Healthcare Manager Spring 2010

issue issue 1 5

February-March spring 2009 2010

healthcare healthcare manager manager

NHS LEADER OF THE YEAR:

DR PATRICK GEOGHEGAN

plus A CODE OF CONDUCT FOR MANAGERS? DEALING WITH BULLYING AT WORK GET TO GRIPS WITH INTERNET ABUSE

helping make healthcare helping you makeyou healthcare happen happen www.miphealth.org.uk

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

www.nhsconfed.org/SDONetwork

SDO Network is funded by SDO (Service Delivery and Organisation Programme) which is part of the National Institute for Health Research

issue 5 spring 2010

healthcare manager inside heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Antony Hooker, University Hospitals Birmingham inpublic: Birmingham Women’s Hospital

letters & comment:8 Ray Rowden on the acute threat to community and mental health services

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 Take me to your leader: Dr Patrick Geoghegan Do NHS managers need a code of conduct?

Sticks and stones: dealing with bullying at work

regulars:20 Legal eye: tackling misuse of the net Tipster: managing one-to-ones MiP at work: partnership in the North West

backlash:24

Welcome to our first anniversary issue of healthcare manager, the magazine from Managers in Partnership, the trade union organisation for managers in health and social care. Yes, it’s a year since we launched, and we are delighted with the response we’ve had. It seems that we are succeeding in filling that gap in the market and giving a voice to managers.

The debate about regulating healthcare management has resurfaced, and our contributors give their opinions on what makes good managers. MiP member Patrick Geoghegan, voted “leader of the year” in the NHS Leadership Awards, tells us what qualities he looks for when making appointments. Derek Mowbray flies the flag for middle managers who must reconcile the demands of policy makers and operational staff, arguing for a code of conduct to help them steer this difficult course. And Jean McCleod from Aston University describes the bullying culture which can develop when there is a failure of leadership.

We also have pictures from our national conference and our regular features giving hints and tips on career development and legal issues.

Marisa Howes Executive editor

issue 5 | spring 2010 | healthcare manager

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HEADS UP

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

Diversity

Kingston NHS chief is ‘public sector’ envoy

bodies. As an ambassador, Neslyn will speak at events and support mentoring programmes, with particular emphasis on increasing diversity in public appointments.

‘It’s an honour to be selected as an ambassador,’ said Neslyn. ‘I want to make sure everyone is able to play a part in managing and influencing their local health services. I’m also looking forward to being an advocate for all of the good work that’s going on at NHS Kingston and the public sector beyond.’

More details on the public appointmnents available at www.miphealth.org.uk/hcm.

Talking of diversity, a new report from the IPPR is a real must read for anyone involved in commissioning, service development, public health or HR. You Can’t Put Me in a Box challenges received wisdom and suggests it’s time to rethink

our approach to equality and diversity.

The authors, Simon Fanshawe and Dhananjayan Sriskandarajah argue that, rather than thinking about equality in terms of an ever-increasing number of ‘strands’ – gender, race, sexual orientation and so on – we should deal with people as individuals with multiple identities who cannot be put in boxes. This reinforces the need to include the public in discussions about policy development so that we can incorporate a

healthcare manager

Executive Editor

Contributors

Conference Pictures

issue 5 | spring 2010

Marisa Howes m.howes@miphealth.org.uk

Pages 2, 4, 10, 11, 15, 18 and 24 © Flashfields

ISSN 1759-9784 published by MiP

Associate Editor

Barbara Hawker, Marisa Howes, Jean McCleod, Helen Mooney, Alison Moore, Derek Mowbray, Victoria Phillips, Jon Restell, Ray Rowden, Craig Ryan.

Craig Ryan editor@healthcare-manager.co.uk

Print

MiP congratulates Neslyn Watson-Druée, chair of NHS Kingston, on her selection as one of 180 women ambassadors for the public sector.

Under the new scheme, launched by equalities minister Maria Eagle in December, Neslyn will work to increase diversity in public appointments and to help and encourage people from all backgrounds to apply for positions on public

All copy © 2010 MiP or the author.

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

Superdiversity

Box ticking?

Broglia Press, Poole

Art Director James Sparling

Advertising Enquiries

Design and Production

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

Lexographic production@healthcare-manager.co.uk

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real understanding of difference in policy making.

The report was welcomed

by MiP vice-chair Rosie Ilett (pictured, left), who is deputy director at the Glasgow Centre for Population Health. ‘Diversity and difference has to be central to our thinking and practice,’ she said. ‘The NHS is still trying, with varying success, to respond to the diversity of its patients and service users, especially in terms of developing inequalities-sensitive practice and working collaboratively with others to tackle health inequalities. And of course NHS staff are also heterogeneous but we know the profile does not reflect the population as a whole and we need to make our recruitment and retention approaches inclusive and non-discriminatory. This welcome report illuminates some of the complex challenges and is essential reading for any MiP member’.

issue 5 | spring 2010 | healthcare manager

You Can’t Put Me in a Box: superdiversity and the end of identity politics in Britain is available from the IPPR. Further details at www.miphealth.org.uk/hcm.

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 Name any of the big issues – money, quality, productivity, service redesign, whatever you like – and you can be confident that “staff engagement” is in the proposed answer. Most board directors are convinced they can’t deliver productivity without it. Every trade union worth its salt bangs on about it. Politicians demand it. In short, staff engagement is the most cited can’t-do-without-it tool for delivering everything and anything.

Why, then, do we appear confused about what counts as good staff engagement? Why is it the first thing to be jettisoned in the rush to change? The social partners – employers, unions and government – could do better on three fronts.

The best senior managers realise that staff engagement means more than dialogue with clinicians. Vital as this is, system change requires talking and listening to everyone in

Workforce

Healthy schools firm to run workforce intelligence centre The company responsible for delivering the ‘healthy schools programme’ has won the contract to run the new Centre for Workforce Intelligence (CfWI), according to Department of Health sources.

“The biggest threat to successful staff engagement will be if managers start to see it as a luxury we can’t afford just now.” that system. And, as we look at care pathways, staff engagement goes beyond existing organisational boundaries, and beyond the traditional limits of the health service.

Partnership working with the unions is a key part of engagement.

But I’ve worked for them long enough to know trade unions are often the ultimate organisational drama queens when it comes to who’s talking to whom. We need to throw off our chains. Trade unions

Business services group Mouchel will work with Manchester University to set up and run the CfWI, which the Department of Health (DH) says will become the primary source of information and intelligence on the health and social care workforce in England. The centre will gather, analyse and distribute statistical evidence and intelligence to support workforce planning at national level.

Mouchel, which has a wide portfolio of local government contracts in addition to running the healthy schools programme, has been the

ought to foster direct and effective engagement between organisations and individual staff and teams.

People need to see how their job fits into the big picture.

The biggest threat to successful staff engagement will be if managers – and that obviously includes MiP members and it includes me – when the pressure is on, start to see staff engagement – and indeed partnership working – as a luxury we can’t afford just now. Experience shows this is a mistake – look no further than robust staff and trade union opposition to new organisational models for community services proposed by PCTs in England. If politicians want to help then they must give managers, staff and their unions the time and space to engage about change properly.

target of intense takeover speculation in recent weeks, after twice rejecting takeover bids from the shipbuilder turned defence and nuclear contractor, VT Group.

The DH said Mouchel had ‘demonstrated an excellent understanding of the complexities and challenges facing the health and social care workforce, and will bring a depth of resource and expertise to setting up the CfWI.’

MiP chief executive Jon Restell said: ‘We just hope the Centre for Workforce Intelligence delivers what it says – intelligent workforce data. This is essential if we are going to deliver the workforce element of the Darzi plan. We have to make sure we are training the right number of people for the right kind of jobs for our evolving health services. And we can only get that right if we know where we are starting from.’

issue 5 | spring 2010 | healthcare manager

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HEADS UP

MiP committee

MiP’s national committee takes up the reins

MiP’s newly elected national committee met for the first time in January.

The members were full of enthusiasm for the role they will play in recruiting members and shaping MiP policy on healthcare and employment practices. They will help raise the profile of MiP on the national and regional stage and work with our national officers to build our networks across the country.

Elections

By-elections for MiP national committee seats in Wales and SE Coast 4

issue 5 | spring 2010 | healthcare manager

East Midlands

Anthony Nichols

NHS Derby City

East of England

Stephen Welfare

East of England SHA

London

David Amos

UCLH NHS FT

London

Ian Haig

Royal Marsden Hospital NHS FT

North East

Alex Sinclair

Darlington PCT

North West

David Cain

Central Manchester University Hospital NHS FT

Northern Ireland

Peter Watson

Belfast HSC Trust

Scotland

Rosie Ilett

NHS Greater Glasgow and Clyde

Scotland

Linda Semple

NHS Ayrshire and Arran

South Central

Phillipa Chapman

Royal Berkshire Hospital FT

South East Coast

Vacant

–

South West

Andy Jones

Somerset Partnership NHS Trust

Wales

Samantha Crane

Aneurin Bevan LHB

Wales

Vacant

–

West Midlands

Zoeta Brown

BEN PCT

Yorkshire and the Humber

Robert Quick

Barnsley Hospital NHS Trust

David Amos (pictured) from London was elected chair, and Rosie Ilett from Scotland, vice-chair. Speaking after the meeting, David said: ‘This is an important landmark in the development of MiP as a significant player in the healthcare world. Our new committee re-energises us at a critical time and will help us to meet the challenges ahead.”

Rosie added: ‘Irrespective of which party wins the general election, there

Are you an MiP member working in the South East Coast region or Wales? Would you like to play a major role in shaping and directing MiP’s policy on employment rights and healthcare?

If the answer is yes, and you’ve been a member of MiP for at least 13 weeks, then you can stand for the by-election to fill these vacancies on MiP’s national committee.

Nominations must be supported by three nominating members from the same constituency. Members elected in this by-election will serve the remainder of the national committee term – until

are tough times ahead for managers in the health services. And MiP and its new committee members will be there making sure their voices are heard by national and local policy makers.’

The full committee is listed above.

Two seats are unfilled at the moment, and details of by-elections to fill those vacancies are set out below.

Timetable for election Nominations open 22 February 2010 Nominations close 22 March 2010 Voting opens 6 April 2010 Voting closes 4 May 2010 December 2011.

Nomination forms and a full guide to the rules and role of the committee are available on the MiP website at www. miphealth.org.uk. If you are interested and would like to discuss this further, speak to your national officer or contact Martin Furlong on 020 7551 1438.

HEADS UP

inperson

“Benefits for staff, including advice on diet, smoking and exercise, add value to their productivity.”

Antony Hooker: R ewards analyst and independent transplant assessor, University Hospitals Birmingham

In 1983 Antony Hooker joined the NHS as a nurse and became involved in critical care early on in his career. By 1992, he was working as a regional donor transplant co-ordinator, approaching the families of people in intensive care to discuss organ donation. In his current role as rewards analyst at University Hospitals Birmingham, he works on developing the trust’s rewards strategy as part of the human resources team.

Antony works on new ways to recruit

Hope, Change and Bottom Up—NHS BME Network conference Friday 4 June 2010: London Hilton MiP is again supporting a national conference for the NHS Black and Minority Ethnic Network.

This will be the launch event for the network and once again they have a great line-up

and retain staff and make the trust an attractive employer, while continuing his specialist organ donation work as an independent transplant assessor for the government’s Human Tissue Authority.

‘My day to day job is about dealing with issues of pay and salaries at the trust,’ Antony explains.

Since giving up clinical work five years ago, Antony became the nursing lead on Agenda for Change, then the Knowledge and Skills Framework lead, and eventually the Agenda for Change lead across the trust. ‘I had always been a member of the Royal College of Nursing but it was when I started working on Agenda for Change that I moved to UNISON who introduced me to Managers in Partnership,’ he says. ‘As a member of MiP I have been personally represented by them and it was this experience that was instrumental in me becoming an MiP link member.’

For Antony, being an MiP Link member involves supporting and recruiting MiP members locally. He also wants to develop the relationship between managers and staff side representatives at the trust.

‘I am keen to encourage union representation here as we have a brand new hospital opening in June 2010, which will mean a lot of organisational change. And perhaps not everyone will continue to

of speakers, including David Nicholson, NHS chief executive, Cynthia Bower, chief executive of the Care Quality Commission, and Lord Herman Ouseley, patron of the network. These influential decision-makers will speak about their activities and views and discuss the fresh approaches that BME staff believe can have a positive impact on race equality in the NHS. MiP chief executive Jon Restell, who will also speak at

work in their present roles – this is when union membership can be really important in terms of representation,’ he says.

As the NHS faces ‘lean times’ with farreaching implications for resources and funding, Antony believes it is important to recognise that NHS staff and services must add value. ‘In this trust we are looking at a whole range of benefits for staff, including using health trainers for advice on diet, smoking and exercise, as well as ensuring access to credit counselling and other advice-based services, as this will add value to their productivity as well as in recruitment and retention,’ he explains.

‘Most rewards are based on pay but most people working in the NHS have been shown not to be motivated by extrinsic factors such as pay, but by helping people. Benefits do not have to cost money, but we need to do things that add benefit to staff and the trust.’

Antony is candid about the tough times ahead. ‘I believe in modern trade unionism, which can help when it comes to the tough decisions that will have to made in future... staff need to appreciate that they are the most valuable asset, but with that goes accountability and the responsibility to deliver the best and most cost effective experience for patients.’

Helen Mooney

the conference, said: ‘MiP is delighted to support this conference. I hope employers will support it, too, by enabling BME staff to attend. We want to see a vibrant and effective network established that can help to sustain local and regional networks, keep race equality on the NHS radar and help make change happen.’

The programme for the day as well as a full line-up of the speakers and the booking form is on the MiP website www.miphealth.org.uk

issue 5 | spring 2010 | healthcare manager

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HEADS UP

SPF

Unions and employers weigh up next five years The NHS Social Partnership Forum (SPF) is considering offering frontline staff local employment guarantees in return for pay restraint and more flexible working, in response to the challenges set out in health secretary Andy Burnham’s blueprint for the NHS, NHS 2010–2015: from good to great.

The SPF is looking at the workforce implications of the document and the estimated £15-20 billion in efficiency savings NHS chief executive David Nicholson has predicted will be needed by 2014.

‘We will explore the pros and cons of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint,’ said the SPF statement. ‘We will also measure staff satisfaction more systematically as a way of driving up standards and we will support work to improve staff health and wellbeing.’

MiP chief executive Jon Restell endorsed the SPF’s approach. ‘We don’t know how managers will fit into a possible deal around job security, or who will count as “frontline” when it comes to protecting budgets and jobs. We do know the parties want to cut ‘backroom’ functions in PCTs

Awards

Excellence in HRM Awards 2010 The Healthcare People Management Association Excellence awards have been running since 1992, aiming to recognise and reward outstanding contributions to human resource management in healthcare.

This year’s awards will recognise achievements across 12 categories – including ‘supporting medical staff’, ‘diversity and equality, ‘staff engagement’ and ‘HR director 6

Health secretary Andy Burnham weighs up the challenges ahead on a visit to the Royal Sussex Hospital. Photo: Gareth Fuller/PA Wire.

and SHAs. The government wants to cut 30% from management costs in four years.

‘There’s always scope for savings, so we will engage with employers to look for improvements. But managers enable frontline staff to get the job done. Any change in management capacity must be carefully considered for its effect on quality and productivity.

Restell warned that MiP members

of the year’. There will also be a special award for the overall winner, sponsored by the NHS Institute for Innovation and Improvement.

The HPMA awards are supported by the UK’s four health departments and by MiP. Jon Restell, MiP chief executive, said: ‘These awards cover key areas of good employment practice. In particular, we are delighted that the Social Partnership Forum is again sponsoring the award for partnership working. We hope these awards will encourage people who are working in innovative ways to achieve real staff engagement and involvement in service

issue 5 | spring 2010 | healthcare manager

needed to be assured that cost cutting would not become a slash and burn’ exercise. ‘No matter how tough the decisions to be made, people must be treated fairly, with dignity and in a way that doesn’t avoidably lose their skills, experience and knowledge,’ he said.

The report NHS 2010-2015, is available on the NHS website, go to www.miphealth.org.uk/hcm.

development.’

The closing date for nominations is 31 March 2010,

to find out more and to enter, you can apply online at www.hpma.org.uk.

HEADS UP

inpublic

“The trust’s research enables us to attract experts in their field.

You would not see this in a district general hospital.”

Birmingham Women’s Hospital

In 1871, Birmingham surgeon Robert Lawson Tait and four colleagues founded the Birmingham and Midland Hospital for Women, a hospital devoted entirely to ‘the alleviation of diseases peculiar to women’.

It was overwhelmingly popular, but with only eight beds, the first hospital’s capacity proved totally inadequate. In 1878, the hospital moved to a converted farmhouse, boosting its capacity to 21 beds, but demand for treatment continued to increase. In 1904, the hospital president, Arthur Chamberlain, laid the foundation stone of a new, purpose-built hospital.

Fast-forward 92 years,

and after a major refurbishment, the Duchess of Gloucester officially opened the new Birmingham Women’s Hospital at a special ceremony in 1996.

Since the Birmingham Women’s Healthcare NHS Trust was set up to run the hospital in 1994, it has continued to set standards for the treatment of women. It has been a foundation for the last two years.

Chief executive Steve Peak says the trust now has a turnover of £85m and employs 1,600 staff. ‘We provide services to South Birmingham as a local provider but we also provide regional and national services in foetal and foetal maternal medicine,’ he

explains.

Peak says the hospital has become a centre of excellence not just for the services it provides, but also for its research and educational activities, which make it unique in many respects. ‘There is a huge amount of research ongoing in the trust which enables us to attract experts in their field, which in turn generates both more research and service delivery. You would not see this in a district general hospital.’

Peak says a stand-alone women’s hospital is important not just for the women it serves, but because of the specialist research which can be carried out into conditions

and diseases specific to women. But Peak would not necessarily support building more specialist women’s hospitals. ‘If we did that, we would end up with more organisations which would increase the management and transaction cost burden [on the NHS], and unless that was balanced with value for money savings and significant improvements in quality I don’t think it would be of benefit.’

Eleanor Smith, a theatre nurse at the trust and UNISON branch secretary, says that the trust looks after 50,000 patients a year and, importantly, can guarantee single sex accommodation to its patients. Birmingham is one of only two NHS women’s hospitals in England – the other is in Liverpool – in addition to the privately-run Portland Hospital in London.

‘Women feel that they will be treated as women. I think there should be more than two women’s hospitals in England... there is obviously a need and desire for it,’ she says. ‘You do often find that women’s services, along with mental health services, get left at the bottom of the pile. Lots of people tend to think that women’s services just means maternity services, which of course it doesn’t, and this makes it even more important that we have dedicated women’s hospitals.’ HM issue 5 | spring 2010 | healthcare manager

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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 not to be published.

to the editor

Keep the cap on!

I read with interest the article by Sue Slipman in healthcare manager (Comment, Winter 2009).

I’m unclear how Ms Slipman can say that ‘Foundation Trusts are the future of the NHS fusing the public ethos of the NHS with the community based enterprise that promotes a 21st century co-operative

ethos’ when FTs are adopting a commercial approach to healthcare and see neighbouring NHS organisations not as allies and collaborative partners but as rivals and competitors for lucrative contracts.

She goes on to argue that the perceived threat of FTs moving away from their ‘fundamental NHS nature’ hasn’t materialised and suggests that the imposition of the private patient income (PPI) cap was never really necessary. The fact that a number of FTs have actively sought out numerous ways to circumvent the ‘cap’, aided in part by the FT regulator, Monitor, with its misinterpretation of the law around PPI (recently changed by judicial review) and light touch regulation, supported by the FTN, must surely raise the question of how safe is the NHS in the

Innovation in healthcare engagement MiP is delighted to support a seminar to bring together innovators in the field of patient and public engagement in healthcare. Hosted by Big Difference Company and NHS Leicester it will build on the success of their collaborative work

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issue 5 | spring 2010 | healthcare manager

hands of FTs. The FTN campaign was not to level the playing field for those FTs that were disadvantaged by the 20022003 definition of NHS work, but to seek the removal of the cap altogether and allow full freedom for FTs to plunge further into the private patient services market. Anecdotal evidence suggests that income generated from private patient services is being reinvested to expand those services further instead of underpinning and developing NHS services. Without the restriction of the ‘cap’, can Ms Slipman seriously contend that FTs would do the ‘honourable’ thing and voluntarily limit private patient services and maintain NHS services?

Whilst recognising the need to address some of the anomalies that have arisen since the introduction of

last year which used comedy as a vehicle to tackle teenage pregnancy.

‘It was fascinating working with NHS Leicester and with local teenagers to produce our video about teenage pregnancy,’ said Geoff Rowe, chief executive of Big Difference Company. ‘We got a real buzz of enthusiasm from the many different people involved, not least the teenagers. Big Difference and the team at NHS Leicester want to share that experience with as many colleagues as possible. And we want to hear from healthcare teams working on other

FTs, ‘loosening the binds’ for all FTs will only serve to undermine the true ethos of the NHS and lay it open to the rigours of the market and to serving only those that can afford it.

Ms Slipman – and presumably the FTN – states that FTs 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.’ How can this be the case when surpluses generated by a FT stay in that FT and don’t go back into the wider NHS community? The only organisations benefitting are FTs and the only individuals are those who can afford to pay for services.

Dave Godson National Officer UNISON

innovative projects and achieving great results.’

MiP has supported innovation in health care with the production of several films, available to view via the MIP website. The partners involved in the other films will be invited to attend the seminar and share their best practice with others. The ultimate goal is to form a community of likeminded health professionals, all of whom demonstrate a commitment to innovation.

The seminar will take place in Leicester in the spring. Keep a look out on MiP’s website for further details.

comment Ray Rowden

OPINION

“I don’t wish to offend colleagues running acute trusts, but they too often don’t understand what lies beyond the hospital gates.”

Director of Mental Health International Development and former CEO of a mental health and community trust in London.

Protect and survive NHS funding is set to get increasingly tight, whoever wins the next election. We know that the most extreme spending pressures are likely to come in acute hospitals and that reshaping these services is unpopular with the public. In mental health and frontline community services, budgetary control is generally much better and the vast majority of these services are breaking even. Perversely, these efficient services have subsequently suffered greater cuts – a clear disincentive for good management!

Frontline staff in community services have now lived with three years of confusion about their future in the rush to commissioning-only status for PCTs. Some were reshaped as semiindependent arms of PCTs, some attempted to become social enterprises, the private sector have been sniffing around, and now we’re told that “vertical integration” is the solution – shorthand for community services being swallowed up by big acute trusts.

This is misguided: the skills required to understand, shape and deliver community services are totally different to those needed in acute hospitals.

Community services are unlikely to have any clout as a tiny directorate within a large acute trust.

The risk is that an acute trust under

financial pressure will almost always raid the community service budget to bail them out. I witnessed this time after time as a unit manager under the verticallyintegrated structures of the old District Health Authorities in the mid-1980s. Lay members of these authorities were very ignorant of the complexities of running community services. When it came to mental health and learning disability services they were even worse. I don’t wish to offend colleagues running acute trusts, but they too often don’t understand what lies beyond the hospital gates.

With the pressure on public spending, it would not be credible to set up hundreds of small community trusts, but there are better options than merging acute and community services. It is likely that we will see fewer and larger PCTs after the election, so why not see if these new PCTs could be grouped with community services, leaving fewer, bigger community trusts? Could community services be linked to ambulance services? Community services could also be merged with mental health services, an option already being looked at in some areas. Many mental health services have already formed partnership trusts with local government social services. Community services could fit well into this model.

Services for the mentally ill, older people and vulnerable children do not resonate with the public. The challenge

facing all these services after the election will be how to protect what they have and prevent their budgets being pillaged by an over-powerful acute hospital sector. Leaders of these services will need to build strong community-based alliances with the patients and carers who rely on their services.

There is an urgent need to reshape acute services, but it will not be popular.

Any whiff of hospital change or closure brings protesters out onto the streets in their thousands. There is a real risk that politicians and health policy makers will duck these challenges Regrettably, the public do not hit the streets for demented old people or people with drug problems or long-term mental illnesses. Mental health and community services will face increased demands as we live with the after-effects of the deepest recession in decades.

Unemployment and poverty will hit the poorest hardest. People with chronic long-term physical and mental health problems will need services protected, not slashed. Those with the least power and least voice will need champions to ensure their needs are recognised and met in the uncertain years ahead

.

Views expressed in Comment are those of the author and not necessarily those of healthcare manager, or MiP.

issue 5 | spring 2010 | healthcare manager

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MiP ANNUAL CONFERENCE 2009

MiP national conference MiP’s national conference ‘Quality through Partnership’ in November was a great success. We had a great lineup of speakers, the interactive voting was as popular as always, as were the speed networking sessions and the new masterclasses. Speakers included (clockwise from top) Lynn Faulds Wood, President of the European Cancer Patient Coalition; Paul Streets, DH, Rosie Ilett, MiP vice-chair with Karen Jennings, UNISON; health minister Mike O’Brien; and Jon Restell, MiP chief executive.

In a special panel session, chaired by Polly Toynbee of the Guardian, delegates quizzed politicians Norman Lamb (Lib Dem), Mark Simmonds (Conservative) and Stephen Hesford (Labour) on their health polices (pictured far right).

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issue 5 | spring 2010 | healthcare manager

MiP ANNUAL CONFERENCE 2009

issue 5 | spring 2010 | healthcare manager

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INTERVIEW

Alison Moore talks to Dr Patrick Geoghegan, NHS leader of the year and chief executive of the South Essex Partnership trust, one of the UK’s most successful mental health providers.

Ask Dr Patrick Geoghegan who is the most important person in his organisation and he will answer, ‘Brenda.’

Brenda is not his deputy chief executive, his PA, or even his chairperson. She’s the lady who serves him a cup of tea in the canteen first thing every morning, and a vital conduit for what’s going on in the South Essex Partnership University Foundation trust and what’s bugging the staff.

Not that chief executive Geoghegan is short of views from the grassroots: he describes his leadership style as inclusive, with a firm belief that every member of staff matters and can affect the patient’s experience. That means top management needs to listen to their frustrations, their complaints and their ideas. He hosts regular lunches for staff from all areas and all grades, and, one suspects, listens to the Brendas of this world as much as his clinical staff. After all, the quality of the tea she serves – and whether it is served with a smile – will influence users’ opinion of his trust, as well as the morale of his staff.

It’s an approach which last year helped him to win the leader of the year prize at the inaugural NHS Leadership 12

issue 5 | spring 2010 | healthcare manager

Awards, co-sponsored by MiP. Getting the award was ‘a bit surreal’, he says. ‘I just get on and do a day-to-day job.’

But he is swift to acknowledge that whatever he has achieved in the NHS is down to the staff around him.

Perhaps his willingness to listen to Brenda reflects his own career path: he must be one of the few NHS chief executives to have also worked as a porter and a domestic. He qualified as a psychiatric nurse, worked in the acute sector and has been a chief executive for the last 14 years. But he confesses to always being attracted to underdogs – and that’s why he is working in mental health.

‘When I came back to mental health people said my career was finished,’ he says. ‘I think that is often the attitude of people towards mental health chief executives. There’s an attitude that the acute sector has the big budgets and the big buildings.

‘But in mental health you need a good leader who can deal with very complex situations. It’s not like being in for a hip operation. People come to us and are often extremely distraught.

Some may be suicidal. I think chief executives in mental health do think more creatively and innovatively about

how they are going to help their communities,’ he adds.

‘I think we have some good leaders in mental health but we could do with some more. I think a lot of people are still attracted to the acute sector because of the kudos that goes with it.’

However, Geoghegan believes there are many good executives coming through in mental health and there are now more opportunities for clinicians to combine management with clinical work.

So does the NHS pay enough attention to leadership rather than just management? Geoghegan sees encouraging signs that leadership is becoming more valued under NHS chief David Nicholson. When Geoghegan sits on external appointment panels, for example, he says he sees leadership style and skills coming to the fore in decisions about who to recruit. ‘You still have to be a manager but you need to go the extra miles and be a leader.’

In an NHS where chief executives come and go with alarming speed, he is notable for his longevity – all down to ‘flexibility and creativity’ he says. ‘It’s always thinking about what’s next, to forecast and to work with communities.

INTERVIEW

My service users and community always tell me what needs to change!

But you are only as good as you are today.’

So how does he ensure this philosophy of putting the patient at the centre affects what happens on the ground? ‘I do the induction programme every month for new starters. I always make it very clear that we are here because of the patients, because of very vulnerable people. My background as a clinician helps me to never forget that we are here for patient safety and care, and to improve standards,’ he

says. ‘Of course, we have to deal with the finances, the budgets, the capital developments. But if I was a patient, how would I perceive the service?’

At the induction sessions he gives each new member of staff a piece of reflective foil and invites them to look into it, imagine that the person they are providing services to is the person they see, and ask themselves what they would want the experience to be like.

All job applicants will soon have to complete a self-assessment exercise before they are considered for a post at the trust. The aim is to tease out their

attitudes and approaches and see if they’re in line with the trust’s: if they’re not, they won’t be considered.

Geoghegan puts a great deal of stress on the importance of getting the right person in the job. The wrong person will underperform and be unhappy – and will probably have to be carried by those around them, creating resentment.

And that will also affect patient care.

‘A lot of the issues raised by patients are about attitudes and how they are treated – a smile, making eye contact, being seen at their appointment time,’ he says. issue 5 | spring 2010 | healthcare manager

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INTERVIEW

“You still have to be a manager but you need to go the extra miles and be a leader... It’s always thinking about what’s next.”

He has used ’mystery shoppers’ – patients who report back on their care – to feed into a ‘dashboard’ of patient experience. Their experience, which can be traced back to individual members of staff, can lead to change.

But staff engagement and training is just as important. All staff get customer service training: ‘I don‘t care who you are and how senior you are, you have to go on customer care training in this organisation,’ says Geoghegan.

The trust was the first mental health and social care trust in the country to get university status – usually only given to teaching hospitals in big cities – and this has helped boost training opportunities for staff. It also employs many former patients, reflecting its approach to bringing about holistic changes in patients’ lives, not just clinical improvements.

It adds up to an attractive employment package which means the trust, despite its proximity to London, has few problems recruiting. It’s also highly rated by staff. In last year’s HSJ/ Nursing Times list of 100 top healthcare employers, the trust was rated the best employer for managers, the top mental health trust to work for, and eighth best employer overall.

Geoghegan’s experience in the private sector gave him a grounding in finance and customer care which is becoming more widespread in the NHS. NHS leaders now have to think about all the elements which contribute to a successful business – including looking to customers, researching markets and thinking about future 14

issue 5 | spring 2010 | healthcare manager

Dr Patrick Geoghegan and his team open the new Brockfield House secure inpatient hospital, which boasts the latest theraputic facilities.

opportunities. ‘That’s a big culture change in the NHS,’ he says. ‘We can no longer say, “we’re publicly funded, we’re safe”. We now have to think in a far more businesslike manner in our whole approach.

‘I’m always very open with my staff that if we lose a contract, we lose jobs.

The only way we can retain staff is if we are retaining business and the customers are getting a good service.’

Geoghegan, an MiP member, says a collective voice for managers is important. ‘It’s not just about the problems; it’s to share best practice…it’s all about working in partnership. It’s there to raise the good, the bad and the ugly!’

His leadership will be crucial over the next few months as he leads a merger between his own trust and the Bedfordshire and Luton Mental Health and Social Care Partnership trust – the first merger of its kind, but he suspects the first of many. He has run both organisations since the autumn of 2008 but there will now be a single board.

The size and geographical spread of the new organisation means local management will be important, especially in ensuring day-to-day delivery. Geoghegan is already working with community leaders and faith groups in these very multi-ethnic areas,

where mental health problems can be seen as a stigma and many people suffer in isolation.

Like all parts of the NHS, mental health trusts are contemplating a future of rising demands and static incomes.

‘It has always been tough – yes, we have had growth monies but we have always had to prioritise how that is spent,’ says Geoghegan. What leaders now need to do with their teams is to reflect on what they are doing with the money coming in. Are we providing services for the sake of providing them?

In a way, it can be seen as a healthy and positive experience. You need to turn it away from negativity, from a spiral where it goes down and down.’

So would he consider moving elsewhere? ‘Never say never,’ he says.

‘In 18 months there may be another opportunity – I always need a challenge. But if I am committed to seeing something happen, I will commit to it – and I’m committed to making the Bedfordshire and Luton site work for the next 18 months.’

.

Alison Moore is a freelance journalist.

A list of all NHS Leadership award-winners is available at www.miphealth.org.uk/hcm

CODE OF CONDUCT

Caught between the NHS bureaucracy and professionals on the ground, middle managers are under more strain than ever.

Derek Mowbray explains how a new code of conduct can help managers promote a more positive working environment in the NHS.

In most organisations, middle managers interpret policies and strategies, turn them into action and ensure they are delivered by other managers and professionals on the ground. It’s often not the most comfortable place to be.

The management of public health services in the UK has some unique characteristics. The NHS is a public service with a constructed commercial undertone, which needs to respond to the availability of taxpayer funds and a range of external influences on size, shape, standards and the range of services provided, while commanding a vast array of resources, including cutting-edge technology and highlytrained staff. Health service organisations are both in competition and in partnership with each other and other health related organisations – whether public, private or charitable.

Health service bodies in the UK are not the most sharply defined organisations.

They are full of ambiguities.

Some argue that there are two public health service organisations running alongside each other; rubbing along, often creating sparks, and sometimes producing harmony. One of these can be described as “background” – the

“Stress causes errors and accidents: it’s potentially dangerous.

A significant number of people are under strain.”

bureaucracy that embraces civil service and agency activities such as supporting policy and strategy initiatives, the supply and distribution of goods and services, regulation, and the routine support services found in all organisations. The background organisation is huge and its purpose is surmised to be ensuring the “foreground” organisation works effectively.

This “foreground” organisation is the uniquely chaotic delivery of healthcare by professionals to their patients. It’s “chaotic”, not because it’s characterised by chaos, but because each individual patient requires professionals to be able to respond effectively to every single change they

may exhibit during the course of care and treatment. Being able to respond to the patient in front of you requires professionals to use their own initiative to react and be active in providing the correct intervention when it’s needed.

This can lead to a conflict of ideologies, where the professional is concerned solely for the care and treatment of the individual at the time, while the bureaucracy is concerned with the care and treatment of all individuals all the time, within the constraints placed on the organisation as a whole.

The people in the middle are the middle managers, who must respond effectively to both the constraints placed on service delivery by the background organisation, and to the professionals in the foreground, who need their individual freedom protected so they can act effectively all the time, without any error, delay, or diversion.

Fallout between staff and managers NHS staff surveys in recent years have highlighted some “fallout” between staff and their managers. While this doesn’t affect all staff and all managers, it does raise serious concerns about how effective issue 5 | spring 2010 | healthcare manager

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CODE OF CONDUCT

managers are in ensuring that staff are engaged in their work and not in some kind of rift with managers.

Research has highlighted the relatively high rates of sickness absence and staff turnover in the NHS. This is sometimes excused by the complex nature and high stress of working with patients. However, the overall picture shows that health services are wasting huge sums of money on agency arrangements, sickness absence and staff turnover. Other data show there will be a massive number of staff who come to work through a sense of responsibility towards their patients and colleagues, while not feeling well enough to concentrate effectively, and who will therefore be under-performing or even counter-productive – a feature known as ‘the Iceberg Effect’ (because most of the strain is below the surface) or “presenteeism”.

The dilemma facing middle managers is how to get optimum performance from their staff in a culture that doesn’t promote a positive working environment, while they themselves are being squeezed between the demands of the background and foreground organisations.

Wellbeing and performance The relationship between wellbeing and performance is well established and common sense – people who feel well perform better than those who feel ill.

However, people’s perceptions of their own wellbeing are heavily influenced by the culture in which they work. When we are looking at psychological wellbeing, the problem of personal perception is particularly significant: half of sickness absence and staff turnover – and most of ‘the Iceberg Effect’ – is attributable to psychological distress, and signs of psychological distress can be camouflaged in a culture of general under-performance.

Stress is at the wrong end of the pressure-strain-stress spectrum. The spectrum moves from a stimulant (pressure) through a diversion (strain) to impairment (stress). People who are 16

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stressed cannot focus on their work, will often be forgetful and will eventually show some physical signs if left untreated. Stress causes errors and accidents; it’s potentially dangerous. A significant number of people are under strain, resulting in poor performance due, among other reasons, to muddled concentration and irritable behaviour.

People under strain have usually experienced prolonged pressure, which has moved beyond being a stimulant to become a threat to performance.

People suffering from strain make up the majority of those who come to work when they don’t feel well enough to concentrate, and whose focus is diverted by all kinds of events, activities, experiences and interactions outside their personal control.

Threats to wellbeing and performance Middle managers may often find that they themselves are a threat to the wellbeing and performance of their staff because of the strain placed on them by having to respond positively to both the background organisation (the bureaucracy) and the foreground organisation (the professionals). As the mediators between the two, middle managers who are under strain will find it harder to negotiate a successful route between competing challenges.

There are three levels of threat to wellbeing and performance (see diagram below). The first is ourselves and our general inability to interact effectively with other people, which often leads to psychological distress. A second level of threat comes from problems of ordinary working life which we are all likely to experience at least once. The third level comes from conflicts that are created from the first and second levels, and these are the things which we normally identify as causes of distress. These tertiary threats are also the types of “failed interaction” identified in employment law and regulations, and about which many people will face disciplinary action or other sanctions.

“The culture of the NHS has some way to go before it provides the context for senior managers to improve their own sense of wellbeing and performance.”

A new code of conduct One way to promote wellbeing and performance at work is to create a positive culture that actively embeds wellbeing and performance into the bloodstream of management. This approach is being adopted in the review of the code of conduct for healthcare management, sponsored by the Institute of Healthcare Management with support from a number of unions and professional bodies, including MiP. The code has three interlocking aspects – the context within which managers are expected to behave, the behaviours they are expected to show and the actions they are expected to take.

As many people adopt stereotypical roles and the behaviours associated with them, the first point of change is the behaviour of senior managers. The culture of the NHS has some way to go before it provides the context for senior managers to improve their own sense of wellbeing and performance.

This requires us to re-establish the context for managing health services by looking again at such basic ideas as the purpose of the NHS (currently ambiguous, as I argue above) and which management structures reduce the risk of psychological distress (essentially they need to be as flat as possible). The “rules” about how the NHS should work need to promote a positive work culture – with less focus on sanctions and more on

CODE OF CONDUCT

Threats to wellbeing and performance PRIMARY THREAT Leaders Managers People SECONDARY THREAT Culture Change Mergers Acquisitions Collapse

Growth & expansion Downsizing Uncertainty ‘Rules’

Structure Ambiguity Accidents Illness

TERTIARY THREAT Conflict Harassment Bullying Autocratic leadership Intimidation

Insecurity Lack of personal control Job insecurity Fear Unexpected events

Loss & bereavement Poor performance Isolation Excess demands Boredom

IMPACT Increased costs Under-performance High sickness & absence High staff turnover Reduced profits

encouragement, involvement and participation.

Within this revised context, managers need to behave in ways that promote trust, commitment and engagement between themselves and the people they manage. These behaviours can be described as: attentiveness, intellectual flexibility, reliability, conflict resolving behaviour, and behaviour that encourages others.

Poor quality Lower market share Recruitment difficulties Negativity

Finally, the actions that managers are expected to take to promote wellbeing and performance require them to provide direction, co-ordination and control through a process of managerial “seduction”: this normally involves adopting strategies of conviction, rather than the prevailing strategies of imposition, and relies on the effective interaction between managers and their staff.

Following the new code of conduct for healthcare management can help middle managers to improve their own wellbeing and performance and that of their staff.

As part of this process, middle managers need to discuss openly with their staff what behaviour they can expect from their managers and what behaviour managers can expect from them. The code provides guidance on what these behaviours should be.

Managers can also try other approaches. Introducing a ‘courtesy code’, for example, which encourages everyone to be courteous to everyone else, can raise the mood and tone of interactions, and have a strong influence on reducing distress in interactions.

Middle managers can also consider improving their own resilience and tolerance levels through training programmes or corporate cognitive behaviour therapy sessions that apply cognitive behavioural therapy to the thinking processes of managers, and encourage them to think positively about ways to create trust, commitment and engagement (see www.the-stress-clinic.net for further information).

The uncomfortable position in which middle managers find themselves can lead to high levels of sickness absence and staff turnover due to psychological distress. Following a wellbeing and performance agenda aimed at building a positive work culture within which managers and staff behave in ways that promote trust, commitment and engagement are known to reduce stress at work and improve general levels of performance. The new code of conduct provides the framework for developing this agenda

.

Professor Derek Mowbray is director of OrganisationHealth, which helps organisations to build and sustain positive work cultures that promote wellbeing and performance at work.

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BULLYING

The effect of bullying has been likened to that of Post Traumatic Stress Disorder. It can damage safety, productivity, staff retention and satisfaction with work life in general. Jean McLeod explains how her new study aims to cut the potentially huge cost of bullying in the NHS.

Why do we hear the same stories about bullying over and over again?

And why are most cases left unresolved, even despite a legal or union-negotiated settlement? One reason is that bullying is often a matter of perception, depending on the context or social situation in which particular behaviour takes place. What is acceptable in the armed forces, the shop floor or in the private sector may not be acceptable in the police force, an office or in the public sector.

Behaviour commonly seen as bullying – over-supervision of work, ‘moving the goalposts’, or refusing requests for days off – can also be seen as nothing more sinister than managerial decision-making. Again, it’s a matter of perception.

This ambiguity means people who want redress for their injury often have to take the legal route, citing discrimination on the grounds of race, gender, age or disability, or the effects of post-traumatic stress, alongside their bullying 18

issue 5 | spring 2010 | healthcare manager

claim. This is a very debilitating process which can seriously affect the quality of working life for everyone involved.

While employers have a responsibility to people who have been bullied, they also have a responsibility to people accused of bullying. Dealing inappropriately with a bullying accusation will have major implications for the organisation, the people involved and staff who witness the subsequent events. So it is essential that managers can tell the difference between individuals who know the effects of their behaviour and those who do not. Those who knowingly bully can be taken down the well-established disciplinary route, and those who do so unknowingly can be supported, through behavioural change programmes, to “unlearn” some of their behaviour. According to a 2003 report from the National Audit Office, dealing with people in these different ways will reduce the waste of NHS resources caused by staff being suspended on full pay, taking extended sick leave or retiring early due to stress.

To tackle bullying effectively, we must first understand the intention behind the act. This, too, is a matter of perception.

Two people may observe exactly the same behaviour, but one may regard it as intentional while the other sees it as accidental. The interpretation of someone else’s actions is informed by the observer’s personal or vicarious experience. This is called “attribution” and is liable to error. Attribution is a shortcut to assessing whether someone’s behaviour is internally driven – by their own thoughts or beliefs – or externally driven – as the result of outside, potentially uncontrollable forces, such as targets, mergers or new legislation. If bullying behaviour is deemed to be externally driven, individuals are often given the benefit of the doubt and the behaviour is ignored or not acted upon. But if the behaviour is consistent, it is usually labelled as internally driven, as intentional and under their control.

Anyone may become a target of bullying but not everyone has to become a victim of it. This is because

BULLYING

Your help wanted

For this important 18-month study, Jean needs help from people who have been accused of bullying or similar behaviour (whatever terminology was used at the time).

It doesn’t matter where you are in the process or what the outcome of any investigation was – it’s your story that counts. She would also like to talk to people who believe they have witnessed bullying, but haven’t been targeted themselves, and people who have never witnessed bullying. All interviews will be anonymised and you may pull out at any stage. Making your voice heard will help ensure that managers can investigate bullying cases in the sensitive, objective manner required to ensure justice is done.

If you know someone who has been accused of bullying, please let them know about this study. It may even help them as part of the healing process. You can contact Jean McLeod at Aston University on 0121-204 3317 or by email to mcleodj@aston.ac.uk.

there is thinking time between the behaviour and the perception: time for the target to consider whether the instigator intended to do harm and whether they had a ‘right’ to (like a dentist inflicting pain during treatment).

Even when the target feels the instigator had no such right, they may still not feel harmed or bullied. They may have a buffer which offers resilience.

One such buffer may be “selfefficacy”, identified by Marilyn Gist and Terence Mitchell of the University of Washington as a ‘belief in one’s capabilities to mobilize the motivation, cognitive resources, and courses of action needed to meet given situational demands’. Put simply, this means knowing how to do one’s job effectively.

If we are confident about our skills and ability, this may give us some resilience to potentially bullying behaviour.

However, the Canadian psychologist Albert Bandura, in his 1997 book Selfefficacy: The Exercise of Control, suggests this may not be enough.

Being able to drive a car, for example, does not mean the driver would be able to perform to the same level when faced with driving in four lanes of fast moving traffic, with fine margins for error and flashing signals.

Newly qualified nurses and midwives face a similar same situation. Student

midwives are supervised during every delivery. When they qualify, they are exposed to those lanes of fast traffic without the instructor in the car. These taxing conditions require higher degrees of proficiency, anticipatory reading of the environmental signs, vigilance and split-second decision making. Around this time, an individual’s skills can be easily overwhelmed by self-doubt about their ability. However, Bandura noted that efficacy beliefs that are firmly established remain strong and are resilient to adversity, and can only be changed through compelling, disconfirming experiences. More recent research by Christine Shea and Jane Howell found that while self-efficacy beliefs do predict performance, it is questionable whether self-efficacy affects performance or vice-versa.

If intention does have an effect on our perception of behaviour, then clarifying people’s intentions may be the simplest way to resolve bullying problems quickly and effectively. And if self-efficacy can act as a buffer against the perception of bullying, then it should be possible to foster resilience in the workforce through training and professional development.

In my research, I want firstly to understand intention and the role it plays in the attitudes of both bully and victim. If

“While employers have a responsibility to people who have been bullied, they also have a responsibility to people accused of bullying.”

actions are judged as unintentional then they are often deemed to be nonaggressive. But if seen as intentional, the interpretation is often the reverse. In addition, such behaviour is less likely to be seen as bullying by individuals who like the person responsible. Conversely, people whom the target doesn’t like are more likely to have their actions attributed to aggression. This suggests that stereotyping and labelling play a very important part in understanding bullying, as does the target’s level of resilience to adverse stimuli.

Secondly, my study aims to develop an early intervention tool for managers which, supported by a culture which actively and positively promotes teamwork, politeness and harmony, will ensure that anti-bullying policies are implemented successfully. But it’s important to note that fostering such a culture requires leadership and a very personal interest from the organisation’s chief executive.

The tool will draw together the differences between an unwitting bully and the victim, helping to restore harmony to the workplace, improve productivity, prevent further misinterpretation and ultimately raise the quality of the service: a winning outcome for all concerned. Naturally, where the tool identifies that conscious bullying has taken place, appropriate disciplinary procedures can be undertaken

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Jean McLeod is supervised by Dr Michael J. R. Butler, Dr Helen Shipton and Dr Paul B. Naylor at the Department of Work and Organisational Psychology, Aston Business School.

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LEGAL MATTERS

legaleye Clear policies on misuse of the internet are better than heavy-handed surveillance.

There are two main ways for employers to tackle misuse of the net by employees. The first is to install software monitoring tools that watch what they’re up to; the second is to implement an effective internet and e-mail policy.

Although using filters and spyware may seem a no-brainer (if not always conducive to good employee relations), employers often don’t realise they aren’t automatically allowed to monitor their employees, except in certain circumstances, and they must tell them in advance. A well-drafted internet policy, on the other hand, will save time and money, and ensure that employees know what they can and cannot do.

For starters, staff need to know whether they are allowed to access the internet for personal use. If they are, they need to know what parameters apply: for example, whether they are allowed to access the net during work time or only during breaks. The policy also needs to state explicitly that browsing offensive or obscene material is strictly forbidden and constitutes gross misconduct that, if proven, will result in dismissal.

Take the case of Mr Thomas, who was dismissed by the London Borough of Hillingdon for accessing internet pornography at work. Although the staff handbook stated that this amounted to misconduct, the employment tribunal held that it did not constitute “gross” misconduct and his dismissal was unfair.

Although the appeal tribunal reversed the decision, on the basis that dismissal was within the ‘range 20

issue 5 | spring 2010 | healthcare manager

of reasonable responses’ open to the employer, the lessons from this case are still worth learning. Firstly, although accessing porn is to be discouraged, it is not necessarily illegal. And secondly, although employers may think dismissal in these circumstances will always be fair, policies still need to be explicit about what is forbidden and what will happen if employees access prohibited material.

Employees should also know what else may be prohibited, such as using work computers for any form of fraud, for software, film or music piracy, downloading commercial software or any copyrighted materials belonging to third parties, hacking into unauthorised areas or introducing malicious software into the network.

Employers must ensure that staff know the organisation has a policy on internet and e-mail misuse, an important point illustrated by the case of Bob Clark, who brought a successful claim for unfair dismissal against his former employer, TXU Energi.

Although Mr Clark was clearly in breach of the company’s strict policy banning the dissemination of racist, sexist or otherwise offensive e-mails, the tribunal accepted his argument that he was not aware of the policy when he forwarded an email to colleagues portraying a semi-naked Arab woman as ugly and hairy.

But what about social networking sites such as Facebook, Twitter and Bebo? Again, employers need to make clear whether accessing such sites is allowed at work, or even at home on

the organisation’s laptops. Employees should also be aware that it may be a disciplinary offence to make disparaging remarks about their employer, patients or other employees even when using their own computer at home on these sites.

Finally, the internet and e-mail policy should make clear that all other company policies – such as those on harassment, discrimination and bullying – apply fully to internet and email use. And it goes without saying that employers must implement all these policies consistently

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Victoria Phillips Head of employment rights at Thompsons Solicitors

Tipster:

Managing oneto-one meetings Regular review meetings make development reviews more effective. Here’s how to get the most out of them.

 PREpare Review progress against your staff’s objectives. Prepare examples of good performance and proposals to address development needs. Agree the agenda in advance.

 Set the tone This is their meeting. Best practice says they should speak for at least

CAREERS

Who’s in charge?

Barbara Hawker helps you to take control.

When you consider the proportion of their lives they spend at work, it’s surprising how little thought or planning many people put into managing their careers. With commitments to work, friends and family, it’s not easy to put yourself first on a regular basis.

And while success is sometimes helped by being in the right place at the right time, wouldn’t it be good to feel that you, rather than luck, were instrumental in you being there? And what if you feel professionally ‘stuck’?

Whatever your situation, the path to successful career progression is the same: regularly take some personal ‘time out’ to take stock, consider options, lay plans, pursue opportunities and, as a result, take control. If you don’t, others will.

First, understand what you’ve got 60% of the time. Listen carefully and make constructive suggestions.

 Review progress Review progress against agreed objectives, not forgetting ones they have met or exceeded.

 Discuss outstanding objectives Are they still relevant? Only add new objectives if others are dropped. How can you help? Review timescales for achieving outstanding objectives.

 Discuss training and development How effective has it been? How will it affect their work? What do they need to follow up?

to offer: conduct a personal audit.

Recognise your growing skills base and take note of other peoples’ compliments.

Working with a coach or a suitable mentor may help. Most healthcare organisations have a good network of contacts – either internally or from external professional organisations. An impartial external perspective is often helpful.

Then, envisage the role you want in four or five years. Aim high, but be realistic. Can you achieve your goal from your current job or within your existing employer? If not, where and how? Do you have skills gaps to fill? If so, make a plan of action.

Next, raise your profile. Get to know the key figures in your field and understand the “big picture” for the future. Develop your own views and passions, and devise solutions to the foreseen challenges. You

 Review performance Offer constructive and motivational feedback. What do they see as the highlights of their current performance?

Thank them for any extra effort they contributed.

 Discuss any difficulties Remember – no surprises! Anything you discuss here should’ve been raised before. Focus on solutions and agree actions to achieve them.

 Focus on any other strengths or concerns Gives your staff time to raise any other personal concerns, such as attendance, team relationships and work plans.

can air these at networking meetings or interviews to show commitment. This groundwork will make future applications less hurried and more likely to succeed.

Life, of course, doesn’t always meet our expectations. But having a plan at least gives you a sense of direction, even if you have to adjust the timescale. And remember that internal re-organisations and mergers can present unexpected opportunities to try something different.

Make the most of them.

It’s your career. No one else is responsible for it. Take control – you’re in charge

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Barbara Hawker is managing director of career planning consultancy Hurst Associates (Europe) Ltd. www.hurstassociates.co.uk

 Constructive feedback Make sure your feedback gives your staff a BOOST! Make it: Balanced – tell them what they’ve done well and give examples of how they can improve their performance.

Observable – only comment on what you’ve seen or have evidence for.

Objective – concentrate on actual performance, not personal comments.

Specific – focus on personal development, not general matters.

Timely – Don’t wait too long to give feedback.

 And finally Summarise the discussion and agree key points. If there is disagreement, agree a constructive way forward. Set SMART action plans.

issue 5 | spring 2010 | healthcare manager

21

MiP AT WORK

Thumbs up for partnership in the North West North West organisations are keen to get involved. Having developed the idea, the Regional Partnership Forum held a consultation event on 26 January to gauge support for the proposal.

They wanted to make sure they had buy-in at both board and operational level. So they hosted two discussion sessions, one for chief executives, chairs, HR directors and staff side chairs from health organisations, and one for the operational side – HR and line managers and staff side representatives.

The event attracted over 80 people, who gave the idea a resounding ‘yes’:  Yes, we want the foundation  Yes, we will use it  Yes, we have a specifiic agenda

Employers and trade unions recently gave a ringing endorsement to partnership working and the establishment of a new North West Partnership Foundation to promote and support it.

Partnership working is well established in the region – growing out of the joint working to implement agenda for change and the CAPLNHS restructuring in 2006. Last year the region hatched the idea for a foundation to support partnership working as the way forward for employee relations in the NHS. As evidence mounts for the positive impact of staff engagement on key performance targets like service improvement, patient satisfaction and productivity, more and more 22

issue 5 | spring 2010 | healthcare manager

Dean Royles (pictured right), executive director of workforce and education for NHS North West, was delighted with the outcome.

‘Partnership is the way we do things round here, he said. ‘For those of us involved in the people agenda, the Foundation will help redefine the art of the possible.’

Jim Keegan, MiP national officer and member of the regional steering

group, said: ‘This is great news for MiP and for partnership working here in the North West. Partnership has always been a key organising principle for MiP and this event has given the green light to the steering group to continue its work.

He added: ‘We aim to launch the Foundation this summer. We want it to be at the leading edge of partnership initiatives and an exemplar of best practice in the North West and hopefully throughout the NHS. Now we need to keep the momentum going.’

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Help for local organisations to embed partnership working; Procedures and training for mediation to help prevent challenges becoming problems; First Steps: the priorities for the North West Partnership Forum

Work to improve the workplace culture in order to reduce bullying and harassment, and help resolve cases at an early stage; Guidance on how to approach issues on a partnership basis.

15274 MiP Rec 213x110 ad:Layout 1

Sharing the learning

6/11/09

12:53

Page 1 WORK MiP AT

These are uncertain times.

Regional SPFs Members of regional partnership forums across the country joined the national partnership forum for a shared learning event in London in January.

With much valuable work being done in the regions, the event gave participants the chance to reflect on activity through the year, share experiences of what worked well and what didn’t, and develop strategies to build partnership working.

Participants came away with plenty of ideas on how to further develop the relationship between the national and regional SPF teams and support partnership working between the regions and at local NHS level.

They heard about a number of innovative projects to stimulate partnership working and staff engagement, including one being run by Dr Tim Anstiss with the staff unions in London, one of the projects funded by the London NHS Partnership.

MiP national officer for South East Coast and London, Jo Cooper, said: ‘This was a really interesting event and gave us the chance to understand the different ways in which each SPF interacts with staff side. Mike Jackson from Unison gave a really useful succinct presentation about what a good SPF looks like as well as outlining some of the negative behaviours which can hamper or block effective partnership working.’

Jane Carter, national officer for the North East and Yorkshire and the Humber, agreed.

‘This kind of event is so useful because it provides the space to stop and reflect on what works and what needs fixing,’ she said. ‘And getting together with colleagues from other regions provides plenty of food for thought and examples of innovative work to take back into our own areas. I was particularly impressed by the work being done in the North West.

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

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Copies of the presentations at the event are available on the social partnership website, follow the link on our website at www.miphealth.org.uk/hcm.

issue 5 | spring 2010 | healthcare manager

23

backlash

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

by Celticus WronG NUMBEr!

Half a million sent home ‘early’ Claims that more than 500,000 NHS patients a year are sent home before they’re well enough ran in a number of papers at the beginning of February. This was simple distortion –claiming a statistic means something it doesn’t and hoping readers don’t spot it. The figure of 546,354 re-admissions refers simply to patients readmitted (for any reason) within 28 days of being discharged – including those who are readmitted because of new developments or unexpected side-effects, or who preferred to stay at home unless their condition got worse. It has nothing to do with the number of people sent home ‘early’.

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

Koop’s scoop of poop

‘Seniors in this country can get the same care I received, but in some places, like the United Kingdom, we would be considered too old and the cost to the state too high.’

Koop’s claims are, of course, completely false. Two out of three hip replacements go to people over 65, and there’s no age limit on cardiac surgery: 76% of pacemaker recipients are aged over 70. And in 2007, 47 were actually centenarians.

Friends like these The NHS continues to be used as a political punchbag by opponents of President Obama’s healthcare reforms in the US. Fresh to the fray is 93-year-old Dr C Everett Koop (pictured above), surgeon-general under Ronald Reagan, starring in a new TV campaign for the conservative ‘60-Plus Association’. Koop says how thankful he is for his two pacemakers, two artificial joints and coronary stent, before warning viewers, 24

Koop’s claims seem to be partly based on an anonymous email, widely circulated in America last summer, which claimed that no one over 59 could get heart surgery on the NHS. Asked to substantiate the claims, the 60-Plus Association could only produce three irrelevant newspaper stories, including an interview with Michael Parkinson about care homes and a 2006 story about the cancer drug Velcade – from our good friends at the Mail.

issue 5 | spring 2010 | healthcare manager

Panel games

With talk of ‘death panels’ being introduced into America, based on the UK model (if you’ve not been appointed to one yet, apply now at www.deathpanels. org), Celticus was pleased to get hold of the new ‘Death Panel’ game for the iPhone.

Sadly, this turned out not to involve consigning legions of undeserving patients to the ninth circle of Hell (otherwise known as a polyclinic), just a rather boring quiz about US

CELEBRITY CORNER

Polly filler Guardian columnist Polly Toynbee gets up to speed with a copy of your favourite mag before chairing MiP’s third annual conference last November.

healthcare reform. After answering 17 questions – including the spectacularly irrelevant ‘Is Barack Obama a US citizen?’ – Celticus scored an undistinguished 95 points, showing he knows as little about their healthcare system as a certain former surgeon general knows about ours.

Twitter ye not?

In response to the US onslaught last summer, supporters of the NHS set up a Twitter feed – #welovethenhs. It’s had thousands of tweets, and some of them are even about the NHS. Plenty of love on there – but not much for managers.

Remember that MiP mousemat from a couple of years ago? Dare we? #welovenhsmanagers – see you there. Bring a thick skin!

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