Using research to shape and improve NHS services – join the SDO Network The Service Delivery and Organisation (SDO) Network supports NHS managers to use research to improve and develop the services they manage. •
and new NHS managers to support them in developing leading-edge services.
• Member services include: events which bring together the latest learning from research and the experiences of front-line NHS managers, action learning sets, chief executives forum, academic fellowship placements and support in conducting and sourcing the latest research. • Membership is free, join the SDO Network today.
“Managers need to have a far greater awareness of research if they are truly to Mike Cooke, Chief Executive, Nottinghamshire Healthcare NHS Trust
“Exposure to research strengthens managers’ ability to successfully innovate.” Ron Kerr, Chief Executive, Guy’s and St Thomas’ Foundation Trust
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SDO Network is funded by SDO (Service Delivery and Organisation Programme) which is part of the National Institute for Health Research
issue 4 winter 2009
healthcare manager inside heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Mark Fox, West Cumberland Hospital inpublic: Somerset Partnership Foundation Trust
letters & comment:8 Sue Slipman from the Foundation Trust Network argues that FT’s need to be freed
published by
Managers in Partnership www.miphealth.org.uk 8 Leake Street, London SE1 7NN | 0845 601 1144 Managers in Partnership is the trade union organisation providing support and advice to senior managers in healthcare in the UK on employment matters, careers and management practice. We represent their views to policymakers, employers, the media and the public.
features:10 Deep Greening the NHS Taking great care: Interview with Cynthia Bower Your pensions choice explained MiP survey results
regulars:20 Legal eye: Landmark equal pay case Tipster: improving your public speaking MiP around the UK: Yorkshire & Northern Ireland
backlash:24
Welcome to issue 4 of healthcare manager the magazine from Managers in Partnership, the trade union organisation representing managers in health and social care. This issue coincides with our third annual conference, where healthcare managers from across the UK meet and share news and views with each other, politicians and other movers and shakers in the world of healthcare. A perennial issue for discussion at our conference is the regulation of health services. In this issue Cynthia Bower, chief executive of the Care Quality Commission, explains how she’s improving on the previous regulatory regime. And Sue Slipman from the FT Network gives her opinion about setting FTs free. I hope they find time to look at our survey, which has some useful comments from healthcare managers about efficient regulation – the heads up on the survey report is in this issue. Also providing food for thought, we hear from the NHS sustainable development unit about their scenarios for the future. And as usual, we have a legal update, tips and advice on career development and news from around the UK. Do let us know if you have any comments on these or any other articles. Finally, best wishes to you from the MiP team for 2010 – may it be happy and healthy.
Marisa Howes Executive editor
issue 4 | winter 2009 | healthcare manager
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HEADS UP
heads up what you might have missed and what to look out for
Leadership awards
Top mentors line up for MiP award MiP is sponsoring the award for ‘Mentor of the Year’ as part of the NHS Leadership awards. The judging panel has chosen three finalists from a high calibre pool of nominees, and the winner will be announced at a special awards ceremony on 25 November. MiP’s chief executive Jon Restell is one of the judges. He said: ‘We want these awards to be different. We want them to be more than just a nice trophy to put on your shelf. We want them to be about shared learning and spreading good practice throughout the NHS. ‘MiP was delighted to sponsor the award for Mentor of the Year. Our experience tells us that mentoring is one of the most effective and rewarding methods of nurturing the leaders of the future. It is rewarding for the individual being mentored, in developing their confidence and skills, and for the mentor, in helping them to reflect on their experience and apply it to new circumstances. It is going to be a tough choice to select a winner.’
healthcare manager issue 4 | winter 2009 published by MiP All copy © 2009 MiP, or the author. Opinions stated are not necessarily those of MiP.
Clinical director for paediatrics, St Helens & Knowsley Teaching Hospitals NHS Trust ‘Laweh has mentored over 50 doctors and, as the first black consultant to be appointed to the trust, 17 years ago, he is a role model to other BME staff. Described by his many mentees as an incredible inspiration, always approachable and hugely supportive, Laweh is deeply committed to the constructive development of others, providing career guidance, motivation and instilling a positive energy among his team to achieve excellent patient care.’
Dr Jagdeesh Dhaliwal
West Midlands GP and programme director of the West Midlands leadership programme for primary care ‘Jag personally mentored me and 5 other ‘Champions’ to help us roll out a leadership programme. Jag acted as a guru, a touchstone, a challenging leader and an absolute inspiration to us all. The group fizzed with energy and commitment. Most important it has delivered, Jags inspiration is measured in concrete outcomes projects and innovations across the West Midlands. His personal commitment and mentoring style allowed the Champions to function in a challenging and inspiring way together and in their own groups creating a cascade of enthusiasm, motivation and personal investment.
Becci Martin
Mental health nurse at Greater Manchester West Foundation Trust and scheme manager for the North West Mentoring Scheme. ‘Becci has been a great pioneer for mentoring within the NHS. As a scheme manager for the mentoring scheme [she] has practiced what she has preached with fantastic results. She has been a supportive mentor to several individuals, including myself and she has been extremely encouraging and inspirational to all of us. She leads by example and ensured that I received her support whenever I required it and provided me with a safe environment to explore my concerns and issues. Without her support and encouragement I would not be where I am today.’
Executive Editor
Contributors
Cover picture & pages 13-14
Marisa Howes m.howes@miphealth.org.uk
Cynthia Bower © Peter Searle 2009
Associate Editor
Mike Foster, Marisa Howes, Helen Mooney, Alison Moore, Jon Restell, Craig Ryan, Martin Shovel, Sue Slipman, Caroline Underhill
Craig Ryan editor@healthcare-manager.co.uk
Print Broglia Press, Poole
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020 8532 9224 adverts@healthcare-manager.co.uk
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Dr Laweh Amegavie
issue 4 | winter 2009 | healthcare manager
healthcare manager is sent to all MiP members. All weblinks mentioned are at www.miphealth.org.uk/hcm
HEADS UP
leading edge Jon Restell, chief executive, MiP Much talk about how to drive productivity in the NHS concerns attacks, of varying ferocity, on the super-massive bloated bureaucracy, slashing the back office and keeping the clinical frontline safe and secure. There’s nothing wrong with shining a light on management costs and reviewing management practice. Since the great shake-up of PCTs three years’ ago, MiP members have always been prepared to debate honestly and openly that sometimes we might be doing the wrong jobs in the wrong places. But the public debate must be balanced and informed. It is not yet there. For example, the savings to be made from management and administration (if done properly – not guaranteed) might add up to hundreds of millions of pounds. But, which ever way you look at it, this money will not be anywhere near enough to deliver ‘the productivity challenge’. The debate
CRB checks
New scheme toughens staff vetting New measures coming into force this autumn to protect children and vulnerable adults are likely to have significant implications for healthcare managers. The new Vetting and Barring Scheme (VBS), which came into force in October, will provide more comprehensive and consistent protection for vulnerable groups in England, Wales and Northern Ireland. A separate scheme will cover Scotland but information will
“The debate swerves past the really big decisions about how we organise services. In other words, the public is being sold a pup.” swerves past the really big decisions about how we organise services. In other words, the public is being sold a pup. MiP is injecting three points into the debate. First, managers are not bureaucrats. The present failure to tell bureaucracy from management seriously undermines the credibility of managers, both with other staff and with the public, besides depressing the capacity of managers to deliver
be shared and barring will be recognised in any part of the UK. The new Independent Safeguarding Authority (ISA) will making barring decisions and all applications to the scheme will be administered by the Criminal Records Bureau (CRB). Robert Quick, a deputy director at Barnsley Hospital Foundation Trust and a member of MiP’s interim national committee, has been representing NHS Employers on the National CRB Consultative Committee for the health and social care sector for England and Wales. ‘In my own trust we decided over two years ago to extend
productivity. Every attack on bureaucracy must come with support for high-quality management. Secondly, we need a more sophisticated understanding of what the ‘front-line’ is. Non-clinical jobs are a critical part of the modern healthcare team. To think otherwise will take us backwards in delivering quality services. Finally, it is vital that the healthcare team sticks together. The pressure will mount on the money, services and staff. The risk is real that staff groups will try to blame each other or seek special treatment. We must protect the progress made on cultural change – which is undeniably fragile – for example between medics and managers. We might all have different skills, experience and knowledge, but, whatever our job, we are all here for safe, effective and dignified healthcare.
the scope of CRB checks to all staff who work with patients – as all NHS patients are deemed to be “vulnerable adults” – rather than only checking those staff who’s work brings them into contact with children,’ said Quick. ‘We took this a step further and rather than just check new staff, we did a retrospective CRB check on all staff who worked with adults and children.’ The new machinery will establish the toughest ever vetting and barring scheme, placing the decisions in the hands of independent experts, while widening the workforce covered by automatic barring of people recently convicted or cautioned for serious
offences. When fully implemented in July 2010, the scheme will cover more than 11 million people. Anyone who wants to work or volunteer with children or vulnerable adults in a regulated activity will be legally required to register with the ISA. Barred individuals will be committing a criminal offence if they seek employment or volunteer in regulated activity and all employers and public bodies will have a legal duty to refer appropriate information to the ISA. For further information see the links on our website at www.miphealth.org.uk/hcm.
issue 4 | winter 2009 | healthcare manager
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HEADS UP
Mental health
MiP backs Positive Mental Attitude sports trust More than 50 people came together to celebrate World Mental Health Day on 16 October by competing in a miniOlympic Festival at the Mile End Stadium in east London. The one-day even was organised by the Positive Mental Attitude Sports Foundation (PMA), a partner organisation of MiP, which uses sport as a therapeutic tool to aid the recovery and social inclusion of people with mental health problems. Competitors from across London and Surrey competed in a range of badminton, table tennis and sprinting events, with the winners going on to represent the London and Surrey region in the national final in Sheffield at the end of November. Teams from across the capital also competed in the PMA ‘World Mental Health Day‘ London region football competition on nearby Wanstead Flats. Hounslow Hawks defeated Newham FC 4-1 in the final to take the London cup, and will go on to compete against teams from Yorkshire, Surrey, Wales and the North East in the Sheffield event. Janette Hayes, founder of the PMA trust, said: ‘We are delighted with the
MiP 2010 subscriptions Members who joined MiP after 1 June 2005 pay MiP subscriptions, as set out in the table. Members who transferred into MiP from FDA or UNISON when it was launched on 1 June 2005 (founding members), pay the relevant rate of the partner union from which they transferred. MiP subscriptions are proposed by MiP’s management board, in consultation with MiP’s national committee, and approved by the FDA annual delegate 4
Members of PMA Football League pictured with the founder Janette Hynes, MBE (centre) and Baroness Molly Meacher, Chair of East London Foundation Trust.
success of today’s competition. The turnout has been fantastic, representative of all the multi-cultural communities across London, and we have discovered some very impressive and talented sports people.’ Hayes, an ex-professional footballer, founded the Positive Mental Attitude Sports Foundation Trust in 2003. The trust works in partnership with health and social care services, local councils, and other community groups, particularly to provide sporting opportunities for people who have left hospital after
conference. All subscription enquiries should be made to MiP head office. All subscription rates shown in the table come into effect on 1 January 2010.
Tax relief on MiP subscriptions As a healthcare manager, you may be entitled to tax relief on your MiP subscriptions under an agreement reached by UNISON. For more information log into the members’ page of the MiP website: www.miphealth.org.uk
issue 4 | winter 2009 | healthcare manager
treatment for mental health problems. MiP chief executive Jon Restell said PMA is ‘a fantastic idea that’s had a huge impact on the way in which mental health patients and service users are treated. MiP would encourage members to help support it by making a donation towards the cost of the Sheffield event. Details are available from the PMA website. For more information on the PMA Sports Foundations Trust and details of how you can help, visit www.leaguewebsite.co.uk/pmafl or email janette@pmasports.com
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HEADS UP
inperson
“We work hand in hand with medical staff on the wards, looking at infection control.”
Mark Fox: t echnical microbiology lead at West Cumberland Hospital, part of North Cumbria University Hospitals Trust.
Mark Fox has worked as a microbiologist for the last twenty years both in the NHS and in the private sector after gaining an applied biology degree. He has worked in a veterinary laboratory, in the food industry and for the Health Protection Agency. For the last ten years Mark has been working at North Cumbria University
TUPE Transfers
Partnership forum launches staff passport The NHS Social Partnership Forum has launched a new staff passport for health workers facing transfer to another employer. The staff passport aims to bring clarity and reassurance to staff being transferred to another NHS organisation or a company working under
Hospitals Trust, dealing with and helping to prevent infection in patients. ‘Microbiology helps in dealing with infections in patients. We work directly with medical staff to make sure that they are using the current microbiological anti-virals in practice,’ Mark explains. His job at the trust is varied and includes co-ordinating the microbiology team and providing information to managers about infection control as well as auditing the trust’s infection control practices. ‘We work hand in hand with medical staff on the wards, looking at infection control audits and turnaround times, and we also develop bespoke improvement programmes,’ he says. As one of the microbiology leads, Mark was involved in both the national and local review of pathology which fed into the government’s recent review. However, he also works on the frontline which means, for example, he could be ‘on call at 3am looking at spinal fluid to check for meningitis’. He says that the job of a microbiologist in the NHS, as in many
contract for the NHS. The passport gives staff facing transfer an easy-to-use, practical guide to the employment standards and rights they can expect when being transferred. It also gives HR advisors, union reps and managers an online advice tool they can use to advise staff facing a transfer. The passport was agreed by the NHS Social Partnership Forum, which brings together unions, NHS employers and the Department of Health to discuss workplace issues.
other professions, now means ‘juggling an ever increasing workload with financial pressures’ and he is looking at both the skill mix of staff and the ‘mechanisation’ of jobs. ‘Some people call it modernisation – that machines can now do some of the jobs that people were once employed to do – but it is also mechanisation.’ Government targets for MRSA and C.Difficile have also changed the pattern of testing for NHS microbiology teams, Mark says, and the decision to test all elective patients for MRSA – and extend this to all admissions by 2011 – has also increased the workload. Mark has been a member of MiP for the last two years having previously been involved in UNISON. ‘I have been given the role of MiP link member at the hospital... I think there has to be a balance in everything in terms of working relationships, and I am a great believer in compromise. If either the unions or management are too powerful everything gets too polarised,’ he explains. He says that staff and management have to work together to form a strong relationship which puts patients’ interests first. Helen Mooney
‘The staff passport ensures that staff are aware of their rights on and following transfer,’ said UNISON lead negotiator Mike Jackson. ‘Knowledge is the key to ensuring those rights are embedded by commissioners and respected by future employers.’ Gill Bellord, director of pay, pensions and employment relations at NHS Emplyers, added: ‘For the first time, comprehensive information on transfers is brought together in one place. We hope that the passport will be welcomed by
NHS staff and their employers.’ The passport applies only to NHS staff working in England and sets down only the minimum standards and rights that will apply after transfer. It is not meant to replace discussions between employers and trade unions about the transfer of staff to new organisations. The staff passport is available through the SPF website. Go to www.miphealth.org.uk/hcm for the relevant links.
issue 4 | winter 2009 | healthcare manager
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HEADS UP
Spending squeeze
Scottish managers face deeper cuts in 2010 David Cheskin/PA Wire/Press Association Images
“the NHS will be asked to yet again meet or exceed challenging savings targets... I will ensure that every penny saved is reinvested in frontline care.” Nicola Sturgeon Scottish Health Secretary
NHS managers in Scotland will face further cuts in their budgets next year after a dire warning about the state of the Scottish Government’s finances from the nation’s spending watchdog. Audit Scotland said the Scottish budget deficit would be between £1.2 and £2.9 billion by 2013-14, based on figures from the Scottish Government and the Centre for Public Policy for Regions at Glasgow
University. NHS Scotland is already committed to savings of 2% next year but now faces further cuts to tackle rising levels of debt. Last year, NHS Scotland reduced spending by £297 million, exceeding its target 2% reduction by £82 million. Scottish health secretary Nicola Sturgeon said she ‘made no apology’ for intensifying the ‘efficiency drive’ in the NHS. ‘This year and next, the NHS will be
asked to yet again meet or exceed challenging savings targets. In return, I will ensure that every penny saved is reinvested in frontline care. ‘I want to thank everyone in the NHS for the hard work they have done to meet these targets and continuing to deliver a first-class health service,’ she added. Claire Pullar, MiP national officer for Scotland, said the union was concerned
MiP video
Making a Big Difference in Leicester MiP has added a new video to its ‘Making Healthcare Happen’ collection. The video shows managers at NHS Leicester City working with the Big Difference Company (BDC) to reduce the number of teenage pregnancies in Leicester. BDC worked with local teenagers to help them write and perform a comedy video to get the message across.
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issue 4 | winter 2009 | healthcare manager
The project was a great example of partnership working, bringing together the teenagers, managers, comedians, health, teaching and social services professionals. All the participants found it an exciting and energising exercise. To watch the video visit the MiP website at www.miphealth.org.uk/videos.
about NHS Scotland having to contribute to further spending cuts. ‘Already NHS employers are expressing their concern and are expecting tough targets and challenging financial constraints. This is a time for strong leadership and top class management to move us forward and beyond the current financial debacle. But it will not be easy for those tasked with these roles.’
HEADS UP
inpublic Somerset Partnership NHS Foundation Trust
Somerset Partnership NHS Foundation Trust was authorised in May 2008. Originally formed in 1999 as the Somerset Partnership NHS and Social Care Trust, it was the first integrated health and social care partnership trust in England. The partnership brought together the Avalon NHS Trust – the mental health services provider for most of the county of Somerset – with some of the mental health services formerly provided in North East Somerset by the Bath and Wiltshire NHS Trust, and some social care services provided by Somerset County Council. As a partnership trust, it has an integrated management structure and county
council staff, mainly social workers, are attached to the organisation, but still remain employees of Somerset County Council. ‘By bringing together the NHS culture and the local authority culture we were able to give service users and their carers what they wanted – which is to be able to go to one place to get the service for all their needs,’ explains Diana Rowe, deputy chief executive and director of operations at the trust. Diana joined the trust from the local authority at the time of the integration. ‘One of the reasons we chose to form this partnership was that on the ground there were already very good working relationships between clinicians,’ she says.
However, she admits that there was ‘a lot of apprehension’ during the integration among both social workers and NHS staff. The trust provides a range of mental health services for the community, including mental and social care services for older people, adults, children and adolescents, and community based specialist health services for adults with learning disabilities. Andy Jones, a trained mental health nurse, corporate governance manager and MiP representative at the trust, explains that staff in the organisation work in multi-disciplinary teams. ‘There is fully integrated working between social workers, nurses and other
“Before the partnership there was insular working. Now we treat most people in the community.”
staff. Before the partnership there was insular working, and 80 per cent of clients were in-patients with 20 per cent in the community. Now it’s the other way round and we treat most people in the community,’ he explains. Andy says that the trust was also the first in the country to run a full electronic patient record system which meant information about patients can be accessed by staff both in the NHS and the local authority. Both Andy and Diana are keen advocates of the partnership model. ‘The way the service is structured means that we can help people to live as independently as possible, and that is the goal,’ says Diana. HM
issue 4 | winter 2009 | healthcare manager
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YOUR OPINION
letters
Letters on any subject are welcome. Please send to editor@healthcaremanager.co.uk or to 8 Leake Street, London SE1 7NN. We may edit letters for length. Name and address must be supplied, but you may ask for them to not be published.
to the editor Chris Sandwell and Mr Nyandera visiting a blind couple with six children. Termites were in the process of eating their home (made of mud) from around them.
My VSO experience I read with interest your feature about VSO in the summer issue (healthcare manager issue 2) and am writing to endorse the message that VSO is such a rewarding experience. I have just returned from a three-month contract in Uganda working for the Rwenzori Region Development Organisation of the Blind (RRDOB) as a management consultant. RRDOB have no funds but an inspirational chairman, Mr Nyandera John, who is also totally blind. He and he his fellow local volunteers are 8
fighting for equal rights for the blind of the region. The reason I did it was that I’d acquired lots of skills over the years as a manager in the NHS and thought myself very fortunate when you consider what you see and hear about the sufferings that go on in other parts of the world. VSO support you throughout the process from application to coming home, although they do not hand-hold you once you’re in place. At first I questioned whether the projects were at all viable given the lack of funds and interest from government officials. I could have packed up and returned home. But
issue 4 | winter 2009 | healthcare manager
I thought if I gave up that easily it would almost spell the end for this fledgling organisation. So I dug deep, started thinking laterally and, after some hard work, I left them with a portfolio of 21 projects to build their capacity and raise funds, all at nil cost. I also developed a website – www.rrdob. yolasite.com – complete with donation page and video of what they’re trying to achieve. Just two months after my return RRDOB have bought a laptop and printer, providing services for the local people in order to raise funds. They have secured another small office where they are teaching braille and mobility
skills. Several communities have set up rotational saving clubs and RRDOB has hosted a seminar across the six districts on sexual and reproductive health for the blind – a magnificent achievement by Mr Nyandera and his colleagues. I cannot begin to describe the abject poverty in which these people are living. Not to mention the constant dangers such as child sacrifice, disease and rebel conflicts which can spill over the border with the Congo at any given moment. My memories, however, will be of a warm, friendly people in the most beautiful part of the world I’ve ever seen, complete with rainforests, savannah and wildlife ranging from lions to gorillas. On leaving Uganda I told Mr Nyandera it was my belief that there was only one thing that set us apart and to a large extent mapped our destiny; not that he was blind but that he was born in Uganda and I was born in the UK. This is the lottery of life – people reading this have already won the jackpot but many will probably never realise it. CHRIS SANDWELL NHS BUSINESS SERVICES AUTHORITY
OPINION
comment
“The Government has accepted the case for loosening the binds on some FTs, now it needs to go further.”
Sue Slipman
Director of the Foundation Trust Network
Throwing the cap up in the air Foundation trusts are the future of the health service – they fuse the public ethos of the 60-year-old NHS with community-based enterprise that promotes a 21st century cooperative ethos. When foundation trusts (FTs) were created five years ago, there was an understandable wariness that they would stray from the NHS family and change their fundamental NHS nature of serving everyone in their local community. This has clearly not happened, but from the outset an arbitrary cap on so-called private patient work – commonly called the ‘private patient income cap’ – was imposed. This froze work outside a narrow definition of ‘NHS work’ at 2002-3 levels. For all mental health trusts that were not doing any work outside the NHS, this meant a complete bar on non-NHS work. So, for instance, when government funding to treat members of the London Transport Police and other emergency services after the 7/7 bombings ended, Camden and Islington Mental Health Foundation Trust could no longer provide this beneficial service, as income received directly from the LTP would count as private patient work. After a rigorous lobbying campaign, led by the Foundation Trust Network,
the Government has decided that it will allow mental health FTs to do up to 1.5% of their work outside the strict confines of the NHS. So, Cambridge & Peterborough, a mental health FT currently with a zero cap, which wants to create a unit for children and young people with brain injuries – typically caused by car accidents or other incidents where an insurance company would pick up the bill – can now begin plans. Acute trusts, meanwhile, are stuck at arbitrary historic levels, with some having much more flexibility than others. And in these times of trying to maximise funds for the health service this cap has inhibited opportunities to bring more resources into the health service. About three quarters of all FTs currently have a cap of 1.5% or less, and analysis by the Foundation Trust Network shows that raising the level of the private patient income cap would have the potential to bring in, on average, an additional £2.4 million to each foundation trust below the 1.5% level. The bar applies to many types of commercial activity such as joint ventures, services to charities and supporting government programmes. It
also undermines government initiatives such as a patients’ right to make top-up payments for cancer drugs and other treatments that the NHS will not fund. The Government has launched a review of the whole capping system and is taking evidence up to the end of the year. Many of the ways in which FTs are using so-called private patient funds or planning services bolster government policy. Liverpool Women’s FT, which has a cap of 1.8%, has a newly built fertility unit serving NHS patients and private patients – many of these are former NHS patients who have decided to self-fund further rounds of fertility treatment after they have exhausted their entitlement to NHS treatment, but who want continuity of care in the same hospital. The NHS is running out of time to prepare for the 2011 funding shortfall. There is no logic in losing out further. Foundation trusts should be able to use their financial and operating freedoms to bring additional resources into the NHS and to provide services that benefit individuals and organisations alike. The Government has accepted the case for loosening the binds on some FTs, now it needs to go further and change the rules for all FTs.
.
issue 4 | winter 2009 | healthcare manager
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SUSTAINABILITY
Alison Moore looks into the future and sees how the shift to low carbon healthcare could be the greatest challenge facing the NHS.
Think about sustainability and carbon emissions and do you think about changing the light bulbs, turning down the central heating and introducing a bus service to your hospital? A new report from the NHS’s Sustainable Development Unit, Fit for the Future, aims to show that the consequences of living in a low carbon economy will be far more profound than this: they will affect the sort of society we live in, and every aspect of how we live our lives, including the healthcare services provided by the NHS or other organisations. This thinking goes far beyond the carbon-reducing initiatives that many
“It will make them think about what a sustainable health service looks like – not just lagging the pipes and car parking” Sonia Roschnik, Operations Director, SDU 10
issue 4 | winter 2009 | healthcare manager
hospitals and PCTs have already taken, and asks those at the top of NHS organisations to take the lead in preparing our healthcare system for a low carbon economy and helping to shape the sort society we will live in. The NHS will need to drive cultural shifts towards healthy lifestyles and acceptance of lower carbon technologies – such as “telehealth” – just as much as it will need to reduce its own emissions. The starting point for this thinking is four fairly grim scenarios of what the future could be like in a low carbon economy in 2030, outlined in the SDU’s report. ‘We recognised that we needed to
think on how this was going to impact on our model of care,’ says Sonia Roschnik, operations director of the SDU. ‘We hope that people will read it with interest. I think it’s a different way of posing the question. We hope it will make them think about what a sustainable health service looks like – not just lagging the pipes and car parking. ‘When we looked at the modelling for carbon in the NHS we realised it was so big that just continuing business as usual and having better transport and buildings was not going to be enough,’ she adds. The scenarios assume that Britain has been forced to move to a low carbon economy. But how we adapt to that – how quickly and with what approaches – will be paramount in determining what our society will look like, the report says. Some of the scenarios outline very individualistic and consumerist societies, with poor public provision of healthcare but technological solutions available to those with the means to pay. There is a reliance on ‘quick fix’ solutions and less interest in healthy lifestyles. Other visions of the future are more positive – with the public
SUSTAINABILITY
interested in wellbeing and community support – but even these will still be challenging. Innovation in healthcare may slow down and even halt. But what can the NHS do to influence the wider community in moving towards the more palatable end of these possibilities? ‘If we start to demonstrate that we are taking this agenda seriously it will be a huge influence on people,’ says Roschnik. ‘It’s the way PCTs and GPs manage their services and do it in a sustainable way, I think that will influence people… I think it’s also about engaging in some of the difficult decisions we may have around this.’ One challenging aspect is getting the NHS to think over a 20-year timescale, rather than meeting more immediate targets. ‘It does require not thinking about the next 12 to 18 months but thinking about 10 years ahead. I think we are not always very good at doing that in the NHS,’ she adds. But there are carbon emission targets in the short term which the NHS will have to address – the aim of reducing emissions by 10% by 2015, for example – which may help. Even doing this would be a massive achievement as it would require the NHS to stop the upwards trend of carbon use – which has increased by 40% since 1990 – sustain this and start on a downward trend. But for many NHS managers, these long-term goals may be difficult to take on board when immediate concerns seem more pressing. MiP chief executive Jon Restell says the first challenge for managers will be to become acquainted with the issues and understand what a low carbon future means for healthcare. At the moment, carbon is unlikely to be their number one priority but there are areas where preparing for a low carbon future will coincide with other drivers of change in the NHS, he says, such as the quality agenda or even saving money. Reducing emergency admissions and keeping people with long-term conditions in their own home, for example, could reduce emissions and save money.
Green routes Five key steps towards a low carbon healthcare system
1 Support people in taking responsibility for their own health. Prevention and healthy lifestyles will free up resources. 2 Build greater acceptance of information technology as a tool in healthcare provision. Cultural change is needed for low carbon alternatives such as telehealth to become more generally accepted. 3 Find the low carbon/high quality of life ‘sweet spot’. Low carbon lifestyles can have benefits for people’s health and avoid some of the diseases of affluence, as well as being good for the environment. 4 Spend far more on prevention and public health to help future-proof services against long-term pressures on public spending and higher carbon costs. Spending on this needs to rise from 4% of NHS income to 20%. 5 The healthcare system needs to take a leadership role in bringing about radical change in order to reduce carbon emissions and build resilience to climate change.
Encouraging people to develop more active lifestyles which could reduce chronic diseases and demand for healthcare in the long-term is already a crucial part of NHS policy. Pharmaceutical procurement accounts for a significant slice of carbon emissions – and also of NHS budgets. ‘We need to make sure that when we consider drugs we consider environmental impact as well as cost and outcome,’ says Roschnik.’ There could be savings from reducing drug wastage, for example. Jenny Griffiths, a sustainability consultant and lead editor of the Health Practitioners Guide to Climate Change, says it is important to enmesh sustainability within the mainstream agendas of NHS organisations – including finance and productivity where there are ‘win-win’ situations. She suggests boards should be looking at these issues in their strategic planning and on ‘away days’ and that staff should be empowered and enabled, as many will have ideas on reorganising their work. But she points out there are other reasons to take the sustainability message on board. Many private sector companies have done so – sensing a shift in public attitudes – and there is some evidence of an association between high performance in foundation trusts and the extent to issue 4 | winter 2009 | healthcare manager
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SUSTAINABILITY
“There is a lot of evidence around that can help commissioners move that agenda forward – people have to be brave about it” Jenny Griffiths, Sustainability Consultant which they have embraced sustainability. The need to manage their reputations may require NHS organisations to take sustainability seriously. And there is a legal imperative too: the UK Climate Act 2008 commits the country to reducing emissions by 34 per cent by 2020. It is likely that NHS organisations will face pressure to ‘do their bit’ and make reductions of a similar magnitude. Some NHS organisations have taken up the baton. Around 50 have signed up to the 10:10 pledge, promising to reduce emissions by 10% by the end of 2010. NHS Norfolk is also putting carbon reduction into its tendering and contracting with health providers, and is involved in a local carbon futures forum – an example of how an NHS body can start to lead the local community. Medway Hospitals Foundation Trust holds ‘energy weeks’ for visitors, patients and staff with displays and demonstrations on environmental and energy saving issues. Paul Evans, environmental manager at Medway, says it can encourage people to make the link between climate change issues and the health of the local population. But the financial climate will bring challenges, says Norfolk’s director of corporate services Jonathan Cook: ‘We anticipate tough times which may well squeeze our “invest to save” plans and capital schemes, such as further replacement of oil boilers and the introduction of technology such as modern metering, will be more difficult to achieve.’ 12
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But financial pressure could help the shift towards telehealth and reduce travel – it is already encouraging staff to work remotely, to conference call and to cycle to work. Telehealth is being used with people suffering from long-term conditions, and in care homes and prisons, and there is some evidence it can reduce hospital admissions and clinician visits, which could make it a low carbon alternative. But the greatest challenge for the NHS may be the suggestion that 20 per cent of its budget should be put into prevention and public health - a five-fold increase over current levels and, inevitably, would involve moving money out of acute services. Such a bold move would have been difficult even during the years of significant growth in NHS budgets, but looks even harder now. Griffiths, a former health authority chief executive says: ‘Public health
interventions are often incredibly costeffective. Somehow we have to persuade people to really invest in prevention and public health, and switch money across to it. There is a lot of evidence and guidance around that can help commissioners move that agenda forward – people have to be brave about it.’ ‘However tough the decisions, there is a need to get to grips with the carbon agenda. The real need for health is to be ahead of the game,’ adds Restell. ‘We can’t predict which of these scenarios will come to pass but we do know we can’t afford to be a carbon-wasteful organisation.’
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Alison Moore is a freelance journalist. The report ‘Fit for the Future’ is available at www.sdu.nhs.uk.
INTERVIEW
Craig Ryan talks to CQC chief executive Cynthia Bower about the new regime awaiting healthcare providers next spring.
Cynthia Bower is very busy. For a top public official, her office on the fifteenth floor of Finsbury Tower in London is busy too (messy would be impolite). She talks fast, with surprising sincerity and passion, in her distinct Nottinghamshire accent. She packs a lot into our short conversation. Her job as chief executive of the Care Quality Commission (CQC) is ‘fantastic’, she says, ‘an opportunity to work with people who use services, clinical and other professional staff, and groups that lobby on health and social care, and to shape quality and how it’s judged. And to make sure we do what everyone knows is right – focus on outcomes for people who use services and give them a stronger voice. The only thing that’s wrong is there aren’t enough hours in the day.’ The CQC took over the functions of the Healthcare Commission and the Commission for Social Care Inspection (CSCI) in April. Bowers’s ‘overwhelming priority’ is to put in place a whole new regulatory framework for health and social care, bringing in providers like dentists and GPs who were never part of the Healthcare Commission’s regime.
‘We have to bring it in a way that makes sense to people who use services and which… is recognised as a system that drives improvement,’ says Bower. ‘But it must also be something that providers themselves recognise as a good lever to assist them in improving the quality of care, because there’s no other reason to be doing this.’ From April next year, trusts and other providers will have to register with the CQC as private sector providers have done in the past. Social care services will be brought fully into the fold from October 2010. Bower insists the CQC’s model of regulation will be ‘entirely different’ from those of the Healthcare Commission and the CSCI. The Healthcare Commission’s ‘big brain’ approach put intelligence and data gathering at the heart of regulation – ‘a strength we want to build on’, says Bower – while CSCI’s heavily inspection-based model was controversially caricatured by CQC chair Barbara Young as ‘running the finger round the toilet bowl’. ‘We’re working to ask what model we want and what’s going to be our particular balance between selfassessment, intelligence gathering and
inspection. Because, essentially, all regulators do those three things,’ Bower explains. The details are still being thrashed out, but we know it will be an ‘outcome’ based system, using 16 quality standards set by the government – covering such diverse things as patient care and welfare, nutritional standards, infection control and staff management. She says her team have spent a lot of time talking to service users and carers about what they want from the new regulator. ‘If a standard says “dignity”, what does that look like? If a standard says “safety”, what does that look like? So we will judge it in terms of outcomes – the patient’s judgement and experience – rather than just looking at data, just looking at processes or just looking at inspection.’ But she is adamant that CQC will not become another centralising force in the NHS. ‘It’s absolutely not a central regime at all! I’m absolutely convinced the role of the local inspector will be paramount in making a judgement… about the risks in particular organisations, whether they’re domiciliary care providers or teaching hospitals, and the rest of the data issue 4 | winter 2009 | healthcare manager
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INTERVIEW
collection will be feeding them, assisting them in making those judgement… So I see it as primarily a local regime.’ A recent MiP survey (see page 18) found plenty of discontent among NHS managers about the overlapping responsibilities of the scrutiny bodies, with many complaining about having to report similar information to different bodies in different ways. Bower takes the point, but insists that CQC will not add to the bureaucratic burden. ‘It’s absolutely incumbent on anyone coming in from the outside and scrutinising the organisation to think about the burden of that.’ She says that CQC collects ‘very little’ information itself – just 17 out of around 250 data sources in the NHS, and none at all in social care. ‘So the entire system is signed up to collect once, use many times.’ And she dismisses as ‘absolutely not true’ complaints from some managers about a ‘battleground’ between CQC and Monitor, the foundation trust regulator chaired by Bill Moyes. ‘We haven’t even begun to exercise our regulatory powers in relation to the NHS, so it would be fascinating if we were already at war with Monitor. Monitor is the only organisation with whom we have a formal memorandum of understanding. We’re absolutely determined… that we won’t make
“I’m absolutely convinced the role of the local inspector will be paramount.”
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INTERVIEW
things harder for trusts who are experiencing difficulties, by going in and saying one thing and Monitor going in and saying another. We will be absolutely shoulder to shoulder for trusts that require intervention.’ She says ‘risk summits’ at SHA level will bring together CQC, Monitor and SHAs, ‘to ask who’s worried about what and what can we do to bring our interventions together?’ Young characterised CQC’s style of regulation as ‘to talk softly and carry a big stick’. Bower prefers to stress the talking, but warns that the public do not expect providers to get an easy ride. ‘When you talk to the public, they’re very interested in having regulation of health and social care; they want an assured system and, actually, an inspection-based assurance system. ‘So, I think everybody who scrutinises the system has to be conscious about the burden, but equally people who run the system have to understand as well that patients are very interested in seeing that there is external scrutiny. And that regulators have a role to play in that.’ That role will not extend to assessing directly the quality of NHS leadership, she says, although ‘management of staff’ is one of the government’s regulatory standards. ‘The model we’re moving into is about how we achieve outcomes for patients,’ she says. ‘We’ll be saying things about the quality of care, but it’s Bill Moyes’s job to judge how the board are functioning in an organisation.’ But surely management has a direct effect on quality? ‘Clearly we’re interested in the extent to which boards themselves are focused on quality,’ she concedes. ‘Where’s the evidence that the board are absolutely on top of this? Do they know how good their surgical services are in comparison to ones down the road? What’s their programme of clinical audit, what’s their programme of leadership and management development for
“When you talk to the public, they’re very interested in having regulation of health and social care; they want an inspectionbased assurance system.” clinicians? All these things are important but, luckily, the quality of NHS leadership is not part of my responsibility.’ But quality of care is everyone’s business, she says. ‘That focus on quality has got to be absolutely evident “from ward to board”, or whatever the cliché is. When you see really great organisations, you see organisations where you can go anywhere… and people are talking about quality, people are talking about improvement, people are learning from mistakes. ‘I don’t just mean where you look at the annual patients’ survey; I mean where there’s a very dynamic relationship between people who use services and the people who are providing them,’ she explains. ‘We’ve seen lots of evidence where people are giving real-time feedback on their experience and that’s being fed back very rapidly to ward level. That’s what generates high quality – that sense of being very directly accountable at every level for the quality of care people are getting. And organisations who are not good at that are the ones who are not doing those things.’ At a conference in October, Bower told NHS managers that race equality would be a major issue for CQC, but promised not to go ‘wading in’. A comment, she says, that reflects her philosophy about how CQC works. ‘The organisation works by assuming
that everybody delivering health and social care, whether you’re a care worker, a clinician, a manager or a member of a board – I’ve worked at those levels, and I’ve never thought any differently than I do now – thinks it’s their job to make sure people receiving care are getting better care. Then…it’s our job to say, what can we do, what tools have we got, what are the levers that a regulator has… to help people at the frontline deliver improved services? We’re not an organisation that goes in and tells everyone else how they should be doing their job. So, that’s my “no wading in” bit.’ ‘We’ve got lots of regulatory tools and we have a loud voice, and we can use that to highlight specific areas around race equality,’ she says. ‘But most particularly, that ongoing monitoring of quality through the registration system is going to be so important, so we can make sure that registration picks up the needs of all service users and makes sure that everybody gets the level of service they need. Bower spent 19 years working in social services in Birmingham – ‘I worked my way up from working on the frontline in a children’s home,’ she says – before joining the NHS in 1995. ‘I wanted a new challenge but had a young son, so moving home was out of the question for me. A policy job came up at the local health authority, which was explicitly set up to tackle the NHS/ local authority interface, and I thought it was a great chance to take. I’d been a manager of services for ages, so a thinking job in policy was very attractive.’ She says it’s frontline experience that has taught her the most valuable lessons: ‘Stay true to your values, always keep close to the frontline, to keep up with what staff and people who use the services are thinking. And be ready to challenge yourself with diverse views.’
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Craig Ryan is a freelance writer and associate editor of healthcare manager.
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NHS PENSION CHOICE
Many NHS staff in England and Wales will need to make an important choice about their NHS Pension over the next two years. But what does this mean for you and what are your next steps? Healthcare manager outlines the key facts about ‘Your NHS Pension Choice’.
What is the “Your NHS Pension Choice” exercise? A package of changes to the NHS Pension Scheme came into effect in April 2008 when health ministers accepted the recommendations of a review. This means that the NHS Pension Scheme now has two sections. If you were already a member of the NHS Pension Scheme on or before 31 March 2008, you are now a member of what is called the ‘1995 Section’ (even if you joined before 1995). Staff joining from 1 April 2008 are in the new ‘2008 Section’. The two sections are not the same and the exercise called ‘Your NHS Pension Choice’ is purely designed to offer the new pension arrangements to members of the 1995 Section.
and future benefits to the 2008 Section. There are a number of differences between the sections, including the age at which you can draw your pension without it being reduced, the way in which your pension builds up and the flexibility you have in drawing benefits. These differences could affect your future lifestyle and retirement options. You can find out more about the differences between the two sections by visiting the NHS Pensions website.
Who will be offered an NHS Pension Choice? If you are a contributing member of the 1995 Section of the scheme on or after 1 October 2009 you are eligible and will be offered the opportunity to make Your NHS Pension Choice.
If you are a member of the 1995 Section you need to decide whether to remain there or transfer all your past 16
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I joined the NHS Pension Scheme on or after 1 April 2008. Will I get a Choice Pack? No. You will have joined the 2008 Section of the NHS Pension Scheme and have no benefits in the 1995 Section. Therefore you have no decision to make and will not get a NHS Pension Choice Pack If you re-joined the pension scheme on or after 1 April 2008, after being a member before, you can make a choice if your gap in service is less than five years. Visit the NHS pensions website find out more.
How will I receive my Choice Pack? When is it happening?
Why is it important?
out when you will receive your NHS Pension Choice Pack, visit the MiP website at www.miphealth.org.uk/hcm to view the full timetable.
Your NHS Pension Choice is a large undertaking and rolled out across the SHA regions and Wales between January 2010 and March 2012. To find
Your employer will give you your NHS Pension Choice Pack You will not be able to make your choice until you have received your pack.
NHS PENSION CHOICE
Do I need to do anything now? No, not yet. Your NHS Pension Choice will not begin until January 2010 and will run until March 2012. Keep an eye on the website for more information.
I work for the NHS but I’m not a member of the pension scheme. Will I get a choice? No, but if you would like to join the pension scheme please speak to your employer.
What happens if I plan to retire before I receive my Choice Pack? If you expect to retire after 1 October 2009, but before you are due to
receive your pack, you can still choose to move to the 2008 Section if you think this is right for you. Please visit the NHS Pensions website for more information. If you retired before 1 October 2009 you will not be offered a choice. If you would like to delay your date of retirement so that you can make Your NHS Pension Choice, please visit the website for more information.
You will only be able to move your benefits to the 2008 Section if you later rejoin the pension scheme.
What if I leave before making my choice?
I have applied for early retirement due to my ill health. What happens if I leave before I receive my choice pack?
If you leave the NHS Pension Scheme before making your choice, your benefits will remain in the 1995 Section.
NHS Pensions
The NHS pension scheme has 1.38 million active (contributing) members and supports 610,000 people in retirement. There The facts are also 476,000 people who used to work in the NHS with deferred benefits under the scheme. Last year the scheme spend £5.6 billion on paying pensions but received contributions totalling £7.8 billion from employers and staff. There is no ‘black hole’ in the NHS pension scheme. The cost to the taxpayer is fully costed and capped at 14.2% of salaries until the next scheme review in 2015, when it will fall to 14.0%. If costs escalate beyond what can be afforded for this level of contribution, there are arrangements in place to share the burden between staff and employers. 75% of members of the NHS pension scheme are female. Around 75% of retired NHS staff receive an annual pension of less than £15,000, while over half of women NHS pensioners receive less than £3,500.
If I am in one of the regions being offered the choice later, will I lose out? No, because everyone who chooses to move to the 2008 Section will have the decision backdated to the same date.
If you leave without retiring and are waiting to find out about your ill health retirement application, you can still move to the 2008 Section if you think it’s right for you, but you will be able to delay your decision until you know the outcome of your ill health retirement application. More information is available on the NHS Pensions website.
How can I find out more? Visit the NHS Pensions website at www.nhsbsa.nhs.uk/pensions and clicking “Your NHS Pension Choice”. The website will be updated throughout the Choice exercise and includes an interactive tool to show you the differences in pension and retirement lump sum you could receive from the Sections at different retirement ages. You can also phone the helpline on 0300 123 1601.
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MANAGERs’ SURVEY
This summer, MiP once again ran an online survey to test the mood of healthcare managers in the UK. Marisa Howes reports on the results.
We hear a lot from politicians, the media and the public about what is right and wrong with the health service. We wanted to hear from the people who manage those services, about what they think. And this year we asked what they would do to reduce the bureaucratic burden if they were health minister for a day. We got some great responses – some going into fine detail, others short and pithy. And while a few were despondent, others were upbeat and amusing. We wanted to find out how healthcare managers feel about their terms and conditions. Most of our respondents thought their role was well-defined and felt supported by their line manager. The majority of them (70%) felt their salary was fair relative to colleagues in their own organisation. But that sense of fairness diminished the further out from ‘base’ the comparison was taken. So only 49% felt their salary was fair compared to managers in other healthcare organisations, and only 32% said it was fair compared to similar roles in other public sector organisations. Just 9% felt it was fair compared to the private sector. We also wanted to hear about job satisfaction, so we asked managers where they saw themselves in three years’ time, and the responses were about the same as last year, with exactly the same proportion (72%) still working in the health service, either for the same or a different organisation. 18
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This year 11% reported that they expected to be retired by then – succession planners please note!
Long hours culture – alive and kicking Last year’s MiP survey revealed the number of managers who were not only working over their contracted hours but also more than the maximum laid down in the working time regulations. And it’s getting worse. This year, over 70% of our respondents said they work over 40 hours per week, and a shocking 25% work more than 48 hours per week, the working time regulations maximum. This is up on last year’s results (22%) and disappointing in the light of the Department of Health’s emphasis on promoting health and wellbeing for staff. Our survey shows the need for employers to tackle the long hours culture for all their staff if they are serious about promoting a healthy work-life balance and efficient working practices.
Equality and diversity MiP has given it’s support to measures to promote equality and diversity, but evidence shows that the health services still have a long way to go to meet their statutory duties on equality for service users and for their workforce. One of those statutory duties requires regular training to ensure staff are aware of their own responsibilities and the organisation’s objectives. So this year we asked when our respondents last received training relating to their employer’s equality scheme. While it’s
How happy are you in your job?
100 Very Happy 17%
Fairly Happy 40%
Average 24%
Fairly unhappy 14% Very unhappy 6%
good to note that nearly half had received training within the past 12 months, 20% had not received any training in the past three three years. This is not an area where health organisations can afford to cut corners, and they must ensure that all staff receive regular training in this area.
MANAGERS’ SURVEY
If you were health minister for a day… Politicians and commentators are quick to complain about bureaucracy in the NHS and propose solutions. MiP decided it was time to ask the targets themselves for their opinion. So we asked managers what they would do to reduce the bureaucratic burden on the NHS if they were health minister for a day. We got some great suggestions, showing that managers really do care about the services they provide and are delighted to have the opportunity to give their opinions about how to improve it. Here are just some of the suggestions. Reduce the number of targets Not surprisingly, the most popular measure. And our health ministers want those targets to be outcome focused: ‘Always target outcomes not processes’; ‘I work in mental health and counting ‘activity’ is not telling us anything.’ Reduce the number of initiatives and new measures Coming in at number two, another firm favourite was to leave us alone! One of our health ministers would: ‘Take the day off – any other act would increase bureaucracy!’
Harmonise the regulatory bodies This was another hot favourite, with respondents pointing to the additional work created by reporting in different ways to different regulatory and scrutiny bodies: ‘Make the various inspection bodies work together so that only one set of performance information was required once per year.’ As one respondent pointed out: ‘Constantly weighing the pig doesn’t make it fatter!’ More or less restructuring? Although a few of our health ministers would set about further restructuring, more pleaded for the structure to be left alone for a while. A few would ask all NHS organisations to review their management structures to ensure they are effective: ‘I would look at the overall structure of NHS management and qualifications/support needed to fulfil the role more effectively within the various organisations. A “root and branch” review.’ Trust the managers to deliver A lot of you pleaded for greater freedom to act, and would welcome greater autonomy and the accountability that brings. This would cut the bureaucratic burden at a stroke and let you get on with the job you are paid to do. Or to put it another way: ‘I’d butt out and leave them to manage.’
On average, how many hours do you work each week? up to 30 hours
31-40 hours
41-48 hours
over 48 hours
%
Managers – part of the healthcare team Managers play a vital role as part of the healthcare team, though they are seldom portrayed in that light. So we asked them how they thought others saw them. The overwhelming majority (93%) of healthcare managers felt very or fairly positively valued by their team. And it’s good to see that the feeling is nearly as
good when it comes to their own managers, with 85% saying they felt very or fairly positively valued by them. On the other hand, it’s gone from bad to worse when it comes to the media, with none of this year’s respondents feeling very positively valued by the media, just 10% feeling fairly positively valued and over half of them saying the media was negative about them.
Emphasise local accountability Linked to this plea is the call for greater accountability to the local population: ‘Remove any one or more of the elements of central reporting and set local health services free to become locally accountable.’ Stop political interference That old chestnut! Many respondents identified this as the problem: ‘Stop using the NHS as a political football’ But a few were fed up with people constantly blaming politicians for the shortcomings in the NHS: ‘I’d introduce legislation to prohibit NHS managers citing political interference as the reason they can’t do their jobs’. But the main message was less about keeping politics out of the health service, more about changing the way politics affects the NHS. Accentuate the positive Our health ministers would insist on a change of attitude: ‘Set in place a programme of empowerment and celebration to shift the culture of the NHS, so people didn’t need to create overly bureaucratic processes to avoid blame and recrimination.’ Another respondent put it more succinctly: ‘Cheer everyone up and stop the moaning!’
The responses to our survey show that healthcare managers care about the job they do. Dedicated to delivering dignified and effective healthcare, managers get on with the job. Despite working excessive hours, most are happy in their work; feel supported by their team and their own managers and feel that their personal development needs are well met. So on the whole, our respondents have a positive glow when it comes to their experience as healthcare managers. Over three-quarters of them would recommend a career in healthcare to their family or friends and two-thirds of them feel positive about the future of the health service in the UK. Now surely that’s a good news story!
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The full report of the MiP survey on life as a healthcare manager in 2009 is available on our website at www.miphealth.org.uk
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LEGAL MATTERS
legaleye Equal pay claims are best settled by negotiation
Payback time? The NHS this year faced one of its biggest challenges since it was established more than 60 years ago. A legal attack on the Agenda for Change pay agreement had the potential to cause chaos throughout the service. Lawyer Stefan Cross told mainly low-paid women NHS workers that he could win them compensation for being paid less than male colleagues, at no cost to them, under the so-called “no-win no-fee” agreement. Having gathered clients, Cross then challenged the whole basis of Agenda for Change, arguing that it breached both equal pay and sex discrimination legislation. However this was really litigation aimed at getting back pay for women who were underpaid before Agenda for Change, something the trade unions were already pursuing but without attacking Agenda for Change. While the approach varied, the grounds for the claims were the same – a law that said anyone whose wages were increased as part of the introduction of equal pay was entitled to six years’ back pay in England and Wales and five years in Scotland. When Agenda for Change was introduced, the government financed the new pay structures, but not the bill for compensatory back pay, even though 20
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it was an obvious corollary of any such agreement. In the event, Newcastle Employment Tribunal comprehensively rejected Stefan Cross’s case of Hartley v Northumbria Healthcare NHS Trust. His arguments were not just defeated, they were blown out of the water. The Newcastle tribunal found that the approach by the trade unions representing NHS workers to develop Agenda for Change in partnership with the employer was ‘a sensible and enlightened decision and one which was in the best interests of their members as a whole.’ Cross didn’t appeal. If he had been successful it would have thrown the whole Agenda for Change agreement back into the melting pot. Instead, the decision was not only a major triumph for the NHS but a vindication of the trade unions’ emphasis on negotiation rather than litigation to achieve equal pay. The mayhem that the case – had it been successful – would have caused by diverting major resources away from the day to day running of the NHS would have been matched by very rich pickings for lawyers. The potential cost to the NHS would have been devastating. And it would have deterred other large-scale
organisations from introducing fairer pay structures – setting back the fight for equal pay by a decade at least. As a consequence of the Hartley ruling, similar cases against up to 30 other trusts fell. In the wake of the judgment Stefan Cross wrote to his NHS clients demanding payment upfront for proceeding with their equal pay cases – an unusual tactic for a “no win no fee” lawyer. Not surprisingly, it appears Cross was unsuccessful in collecting money from the women and was forced to abandon almost all of his cases against the NHS. Most of those who had been tempted away by Cross are now back being represented by their unions, which were already taking the lion’s share of claims for back pay in any event. Sadly the unions have been forced to issue litigation against 270 trusts, as apparently the only way of achieving financial compensation for women who have suffered wage discrimination for the whole of their working lives. The unions have always wanted to negotiate a way through the back pay issue, as they negotiated Agenda for Change. But if that cannot be achieved then the injustice of unequal pay before Agenda for Change has to be tackled through the courts.
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Caroline Underhill Thompsons Solicitors
CAREERS
Your flexible friend? NHS Employers explain their new service for interim managers. NHS Flexible Resourcing, the new service provided by NHS Employers and SOLACE Enterprises, provides experienced and quality-assured interim non-clinical managers to the health sector. The service rigorously matches employers with quality applicants through its website, with client handling provided by SOLACE, who have been successfully providing quality public sector interims for over 15 years. Both organisations have a pedigree in recruitment and NHS Employers already runs NHS Jobs, the UK’s biggest recruitment website. Sian Thomas, director of NHS Employers (pictured), said: ‘The wide public sector knowledge of SOLACE Enterprises is a key to the success of NHS Flexible Resourcing. They are a partner
that shares our “not for profit” philosophy and a commitment to re-investment of surplus income from client fees, maximising the benefit to our customers. ‘This is our opportunity to positively influence and add value to a market where appropriate contracting, cost, legalities, employment compliance and quality assurance can be very variable. We are making the process of recruiting these interims better value, lower risk and faster.’ Research showed strong support for creating the new service, and a growing
need for cross-sector skills, particularly to support the growing partnership agenda in the NHS. The service has made a range of commitments to fulfil the expectations of clients revealed by the research, including: Boosting value for money and beginning to act as a market moderator Requiring interims to work as limited companies, providing more protection to clients Testing applicants to establish personal and professional credibility and right to work, with a high proportion screened out to ensure the quality of those put forward Providing a fully-serviced contracting service to take the hard work out of recruiting an interim manager Testimonials from clients indicate good initial feedback from trusts that have used the service.
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NHS Employers have a comprehensive database of interim managers for all parts of the health sector – contact 0845 652 7070 or visit www.nhsflexibleresourcing.org.
Tipster: POLISH UP YOUR SPEECHES
by speech coach Martin Shovel – www.creativityworks.net
1 PURPOSE
7 KEEP IT CONCRETE
Think about why you’re giving your speech or presentation. What do you want your audience to do, know, or feel, as a result of experiencing it? Is this the best way to achieve your aims? For example, speeches and presentations are a very inefficient means of sharing lots of content – consider an emailed PDF instead!
2 AUDIENCE Who are you talking to? What’s in it for them to listen to you? Think about what will interest them and start planning your presentation from there.
3 MESSAGE Don’t drown your audience in content. Work out your key message and stick to it. Write it out as a proposition – a brief sentence that asserts or denies something about your content. ‘My day at the zoo’ is not a proposition, ‘All zoos should be banned’ is. Propositions make
content interesting because they express a point of view. Use your proposition as the spine for your whole speech or presentation.
4 BEGINNINGS, MIDDLES AND
ENDINGS Begin with something that grabs your audience’s attention and keeps them listening. Never make more than three points. And end by repeating your key message.
5 SIGNPOSTS People are easily bored, so keep your audience with you by summing up, clarifying and using verbal signposts throughout.
6 WRITE YOUR SCRIPT Even when speaking “off the cuff”, write out a draft in full first. And then break it down into sections and keyword notes later. If you use a script, design it in short, well-spaced sentences and use a large font.
Avoid abstract language. Give plenty of examples, and use stories, case studies and analogies to illustrate and clarify your points.
8 VISUALS Your speech or presentation will almost certainly be better received if you avoid using PowerPoint. But, if after writing it you feel the need to show some slides, use PowerPoint sparingly!
9 REHEARSE Rehearse out loud, and time yourself. Don’t memorise word-for-word, but practice speaking from your notes and looking out at your audience.
10 ANTICIPATE QUESTIONS Put yourself in your audience’s shoes, and write down any questions you think they will want to put to you when you’ve finished speaking. Prepare your answers, but be ready to deal with the unexpected, too!
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MiP AT WORK
Barnsley staff get engaged in boosting services
Managers face Stormont cash squeeze Northern Ireland
Yorkshire The Barnsley Partnership project if one of 18 projects which have been funded by the national Social Partnership Forum, which comprises the Department of Health, NHS Employers and NHS Trade Unions. The grants were awarded in July this year to NHS projects across the country with the aim of promoting partnership working between the NHS and trade unions. Announcing the awards, health secretary Andy Burnham said: ‘Partnership working is a great way for trade unions and employers to work constructively together on important issues of common interest and on changes which are important in the delivery of high quality services...These innovative projects will allow staff to have their say in making improvements which will improve the quality of service that is offered to patients and the conditions in which staff work.’ In Barnsley, the project aims to develop an engagement strategy and staff charter that will embed the principles of partnership working within Barnsley Hospital NHS foundation trust. The majority of staff at the trust belong to a trade union; many are ex-miners who retrained when the collieries closed. The project will include external workshops with staff side and managers working together to try
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to identify an action plan as well as monthly steering group meetings to monitor and evaluate the progress of the project. Robert Quick, a member of MiP’s interim executive committee and deputy director of human resources and organisational development at the trust, explains that the hospital is the only one within Yorkshire to have won funding to cement partnership working with staff and trade unions. ‘We are looking at how we engage all of the unions at the trust to develop an employee engagement strategy... we want the staff charter to incorporate the NHS Constitution and to get real ownership from the unions on this,’ he says. Quick says the workshop, held at the Northern College of Adult Education in Barnsley in November, is an attempt to come up with tangible ways to engage the workforce. ‘We want to get more staff involved in the day-to-day activities of the trust; for example, in helping to develop business plans and improvements to the quality of services,’ he says. The trust is aiming to develop a “microsite” on the hospital’s website to share learning as the partnership progresses and is also planning to host an event next April to pass on the learning from the partnership project to other organisations across the Yorkshire region.
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Helen Mooney
Healthcare managers in Northern Ireland are facing the prospect of having to maintain and improve health services against a background of major public sector spending cuts. The Northern Ireland Executive is debating how to deal with a shortfall of £370 million in public finances, with the prospect of further cuts in public spending to come. The finance minister is threatening to top slice 3% from all Stormont departments unless the Executive can agree specific targets for reducing expenditure. Health minister Michael McGimpsey has called for targeted spending cuts, arguing there is no room for cuts in the health budget. On 6 November he joined a rally at Belfast City Hall organised by the Irish Congress of Trade Unions to show his support for their day of action in defence of health services. ‘The health service is struggling to provide all that it does for the people of Northern
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“The health service is struggling to provide all that it does for the people of Northern Ireland”
Ireland and these folks here today are giving a very strong message which I fundamentally support,’ said McGimpsey. Commenting on his appearance at the rally, UNISON regional secretary Patricia McKeown said: ‘Are we going to protect frontline public services and, particularly, vulnerable people in our society? If the minister for health is saying he supports what the trade union movement is saying... then that is something to celebrate and something we want from the rest of our ministers.’ MiP chief executive Jon Restell said: ‘No matter what the outcome of the budget discussions, healthcare managers in Northern Ireland are going to have to manage their services within a tighter budget. The key to success is ensuring they maintain staff engagement and work together with community groups to develop the services people want and need.’
6/11/09
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These are uncertain times.
Reduce the uncertainty, join MiP. One thing is for certain in such times, you need support. MiP is the UK’s only trade union organisation that solely represents healthcare managers. We provide an influential voice, personal support and employment advice, management skills and access to leadership networks. Our experienced team of employment professionals is on hand to offer one to one confidential advice, negotiation and representation and fast access to legal resources. Join MiP today. Visit www.miphealth.org.uk/membership/whyJoin.asp
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issue 4 | winter 2009 | healthcare manager
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backlash
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
by Celticus WronG NUMBEr!
‘Shame’ of Britain’s cancer death rates The death toll from cancer in Britain ‘is 20% higher than Europe [sic] and getting worse’ according to another unnamed reporter in the Daily Mail on 5 November (I know it’s the Mail again but they are good at this sort of thing). Apparently, British cancer patients are ‘far more likely to die than those in the rest of Europe and the gap is getting wider, research suggests’. In fact, there was no ‘research’ – the claims were based on a ‘new analysis’ (unpublished) of old OECD data by the Conservative Party, which actually showed death rates had fallen by 10% between 1997 and 2007. And ‘Europe’ in this context meant only Western Europe; figures for the rest of the continent were presumably unavailable or inconvenient. And as the latest figures are for 2007, how does the Mail know the gap is getting wider? Wrong Number! exposes misleading statistics used to attack people who work in the NHS.
Your glass is half-full
Health secretary Andy Burnham is worried that NHS managers, spooked by sightings of black holes in the public finances and budgets turning into red dwarfs, will jump the gun and start slashing services off their own bat. ‘We don’t want any of that glass half-empty thinking,’ he told an audience at the King’s Fund in September, warning managers not to do their own ‘minispending reviews’ before the Department of Health has taken the ‘political decisions’ on how to cut £20 billion (or whatever this week’s number is) off NHS spending. Whatever happened to local managers making local decisions? Surely, in today’s NHS there are ‘mini spending reviews’ every week – it’s called ‘managing your budget’.
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Slay bells We’re guessing Michael Fallon, Conservative MP for Sevenoaks, won’t be sending us a Christmas card this year. Fuming away in the Daily Telegraph on 23 October, Mike reckons ‘it’s time to slay the bureaucratic monster that’s ruining the NHS’ (he means you). He’s up in arms
CELEBRITY CORNER Celticus missed this year’s NHS Employers conference in Birmingham, but editor Marisa Howes was on hand when health minister Mike O’Brien stopped by the MiP stand to collect his copy of healthcare manager and plug his appearance at MiP’s conference.
Photo: Billy Turner
issue 4 | winter 2009 | healthcare manager
about the 21 directors at West Kent PCT (there are 13 plus seven non-execs), hopping mad that they have two directors of strategy (they don’t) and hot under the collar because half the NHS workforce ‘isn’t treating patients’ (51% are clinical professionals with another 26% directly supporting them). But this is the same
Michael Fallon who overclaimed £8,300 from us for the mortgage on his second home, so perhaps facts and figures aren’t his strong point.
Overheard… (on the blogosphere) ‘The myth that says sack all ‘managers’ and put doctors back in charge has been tried with trusts, with GP fundholding, primary care groups and with foundation trusts; the doctors then re-hire the managers to do the bits they do not want to do as they want to be DOCTORS!’ “Dan” on telegraph.co.uk 25 October
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Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus. More often than not, these benefits will be on an exclusive basis with leading companies. But it isn’t only excellent terms and value for money we look for in a potential Partner. The products or services they offer have to be among the ‘best in class’. They must share our values and deliver a high quality service, including straightforward call-handling and easy-to-navigate websites. On the UNISON website you’ll find full details of all the criteria we look for, before we award companies with our official Partner accreditation. All you have to look for when you are looking for a name you can trust is the UNISONplus logo. For more information visit www.unison.org.uk and click on the UNISONplus logo or call MiPLink tel 0845 601 1144. You could save the cost of your subscription many times over and guarantee yourself the value for money that you and your family deserve.
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Healthcare managers are passionate about delivering effective healthcare. In fact, it couldn’t happen without them. That’s why they deserve specialist representation. MiP is the only trade union organisation dedicated to providing personal support and employment advice, management skills and networks, and an influential voice for the UK’s healthcare managers.
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