Healthcare Manager Autumn 2012

issue 15 autumn 2012

healthcare manager

JAN SOBIERAJ

GETTING LEADERS BACK TO SCHOOL plus

HOW STAFF WELLBEING MAKES A DIFFERENCE TO PATIENT CARE BREAST CANCER AWARENESS MONTH

helping you make healthcare happen

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Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus.

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issue 15 autumn 2012

healthcare manager inside

heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Jane Davies, deputy director of operations, Whipps Cross Hospital, London inpublic: Queen Elizabeth Hospital, Birmingham

letters & comment:8 Roy Lilley: good management in changing times

features:10 published by

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

Breast Cancer Awareness Month Interview: Jan Sobieraj, NHS Leadership Academy Staff wellbeing: Michael West on how looking after staff leads to better care for patients Complex needs: new approaches to caring for vulnerable people

regulars:20 Legal Eye: could you be sacked on capability grounds?

Tipster: promote yourself with a polished CV MiP at Work: helping you through the NHS transition

backlash:24

healthcare manager | issue 15 | autumn 2012

Welcome to the autumn issue of healthcare manager, the magazine from MiP, the specialist trade union for health and social care managers.

October is Breast Cancer Awareness month, and we have again invited Maggie Alexander, from Breakthrough Breast Cancer, to give us the heads up on the current state of play and how healthcare managers can get involved in work to bridge the gap in breast cancer survival.

In this issue we also hear from Jan Sobieraj, the newly appointed managing director of the Leadership Academy about how the academy will support his vision for health services leadership. Good leaders must promote the health and well being of their staff, argues Professor Michael West in his article, and who would argue with that? He runs through the evidence to show how this and good staff engagement will deliver better patient outcomes. We also hear about some pioneering work in the NHS to achieve integrated care for those with complex needs.

And of course we have our regular features, including tipster, MiP at Work and Legal Eye. So please do send us your comments on the magazine and on any other issues you want to highlight.

Marisa Howes Executive editor

1

HEADS UP

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

London 2012

Tracey’s Olympic experience

Prevention

Flu Fighter is back!

MiP members joined other healthcare workers to celebrate the NHS at the opening ceremony for the London Olympic Games in August. Pictured (far left) is MiP member Tracey Coyne, one of the NHS nurses dancing with the puppet bed ‘Voldemot’. Back in the real world of the NHS, Tracey said: ‘I met loads of

staff who work in the NHS in all kinds of capacities and from all age ranges. It was great to meet so many dedicated people wanting to represent the NHS on such a high profile worldwide stage. There were loads of rehearsals but it was worth the effort. It was very exciting and loads of fun.’

After the success of last year’s national seasonal flu campaign, which saw the uptake of the flu vaccine among health workers increase significantly from 35% per cent to 45%, MiP and the other NHS unions will again be working with NHS Employers on the 2012-13 staff vaccination campaign.

As last year, the ‘Flu Fighter’ campaign will be organised by the Social Partnership Forum, which brings together the NHS unions, the Department of Health and NHS Employers.

healthcare manager

Executive Editor

Contributors

issue 15 | autumn 2012

Marisa Howes m.howes@miphealth.org.uk

ISSN 1759-9784 published by MiP

Associate Editor

Maggie Alexander, Roy Lilley, Marisa Howes, Liz McCarten, Helen Mooney, Alison Moore, Jon Restell, Craig Ryan, Jo Seery, Jenny Sims, Michael West.

Craig Ryan editor@healthcare-manager.co.uk

Print

All copy © 2012 MiP or the author.

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

Art Director

An independent evaluation of the 2011-12 flu fighter campaign found that 98% of NHS organisations ran flu vaccination campaigns for staff and 35% of users rated the campaign as ‘very effective’.

This year’s campaign will focus more on embedding the campaign at local level, with a higher priority for training vaccinators and new campaign materials.

NHS Employers have sent sample campaign packs to flu leads in each trust, containing samples of this year’s campaign materials and a multimedia DVD. For more information visit the Flu Fighter webpages at: www.tinyurl.com/4xt7o5g healthcare manager is sent to all MiP members.

All weblinks mentioned are at www.miphealth.org.uk/hcm healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.

Warners Print, Bourne, Lincs

James Sparling

Advertising Enquiries

Design and Production

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

Lexographic production@healthcare-manager.co.uk

2

healthcare manager | issue 15 | autumn 2012

HEADS UP

leadingedge Jon Restell, chief executive, MiP

M

iP strongly supports Agenda for Change, because there is no credible alternative to nationally agreed NHS terms and conditions.

We all know the grass is greener on the other side of the fence, and people have moaned about Agenda for Change from the off. But let’s keep in mind what Agenda for Change does for us. The system gathers hundreds of different jobs into a coherent grading framework. It ensures that healthcare workers are paid the same for work of equal value – we seem quick to forget that equal pay was a huge problem in the recent past. Employers and staff readily understand the system and thus Agenda for Change supports staff mobility. The system is flexible and allows local employers freedom, for example, to address recruitment and retention problems and to pay local performance bonuses. Finally, employers and unions have pooled resources across the UK to design and maintain a complex system. It is wishful thinking to suggest even the larg-

“Agenda for Change was created for the same reasons we must now protect it from fragmentation and collapse.” est NHS employers have – or could develop – the skills and resources to attempt the same.

Agenda for Change was created for the same reasons we must now protect it from fragmentation and collapse.

Some local employers, for example in the south west, are ready to break with Agenda for Change. We oppose this move. Let’s be clear. They don’t wear horns. As a managers’ union we understand the financial pressures facing the NHS. We understand that managers, often our own members, must take tough decisions. But that doesn’t mean we agree that breaking with Agenda for Change is right or

inevitable.

The south west employers have been cack-handed. But this is not the real issue. Here is a summary of our objections. Their plans treat staff more as a cost than a resource. They make little allowance for the battering taken by our members’ incomes through the pay freeze and higher pension contributions. The suggested paybill savings won’t be worth the candle after the loss of staff engagement and poisoned industrial relations. A bitter wrangle over local pay diverts our attention from long term productivity gains, especially from service re­design. Any sense of ‘win-win’ is lacking in the employers’ approach. The national system with all its benefits would be fatally undermined.

Nationally, NHS Employers and unions are not angels. They have tended to push difficult decisions down to local employers and staff sides. They need to be better leaders.

But the place to make change remains the national bargaining table – and MiP is working to keep it that way.

Making a Big Difference Big Difference Company, the health promotion charity supported by Managers in Partnership, has been shortlisted for an NHS Innovation Challenge Prize. The charity’s ‘What’s Up Doc?’ project, commissioned by Leicester City NHS, raises awareness of early signs and symptoms of cancer. The project builds on the work the charity has been doing for over 10 years, in healthcare manager | issue 15 | autumn 2012

aiming to use comedy to reduce health inequalities and promote positive health messages. Rob Gee (pictured) from Big Difference will be opening MiP’s national conference on 23 November.

For further information about Big Difference Company visit their website: www.bigdifferencecompany.co.uk

3

HEADS UP

Public service

Public back state to run services Most people still want public services to be run mainly by government and are hostile to the idea of running them like businesses, according to new research by the Fabian Society, sponsored by the TUC. Polling carried out by YouGov found that 62% wanted public services provided wholly or mainly by the government, with only 5% supporting provision mainly by the private sector.

The research also found little support for importing private sector practices into the public sector, with 60% supporting the view that public services should not be run like businesses but rather should reflect the values and ethos of the public good. Only 29% supported the statement: ‘Government does things very inefficiently. We should let private companies or charities run more of our services.’

Outgoing TUC general secretary Brendan Barber said the research showed that the public still has a deeprooted commitment to public service.

‘The quiet majority that support public services now need to stand up for them like never before. We need to advocate an alternative economic programme that sees public services as a way to invest in people and our communities.’

NHS Scotland

Management cuts deeper than expected

MiP has warned that management cuts in the NHS in Scotland could be putting patients and staff at risk, after new figures revealed that the number of senior NHS managers in Scotland has fallen by 16% in the last two years.

The Scottish Government said the number of senior management posts has fallen by 212 since March 2010, much faster than necessary to meet its target of reducing senior management jobs by a quarter by April 2015.

‘The Scottish government announced

NHS Wales

Griffiths launches ‘People’s NHS’ review The Welsh Assembly Government is consulting the public on ways to improve health services in Wales, as part of a comprehensive ‘compact’ planned between the NHS in Wales and the public.

The consultation exercise, entitled ‘The People’s NHS’, is part of the wide-ranging review of health services in Wales being undertaken by health secretary Leslie Griffiths. In an interview with Healthcare 4

Manager in June, Griffiths said: ‘The service review we are going through is not just because of money; it’s because I’ve been told we have to have sustainability. Even with all the money in the world we would have to look at this.’

The consultation will be asking people for their views on improving health services and information, working with communities, and whether people can be

this across the board cut in senior managers in the NHS without discussion, but they haven’t reduced the work that needs to be done,’ said Claire Pullar (pictured), MiP national officer for Scotland. ‘We are now risk assessing new senior manager jobs much more than at any other time and finding many jobs are too big for one person to undertake without risking their own health.

‘These cuts will have a detrimental impact on service delivery as we end up doing more fire-fighting and less strategic planning. NHS Scotland needs to consult with the trade unions and work in partnership to identify where productivity savings can be made. Any more arbitrary cuts could threaten patient safety.’

Outgoing Scottish health secretary Nicola Sturgeon defended the cuts as part of the Scottish government’s ‘policy on keeping a tight rein on the pay bill for the highest earners during these challenging economic times’.

‘This will contribute to more than £100 million a year in non-clinical efficiency savings which will be reinvested in frontline services,’ she claimed.

The figures also revealed more widespread reductions in staffing, with total NHS jobs down more than 800 between March and June 2012, and nursing and midwifery posts cut by 284. better helped to manage their own health and health problems.

Griffiths said the consultation ‘is the start of a new discussion about what are the responsibilities of the Government, the NHS and people across Wales’.

‘To have a health service which is safe and sustainable and meets everyone’s needs as much as possible, we want to hear what people expect from the NHS and how they think the NHS can work with them to protect and improve health,” she added.

The People’s NHS consultation closes on 24 October. Further details are available from wales.nhs.uk/thepeoplesnhs.

healthcare manager | issue 15 | autumn 2012

HEADS UP

inperson

“My great joy is getting out there and seeing people doing their jobs, and this is something we need to do more of.”

Jane Davies deputy director of operations, Whipps Cross Hospital, London ‘I have worked in the NHS for the last 40 years and in that time have been involved in establishing many different projects to improve the patient experience,’ says Jane Davies, deputy director of operations at Whipps Cross Hospital in north-east London.

‘I think that is why I received an MBE for services to healthcare this year. It’s something that I am proud of and that I am also proud of for my team and the hospital.’

The hospital, which serves a diverse local population of more than 350,000 from Waltham Forest, Redbridge, Epping Forest and further afield, merged with Barts and The London NHS Trust and Newham University Hospital NHS Trust in April 2012 to form Barts Health NHS Trust. With a turnover of £1.1 billion and a workforce of 15,000, Barts Health is now the largest NHS trust in the country, and one of Britain’s leading healthcare providers.

Barts Health offers the full range of local hospital and community health services to patients – from one of the biggest maternity services in the country, to compassionate end of life care at home. The trust’s hospitals are also home to world-renowned specialist centres, including cancer, cardiac and trauma and emergency care.

Ms Davies, who has been an MiP member from its launch in 2005 and

was previously a member of UNISON, admits that she is unsure of her future in the new organisation but is confident that there will always be a need for managers who have the skills and knowledge to help run hospitals efficiently and effectively.

Jane has worked her way up through the organisation, having started as a ‘very bad secretary’ at Barts Hospital in 1972. ‘I have been in my current role for about ten years and now have a “portfolio”, which means I look after outpatients, medical records,

healthcare manager | issue 15 | autumn 2012

pathology, radiology and physiotherapy, amongst other things,’ she says.

Proud of the work she does, Jane highlights the volunteer programme she helped to establish at the trust ten years ago, which now counts 200 volunteers who feel ‘engaged and valued’ within the organisation. Elsewhere, she is happy to boast about how outpatients are offered free cups of tea and coffee and that for some, like those in the trust’s cancer clinics, there is the chance of a manicure.

‘When I was first asked to take on outpatients I thought it might be a bit of a poisoned chalice, but actually it’s brilliant and I think it’s wonderful what we have achieved,’ she says.

‘Every day is different and one of my great joys is looking in my diary and seeing I’ve only got one meeting for the day, and on a day like that what I try to do is go and meet the staff I manage and the patients. So I might go up to the path lab and, if I’m really lucky and they let me in, I might get to see what they are doing, for example in the cutting room in histopathology.

‘My great joy is getting out there and seeing people doing their jobs, and this is something we need to do more of.’

Helen Mooney

5

HEADS UP

NHS Jobs Service

NHS Jobs prepares for move to new provider The online NHS Jobs service will be managed by the NHS Jobs team based at Cwm Taf Local Health Board from 1 October 2012.

From that date the NHS Jobs team can be contacted via enquiries@ nhs.jobs. Key staff will transfer with the new arrangements to ensure continuity. The Department of Health recently launched a website with all the information you need to know about the new NHS Jobs service which is scheduled to go live on 3 December 2012. Find out more at tinyurl.com/9mer845

TUC 2012

TUC appoints first woman boss

FOR H C MAR

DON LON

DAY ER 2012 R U SAT CTOB1:30pm 20emOble at 1H1aymde– Parink srtarullyctions)

US IN JOIN

Ass arch to r joining for m ebsite fo w (see

Send the message that

AUSTERITY ISN’T WORKING

spending cuts threaten a lost decade invest for jobs and growth defend quality public services

@futurethatworks #oct20

March&Rally_2012_Generic_A5_Flyer_CMYK_AW.indd 1

6

Join the campaign at www.afuturethatworks.org.uk

Frances O’Grady is set to become the first woman General Secretary of the TUC when Brendan Barber retires at the end of 2012.

O’Grady, TUC deputy general secretary since 2003, was the only candidate nominated by the TUC’s 54 constituent unions at the 144th Congress in Brighton in September. The former Transport and General Workers Union official will lead the TUC, which represents more than six million trade unionists, from the beginning of 2013.

‘This is a great honour,’ said O’Grady. ‘Never has a strong responsible trade union movement been so needed. With austerity policies biting hard and with no evidence that they are working, people at work need the TUC to speak up for them now more than ever.

‘We must be the advocates of the growth and jobs alternative. And with the policy prescriptions of the last 30 years increasingly

discredited, we have the best opportunity in a generation to help build a fair, productive and green economy that works for ordinary people.’

She paid tribute to Barber, who is stepping down after nearly ten years in the job.

‘Brendan has been a great servant of the TUC, wellrespected both within and beyond our ranks, and he leaves a firm foundation on which to build.’

O’Grady joined the TUC in 1994 as a campaigns officer running campaigns for equal rights for part-timers and against low pay. She was instrumental in setting up the TUC’s organising academy in 1997 and went on to head the TUC’s key organisation department in 1999. In 2012 she led for the unions in negotiating an agreement with the Olympic authorities which secured minimum standards for local jobs, health and safety and the London living wage.

08/06/2012 11:07:29

healthcare manager | issue 15 | autumn 2012

HEADS UP

inpublic Queen Elizabeth Hospital, Birmingham

In June 2010, University Hospitals Birmingham NHS Foundation Trust officially opened the first acute hospital to be built in the city for 70 years.

And in July 2012 the Queen Elizabeth Hospital Birmingham (QEHB) was officially named by the Queen herself.

The state-of-the-art hospital in Edgbaston has been in development since 1997. It has 1,213 beds and boasts both the largest single critical care unit and the biggest solid organ transplant programme in Europe. It is also the biggest single-site hospital development in the UK. It serves as a major trauma centre for the West Midlands

and as a centre of excellence for burns, cancer and transplantation. Notably, the hospital is also the primary treatment receiving centre for Britain’s injured military personnel.

According to Dame Julie Moore, UHB foundation trust chief executive, the new hospital has been ‘built on a proud history of the old Queen Elizabeth and Selly Oak hospitals’.

‘Staff from both sites moved to the new hospital and have brought with them the dedication and commitment to their profession that means the new building can uphold and build on a reputation for excellence.’

Moore explained that the new hospital offers the clinical

healthcare manager | issue 15 | autumn 2012

“We are building academic knowledge around pioneering clinical innovations, often performed for the first time, to save lives and limbs.”

Surgical Reconstruction and Microbiology Research Centre (SRMRC).

The SRMRC was set up in January 2011 and is the only partnership of its kind in the UK. It pools expertise and innovation from the Ministry of Defence, University of Birmingham and QEHB, which has a record of excellence in treating trauma.

In March 2012, the QEHB was designated a Major Trauma Centre, and now receives the most badly injured civilian patients from across the West Midlands. This means the hospital can provide trauma, burns, plastics, orthopaedics, neurosurgery, critical care – all under one roof.

The SMRC is the first and only research centre of its kind in the UK to focus both on military and civilian care and expertise needed to treat highly treatment. The establishment complex conflict injuries. of the SRMRC means that there ‘Bringing together trust staff is now a central point in Engand their Royal Centre for Deland for trauma research, fence Medicine partners over where knowledge gained the years has provided the opthrough treatment of injured portunity to build academic service personnel can be transknowledge around pioneering lated into real improvements in clinical innovations, often per- care for all NHS patients. formed for the first time to save To date, three major research lives and limbs. strands have been established ‘Thanks to these partnerships under the SRMRC umbrella. many more people, both miliInitially, they will focus on the tary personnel and NHS most urgent challenges in traupatients, survive injuries, when ma, including identifying not so long ago they would effective resuscitation techhave died due to the rapid loss niques, surgical care after of blood and severe trauma.’ multiple injuries or amputaFor the past 18 months the tion, and fighting wound hospital has also been home to infections. the National Institute for Helen Mooney Health Research (NIHR) 7

LETTERS

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 Olympic momentum going Many Trusts in England participated in the Department of Health Olympic Challenge. My own trust received a bronze award for our work in the run up to the Olympics: facilitating healthy activities – from Salsa to Bollywood, cycling to walking.

Many healthcare organisations have long realised that they need to invest in the health and wellbeing of the workforce to motivate and ensure attendance. Sickness absence is costing the NHS millions of pounds and has a direct impact on services to patients. In these days of financial pressures, every pound saved contributes to saving jobs and services.

8

And we can all feel better too.

There is a sound business case for NHS organisations to invest in the health and wellbeing of their workforces – a lesson not just from the recent Boorman Review of the NHS health and wellbeing service, but from countless case-studies from employers in all sectors.

The provision of fitness facilities – gyms, exercise classes, complementary therapies, lifestyle checks, cycling and walking groups will improve the health of our workforce. Trust Boards can be convinced by the simple formula: investment in health and wellbeing equals less staff taking time off sick.

Alongside fitness, health education on smoking and weight control, many trusts have already seen the benefit of providing dedicated mental health support to stressed colleagues and fast track physiotherapy to staff with musculo-skeletal problems. NHS Employers has produced a very timely publication arguing the case for a broader fast track treatment route for our own NHS staff, Rapid Access to Treatment and Rehabilitation for NHS Staff.

Is it controversial to argue for

a fast track for treatment of NHS staff?

Less time managing staff absence gives us more time to focus on delivering for patients and service users and the logic of investing in the health and wellbeing of our workforce is irrefutable.

Robert Quick MIP National Committee Member, Yorkshire & Humber

It has been fantastic to see the different ways the NHS has been involved with the Olympics. I was lucky enough to be invited to some events where the NHS took advantage of overseas visitors coming to the Olympics to engage in some shared learning and build its networks overseas.

The inaugural Global Health Policy Summit, set up by Lord Darzi, brought together a number of health ministers and their staff in working groups on areas such as primary care, to work together to change health systems in different countries, and ensure the best global approach to change was taken. The event was very well attended by senior NHS staff, and the prime minister even came

along to take open questions from the floor. It was exciting to be involved in sharing the NHS’s insight overseas and celebrating what the organisation has to offer.

The UK Trade and Investment event focused on healthcare and the life sciences, promoting the work of NHS organisations and industries which work with the NHS, to CEOs from overseas. Hosted at Lancaster House, it was a great networking opportunity to attract foreign investment into UK health related industries such as pharmaceuticals. Hopefully these events will help promote Britain overseas and ensure the Olympic legacy will benefit the NHS. For further details of the Global health policy forum visit www. globalhealthpolicyforum.org, and for more information on the UKIT British Business Summit visit www.ukti.gov.uk Name and address supplied

healthcare manager | issue 15 | autumn 2012

comment

COMMENT

Roy Lilley

health policy analyst, writer & broadcaster

The essence of good management won’t change Cast your mind back a year or so.

The NHS was consumed by Health Bill fever. The NHS was plunged into chaos as politicians struggled to explain why the NHS had to be dismantled.

It was hard to discern a solid management reason. PCTs were getting to grips with World Class Commissioning and their performance ratings were on the way up. Outcomes were improving and the public’s approval of the NHS was consistently north of 80%.

With no other reasons for reforming the NHS to fall back on, the politicians turned to ‘management’. There was too much of it and it was no good.

Well, that isn’t right, either. Across UK plc about 16% of the population are employed in management roles. In the NHS, the figure was 13%. If you read the Daily Mail, you’d think management costs were 90% of NHS turnover! The fact is that, although management costs in the NHS are complicated by some clinicians having management responsibilities, they are at most around 5%.

In August, the Health and Social Care Information Centre told us that the number of people classed as “NHS infrastructure support” workers fell by about 20,000 between 2009 to 2012.

Managers and senior managers lost 5,000 and 2,000 positions respectively.

But as the relatively streamlined NHS healthcare manager | issue 15 | autumn 2012

– with three layers of management (DH, SHAs, PCTs) – is replaced with the DH, the NHSCB, Regional Outposts, 50odd support units, over twenty Clinical Support Units, nearly 250 Clinical Commissioning Groups, and a handful of Clinical Senates – it is more than a fair bet that management posts will start to grow again.

I can see a lot of argy-bargy coming on, with headlines about headcounts. I think it all misses the point. It’s not the number of managers that matters. The question is, are the managers any good?

That’s what counts.

The important thing for us is that management – leadership and getting things done – will still be our job. The essence of management didn’t change after they invented canals. Leaders were still leaders after the railways came along. Management and leadership were the same, even after the internet and neither will change after the dust has settled after the NHS’s latest palavering about. Management and leadership was, and still is, about creating the time and space for people to do the things they do best, better. Good managers, to be good leaders, do not have to be the best technicians, the best accountants, the best clinicians. They do have to have the knack of letting other people become the best they can be.

NHS managers and leaders are about to face their most critical test yet. Not

the NHS reforms, but the Francis Report into the goings on in Mid-Staffs, which is due out this October.

You can bet your shirt, your house and your first born that there will be calls for change, retribution, greater regulation and more control. It is my belief that the problems at Mid-Staffs grew out of the boardroom. I suspect a lot of other people will come to the same conclusion. There will be calls for the regulation of managers, and probably for a license to hold public office.

Will it make a difference? Did regulation of the medical director, the medical team and all the nurses and clinicians make for a safer Mid-Staffs?

You know the answer. No one blew the whistle. No one battered down the boardroom door and shouted, ‘Come and take a look at this!’ Did Monitor or the CQC make a difference? No. So what will the message be for managers after Francis? Every management guru and think tank will have something to say. (Remember they are only called “gurus” because most of them can’t spell charlatan.)

The message for top managers is the same: create space for good people to do good things, well. Only there is now even more of an imperative to do it more and better.

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

9

BREAST CANCER AWARENESS MONTH

October is breast cancer awareness month in the UK. Survival rates have improved significantly since the 1970s, but the UK still lags behind Europe’s best in diagnosing and treating our most common cancer, says Maggie Alexander.

We often hear the mantra that more women are surviving breast cancer thanks to better awareness, better screening and better treatments.

Five year survival rates in England have increased from 52% during 1971-75 to 85% in 2005-09, and one year survival rates from 82% to 95%. Sounds great doesn’t it?

But that’s only half the story.

Despite these improvements, breast cancer survival in England lags behind the best performing countries in Europe. If England were to achieve survival rates in line with the best in Europe, then an estimated 1,000 deaths from breast cancer could be avoided each year. That’s just over one in ten of the women who die from breast cancer every year. These are women who lost their lives simply because the treatments and services we provide are not the best, and because we failed to alert them to the signs and symptoms of the disease, or to enable them to get that vital early diagnosis.

At Breakthrough Breast Cancer we know more has to be done. We have to bridge the gap in breast cancer survival. Yes, we acknowledge that there have been vast improvements in breast cancer services and treatments, but we still have a long way to go 10

Breast Cancer in the UK

Breast cancer is the most commonly diagnosed cancer in the UK – more than 48,000 women and around 350 men are diagnosed every year. Breast cancer accounts for nearly one in three of all female cancers and one in eight women in the UK will develop breast cancer at some point in their lifetime.

Around 1,000 women die of breast cancer every month in the UK. Throughout the article we have referred to the survival gap in England, due to the available evidence on avoidable deaths. Since survival rates in the UK constituent nations are broadly similar, we need to bridge the gap in survival across the UK. Breakthrough Breast Cancer is dedicated to improving and saving lives through finding the causes of breast cancer, discovering new treatments and improving detection, diagnosis and medical services. For more information go to breakthrough.org.uk Breast Cancer Awareness Month is October every year.

before we can claim to offer world class services.

Put simply we believe more lives can be saved if we: ■■ Increase awareness of the signs and symptoms of breast cancer through our TLC breast awareness message (see breakthrough.org.uk/tlc) ■■

Continue to drive early diagnosis

■■

Ensure that everyone with breast cancer has timely access to safe and effective treatment

Awareness and early diagnosis When we examine five year survival rates, excluding women who have died within one year of diagnosis, breast cancer survival rates in England do not differ significantly from the European average. This suggests that the UK’s poorer survival rates are driven by lower one year survival, which has long been regarded as a proxy measure for early diagnosis.

Breast awareness remains low in the UK. A recent online survey for Breakthrough showed that less than half of women regularly check their breasts, and less than a third can name three or more signs and symptoms to look out for. We must to do more to ensure that more women healthcare manager | issue 15 | autumn 2012

BREAST CANCER AWARENESS MONTH

“We know more has to be done. We have to bridge the gap in breast cancer survival. There have been vast improvements... but we still have a long way to go.”

receive vital breast awareness information and that primary care and breast screening services ensure that awareness translates into early diagnosis and prompt treatment.

Improving patient experience At Breakthrough we believe that everyone with breast cancer should have timely access to safe and effective diagnosis and treatment and the information they need to make informed decisions about their care.

But it’s not only treatments that are important. A diagnosis of breast cancer is a frightening experience. Patients don’t know what to expect from their treatment or what kind of help they will get from their hospital.

This is why we have been delivering the Service Pledge for Breast Cancer in hospitals across the country since 2003. The Service Pledge helps ensure all breast cancer patients receive the best possible experience of care. healthcare manager | issue 15 | autumn 2012

Breast cancer patients tell us what matters most to them and we use their experiences to improve things for future patients. To date more than 50 hospitals have developed their own Service Pledge and an estimated 30,000 patients have benefitted.

The Service Pledge sets out the standards we believe breast units should aspire to achieve. Staff work with patients to develop their own local pledges, outlining both the standard of service patients can expect and the improvements they are working towards.

Questionnaires and face to face interviews help us to understand patients’ experiences, but patients are also invited to be representatives at their local hospital to help staff identify improvements needed based on patient feedback. Once the improvements are agreed, Breakthrough develops the hospital’s Service Pledge booklet which outlines these goals and timelines, as

well as explaining how newly diagnosed patients can expect to be treated while at the hospital.

Former patient representative Maureen Lubert, said: ‘Becoming part of such an important step forward in improving conditions and services for patients was very rewarding. I wish that such an initiative had been available when I was going through my own cancer journey so I could have expressed my voice as a patient.’

The Service Pledge is leading the way to an era of patient centred care and has been recognised as a model of patient involvement by the National Centre for Involvement, the Excellence in Oncology awards, the Nursing Times and the Picker Institute. By being involved in the Service Pledge patients are helping to shape services for the future.

What can you do?

Find out more about how we are working to Bridge the Gap in breast cancer survival at www.breakthrough. org.uk/gap. If you want to know more, or feel you would like to be involved in the Service Pledge, contact the Service Pledge Team for further information, call 08080 100 200 or email: servicepledge@breakthrough.org.uk

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Maggie Alexander is director of policy and campaigns at Breakthrough Breast Cancer.

11

INTERVIEW

Alison Moore talks to Jan Sobieraj, head of the NHS Leadership Academy, about leadership, developing the next generation of managers and how no one is too big to learn.

Talking about leadership to NHS managers is a hard sell at the moment. Many are more concerned about losing their jobs or coping with the tsunami of change which is engulfing them. And those from a non-clinical background may be wondering where they fit in a system whose mantra seems to be ‘clinical leadership good, managerial leadership bad’.

But that hard sell is the job Jan Sobieraj has taken on. The former PCT chief executive from Sheffield was appointed managing director of the NHS Leadership Academy earlier this year. His career has seen him seconded to the Department of Health, running a foundation trust and community and mental health services, as well as working in the private sector and social housing.

So it is not surprising his perspective on the current upheavals goes beyond the NHS managers whose jobs are on the line. ‘You can get caught up with the 45,000 involved in PCT system management – that leaves about 1.1m people [in the NHS] who are not,’ he says.

‘Clearly for the people involved in transition it is enormously difficult and we need to get it right, but it is a big system out there.’

12

One of his continuing concerns is how the changes will affect diversity among NHS leaders. ‘I worry about this.

We have done some very good things over the last few years but there is a real risk we will end up with a less diverse community going forward,’ he says.

‘It’s not a numbers game... it’s about having a diverse set of leaders at every level. We are not doing as well as we could. I’m hopeful that we can learn from other industries.’ He points to the fact that his own interview board comprised David Nicholson, Jim Easton and a female CCG lead and to the evidence that having leaders from diverse backgrounds can lead to a reduction in health inequalities and improve patient care. Inclusion has to be ‘everyone’s business’, he says, and must be embedded in everything the Academy offers. This includes building a ‘talent pipeline’ for leaders from diverse backgrounds, strengthening accountability and developing senior leadership capability in inclusion and diversity.

Looking forward he is acutely aware that he and his team will be working in a very different context, one in which power is much more devolved. Central diktat has been replaced by a complex system of levers consisting of regulators, service standards, tariffs

and other financial controls: the challenge for NHS leaders will be putting the system’s priorities above those of their own organisations.

‘Leaders have to work together to deliver better care for patients,’ says Sobieraj. ‘That’s something that some people do very well and some may not have addressed very well. Our premise is that in a more devolved economy we need to invest even more in how leaders interact across the system. The right sort of behaviours will be important in supporting change.

The need for leaders to behave differently in the future is a theme which he often returns to: it’s not just more leadership or better leadership the NHS needs, it’s a different type of leadership: leaders who take risks, who emulate good practice more than in the past and who adjust their own behaviours to the new world they are operating in. ‘We want to ultimately professionalise leadership,’ he says.

Leadership has been flavour of the month in the NHS many times. His own organisation takes over from the National Leadership Council – only three years old – and there are many other organisations both inside and outside the NHS with an interest in developing leaders. What will make the Leadership Academy succeed? healthcare manager | issue 15 | autumn 2012

INTERVIEW

“‘We need leaders who can engage more with their staff and a wide set of stakeholders. We know what we have got and what we have to do to change it.”

‘We now have evidence about what works. We have never had it before,’ Sobieraj says. This could create a different dynamic: for ten to 15 years what was effective in leadership was simply supposition. And the Academy also has an evidence base of its own, he points out: ‘Many hundreds of top leaders have been through our assessment process and that has told us what sort of leaders we have.

‘We need leaders who can engage more with their staff and a wide set of stakeholders. We know what we have got and what we have to do to change it.’

Key to the Academy’s vision is the ‘leadership framework’ which describes what good leadership looks like, with a common set of behaviours expected of leaders from whatever discipline or background they are from. But Sobieraj has also talked about the ‘industrial levels of transformation and innovation’ which will be needed.

‘We’re planning to launch one of the largest leadership development programmes in the world, a project which is being led by the Department of Health. It will be aimed at both managers and clinicians and be focussed on raising the profile, performance and impact of health system leaders, requiring and supporting them to demonstrate their fit and proper readiness to carry out their leadership role,’ he says.

‘It would be aimed at entry, midcareer and our most senior leaders, so would “capture” people throughout their careers. Any decision about the healthcare manager | issue 15 | autumn 2012

regulation or registration of managers would not be ours to take. We have the best opportunity with a new set of people coming in who may not have learnt the old ways who are not vested in history.’

A willingness to take risks is part of this. Sobieraj knows transformation won’t happen without it, but he says people need to be supported in taking those risks. And he points out that responsibilities within the NHS are shifting: CCGs and the switching of public health functions to local authorities may be at the forefront of people’s minds, but there are also new responsibilities for foundation trust governors and the development of community foundation trusts.

While the NHS is the biggest employer of healthcare staff, the Academy will also be working with other players including social enterprises (which he describes as being ‘like Zebedee’ in their enthusiasm) and independent providers of NHS-funded care. The programme board has sought members from the independent sector and he expects to see social enterprise chief executives

and managing directors of independent healthcare companies on the top leaders programme.

This flagship scheme for the Academy has not been without its critics. Last year Gareth Goodier, chief executive of the Cambridge University Hospitals Foundation Trust, walked away from the programme after being told he had to do an assessment to identify his development needs or be thrown off the scheme.

‘Even though Gareth might be dismissive, I hope it would have raised questions in his own mind about what he is doing to develop leaders,’ says Sobieraj diplomatically.

With 1,000 managers on the scheme there is inevitably a wide range of people, from very experienced chief executives, like Dr Goodier, to people who are at director or assistant director level and working towards their first chief executive job in much smaller organisations.

Sobieraj sees a cadre of future healthcare leaders among them and wonders if there should be a supernumerary programme to allow them to try roles without the extreme 13

INTERVIEW

“When we look at ourselves in the NHS we always see our failures.

But internationally, healthcare organisations look at us longingly...”

pressure of having to immediately succeed. ‘We probably need to deliver a very senior cadre within the thousand, to craft a very senior cohort which will be supported to take on the very big roles,’ he says.

He warns that leaders who accept the prestige of being on the programme but don’t do much in response could be out on their ears. ‘But you get out what you put in. We have some inactive people [among the] top leaders. I would say, what are they doing there? I think we will offer some challenge in the system.’

And just in case anyone thinks they are too big to learn, he points out Sir David Nicholson and his team have taken the assessment the Academy offers and Nicholson talks openly about the feedback he received, about what he is not very good at and what he is doing to change his style.

But the Academy also wants to support people at entry level and in mid-career as well as those in more senior roles. Middle managers who aren’t chief executive material still need support. Better working between different professional groups can be encouraged by joint learning.

The Academy will work through a small number of local delivery partners who will work closely with the new local education and training boards. ‘We want the local delivery partners to be our eyes and ears on the ground, working with employers, LETBs and academic health networks,’ Sobieraj says.

And the successful graduate 14

management scheme will continue. ‘It’s a key part of our plans that we have a successful entry level programme,’ he says. But will the scheme see a shift towards local delivery? ‘It’s not really nationally based now,’ says Sobieraj.

‘The trainees are from all parts of the country and carry out their training in different organisations around the country, so they are effectively local to that area. We will regularly look at all our national programmes to ensure that they are fit for the future and are able to meet the ever-changing demands of the health system and our patients.’

Involvement in the Academy’s leadership programme is discretionary – organisations can choose to go their own way, commission their own leadership programme or simply not engage. ‘We have to convince them it is worth it,’ admits Sobieraj. The Academy will increasingly need to find more of its funding externally, so proving its offer is ‘worth it’ will be crucial.

In his first few months in the job, Sobieraj has been keen to visit organisations across the country to avoid becoming detached from the reality of what is happening in the NHS. As change continues – and in some areas accelerates – Sobieraj urges

organisations to spend time developing their vision and leaders to articulate the benefits and opportunities of the changes, such as allowing staff to drive the improvements they want to see.

And he is keen to learn from elsewhere. ‘What sectors have got leadership development cracked?

Commercial organisations have been into it for decades – so part of what we are going to do in the future is talk to these people.’ He cites the General Electrical Leadership Academy as an example, and closer to home points to the Ministry of Defence and the armed forces, especially the way very young officers are given incredible responsibility in, for example, Afghanistan. The structure and approach to leadership may be different but there may still be things to learn.

‘When we look at ourselves in the NHS we always see our failures. But internationally, healthcare organisations look at us longingly.’ There has been international interest in the academy’s work but Sobieraj is keen this interest should go both ways. ‘We want to nick, steal and copy other systems!’ he jokes.

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Alison Moore is a freelance journalist. healthcare manager | issue 15 | autumn 2012

STAFF WELLBEING

The evidence is clear: better staff wellbeing saves money and leads to better outcomes for patients. Michael A West says the NHS should not just close the gap with the private sector, but make itself a model for others to follow.

The news earlier this year that the NHS lost 390,000 fewer days to absenteeism last year is welcome.

Over ten million working days are lost each year in the NHS because staff are unwell – equivalent to 14,500 staff. NHS Trusts have been working hard to reduce absenteeism figures, partly as a result of the Boorman Report (nhshealthandwellbeing.org) which identified the scale of the problem and suggested strategies for change. Slowly, the NHS is closing the gap with the private sector, which records an average of 6.4 days absenteeism per employee a year compared with more than 10 in the NHS. Good news, but the NHS should be a model for managing the health, wellbeing and absenteeism of staff. The NHS should be showing the private sector how it’s done. NHS organisations are focused on improving the health and wellbeing of the population.

As with any organisation, it is important to have integrity between what it does and how it does it – between its purpose and processes. Where NHS organisations fail to manage staff health and wellbeing effectively, there is a fault line in the organisation, since healthcare manager | issue 15 | autumn 2012

“The best predictor of patient mortality is the percentage of staff working in effectively functioning teams, and positive climates are also associated with low patient mortality.”

staff charged with caring for the health of others are not able to manage their own healthcare effectively.

NHS staff should be helped to ensure they manage some of the obvious threats to their health such as smoking, obesity and alcohol abuse.

But they should also be helped to understand the most powerful factors that determine human wellbeing and to put this understanding into practice in

their own lives. Then they can be models of good health management for patients and the rest of the community, and save the NHS money via lower absenteeism.

The UK Foresight programme reviewed research worldwide and identified five key factors for health and ‘mental capital’: first and most important is spending good time with the people we love and who love us.

15

STAFF WELLBEING

‘Connectedness’ and belonging are powerful buffers against ill health across all cultures. Loneliness is a killer.

Second is the importance of exercise to both physical and mental health. We think better when we take regular exercise and we are likely to resist the onset of diseases like Alzheimer’s for longer. Running, cycling and swimming are good but a half hour of walking a day is particularly good (see the great YouTube video ‘23 and a half hours’ on this: www.youtube.com/ watch?v=aUaInS6HIGo). Third is learning – continuing to be stimulated by learning new things such as improving skills on an instrument, learning new recipes, practising sport and stretching our capacities by taking on new learning opportunities whether we are five or 85 years old. Fourth is living more in the here and now rather than ruminating about the past or angsting about the future. Mindfulness and being present means seeing the leaves on the trees as we walk by, being present with people we are interacting with and perhaps practising techniques like mindfulness (oxfordmindfulness.org). And finally, helping others: we derive great benefit from taking the time to help other people. Giving, altruism, co-operation and kindness benefit the giver as much as the receiver, so working in a role that involves helping others is a privilege.

But NHS leaders and managers also need to change their management styles from the predominantly autocratic and directive, to a more participative, supportive and engaging style. Too few NHS staff feel they have a voice at work, and as many as one in seven report being bullied by their managers each year – a key cause of absenteeism.

Many staff say they are overworked and have no control over their workload, affecting their ability to do their job properly. Many report spending large amounts of time doing what seem like pointless tasks rather than delivering patient care; they feel their motivation and satisfaction drop as a result. And fewer than half report having a well structured appraisal or working in 16

“High engagement was associated with much lower absenteeism... An increase of one standard deviation in engagement would yield a saving of around £150,000 in salary costs alone for an average acute trust.”

effective teams. As a consequence the quality of their daily working lives is more stressful than it needs to be. A shift to a more inclusive, engaging and listening style of management is vital in an NHS facing major change and uncertainty. The NHS should be a model of outstanding staff management in order that its staff can deliver compassionate and high quality care. Patients report being treated like tasks not like people in NHS trusts where staff feel run off their feet, stressed, and directed rather than listened to and appreciated.

We know there is a strong relationship between how staff are managed and patient satisfaction. Staff views of their leaders are strongly related to patients’ perceptions of the quality of care. Staff satisfaction and commitment predict patient satisfaction, as do the supportiveness of immediate managers and the extent to which staff feel positive about their work. In trusts with poor staff health and wellbeing, high levels of presenteeism (staff attending work when they are not well), work-related stress, injury rates, and high levels of staff turnover, the patients report being less satisfied, and inspections by the Care Quality Commission reveal poorer quality of care and poorer use of financial resources.

The best predictor of patient mortality is the percentage of staff working in effectively functioning teams, and positive climates are also associated with low patient mortality.

The evidence is clear: staff need to be

well led and managed; they need to feel positive and that they can improve the quality of patient care; they need to have manageable workloads and to have supportive rather than snippy, autocratic managers; and they need to work in an environment where managers and colleagues are positive, optimistic, supportive, humorous and appreciative of their contributions. All these relationships are well documented in work I and my colleagues have produced for the Department of Health (www.dh.gov.uk/health/2011/08/ nhs-staff-management/).

In work for the King’s Fund, we closely examined the relationship between employee engagement (motivation to work, involvement in decision making and advocacy of the organisation) in the NHS and individual and organisational outcomes (www. kingsfund.org.uk/publications/ leadership_review_12.html). There were significant differences in engagement levels between types of trusts and staff groups. Ambulance trusts generally had much lower engagement than others (although with only slight differences in psychological engagement), and ambulance staff had the lowest scores of all staff groups, while general managers usually had the highest scores.

Engagement is also linked to staff health. Staff with high engagement levels were less likely to report suffering from work-related stress, and were less likely to feel pressure to work when they were not fully fit to do so.

Generally speaking, employees who reported higher engagement were more likely to rate their own health and wellbeing highly. The quality of patient experience, as measured by inpatient satisfaction in acute trusts, is also strongly linked with engagement (as it is with other aspects of staff experience). Patient satisfaction is significantly higher in trusts with higher levels of employee engagement.

The main driver for this is the “advocacy” element of engagement, which has by far the highest correlation with patient satisfaction. This may healthcare manager | issue 15 | autumn 2012

STAFF WELLBEING

partly reflect the symbiotic nature of staff and patient experience: if staff are aware that patients are largely satisfied with their care, they may be more likely to view the quality of care more positively themselves.

Engagement is also significantly linked to patient mortality in acute trusts, both when mortality is measured in the same year as engagement, and when it is measured in the subsequent year.

Engagement was also a critical factor in explaining absenteeism. High engagement was associated with much lower absenteeism than lower levels of engagement. An increase of one standard deviation in engagement would yield a saving of around ÂŁ150,000 in salary costs alone for an average acute trust.

The Annual Health Check (AHC), which was until 2009 the main regulatory monitoring mechanism for NHS trusts, provided two measures of organisational performance: quality of services and quality of financial performance. healthcare manager | issue 15 | autumn 2012

Although relatively blunt instruments, the range of different indicators used by the Care Quality Commission to derive them ensures they represent organisational effectiveness in a wide-ranging way. Both measures were again related to engagement. Finally, in trusts where a large percentage of staff felt they could contribute towards improvements at work, infection rates decreased, reinforcing the value of staff involvement in improving services and creating cultures of engagement and innovation.

When staff are well managed, where they are enabled and encouraged to take care of their own health and wellbeing, and when they are working in positive, supportive and effective environments they deliver better patient care. And they do so with far fewer days sick leave because stress, negativity and bullying are dramatically reduced.

So this is the challenge for the NHS in the future: not merely closing the gap on absenteeism with the private sector but becoming a role model for good staff management and ensuring the health

and wellbeing of staff.

NHS workplaces should enable all staff to flourish, learn, grow, help others and feel that they are making a valuable contribution. That means changing cultures so that all NHS organisations mirror those that are currently best at this. And there are good examples to be found the length and breadth of the UK: Buckinghamshire Healthcare NHS Trust, York Teaching Hospitals NHS Foundation Trust, South West Yorkshire Partnership NHS Foundation Trust, Nottinghamshire Healthcare NHS Trust and Abertawe Bro Morgannwg University Health Board. Encouraging managers and leaders in the NHS to visit these outstanding organisations and learn from their examples is an excellent way to spread the very good practice that exists within the NHS at a time when such good practice is desperately needed.

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Michael West is Professor of Organisational Psychology at Lancaster University Management School and a Senior Research Fellow at The Work Foundation.

17

COMPLEX NEEDS

Integrated services can transform the care of vulnerable older people. Jenny Sims looks at two innovative partnerships that are setting the pace for tomorrow’s NHS.

It sounds like a call to arms. In fact it’s a call to managers to use their skills to transform the lives of older people and their carers in the UK. According to Dr Jocelyn Cornwall, author of the King’s Fund report The care of frail older people with complex needs: time for a revolution, healthcare team managers have a key role to play in transforming health and social care services for older people with complex needs.

‘Effective managers and staff working in a supportive organisational context could remedy many of the problems encountered by patients and carers in their own homes and hospital,’ she says.

And there are plenty of pockets of excellence throughout the UK to prove it, showing how the rhetoric of ‘personalised care’ in relation to frail older people can be realised in everyday care and practice.

These include an ‘integrated primary care mental health and wellbeing service’ in Sandwell, and ‘community care closer to home’ services in Pembrokeshire. They show that team 18

leaders are helping to change cultures and practices, raise quality and improve outcomes for vulnerable older people with complex needs. But nationwide the changes are not happening fast enough, says the King’s Fund.

‘There are many brilliant services.

The problem is slow dissemination and adoption,’ Professor David Oliver, national clinical director for older people at the Department of Health, told a recent King’s Fund conference.

‘We don’t need any more NICE guidelines or reports on complex needs in vulnerable and older people, we need implementation and dissemination of good practice.’

The task of improving care for the growing number of people with complex needs is undeniably challenging. Figures show: Most people over 70 have three or more conditions ■■ There are currently three million people over 80 in the UK – this figure is expected to double by 2030 ■■ The number of centenarians has risen 50% since 2002.

“We had a silo approach to commissioning... and a silo approach to provision. We had the wrong care, for the wrong people at the wrong time.”

Angela Watwood, Pembroke About 750,000 people in the UK have dementia – this figure expected to double in the next 30 years ■■ One in four hospital beds are occupied by someone with dementia.

■■

■■

Unfortunately, the current model of acute care is unsuitable for many patients with complex needs, as many reports have recognised. Older people’s care lacks social and professional status, and working conditions healthcare manager | issue 15 | autumn 2012

COMPLEX NEEDS

for many nurses, care assistants and home care workers involved in caring for older people are poor.

Successive reports have called for improvements to the education, training and support of frontline staff, better leadership, management and strategies for people with complex needs, and for more priority to be given to hospital and community services for vulnerable older people.

‘There should be more focus on prevention and integration of care closer to home,‘ suggests Prof Oliver. One example of where the NHS and local authority are working together successfully to integrate services is the partnership between Pembrokeshire County Council and Hywel Dda Health Board.

Two years ago they set up four geographically based Community Resource Teams (CRTs) across the county. Each team comprises a mix of health and social care professionals and third sector support, including GPs, social workers, district nurses, occupational therapists, physiotherapist, dieticians, voluntary sector brokers, chronic conditions nurse practitioners, domiciliary care and support workers.

As a result, Pembrokeshire has seen a reduction in the number of older people in long-term institutional care and acute admissions, and more people being cared for in their own home. The county has also seen a marked reduction in delayed transfers of care.

Currently, the average age of service users is 80, and 71% have a contingency plan in place. Their eldest user living in the community is 106.

Angela Watwood, head of Community Health and Social Care Services for the combined authorities, said: ‘We have seen a real decrease in people with long term conditions and saved £1.5 million. Now we’ve got the best outcomes in Wales.’

Before Pembrokeshire created an integrated management structure and set up the CRTs there was poor communication between services resulting in ‘customer bounce’, delayed assessments, and many inappropriate admissions into hospitals and healthcare manager | issue 15 | autumn 2012

residential nursing care.

These problems were compounded by the use of different performance measures in health and social care and the voluntary sector, and poor information systems for community services.

‘Through the establishment of CRTs we are promoting good communication and care co-ordination of customers’ needs,’ says Watwood.

The team’s excellent public website (www.pembrokeshire.gov.uk) is an example for others to follow. It explains how the integrated team aims to ‘help people take control of their health and social care needs, reduce emergency situations and prevent crisis, help people stay in their own homes longer, reduce the risk of admission to a care home or hospital, and promote healthier communities and better well-being.’

Service users are assigned a named co-ordinator who leads on their assessment, works with them to understand their lifestyles, and identifies their health and social care needs. The co-ordinator may ask other team members to assist in the assessment to make sure needs are correctly supported. A range of care options are available, and users are fully supported in obtaining the care most appropriate to their needs. They are also given choices on how to manage their care and a written care plan saying who will do what and when.

The team review every individual’s progress weekly, and their GP’s are kept informed. The team check on anyone who has been in hospital more than 10 days to see what action might be needed.

The partnership are currently carrying out a mapping exercise across all services and an assessment of the impact of the CRTs, and developing a new approach to proactive predictive care management.

‘The overall purpose of the service is to promote individuals’ independence ensuring the right person receives the right service from the right people in the right place at the right time and at the right cost,’ adds Watwood.

Lisa Hill, Sandwell Sandwell’s innovative complex needs service for people with long term mental health conditions has similar aims. Lisa Hill, primary care mental health and wellbeing lead at Sandwell Primary Care Trust, says: ‘We had a silo approach to commissioning, and due to that we had a silo approach to provision. We had the wrong care, for the wrong people at the wrong time’.

Now Sandwell has developed a ‘bio-psycho-social’ model of care and a collaborative, ‘shared-care’ approach, with GPs, psychiatrists, carers, service users and others contributing to decision making. Gone are the days when people might have to endure up to 30 different assessments before getting access to health and social care services – and then not necessarily the right service at the right time.

After referral, Sandwell’s service users see a single co-ordinator who will facilitate access to the most appropriate service for them, whether GP, psychiatrist or social support. A report on the project, one of five King’s Fund demonstrator sites, will be published in late 2013.

‘There is no magic bullet. We need to focus on constructive solutions that are relevant, effective, multifaceted and multi-agency,‘ says Prof Oliver.

Sandwell and Pembrokeshire are doing just that!

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Jenny Sims is a freelance writer and editor specialising in healthcare management.

19

LEGAL MATTERS

legaleye Employers must have good reasons before sacking staff on capability grounds, says Jo Seery In the current climate of austerity and mass redundancies in the public and private sectors, employers will often look for reasons other than redundancy – such as capability – to dismiss employees in order to avoid paying a redundancy payment.

Capability is defined in the Employment Rights Act 1996 by reference to the skill, aptitude, health or any other physical or mental quality of the employee. It’s up to the employer to establish that capability was the reason for the dismissal: they don’t have to prove that the employee was incapable of doing their job, just that they honestly believed they were incapable and had reasonable grounds for that belief. They do, however, need evidence of the standards applying to the employee and of his or her failure to meet them.

In many cases employers have appraisal or performance management systems which can be used to initiate capability proceedings when an employee is accused of not meeting certain standards. Equally, employees can rely on recent appraisals as evidence that their performance is not below standard; for example, if they have been awarded a pay increase or bonus.

Employers also need to ensure that capability and not some other reason such as disability or age, is the reason for dismissal.

Having established that capability was the reason for dismissal, employers must then show that they acted reasonably. This duty is two-fold: tribu20

nals will examine not only what steps the employer took once they realised the employee was not up to the job, but also what they did to ensure they could do the job in the first place.

As a result, employers cannot usually defend a claim of unfair dismissal if they failed to provide proper instructions or support to their employees at the outset, set unrealistic targets or gave them too short a time in which to improve.

If an employee has received adequate training and support but still cannot meet the employer’s standards, dismissal on the grounds of capability is likely to be fair. Employers do not have to find alternative work for an employee who’s struggling to do their job. For example, an employee who fails to make the grade following a promotion, but does not have a contractual right to return to their previous post, could be at risk of being fairly dismissed for capability.

Equally, employers do not have to consider demoting an employee instead of dismissing them on the grounds of capability, unless this is specifically provided for in the employment contract or a collective agreement incorporated into the contract. Nor is it necessarily unfair for employers to take an ‘expired’ warning into account when dismissing on grounds of capability, but whether this is reasonable will depend on the particular circumstances of the case.

The duty to act reasonably also means following a fair procedure before dismissing someone on capability grounds.

Employers have to show they:

carried out an investigation or assessment of the employee’s performance ■■ warned the employee of the likely consequences if they failed to improve ■■ gave the employee a reasonable chance to improve ■■

The ACAS code sets out the minimum procedure that employers should follow when disciplining an employee: ■■ Inform the employee of the problem.

■■ Hold a meeting with the employee to discuss the problem.

■■ Allow the employee to be accompanied at the meeting.

■■ Decide on appropriate action.

■■ Provide the employee with an opportunity to appeal.

Generally, capability issues develop over time. Therefore, tribunals expect employers to provide employees with a structured improvement programme to complete over a set period of time.

Employers should also make clear the consequences if staff fail to improve, including dismissal. If the employee’s performance improves during the requisite period but the employer still dismisses them, the dismissal is likely to be unfair.

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Jo Seery Thompsons Solicitors Legaleye is not intended to provide legal advice on individual cases, and MiP members in need of personal advice should immediately contact their MiP rep. healthcare manager | issue 15 | autumn 2012

tipster

Promoting yourself with a good CV There’s much more to a good CV than just a list of jobs you’ve done. An informative and targeted CV will give you a head start in today’s competitive job environment. Liz McCarten offers some basic tips. to people already working for your target employer to get an insider’s view.

Nothing puts off a potential employer more than a CV which does not address their requirements and you won’t get shortlisted if your CV gives the impression that you are just going through the motions.

3 Preparation is key

 What does your CV say about you?

Your Curriculum Vitae says a great deal about you and it is the first – and maybe only – chance you will get to sell yourself to a potential employer. To get to the next stage, the interview, your CV must clearly and succinctly promote your skills and experience. Read your CV with a critical eye. Does it really describe your experience, your seniority and what you have to offer? If the answer is yes, you’re ready to send it in.

2 Know your audience Each position you apply for will be different and your CV needs to be targeted for every application. The primary skills required in the job description and person specification will vary. Spend some time on research and if possible talk

healthcare manager | issue 15 | autumn 2012

A good CV takes some time to prepare. Start by listing tasks you undertake daily, weekly and monthly, then draw out the skills required to complete these tasks. Next add your achievements.

Finally consider your one-off projects, the target audience and the impact of the project. Use figures where possible to show the extent of your financial control, numbers of direct reports and impact on targets or other outcomes. Being specific gives your CV more credibility.

4 Start with a personal statement Surveys show that when reviewing a CV people spend an average of 20 seconds reading the first page and less on subsequent pages. A synopsis of your unique mix of skills, experience and education is key. Aim for a paragraph for this section.

5 Choose a CV format

employment history in reverse chronological order. Use it for applying for jobs in your current field to demonstrate your accomplishments and career progression.

Functional: This format highlights principal skills and experience and is often used by people seeking a change of career direction. Group evidence under eight to ten headings to show how you meet key criteria for the role and your additional experience. Follow this with a brief career history.

6 Writing style This is a business document so avoid the first person and use bullet points if possible. Begin each point with a strong adjective. Ensure your style is consistent throughout: a mixture of present and past tense can be confusing to read and undermines your presentation.

7 Don’t oversell There’s a fine line between emphasising your experience and qualities and overstating your achievements. If you managed a project and can describe real outcomes, make sure you take the credit. If you were part of a project team, don’t claim you led it if you didn’t – potential employers may use their networks to check you out and it could undermine your real achievements.

8 Avoid...

Don’t use jargon. Do check and proof read carefully. Don’t seem to be begging – remain professional. Don’t include your date of birth, gender, salary details or contact information for your referees.

9 AND....

Good luck!

Liz McCarten provides advice to MiP members on drafting CVs. Contact her on l.mccarten@miphealth.org.uk.

Chronological: This format lists your

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MiP AT WORK

Supporting You through change MiP has joined with University College London Hospitals Foundation Trust to develop an innovative programme of training and coaching to support staff in dealing with organisational change. The ‘Supporting You’ programme is designed to equip staff to deal constructively with the challenges thrown up by change.

MiP made a succesful bid to the Department of Health for funding to support the project. We became involved as a result of our experience in representing members facing restructuring, redeployment and worries about redundancy. The programme aims to help staff take control in difficult times rather than waiting for things to happen

Restructuring our NHS in England MiP continues to play a key role in the HR Transition Partnership Forum (HRTPF), overseeing the HR aspects of the restructuring of commissioning in the NHS in England. We want to ensure staff are treated fairly in this huge exercise affecting 43,000 staff from PCTs, SHAs, arms-length bodies and the Department of Health (the “sender organisations”) whose functions are transferring to the new organisations established by the Health and Social Care Act (the “receiver organisations”).

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to them. It offers workshops and individual coaching sessions, provided by MiP national officer and trained coach, Karen Constantine (pictured).

The programme will run for a year and includes: Communication Skills for Positive Change: workshops which use an interactive approach to help staff learn about their personal style of communicating, develop useful influencing and negotiation skills and build confidence to deal with restructuring and the cycle of change.

Coaching Skills to Support Change: workshops for people recently given team supervisory roles as Filling of Posts Policy and FAQs Finally agreed in July, this policy sets out the terms of transfer and the process for filling posts in the new organisations to ensure fairness and transparency. It took a long time to reach agreement on this policy, but it was essential to get it right, because it affects the terms of transfer for staff, including continuity of service and other protections.

Most staff in sender organisations should know whether their function will transfer to a receiver organisation, and if their job has been matched to a post or if they will have to go for wider ring-fenced competition. If you are affected by the transition and have not been informed what will happen to you, or if you disagree with the outcome of the matching process, you should seek advice from your MiP national officer.

a result of organisational restructuring, which will help them to develop their listening skills, gain practical experience in informal coaching and practice those difficult conversations with staff which we have to have.

Individual Coaching Sessions: one-to-one sessions to help people define and achieve major goals (both professional and personal) faster and easier. These are designed to help staff see things from different perspectives, identify ways of overcoming obstacles and decide on action to achieve their goals.

MiP’s Karen Constantine said: ‘This is partnership in action and I am delighted to be working with UCLH The microsite www.hrtransition.co.uk is a one-stop-shop for people involved in the transition, and contains all the agreed policies, procedures and guidance governing the process. It also has an HR zone for HR managers and trade union representatives, with tools and templates to manage the transition fairly and consistently.

Transition job vacancies Most vacancies will be advertised on NHS Jobs, not the microsite as originally intended. A sifting mechanism will ensure that only those entitled to apply under the ‘Filling of Posts’ policy can do so. Our advice is to check the microsite which will point you in the right direction.

Planning for a secure transition MiP has had discussions with the

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MiP AT WORK

These are uncertain times.

to support NHS staff through these challenging times. I really do hope that managers and staff take advantage of this opportunity to get training in communication skills and coaching as well as support and practical advice on how to deal with organisational change both for themselves and for their staff.’

.

If you work for UCLH, you can get more information about the project from UCLH on: supporting. you@uclh.nhs.uk. If you would like to discuss the project and the possibility of developing a similar programme, contact Karen on k.constantine@ miphealth.org.uk

Department of Health about plans to transfer some day-to-day responsibilities to receivers from 1 October, and the impact on SHA and PCT directors. Advice has now been sent to SHA cluster chief executives. We want to ensure that lines of accountability are clear during this transitional period to minimise risks to the system, protect service delivery and to ensure that the employment status of those affected is clear.

Keeping up to date Check out the MiP website for regular updates on the transition. We also email members about major developments. If you don’t receive our emails your membership record may be out of date. Do take a few minutes to check or email us on info@miphealth.org.uk

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healthcare manager | issue 15 | autumn 2012

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/joinus

helping you make healthcare happen

23

backlash

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

by Celticus

I

t’s probably fair to say Andrew Lansley won’t be much missed around the NHS or Richmond House. Our columnist Roy Lilley (see page 9) spoke for many when he said the ex-Secretary of State for the Time Being was ‘a man who lived in a windowless world that he could not describe and we could not see into’. But his replacement by culture secretary Jeremy Hunt left most people baffled, including, it seemed for a while, the new SoS himself.

As the ever-astute health commentator Paul Corrigan put it, ‘Lansley had an idea but couldn’t communicate it.

Jeremy Hunt has no idea and communicates that very well.’

Blue Sky thinking

T

here’s probably never been a worse time to become SoS for Health, so Mr Hunt could do without all the unkind references to his belief in homeopathy (‘clinically effective and cost-effective’ according to a Commons motion he signed in 2007) and his one-time support for breaking up the NHS. Some even claim that Hunt, as culture sec, tried to block Danny Boyle’s NHS celebration at the Olympic opening ceremony, but was overruled by the PM. Still, if Jeremy wants to win some quick friends in the NHS, he could replace all those unused PatientLine tellyboxes clogging up the

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wards. If only he knew someone who could help...

Book hunting

H

unt is listed as ‘co-author’ of a 2009 tract with the faintly sinister title Direct Democracy: An Agenda for a New Model Party. Apparently, this book, masterminded by the ultra-Thatcherite Tory MP Douglas Carswell, describes the NHS as a ‘fundamentally broken machine’ and calls for its replacement by a system of ‘universal insurance’. We say ‘apparently’ because Direct Democracy has proved hard to track down. A link on Mr Carswell’s website leads only to a page of Chinese characters. Even the mighty Amazon could only offer a single used copy at a price of £71.41. A month’s Sky subscription? You must be joking.

Minister of the future

A

s Mr Lansley is the only human to understand the health reforms, it’s lucky we have new junior health minister Dr Dan Poulter on hand. For we can reveal that ‘Dan Poulter MP’ is actually a prototype ministerial robot known to Whitehall mandarins as the ‘D100’.

Under the guise of ‘Dr Dan’, the D100 was tested out at a hospital trust between 2006 and 2010, where it ‘regularly’ put in 100-hour weeks, in

I’ve been at the Magic Water again!

Homeopathy fan Hunt takes over at Health defiance of working time regulations and without any noticeable ill-effects at all. So efficient was the D100 that it also functioned as deputy leader of Reigate and Banstead council at the same time. The D100 still suffers some glitches: quizzed on its remarkable work-rate, it has so far only been capable of reproducing a standard reply (‘mind your own business’) and remains unable to recall at which trust it was deployed.

Choice, Jez, but not as we know it

I

f you thought ‘patient choice’ meant patients choosing hospitals, think again. Under Monitor’s new

licensing regime, it could be the other way round.

NHS healthcare providers (public or private) will be able to impose ‘eligibility and selection criteria’ for patients as long as they are ‘transparent’. In other words, they can refuse treatment for any reason as long as they tell you what it is. It’s cheaper that way. According to the impact assessment report on the provider licence, prepared by accountants Pricewaterhouse Coopers, making the criteria ‘fair’ would ‘result in a significant administrative burden without clear incremental benefit over the proposed option’.

healthcare manager | issue 15 | autumn 2012

ROSIE HALLAM/GETTY IMAGES

Ta-ta Lala

Working together for you The Open University and Managers in Partnership have joined forces to encourage greater participation in health sector education and training. Between us, we offer a wide range of modules and qualifications to make a difference to your life, your career and the people in your teams.

Whether you are an Administrator or CEO, Clinical Nurse Manager or Business Manager, there are a range of modules and qualifications that will help develop skills in areas of practice from policy interpretation to research. Our flexible work-based learning fits with busy work and home commitments. Modules are vocationally relevant based on cutting-edge research and learning materials, to ensure that what you learn today, you can apply tomorrow – making an immediate and effective impact to improving levels of care.

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18/02/2011 10:10

EE i P S FR R M ER B FO EM M

MiP national conference 2012

Supporting managers to keep the NHS on track Friday 23 November International Convention Centre, Birmingham B1 2EA keynote speakers include conference chair

Prof Michael West Lancaster University Management School

Victoria Macdonald Health Correspondent Channel 4 News

Christina McAnea Head of Health UNISON

Robert Francis QC Chair Mid Staffordshire FT Inquiry

MiP’s 2012 conference will take place at a time of mounting pressure on healthcare managers. They are the ones keeping the NHS on track in the face of huge financial savings and increasing demand. Management posts are being cut, but the workload continues to grow.

This year the conference will focus on the needs of managers. How can you build your personal resilience?

How can you continue to motivate staff in uncertain times? How will your career develop?

Other speakers include: • • •

Jon Restell, Chief Executive, MiP Dr Andrew Goodall, Chief Executive, Aneurin Bevan Health Board Andrea Sutcliffe, Chief Executive, Social Care Institute for Excellence

• • •

Derek Mowbray, Director, Management Advisory Service Prof Elisabeth Paice, Chair, NW London Integrated Care Management Board Mike Farrar, Chief Executive, NHS Confederation

places are limited: for more information and to register online go to

mip-conference.co.uk or telephone 020 7592 9490 sponsored by

helping you make healthcare happen