Healthcare Manager Winter 2017-2018 by lexographic

HCM36_COVER_front_final.pdf

issue 36 winter 2017-18

12/4/17

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healthcare manager

RETHINKING NHS MANAGEMENT

With Paul Taylor-Pitt, Roger Kline—and you MiP MEMBERS’ SUMMIT Shaping the future of our union—reports from MiP’s new-look gathering plus HEAR, HEAR! How to talk to MPs about your job

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There’s more to life than work

That’s why UNISON Living is here to help you get the most from your own time too. Maybe you want to head off to the sunshine on a budget, or perhaps upgrade your car and you want a good deal. Whatever your need, UNISON Living can connect you with a trusted partner. We’ve used the huge power of our 1.3 million members

to secure some of the best deals exclusively for you. Take a look at benefits.unison.org.uk Or call UNISON Direct on 0800 0 857 857 You’ll see how your UNISON membership can benefit your everyday life too.

issue 36 winter 2017-18

healthcare manager inside

Craig Ryan Editor

heads up:2

One of the most encouraging things to come out of MiP’s Members’ Summit – as rewarding a day as I’ve spent at a union conference, and I’ve been to a few – was the sense that managers have had enough of apologising for what they do and want to be much more assertive about the value of their work.

Leading edge: Jon Restell on finding inspiration

analysis:8 Budget 2017: Movement on pay, but funding settlement comes up short.

features:10 Members’ Summit 2017: Full report from MiP’s new-look Summit and parliamentary reception. Hope and purpose: It’s time to challenge the denigration of NHS management. The cost of blame: Roger Kline talks about new approaches to line management. published by Managers in Partnership

miphealth.org.uk Elizabeth House 39 York Road, London SE1 7NQ | 020 3437 1473 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.

regulars:20 Legal Eye: What are ‘protected conversations’? Tipster: How to talk to MPs about your work MiP at Work: A breakthough partnership agreement in Birmingham. Plus: Victimisation – one manager’s shocking story.

the sharp end:24 Malicious complaints: Abusing whistleblowing protections can wreck managers’ careers.

To be honest, representative organisations have let managers down a bit in this respect. But none of us are in any doubt that the NHS just couldn’t function without your skill and dedication, and MiP is determined to find a way to get that message across to people. You can read more about this difficult but important work on page 15 of this issue. As well as full coverage of the Summit, we have Matt Ross talking to Roger Kline about better approaches to line management and discipline, and a bit of analysis from me on what Philip Hammond’s disappointing budget means for the NHS. And we have some good news – Pete Lowe will fill you in on a MiP’s groundbreaking partnership agreement with Birmingham CCGs. This issue should reach you a week or so before Christmas – so have a good one, stay out of A&E (unless you’re on-call) and best wishes for the new year. 2018 won’t be dull – if nothing else, you can count on that.

healthcare manager | issue 36 | winter 2017-18

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

MiP Elections

MiP National Committee by-elections

ELECTION TIMETABLE

Deadline for nominations and submission of election addresses

15 January 2018

Elections open

13 February 2018

Elections close

26 February 2018

Results announced

If you’re interested in standing for election to MiP’s main policy making body, there are still a few days left to get your nomination

in. Nominations close on 21 December 2017 and elections will be held in any constituency for which there is more than one nomination. The election timetable is shown above. The National Committee formulates MiP policies on healthcare, the NHS and workplace relations – including negotiations, and the representation, recruitment and organisation of MiP members. Committee members are ambassadors of MiP, representing the union on public platforms and talking up

issues that matter to you, upholding MiP’s values and maintaining our political neutrality. The National Committee is made up of elected representatives from each geographical area of the UK with co-optees for any areas of healthcare not represented. There are two seats for Scotland, Wales and London, and one seat for each of the other English regions and for Northern Ireland.

healthcare manager

Design and Production Lexographic www.lexographic.co.uk

Cover image

issue 36 | winter 2017-18 ISSN 1759-9784 published by MiP

Contributors

healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.

Advertising Enquiries

Letters

MiP is holding four by-elections for vacancies on the new National Committee, which takes office on 1 January 2018. The four vacant seats are: Scotland (2nd Seat)

Editor

Craig Ryan editor@healthcare-manager.co.uk 07971 835296

21 December

South Central South East Coast Wales (2nd Seat)

Iain Birrell, Matt Foster, Matthew Limb, Pete Lowe, Alison Moore, James Noble, Jon Restell, Matt Ross, Craig Ryan. Opinions expressed are those of the contributors and not necessarily those of healthcare manager or MiP.

healthcare manager | issue 36 | winter 2017-18

© 2017 Tom Hampson Captiv8 UK, Lewes, East Sussex 020 8532 9224 adverts@healthcare-manager.co.uk healthcare manager is sent to all MiP members. If you would like to join our mailing list to receive copies please email us at editor@ healthcare-manager.org.uk.

For further information or to download a nomination form, visit the MiP website: miphealth.org.uk

Letters to the editor on any subject are welcome by email, or by post to MiP, Elizabeth House, 39 York Road, London SE1 7NQ, Letters must be clearly marked “For Publication”. We may edit letters for length. Please supply your name and address, which may withheld from publication on request.

HEADS UP

leadingedge Jon Restell, chief executive, MiP

’ve had a surfeit of inspiration in the last month. Unlike the lamprey variety, this surfeit hasn’t carried me off but instead given me hope, energy and direction. There have been more encounters with inspiration than I have space here to recount. Once you start looking out for it, you find the bloody thing everywhere. But there are a few stand-out moments.

The Members’ Summit and parliamentary reception, coverage of which dominates this issue of the magazine, was the most important for me: MiP members and reps leading, debating, sharing and planning for the union. We saw managers working with each other and our partners on your key issues: equality, good management practice, mental health and wellbeing, partnership working, the positive story about management, pay and pensions, gaining influence. We saw members lobbying their MPs on your behalf about the value of management and the need for a fullyfunded pay award well above the pay cap. (MPs who, by the way, now want to hear much more from frontline managers – a newly discovered species for most of them.) We saw leadership from managers like Dean Royles, whose speech challenged myths, made us cry and laugh – hard – and gave us an inspirational take on our role and the meaning of work. The new event format worked well and everyone on the team and national committee is still buzzing. I’m proud they took a punt and tried something new. The action plan from

“Managers are somehow surviving and thriving at the same time. They are impressive, stand-out people because they are managing in a system under intense pressure, without the money to keep up with demand, while facing huge workforce challenges.”

the summit will be our guiding star in 2018. In his opening speech to our Summit, Simon Stevens trailed his intervention at the following week’s NHS Providers Conference – when he reminded government of that Brexit supporters had promised £350m a week for the NHS. This was my second stand out. Now, Simon has always put the ‘chutz’ in ‘chutzpah’, but nonetheless it took courage and represented a departure from the norm to lay out clearly the political choice facing the Chancellor in his Budget: fund the NHS properly or accept cuts in services and longer waiting lists. As a public servant, Simon deserves praise for his unflinching willingness to speak truth to power. We will amplify the message that this is the choice facing the country. My third injection of inspiration came from the HSJ summit in thriv-

ing Manchester. The after-dinner speech by polar explorer Felicity Aston was pretty motivating, as you might expect. Her account of skiing solo across the Antarctic had me spellbound. She reached the edge of her resilience, she recalled. Every morning she woke up and felt she couldn’t go on, that she was bound to fail – as everyone said she would – and that the challenge was beyond her. She then told herself that all she had to do was to get out of the tent. So, with a supreme effort of will she would do this one thing and that would lead to another day of achievement on the journey. After Felicity’s speech, I have adopted ‘Just keep getting out of the tent’ as my personal motto. But amazingly heroic though Felicity’s story was, it was the many managers at the summit – passionate, honest, calm – who inspired me more, as they talked about what they are doing to make the most of their resources for NHS staff and local people. These managers are still leading and striving for better – and somehow surviving and thriving at the same time. They are impressive, stand-out people because they are managing in a system under intense pressure, without enough money to keep up with demand, while facing huge workforce challenges. They keep getting out of the tent every morning, and go on to achieve something worthwhile in the most difficult environment. They – and by they, I mean you – are the managers the country needs right now. You’re worth fighting for and definitely worth getting out of the tent for.

healthcare manager | issue 36 | winter 2017-18

HEADS UP

Obituary

Trade union giant Rodney Bickerstaffe dies

Tributes have been paid to Rodney Bickerstaffe, the former UNISON general secretary and a giant of the labour movement in the NHS, who died on 3 October. Bickerstaffe, a tireless campaigner for low-paid workers and an early champion of a national minimum wage, led the National Union of Public Employees (NUPE) from 1983 to 1992 and was general secretary of UNISON from 1996 to 2001. “Rodney, or Bick as he was known to many, was a great personal friend to many of us and a dedicated champion of all the union members he proudly represented throughout his career,” said UNISON general secretary Dave Prentis. “He coupled a great sense of humour and love of laughter with a deep-rooted sense of social justice and commitment to UNISON.” Bickerstaffe’s ferocious attacks on low pay and inequality made him a darling of trade union and Labour Party conferences, but he was also a pragmatic and

thoughtful trade unionist, who managed to stay on good terms with both Tony Blair and Arthur Scargill. His long campaign against poverty pay – which was not always supported by other union leaders – finally bore fruit when the national minimum wage was introduced in April 1999 – while Blair was prime minister and Bickerstaffe was UNISON leader. Blair praised Bickerstaffe’s “great service to his members” and “his contribution to Britain”. He said: “Where we had our disagreements, he was firm but always friendly… and knew at a profound level the importance of having a Labour government. Rodney had a great sense of humour, no pretensions despite his success and was wonderful company.” Labour leader Jeremy Corbyn, who worked with Bickerstaffe as a NUPE area officer in the 1970s, said: “Rodney was a warm, decent and principled man, an outstanding trade unionist and socialist, and a great friend and support to me over many years… Thank you Rodney for being a pal, a leader and a very decent human being.” Bickerstaffe was an early and enthusiastic supporter of the merger between NUPE, the Confederation of Health Service Employees and the white-collar local government union NALGO, which came together to form UNISON in 1993. “Rodney was at his best when he was fighting for the causes he believed in, and our movement has lost one of the greatest campaigners and orators of his generation,” Prentis added. “Thanks to his work the lives of countless people have been changed for the better. Rodney was the very best of us. We will all miss him greatly.”

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Unions take action on payroll errors MiP and other health service unions have formally complained to NHS England about mistakes by Shared Business Services (SBS), the public-private partnership which provides payroll and pensions services to 40% of NHS employers. The move follows a string of complaints from members about errors by SBS which, in some cases, have left NHS staff with unexpected bills running into thousands of pounds (see Healthcare Manager 35, p23). Over 300 staff are believed to be affected by mistakes in calculating tax and pension deductions, and errors in pension banding. In its initial response to the unions’ complaint, NHS England agreed to extend the repayment period for staff who have been overpaid from 11 to 24 months, with a maximum repayment of £146 a month. Staff facing “financial hardship” would be able to request longer repayment periods, NHS England said. SBS denied responsibility for the mistakes in pension banding, blaming “ambiguity” in the guidance from NHS Pensions. But the company did not explain why it had taken several months to obtain clarity from NHS Pensions since the issue first surfaced in December 2016. “It’s disgraceful that SBS has refused to accept liability for their own mistakes. It was only after unions repeatedly requested further data checks that the full number of affected staff was revealed,” said MiP national officer Jo Spear. “We are pleased to hear that the organisation is taking a much more reasonable and flexible approach to repayments, but we still believe individuals should not be asked to cite financial hardship as a reason to repay over a longer period of time,” she added. In a letter to NHS unions, Helen Bullers (pictured), NHS England director of people and organisational development, said: “Having staff affected by pension banding errors is a deeply regrettable situation, for which we are sorry. We are committed to resolving this for each person affected in the most sensitive, supportive and pragmatic way possible.” If you think your pay or pension contributions have been miscalculated, contact your MiP rep or national officer for advice.

HEADS UP

MiP Scottish Network The MiP Scottish Network brings together all MiP members north of the border to share developments in their local organisations, discuss issues with MiP’s national officer, set up local meetings and training sessions, and generally network among themselves. Network meetings are a great opportunity to meet fellow active members and join

the discussion about shaping MiP’s priorities for the future. The next meeting of the Scottish Network takes place from 10am to 2pm on Thursday 1 February 2018, in the Board Room at Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX. Contact Claire Pullar, MiP national officer for Scotland, on c.pullar@ miphealth.org.uk for more details or to reserve your place.

Mental health

Therapy services facing workforce crisis Mental health therapy services in the UK could collapse within a decade without urgent action to boost recruitment and improve working conditions for mental health staff, according to new academic research. A survey of 1,500 mental health workers by the Surviving Work website, in association with the Tavistock and Portman NHS Trust, found that 21% of therapists were working in unpaid jobs and more than half had to take on more than one job to make ends meet. The findings present “a bleak prognosis for earning a living as a therapist in the UK” said Dr Elizabeth Cotton (pictured), founder of Surviving Work and a specialist in workplace mental health at Middlesex University, who led the research. “Job insecurity is a major theme with many therapists on precarious contracts, and a rapid rise in self-employment,” she added. Unpaid therapy work was now widespread across the NHS and the notfor-profit sector, Cotton explained. “If trained professional therapists cannot earn a decent living, when the current 21% of psychotherapists who are 57 years or older retire, who will provide services for the one in four of us who experience mental health problems?” she said. Mental health workers taking part in

“The findings present a bleak prognosis for earning a living as a therapist in the UK. Job insecurity is a major theme.” – Dr Elizabeth Cotton

the survey said that only 25% of concerns about patient safety were resolved by employers, a figure that falls to 8% for complaints about poor working conditions. Cotton warned that the ageing workforce, poor pay and working conditions, and the lack of promotion opportunities for senior professionals mean “the sector will over the next ten years face a crisis of developing experienced and qualified therapists to manage the mental health crisis in the UK”. The research, which was supported by several trade unions including the RCN and UNISON, included in-depth interviews with 68 mental health professionals. They revealed widespread concerns that the current mental health system is unsustainable. “It’s a bad time to have a mental health problem as well as working in it. It’s the worst I’ve ever known. It’s just not sustainable emotionally for people,” said one senior therapist. “There is a lot of staff sickness absence, everywhere I look I see burnt out therapists, trying to survive, waiting and praying for change,” added another. Read the full results of the survey at www.thefutureoftherapy.org. Find out more about mental health at work by visiting survivingwork.org.

healthcare manager | issue 36 | winter 2017-18

HEADS UP

Workforce

Health secretary Jeremy Hunt has unveiled plans for a new national workforce strategy for the NHS in England, to tackle staff shortages and ensure the supply of skilled healthcare professionals in the years ahead. Speaking to the NHS Providers conference on 8 November, Hunt said the government would bring together NHS England, Health Education England (HEE), NHS Improvement and NHS Employers to “to provide a whole system view of workforce pressures and how they will be tackled”. HEE is leading work on the strategy and a single document setting out the government’s plans is expected to be published in the new year. The government has previously rejected calls for a national strategy, with ministers arguing that the Department of Health’s role should be limited to co-ordinating existing work

done by arm’s-length bodies such as HEE and NHS England. Recent reports by NHS Providers, the King’s Fund, and other think tanks and royal colleges have revealed mounting pressures on staffing levels among nurses, doctors and other clinical professions as well as senior managers and IT staff. Official figures have also shown a sharp drop in the number of EU staff joining the NHS since Britain voted to leave the EU in June 2016. MiP chief executive Jon Restell called on the government to consult with trade unions and professional bodies in drawing up the strategy. “It’s obviously good news that ministers and other system leaders now agree that the NHS needs a coherent national workforce strategy.” he said. “We need to start with a realistic analysis of where we are now and where we should be, and where the key gaps are – otherwise it will

ALASTAIR@FYFEPHOTO.COM

Government to draw up national plan to tackle staff shortages

“We need to move away from short term announcements and put in place a workforce strategy that gives those working for the NHS what they need.”

lack credibility. “The lack of money to keep up with demand, the negative impact of pressures and workload on employee experience, Brexit, and recruitment and retention need to be broached openly. We need to avoid creating a long, undeliverable wish list and we must give attention to the whole NHS team and the vital social care workforce. A long consultation period with good engagement with unions will help to create decent strategic priorities for the NHS.” The announcement was welcomed by Jennifer Dixon, chief executive of the Health Foundation (pictured). “As our latest report Rising pressure made clear, we need to move away from short term announcements and put in place a workforce strategy that gives those working for the NHS what they need to meet the considerable challenges they face,” she said.

Women into Leadership Health 2018 The unique Women into Leadership Healthcare conference, supported by MiP, offers practical advice and coaching on how to further develop your career in times of change. We will discuss how we can manage the challenges of modern leadership, and help to ensure we recognise and reward female leaders in the health and social care. Why attend? ■■ Identify the unique leadership challenges and opportunities for women in health and social care ■■ Learn how successful women negotiate for what they need to be effective leaders

healthcare manager | issue 36 | winter 2017-18

■■ Gain a deeper understanding of the skills, qualities and

attributes needed to be a successful leader ■■ Raise the visibility of women as senior leaders in health

and social care ■■ Create a lasting personal network of women leaders across

our health and social care services Chaired by MiP vice chair Zoeta Manning. Other speakers include UNISON head of health Sara Gorton, RCN president Cecilia Anim, NHS England’s Sheree Axon and MiP national officer Jo Spear. For full details and to book a place, visit: healthcare.womenintoleadership.co.uk

HEADS UP

Technology

MiP backs “WhatsApp for health” as staff face cyber security crackdown MiP and UNISON are supporting trials of a new secure messaging app for NHS staff, amid concerns that staff using WhatsApp and other commercial social networks could be in breach of data protection and patient confidentiality rules. Many NHS staff have turned to using WhatsApp or Facebook to communicate with colleagues out of frustration with inefficient and unreliable NHS systems. But the new General Data Protection Regulations (GDPR), due to come into force in May 2018, means staff using these apps to send information about patients will automatically be reported to the Information Commissioner’s Office (ICO), exposing their trusts to fines of up to 4% of turnover. Healthcare Manager understands that the General Medical Council is already investigating around 30 cases of doctors’ use of WhatApp, FaceBook and Twitter, even before the new regulations come into force. The new app, called Hospify, offers a WhatsApp-style user experience but is fully compliant with new and existing data and confidentiality regulations. MiP and Unison began trialling Hospify in September, and Birmingham Community NHS Trust has begun a 100-user trial with a view to offering the app to all 2,000 staff. “People think that WhatsApp is safe to use because WhatsApp

is encrypted, but encryption is only part of the story,” said Hospify chief executive James Flint (pictured). “All WhatsApp messages are stored on WhatsApp’s servers, most of which are outside Europe, which is itself is a breach of the new EU rules – which will still apply in the UK regardless of Brexit.” WhatsApp also fails to comply with existing confidentiality rules which give patients the right to view information held about them at any time, since WhatApp’s end-to-end encryption means not even the company itself can read the messages stored on its servers. Hospify encrypts and delivers text messages from phone to phone, then deletes them from its servers within 72 hours, so the only copies are held within users’ phones. Messages are automatically deleted from staff phones after 90 days. “This design

massively reduces the risk for security breaches or legal liabilities of any kind,” adds Flint. “Messages remain the legal responsibility of the individuals in the conversation

or their employers – which is how it should be.” Trial versions of Hospify are free to download from the Apple Store or Google Play. For more on Hospify, visit hospify.com

healthcare manager | issue 36 | winter 2017-18

BUDGET 2017

Analysis The Chancellor’s £2.8bn boost for the NHS is nowhere near enough to keep services running and meet the government’s own policy priorities, MiP and other experts have warned. Craig Ryan reports.

“Make or break” Budget comes up short The reaction across the NHS community to the Chancellor Philip Hammond’s Budget on 22 November was almost universal: relief at some new money – and the (sort-of) end to the pay cap – laced with disappointment over the size of the investment and the many strings the chancellor attached. John Appleby, chief economist at the Nuffield Trust, probably summed it up best: “I’ve been asked if the glass is half-full or half-empty,” he said. “Frankly, I just think we need a bigger glass.”

The Chancellor used the old trick of adding together increases over several years with those already in the pipeline to claim he was raising the NHS budget in England by £7.5bn. In reality, it boils down to an emergency injection of £335m for the rest of this year, with £1.6bn extra next year and £850m of new money in 2019-20. Hammond’s widely-welcomed plans for a £10bn capital investment programme also turned out to be somewhat less than advertised: only £3.5bn is new money from the Treasury – the rest will have to be raised from asset sales or private investors. What’s more, the Treasury insisted the NHS funding boost was “exceptional” – one-off, non-cumulative increases to existing totals – leaving the funding 8

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“Hospitals are printing their own money to some extent. They don’t have to break even by law and people can’t be turned away at the door.” – John Appleby, Nuffield Trust position after 2020 uncertain. As for social care, it didn’t even merit a mention in the Chancellor’s speech. The Budget was “yet another missed opportunity to pull health and care services back from the brink” said Niall Dickson, chief executive of the NHS Confederation. It leaves NHS funding growing at just 1.4% above inflation up to 2020, way below the historical average of 4%, and at a time when the need for investment in innovation, system change and infrastructure has never been greater. “It was better than we expected but it does not begin to take account of the enormous challenges we face in the next few years,” Dickson added. Two weeks before the Budget, the King’s Fund, the Health Foundation and the Nuffield Trust published a joint report on NHS funding. They concluded that

the NHS needed £4bn next year alone, just to maintain existing services, and that the potential funding gap by 202223 was approaching £20bn. In a speech on 8 November, NHS England chief executive Simon Stevens indicated that he agreed with the report’s analysis of the funding position. MiP said the Chancellor was “failing to fund the health and care needs of our citizens” and warned it was managers who would have to make the tough calls. “The extra money in today’s Budget for the day-to-day running of the NHS falls well short of expert recommendations, and there’s nothing at all to relieve the crisis in social care,” said MiP chief executive Jon Restell. “We will now see two things: longer waiting lists, and managers having to make more decisions about what the NHS can no longer do safely – or can no longer do at all,” he added. “NHS staff will be under even more pressure than they are already.” Of the £1.6bn extra cash for next year, £1bn was earmarked by the Chancellor to tackle waiting lists for elective surgery, with the remaining £600m to be spent on reducing A&E waiting times. Speaking at a BMJ webinar the day after the budget, Anita Charlesworth, director of research and economics at the Health Foundation said: “The money offered will probably help with emergency care, but the real issue is when patients are

XINHUA NEWS AGENCY/PA IMAGES

BUDGET 2017

admitted to hospital from A&E. And it won’t be enough to tackle waiting lists – we’re missing the 18 weeks more or less everywhere at the moment.” She warned that with all the new money going to acute hospitals, services like mental health and community nursing would suffer. “We’re not being honest with the public about what can be delivered,” she said. The King’s Fund’s John Appleby warned that, as well as reducing some services, hospitals and other providers would continue to overspend as they have in recent years. “Hospitals are printing their own money to some extent. They don’t have to break even by law and people can’t be turned away at the door,” he said. The need for tough choices and tradeoffs was emphasised by the chair of NHS England, Sir Malcolm Grant. While acknowledging that the extra money in the Budget “will go some way to filling the widely accepted funding gap”, Grant warned that “we can no longer avoid the difficult debate about what it’s possible to deliver for patients with the money available.” Experts were particularly critical of the Chancellor’s failure to come up with extra money for social care. “It’s a

serious omission,” said Appleby. “Our estimate is that the funding shortfall for social care is around £2.5bn, probably more.” Playing off one part of the health and social care system against another “was a dangerous game,” he warned. Charlesworth said the government’s failure to properly fund services like social care and housing simply put more pressure on the NHS: “It’s bad economics and it’s bad for people. We need to end the zero-sum game

Caps off, but only two cheers Chancellor Philip Hammond promised extra money in the Budget to fund pay rises for most NHS staff, effectively lifting the sevenyear cap on NHS pay. But the new money is conditional on agreement between employers and unions on reforms to the Agenda for Change (AfC) pay system, to “enable” increases in productivity and “improve” recruitment and retention. Hammond said he would fund settlements recommended by the NHS Pay Review Body in 2018, provided the talks “bear fruit”. NHS employers and unions, including MiP, have already agreed “broad principles” on a “refresh” of the AfC pay system, but talks have stalled recently because of the lack of funding for reforms. The Treasury confirmed that pay rises above 1% for doctors and very senior man-

between public services.” She called for a new independent body – modelled on the Office for Budget Responsibility (OBR) – to identify the UK’s long-term health and care needs and work out the funding needed. “We need to move away from the boom and bust that has bedevilled our funding. The OBR has improved the quality of debate and made it harder for politicians to duck the difficult questions,” she said.

agers, who are not on AfC contracts, would have to be paid for out of existing budgets. MiP has campaigned strongly for the Treasury to fund a fair pay rise for all NHS staff, most recently by pressing MPs on the issue at the union’s parliamentary reception on 31 October (see page 11). “We welcome the promise of extra funding for a pay rise for Agenda for Change staff,” said MiP chief executive Jon Restell. “However, there is much work to be done by the Pay Review Body, unions and employers before we achieve a fair settlement. No one should be counting any chickens.” Nuffield Trust chief economist John Appleby said the government was looking for a “something for something deal” on pay. “What do they mean by productivity? I think they mean ‘your terms and conditions will have to change’. I think they will probably be looking at progression up the pay spine, or something like that, and saying that has to change.” healthcare manager | issue 36 | winter 2017-18

MEMBERS’ SUMMIT 2017

MiP’s new-look Members’ Summit on 31 October was hailed by delegates and partners as a great success. Health and care managers from across the UK gathered in Westminster Central Hall for a full day of debate and interactive workshops, helping to shape the union’s priorities for the next year and find ways to make the NHS a better place to work. Conference reports by: Matt Foster, Matt Limb, Alison Moore, Matt Ross and Craig Ryan. Photos by Tom Hampson of Visual Eye Creative.

“We need better financial incentives for employers to promote healthy workplaces, and action to improve workplace mental health.”

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orcing NHS organisations to fund staff pay rises from existing budgets would be “an own goal of the first magnitude”, NHS England chief executive Simon Stevens told delegates in in his opening speech at MiP’s Summit. Speaking three weeks before Chancellor Philip Hammond’s conditional promise to fund pay rises for most NHS staff, Stevens warned ministers that “they have some big choices coming up over the next year or two” on pay and NHS funding. “It’s very important pay rises for the NHS are properly funded rather than in some sense having to be offset by other parts of what we’re doing. That would be an own goal of the first magnitude,” he said. In his Budget on 22 November, Hammond subsquently agreed to find extra cash for pay rises above 1% for Agenda for Change staff, if NHS employers and unions can agree on pay reforms.

Thanking MiP members “in advance” for their efforts in what was expected to be “a highly pressured winter”, Stevens urged NHS managers to “lead the charge” in tackling the big workforce challenges – including dealing with staff shortages, encouraging diversity and improving employees’ mental health. The focus of operational management was shifting towards “collaborative working” and away from the competitive model which has predominated for the last 25 years, Stevens said. “Senior leaders and boards will need to accept responsibility not just for their own institution but also to work more collaboratively in partnership with a range of other organisations in their area.” Citing evidence from the 2016 NHS staff survey, which found that 37% of staff were experiencing work-related stress or mental health problems, Stevens pledged better financial incentives

MEMBERS’ SUMMIT 2017

MANAGEMENT LIFE WORKSHOPS:

Equality: make leaders accountable NHS leaders should be “made accountable for inclusion” and face consequences for failing to ensure workplaces reflect diverse communities, a Management Life workshop on equalities heard. Catherine Loftus from the NHS Leadership Academy explained that minority ethnic staff and women, many of whom work parttime, are often the first to lose their jobs during restructuring, or get stuck in lower-band jobs while other colleagues progressed in their careers. “They are value-driven like most people in the NHS, skilled, experienced and have connections with communities that the NHS sometimes struggles to connect with. But we’re not really drawing on their talents,” said Loftus. Rather than reflect the diversity of communities, the NHS workforce had

for employers to promote healthy workplaces, and action to meet the standards set out in the independent review of workplace mental health by Lord Stevenson and MIND’s Paul Farmer. “I’m calling not just on MiP but the whole trade union staff side to work with NHS Employers, NHS England and NHS Improvement to formulate a detailed action plan,” he explained. Stevens, who co-chairs the NHS Equality and Diversity Council, said it was now time to consider “explicit” recruitment goals or targets for black and minority ethnic staff to improve workforce diversity, particularly at senior levels. He also said newly “differentiated incentives” might be needed to get more people to work in some parts of the country, and in specialities such as child and adolescent psychiatry, learning disability and general practice, where skill shortages were most acute.

Managers’ revolving door damaging NHS, admits minister

ailing NHS organisations are often characterised by excessive turnover among managers, health minister Philip Dunne told Summit delegates at the evening Parliamentary reception – and he promised to spend his time in office strengthening leadership development. Dunne, minister of state at the Department of Health since July 2016, said that every trust in special measures has had a “problem with leadership – and the leadership problem often comes from a revolving door” in senior posts. When executives aren’t in post “for long enough to be respected by the clinicians and the management structures underneath them, things that they try to change don’t

become “increasingly white, increasingly male, increasingly able bodied and older”, she added. She asked participants to think about how they might have personally been affected by issues of “power and privilege” in their careers and what actions they could take in their workplaces to improve inclusion. Isaac John, deputy director of research and development at Ashford and St Peter’s NHS Foundation Trust, said many formal inclusion programmes were “rubbish” and ineffective. “What works is the top leadership, the board and others taking action,” he said. “You need somebody who can just go out and do something and who believes it’s important.” He argued the main problem was a lack of accountability. “If you are a CEO of a FTSE company and not delivering for the shareholders they will just sack you. Boards have to understand this is important and there will be consequences for failing to deliver,” he said.

get implemented,” he warned. His goal is to “instil a greater sense of leadership development and talent spotting and talent management across the NHS,” Dunne said, particularly by encouraging more clinicians and people from ethnic minorities into leadership jobs. “The role of management is less talked about than most of the other roles within the NHS, but it’s vitally important,” he added. Dunne was introduced by Labour MP and MiP member Karin Smyth, a former NHS manager in Bristol. She told delegates she joined the NHS to help make it “more responsive to local people and more democratically accountable.” But she eventually grew frustrated with the constant reorganisations, and left to continue her mission in Parliament. “You do an incredibly difficult job,” she said. “I’m very proud to have had a career in NHS management.”

healthcare manager | issue 36 | winter 2017-18

MEMBERS’ SUMMIT 2017

MANAGEMENT LIFE WORKSHOPS:

Wellbeing: working towards a healthy workplace

The NHS is not always a healthy workplace – stress and workload pressure can often lead to mental health problems. At a Summit workshop, delegates discussed some of the practical steps managers and staff can take to improve wellbeing at work. Suggestions included: ■■ training in mental health ‘first aid’, such as dealing sympathetically with someone who had been off sick with stress ■■ raising awareness of sources of help with stress ■■ developing from the “bottom up” a culture that recognises and respects people – with backing from visible senior staff ■■ ensuring all staff have opportunities to take a break from work ■■ being able to say you’re having a bad day – rather than having to pretend to be all right all the time ■■ pressing employers and system leaders to revive the ‘Improving Working Lives’ initiative, which did much in the last decade to improve staff wellbeing but now seems to have disappeared Participants developed their own ideas on what a healthy workplace would look like. It would be inclusive, but with clear lines of accountability and ownership. It would reject a “long hours culture” with, for example, far less answering of emails out of work time – and senior staff would play their part in modelling this behaviour. And there would be “joy and laughter” – not something much associated with NHS management at the moment!

healthcare manager | issue 36 | winter 2017-18

Our job is to bring hope to the workplace

ormer NHS Employers chief executive Dean Royles set out the need for compassionate leadership and for managers “to bring hope to the workplace”, in a rousing and often funny speech to Summit delegates. Royles, now director of HR and organisational development at Leeds Teaching Hospitals, said: “Compassion is a word that demands an emotional response. It’s a word we want to hear when those close to us are receiving care. It’s probably a word that you hope sums up your approach to work. But all too often, when people talk about management in the NHS, they precede that word compassion with ‘a lack of’. “Grey suits and uncaring bureaucrats is how many portray managers, and I’m sick of it,” he added. “I know it can be hard but I also know that we can all commit to do our part in challenging that narrative about managers. We can use our collective voice as managers and leaders to talk about compassion and empathy and love.’’ While backing MiP’s call for better NHS funding, Royles warned that three

big myths are also obstructing effective transformational change. One myth is that the NHS is a single organisation when it is, in fact, “a system”. Transforming systems requires “careful alignment of incentives”, “a social movement including people outside the organisation” and strong leadership, he said. “The current approach to aligning these system incentives is not working.” A second myth is that what gets measured gets done. “Measuring financial performance does not deliver financial sustainability. Weekly reporting does not improve A&E performance. Continually weighing the pig doesn’t make it any fatter,” he said. The focus on measurement helps to embed the view that managers are faceless bureaucrats, he argued. In reality, managers are not atypical of the population they serve. “They are mostly valuesled and compassionate, whether they have a background as clinicians or accountants,” said Royles. The final myth is that partnership can trump legislation, said Royles. Assuming that problems with the current system can be overcome by simply “working together” is “a dangerous fallacy”, he warned. “Partnership can achieve only so much when boards remain responsible for the performance of individual organisations.” Royles concluded by urging members to bring “some hope into the workplace”. He added: “I think there are four things people want from work and, as managers and as a trade union, we have the ability – indeed the duty – to provide all four: meaning, belonging, growth and hope. We want people to feel that they will look back on these as the bad old days.”

See page 15 for more from Dean Royles and other leaders on making the positive case for NHS management.

MEMBERS’ SUMMIT 2017

“Tide turning” on NHS pay

MANAGEMENT LIFE WORKSHOPS:

Partnership: employers and unions team up to tackle bullying

he “tide of consensus” on NHS pay is turning after years of austerity, UNISON head of health Sara Gorton told Summit delegates, with unions pressing for a better deal for the NHS workforce increasingly confident that they “might be getting somewhere”. Gorton, who leads pay negotiations for 14 NHS unions, was speaking three weeks before the Chancellor announced an end to the seven-year cap on NHS pay, with conditional funding for pay rises for all Agenda for Change (AfC) staff. “There might be a glimmer of hope alongside the evidence that’s stacking up of the damage that has been visited on the NHS workforce by austerity pay policy,” she said. The unions’ joint pay claim – submitted directly to the Treasury in September – was designed to fill the “vacuum where we felt some pay policy should be,” Gorton explained. The pay claim calls on the Treasury to set aside money for a 3.9% pay rise to keep pace with the rising cost of living, with a further £800 for all staff as a first step towards restoring pay lost over the last seven years. Gorton highlighted the findings of recent independent poll, carried out by ComRes, which found that 69% of voters backed the unions’ claim. Health secretary Jeremy Hunt had previously hinted that an above-inflation pay rise is likely to come with strings attached. In his subsequent Budget announcement, Chancellor Philip

Hammond said extra funding for NHS pay rises would be conditional on sucessful talks between employers and unions on restructuring the AfC pay system. Gorton said that unions and NHS Employers has already reached “agreement in principle” on restructuring the pay system. She added: “Our priorities are a pay structure that is… simpler and easier to explain, which reduces the time taken for people to get the full rate for their job, removes some of the overlap between bands, and which looks at restructuring bands Bands 1 to 3 as a priority.” Gorton also praised the “fantastic campaign” run in recent months by the Royal College of Nursing to make the case for higher nurses’ pay. However, she warned ministers against trying “to cherry-pick and to set pay by focusing on one particular occupational group or focusing on one particular point in the system”.

See “Make or break budget comes up short”, page 8.

One Summit workshop gave delegates a close-up view how of partnership working between unions and employers can improve working lives. Managers and union reps from West Suffolk Foundation Trust explained how they have worked together to tackle a culture of bullying and harassment at the otherwise highperforming organisation. In the trust’s 2015 staff survey, only 25% of staff said they had reported their last experience of bullying or harassment. “That set off alarm bells for us,” said Jan Bloomfield, executive director of workforce and communications. “We were top of the country on staff engagement, but staff did not feel confident to speak up on bullying and harassment. Working with the trade unions as partners, the trust introduced a ‘Freedom To Speak Up, Freedom To Improve’ charter. The trust designated all managers as “Freedom to Speak Up Guardians” and encouraged staff to speak openly about their concerns over behaviour or patient safety. They also began to make more use of exit interviews and turnover data to target problem areas, and explicitly encouraged staff to raise workplace issues with union reps. “I cannot overstate how important it is to do an exit interview,” Bloomfield explained. “We pick up when departments aren’t demonstrating the values and behaviours we would expect of them.” Paul Pearson, UNISON branch secretary at the trust, said partnership working is vital in tackling workplace bullying – and stressed how employers can help themselves by recognising the value that unions bring. “Confrontation doesn’t work,” he said. “But partnership working can only be achieved through decent facilities time for trade union representatives. Without this time we cannot work in partnership.” He advised delegates: “Deal with problems as they arrive, don’t let them build up. If you come across bullying behaviour – and it’s managed properly – you can stop it escalating.” Bloomfield explained how, since the campaign began, the proportion of West Suffolk staff who reported their most recent experience of harassment or bullying has risen to 51% – a 26 percentage point increase in just one year.

healthcare manager | issue 36 | winter 2017-18

MEMBERS’ SUMMIT 2017

Restell plans a more active and engaged union

iP chief executive Jon Restell pledged to build on MiP’s traditional strength in supporting individual members by seeking a more powerful collective role to “negotiate realistically with our employers on pay, pensions and terms and conditions”. In his opening speech to MiP’s Members’ Summit, Restell said MiP needed to spread the message that managers were critically important to making “Nye Bevan’s model” work, as part of a wider workforce who shared a common belief in the enduring values of the NHS. “If the NHS is to survive and thrive for another 70 years, and I do believe it can do that, it will be managers who help to make that happen,” he added. “Exhausted” NHS managers giving their all to help the NHS to thrive deserve a meaningful pay rise, he added. Restell said many managers and staff in the NHS were understandably “pissed off”, and warned that the high turnover rate among managers would adversely affect the quality of the workplace for all staff. Restell explained that MiP’s new-look Summit was part of the union’s drive to attract more members across the UK’s four national health systems, become more influential and member-led, promote better partnership working, and tackle workplace problems like bullying and inequalities. He urged MiP members to take action in their own workplaces. “We know it’s going to be tough, we know the economy’s going to get worse, we know the demands are growing, but we should be doing everything we can to make those workplaces safe, positive and productive,” he said.

healthcare manager | issue 36 | winter 2017-18

MIP AROUND THE UK

In a series of regional workshops, Summit delegates discussed the key issues facing members and what MiP should be doing about them. Here’s a summary of the key points discussed.

LONDON Issues raised by members:

Too many interim managers leave with “big change” jobs half delivered STPs aren’t formal organisations and have no employment policies – leading to fragmentation, loss of staff rights and lack of equality impact assessments Age discrimination during reorganisations HR departments need strengthening Failure to tackle the challenges facing staff working across organisational boundaries. Poor consultation, and lack of clarity from leaders about how reforms will pan out and which jobs are at risk

MiP needs to:

Develop local members’ networks Get involved in organisational change at an early stage Communicate better about what the union does within partnerships Inform members which MiP people sit on which forums

MIDLANDS & EAST OF ENGLAND Issues raised by members:

SOUTH OF ENGLAND & WALES Issues raised by members:

Unpaid carers are shouldering much of the burden from social care cuts Massive disconnect between health and social care remains Lack of long-term and cross-party planning Poor quality leadership – too many interims and people not committed long-term to the job Too many inspection bodies and a lack of joined up working Recruitment and staff shortages, exacerbated by uncertainty

MiP needs to:

Feed into long-term planning and take more of a lead on organisational change Focus on improving leadership and promoting best practice Hold organisations to account for poor practice Clarify its policy positions Encourage members to lead by example

NORTH OF ENGLAND, SCOTLAND & NI Issues raised by members: Managers often dictated to by HR and not allowed to manage properly

Uncertainty and lack of transparency over mergers – many members don’t know what’s happening to their jobs

STPs not consulting with staff, despite massive implications for structures and the workforce in England

Pressure is becoming “the new norm” but the impact on staff is being ignored – members need help on how to “speak truth to power”.

Members need more support dealing with service integration in Scotland

Transfer of jobs to new organisations is a threat to unions’ capacity to represent members. Unions need to agree a process with employers for dealing with mergers Need to develop online resources to preserve organisational memory – MiP could have a role in this.

MiP needs to:

Managers need more support in coping with stress and safeguarding their mental health Misinformation about the NHS and managers is not being effectively challenged Clinicians, particularly doctors, find it hard to step up and become managers

MiP needs to:

Have more local meetings for members to network and help each other

Find better ways to engage with STPs and represent members

Raise its profile and build density by doing relevant things in the workplace

Further expand its network of reps and link members

Become an authoritative source of hard facts about the NHS

Get members to share experiences and spread the workload of representation

Ensure there is an MiP voice on every social partnership forum (SPF), and make better use of the national SPF

Focus its campaign work on the value managers bring to the NHS Be proactive over mergers and ensure members are kept informed about best practice

Make better use of social media and smartphone apps Become more diverse, encouraging more women to play an active role in the union

MANAGERS MATTER

Following the union’s successful Summit, MiP wants to challenge the denigration of NHS management and create a hopeful and compelling story that shows the true value of what managers do. Craig Ryan looks at the work ahead.

t MiP’s Summit in October, a group of MiP members got together to talk about developing a more positive and hopeful story about NHS management. It was a difficult but revealing discussion. MiP chief executive Jon Restell, who sat in on the session, says the 20-odd managers in the room had no illusions about how they were seen: “People realised that they are seen as bullies or just in it for the money or on

the take – even corrupt in some senses; that people think they are interfering, controlling and taking clinical decisions.” Several managers described how they, or their relatives and friends, were embarrassed to talk about their job, while others admitted hiding behind their previous professional status as a nurse or chiropodist to avoid telling people they had become a senior manager. “I’ve heard a lot of heart-rending stories recently about how people basically

lie about being an NHS manager,” says Restell. “These are people who are trying to manage very difficult decisions and situations and I think they just don’t deserve that at all. It’s a heroic performance. And every time I hear them, I just come away thinking: ‘you really are worth fighting for – the job you’re doing is absolutely essential and we have to find a away to get that across to people’.” In his speech to the Summit later in the day, former NHS Employers chief healthcare manager | issue 36 | winter 2017-18

MANAGERS MATTER

executive Dean Royles won sustained applause when he said it was time for managers to stop apologising and talk up their achievements in the NHS. “Grey suits and uncaring bureaucrats is how NHS managers are portrayed, and I’m sick of it,” he told delegates. “It’s our job and the job of representative organisations like MiP to not only deny that view, but through our actions to refute that view. To stand up and challenge it every time we hear it.” While managers often find it easy to list the individual things they achieve and how they contribute to better patient care, both managers and managers’ organisations often find it difficult to sum up, in simple, clear terms, what managers bring to the table. “I think we’re so busy explaining how we’re not as worthy as doctors and nurses and frontline staff that we then fail to create the right kind of language and positivity,” says Restell. “And I think that’s why Dean’s speech went down so well – because people were buoyed by it and felt their worth, their value and their skills were being acknowledged publicly, without apology or qualification.” Even among those who appreciate the work managers do, there seems to be a kind of “block” on seeing management itself in a positive light, Restell suggests. All too often, this means popular and widely-supported initiatives get spun negatively when it comes to implementation – so health and social care integration, for example, becomes associated with cuts and service closures as soon as managers get involved. Even managers themselves are often defensive about what they do. “There’s a feeling that it’s best not to draw attention to ourselves as managers because all we get is negativity,” Royles tells Healthcare Manager. “People feel defeated by it – they know if they thank managers on Twitter for doing something, someone will come back saying it would be better if we had more nurses and fewer managers, so they just keep quiet about it.” Royles, now director of HR and organisational development at Leeds Teaching Hospitals, describes how his trust has just completed a programme 16

healthcare manager | issue 36 | winter 2017-18

“It’s a bit like saying, ‘I’m late because I’m stuck in traffic’, when you are the traffic… You’re not stuck in the culture, you are the culture.” – Paul Taylor-Pitt which vaccinated more than 12,000 staff against flu. “Of course we put messages out thanking the fantastic and dedicated clinical staff, but we didn’t particularly talk about the fantastic planning and management that went into making it happen. We’ve got to start saying publicly that these things take management skill and dedicated administrative staff.” The denigration of management in the NHS is, in many ways, fantastically unusual. You don’t see it in private healthcare companies, for example, and in most other sectors getting a management job is a reason for congratulation, not feelings of shame. But NHS managers are in a totally different situation to their counterparts in the private sector – juggling many competing priorities in a highly-politicised environment, and operating in an often unhealthy culture they feel powerless to change. And in terms of values, it’s arguable that NHS managers have more in common with doctors and nurses than with mangers in, say, the oil industry or financial services.

“Managers are the lightening rod between politicians and clinical staff – and when things go wrong it’s quite easy to blame it on managers generically and call for management heads to roll,” Royles explains. At the same time, the pressure on managers to focus on meeting budgets and targets for their own sake, rather than the stable organisations and better patient care they’re designed to achieve, “suggests managers’ work runs counter to what’s good for patients”, he warns. “When we’re talking about our financial or organisational performance we’re really talking about improving services to patients,” Royles adds. “How do you know you’re achieving that? Because you can track some indicators that help you see that. But as soon as you do that, they call you a bean counter.” Restell says many managers simply can’t manage as they want or as their clinical colleagues expect. “I think people want to be coaching and empowering, they want to integrate services and make improvements, but they find themselves in cultures and situations that make that very difficult. If people are constantly shouting at you for figures and about targets you can’t meet, how can you carve out even an hour to spend with someone who’s struggling and needs support?” But managers can’t escape some responsibility for the workplace culture within teams, organisations or the NHS as a whole, warns Paul Taylor-Pitt (pictured above), the assistant director of organisational development at NHS Employers, who facilitated the MiP Summit workshop. “It’s a bit like saying ‘I’m going to be late because I’m stuck in traffic’, when you are the traffic… You’re not stuck in the culture, you are the culture,” he says. Taylor-Pitt describes workplace culture “as the vehicle for an organisation to deliver on its promises.” This culture isn’t set by the board or by corporate policies, he argues, but by “conversations in the kitchen and in the car on the way home… by the people who are working with patients every day – it happens

MANAGERS MATTER MANAGERS MATTER

The rough and the smooth

Delegates at MiP Summit made their own honest assessment of what’s good about NHS management, and what’s not. Here are their key findings: What’s good about NHS management? ■■ A clear sense of purpose built around the values of the NHS ■■ Supportive, skilled and knowledgable colleagues who share a strong commitment to the NHS ■■ Ability to change people’s lives and share in life-changing moments ■■ Good access to training and development compared to other sectors ■■ Skilled in managing conflicting demands – public sector management is hard but rewarding ■■ Dedicated and caring staff who get the job done no matter what What’s bad about NHS management ■■ Lack of resources to meet unrealistic targets and service expectations ■■ Lack of authority – managers feel disempowered by “the system” ■■ Not enough time to think, talk to people or be a good line manager ■■ Many managers are used to managing in controlling, autocratic ways ■■ Denigration by some colleagues, the media, politicians and the public ■■ An NHS structure (in England) that works against the direction of policy What do you think is good and not so good about NHS management? Send your views to us at info@miphealth.org.uk. And look out for full details of MiP’s Managers Matter roundtable on the MiP website (miphealth.org.uk) in the new year.

everywhere”. Managers need to take the chance to shape their own culture, he says, “because no one is going to do it for us”. Giving managers a clear and powerful role in shaping better workplace cultures in the NHS would go a long way towards giving managers a clearer sense of purpose that’s more widely appreciated by their clinical colleagues and the public. But Royles warns that managers and even organisations are not entirely free to set their own culture. “The regulatory system is actually setting that culture as well,” he says. “How NHS Improvement, NHS England, Health Education England, Public Health England and CQC relate to each other and behave plays a a huge part in setting the tone for how the system as a whole operates. “If you feel as though you’re constantly under threat, constantly under scrutiny, and you feel fearful, that has an impact,” he adds. “You can’t just say to people, ‘well, what have you done for the culture?’ when you’ve got things like that happening.” To start to get to grips with these issues, and to begin to build confidence among NHS managers, MiP is planning a workshop for members and system leaders in early 2018 (see right). “I think the time for being apologetic and defensive about NHS management is over,” says MiP’s Jon Restell. “We need to have another go at creating a positive narrative and language for NHS management. And we need a much clearer set of professional values and skills for managers. “It needs to be properly inspiring, it needs to be unapologetic and it’s got to avoid the kind of defensive humility which I think we see too much of now,” he adds. “Either you’ve got an important job that’s worth £75,000 a year from the taxpayer, or you haven’t – and if you have, we need to be able to tell people why it’s important, in clear terms that everyone can understand.” Taylor-Pitt talks about setting out a “vision” for NHS management – something that makes a clear link between being an excellent manager and making

a difference on the ground. “You need something ambitious to work towards, something that’s bigger than you. Visions aren’t always tangible, sometimes they’re not even achievable, but they’re something to strive towards other than metrics and targets.” Restell and Taylor-Pitt agree that the relentless focus on leadership in recent years has taken attention away from the important work managers do day-inday-out to develop staff, manage budgets and run patient services. “There’s a growing body of academic opinion saying that chief execs should be doing less visioning and strategy, and be more focussed on execution, relationships, and building the morale and capacity of people to deliver,” says Restell. “Re-designating managers as leaders can seem like another way of erasing the manager’s identity.” “I know a tax inspector who tells people that his job is building hospitals and schools,” he adds. “That might seem a bit ridiculous, but it’s a way to get people to focus on the real value of the job, rather than processes or stereotypes. That’s the kind of thing we’re looking for.”

Managers Matter An MiP Workshop Early 2018 – Free to all MiP members ■■ How can we develop a clear and compelling story about the value of NHS management? ■■ How can we encourage managers to be confident about their jobs and proud of what they do? ■■ What are the professional values and skills that good managers need? ■■ How can we challenge the denigration of NHS managers in the media? ■■ What do patients and staff want and expect from NHS managers? Join MiP chief executive Jon Restell and a panel of influential system leaders to discuss all these issues at MiP’s Managers Matter workshop early in 2018. Date and venue to be confirmed.

Visit the MiP website for updates or email info@miphealth.org.uk to register your interest.

healthcare manager | issue 36 | winter 2017-18

LINE MANAGEMENT

Research shows the blame culture in the NHS is costly to both patients and staff. At an MiP Summit workshop, NHS managers and workforce expert Roger Kline discussed new approaches to line management which focus on learning and improvement. Matt Ross reports.

ealth professionals know that prevention is better than cure; by improving public health, we hope to reduce the load on NHS services. But as Roger Kline told a workshop at the 2017 MiP Members’ Summit, the NHS often takes a purely reactive approach to disciplining its own staff. The typical NHS approach to HR is “to wait until something goes wrong or somebody raises concerns and then respond to it, rather than taking something like a public health approach to these things: being proactive and preventing it,” said Kline, who has been both a workforce adviser to NHS England and a senior trade union official, and is currently a research fellow at Middlesex University Business School. Rather than seeing complaints and service failures as a cue to improve systems and processes, he argued, NHS organisations focus on acting against the alleged culprit. This pushes employees straight into punitive disciplinary procedures that damage their careers, suck up resources and weaken NHS service delivery. Meanwhile, underlying and systemic problems are left to fester, perpetuating the risks for both patients and staff. Kline’s perspective clearly chimed with the experience of the audience of MiP members attending the workshop. Members agreed that senior managers and regulators frequently react to suspected malpractice by pushing for

healthcare manager | issue 36 | winter 2017-18

““The fish rots from the head. If you can’t get leaders to take this on board, it’s a very brave manager who does so. What happens at the top is crucial: the leadership has to buy into this, and model the behaviours extensively.” immediate suspensions. Often, said one HR manager, the staff handling a disciplinary case “are getting pressure from above saying: ‘I want them out, I want them suspended, and you have to do whatever it takes to make that happen’”. In some cases, an MiP national officer added, senior leaders suspend people without any evidence of gross misconduct simply to strengthen their case in any future employment tribunal case. This is a tragedy for those subsequently found innocent of any malpractice, as suspensions wreck people’s careers, Kline replied: “The number of people who are suspended and then come back to work is very, very small indeed – they tend to move on”. So the NHS organisation loses an experienced manager, while saddling itself with recruitment costs and productivity losses estimated by Oxford Economics to average £35,000 (see The Sharp End—p24).

What’s more, Kline argued, a kneejerk recourse to formal disciplinary procedures often leads to discrimination against BME staff. Managers are less likely to hold informal discussions with BME staff than with white workers, he said, so a higher proportion of BME staff are pushed into an HR process – “and once you go down a formal path, you’ll always find things that people shouldn’t have done or could’ve done better.” BME and white nursing staff, he noted, have about the same chance of being referred to the Nursing and Midwifery Council (NMC) by members of the public – but BME workers are far more likely than their white colleagues to be referred to the NMC by their employers. “You can draw your own conclusions as to why that might be,” he added. It doesn’t have to be like this, Kline argued. By adopting “an approach focused on what to learn, not who to blame”, employers can both avoid mission creep in the application of formal disciplinary procedures, and address the organisational or process weaknesses that led to the failure in the first place. When considering disciplinary procedures, he explained, managers should ask themselves four questions. Did the worker intend to cause harm? Were they drunk or otherwise impaired? Did they knowingly and unreasonably increase risk by violating safe operating procedures? And would another similar employee have acted in the same manner?

TOM HAMPSON: VISUAL EYE

LINE MANAGEMENT

“If the answer to those questions is no, no, no and yes, it’s very likely that we’re looking at a system problem rather than an individual problem,” he said. Trusts piloting this “disciplinary triage” approach have had remarkable results, Kline explained. One big London hospital halved the number of disciplinary cases in seven months; another trust’s mental health services have seen an even bigger fall. And following reforms, staff are more likely to alert managers when something has gone wrong, so system weaknesses are more easily identified. “The evidence is that their outcomes for patients are significantly better,” Kline said. Asked whether NHS organisations have “gone backwards” on these issues since 2000, Kline suggested many are distracted by funding problems: “As long as the pressure on resources is there, this is a bit of an uphill struggle – but that doesn’t make it any less important.” And strong leadership is more important than cash to successfully delivering reforms. “The fish rots from the head,” he said, “and if you can’t get leaders to take this on board, it’s a very brave manager who does so. What happens at the top is crucial: the leadership has to buy into this, and model the behaviours extensively”. Even with buy-in from the board, Kline acknowledged, enacting these reforms isn’t always easy. As an audience member pointed out, professional bodies

often run their own investigations into alleged malpractice – so even if an employer stops short of formal disciplinary action, professional bodies can “jump the gun, triggering a series of events regardless of what’s going on in the employer”. Kline was optimistic that professional bodies are starting to shift their position. “Having spent five years arguing with the NMC about this, I’m now persuaded that they’re serious about adopting a similar approach,” he said, adding that the General Medical Council “in different ways, is trying to move in a similar direction”. Meanwhile, Kline noted that senior managers are increasingly protecting themselves from disciplinary action – for example, by closing services when shortages of staff or resources create the potential for mistakes. “The chief executive at Portsmouth has said that they’re going to take a financial hit rather than run the risk of running unsafe services,” he said. “The nursing director at Hull and East Yorkshire last week closed an orthopaedic ward, and said: ‘I’m not prepared to run any ward with less than two registered nurses on it’.” That decision is “absolutely right”, Kline said, “because case law on duty of care makes clear that whatever you do, you must be able to do it safely. Better to do what you can safely, than to try to do everything and have something go wrong – because it’s the manager who

gets the blame.” Against this dark background, Kline insists he is “a bit optimistic, because nowadays there are more people at senior level that understand some of this. And there are a number of trusts – if not many and not enough – who understand it”. Along with NHS Resolution and the NHS Litigation Authority, Kline explained, he’s gathering evidence to support more widespread change. Early next year, he intends to publish a paper on the experience of trusts who’ve adopted a disciplinary triage approach. “I think that will make it much easier for people like yourselves to say: ‘If they can do it, why can’t we?’” The current approach may provide short-term protection for trusts by loading the blame for errors onto individuals. But in the long term, the costs are shared between innocent staff whose careers are ruined, NHS bodies which lose experienced managers and damaged staff engagement, and the patients put at risk by continued systemic weaknesses. “It really is time that the NHS looked at the literature and learned that we need accountability, but without blame,” concluded Kline. “We need interventions that work, rather than simply ticking a box.”

Matt Ross is a journalist, change manager and adviser to MiP. healthcare manager | issue 36 | winter 2017-18

PROTECTED CONVERSATIONS

legaleye With more and more people leaving the NHS under settlement agreements, managers need to know what can and can’t be said. Iain Birrell explains the rules about so-called ‘protected conversations’. Being able to talk candidly about sensitive issues, such as dismissal, is a basic necessity for members of staff and employers. So it’s important for managers in the NHS to understand the rights and responsibilities of both employer and employee in what are often called ‘protected conversations’. In 2013, new rules were bought in which allow employers to talk to their staff off the record about whether they might be interested in leaving under a settlement agreement (see below). The new rules mean that, in most cases, employers are protected from having what they say during these negotiations raised in unfair dismissal claims at employment tribunals. The 2013 rules do not, however, give employers complete freedom to say or do whatever they like during these conversations. There are number of important points to consider when considering the option of a protected conversation – either as a manager or as an employee. How has the law changed? Before protected conversations were introduced, employers could speak to employees on what was known as a ‘without prejudice’ basis. This meant that anything discussed could not be used as evidence in any subsequent employment tribunal. However, the conversation would only gain that confidential protection if it was held as part of a negotiation process that made genuine attempts to settle an existing dispute. If there was no existing dispute, then the conversation could not be held ‘without prejudice’, and the worker would be free to raise the 20

healthcare manager | issue 36 | winter 2017-18

KEY POINTS ABOUT SETTLEMENT AGREEMENTS ■■

Settlement agreements are legally binding contracts that waive an individual’s rights to make a claim covered by the agreement to an employment tribunal or court

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The agreement must be in writing

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They usually include some form of payment to the employee and may often include a reference

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They are voluntary

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They can be offered at any stage of an employment relationship

content of the conversation at an employment tribunal in the future. With ‘protected conversations’ there is no need for there to be an existing dispute – an employer can talk ‘off the record’ to workers almost whenever they like. Employers can open pre-termination discussions safe in the knowledge that the details of that conversation cannot be used by the worker in most unfair dismissal claims before an employment tribunal. Protection for employees Under the legislation, workers still have some rights in respect of protected

conversations. Ensuring all parties know their rights and responsibilities will help you to bring negotiations over a settlement agreement to a successful outcome for everyone involved. Conversations are only ‘protected’ in the context of ‘ordinary’ unfair dismissal claims. In cases involving discrimination or automatic unfair dismissal, the protection does not apply and the discussions can be used as evidence at an employment tribunal. Only conversations relating to ending the employment relationship are protected – so any prior conversations about performance or disciplinary issues, for example, could still be raised at a tribunal. Finally, if there is any improper behaviour by the employer during the discussions, the protection is broken. Improper behaviour includes putting unfair pressure on workers to leave or accept a settlement agreement, and any form of harassment, discrimination and victimisation. Employers attempting to make a settlement agreement should follow the recommended procedures to make sure they enjoy the benefit of protected conversations. Acas, the government’s dispute resolution service, offers a helpful guide on settlement agreements which sets out detailed examples of what constitutes improper behaviour by employers. The guidance is available online at acas.org.uk/settlementagreements.

Iain Birrell is the national case management coordinator for Thompsons Solicitors’ Trade Union Law Group. For more employment law advice and expertise, visit thompsonstradeunion.law. Legaleye does not offer legal advice on individual cases. MiP members in need of personal advice should immediately contact their MiP rep.

TIPSTER

Talking to MPs Following MiP’s successful parliamentary reception on in October, James Noble offers ten tips to help you get your story and MiP’s message across to your MP. 1. TREAT MPs AS HUMAN BEINGS

7. TALK ABOUT NHS STAFF Tell your MP about staff shortages at your organisation and how they affect patient services. Don’t be afraid to talk about pay: emphasise that all NHS staff, including managers, deserve a proper pay rise after years of falling living standards. And tell them about MiP’s long-standing support for a better deal for the low-paid and unqualified staff who deliver most health and social care.

There’s nothing odd about MPs. Just like you, they’re human beings doing an oftendifficult job. You don’t have to call them Sir or Madam and you don’t have to curtsey or bow. Don’t be nervous: they are your representatives in parliament, whether you voted for them or not, and it’s their job to listen to you.

2. GIVE THE LOCAL PICTURE Most MPs will know about headline NHS issues and will quote national statistics that support their party’s position. But they probably know a lot less about the local picture. Talk about what’s actually going on in your hospital or organisation and how it affects your work. The NHS is always a big election issue locally, so get their attention by telling them something they don’t know about how national policies affect staff and patients in their constituency.

8. TALK ABOUT GOOD MANAGEMENT

3. BE DIRECT BUT POLITE

Tell your MP about your work looking after scarce NHS resources and planning essential services. Talk about being on-call, about the improvements and innovations you’ve introduced and the money you’ve saved. Talk about how difficult it is to redesign services with no money and little support from politicians.

You probably won’t have much time with your MP, so be direct and get your points across as crisply as possible. But stay polite, even if your MP is unsupportive. Labour and SNP MPs are more likely to be sympathetic to trade union concerns, but won’t always be supportive towards managers. Conservative MPs are more likely to listen to concerns about government policies if you can give examples of how they affect your local services.

4. TALK ABOUT MIP Always explain what MiP is when you meet MPs. Emphasise that MiP is committed to working in partnership with employers, politicians and other unions to improve the NHS. Encourage them to use MiP to find out more about managers’ work and what’s happening in the NHS on the ground, and suggest they get in touch with MiP head office or meet with you and your colleagues locally.

Ask your MP to publicly respect and value managers as a vital part of the healthcare team, and to repudiate derogatory terms like “pen pushers” and “fat cats”. Make sure they understand that only 3-4% of NHS staff are managers, compared to 15% of UK workers as a whole. Ask them: with everything that’s going on, do you really think the NHS needs less skilled management?

9. TALK ABOUT YOUR JOB 5. TALK ABOUT FUNDING Explain why we need to devote more of our national resources to the NHS. Ask why British people deserve to have less spent on their healthcare than people in France or Germany. If we raised healthcare spending to the same level as those countries – around 11% of GDP – the NHS would have another £23bn to spend. Many MPs will not know this.

6. TALK ABOUT HOW WE USE NHS RESOURCES Tell your MP that MiP is fully committed to making the best use of the money we already spend on the NHS. Ask them to support managers who are managing change locally and working to deliver government policies on integration, community care and mental health. But emphasise that transforming local services requires investment and time.

10. ASK MPs TO DO SOMETHING If your MP is supportive, ask them to table a parliamentary question or talk to health ministers or shadow ministers in the tea room or around Westminster. Suggest they sponsor an Early Day Motion or provide a press quote in support of the work of NHS managers. Invite them to a round table discussion with your colleagues – most MPs visit local hospitals regularly, but ask when they last met the people managing healthcare in their constituency. James Noble is an associate director of Connect Public Affairs and an adviser to MiP.

healthcare manager | issue 36 | winter 2017-18

MIP AT WORK

BIRMINGHAM CCGs

Partnership for Brummies A new partnership agreement gives MiP full negotiating rights for members in one of England’s biggest CCGs, marking an important breakthrough for the union. Pete Lowe explains.

MiP has signed an important recognition agreement with the new Birmingham and Solihull Clinical Commissioning Group, one of the largest CCGs in the country. This is an important step forward for MiP as we expand our role in negotiating for members collectively across the NHS. Recognition agreements, or “partnership agreements” as they are often called in the NHS, are important because they give MiP the right to negotiate for members as a group, not just represent them as individuals. They also give MiP the right to take part in partnership forums and be fully consulted on a range of workplace issues. Birmingham and Solihull CCG was formed from the merger of three existing CCGs in the Birmingham metropolitan area, and comprises 95 GP practices. It’s currently operating in shadow form, and will assume formal powers in April 2018. Unlike many trusts, where MiP members are a very small minority of staff, we are a big player in CCGs and it was particularly important for us to 22

healthcare manager | issue 36 | winter 2017-18

secure full recognition rights in such a high-profile merger. The three component CCGs all had different approaches to negotiating with staff, and one didn’t recognise trade unions at all. But the Birmingham South Central CCG, where MiP vice chair Zoeta Manning is the local MiP rep, had a recognition agreement with MiP and UNISON, and a history of working in close partnership with trade unions. It was important for MiP to replicate that constructive working relationship as closely as possible in the merged CCG. We needed to convince all the organisations involved that it is in everybody’s interest to have a formal partnership arrangement. That’s what we’ve done. I believe we demonstrated that our approach to collective bargaining and individual representation has benefits for MiP members and for employers too – they know that members will get expert advice and support, and that MiP will help to resolve contentious issues in a timely and professional way. The partnership agreement builds on the legal rights that trade unions have by introducing aspects of best practice into industrial relations within the CCG. This means the employer commits to an open and transparent discussion on all workplace issues and to longer consultation periods on proposed changes than the legal minimum (usually just 30 days). Just as importantly, the agreement recognises the role unions play in making the organisation a good place to work, and gives MiP more scope to recruit and organise members – for example, by holding recruitment events, members’ meetings, and using the employer’s communication channels to advertise what the union is doing.

The agreement also establishes a partnership forum with representatives from all the unions – predominantly MiP and Unison. This is a place for local reps like Zoeta, and full-time officers like me, to formally discuss workplace issues with the employer. But the agreement also emphasises the importance of resolving problems outside the formal apparatus – it’s about building a constructive relationship that involves all parties and benefits all parties. To do all this, the agreement also grants “facility time” to local union reps – time off from the day job to represent members, go to meetings and negotiate with the employer. The new partnership forum will have its work cut out. The two big issues on the table are the consequences of the merger for members’ jobs, and the harmonisation of terms and conditions between the three existing CCGs. We are expecting the merger to lead to further reforms, and this probably means further merging of posts. We hope to avoid any redundancies, but some members are likely to face a change of role or workplace. The partnership agreement gives us the chance to be much more proactive since we will be much better informed and will be able to get involved at a much earlier stage. Bringing together local terms and conditions – such as grievance and disciplinary procedures, redeployment schemes and on-call arrangements – from the three CCGs could prove tricky. The partnership agreement will give MiP a seat at the table, so we can get the best deal possible for members – and for the CCG as a whole.

Pete Lowe is MiP national officer for the East and West Midlands.

MIP AT WORK

CASEWORK

The fall guy fights back MiP always supports managers who are victimised by their employers. Craig Ryan speaks to one senior manager about how the union helped to protect her from being made a scapegoat for leadership failures at her trust. Bullying and victimisation often result from employers looking for quick fixes and legalistic solutions instead of tackling the root causes of problems in the workplace. In the NHS, this can lead to individual managers being scapegoated when things go wrong. Just weeks after joining the board of a large acute trust on a short-term contract, Caroline (not her real name) was instructed to chair a disciplinary panel involving a senior member of staff. “My stomach did a bit of a flip because I knew none of the other staff wanted to touch it with a bargepole,” she recalls. “But it was made abundantly clear that I had no choice.” Caroline was supported by an external HR adviser and insisted the adviser was present for every meeting, telephone discussion and conference call. “My sense from the beginning was that the trust and its lawyers wanted rid of the individual,” she explains. “I thought, it’s my head on the block, so I want someone purely objective to advise me.” She adds: “Through every stage of the disciplinary process, the trust leant on me in various ways, some of them subliminal and some quite overt. The external lawyer was at every point trying to instruct me what to do, which made for quite a difficult relationship.” Caroline concluded there wasn’t enough evidence for dismissal and recommended a final written warning. But to her surprise, the outcome letter drafted by the trust’s solicitors pointed to the opposite conclusion. “The language was aggressive, the tone was wrong. There was hardly a sentence that was a fair reflection of my view coming out of the hearing,” she explains. Despite “a constant barrage of pressure”, Caroline insisted on drafting and issuing her own outcome letter, with advice

from her independent adviser, ACAS and an independent employment lawyer. She also raised concerns about the process with the chief executive and NHS Improvement. Shortly afterwards, the trust instructed another law firm to investigate Caroline’s “competence” as a director and the “validity” of her complaints about the process. “By that point I wasn’t eating, I wasn’t sleeping,” Caroline recalls. “I went to the doctor and he said, ‘I’ll sign you off work and you don’t ever walk back into that building again.’” Shortly afterwards, with a month left on her contract, Caroline resigned and contacted MiP national officer Jo Spear. Jo took over dealing with the trust and obtained advice from the union’s lawyers, Thompsons Solicitors. “Every single exchange I had with the trust was vetted by MiP and Thompsons, which gave me a huge amount of security and confidence,” says Caroline.

The individual at the centre of the disciplinary case then filed a tribunal case, making personal claims against Caroline. The trust’s solicitors threatened to run a “cutthroat” defence – essentially to concede the case but shift the blame onto Caroline personally – if she didn’t back their version of events when questioned. “It was the most Machiavellian situation I’ve come across in more than ten years working for MiP. I was speechless,” says Jo. After lengthy negotiations, the trust’s solicitors agreed to represent Caroline, but to stand aside in favour of Thompsons if they judged she had become a hostile witness. “This was a big win for us,” says Jo. “It’s was subtle change, but very important.” The tribunal case against Caroline was dropped before the hearing took place, while the trust’s internal review offered no criticism of Caroline and recommended that the trust accept her findings in the disciplinary case. Ultimately, Jo says Caroline was the victim of poor leadership and the trust’s failure to deal with the long-standing issues behind the disciplinary case. “They didn’t have the backbone to deal with it themselves. I’m absolutely convinced Caroline was brought in to give a veneer of independence to the process, and to be the fall guy for the tribunal case that would inevitably follow.” Caroline now works as a consultant and, partly as a result of her experience, is retraining as a psychotherapist with particular interest in workplace bullying. “What strikes me now is the degree of deliberate manipulation, isolation and control the trust management sought over me,” she says. “We hear about these situations in other relationships; I never expected to be talking about it in a healthcare management context.”

healthcare manager | issue 36 | winter 2017-18

THE SHARP END: WHISTLEBLOWING

In today’s NHS, we know it’s crucial to protect people who raise the alarm about poor patient care or incompetent staff. But it’s just as vital to avoid giving cover to people with axes to grind – as one innocent NHS manager discovered.

Whistleblowers need protection – but so do victims of malicious complaints

healthcare manager | issue 36 | winter 2017-18

JOHN LEVERS

ntil recently, I had a good career and an unblemished record as an NHS manager: I had spent three decades working my way up to a responsible senior job in a hospital trust. Then one morning I was summoned to see the chair, who handed me an envelope and had me escorted off the premises. What happened next was a miscarriage of justice that wrecked my career, did huge damage to my family, and cost the NHS an experienced manager. We have to find a better way to handle these matters. Three whistleblowers had made allegations about me and several other executives: I was accused of lacking integrity, being dishonest and negligent, bullying, and misusing funds. I was sent home whilst an exhaustive investigation was launched, and entered a process of slow torture. I wasn’t allowed to talk to anyone in the trust, so I felt very isolated. People always think there’s no smoke without fire, and I started to think that people in my community were giving me a wide berth, which was very upsetting. It was several months before I was interviewed, and then I was questioned for hours. I felt bullied, intimidated and powerless; I ended up taking medication for high blood pressure and anxiety. After more than a year, I was completely exonerated: “no case to answer”, the investigators said. The trust’s statement explained that three people would face disciplinary action, while the fourth – me – would “return to work”. But it’s not that simple. My wife had kept the family going whilst I struggled through the investigation. But when the decision came through, she broke down; she was so angry about what we’d been put through. The handling of the announce-

ment didn’t help: it was several weeks before the trust issued a press release and a staff email naming me as innocent, and no apology was offered. The trust required taxpayers to pay hundreds of thousands of pounds for legal advice, whilst I had to borrow to pay legal bills I’d incurred challenging errors in their handling of the investigation. But the trust maintains it was my decision to seek advice, so they won’t cover my costs. Their attitude was: “You’ve kept your job: what’s the problem?” Indeed, I did have a job – but everything had changed: my office, my role and my boss were all different. And because the whistleblowers had retained their anonymity, I constantly wondered if my colleagues were among my accusers. I might have been sitting next to one of them. I’d lost all trust in those around me. So I found it very hard to go back,

and I had bad days there. I was suffering from depression, and eventually I was offered a secondment out of the trust. My new role is helping me to recover – but the horrible experience of being investigated, and the insensitive way in which I was brought back into the trust, had a huge effect on me. The damage has been done, and I don’t think I could ever be as committed or effective in an NHS job again. I’ve written whistleblowing policies myself, and know how important it is to give people a safe way to report legitimate concerns. But the trust’s current policy allows people to lie maliciously about their colleagues without ever being held to account. And there’s no support for innocent victims: I was treated from the start as if I was guilty, and when I was exonerated no effort was made to restore my good name. It takes courage to speak out about bad practice in the NHS, and we’ve a long way to go in terms of giving people the confidence to raise the alarm. But meanwhile, we need to protect the innocent victims of malicious accusations. The trust is consulting on a new whistleblowing policy – but it does nothing to encourage whistleblowers to ensure that allegations are well-founded, or to hold accountable those who use the system to settle scores. For the foreseeable future, the NHS has lost a hard-working and experienced manager. What matters now is that no innocent NHS employee ever has an experience like mine again. But as things stand, sadly, that’s far from guaranteed.

The Sharp End is your chance to tell politicians and civil servants how their policies affect your work and your organisation. This story was also published in the Guardian. To work with a reporter on your own story, email thesharpend@healthcare-manager.co.uk. When requested, anonymity is guaranteed.

Our pledge to you

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Thompsons Solicitors has been standing up for the injured and mistreated since Harry Thompson founded the firm in 1921. We have fought for millions of people, won countless landmark cases and secured key legal reforms.

We have more experience of winning personal injury and employment claims than any other firm â&#x20AC;&#x201C; and we use that experience solely for the injured and mistreated. Thompsons pledge that we will: work solely for the injured or mistreated refuse to represent insurance companies and employers invest our specialist expertise in each and every case fight for the maximum compensation in the shortest possible time.

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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 UKâ&#x20AC;&#x2122;s healthcare managers. Join MiP online at miphealth.org.uk/joinus

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