recognises their hard work,’ Paget said.

The award recognises not just the important financial contributions the BSC has made to health services in Wales, but also the steps they have taken to involve staff in developing the strategy to provide better services to customers. Well-being at work has been embedded in the culture at BSC through

staff involvement, both in a working party and as champions promoting activities linked to health and wellbeing, such as pilates, complementary therapies, and the provision of 15 minutes a day for exercise. Managers were given training and advice to understand the causes and effects of occupational stress. This in turn helped them to better motivate staff and improve performance in general.

Benchmark data has demonstrated the impact of these policies, with a significant reduction of sickness absence and low staff turnover.

These findings concur with the Boorman report, which says that ‘by putting staff health and well-being at the heart of how the NHS operates, we will not only help improve the working lives of 1.4 million people, but evidence suggests we will make significant savings and improve outcomes for patients.’

‘We always did feel we were doing a good job,’ said Andrew. ‘It’s good to have that confirmed by benchmarking against other organisations through the Standard for Excellence. It is a great boost for morale and an important demonstration of the positive impact on performance of staff involvement and good policies to promote health and well-being.’

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The Interim report of the Boorman review of NHS Health and Well-being is available by clicking on the relevant link at www.miphealth.org.uk/hcm.

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MiP AROUND THE UK

Boost for local partnerships London The London NHS Partnership is expanding its remit and has agreed a programme of work to support and encourage local partnership working.

The Partnership has set up working groups to deal with specific workstreams. The first produced a change management policy for use across London. The joint chairs of the partnership will be writing to all NHS organisations in London recommending the policy to them.

John Bancroft, MiP national officer for London, welcomed the new policy and the new way of working. ‘We desperately need a common change management policy in London to achieve buy-in to the changes coming out of the Healthcare for London review,’ he said. ‘Staff in all organisations need to be confident they will be treated fairly under any re-organisation and we think this policy will help by providing a transparent and fair process. We are encouraging all London NHS organisations to adopt it.’

The change management group was chaired by Ann Macintyre, director of workforce at Guys and St Thomas’s Foundation Trust, and an employers’ representative on the Partnership.

‘I have enjoyed chairing this group which has been a real partnership experience with tangible results,’ she said. ‘The change management policy is something the London NHS Partnership can be proud of and I have no hesitation in recommending the policy and this form of working to colleagues in local organisations.’

The London Partnership is also 22

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investing in local partnership working.

Earlier this year, local organisations were invited to submit bids for funding for local projects from a London Partnership fund of £400,000. ‘I am delighted with the progress we have made in the two years since we established the London NHS Partnership,’ said UNISON’s Phil Thompson, staff side chair of the Partnership. ‘We have also created what we believe is the first regional post dedicated to supporting

local partnerships. This shows a real commitment to embedding partnership working in the NHS in London.’

Six local partnerships were successful in bidding for funding.

The London health unions were also successful in bidding for funding for their project ‘Changing Minds’.

Among the successful groups were those working on patient pathways at London Ambulance, coaching skills for managers and staff representatives at Whittington Hospital, and ‘respect at work’ at Mayday Hospital.

‘The learning from these projects will be shared across London and will also be available nationwide,’ said MiP’s John Bancroft. ‘Partnership is here to stay. It is definitely the future for the NHS in London.’

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For more information about the work of the London NHS Partnership and the local projects it is funding, visit the NHS London website at: www.london.nhs.uk.

The partnership team from Mayday Healthcare NHS Trust are presented with the cheque to fund their partnership working project aimed at embedding a culture of respect by increasing understanding of the different cultures, beliefs and attitudes of diverse staff and patients at Mayday. The award was presented by UNISON’s Karen Jennings, chair of the staff side of the national social partnership forum. Pictured from left to right: Annette Gately, director of HR and OD, Mayday; Julie Screaton, head of workforce strategy and development, NHS London; Karen Jennings; Debbie Eyitayo, deputy director of HR, Mayday; Wendy Chapman, deputy chair of the staff side at Mayday.

MiP AROUND THE UK

New network keeps members in touch Scotland helping you make healthcare happen

MiP members in Scotland have set up a network to provide support and advice to each other. Members use the informal network to keep up with changes and potential changes, share good practice and find solutions to problems.

‘It allows us to bounce ideas off each other – or just have a general chat and catch up,’ said network member Anne Clarke. ‘It helps to realise that the issues we are facing are common to all of us – and sometimes colleagues elsewhere have found novel solutions.’

The network is small, but growing steadily. Members keep in touch by regular emails and hold meetings at least twice a year. ‘It’s not always easy to get to the meetings as there are considerable distances to travel,’ said Anne. ‘But there is a commitment to supporting MiP and enough members manage to make it to keep the meetings going.’

Recently, the Scottish Network has been working with Godfrey Perera and Dr Tina Weber from the Partnership of Public Employees to raise awareness of the impact of European directives on Scottish health services, and how healthcare managers can influence these directives at the drafting stage. Godfrey and Tina will be attending the next network meeting on 21 October at 1pm at the Scottish Health Service Centre in Edinburgh .

‘If you are based in Scotland do join us,’ said Anne ‘You will be made most welcome.’

For more information about the network and details of meetings, contact Claire Pullar, MiP national officer for Scotland, on c.pullar@miphealth.org.uk.

MiP is the trade union organisation for healthcare managers.

This magazine gives you a flavour of the work MiP does in the interests of managers in the UK’s health services, but it is just a part of the package that MiP offers its members.

Managers in healthcare are under scrutiny and pressure like never before and we know that pressures on budgets will only increase.

Given the uncertain future we face it is more important than ever that you and your colleagues are members of the only union that exists specifically to represent you.

We do this in a number of ways, including: 

MiP is the voice of managers in the workplace, regionally and nationally.

 We

represent our members’ employment interests, individually and collectively – for example, during major reorganisations.



We provide networking and development opportunities for members to encourage career development.

 We

actively seek the views of managers in healthcare.



We promote good management practice and provide guidance on this.

Join MiP today, and you will join a network of over 5,500 healthcare managers.

Join online at www.miphealth.org.uk email info@miphealth.org.uk or call us on 0845 601 1144.

issue 3 | autumn 2009 | healthcare manager

23

backlash

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

by Celticus

Dr McKinsey will see you now Among the more eyepopping revelations in the McKinsey report, leaked to our friends at the HSJ last month, was that 40% of patients in hospital shouldn’t be there at all.

Surely, this is something that should only be decided by a clinician after a thorough assessment of the health and circumstances of each individual patient. Did McKinsey ask the doctors

on the wards? In which case, why didn’t those same doctors discharge them? Or did McKinsey’s consultants don white coats and stethoscopes to wander the wards assessing patients themselves? Now, there’s a scary thought.

This one goes up to eleven Chop, chop! Decimation is the order of the day it seems. First, Labour accused the Tories of planning to

CELEBRITY CORNER

Finger on the pulse Celticus was pleased to catch Lord Darzi with a copy of healthcare manager over the summer.

The noble surgeon may no longer be a minister, but he still knows how to keep abreast of what’s going on!

24

issue 3 | autumn 2009 | healthcare manager

cut public services by 10%.

Then along come McKinsey’s with their plan to lop 10% off the NHS workforce. And now the Treasury itself has been caught with ‘secret’ plans to slash 10% from public spending. According to Simon Jenkins in the The Guardian (16 September), the corridors of Whitehall are ‘awash’ with Swedes eager to peddle their cost cutting ideas, including former Swedish PM Goran Persson who pops up to tell us how he cut 11% off Sweden’s public spending in the 1990s and how we can do the same. You can read all about it – in McKinsey Quarterly, of course.

Don’t come in, it’s freezing in here!

Ministers have publicly rejected McKinsey’s call for a recruitment freeze in the NHS, but on the ground something may be afoot.

In a poll by Nursing Times, 49% of hospital nurses said there was already a recruitment freeze at their trust, while 78% said there were restrictions on the use of agency or bank nurses.

Among community nurses, 63% said a recruitment freezes had already been introduced by their employer.

WronG NUMBEr!

Those 45,000 ‘fat and unfit’ NHS workers ‘More than 45,000 fat and unfit health service workers call in sick every day,’ screamed Claire Ellicot and Daniel Martin in the Daily Mail (20 August). It’s ridiculous to suggest, of course, that all sick staff are necessarily ‘fat and unfit’. And the 45,000 figure is actually the equivalent in fulltime staff of the 10.3 million days lost to sickness each year, and has nothing to do with the number of people calling in sick each day. But statistics is clearly not Ellicot and Martin’s strong suit: they also claimed that NHS sickness absence (10.7 days a year) is 150% higher than in the private sector (6.4 days) – it should have been 67%. And that’s hardly surprising for an organisation that works with, er, sick people.

Wrong Number! exposes misleading statistics used to attack people who work in the NHS.

MiP national conference 2009 5VFTEBZ UI /PWFNCFS r $POHSFTT $FOUSF -POEPO 8$

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Quality Through Partnership

photos from MiP 2008

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How can partnership working deliver improved quality when budgets are being squeezed?

How can we ensure locally-driven health services?

Keynote Speaker: Mike O’Brien MP Minister of State for Health $IBJS 1PMMZ 5PZOCFF Social commentator and Guardian columnist Join delegates and guest speakers at this year’s MiP conference to debate these and other questions about healthcare and hear from the political parties about their manifestos for health.

We will also focus on how healthcare managers can foster sustainable local partnerships – working with the rest of the healthcare team, patients and community organisations to deliver innovation, quality and value for money.

Join us to network and share best practice with colleagues from across the UK, explore partnerships with a range of stakeholders, and discuss the key issues with top policymakers. register online and ďŹ nd out more at

mip2009.co.uk or telephone 020 7592 9490 sponsored by:

helping you make healthcare happen

It’s not just doctors who make it better.

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

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

helping you make healthcare happen.

www.miphealth.org.uk