South Wales Business Review Vol 6 Issue 1 by Lucy Griffiths

Vol 6 Issue 1 2015

Adolygiad Busnes De Cymru

A Full Recovery? The Economic Impact of Health in Wales Big Interview: Andrew Davies The Health Economy in Wales 10 Minute Guide

Mindfulness in the Workplace

Whose Health is it Anyway? Employers and Employees Creating Healthy Workplaces

Swansea Business School Ysgol Fusnes Abertawe

inside | SOUTH WALES BUSINESS REVIEW

SPRING 2015 Volume 6 Issue 1

3 Editorial:

12 In Conversation:

4 The Big Interview:

14 Point of View:

A FULL RECOVERY? The Economic Impact of Health in Wales

PROFESSOR ANDREW DAVIES

8 Industry View:

HAPPIER HEALTHCARE STAFF WILL DRIVE NHS PRODUCTIVITY

18 Point of View:

DEVELOPING THE HEALTHCARE WORKERS OF THE FUTURE WHOSE HEALTH IS IT ANYWAY?

16 Opinion:

CO-PRODUCTION - PUTTING PEOPLE AT THE CENTRE OF PUBLIC HEALTH

20 News and Events 24 Next Issue:

IN THE MIX THE ABSENCE OF TALENT How Creative OR THE “TALENT OF Collaboration is ABSENCE”? Transforming Business in Wales

10 10 Minute Guide: MINDFULNESS IN THE WORKPLACE

Alternative formats If you require this document in an alternative format (e.g. Welsh, large print or text file for use with a text reader), please email swbr@sm.uwtsd.ac.uk Fformatau eraill Os hoffech y ddogfen hon mewn fformat arall (e.e. Cymraeg, print mawr neu ffeil tesun i’w ddefnyddio gyda darllenydd tesun), anfonwch e-bost i: swbr@uwtsd.ac.uk ISSN 2049-5544 Disclaimer: The articles in this publication represent the views of the authors, not those of the University. The University does not accept responsibility for the contents of articles by individual authors. Please contact the editor if you have further queries. Ymwadiad: Mae’r erthyglau yn y cyhoeddiad hwn yn cynrychioli barn yr awduron, nid rhai UWTSD. Nid yw’r Brifysgol yn derbyn cyfrifoldeb am gynnwys erthyglau awduron unigol. Cysylltwch â’r golygydd os oes gennych gwestiynau pellach. Registered Charity Number / Rhif Elusen Gofrestredig 1149535 © UWTSD 2015. All rights reserved/ cedwir pob hawl. Cover image: ©Anaken2012/shutterstock This page: © Ingka D. Jiw/shutterstock

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Post:

Lucy Griffiths

South Wales Business Review Adolygiad Busnes De Cymru Swansea Business Campus Campws Busnes Abertawe University of Wales Trinity Saint David Prifysgol Cymru Y Drindod Dewi Sant High Street / Stryd Fawr Swansea / Abertawe SA1 1NE

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PRODUCTION TEAM Editor: Lucy Griffiths Editorial Board: Kathryn Flynn Christopher Thomas Design & Print: UWTSD TEL

Editorial: A Full Recovery?

The Economic Impact of Health in Wales

Selected Contributors:  Dr Maggie Inman

Dr Inman is Head of the School of Business, Finance and Management at the University of Wales Trinity Saint David. The focus of her research is leadership and she has published a number of papers in this field.

Lucy Griffiths

 Dr Rachel Casiday

Dr Casiday lectures in Anthropology at UWTSD and her research focuses on the social context of risk, children’s health, and the health impacts of poverty and inequality. She has also done work on infant feeding, including an NGO consultancy on child malnutrition in subSaharan Africa during the 2005-6 famine in the Sahel region.

 Amanda Owens

Amanda Owens, Programme Director of the Health and Social Care Portfolio within Swansea Business Campus, has lectured in both Health and Social Care and Public Services for the past six years. Prior to entering academia Amanda was employed with British Telecom as a senior operations manager.

Editor

In this issue we highlight the vital role health plays in economy here in Wales, both from the perspective of health as an industry and in terms of the impact poor health can have on the wider economic wellbeing of our country. Our Big Interview with Professor Andrew Davies, Chair of ABMU Health Board, highlights just how big a player the health service is in our economy, and how different the system we have here in Wales is to the approach across the border in England. Mark Bandalli and Andrew Laird of Mutual Ventures give an industry perspective on productivity in the NHS on page 8, while Amanda Owens and Dr April May Kitchener discuss the skills needs of the sector on page 12. We also take a close look at the importance of employee wellbeing in a piece by Dr Maggie Inman on p 14 and Julian John highlights the hidden potential of those some employers overlook on page 16. Our 10 Minute Guide gives a brief introduction to mindfulness – a practice many employers are now recognising as a potential way to improve employee wellbeing and have a positive impact on productivity. I hope you enjoy this issue. As always, please email us at swbr@uwtsd.ac.uk if you are interested in submitting for future editions. Best wishes Lucy

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The Big Interview: Professor Andrew Davies Lucy Griffiths recently met up with Professor Andrew Davies, Chair of Abertawe Bro Morgannwg University Health Board, to hear his views on the role the health service plays in the region’s economy and the how the service can tackle the challenges it faces in the future. LG What role do you see the NHS playing in the Economic development of Wales? AD It’s vital – we’re the largest single employer in this area, with 16,500 people. We have an annual budget of £1.3 billion. 70% of our budget is spent on salaries so staff buying goods and services puts money into the economy and of course we’re buying lots of goods and services ourselves as a major organisation. We’re shortly going to be opening a new entrance and major outpatients centre at Morriston Hospital; that’s a £60 million investment. A lot of the construction work will bring money into the local and regional economy. So, we’re a big player whichever way you cut it. We’re also doing a huge amount of research and development. A lot of our clinicians are working on research and development with the local universities, and that is essential for designing new drugs, new services, which could potentially be job creating. If you look at the bigger picture, obviously one of the big growth sectors is in Life Sciences, and we’re a major player in that area – driving education and training, but also driving research and development.

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LG How do you see the NHS’s connection with the private healthcare sector developing in Wales? AD Well, there are two aspects of it really. Obviously a lot of the goods and services we buy are from the private sector. For example, most of our GPs are independent contractors; they’re not actually salaried like most of our staff, so while we fund a lot of these services, in most cases they’re provided by independent contractors or the private sector. Unlike in England where the UK Government want to open up the health service for greater competition, in Wales we have a different approach which is a nonmarketised, planned and collaborative approach. So, in some areas, from a Welsh Government point of view, the private sector would not be encouraged and the policy drive is very much – public services, publicly funded, publicly delivered.

LG What do you see as the major challenges the NHS in Wales is facing? AD There are lots of demographic challenges – obviously more people are, thankfully, living longer and, on the whole healthier lives, but of course most of the money that is spent on people by the health services is overwhelmingly spent in the last 18 months to 2 years of their lives. That’s one of the major pressures in the UK, and across the industrial world, and

in our case, core business is people in their 80s. If you go to most of our acute hospitals, on the medical wards (as opposed to the surgical wards) you’ll find that the median age of patients is 85. In many cases they will have more than one thing wrong with them – what we call comorbidities. So they may go in with heart problems, but they may well have diabetes, circulatory problems, respiratory problems, muscular-skeletal problems, or arthritis. 25-30% of them will have some form of dementia or cognitive impairment. So, we’re dealing with very complex patients in many cases, very old and very frail. Of course, the health service was set up in 1948 and the main thing they were dealing with were infectious diseases, industrial diseases or industrial accidents etc., whereas now it’s largely illness and frailty because of people’s age and/or lifestyle. The incidence of diabetes is increasing quite substantially, and there’s a very close correlation with obesity and a lack of exercise. The other big challenge is that there are new treatments all the time, new drugs, new interventions are being devised. I had a blocked coronary artery back in 2008 and I had a stent installed by putting a tube up through my arm into my heart, so it’s not open heart surgery, it’s done almost remotely. That, 20 years ago was extremely rare. With the growth of life sciences we’re increasingly looking at how you target interventions and treatments because of people’s

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“...the policy drive is very much – public services, publicly funded, publicly delivered.” genetic makeup, so you’re tailoring and personalising care. So those are going to be increasing trends, and of course we still don’t know what the cost of those will be. But, linked to that will be people’s expectations that if these approaches have been created they should be available. So, demographic pressures, technological and treatment pressures, but also expectations are changing.

LG Is the NHS Sustainable? Or how can we make it sustainable? AD Ultimately that’s a political question. I think in Wales we’re in a better position to deal with the demands on us because we do have an integrated, planned, collaborative approach whereas in England the system is becoming more fragmented. That’s why I tend not to talk about the National Health Service as such, I talk about the health economy. That’s because for a lot of people we’re dealing with if you’re talking about our core business being very old, very frail people, the NHS, a hospital or even a GP will only be part of their care, a lot of the other care will be provided by, for example, social services, or it could be provided by the local community or the third sector. So, again it’s about how all of the various aspects of the health service come together with the third sector and other public sector bodies to provide that holistic, planned and integrated care.

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| SOUTH WALES BUSINESS REVIEW The other way that we’re different to England is we’re a very very large organisation – there aren’t organisations like ABMU, or the other seven health boards we have in Wales in England. We have within ABMU specialist services, for example in Morriston Hospital (which is going to become increasingly important as a regional centre), burns and plastics. We provide services for the local community, we cover a local population of about half a million, so that’s in Swansea, Neath Port Talbot and Bridgend, but we also provide specialist services for a wider population of West Wales, parts of Powys as well as other parts of South Wales for burns and plastics. If someone has a serious burn, they will come to Morriston. And indeed we also provide services in the South West of England. If you have a very major burn injury in Penzance or Land’s End you’ll come to Morriston. So there are specialist services at Morriston, and what we call secondary, hospitalised care in Morriston, Singleton, Neath Port Talbot and Bridgend hospitals. In Primary Care, there are GPs (we have something like 75 GP practices), dentists, also community services, district nurses and health visitors. We also cover mental health, so we have two mental health hospitals. Finally, we have public health. In England, public health is a local government function.

So, in England you don’t have the integrated structures that you have in Wales. We’re much more similar to Scotland in that regard. This provides an opportunity for Universities like the University of Wales Trinity Saint David because health policy as well as the organisation structures are very different in Wales than in England. So how do you train managers today and in the future to work in the new health economy which is based on collaboration and the ability to work across boundaries? Ultimately the decision about whether it’s sustainable is a political decision about funding and how the health service needs to be funded. That’s ultimately a question about how much Government is willing to tax people and indeed how willing people are to pay tax for services.

LG What skills do managers in the health economy need, and is there a shortage of those skills? AD Pre-devolution there wasn’t that much difference between the health services in England, Wales, Scotland and Northern Ireland. People could move between England and Wales as a health manager and there wouldn’t be a great deal of difference. Now, both policy and the organisational cultures and structures are very different. So, people working in England for the health service, if they wanted to apply for a job in Wales they probably wouldn’t have the experience

of working in a large integrated health organisation. In the last year we’ve changed half our senior management team, we have a new Medical Director, new Nurse Director, new HR Director and a new Strategy Director. Of the four, one was an internal appointment, one other person was working elsewhere in Wales and the two others were from outside Wales. One was working in Scotland, one in England. One of the strengths of our new Nurse Director is that he has worked in the Glasgow Health Board, which I think is the largest health organisation in the UK. He was responsible for around 12,000 nurses. There is virtually no organisation in England which is comparable. It’s a big challenge – where do you get the leaders and managers of today but also the future? I think for organisations like Swansea Business School there’s a real opportunity, but it’s also going to need people, if we talk about the health economy rather than the NHS, who have the ability to work across boundaries within the health service, but also with local authorities, social service departments, universities, and the third sector. A different type of leader is needed. ‘Command and control’ dictatorial leadership will not work in large complex organisations, so you’re going to need new skills. When I was a Minister, I went on a ministerial visit to Philadelphia in the States, and I was talking to the Chief Exec of a public/private partnership called Innovation Philadelphia. In many ways, Philadelphia is very similar to Wales – its old industrial base had disappeared, and it was trying to be at the forefront of the knowledge economy. This guy, Rich Bendis, said something to me I’ve never forgotten; he said “In the industrial economy the paradigm was competitive advantage; in the knowledge economy the new paradigm is collaborative advantage”. I think that’s just as true for public services as it is for the private sector. LEFT: The unveiling of the new mural in the A&E Department at Morriston Hospital which was created by UWTSD Illustration graduate Karl Mountford as part of the Arts in Health Project which brings together ABMU and UWTSD to promote the impact the arts can have on health. Image courtesy of ABMU.

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LG How does that play out in terms of the way the organisation is structured? Are you making changes to the structures as well? AD The current health board was set up in 2009 when I was in government, by the then Health Minister. I’ve been in post about 2 years now and we inherited the structures, and to a large extent the senior management team. Basically, what we found was that it was just too complex. We had something like 15 or 16 different directorates, or organisational management units. We had 3 localities which covered the same area as the 3 local authorities, and then we had cross-cutting directorates, for example surgery, and a range of other specialisms across the health board area. Some of the problems we encountered in some of our hospitals, particularly in Bridgend, were that the management were insufficiently visible at the local level, and the decision-making and accountability arrangements were just too unclear or opaque. So when I was appointed I said I wanted to undertake a governance review and that’s what I did. All these problems came to light, and then we had the external review, the Andrews Report, which said the same things. So, my Chief Exec and I had come to the same conclusion. We needed to streamline and simplify decision-making, so the idea is (and we’re just consulting with staff now), we’re just going to boil the whole organisation down into five, for want of a better word, divisions. So, we’re going to get rid of the localities, then we’ll have the acute hospitals much more directly managed at a senior director level. So there will be much more visible management of hospitals like Morriston and Princess of Wales. We moved to that structure in the Princess of Wales because of the problems we’d identified two years ago and which the Andrews Report confirmed. And then we’re going to have to have Primary Care and Community Services in one division and Mental Health and Learning Disabilities together in another. So, those will be managed across the health board area. We think having a much simpler structure and decentralising decision-making to a local level is going to make the organisation much more effective.

“enlightened and progressive employers understand that providing support for their staff,... is not only going to be better for the individual and the collective workforce, it’s going to be better for productivity.” LG What do you think the private sector could learn from the way things are done in your organisation? AD I’m loath to lecture to anyone, but what struck me from the very beginning about the health service was how values driven it is. I don’t think I’ve ever come across an organisation which is so values driven. I’ve worked in government for 10 years, the Civil Service didn’t have the same sort of values, I’ve worked in the private sector and in higher and further education and they didn’t have this to the same extent. One of the things we’ve done in the last year to 18 months is actually develop and make more explicit what our values are. We’ve established our core values, and below that will be the behaviours that we feel will derive from them. I know a lot of private companies have already done this work, but the important thing for us is not only having established those (and we’ll be launching them next month), but that you can only really do this by engaging with your staff and patients, families and carers. It hasn’t been the board saying ‘these are your values’, it’s staff and patients telling us ‘these are the values we think the organisation can demonstrate’. So I think for me that has been one of the most powerful things we’ve done in the last 18 months to 2 years.

LG What do you think the role of employers is in maintaining the health of the nation? AD I think it’s very important, given that people spend (despite all the talk about increased leisure) an increasing amount of time in work -well lots of people do. There’s a collective responsibility. As I said earlier, a lot of the illnesses and conditions we deal with are due to lifestyle.

People are leading increasingly sedentary lifestyles, eating the wrong food, drinking too much. So I think employers can do a lot to encourage staff to lead healthier lifestyles, and work with staff to do that. They can encourage, for example, staff to use more sustainable forms of transport. For example I know from my time at the Assembly that UWTSD did a lot on developing travel plans etc. There are a wide range of examples of how employers can help – such as providing showers and changing facilities for staff who want to cycle or run to work, or working within the local community to support activities that promote healthy lifestyles. For example sponsoring or encouraging employees to take part in events such as the Gower Bike Ride or the Swansea Bay 10k.

LG What about mental health and stress in that mix as well? AD The link between stress and mental ill-health is so clear cut now. It seems almost obscene that you keep having to make the case for it, and I think enlightened and progressive employers understand that providing support for their staff, dealing with them as whole people and not just somebody who’s there from 9 ‘til 5 or how many hours they work, and creating a supportive environment is not only going to be better for the individual and the collective workforce, it’s going to be better for productivity. By having a rewarding and supportive environment, all the evidence is very clear, you get not only happier, fitter, healthier employees, you also have a more productive, committed and engaged workforce as well.

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Industry View: Happier Healthcare Staff Will Drive NHS Productivity

Image: ©MarcelClemens/shutterstock

Andrew Laird and Mark Bandalli of Mutual Ventures consider the importance of staff engagement in the NHS. There has been a lot of coverage recently about the crisis in NHS funding. It’s a perfect storm of budgets that have been reducing over recent years in Wales (by 2015/16 the budget is expected to be 3.6% lower in real terms than it was in 2010/11) and also demands on the service that are ever increasing. Simplifying the problem there are three ways to respond: increase funding; do less; or increase the amount that is done with the funding available (i.e. increase productivity). The solution may be some combination of all of the above but we want to focus on productivity. Generally speaking, productivity is a problem for the UK. The gap between our productivity and those of our rivals is startling – we are 31 percentage points behind Germany and 35 behind the US. 8 | Vol 6 Issue 1 2015

Economist Paul Krugman has said that “in the long run productivity is almost everything”. He is absolutely right – and particularly in public services in the current economic climate. Without improving productivity it’s not possible to maintain current standards in any service as budgets reduce, never mind the ultimate goal of doing “more for less”. Driving productivity within the NHS has always been difficult, especially when the back drop is a prolonged period of substantial funding increases (4.7% a year in Wales between 1992/93 and 2010/11). For any service used to substantial year on year increases, being asked to do more for less is always going to be a challenge - and so it is proving. Monitoring from King’s Fund shows that 74% of NHS Trust Finance Directors (out of 90 respondents) thought that there was

either a high or very high risk of failure with regard to the “Nicholson challenge” to achieve £20bn of productivity gains by 2014/15. Only one solitary respondent thought there was little risk of failure… When productivity is mentioned many public sector leaders immediately think of their systems and processes and whether or not they are efficient. This is important but in order to make any sustainable progress leaders need to accept that productivity is driven as much by organisational culture as it is by systems and processes. In fact, we would argue that culture is the single most important factor. In the same King’s Fund survey referred to earlier, nearly half of respondents listed staff morale as one of their top three concerns. This is extremely dangerous.

ADOLYGIAD BUSNES DE CYMRU | The NHS must grasp this concept and there are some positive signs. The recently published Dalton Review on NHS providers builds on the findings of Chris Ham’s report on staff engagement and empowerment in highlighting the importance of staff engagement and organisational culture. The Dalton Review highlights the evidence that shows that increased staff engagement has a positive correlation with decreased patient mortality, infection rates as well as reducing staff absenteeism. A great way for a public service organisation to increase staff engagement is to look at the possibility of setting up a staff-led mutual. Our organisation, Mutual Ventures, spends a lot of time supporting groups to design and develop such models. In England, the NHS is supporting this through the NHS Mutuals Pathfinder programme which has attracted well known NHS trusts like Moorfields Eye Hospital who are keen to look at the mutual model as a way to further empower staff. There are great examples of where such cultures are alive and well in organisations delivering NHS services. Spiral Healthcare CIC (an intermediate nursing service in Blackpool) and Social adVentures (a public health service in Salford) are experiencing tightening budgets but are still maintaining and improving service quality. These are fantastic and inspiring places to visit. The sense of pride in their service emanates from staff and impacts in a very positive way on their patients and clients leading to better outcomes and therefore increased productivity.

The key point is that productivity is not just about new computer systems or even improved or simplified processes (although these can have a positive impact on productivity). It’s about putting in place a culture that has trusting and empowering staff to take decisions at its core, allowing them to make the continuous small changes that keep an organisation focused and efficient. In our view, getting the right culture in place trumps everything else and will be absolutely essential if the NHS is to weather the perfect storm ahead.

“increased staff engagement has a positive correlation with decreased patient mortality, infection rates as well as reducing staff absenteeism.”

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10 Minute Guide: Mindfulness in the Workplace Heather Fish

Heather Fish, Work-based Learning Fellow and Mindfulness practitioner explains why so many major employers are making mindfulness a key part of their business.

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ADOLYGIAD BUSNES DE CYMRU | What is Mindfulness? Although its roots lie in Buddhism, the mindfulness we read about in the press these days is a secular affair, affiliated with no religion or belief and therefore available to all. Definitions are many, but perhaps the simplest is: “the awareness that arises from paying attention, on purpose, in the present moment and without judgement” (Kabat-Zinn, 2013). The current focus on mindfulness has its roots in an 8-week Mindfulness-based Stress Reduction (MBSR) programme started in 1979 in the University of Massachusetts Medical Centre. Skilfully structured to engage the typical Western meditation-resistant mind, the course is offered to those with chronic conditions not responding to the interventions offered by the medical model. This course is now available world-wide, through institutions and individual teachers and forms the basis for much of the growing body of research in the field of Mindfulness. Mindfulness in the Workplace Many workplaces offer the 8-week course, or a shorter adaptation of it, to their employees. Some of the ‘giants’ amongst these include Google, whose ‘Jolly Good Fellow’ (yes, that’s his job title) Chade-Meng Tan developed their ‘Search Inside Yourself’ mindfulness and emotional intelligence programme. The US marines have a mindfulnessbased programme they term ‘mindfitness’. This is undertaken in the pre-deployment to conflict areas period. Research carried out on this programme demonstrates increases in working memory capacity after several weeks of meditating for an average of 12 minutes per day. Research and Benefits of Mindfulness in the Workplace Research has shown that just 8 weeks of MBSR training leads to increases in grey matter density in parts of the brain associated with learning and memory, emotion regulation and perspective taking. It has also shown that the amygdala, a part of the brain implicated in the fight or flight response and therefore highly engaged in reactions to stress, was thinner after the same period of training. Another study showed that 8-weeks of mindfulness training brought about a significant increase in the left pre-frontal cortex of the brain. This correlates to taking a more ‘approach’ orientated perspective to life, rather than an avoidance response.

In the workplace, in the simplest terms, this can be translated into: • • • •

Better relationships More skilful approaches to challenges Improved decision making Reduced stress and anxiety

Research into Transport for London’s 6-week mindfulness based programme launched in 2009 has reported a 71% reduction in time taken off for stress, depression or anxiety over a three-year period. Qualitative responses to the same group showed 80% improvement in relationships, 79% improvements in the ability to relax and 64% increase in the ability to sleep. Further public information on this project is limited but it is a frequently quoted study and the training continues to be offered to employees. Mindfulness and the Government So far over 80 MPs and Lords, led by Chris Ruane, MP for Clwyd, have practised mindfulness with more signed up for 2015. The Mindfulness All Party Parliamentary Group (APPG) has released an interim report recommending that public sector employers such as the NHS and Civil Service pioneer good practice by setting up pilots which can be evaluated. This will increase the evidence base and influence public sector employers. The final report, ‘A Mindful Nation’ exploring Mindfulness in the workplace, in schools, in the health sector and criminal justice system, is to be published in June this year.

What is Mindfulness Practice? This can be formal, where you practice the longer meditations such as the body scan or sitting meditation alone or in a group, or informal, where you bring shorter awareness exercises into your daily life. Overall there are two elements to mindfulness practice. One is the skill of bringing a wandering attention back over and over again to where you want it to be, thereby building the ‘muscle’ of attention. The other is an embodied approach, where we learn to inhabit our bodies more consciously, with acceptance and kindness. Mindfulness could be seen as ‘coming to our senses’ where we live more fully in each moment and with a metacognitive awareness that enables us to make more skilful choices.

Try it Yourself

Mindfulness practice switches us from a relentlessly ‘doing’ to a ‘being’ mode, where we are present with our experiences, moment by moment.

One Minute Mindfulness

• Tune into the natural rhythms of your breath for few moments. • Set a timer to go off in 60 seconds time. • Simply count the number of breaths you take until the timer sounds. One inbreath and one outbreath equals one breath. • You now have the number of breaths you naturally take in one minute. Simply bringing your attention to your breathing this number of times can help you regain your equanimity when you feel offbalance.

Mindfulness at UWTSD Our unique ‘Mindfulness in the Workplace’ module has so far attracted interest from learners as far away as the West Midlands and the Isle of Man, who are happy to absorb the extra costs of travelling and accommodation for the three separate days of the course. Originating through the ESF-funded pan-Wales ‘Elevate’* project, which is now drawing to a close, over 66 learners from 25 different organisations have engaged with the module.

Useful Links: goamra.org • mindfulnet.org

themindfulnessinitiative.org.uk • mindfulnessforstudents.co.uk *The Elevate Cymru project is part of the Work Based Learning programme made possible by the European Social Fund (ESF), through Welsh Government. Vol 6 Issue 1 2015 | 11

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In Conversation: Developing the Healthcare Workers of the Future In this head to head conversation, Dr April May Kitchener, whose career has spanned various roles in the health and social care sectors and Amanda Owens, Programme Director for Health and Social Care programmes at Swansea Business School, discuss the future skills needs of the health and social care sector.

AMK – The ever changing roles are impacting on the care, support and service provided. An example of that can be seen in the role of the nurse where we have lost clearly defined roles. There is greater emphasis on academic nurses and too much crossover in roles, leaving too many gaps. This is partly due to the reshaping of the health service but also the focus on “professionalising” the role of the nurse. This has meant that there is less focus on the vocational role, which is essential. AO - It is perhaps difficult to visualise the transition between the professional and vocational role of those currently employed, or seeking employment, in the Health and Social Care sector. The perceived challenge is to develop professional transferable skills relevant to the sector as well as those softer skills that are so often viewed as lacking by the media, general public and Government alike. As a consequence the Health and Social Care sector is often portrayed in a negative light, thus doing little to encourage or promote the Health Sector as a valid career choice. Therefore, the key challenge is related to the Health sector engaging with a new cohort who are able to exhibit the ability to balance technical aptitude against the more tangible softer skills associated with delivering world class care. 12 | Vol 6 Issue 1 2015

Q2 What skills do students need to enter this sector? AMK – Ability to build rapport, to demonstrate empathy, be nonjudgemental and recognise people as individuals. This key skills training is fundamental within their academic studies. An understanding of Emotional Intelligence and its impact on delivering high standards of service will re-introduce the vocational element of this profession. AO – Following on from the skills identified by my colleague, it is also imperative that any student wanting to enter the Health and Social Care Sector should possess the passion to make a difference to the delivery and quality of care provision. Whilst there are a number of skills that are vital, of equal importance is the student’s ability to be able to understand and interpret correctly a wide range of socio-economic, cultural and religious factors.

“A focus on individual care will be at the top of the agenda for employers in the sector.”

Q3 With the increasing pressure on those in the profession hitting the headlines on a daily basis, what rewards and benefits can new recruits expect? AMK – There is always going to be a need for health and social care so employability and career longevity are key benefits. It’s a hugely rewarding profession that covers lots of different roles and opportunities. There are work/ life benefits such as family flexibility and opportunities to train and develop. This is not always covered in the media, as they focus on the difficult/challenging aspects. I think this is a good time to enter this sector as we are on the cusp of a major change and new thinking. Changes to the way we deliver these services are inevitable as more people are relying on them and budgets are decreasing, but that also presents opportunities for those who want to be part of the change. AO – A career in the Health and Social Care sector is always going to represent a challenge. Often both physical and mental capabilities can be pushed to the limit. However, for those seeking a career in the profession, where financial rewards are not necessarily deemed as symbols of success the benefits are many. Where external financial rewards may often be lacking within the sector there is an abundance of personal satisfaction, gratification and the ability to impact positively upon people’s lives.

Image: ©Hilch/shutterstock

Q1 What are the key challenges that you see in the Health and Social Care sector in relation to employment?

ADOLYGIAD BUSNES DE CYMRU | Q4 What are your predictions for 2015 from both the employer and employee perspective? AMK – I think we will see a move back towards the more ‘vocational’ roles and an awakening of the recognition of the hard work and valuable skills of the ‘vocational professional’ as opposed to the ‘career professional’. This does not mean academic qualifications are not important. Academic qualifications are essential but we need to have a balance, there’s no middle ground for people within the profession. The integration of soft skills, will be essential from both an employer and employee perspective.

AO – A focus on individual care will be at the top of the agenda for employers in the sector. Health care employers will be expected to meet the demands of an increasingly aware population presenting an ever widening range of complex Health and Social Care needs. Employees within the sector will expect and demand greater recognition of their related skills and attributes. Job descriptions and roles will become more clearly defined. There will be more specialised roles in particular fields such as dementia care, and the sector will develop pathways that have yet to be explored. In addition the 2015 General Election will bring the Health and Social Care Sector to the forefront as a key battle ground to win over the electorate.

“The perceived challenge is to develop professional transferable skills relevant to the sector as well as those softer skills that are so often viewed as lacking by the media, general public and Government alike.”

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Point of View: Whose Health is it Anyway? Dr Maggie Inman

Dr Maggie Inman explores the link between employee engagement, the wellbeing of employees and the health of the organisation. It is no secret that the link between employee engagement and organisational success has been widely recognised over the last 20 years. Research suggests that organisations that employ robust engagement strategies enjoy higher growth rates, better safety records, fewer absences and reduced labour turnover than organisations with lower engagement levels. However research by the CIPD (2012) suggests that organisations’ efforts to improve engagement could be jeopardized if employees’ health and wellbeing are ignored.

The issue of health and wellbeing and in particular stress at work, is a businesscritical one. Stress is the second most commonly reported condition in self-reported work related illnesses. In Wales in 2013/14 there were 25,000 cases of work related stress reported with an average of 23 work days lost per case (IOSH, 2014). By viewing health and wellbeing as intrinsically linked to engagement, it will ensure the sustainability of organisation initiatives to drive up engagement levels. The economic climate of recent years has seen many organisations downsizing and restructuring. This coupled with

technology advancement allowing employees to potentially work around the clock has meant that there is less certainty about where and when work ends and personal life starts. Working harder for longer is a ticking time bomb for the health and wellbeing of employees. The CIPD (2012) report on ‘managing for sustainable employee engagement’ combines enhancing employee engagement with preventing and reducing stress at work into 5 behavioural themes in order to support managers and organisations to achieve sustainable employee engagement:

Competency

Brief Description

Open, fair and consistent

Managing with integrity and consistency, managing emotions/ personal issues and taking a positive approach in interpersonal interactions.

Handling conflict and problems

Dealing with employee conflicts (including bullying and abuse) and using appropriate organisational resources.

Knowledge, clarity and guidance

Clear communication, advice and guidance, demonstrating understanding of roles and responsible decision-making.

Building and sustaining relationships

Personal interaction with employees involving empathy and consideration.

Supporting development

Supporting and arranging employee career progression and development. CIPD (2012)

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ADOLYGIAD BUSNES DE CYMRU | What can organisations do to enhance employee health and wellbeing?

What can Managers do to enhance employee wellbeing?

• Personalise the wellbeing agenda for the individual and the organisation. TSB has ensured that wellbeing is at the centre of its mission to be ‘a different sort of bank’. Similarly British Airways has placed well-being at the heart of its brand.

Managers have a critical role in reducing stress levels by taking relatively small measures which could fill gaps in employee engagement.

• Ensure accurate job matching. Invest in comprehensive selection and assessment tools to make sure selection is based on employee fit with the role, the organisation and the work environment. Poor job matching often leads to employees struggling to meet the requirements of the job, resulting in higher stress levels. The classic personenvironment fit model suggests that the main source of work-related stress and ill health is a misfit between the employee and their work environment. • Strengths based interviewing is becoming popular with companies such as Nestlé, Barclays and the Royal Mail. The approach is designed to establish what really makes candidates tick and by doing so is a way of determining long term fit with the company.

• Watson (2014) suggests spending time on prioritisation. Having frequent conversations about what’s urgent and what can wait will focus employees on the most important task rather than feeling overwhelmed by excessive workloads. • Regular one to ones, rather than (or as well as) a 6 monthly review, can result in people feeling valued and able to ask questions.

The challenges created by changes in the workplace and its impact on employee health and wellbeing are widespread. The business case for focusing on wellbeing of employees is strong as it drives low absenteeism, high productivity and engagement. Taking steps to implement effective ways to improve employee wellbeing and engagement should not only reduce the amount of stress within the workplace, but also improve the business results of organisations. Sustainable employee engagement could be the key to the economic health of Welsh businesses.

• Genuine and meaningful praise creates a positive environment and celebrates achievements. • Focusing on people’s strengths and encouraging them to excel can take the focus away from costly monetary rewards. Focusing on purely transactional methods of engagement such as financial rewards, warns the CIPD, is unlikely to be sustainable over time.

• Spend time on induction and ‘on boarding’ of new employees. Not only will this help new staff feel like team members and become effective quickly but it will reduce anxiety and stress levels in the crucial early weeks of employment.

• Allocating a coach or mentor to vulnerable employees as a specific support mechanism can be particularly beneficial in helping individuals cope with stressful situations. Similarly career development and clear succession management strategies which stretch employees without being overwhelming can improve employee wellbeing and engagement. • Inform, consult and communicate. Giving employees a feeling of control can greatly assist in employee wellbeing. According to the HSE good information and consultation mechanisms are likely to prevent stress.

Image: ©Ingka D. Jiw/shutterstock

• Invest in comprehensive training and development. Individuals who do not have the necessary skills to do their jobs can be a key cause of stress and lead to disengagement. Resilience and pressure management development interventions can be highly successful in enhancing an individual’s ability to cope with stressinducing situations.

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Point of View: The Absence of Talent or the “Talent of Absence”? Julian John

Julian John, Founder of learning and development and HR consultancy, Delsion Diversity highlights the hidden potential of a workforce often overlooked by employers. As a HR manager in retail for over 15 years, absence has always been a key performance indicator at every level I’ve worked at, whether it be as a single unit manager of 150 staff or at a national level with over 15,000 employees.

fault. When your business resources, recruits, trains, develops and manages an employee anything that goes wrong or right for that matter is down to the business. Now that may be an overexaggeration, but there’s a fundamental basis of truth in it.

As a figure or a measurement absence can be seen as a loss of productivity - the financial impact of sick pay or having to replace lost hours within the business, but it’s so much more.

There is one exception however, and that’s when an employee leaves the business due to ill health. That for me has always been so regrettable to the individual and to the business. It’s at this point that I’ve always done anything to keep people in work if practicable: reasonable adjustments, flexible working, suitable alternative work or whatever was needed.

If you have ever spoken to me in an HR context, invariably at some point I’ll probably say: “It’s all about the people, people”. I’ve always found HR practices a lot less complicated if I take that approach. The second thing you need to know about the people aspect of an organisation is that everything is your

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But what if people can’t work for an extended period of time or their circumstances change so that they have to seek employment? What is the support for these people? I should quantify at this point, that within this number I mean people that have the capacity and capability to work. Firstly, let me make a very bold statement: The talent pool of people who are not in work due to health reasons or disability but want to work is the greatest resource of untapped potential within this country. Also that talent pool is huge: In Swansea as of November 2014 the figure for unemployment was 4110 i.e. people claiming Job Seekers Allowance. However there were an additional 13,970 Employment and Support Allowance and Incapacity Benefit claimants*. That is a staggering number.

ADOLYGIAD BUSNES DE CYMRU | Furthermore, from my experiences, the support to help these individuals is limited. Not because of the lack of finance or resources but because the approach mainly taken does not mirror the modern job design, resourcing and recruitment practices adopted by the majority of employers. The organisations that support people into work in reality are talking a different language to employers.

My point? Do everything and more to keep the talent you’ve got and do everything you can to open up your business or organisation to the talent that’s out there because you’re limiting the potential of your organisation if you don’t. Be flexible, be adaptable, be supportive and find solutions not problems because it’s all about the people, people.

When modern recruitment is based around interventions such as competencies and behaviours why doesn’t the provision of support and training account for this? At this point I should clarify why I feel so strongly about this and how I feel that I’m qualified to have this opinion.

It’s human nature to want to manage known quantities and there is a perception that by employing a disabled person or somebody with health issues that more will be spent on time, resources and unknown quantities when from my experience that just isn’t the case. What is a known quantity anyway? My wife had an exemplary attendance record for 19 years with the same employer until she had cancer and I know from my own experiences that we don’t know how suddenly long term heath issues and disability can affect someone.

Nine years ago I became disabled with a chronic neurological condition that has left me with a severely impaired balance function. I was housebound for over three years and I’ve learned to stand, walk and talk again. Every one of my cognitive abilities has been affected and my recovery to this point has been through completing rehabilitation therapy exercises four times a day for five years. Throughout this, my main driving motivation was to be able to return to work and it is this experience that has led me to look at the resources available and be able to evaluate their effectiveness, both as a senior HR manager that has personally recruited over 2,000 people and as a disabled person looking to reenter employment. As part of my journey I’ve had the opportunity to be involved with a large number of people with disabilities or health issues that are looking for employment and I promise you I have never seen so much unrealised potential in my career.

So, I’ve written this article and made some audacious statements but what am I doing about it? In December I started my own HR & training consultancy based in Swansea and we’re producing some leading edge work for our clients at the forefront of their industry. This includes organisations such as SA Brain & Co Ltd and national training providers. However, the big difference to our approach is that we’re also a social enterprise. We’ve devised an employability training model that utilises key L&D interventions that I’ve personally achieved world-class people orientated results with. We work with local organisations on a not for profit or where possible free basis to support people back into sustainable employment and in addition to the benefits to the individual, for every 15 people that we

get into employment we potentially save the economy up to £59,600 before even factoring in the saving from the provision of any form of benefit. It’s a new approach, it’s having an impact and vitally it’s engaging employers. From the feedback I’ve had from CEOs, HR directors, diversity managers, and group heads of health they all recognise and welcome the need for a change in the support mechanism to get people into work and are keen to be a part of that change. Finally, I’d like to repeat a point I made when I spoke at the Cardiff DWP Disability Confident event alongside Simon Weston, OBE and the Minister of State for Disabled People last year: “From my experience at both ends of the spectrum it’s about results. It’s not about paying lip service, it’s not about the implementation of policies that can tick a box, it’s about the number of disabled people you recruit and how you remove the barriers, conscious or sub-conscious, to allow those disabled people to be recruited.” It’s about engaging in the issue of enabling those who have or have had health issues to get back into the workplace and unleashing that potential talent for the benefit of the individual, organisation and the community. This issue is a huge opportunity to be seized and embraced as an enabler to your business rather than perceived as a potential barrier, but more aptly it should be seen as just common sense prevailing. It’s time for change and I’m glad to say that it’s already started.

*Source: Department of Work and Pensions (DWP) Longitudinal Study (WPLS), ONS/Nomis, 12 Nov 2014) Vol 6 Issue 1 2015 | 17

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Point of View: Co-production - Putting People at the Centre of Public Health

Dr. Rachel Casiday

Dr Casiday, who lectures in Anthropology at UWTSD, considers the pros and cons of the co-production model and the impact of current Welsh policy on public health.

Few of us can have missed these health promotion messages: eat five servings of fruits and vegetables a day, stop smoking, exercise more, and so on. And yet, there are serious problems with public health today. Health inequalities between rich and poor persist across all population groups, geographical areas and ages (Department of Health, 2003; The Marmot Review, 2010). Thus, public health appears to be failing particularly those people who need it most, whose lives are affected by poverty, vulnerability and, disproportionately, ill health.

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On top of this, the shifting emphasis from population and environment (as in John Snow’s day) to individual responsibility for health may be undermining the sense of community and collective responsibility that the NHS was founded on. Individuals who find themselves unable to overcome the health challenges they encounter may find themselves blamed by ‘experts’ who do not share their life challenges. Across the UK, policy makers, practitioners and researchers are calling for action to tackle these problems: a new model for public health that puts people at the centre and overcomes the paternalism and inequalities in healthcare (The Marmot Review, 2010; South et al., 2013). Co-production is one such model, referring to the idea that service users (patients) should work alongside traditional service deliverers (e.g. the NHS, local authorities) to provide a service together, in order to better meet the needs of the community (Bovaird and Loeffler, 2014). In Wales, co-production of health sits alongside another Government agenda known as prudent healthcare. In this article, I will outline the principles of co-production and prudent healthcare as expounded in Welsh policy

and provide some examples of how they are already driving public health activities across Wales. Finally, I will offer some thoughts about how co-production and prudent healthcare might affect the relationships between health policy makers, managers, practitioners and members of the public. Co-Production Wales defines the concept as follows: “Co-production enables citizens and professionals to share power and work together in equal partnership, to create opportunities for people to access support when they need it and to contribute to social change.” As a model of client engagement, coproduction can be applied to any of the service sectors, but it is particularly relevant to the public health problems described above. But what does it really mean for citizens and professionals to work together in ‘equal partnership,’ and how can this be brought about?

Public health has come a long way since John Snow solved the 1854 London cholera epidemic by establishing the germ theory of disease and the modern science of epidemiology (Schneider, 2010). Today, non-infectious diseases have replaced cholera and other infections as the primary killers, and public health is increasingly about promoting individual lifestyle changes to reduce the burden of cancer, diabetes and heart disease (Tulchinsky and Varavikova, 2010).

ADOLYGIAD BUSNES DE CYMRU | Co-production is catching on in Wales, and there are many examples that illustrate the diversity of perspectives on partnership working in public health. Here are a few: • Hywel Dda Health Board engaged a group of adults with learning disabilities, patient representative and outreach groups, hospital staff and the Estates department, to develop, test and implement a new accessible system of signage incorporating symbols at Withybush Hospital in Haverfordwest. This initiative won the NHS Wales Awards 2013 and is now being rolled out across the Trust (1000 Lives, n.d.). • Co-Creating Healthy Change is a portfolio of ten major projects across Cardiff and the Vale of Glamorgan that aim to increase the voice and confidence of community members, users and beneficiaries of public and voluntary sector services (C3SC, n.d.). To highlight just one example, Action in Caerau and Ely (ACE, n.d.) has set up a team of Community Ambassadors whovolunteer to give feedback on services and provide information for other community members. Residents also worked together with the NHS to co-design the 111 NHS Direct helpline. A time bank system is in operation so that community members earn credit for their contributions to co-production of local services (ACE, n.d.). • Disabled People Together is a new forum in Ceredigion for individual disabled people, disability organisations, and professionals to ensure that the voice of disabled people is fully heard and valued, to remove the barriers to independent living in Ceredigion and to make improvements to the Council’s Strategic Equality Scheme (Disabled People Together, 2013). These examples show that co-production is about more than consultation, but involves some form of active involvement from communities or service users. It is about considering the assets that both communities and professionals have to offer, and how these can be effectively mobilised together in order to provide a service that better meets local needs.

This leads us to another current Welsh Government policy agenda, prudent healthcare. Mark Drakeford, the Welsh Minister for Health and Social Services, defines prudent healthcare as ‘healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit’ (cited in Bradley and Wilson, 2014, p. 5). This policy arises from a context of austerity and rising costs, but it also emphasises the need to continue to improve the quality of healthcare across Wales. According to Welsh Government, it is based on these principles: • Do no harm. • Carry out the minimum appropriate intervention. • Promote equity between professionals and patients. The final principle shows that coproduction and patient-centred care are embedded in the policy of prudent healthcare. Enabling the health service to make full use of the assets offered by both health professionals and patients is seen as a way of improving services while promoting efficiency; this will require organisational flexibility and learning new ways of practice. Prudent healthcare also has significant messages for public health practice: in terms of promoting healthy lifestyle, it calls for a shift ‘from education to motivation’, and warns that certain healthcare practices might actually reinforce harmful lifestyle choices. There are tensions in applying coproduction and prudent health care to the NHS and particularly its public health activities. It could be viewed as a way for the state to ‘opt out’ of delivery of services at point of need, and move toward a model based on individual self-reliance. Thus rather than being empowering,

it could leave vulnerable groups more marginalised (Casiday and Booth, 2014). What is needed is an approach that capitalises on the contributions that citizens can make, thus conferring a real voice and increased sense of worth, while also ensuring that services continue to be available as needed, regardless of individuals’ ability to contribute. How can managers, practitioners and citizens expect their health service to change as a result of these policy directions? Managers and practitioners may find their traditional authority challenged as they are required to work on a more equal footing with patients. Patients may find that their voice is increasingly in demand, as they become partners with clinicians in planning their own care and with the NHS and other organisations in influencing the ways that public health and healthcare are provided. On the other hand, they may find that some options are no longer available to them if they are deemed not to have taken sufficient responsibility for their own health. But the challenges of finding new ways of working together can also provide exciting opportunities for us to develop as citizens and to solve the problems facing our public health system.

For a full list of references for this article, please contact the editor.

“Co-production enables citizens and professionals to share power and work together in equal partnership, to create opportunities for people to access support when they need it and to contribute to social change.” Vol 6 Issue 1 2015 | 19

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News and Events

Events @ Swansea Business School

For full details and booking for any of the below events please contact: Jamie Tavender (Faculty Marketing Officer) jamie.tavender@uwtsd.ac.uk

28th February 2015

Undergraduate Open Day

Come along to find out more about undergraduate study at our Swansea Business Campus. For details and booking please visit: www.uwtsd.ac.uk/visitus

5th March 2015 6pm at Swansea Business School room G01

St David’s Day Lecture: Welsh Health Trends Prof Andrew Davies, Chairman of ABMU Health Board

A presentation on the challenging environment of health services in Wales. Andrew will relate his experiences of his current role and past experiences at the Welsh Government level. All welcome.

14th April 2015 6pm at Swansea Business School

Stress Management The Employer’s Viewpoint.

Matthew Huggett, from the Engineering Employers Federation considers stress in the workplace from an employer perspective. All welcome.

23rd April 2015, 6pm at Swansea Business School

Is mutualisation a model to save and regenerate public services?

Mutualisation Update on the SBS/ Mutual Ventures WAG contract to develop Welsh Cooperatives, Mark Bandalli, Consultant. All welcome.

Business School Welcomes Exporters Association West Wales Exporters Association recently held their first event at Swansea Business Campus. The Faculty of Business and Management is a member of WWEA and made a contribution to this event as well as hosting. Swansea Business School has close links to many local trade organisations and professional bodies and Assistant Dean, Steve Griffiths said of the event: “We were delighted to be able to support the West Wales Exporters Association by hosting this event. Our students are the future business people of the region, and by showcasing examples of local organisations like Wolfestone who are building a successful international business we hope this event will inspire them to become the exporters of the future.”

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ADOLYGIAD BUSNES DE CYMRU |

21Yr Old Tech CEO Speaks to UWTSD Students UWTSD was lucky enough to host a guest speaker with a difference recently, when one of the youngest Tech CEOs in the world to lead a listed company paid us a visit. Brandon Evertz launched his company in Australia with a $500 loan from his father and the company floated on the Australian Stock Exchange just after his 21st birthday.

Brandon’s company Big Review TV offers businesses a platform to promote themselves where consumers can post their own video reviews, taking the concept of review sites to the next level with the addition of video content. His visit was supported by Welsh Government’s Big Ideas Wales and formed part of the newly launched ‘Life Design’ initiative that the University has

developed to help students design their own futures. We hope his presentation about his experience of starting up and growing a company and his plans to expand into the UK will encourage our students to consider starting their own businesses.

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Welsh Government and UWTSD Sign Waterfront Innovation Partnership Agreement Economy Science and Transport Minister Edwina Hart and ViceChancellor of the University of Wales Trinity Saint David, Professor Medwin Hughes have signed an agreement to work together to maximise the positive impact of the University’s Swansea Waterfront Innovation Quarter on the city and the wider Swansea Bay City Region. The Waterfront Innovation Partnership will bring together both parties’ resources to redevelop the SA1 region of the city. It aims to improve access to higher education and skills development for local communities and employers, enhance the employability of the University’s graduates, and ensure the University exploits its potential for knowledge transfer to contribute to the economic regeneration of the Swansea Bay City Region. The ambitious plans also aim to cement Swansea’s reputation as a first-choice destination for students in the region, as well as further afield through the provision of innovative learning and teaching methods which facilitates education and industry interaction.

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Dip HE

Nursing Studies and Health Seeking a career in nursing but lacking the skills to get on to the degree of your choice?

Aimed at those students who wish to enter into a nursing career but lack the qualifications and experience, this course is a valuable foundation that will prepare you to further your studies on a nursing degree or in a related field.

For more information contact:

amanda.owens@uwtsd.ac.uk

Image: ÂŠMonkey Business Images/shutterstock

The New UWTSD Nursing Pathway will provide you with the necessary skills in Nursing Studies and Health.

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In The Mix

Out Summer 2015 To reserve a copy please visit www.uwtsd.ac.uk/swbr or email your name and address to: swbr@uwtsd.ac.uk

How Creative Collaboration is Transforming Business