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. Did you know? • UNISON/MiP members receive a 10% discount on many of our courses • Learning materials reflect the day-to-day practical issues involved in running a hospital ward or clinic.
Postgraduate options designed with you in mind Postgraduate Certificate in Advancing Healthcare Practice (C92) Postgraduate Diploma in Advancing Healthcare Practice (E46) MSc in Advancing Healthcare Practice (F52) MBA (AMBA accredited) (F61) Professional Certificate in Management (C31) Certificate in Professional Practice in Delivering Public Services (K02) Postgraduate Certificate in Clinical Leadership (K04) Postgraduate Certificate in Professional Practice (Children and Families) (K14) Postgraduate Diploma in Advancing Professional Practice (Children and Families) (E70)
Advance your career www.openuniversity.co.uk/mip
0845 300 8846 Quote: GAMAEG
INSPIRING LEARNING
The Open University is incorporated by Royal Charter (RC 000391), an exempt charity in England and Wales and a charity registered in Scotland (SC 038302).
57908_OU_HealthcareManager.indd 1
18/02/2011 10:10
issue 14 summer 2012
healthcare manager inside
heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Brian Armstrong, co-director of acute services Belfast Health and Social Care Trust inpublic: Body and Soul, London
letters & comment:8 Nav Chana: the new NHS needs committed and innovative leaders
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.
Leadership: John Clark argues that engaging clinicians will boost performance Interview: new Welsh health minister Lesley Griffiths Raised voices: will the new NHS listen to patients? Diversity: promoting equality in tough times
regulars:20 Legal eye: the new agency workers regulations Careers: keeping in touch and working with LinkedIn MiP at Work: farewell to Jim Keegan
backlash:24
healthcare manager | issue 14 | summer 2012
Welcome to the summer issue of healthcare manager, the magazine from MiP, the specialist trade union for health and social care managers. As the pace hots up in implementing the Health and Social Care Act in England, managers are facing huge pressures having to maintain and improve services in the face of not just this massive upheaval but also increasing demand and shrinking budgets. GP Nav Chana sets out his views on how this can be done. The health services in the other nations face this challenge as well: Welsh health minister Lesley Griffiths describes their very different approach and MiP committee member Brian Armstrong talks about the integrated health and social care system in Belfast, where he thinks size delivers better services as well as economies. We also hear about the latest King’s Fund report, stressing the importance of managers like Brian in delivering healthcare and we look at how the new health and well being boards will operate. We also have our regular features and I hope you enjoy this issue. Do let us know what you think of the magazine, and send us your comments on the state of the health service. Marisa Howes Executive editor
1
HEADS UP
heads up what you might have missed and what to look out for
Patient experience
NHS patient feedback challenge
The NHS Institute for Innovation and Improvement has launched a £1m scheme aimed at helping NHS organisations make better use of patient experience and feedback to improve services. The NHS Patient Feedback Challenge aims to identify and share the best patient experience work across the NHS. The £1m challenge fund will support pioneering projects by NHS organisations which: ■■ develop a fully integrated patient experience measurement system that leads to continuous improvement cycles ■■ create wholly patient-focused organisations ■■ encourage spread and adoption of positive patient experience practice within and across organisations ■■ develop sustainable approaches that live beyond the initial programme Sam Hudson, head of experi-
ence and engagement at the institute, said: ‘No NHS organisation can remain static in its assumptions about having the experience right for its patients every time, and this year’s operating framework places a clear responsibility on the NHS to actively seek out, respond positively and improve services in line with patient feedback.’ To find out more about the challenge or join the challenge network, visit: www. institute.nhs.uk/innovation/spread_ and_adoption/nhs_patient_feedback_ challenge.html
Community
Scottish NHS plans shift to home care The Scottish Government has launched a major public consultation on ambitious plans to treat more patients at home as part of its drive to integrate health and social care services. The Holyrood Government wants to cut the number of hospital admissions and reduce hospital stays in a bid to meet its target of reducing discharge
delays to a maximum of four weeks by April 2013, and two weeks by 2015. Integrated care services have already been introduced in some areas, with local councils in Perth, Kinross and highland districts forming partnerships with local NHS bodies, moves which have included transferring staff between the NHS and local government. The number of nurses working in the community in Scotland has increased by 25% since 2006. Scottish health minister Nicola Sturgeon said: ‘We know that in Scotland more people are living for longer, and this brings challenges in terms of the way we plan for, organise and deliver our health and social care services, particularly for people in their later years. ‘By allowing people to be treated closer to home, and adopting a more communitybased approach, this will help us to improve health and social care, consistently, for older people in all parts of the country.’ The consultation exercise will run until 31 July. Further information is available from: http://www.scotland.gov.uk/ Publications/2012/05/6469.
healthcare manager
Executive Editor
Contributors
issue 14 | summer 2012
Marisa Howes m.howes@miphealth.org.uk
ISSN 1759-9784 published by MiP
Associate Editor Craig Ryan editor@healthcare-manager.co.uk
Carol Baxter, Daloni Carlisle, Nav Chana, John Clark, Marisa Howes, Jim Keegan, Liz McCarten, Helen Mooney, Alison Moore, Victoria Phillips, Jon Restell, Craig Ryan, Helen Stevens, Ron Ward.
Art Director
James Sparling
Warners Print, Bourne, Lincs
Design and Production
Advertising Enquiries
Lexographic production@healthcare-manager.co.uk
020 8532 9224 adverts@healthcare-manager.co.uk
All copy © 2012 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
2
Awards
HSJ Awards 2012 The HSJ awards 2012 are now open for entries. MiP is delighted to once again sponsor the award for staff engagement, along with Unison. These awards are an important forum in which we can celebrate the excellent work being done by healthcare workers up and down the country. The award for staff engagement gives recognition for the fantastic contribution that good teamwork makes to the quality of health outcomes. So don’t be shy – enter your team now. For more information and to make your entry visit the awards website at www. hsjawards.co.uk 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.
healthcare manager | issue 14 | summer 2012
HEADS UP
leadingedge Jon Restell, chief executive, MiP It is important to talk up management. The King’s Fund, for example, has pulled another leadership report from the top drawer. Positive, encouraging reports are good for morale. They hand us bullets to fire at lazy prejudice. Most of all, they underscore the fact that patients, and the staff who care for them, depend heavily on managers doing a good job. Such reports give permission to employ, value and train great managers. But permission only matters if you act on it. And here’s the problem. We spend much energy deciding what managers need to do, and very little putting them in a position to do it. We need the right numbers, the right jobs and the right training. First, numbers. Massive cuts are tearing into management. Between May 2010 and December 2011, the numbers of managers in England’s NHS fell by 15%. More managers have lost their jobs since the turn of the year. And the bone-cutting isn’t restricted to PCTs and SHAs. It’s system-wide. In May, most of MiP’s new members came from providers – people turning to us as
“The false logic of ‘protecting the frontline’ is cutting the relatively small number of managers by a relatively large percentage.” redundancies, restructuring and downgrading bite hard. The false logic of ‘protecting the frontline’ is cutting the relatively small number of managers by a relatively large percentage. MiP argues there’s no point talking up management if there aren’t enough managers. As well as safe staffing levels, we should be asking about safe management levels. Second, management jobs must be ‘fit for person’. Cutting managers doesn’t make the work go away. Far from it. There’s even more work and the managers left behind are stretched. Huge jobs are being created with absurd workloads and spans of control. Employers must not shut their eyes and hope for the best. People are not
indestructible simply because they are managers. MiP’s national officers are demanding more and more risk assessments of new jobs and are advising members on how to protect themselves. Ultimately, we will use the law, and regulators such as the Health and Safety Executive, to protect our members. Otherwise we will see greater occupational ill health and more use of capability procedures. Third, there are green shoots on training and development. The NHS Leadership Academy may reap a rich harvest, and MiP has started some interesting discussions with new organisations, such as the NHS Commissioning Board, about management careers. But the reality for too many managers is poor quality appraisal and paltry investment in their development. MiP will keep campaigning for non-clinical staff to receive a proper share of training funds. Fine words butter no parsnips. Patients and staff need enough managers, doing realistic jobs, with proper career development. MiP will continue to make the case and act on your behalf, whenever necessary.
MiP conference 2012 23 November 2012, Birmingham
MiP’s conference this year will take place in Birmingham, at the International Conference Centre, on Friday 23 November. The conference will focus on the needs of managers. MiP knows that you face mounting pressures as you work to keep the NHS show on the road at the same time as worrying about your own future. healthcare manager | issue 14 | summer 2012
How can you build your resilience? How can you continue to motivate staff in uncertain times? How can you look after your career progression? And how can you achieve a reasonable work-life balance? We will have a great line-up of speakers and experts – so put this in your diary now. You can register now, and get further details, on the conference website at: www.mip-conference.co.uk
3
HEADS UP
Transfers
Making the transition
Mary Seacole
St Thomas’ to host Seacole memorial The campaign for a permanent memorial for the pioneering black Jamaican nurse Mary Seacole received a major boost in April when Lambeth Council granted planning permission for a permanent statue in the grounds of St Thomas’ Hospital in London. Mary Seacole (1805-1881) overcame racial prejudice to serve as a nurse on the frontline during the Crimean War of the 1850s, where she risked her life to tend wounded soldiers from both sides. In 2004, Seacole was voted ‘greatest black Briton’ in an online poll organised by the ‘100 Great Black Britons’ campaign. Despite Seacole’s contribution to nursing, she was excluded from the official Crimean War Memorial in Lower Regent Street, which does include a statue of her fellow nurse and contemporary Florence Nightingale. The Mary Seacole campaign, chaired by former Labour MP Lord Soley, is now concentrating on raising funds for the memorial at St Thomas’. To learn more about the campaign or to make a donation visit www.justgiving.com/maryseacolememorial/donate
4
The pace is quickening in the staff transfer process generated by the massive restructuring of the NHS in England. After months of discussion, policies and guidance are now being issued covering issues such as matching, pooling and suitable alternative employment. Documents relating to the transition will be located on a new website set up by the Department of Health. The website, www. hrtransition.co.uk , goes live on 28 June and will be a one-stopshop where you can access policies and guidance produced in partnership and job adverts. As we go to press, urgent meetings are being held between the Department of Health, employers, unions and receiving organisations to agree the scope and detail of the transfer schemes that will protect terms and conditions at the time of transfer and thereafter. MiP and the other trade unions want to make sure we get this crucial point right – hopefully it will be resolved by
the end of June. The scale of the transition is huge. There are 170 sender organisations – primary care trusts, strategic health authorities, arms length bodies and the DH - transferring staff to 400 receiver organisations, including the Commissioning Board, clinical commissioning groups, commissioning support services and local authorities. There has already been considerable slippage in the timetable for transition, putting even greater pressure on all involved. MiP is working in partnership to make sure managers’ concerns are addressed and to look after our members’ interests. We are posting information on our website and emailing members with important news. If you are an MiP member, but don’t receive our emails, we may not have your current email address. Please take a minute to check your details in the members’ area of our website or telephone 020 7121 5146.
Managers in Partnership will be supporting the upcoming Healthcare Efficiency Through Technology Expo, which is the only event of its kind dedicated to helping healthcare professionals deliver more effective services and better patient outcomes. Registration for this must-attend event is free of charge and offers an unrivalled conference agenda, with over 25 hours of seminars, an exhibition area full of leading suppliers, the chance to question high level speakers and to network with over 2,000 health sector peers. For further details and to register please visit the Expo website at: www.hettexpo.co.uk
healthcare manager | issue 14 | summer 2012
HEADS UP
inperson
“Even if it’s 4am on a Saturday there are enough cardiologists pulled together in one rota to ensure that all patients can be treated quickly.”
Brian Armstrong co-director of acute services Belfast Health and Social Care Trust
‘Belfast Trust is unique in that it is the only NHS trust in the UK that provides health and social care and it is also the largest trust in the UK,’ explains Brian Armstrong, Belfast’s co-director of acute services. The trust was established in 2007 and is responsible for the services previously delivered by six different trusts across the greater Belfast area. The trust’s hospitals treat approximately 210,000 inpatient and day patients a year, see 680,000 healthcare manager | issue 14 | summer 2012
outpatients, and more than 200,000 people go through its A&E departments. In the community, the trust is responsible for 600 children in care and for between 500 and 550 children on the child protection register. It also provides nine residential homes for older people as well as commissioning services from the independent and voluntary sector to support older people who want to remain in their own homes. Brian is responsible for co-coordinating secondary and tertiary care across three of the trust’s sites. With 20,000 members of staff and a trust whose budget accounts for one-eighth of the Northern Ireland Assembly’s total expenditure, this is no mean feat. Brian also helps to manage and run a number of regional specialist services, including those for cardiac and vascular surgery. When the various component trusts merged to form Belfast, Brian says there was a clear decision to establish management teams that were not site specific but based on patient pathways. Brian helped to establish the cardiac management
team which has set up just one on-call cardiac rota for the entire trust. ‘We have achieved an innovative outof-hours rota so that heart attack patients are treated within one hour, 24 hours a day, seven days a week,’ he says. ‘Even if it is 4am on a Saturday there are enough cardiologists pulled together in one rota to ensure that all patients can be treated quickly.’ Brian is convinced that bigger teams mean a better service for patients and also contribute to giving staff a better worklife balance. ‘Prior to merging the cardiac team, staff would have been on a one in one, one in two or one in three rota, whereas now it’s one in five, six, or seven...With larger teams we can ensure that there is also a consultant-led service every day.’ He believes that ‘high volume’ sites provide a better service to patients as he says people feed off each other’s talent and ‘doctors get better at what they do because they are doing more work.’ Given that integration and joint working is the order of the day for the NHS of the future, what are his top tips for a successful merger? ‘I would say that organisations do need to work in networks first and these should be established for one or two years in advance of merger in order to build up sustainable relationships and trust. Once that good communication and relationship is there, anything thereafter is possible. ‘Communication needs to be daily and sustained and face-to-face. It’s about walking the beat and having strong, transparent leadership and integrity, and in that way you will be respected,’ he adds. Helen Mooney
5
HEADS UP
TUC
Barber steps down as union chief
Employment Tribunals
Weaker protection for sacked workers Several important changes to employment law came into effect on 6 April, affecting the rights of people who claim they have been unfairly dismissed. The changes include: ■■ Employees must now work for two
years rather than one before they can make a claim for unfair dismissal. The new rules apply only to people starting new jobs on or after 6 April 2012; those already in employment on that date can still make claims after one year.
a significant dispute about the facts. ■■ Witness statements at employment
tribunals can now be submitted in writing only; it will no longer be necessary for all statements to read aloud to the tribunal. ■■ Where a judge determines that all or
part of a tribunal case has no merit, the deposit required from claimants is increased from £500 to £1,000. ■■ The guidance for an employment tri-
■■ Judges can now sit alone in unfair dis-
Brendan Barber is to retire as general secretary of the TUC after nine years in the post, with a successor due to be elected at the TUC’s annual gathering in September. Barber, who has worked for the TUC since 1975, took over as general secretary from John Monks in 2003 and has played a major role in promoting union organisation and the launch of the TUC’s successful learning and skills operation Unionlearn. Barber also played a major role in organising protests against government cuts and co-ordinated the negotiations and recent strikes over cuts in public sector pensions. ‘I have decided that this is the right time to make a change in my life, said Barber. ‘The TUC has always been a powerful voice for the millions of ordinary people who depend on trade unions to better their lives and there is so much of our work over the years in which I take great pride. But I have every confidence that under new leadership the TUC can go from strength to strength.’ MiP chief executive Jon Restell said: ‘Brendan has done much to modernise the TUC and demonstrate its relevance to working people today. His leadership during the public service pension dispute was outstanding. We wish him well for the future, wherever that takes him.’
6
missal cases at employment tribunals (previously cases were heard by a panel of one judge and two lay members). Judges may still convene a full panel if they feel it is appropriate – e.g. if there is
bunal application now includes the average value of awards and the time taken to reach a hearing, so that everyone knows ‘what to expect from the tribunal process before they enter the system’.
Pay
More top managers walk as pay stays frozen Turnover of board-level managers has increased sharply as the government’s NHS pay freeze begins to bite, according to a new report from the respected labour market analysts Incomes Data Services (IDS). IDS found that annual turnover at board level in NHS trusts increased from 17% to 24% in the two years to March 2012, while pay levels have remained static since 2010. With inflation running at 3.5% in March, this amounts to a considerable pay cut in real terms. Steve Tatton, editor of the IDS Executive Compensation Review, said it appeared that senior NHS managers had responded to governments demands for pay restraint. ‘This reflects the ongoing reorganisation and consolidation within the NHS, along with continued pressure from central government to reduce costs, increase efficiency and curb senior executive pay. ‘Those remaining in post are earning less
in real terms than those who occupied those posts the previous year. It remains to be seen whether this is a temporary blip or the start of a longer-term trend. But as turnover rates of senior level NHS staff continue to rise, the question must be asked as to what impact instability at the helm will have on performance.’ MiP chief executive Jon Restell said: ‘This is a timely warning to the government. NHS managers’ pay has stood still while inflation continues to rise, and the hike in pension contributions means their take home pay has actually been cut. Ministers need to stop criticising managers and think about how they can keep talented managers on board to steer the NHS through the biggest restructuring in its history.’ IDS found that the average pay of chief executives at NHS trusts was running at £157,500 in 2011-12, but the median salary increase was zero. healthcare manager | issue 14 | summer 2012
HEADS UP
inpublic Body and Soul, London
Body and Soul is a Londonbased voluntary sector organisation, working with children, young people, and families living with or closely affected by HIV. The organisation provides a number of services that address the interaction between mental and physical health and it has recently joined forces with two young adult outpatient HIV/Aids clinics at London’s St George’s Trust and Guy’s and St Thomas’ Trust, to help develop and provide inclinic peer mentoring programmes for patients. Through these schemes, trained HIV positive peer mentors provide one-to-one and group support to young people using HIV services at the hospitals. Between
October 2010 and October 2011 – the programme’s first year pilot at St George’s – the scheme helped to reduce missed clinic appointments by nearly 50%. Around 16% of the total number of people diagnosed with HIV in the UK are between 16 and 24 years old. On average this adolescent population misses between 15 and 36 per cent of their clinical appointments, which has a significant impact on NHS resources. Early results from St George’s have shown that prior to the peer mentoring scheme patients missed on average two appointments every five months. Following the peer mentoring scheme, patients missed two appointments every eight-and-
healthcare manager | issue 14 | summer 2012
“It demonstrates the value of partnering with experts in these areas to maximise outcomes and ultimately help to save the NHS money.”
a-half months. The peer mentoring scheme involves patients meeting monthly with a peer-support team to discuss key topics, including psychological considerations, adherence to treatment programmes, healthy sexual relationships and disclosure. According to Body and Soul health outcomes manager Alison Barnes the charity has 15 years of experience of providing peer mentoring support to young people with HIV. ‘Through peer mentoring in these clinics young people are attending their appointments more often, helping them to better manage their condition and to avoid a deterioration in health, which we anticipate will lead to better
long term health outcomes,’ she says. She says this benefits the NHS in terms of the cost savings made from both the reduction in the number of missed appointments and the reduced need to prescribe costly secondary medications when patients become resistant to their primary medication because they are not taking it regularly. ‘We are targeting the service at young people in the hope that developing these good patterns of behaviour will continue into later adulthood,’ Alison adds. Dr Katie Prime, a consultant in HIV and Sexual Health at St George’s says that the programme ‘demonstrates the value of partnering with experts in the area of young people and HIV to maximise outcomes and ultimately help to save the NHS money. ‘We urgently need investment in this scheme for it to continue within our service, with a view to this peer support model being replicated in other services seeing large number of HIV infected adolescents nationwide.’ And Emma Colyer, director of Body and Soul, urges the NHS ‘to continue to consider how to partner with organisations such as Body and Soul to ensure that all young people get the support they need, whilst saving the NHS valuable resource.’ Helen Mooney
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
Bad practice I have been a practice manager for nine years now and worked in the public sector for 17 years, and I can honestly say that I have never seen such abuse of nonclinical staff as I have with Andrew Lansley’s NHS Reforms. I have witnessed the development of an NHS culture of occupational fear and the demoralisation of all those working in the NHS apart from GPs. In my patch practice managers have been
TOTALLY written out of locality CCG constitutions so that, by the stage of regional CCGs, any practice manager involvement has already been eradicated. GPs in my patch have been encouraged to leave their managers behind when attending CCG meetings to discuss and agree practice process functions that will inevitably require practice manager interpretation and drive to achieve successful outcomes. As a result, arguments have already raged in practices in my area between practice managers and doctors which
have led to divisions within previously content and successful practice working environments. Why is this happening? Are these not the same managers that have run successful and profitable practices for the GPs for many years, working alongside, and to a great extent protecting, GPs, and ensuring that GPs can concentrate on the patients and feel confident that all around them is efficiently managed? It is a great shame but I can see, as a result of the latest NHS reforms, the
demise of general practice and the demise of the NHS. I predict that good nonclinical people in general practice will turn their backs on GPs, leaving to pursue careers that provide them with dignity, respect and recognition for their contribution. That is when I see the private sector stepping in to support and then, ultimately, take over our world-envied NHS and privatise it. Name and address supplied
Tweet Box
A selection of tweets on issues covered in healthcare manager
#NHS Satsifaction (British Social Attitudes survey found record fall in NHS satisfaction between 2010 and 2012)
#GP league tables
#multimorbidity
Q: What do you do when a profession is on its knees with work. A: Demoralize it further by bringing in league tables. @ClareRCGP
We have “young geriatric” patients excluded from services by age. Let’s get out of “silos”. @shanemuk
At Jubillee Event woman came up & thanked me for diagnosing her daughter who I saw once 30 years ago. That to me much better than stars. @DoctorAngry
Perhaps we should move from quantity to quality of life when determining health inequalities. @richardblogger
Lesson for govt from [British Social Attitudes survey] - Sec of State & @DHgovuk have talked down good news about the NHS - must have damaged NHS reputation @nedwards
Don’t ever feel a nuisance! Most people who worry they are a nuisance generally aren’t! @Trisha_the_Doc
Tory voters believe the spin about a failing #NHS, everyone else believes they are making it fail. Hence satisfac-
8
tion falls whatever happens. @mellojonny DH pulled its BSA NatCen health questions funding last year. Did it not? @HPIAndyCowper
#BMA strike Doctors have a right to strike but if patients are harmed it’ll be a PR disaster for the BMA. My Times column is here: www.drphilhammond.com @drphilhammond
line between “harmed” and “inconvenienced” though. @Welsh_Gas_Doc
#MiP Happy birthday to the trade union Managers in Partnership (created by and part of Unison + the FDA): 7 years old today! [6 June 2012]
The Government will be very happy to merge the healthcare manager | issue 14 | summer 2012
COMMENT
comment Nav Chana, GP
GP and Vice Chair, National Association of Primary Care
New NHS needs committed and innovative leaders As the nation’s 212 clinical commissioning groups (CCGs) embark on a voyage across the stormy waves of authorisation later this year, it’s worth reflecting on the challenges that lie ahead in transforming the country’s health services. The days of “no decision about me without me” seem distant, especially as CCG energy is consumed with jumping over the authorisation hurdles during this Olympian Summer. While all this unfolds, it is important to remember the core purpose of these reforms: to improve the health and well-being of the population through commissioning services which are flexible, responsive and integrated, where appropriate, around the needs of patients and local communities. But as we all know there are significant fiscal challenges facing these new commissioning organisations; challenges heightened by the year-on-year increase in health-related activities and our ageing population. Does this fundamentally threaten the reforms? The money (or lack of it) could and indeed should act as a driver for solutions that are not constrained by the normal organisational and bureaucratic constraints of the NHS. It’s important to note that even a small amount of funding can go a long way when it purchases co-ordinated care focused on the needs of patients rather than on the needs of professionals and the healthcare manager | issue 14 | summer 2012
buildings they work in. If CCGs are to succeed, commissioning needs to shift from purely reductive processes to whole system design approaches, in which all providers of health and social care are aligned to the principle of population health management. Commissioning along an entire programme of care offers opportunities to align providers with appropriate incentives to support the aspiration of delivering of care in the right settings at the right time for the right outcomes. The success of clinical commissioning will ultimately depend upon clinicians within CCG-member practices being dedicated to the vision and values of the CCG and committed to doing things differently. Top-down autocracy will not work. Instead, meaningful engagement of clinicians – through enabling their knowledge of practice-based population health management, including understanding the health needs of the population, identifying gaps in service provision and seeking their views on prioritising the re-design of services – will enable greater ownership of the commissioning process. In other words, a collaborative approach involving those who, through the clinical decisions they make, commit the majority of NHS resources. Additionally clinical commissioning (nationally or locally) should create the environment in which GP practices are supported to develop as high-quality primary care providers, unwarranted variation is tackled, transformational change
is encouraged and strategies for its diffusion are implemented. Such diffusion approaches must allow clinicians the opportunity to reflect on and co-design the change process, rather than having it directed from a great distance. Otherwise there is a danger that those clinical behaviours that need changing – those that are stubbornly hard-wired – will continue unchecked and the transformation will stall. The environmental support must include directing sufficient resources from whatever’s left out of the operating cost envelope (after commissioning support and board costs) to genuinely incentivise the clinical behavioural change needed to support clinical commissioning. All this calls for system leadership, which offers a different way of identifying unique solutions to the problems commissioners face, eschewing a “one size fits all” approach. The sustainable development of high quality services requires more than just contractual levers to align providers to the population health challenge facing clinical commissioners. It requires leaders to have those difficult conversations and favour a more horizontal style of leadership. Effectively it requires, as Atul Gawande wrote in his 2007 book Better: a Surgeon’s Notes on Performance, system leaders who are diligent, innovative and committed to doing the right thing!
.
Views expressed are those of the author and not necessarily those of healthcare manager or MiP.
9
CLINICAL ENGAGEMENT
John Clark, Senior Fellow, The King’s Fund says doctors who are more engaged with management can deliver better performance in the NHS.
In response to the prevailing political climate after the last general election, in which NHS managers were regularly derided as ‘bureaucrats’ and ‘pen-pushers’, The King’s Fund established a commission to investigate the future of leadership and management in the health service. The Commission’s report No More Heroes was published in May 2011. It concluded that, contrary to the assumptions of many, the NHS is not over-managed and that swingeing cuts in management proposed by the government will result in the loss of thousands of experienced leaders at a time when their expertise is needed more than ever to meet the very significant challenges facing the NHS. The report also argued for a shift away from a predominant NHS culture in which ‘heroic’ leaders drive others to meet performance targets, to a ‘shared’ leadership model based on leaders working collaboratively with all those involved in patient care. Our latest leadership review, pub10
“The key to increasing medical engagement is to encourage and empower clinicians to take the lead on a wide range of service improvement initiatives.” lished on 23 May, builds on these arguments and explores in more detail the importance of NHS leaders engaging – with patients, carers, colleagues, staff and each other – to improve services. It draws on evidence from national and international studies in both the public and private sectors to confirm that leaders who engage in this way deliver better patient experience, stronger financial management, higher staff morale and less absenteeism and stress. The review also highlights evidence linking greater medical engagement with improved organisational performance and cultures where staff feel valued and involved. There is growing rec-
ognition that just focusing on clinical work and medical expertise is not enough to be a top doctor. As Richard Bohmer suggests in one of the papers commissioned for the King’s Fund review, while individual excellence as a doctor is essential, it is no longer sufficient just to generate good patient outcomes; practising physicians must also contribute to improving the performance of the health system through effective team working. In the UK, United States and Australia, efforts to develop medical leadership have tended to fall into the trap of simply trying to integrate doctors into management structures, often with limited impact. Now a number of organisations and systems are engaging doctors by uniting clinicians and managers to drive service improvement. Perhaps the nub of the issue is best summarised by Ross Baker and Jean-Louis Denis who argue that transforming health care organisations to improve performance requires strategies for engaging doctors, developing medical leadership and ensuring greater alignment healthcare manager | issue 14 | summer 2012
CLINICAL ENGAGEMENT
Engagement points Some key findings from the King’s Fund report ‘Together We Can’.
between clinical and managerial goals, particularly to improve the quality of care. The medical engagement scale adopted by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges could have a role to play here. This model is based on the conceptual premises that: ■■ medical engagement is critical to implementing changes and improvements sought in the NHS but engagement levels are not universally high ■■ medical engagement cannot be understood from consideration of the individual employee alone – organisational systems play a crucial role in providing the cultural conditions under which the individual’s propensity to engage is either encouraged or inhibited ■■ there is a distinction between competence and performance in the context of work behaviour – competence can be thought of as what an individual can do, but this is not the same as what they actually do; the two together equal performance. The scale measures the extent of healthcare manager | issue 14 | summer 2012
NHS leaders need to give greater priority to patient and staff engagement; the involvement of doctors, nurses and other clinicians in leadership roles; and leadership across organisations and systems of care.
outside health care. NHS boards should value patient and staff engagement and pay attention to staff health and wellbeing, for example by acting on the results of the NHS staff survey.
There is specific evidence that links medical engagement with organisational performance both from the NHS and other health care systems.
The role of team leaders in hospitals and the community is critical in creating a climate that enhances staff well-being and delivers high-quality patient care.
To support more integrated care, leadership development programmes should bring together leaders from different professions and different organisations within and
The NHS Commissioning Board and the Leadership Academy have a key role to play in modelling and supporting the development of leadership and engagement.
medical engagement and enables hospitals to benchmark themselves and identify where interventions should be targeted. Initially piloted in 30 hospitals, it is now used by 50 worldwide. Those hospitals with the highest levels of medical engagement are typified by a sustained approach involving clinicians at all levels, not just those in leadership roles. Although this takes time and disengagement can be sudden and precipitous, improved clinical outcomes and stronger organisational performance provides a good return on investment made in creating more engaged cultures. The key to increasing medical engagement is to encourage and empower clinicians to take the lead on a wide range of service improvement initiatives and get more involved in setting the overall direction across local health systems. General practitioners and hospital consultants tend to remain static for the majority of their careers, which helps them to build a deep understanding of the needs of their local communities. Ideally, both groups of clinicians should work together to develop a shared view of the service improvements required in their local health systems. All too often, however,
organisational boundaries hinder this. Nevertheless, all clinical commissioning groups and trusts have opportunities to create more medically engaged cultures, both within their organisations and across local health systems, provided there is a will to do so. There are already some exciting programmes working in this way. In Surrey, clinicians are working with The King’s Fund on a whole system leadership programme which aims to optimise the care of frail older people. The work has encompassed social care, community providers, GPs, mental health and acute trusts along with nursing homes. This is just one example where an engaging approach to leadership, based on openness and effective communication, is driving sustainable change across a local health system. Meeting the challenges facing the NHS will require the very highest quality of leadership. The case for a more engaging style of leadership is compelling.
.
The report Leadership and engagement for improvement in the NHS: Together we can is available to download from The King’s Fund website: www.kingsfund.org.uk
11
INTERVIEW
NHS Wales has to change, new Welsh health minister Lesley Griffiths tells Healthcare Manager, but there will be no ‘Englishstyle’ market reforms. Interview by Alison Moore.
One day in April, a somewhat surprised Welsh hospital manager got a call from his reception desk, which probably went something like this: ‘There’s a lady here wanting to look around – but she says she’s the health minister. What shall I tell her?’ Lesley Griffiths – Welsh health minister since May 2011 – is too polite to suggest the manager’s response to her unannounced visit was anything other than unbridled delight. But her visit to the unnamed district general hospital symbolises her informal approach and her desire to see things ‘in the raw’. ‘When I go on [official] visits, it’s all choreographed,’ she says. ‘It’s great to go on unannounced visits. I wanted to go to A&E and see what was happening. A hospital manager came round with me… they were very keen and asked me where I wanted to go. But I think a few of the patients were a bit shocked!’ As a former medical secretary at Wrexham’s Maelor hospital, Griffiths is well-placed to understand the workings of the NHS. She has found her 20 years NHS experience invaluable since she became health minister. As well as a headstart on understanding the system, it has given her a group of 12
friends whom she can bounce ideas off. ‘It’s been good to be able to talk to people I know I can trust,’ she says. ‘I also think people treat you differently as a minister.’ Griffiths has taken the health portfolio at an unprecedentedly tough time. The Welsh Government’s budget has shrunk – capital spending will fall by 40% over four years from 2010 – and with no tax raising or borrowing powers of its own, its options are limited. With the NHS budget protected, health and social services now make up an astounding 43% of the Welsh Government’s £14bn spending, but any extra money for the NHS can only come at the expense of other departments. So Griffiths’ priorities are to make the best use of the existing funding and put the NHS finances on a stable footing. Griffiths wants to hold managers accountable for the financial management of their organisations and has promised that the extra funding she secured at the end of last year will be spent on service improvements. After being bailed out every year since devolution, the Welsh NHS broke even in 2011-12, although three boards had to bring forward a small amount of next year’s budget to balance the books. The difficult financial situation
coincides with another problem which has almost come to dominate the future of services in Wales: getting the right workforce in place. Wales has particular problems with recruiting medical staff: estimates differ, but it is thought between 50 and 200 extra doctors and dentists are needed. The shortage has made it difficult to cover rotas and raises issues about sustainability and – potentially – patient safety. And, as in the rest of the UK, it raises questions about the benefits of centralising some clinical services in centres of excellence. So reconfiguration is on the agenda of the wideranging service review Griffiths initiated on becoming minister. ‘The service review we are going through is not just because of money, it’s because I have been told that we need to have sustainability,’ she says. ‘Even with all the money in the world we would still have to look at this.’ The seven Welsh health boards are currently in an engagement period, and are developing options which are likely to be unveiled in the summer. Public consultation could then follow. Griffiths is well aware that any suggestions for moving services will be controversial. As she spoke, protestors concerned about the future of A&E services at Llanelli hospital were gathering outside healthcare manager | issue 14 | summer 2012
INTERVIEW
“People may need to travel to good specialist centres but when they go home the services have to be there for them”
the Welsh Assembly. It’s one of several campaigns across the country by people who fear that their local hospital will lose out. Griffiths is adamant no decisions have been taken and has said no district general hospital (DGH) will be shut as a result of the review. But a document considered by the Cabinet in March proposed reducing the number of sites offering 24/7 consultant-led A&E and emergency surgery services, some bed reductions and a review of the role of community hospitals. With 14 DGHs and an astounding 101 community hospitals – for a population of three million – it would be surprising if the review did not find scope for some rationalisation and centralisation of services. The challenge is that centralisation often means concentrating services in the heavily populated southern strip, leaving many in north Wales to look across the English border, and those in west Wales facing long journeys. As healthcare manager | issue 14 | summer 2012
the first north Wales assembly member to become health minister, Griffiths is likely to be sensitive to that issue. She has already set up a national clinical forum which will review proposals and advise local health boards. ‘It’s not my role to tell people what to do,’ she insists, although she admits her formal position may require her to make final decisions. The ‘no closures’ pledge does not apply explicitly to community hospitals, although such closures would require good reasons, she says. ‘People may need to travel to good specialist centres but when they go home the services have to be there for them,’ she points out. ‘This had to be done but it is so difficult – I can see why people don’t want to do it… but the status quo is not acceptable. You can’t preserve services in aspic. But I do understand people get very attached to hospitals and their local services.’ Explaining the benefits is likely to be crucial in getting people to accept
change. And she suggests doctors and other healthcare professionals are the ones to do the persuading. ‘People will believe clinicians and not politicians. They are saying to me that they must be involved. We are in a very difficult financial situation and people assume that we are doing it because of the finances. But we can’t pluck clinicians out of the air.’ The Welsh government recently launched a clinical recruitment campaign, ‘Work for Wales’, as well as a framework for workforce development. Incentives include continuing free accommodation for first-year doctors and rewards for people who develop healthcare-related inventions. Hospital doctors seem happy to come to Cardiff, but recruitment gets more difficult further west, despite the beautiful countryside and high quality of life. ‘It’s just making sure we tell people how good we are. We should be shouting more. I think clinicians look very enviably over Offa’s Dyke,’ she says drily. 13
INTERVIEW
“it is good that we got away from that sort of market or competitive behaviour... the distance between us and England may be widening. The people of Wales are very pleased about it.”
This recruitment issue does not seem to have yet spread to managers. A key position in Cardiff and Vale has recently been filled without difficulty, with a new chief executive coming from an English trust. ‘Managers are incredibly important,’ says Griffiths, adding that ‘frontline’ staff need to be managed well to give them confidence. ‘I work very closely with our chief executive. If they are strong leaders they take people with them. Managers have a huge role to play. We are very lucky that we have very dynamic senior managers in Wales.’ Despite the difficult financial situation, Griffiths is determined not to go backwards on some key planks of Welsh health policy. Wales’s free prescriptions will continue throughout the term of the government, Griffiths says, and there are no plans for hospital parking charges. The Welsh government would like to be able to borrow money to fund worthwhile capital spending but, despite the difficult financial situation, PFI is not on the agenda as a solution. ‘I think it is good that we got away from that sort of market or competitive behaviour. Certainly the distance between us and England may be widening. The people of Wales are very pleased about it.’ Nor does she feel that Welsh GPs are crying out for commissioning powers: she met with the RCGP recently and insists there was no clamour for English-style reforms. The Welsh NHS has benefited over the last few years from vastly improved 14
facilities for primary care and new hospitals. But with so many future projects subject to funding, could the good times be over? Just two months ago Griffiths opened a £172m hospital (Ysbyty Ystrad Fawr in Caerphilly) and she admits, ‘I do wonder how we are going to do that in the future’. Griffiths is acutely aware of the legacy of chronic disease – partly a result of the heavy industry in parts of the country – and of demographics. She recalls visiting the South Wales industrial heartland of the Rhondda soon after she was appointed and being shocked at the number of elderly people struggling in accommodation which would rapidly become challenging as they lost mobility. As health minister, Griffiths has also been criticised for not establishing a cancer fund for Wales to mirror the one in England. ‘There’s no evidence to prove that a cancer drugs fund improves quality of life or survival rates,’ she points out, adding that spending on cancer drugs is actually higher in Wales than England despite the different funding structures. ‘I’m confident that we are doing it right.’ With this widening gap between the NHS models in England and Wales, are there any messages for Griffiths to take home from the Health and Social Care
Act across the border? ‘They have not gone about it very well,’ she laughs, before confessing to having some sympathy. ‘It is very difficult to have a debate about health services on a certain level. I wanted to have a very mature debate about the NHS and it is very difficult to do when people whip it up into something that it isn’t,’ she says. ‘I just think the UK government did not listen to anybody.’ So what would she like to see in four years time, when the current Labour administration’s term in Wales ends? ‘I want to see that the integrated system is much more focused on collaboration, I want to see standards driven up with better outcomes,’ she says. The system also needs to move to seven-day working so that outcomes are not determined by which day patients come into hospital. Medical workforce issues need to be addressed. And the government is planning a compact with the public outlining their responsibilities as well. Whether Griffiths succeeds on all of these issues is impossible to predict: but whatever happens, the distance between the Welsh and English NHS looks set to widen further.
.
Alison Moore is a freelance journalist.
healthcare manager | issue 14 | summer 2012
PATIENT VOICE
How loud will the patient voice be in the new NHS? Daloni Carlisle finds plenty of goodwill but widespread scepticism to greet Healthwatch and the new Health and Wellbeing Boards.
There are a lot of people who like the idea of Healthwatch and the Health and Wellbeing Boards now being set up under the Health and Social Care Act 2012. There are fewer who think they will deliver their promise. The two bodies are designed to be the power behind the patient voice in the NHS. Healthwatch, comprising of a national body, ‘Healthwatch England’ based at the Care Quality Commission, and local Healthwatch organisations commissioned and paid for by local authorities, will be the ‘consumer champion for patients, service users and the public.’ In the words of the Department of Health, ‘Local Healthwatch will give patients, members of the public, and carers a real say over how their local health service is run. They will drive up local involvement in the community and ensure patients understand the choices available to them in a modern NHS.’ Each of these local groups will have a representative on the local Health and Wellbeing Board (HWB), sitting alongside health and social care leaders in a forum designed to take an overview of local needs, support the development of integrated services and bring a democratic legitimacy to the healthcare manager | issue 14 | summer 2012
new NHS. The HWBs are now working in shadow form with the Local Government Association providing regional training workshops to help them hit the ground running on the official start date of April 2013. Observers have watched with interest the preparations for both sets of bodies but many fear that lack of experience, lack of money and even lack of independence will prevent them from giving patients, service users and the public the promised voice within the NHS. Among them is Patrick Vernon, chief executive of the Afiya Trust and former chair of the government’s Healthwatch Advisory group, who has applied to become chair of Healthwatch England, which will be launched in October 2012. It would be fair to say he is committed
Who’s watching?
to the principles behind the new body. Vernon hopes Healthwatch England will give a voice to the disenfranchised – people with mental health problems, carers, those from black and ethnic minority groups, travellers and gay and lesbian people. ‘If Healthwatch England can take forward the key concerns of these marginalised groups that would be a good thing,’ he says. But even so, he has reservations. He is disappointed that Healthwatch England will not be autonomous and independent and he thinks the £2m budget may make it ‘lean and mean’ but could be insufficient to allow it to carry out its mandate in full. CQC and the DH disagree. Creating Healthwatch England as a CQC committee will strengthen the CQC, they say, by making firmer links
The Health and Social Care Act 2012 mandates a minimum membership of:
Membership of ■■ one local elected representative local Health and ■■ a representative of local Healthwatch organisation Wellbeing boards ■■ a representative of each local clinical commissioning group ■■ the local authority director for adult social services ■■ the local authority director for children’s services ■■ the director of public health for the local authority. Local boards can choose to add others, including representatives from charities and the third sector.
15
PATIENT VOICE
“The question is how will Healthwatch work? It has to have a life of its own, which it won’t if it’s seen as a bureaucratic process” Patrick Vernon former chair Healthwatch advisory group
between the views of patients and the public, and the work of regulatory bodies. It will be independent but able to benefit from corporate functions such as HR and finance. But Vernon is also concerned about the general scepticism surrounding Healthwatch. ‘There is so much scepticism,’ he says. ‘The question is how will Healthwatch work? It has to have a life of its own, which it won’t have if it is seen as a bureaucratic process saying “we listened to the patient voice”. But if it has its own brand, and has a feeling of independence from the regulator, then who knows? I think we need to give it a chance.’ Ruth Marsden, vice chair of the National Association of LINks Members, agrees that the aims behind Healthwatch are laudable but thinks the legislation has watered down the original vision. ‘I am an absolute advocate for patient empowerment but the concept has been diluted and diluted and diluted,’ she says. ‘The whole rug has been pulled from under them.’ Yes, she concurs, Andrew Lansley has allocated an extra £3.2m to local authorities to fund their local Healthwatch – but that money is not ringfenced. Meanwhile, local Healthwatch 16
are expected to take on additional duties to those performed by the LINks that they replace, such as carrying out patient-led inspections, supporting patients to make choices about their care and overseeing children’s residential services. Marsden also points out that local authorities can commission their Healthwatch from more than one provider. ‘In some areas, there may not be a single organisation,’ she warns. ‘If you want advice you go to one place, reports you go to another. It’s absolute lunacy.’ There is equal scepticism about the effectiveness of the patient voice on HWBs. Helen Findlay is both a member of the National Council of Palliative Care service user group and has been working with community interest company Councillor Direct to set up a social network for people with an interest in HWBs. ‘I’m sceptical,’ she says. ‘I do not think that service user involvement in health or local government is understood properly or produced properly and I don’t see this as being any different.’ Findlay says there is a lot of lip service paid to user involvement. While executive directors attend board
meetings as part of a paid job, service users are there as unpaid volunteers. Where the executive has a secretariat to print off papers and sift through them, services users do not. The only mandated patient or service user involvement in HWBs is one Healthwatch member; any other involvement is entirely discretionary. As Findlay points out: ‘They are expected to set up sub groups that could involve more service users but that will require a cultural shift, and I am not sure that they are up to it.’ Jon Restell, chief executive of MiP, thinks it is too early to say how HWBs will pan out. ‘They might do what they say on the tin,’ he says. ‘That’s all you can say for any part of the reforms. My fear is that they will not get the impetus put into their development that they need.’ They will require not just resources but also managerial and system support, he says. ‘And I do not see that happening in quite the same way that other parts of the reforms are being developed.’ What, Restell asks, are their real powers to hold to account different parts of the system for their delivery? ‘I’m not sure what they can do,’ he says. ‘It’s hard to say how health and social care healthcare manager | issue 14 | summer 2012
PATIENT VOICE
“‘In some areas, there may not be a single organisation. If you want advice you go to one place, reports you go to another. It’s absolute lunacy.” RUTH MARSDEN vice chair of NALM
integration will take off as an organising principle and the extent to which people will get behind that. And that will influence the extent to which people view the health and wellbeing board as a place to go to get things done. ‘So if they are not resourced, and there is no leadership drive throughout the system to use them as a central point for strategy, I fear they may not have much impact.’ And that, of course, will reduce the effectiveness of the patient and service user voice. Even the NHS Confederation has doubts. ‘There is a risk that they will become talking shops,’ says David Stout, deputy chief executive. ‘If that happens, then clinical commissioning groups will disengage quite quickly. My guess is that they will vary in their effectiveness across the country.’ There are a few passionate advocates, including Charles Alessi, chair of the pro-reform National Association of Primary Care. ‘This is about getting commissioning plans legitimised, about understanding the health needs of our populations and choosing the best options for them,’ he says. Alessi sees the HWBs as the only place where everyone in a health community – providers and commissioners as well as local government and patients and service users – has to come together. Without them, CCGs simply can’t do their job properly. healthcare manager | issue 14 | summer 2012
But, like Stout, he believes the picture nationally will be mixed. ‘There will be a third who want to make it a success, a third who will wait to see how it goes and a third who are unhappy about the changes.’ And Dr Alessi is typical of CCG leaders. That, at any rate, is the view of John Wilderspin, chief executive of West Sussex PCT and now on secondment to the DH as national director for health and wellbeing board improvement. ‘There is a huge sense of ambition and desire for these boards to make a real difference, particularly among CCGs,’ he says. ‘They get the fact that if they are going to deliver what they want to deliver, they cannot do it without local government or the public.’ Wilderspin says he has been inspired by the enthusiasm of local health communities as he has travelled England in his current role. ‘I was in South Tyneside for a meeting of their shadow HWB. Everybody was around the table – CCGs, local authority, providers, public health, public representatives. They were talking not just about the services and public health improvements, but the fact that youth unemployment and therefore economic regeneration was at the heart of what they wanted to do together and how they were going to do it. There is no other forum where that could happen.’ He argues that there is a real chance
that Healthwatch will deliver a genuine patient and public voice but agrees that the NHS in particular has a great deal to learn about genuine patient and public engagement. ‘It is still quite a new thing in the NHS and is much more embedded in local government and that’s why giving responsibility for commissioning Healthwatch to local government was the right thing to do,” he says. “We have to make sure that Healthwatch is owned and understood by the NHS as well as by local government.” Perhaps Vernon is right, and scepticism is the main enemy of Healthwatch and HWBs. As Wilderspin points out: ‘If we don’t do things differently, we are going to be in a pickle. If these new structures work, they really could make that difference. And I think there is a real desire to do things differently.’
.
Daloni Carlisle is a freelance writer specialising in health and social care.
17
DIVERSITY
Carol Baxter, head of equality, diversity and human rights at NHS Employers, on keeping equality and diversity on the agenda
Last month, NHS Employers coordinated the first ever NHS-wide Equality, Diversity and Human Rights Week. Working closely with NHS organisations in England, and with the support of several healthcare trade unions, the week-long campaign was designed to showcase best practice and the commitment of NHS staff to the equalities agenda – as well as the positive impact equality can have on patient care. The week included conferences in London and Manchester, where up to 200 equality, diversity, HR and workforce leaders met to share thinking and to identify priorities for the coming 12 months. At local level, more than 30 NHS organisations participated. But the week wasn’t without its critics. The Sunday Telegraph questioned whether it was appropriate to stage a week of ‘distracting’ equalityfocused events and activities at a time when the NHS in England is facing its biggest ever challenge, with the requirement to find £20 billion in productivity savings over four years. 18
However I believe that if there was ever a time to propel equality and diversity into the spotlight and ensure that it remains firmly on the leadership agenda, this is it. As well as huge cost pressures, the NHS is experiencing unprecedented change – with a move towards a model of clinically led commissioning that is radically reshaping the healthcare landscape on one hand, and the growing and increasingly complex health needs of diverse communities on the other. If we are to continue driving up quality of care and health outcomes, NHS leaders will have to work harder than ever before to ensure that equality and diversity is rooted into their organisation’s culture and business planning processes. There are large personal and cost implications for not getting this right. Did the week achieve what it set out to do? I think so. The week provided an important focal point – an opportunity to take stock. Employers shared ideas and best practice, captured the attention of the media, sparked debate and came up with creative ways to
address some of the most pressing equality issues in the NHS today. Key themes to emerge out of the week included: the importance of monitoring and using quality data to influence decision making ■■ the need to integrate equality objectives into the wider business planning process ■■ the strategic importance of ensuring that, at a senior leadership level, conversations about equality and diversity are timely and aligned to other high level priorities ■■
Another issue highlighted several times, by speakers at events in both London and Manchester, was ethical and authentic leadership. Lisa Rodrigues, chief executive at Sussex Partnership Foundation Trust, told delegates that in order to address the needs of diverse communities, the NHS leadership team would need to ensure that it brought ethics and authenticity to the table. This was echoed by Ruth Hunt, director of public affairs at Stonewall, the UK’s healthcare manager | issue 14 | summer 2012
DIVERSITY
Delegates at the London conference for Equality, Diversity and Human Rights Week 2012
Equality, Diversity and Human Rights Week 2012
Key Themes Ethical and authentic leadership being yourself at work drives up productivity and is an important part of the business case for equality and diversity. The NHS needs ethics, authenticity and diversity in its leadership. Quality data and information what doesn’t get measured doesn’t get done. Data must be used to support outcome focused decision making. Building on organisational priorities equality objectives must be aligned and integrated into the business planning processes. Timely delivery having timely conversations with appropriate leaders over the next six months will help to keep equality and diversity on the agenda. Significant opportunities will include the Francis Report 2012, the review of the NHS Constitution and the establishment of Healthcare England.
healthcare manager | issue 14 | summer 2012
leading gay rights campaigning organisation, who gave the example of sexual orientation. ‘It is entirely relevant when it’s perceived as a barrier in the workplace, or if patients don’t feel able to share information with their GP,’ she said. We know that being able to ‘be yourself’ at work drives up productivity. In fact, authenticity is an important part of the business case for equality and diversity. By ensuring that its leaders don’t conform to just one type, the NHS will produce more role models and be better equipped to understand and respond to the diverse needs of the communities it serves. The official theme for the week was “Changing behaviours, creating champions” and NHS Employers is keen to stress that equality and diversity is not solely the responsibility of NHS senior leaders – but a matter for champions in all parts of the organisation. Leadership in this area is crucial at all levels of the NHS. Senior managers need to make equality a core part of quality service delivery. Middle managers are vital for putting this into
practice, and all NHS staff should be able to identify the little things they can do in their day-to-day roles to put patients first and ensure that everyone has equal opportunities and treatment. To encourage more staff to make equality their business, NHS Employers is running a campaign with the Equality and Diversity Council. The Personal, Fair and Diverse (PFD) champions campaign invites staff working in health and social care to join a network of champions who are committed to taking some action, however small, to help create a fairer more inclusive NHS for patients and staff. During NHS Equality, Diversity and Human Rights Week the number of PFD champions increased to 2000. The campaign was launched in November 2011 and its ambassadors include Sir Keith Pearson, chair of the NHS Confederation, and Christina McAnea, Unison’s head of health and staff side chair on the Social Partnership Forum.
.
For more information about the Personal, Fair and Diverse campaign, and to sign up as a champion, visit: www.nhsemployers.org/PFDchamps 19
LEGAL MATTERS
legaleye Victoria Phillips of Thompsons Solicitors explains the provisions of the agency workers regulations. The Agency Workers Regulations, which came into force last October, introduce rights for agency workers to the same basic working and employment conditions they would have if directly employed by the organisation that hires them. This means they have the same rights in relation to pay, duration of working time, length of night shifts, rest periods and breaks, and annual leave as the organisation’s own employees. However, agency workers only qualify for the new rights when they have been with the hirer for 12 weeks, and they do not become employees of the hirer. Agency workers are not entitled to redundancy pay, and cannot claim unfair dismissal, unless they are dismissed because they tried to enforce their rights under the regulations. The regulations apply to people who are supplied by a temporary work agency to work under the supervision of the hirer. They apply when: there is a contract between the worker and the temporary workers agency (TWA) ■■ the worker is temporarily supplied to a hirer by the TWA, and ■■ the worker is subject to the supervision and direction of the hirer during the assignment ■■
An agency worker will have continuity of service, counting towards the 12-week threshold, provided they work for the hirer in the same role and have not had a break of more than six 20
weeks. Sickness absence of up to 28 weeks will not break continuity and other absences, such as maternity or paternity leave, will also count towards the 12 week threshold. But continuity is broken if the agency worker is moved by the hirer to a ‘substantially different’ role. Although agency workers are entitled to the same basic pay as employees, including bonuses, holiday pay and vouchers, they have no pension rights and are not entitled to sick pay, maternity, paternity or adoption pay, or to redundancy or other payments if their employment is terminated. However, they are entitled to some benefits from day one of their assignment, including the same access to the hirer’s canteen facilities, childcare facilities and transport services as employees. Agency workers also have the right to be informed about vacancies with the hirer and to the same opportunities to find permanent work as other employees. If they are denied these rights then they can be enforced directly with the hirer rather than with the agency. Agency workers must on request be given information by the agency about the hirer’s basic working and employment conditions within 28 days. If the information is not provided by then, the agency worker can apply directly to the hirer for the information. If an agency worker does not receive equal treatment they can pursue a claim in the employment tribunal (ET). A tribunal can make a declaration as to the rights of the agency worker and
order unlimited compensation – with a minimum of two weeks pay. The agency will usually be liable for a hirer’s failure to provide equal treatment but will have a defence if it can show that it took reasonable steps to obtain information from the hirer about its basic employment and working conditions and that it acted upon any such information received. It may be that an ET will apportion liability for the breach of the regulations between the agency and the hirer. The agency worker has the right not to be unfairly dismissed or otherwise treated differently if they bring ET proceedings, or do anything else, to assert their rights under the regulations The regulations contain anti-avoidance provisions aimed at preventing assignments being structured so as to avoid the obligation to provide equal treatment, such as by preventing an agency worker achieving 12 weeks continuity of service. An ET can impose a penalty of up to £5,000 if a hirer or agency is found to have tried to avoid the provisions. However there is nothing to stop a hirer from simply not using agency workers on long-term assignments.
.
Victoria Phillips 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 14 | summer 2012
CAREERS
“We must keep in touch” by Liz McCarten. When colleagues and contacts move on, we often mean to keep in touch, but life is busy and we don’t quite get round to sending that email or looking them up when we’re visiting their new office. Sometimes we exchange business cards with someone we’ve clicked with at a professional event or through the union, but we’re hesitant about taking up the offer of advice or an introduction they were keen to help us with.
Some people are natural networkers; they’re the ones who always have a contact who can solve a problem or make an introduction. Their group of work contacts and friends is wide and varied. The rest of us have to work a bit harder, but there’s nothing wrong with that. In fact, networking is a skill that can be learnt and is invaluable in offering support, friendship and the potential for professional advancement.
How do you do it? Take that business card or offer of help at face value. Don’t just think about getting in touch – put it on your task list and do it before the moment fades. Whether you’re maintaining a friendship, seeking information or asking advice, networking has great advantages. And don’t forget that you have knowledge and expertise to offer in return.
.
getting the most out of your LinkedIn Profile? Promote your business and yourself, and clearly deliver your message – Helen C Stevens of Showcase Communications shows you how.
Why am I on LinkedIn? Before you review your Profile, think about why you are using LinkedIn. Who do you want to find you? Eg. New business leads, Headhunters. Once you have a clear vision, check that all your job descriptions / summaries are aligned with your goal.
2 Who am I? What is your story? How do you want people to know you?Your Profile is your professional ‘shop window’, it should have a strong, clear message. Use features like Slideshare, weblinks and Twitter feed to bring your story to life.
3 Do I show up in searches? Is your profile 100% complete? LinkedIn gives preference in search results to Profiles that are complete. Remember to add a professional head shot - looking at the camera, friendly and approachable.... a pleasure to do business with.
4 What am I known for? Identify the keywords for your area of
healthcare manager | issue 14 | summer 2012
expertise. Add the main keyword(s) to these five areas to optimise your search rank and enable more people to find you: Headline (this is the first thing that people read) / Current work experience / Past work experience / Summary / Skills & Expertise
5 Building my Connections Actively add to your network after face to face meetings or online conversations. If you receive an Invitation from someone you do not know, send a message using Reply (dont accept yet) to find out why they would like to connect.
6 Keeping up to date Professionals generally keep their LinkedIn details up to date. Use the easy Export to Outlook or Mac Address Book to quickly update your business contacts there too.
7 Do I need Recommendations? People do read them. Ask connections for Recommendations at the end of each project or assignment whilst your
contribution is fresh in their mind. Display Recommendations relevant to your current situation.
8 Should I join a Group? Join relevant Groups to increase your visibility in your area of expertise. Add real value by being an active Group member sharing your knowledge. Raise your profile by asking and answering questions in LinkedIn Answers. There are many observers to Group discussions / Answers who may contact you directly, after reading your responses.
9 Who’s Viewed Your ProfIle? Check the people who have looked at your profile. Are they recruiters/potential clients/past colleagues? If they did not contact you, and you can see a potential link, send them a quick message. Showcase Communications are happy to help and give further specific advice. Call them on 020 7484 8086
21
MiP AT WORK
Hanging up my Employment Rights Manual Jim Keegan, MiP national officer for the North West retires at the end of June 2012. Here he reflects on his considerable career in the trade union movement – most of it spent representing members working in the health services.
I have spent the best part of my working life working for the trade union movement and essentially for the same employer – I started in NALGO, then moved into UNISON on
Working together to develop skills in the Highlands MiP national committee member Ron Ward describes how partnership work in NHS Highland is supporting lifelong learning. In NHS Highland, the employer and the trade unions are firm advocates of lifelong learning, recognising the mutual benefits it offers, and in December 2007
22
its formation in 1993, and then into MiP when it was created in 2005. And for most of those years I have represented health service staff. I have seen considerable changes since I started my career – both in employment rights and in the NHS. The fact that we now talk about employment “rights” is itself a sign of the radical change we’ve seen in the last 40 years: from the introduction of rights to redundancy pay and protection from unfair dismissal in 1968, to the Equality Act in 2010, which consolidated the rights of all employees to be treated with dignity and respect, and to be protected from discrimination. Many of the great advances were made in the 1970s, including the
introduction of the Health and Safety at Work Act, which was a landmark piece of legislation at the time. Some people now make fun of this legislation, but they forget – or didn’t live through the times before the act – when accidents at work were commonplace and often resulted in serious injury or death. In the health service we achieved major improvements in procedures, for example on lifting and manual handling and the disposal of sharps. The 1970s also saw the introduction of the Equal Pay Act, protection from race and sex discrimination and the right to paid maternity leave. As a consequence the gender pay gap in the NHS has narrowed considerably, culminating with the introduction of
we signed the Learning Partnership Agreement (LPA). The leading light in achieving the agreement was Janette McQuiston, Unison Branch Education Officer and now Lead Union Learning Representative. Her enthusiasm and drive convinced the other unions and the employers of the benefits of working together to support staff development. It is the first agreement of its kind in the NHS in Scotland. The Agreement follows the very simple philosophy of investing in staff to improve patient care. Evidence demonstrates that when staff receive good quality training they are better equipped for their role, which in turn improves the patient experience and the quality of care. The employer also benefits from ‘growing their own’ talent. By investing in staff
development, NHS Highland can fill skills gaps and the staff benefit from career progression. Some 97% of staff who have had some kind of union learning experience go on to undertake more courses, adding significant value to the organisation and its productivity. We have many examples of staff who have caught the learning bug through our learning programme and have progressed in their careers. When we introduced the Learning Agreement, some managers on the “shop floor” did not welcome or support it, we think because the immediate pressures to maintain services made them reluctant to release staff for training. So we produced a Manager’s Information Pack to explain the benefits and held face to face meetings to discuss the issues and resolve problems through simple negotiations.
healthcare manager | issue 14 | summer 2012
16332 MIP ad 213(h) x 110(w):Layout 1
Agenda for Change in 2004, which is based on equal value principles and did away with the 14-or-so different pay and grading agreements for different staff groups. It’s still not perfect, though, and MiP still uses the Equal Pay Act to challenge inequality for members where necessary. At the beginning of this century, we saw the extension of rights for working parents, with the introduction of regulations for part-time workers, the right to paternity and parental leave and the right to request flexible working. As the biggest employer of women in the UK, the NHS has been willing to adopt and build on these minimum rights, and the Agenda for Change terms and conditions are a tribute to the partnership working we have built up in the NHS. These moves towards fair employment rights and social change have been driven by the trade union movement. Working for a trade union, and in particular for this trade union, has been a great privilege. There is also something special about our NHS and the people who work in healthcare. It has been hugely satisfying to represent healthcare staff at all levels in the service and to help make sure they are treated with dignity and fairness at work.
.
We conduct learning surveys every two years to gauge staff needs and to promote the varied roads into lifelong learning. The initiative also embraces the equality and diversity agenda, recognising and addressing specific learning and cultural needs irrespective of working patterns. Investing in learning has proved to be a win win initiative in NHS Highland. Try it.
.
healthcare manager | issue 14 | summer 2012
31/8/10
13:11 Page 1 MiP AT WORK
These are uncertain times.
Reduce the uncertainty. Join MiP. One thing is for certain in such times – you need support. MiP is the UK’s only trade union organisation that solely represents healthcare managers. We provide an influential voice, personal support and employment advice, management skills and access to leadership networks. Our experienced team of employment professionals is on hand to offer one-to-one confidential advice, negotiation and representation and fast access to legal resources.
Join MiP today. Visit www.miphealth.org.uk/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
Careful what you vote for
N
ews that William Hague has held no less than four meetings with Andrew Lansley over the future of the Friarage Hospital in his North Yorkshire constituency. At a demonstration in May against plans to downgrade Friarage’s A&E and maternity services, Hague urged protestors to protect the right ‘to have your babies born in God’s greatest county’. The Foreign Secretary should perhaps reacquaint himself with the coalition agreement he negotiated, which promises to ‘free NHS staff from political micromanagement’. If Hague had also read Lansley’s bill before voting for it, he would know that the SoS has no role in the internal affairs of a foundation trust. And a quick glance at the rulebook of Yorkshire CCC would inform him that, since 1992, you don’t have to be born in Yorkshire to play cricket for the county.
Think again
M
rs Thatcher’s favourite think tank, the Institute of Economic Affairs, enjoys its reputation for thinking the unthinkable. They were at in again in June, with a curious debate on ‘abolishing the NHS’, at which five rightwingers debated the IEA’s
24
plans to ‘undermine’ (their word) the NHS. According to no less an authority than universities minister David Willetts, ‘the IEA continues to show the vitality and relevance of free market economics.’ We wonder if these relevant and vital ideas include IEA’s proposal that ‘anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names... to ensure quality’? Or how about making all drug treatments available over the counter with no safety regulations? Some ideas are unthinkable for good reason. They’re nuts.
Lame excuses
T
he Health and Safety Executive now has a special panel to review complaints about stupid or over-zealous use of ‘elf ‘n’ safety rules. There’s a lot of it about. Among the first 30-odd cases shamed (but sadly not named) were a housing association which ordered residents’ letter boxes to be sealed as protection against fire bombs, a shoe shop which refused returns of faulty boots if they were dirty, and a school which cancelled a student play because the lighting technician had missed a ladder safety course. There was even another housing association which removed fire extinguishers ‘on health and safety grounds’. It’s often not hard to spot the control-
You have been ‘liberated’ It’s easy to forget that the Lansley reforms began with a white paper entitled ‘Liberating the NHS’, which promised to ‘liberate clinicians to innovate’ and let the NHS ‘focus on continuously improving’ patient outcomes. In fact, the NHS is now focusing on moving over 30,000 staff out of 170 ‘sender’ organisations and fitting them into no less 400 ‘receiver’ organisations, including CCGs, CSSs, LETBs and NHS Property Limited. And before April next year. Then there are new patient voice and quality assurance bodies to set up – Clinical Senates, Health and Wellbeing boards and so on. All this could take years to bed down. Only in La-La-Land can this pass for reducing bureaucracy.
freakery or self-serving motives behind most of these abuses, but the one thing they have in common is that they have nothing to do with health and safety.
Don’t ask
W
ith ministers spending most of last year talking down the NHS to pave the way for Lansley’s wrecking ball, it’s no shock that public confidence in the service has
taken a knock. According to the authoritative British Social Attitudes survey, satisfaction with the NHS fell from 70% in 2010 to 58% in 2011, the biggest fall since the survey began in 1983. Perhaps the Department of Health got wind of the public’s feelings. It pulled its funding for the BSA last year, leaving the heroic King’s Fund to step in to make sure the NHS questions got asked.
healthcare manager | issue 14 | summer 2012
e
insuranc
holidays
The added va lue of membership
s
mortgage
savings
motoring
finance
Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus. More often than not, these benefits will be on an exclusive basis with leading companies. But it isn’t only excellent terms and value for money we look for in a potential Partner. The products or services they offer have to be among the ‘best in class’. They must share our values and deliver a high quality service, including straightforward call-handling and easy-to-navigate websites. On the UNISON website you’ll find full details of all the criteria we look for, before we award companies with our official Partner accreditation. All you have to look for when you are looking for a name you can trust is the UNISONplus logo. For more information visit www.unison.org.uk and click on the UNISONplus logo or call MiPLink tel 0845 601 1144. You could save the cost of your subscription many times over and guarantee yourself the value for money that you and your family deserve.
14856
MiP Ad 250x200 NEW:Layout 1
24/4/09
13:27
Page 1
It’s not just doctors who make it better.
Healthcare managers are passionate about delivering effective healthcare. In fact, it couldn’t happen without them. That’s why they deserve specialist representation. MiP is the only trade union organisation dedicated to providing personal support and employment advice, management skills and networks, and an influential voice for the UK’s healthcare managers.
helping you make healthcare happen.
www.miphealth.org.uk