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issue 23 autumn 2014
healthcare manager inside
heads up:2
What you might have missed & what to look out for Leading edge: Jon Restell inperson: Ian Haig, University College London Hospitals inpublic: Bristol Breast Care Centre
comment:9
Nikki Joule: Tackling the diabetes crisis published by
Managers in Partnership www.miphealth.org.uk 8 Leake Street, London SE1 7NN | 0845 601 1144 Managers in Partnership is the trade union organisation providing support and advice to senior managers in healthcare in the UK on employment matters, careers and management practice. We represent their views to policymakers, employers, the media and the public.
features:10
NHS finance: Getting finance fit for the future Interview: Kevin Fenton, Public Health England Race equality: Less talk, more action? Consultants: How to get your money’s worth
regulars:20
Legal Eye: new rights to request flexible working Tipster: Avoiding unconscious bias at work MiP at Work: MiP secures fair redundancy pay
backlash:24
healthcare manager | issue 23 | autumn 2014
Welcome to the autumn issue of healthcare manager, the magazine from MiP, the specialist trade union for managers working in health and social care. We hear from Kevin Fenton, the dynamic national director of health and wellbeing at Public Health England, who argues that PHE is in a great position to empower people to take control of their health and wellbeing. Kevin also observes that the NHS needs greater diversity among its leaders. Simon Stevens, the new NHS England chief executive has taken up that challenge, like many before him. Our feature on race equality considers whether his promises will lead to lasting change. MiP will certainly be doing our bit to keep it high on the agenda. This issue’s Tipster gives some some simple tips on how to avoid unconcious bias at work. We also feature the Future-Focused Finance initiative to modernise and promote better understanding of NHS finances, and look at how to get better value from consultancy. October is Breast Cancer Awareness Month, and we feature the brand new Bristol Breast Care Centre, which brings all breast care services under one roof. Enjoy the magazine, and do let us have comments and suggestions. Marisa Howes Executive editor 1
HEADS UP
heads up what you might have missed and what to look out for
People management
Taking the headache out of sick leave
Whistleblowing
Free training package for managers A free training package for managers is available from the Whistleblowing Helpline. It is designed to explore your responsibilities as a manager in relation to staff who wish to “blow the whistle” and help you to respond confidently and effectively. The course helps managers to: ■■ Explore definitions of whistleblowing ■■ Understand the benefits of fostering an open and transparent culture where staff are encouraged to raise concerns ■■ Explore the legislation covering whistleblowing ■■ Know how to handle whistleblowing cases ■■ Know where to go for help and support For more details, please contact Rosemary Crockett, policy manager, Whistleblowing Helpline, by email at rosemary.crockett@mencap.org.uk
NHS Employers has launched a free online tool to help managers develop a consistent and fair approach to sickness absence. Everything you need to know about sickness absence provides step-by-step information about what to do when staff call in sick, practical advice on some of the common reasons for sickness absence and information on what to do if staff are frequently off sick.
“It can be hard to know how best to react to, and manage, staff absence,” says Sarah Hirst from NHS Employers. “Our response when a staff member calls in sick can make a big difference to how they feel and how they behave next, so getting these things right is invaluable.” “[The tool] aims to complement local sickness absence policies and is must-read for anyone managing staff in a
healthcare setting.” To encourage the spread of good practice, the tool includes 30-second guides on: ■■ When staff call in sick ■■ Staff who are frequently off sick ■■ Staff with long term illnesses ■■ Common reasons for sickness absence ■■ Supporting staff who are off
sick ■■ Supporting staff to return to work ■■ Preventing absence
healthcare manager
Associate Editor
Craig Ryan editor@healthcare-manager.co.uk
issue 23 | autumn 2014 ISSN 1759-9784 published by MiP
Design and Production
healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.
All copy © 2014 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
Executive Editor
Marisa Howes m.howes@miphealth.org.uk
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Lexographic www.lexographic.co.uk
Contributors
Debbie Andalo, David Ellcock, Marisa Howes, Nikki Joule, Joe McGarry, Helen Mooney, Alison Moore, Jon Restell, Dan Robertson, Craig Ryan, Jo Seery.
Warners Print, Bourne, Lincs
Advertising Enquiries
020 8532 9224 adverts@healthcare-manager.co.uk healthcare manager is sent to all MiP members. If you would like to be on our regular mailing list or require copies please email editor@ healthcare-manager.co.uk
Detailed information on each topic is also available for managers who need it. Everything you need to know about sickness absence is available at www. nhsemployers.org/sickness.
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.
healthcare manager | issue 23 | autumn 2014
HEADS UP
leadingedge Jon Restell, chief executive, MiP
S
ince my last column, there have been some important developments in the trade union campaign for fair pay in the NHS, which MiP is strongly supporting. The “day of protest” on 5 June started the ball rolling, with MiP highly visible at key events and in the workplace, while MiP link members represented you energetically at the lobby of Parliament on 1 July. Several unions are ballotting for industrial action, including Unison and, for the first time in its history, the Royal College of Midwives. The pay campaign now includes Wales. This activity is a great start, but there’s no quick win here. The long pay freeze requires a long campaign to thaw it. The campaign is about much more than the shabby treatment of NHS staff in England and Wales this year. It’s about the losses of the last five years – on average salaries are worth 10% less now than in 2009 – and it’s about the prospect of even more to come – the government wants to keep squeezing salaries until 2017. All the unions have agreed some key campaign objectives. These include immediate payment of the 1% increase recommended by the pay review body; raising all salaries to at least the Living Wage of £7.65 an hour; the breaking of the pay freeze next year with a cost of living rise that for once beats inflation; measures to restore the value of NHS
healthcare manager | issue 23 | autumn 2014
“Jeremy Hunt and employers admit that NHS staff deserve a pay rise but say the NHS can’t afford one. They can’t keep up this refrain for a decade.” pay lost in the last five years; consistency across the UK; guaranteed independence for the pay review body; and a pay policy that lets NHS staff benefit from their contribution to better productivity. Jeremy Hunt and employers admit that NHS staff deserve a pay rise but say the NHS can’t afford one. They can’t keep up this refrain for a decade. A varied group of important organisations, including Monitor, are making clear that the pay freeze is not sustainable. Let’s talk about more productivity – extra funding alone can’t create sustainable pay – but the NHS must stop avoiding reality and
fund pay properly. Your national committee decided that, as members of Unison, MiP members should have their say in the industrial action ballot. The result should be known about the time you receive this. The priority must be responsibly-led industrial action aimed at gaining public support and getting employers and government to take pay seriously, rather than causing maximum disruption for patients. Short stoppages and imaginative action such as taking your breaks (which will highlight the huge amount of discretionary effort that keeps the NHS running) are the name of the game. Whatever the outcome, we will give guidance to members during any industrial action. But I hope that whatever you choose to do, you do something to support the campaign for your pay and play your part to deliver MiP’s message: NHS staff deserve fair pay and that includes NHS managers, who deliver day in, day out for their colleagues and patients, with skill and ceaseless dedication.
Update your details There have been many changes in the NHS over the past few years, so please make sure we have your correct home address, work address, employer, job title and preferred email address. Please take a few moments to check your membership records and make any necessary changes. Simply log in to the members’ area of the MiP website and follow the prompts to update your details. Alternatively, please email us at info@miphealth.org.uk.
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HEADS UP
Regulation
Survey
2014 staff survey Questionnaires for the 2014 staff survey will be distributed to participants at the end of September. The NHS Staff Survey provides an opportunity for organisations to survey their staff in a consistent and systematic way. This makes it possible to build up a picture of staff experience and to compare and monitor change over time and to identify variations between different staff groups. Obtaining feedback from staff, and taking account of their views and priorities, is vital for driving real service improvements in the NHS. It is also an important way for MiP and the other health unions to gauge the mood of NHS staff across organisations and to identify key concerns that should be addressed in partnership at the local, regional or national level, giving feedback on issues such as personal development, communications and raising concerns at work. So if you have been sent a survey questionnaire, please do complete it. The survey is confidential and conducted on behalf of NHS organisations by accredited independent consultants.
Healthcare directors face “fit and proper person” test MiP has raised concerns about the new fit and proper person test for directors of healthcare providers which, subject to parliamentary approval, comes into force in October. The test will be overseen and enforced by the Care Quality Commission and gives it the power to require the removal of any director it considers to be “unfit”. The fit and proper person test and a new duty of candour for NHS providers aim to ensure safe standards of care as part of the Government’s response to the Francis report. Speaking about the regulations and the draft guidelines, MiP chief executive Jon Restell said: “MiP supports any initiatives to help organisations to ensure they recruit and retain the highest calibre of senior staff, including the development of standards for those holding director-level posts, and appraisal, support and training for those who take on these roles. We have repeatedly offered to contribute to the development of these standards.
Engagement
Better care for Sickle Cell patients
A new survey tool has been developed to improve understanding of the impact of Sickle Cell Disorder (SCD) on
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patients, families and carers. The Patient Reported Experience Measure (PREM) allows healthcare services to
“However, we are concerned that the fit and proper person test set out in the regulations may involve subjective judgements about post-holders, for example, if they are ‘of good character’, or how to define ‘mismanagement’. Any criteria used to judge someone’s fitness for the role must be clearly defined and objective to ensure they are fair. The processes used to decide if a person meets the requirements must be clear and open, and those judged under the criteria must be able to appeal against any decisions made.” For more information, see the CQC website: www.cqc.org.uk.
collect feedback from SCD patients of all ages, and to use it to improve patients’ experience of care in the future. The tool was developed by Picker Institute Europe for the National Institute for Health Research CLAHRC for North West London, based at Imperial College London and Chelsea and Westminster Hospital, in partnership with the Sickle Cell Society. The data collected covers access to healthcare services, the experience of seeing clinicians, and the stigma associated with sickle cell disease. The tool will be used to monitor the integrated care programme for improving management of SCD, which is funded by CLAHRC North West London, and will be implemented initially in that
area, where many SCD patients live. SCD commonly affects people of black or Afro-Caribbean descent, which is widely believed to have contributed to its maginalisation. “Sickle Cell Disorder is unpredictable, agonising and most importantly there is no cure, so it’s a life-long battle that has a massive impact on an individual’s quality of life,” said John James, chief executive of the Sickle Cell Society. “Good quality patient feedback can really help clinicians to understand the impact of the care they give. Don’t get me wrong, some SCD patients do get good, even exceptional care, but more get the reverse and that needs to change.”
healthcare manager | issue 23 | autumn 2014
HEADS UP
inperson Ian Haig divisional manager, National Hospital for Neurology and Neurosurgery, University College London Hospitals.
Ian Haig describes his role as “knitting everything together”. As divisional manager for UCLH’s National Hospital for Neurology and Neurosurgery, a job he took up in November 2012, he is in charge of running the hospital “from quality through to finance”. As the hospital’s general manager, Ian’s job encompasses recruitment, quality, patient experience, governance, finances and risk management. “I also work closely with estates, facilities and food. I have an overview of everything,” he explains. “My role brings everything together at the hospital and although the hospital is run by a multi-disciplinary team, it could not run without my role,” he says.
Ian’s NHS career began in 2001 as a finance officer at Oxfordshire’s John Radcliffe Hospital before he moved to Ealing Hospital in 2004, where he became a general manager after making the business case for a new MRI lab at the trust. He admits that changing from finance to operational management has required some resilience. “In operational management there are many more complaints to deal with and staff relationships [are important]… I describe NHS operational management as the show that never ends because there is always something that needs fixing.” After working in general management roles at London’s Guys and St Thomas’s and the Royal Marsden
healthcare manager | issue 23 | autumn 2014
“NHS operational management is the show that never ends because there is always something that needs fixing.”
Hospitals, he joined the team at the National Hospital for Neurology and Neurosurgery. Ian believes good general management is essential if clinical management is to function effectively. “From billing to estates and facilities to recruitment, general management brings that all together, and as a general manager you have to have that set of skills, to improve the patient experience and patient care. You have to have that global view,” Ian explains. The hospital employs 1,400 staff and its management team includes medical, nursing and therapy staff as well as general managers. “Without the clinical management, general management would also be useless,” Ian adds. The hospital has a 20-year strategy to improve the quality of life and outcomes for everyone with a neurological disorder, and has 70 different specialties to help patients with a range of conditions including multiple sclerosis, Parkinson’s disease, dementia and brain tumours. It’s Ian’s job to make sure the hospital runs as smoothly as possible, treating the thousands of patients that come through its doors each year and making their experience and their journey as positive as possible. Although he admits to sometimes being envious of clinicians and wishing that he himself was better at science he says that he feels very lucky to be working alongside them. “To be able to work as an effective general manager you have to have the right values and be able to add value,” he says. “Having the right values means treating every patient as if they were your gran or your mum or dad.” Helen Mooney
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HEADS UP
Telecare
Development
New device offers NHS boards urged to encourage support on the voluntary work abroad move
New telecare technology promising to give people with dementia and learning difficulties more independence outside the home was launched in August. The new wristwatch gadget, known as the “Vega”, was developed by not-forprofit telecare technology provider Centra Pulse and Finnish technology firm Everon. The device aims to support older and disabled people who are out and about in the same way that existing technology supports them in the home. The Vega uses a GPS tracking system and mobile communication to bring emergency care and support directly to the wearer by instantly tracking their location and connecting them with a trained care professional at a monitoring centre. It can also be set to alert carers if the wearer strays beyond a preset area. The service costs around £30 a month. “We have developed the technology we offer to give more reassurance, freedom and independence to the users and relatives we support,” said Wendy Darling, managing director of Centra Pulse. “By ensuring they can be instantly located and provided with immediate care in an emergency, new devices like the Vega allow more vulnerable people to leave the home, explore their surroundings and take up more active hobbies.” Research by the Cochrane Collaboration published last year found that exercise can improve the thinking abilities and everyday life of people with dementia.
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Voluntary development work overseas should be seen as “the norm not the exception” for every healthcare worker’s career, according to a new “framework” published by the government in July. The document, Engaging in Global Health, published jointly by the Department of Health and the Department for International Development, claims demand for the skills of British healthcare professionals is growing in developing countries, and UK health services “can benefit enormously from the knowledge and experience gained from work in low and middle income countries”. The authors, Murray Cochrane from the Trust Development Authority, Graham Chisholm from the Tropical Health and Education Trust and Nick Tomlinson from the Department of
Health, call on NHS employers to do more to support workers who want to volunteer overseas. “There remains a lack of awareness among NHS board members about the benefits and value of international health activities. There is also uncertainty about how organisations should respond to the risks and costs involved,” they say. “In the past much of the charitable work overseas
has been based on individual clinicians following their passions and making their own arrangements,” they add. “By embedding international volunteering as a valued part of mainstream operational objectives… UK health organisations, individuals and charities can strengthen the sustainability of their activities.” Download the framework Engaging in Global Health from www.gov.uk.
MiP Conference
Managers Matter Wednesday 19 November 2014
Preparations are almost complete for MiP’s annual conference in London. The conference will be chaired by Victoria Macdonald, health correspondent at Channel 4 News and delegates will get the opportunity to quiz health minister Dr Dan Poulter and shadow health secretary Andy Burnham about their plans for the NHS in 2015 and beyond. Simon Stevens, chief executive of NHS England will set out his priorities and we’ll have a great panel of speakers, including Karen Lynas from the NHS Leadership Academy, MiP chair Zoeta Manning and Annie Ingram, director of workforce at NHS Grampian discussing leadership in the NHS and the role that managers play in developing and deliver-
ing high quality health care. There’s a new session about pay determination in the NHS, with MiP’s Jon Restell and Unison’s head of health Christina McAnea debating with Gill Bellord from NHS Employers. The conference is CPD accredited and free to attend for MiP members. If you are not yet a member, you can join now and register for free attendance. Visit mip-conference.co.uk or telephone 020 7592 9490 to book your place. healthcare manager | issue 23 | autumn 2014
HEADS UP
inpublic
“Bringing all breast care services for the Bristol area under one roof has huge advantages for patients.”
Bristol Breast Care Centre The new Bristol Breast Care Centre at Southmead Hospital opened its doors for diagnosis and after-care support for cancer patients in May and is now providing breast cancer screening services. The original centre, the first of its kind in the south west, opened in 1995 as a self-contained, dedicated unit where patients can be seen by various specialists – all experts in diverse aspects of the management of breast disease. The new breast care centre has been built as part of a £4m project at Southmead Hospital, run by North Bristol NHS Trust. The historic Beaufort House on the hospital site has been refurbished to create a centre tailored to the needs of breast cancer patients undergoing diagnosis, treatment and after-care. The interior was designed to be sensitive to the needs of breast cancer patients, with inspiration taken from the building’s history as a workhouse. The donation tree artwork (pictured) was inspired by a cherry tree outside the centre and blossoms are engraved with the details of donors and supporters. Patients can attend the centre for routine screening or make appointments if they think they have symptoms of breast cancer. The building has been designed with two distinct areas, so that patients who may be diagnosed with breast cancer during their visit have a separate waiting area and exit from people who are there for screening. There is also a separate secluded garden area, which can be accessed from all of the consulting rooms, where patients can spend time in quiet contemplation after appointments. The new centre offers private rooms for complimentary therapies and treatments and dedicated meeting rooms for wellbeing and advice programmes. Patients from Bristol, South Gloucestershire and parts of Bath and North East Somerset CCGs, who are referred by their GP with symptoms of breast cancer healthcare manager | issue 23 | autumn 2014
or have had an abnormal mammogram, will be seen by the centre. Surgeons, radiologists and radiographers are all based in the centre, which means that patients can have all the tests they need in one visit. Dr Mike Shere, lead breast care clinician specialist at the trust, says: “It is wonderful to have moved into the new Bristol Breast Care Centre. So much thought went into planning the centre to make it a sensitive environment for patients facing a potential cancer diagnosis and we are pleased to now be delivering care in a space that is better suited to their needs. “The refurbished Beaufort House brings all breast care services for the Bristol area under one roof, which has huge advantages for patients. “We have always been a fragmented service in Bristol,” Shere adds. “I think
there are two aspects to it – working with the bigger team and the advantages that brings, but also moving from three very old buildings into this [newly-refurbished] centre.” Alongside the breast care centre will be a new £1m Macmillan Wellbeing Centre, providing emotional, practical and financial support for people affected by any type of cancer, as well as their families, friends and carers. It will provide computers, a library of information and rooms for complementary therapies and the fitting of special underwear and wigs. It will be the first centre of its kind in the area supporting people from across Bristol – including patients, friends, relatives and even employers – affected by any type of cancer. Helen Mooney
Breast Cancer Awareness month Campaigners use October to raise awareness about the common symptoms and the importance of early diagnosis and treatment of breast cancer. It is also the time when the public show support and raise vital funds for research. See how you can support it at www.wearitpink.org.uk.
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HEADS UP
Patient engagement
Health information for kids: must do better
Healthcare organisations need to improve the quality of health information for young people, which is often unsuitable and hard to access, according to the Patient Information Forum (PiF), the organisation for health information professionals. The PiF has published a new guide for anyone working in healthcare with children and young people. The Guide to Producing Health Information for Children and Young People sets out new standards for health information and shares practical advice and examples of current best practice in the field. Sarah Smith, PiF’s operations directors said child psychiatrists, leading children’s health charities,
Great Ormond Street Hospital, NHS England and children’s authors had all contributed to the guide. “There’s a huge array of children’s health information available, but it is often inappropriate, difficult to access and of varying quality,” she added. “Resources are not freely accessible to all and there are significant gaps in provision. “Children and young people need information that’s specifically for them. They’re not small adults, but neither are they big babies. Getting information across about sensitive and complex health matters is challenging, but possible, if it’s done in an age appropriate way.” The guide covers the practical aspects of creating good health information, including involving children, choosing the right format, writing for children and tackling sensitive issues. It includes information on using stories and play, social media and apps, and the role of schools and the internet as information channels, as well as advice on communicating with children with disabilities and special needs. Visit www.pifonline.org.uk/childrens-guide for more details.
NHS Scotland
Hospitals to get £90m upgrade The Scottish Government has given the green light to plans to modernise two hospitals at a cost of more than £90m. Health minister Alex Neil said the redevelopment of East Lothian Community Hospital and the refurbishment of operat-
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Research
£300m investment puts NHS in vanguard of “genomic revolution” The NHS will become the first health service in the world to offer genomic medicine as part of mainstream care, the government has promised, as it unveiled plans for the world’s most extensive genome sequencing project. Scientists believe that sequencing human genomes – a person’s complete DNA code – will transform scientific understanding of diseases, leading to better diagnosis, drugs and treatment. The 100,000 Genomes Project aims to sequence the genomes of 100,000 people by 2017, starting with those suffering from cancer and rare and infectious diseases. The government is investing £300m in the project through a complex series of partnerships involving the NHS, Genomics England, the state-owned firm set up to run the
ing theatres at Monklands General Hospital, Airdrie, showed the Scottish Government’s commitment to investing in “world class care”. The £75 million development of East Lothian Community Hospital will provide orthopaedics, stroke rehabilitation, enhanced imaging and a social care day unit. Construction on the site should begin in 2015, with services going live by the end of 2017. The £17.9 million investment at Monklands General Hospital will see a new tenbed intensive care unit and the refurbishment of seven existing operating theatres, bringing critical-care beds together in a new modern unit. Work is planned to begin by the end of this year and last for four years.
100,000 Genomes Project, the Medical Research Council, US genetic research company Illumina and the Wellcome Trust. NHS chief executive Simon Stevens said the project would make the NHS one of the world’s “go-to” organisations in the development of genomic medicine. “The NHS’s comparative advantage in unlocking patient benefits from the new genomic revolution stems from our unique combination of a large and diverse population with universal access to care, multi-year data that spans care settings, world-class medicine and science, and an NHS funding system that enables upstream investment in prevention and new ways of working,” he said. For more information visit the Genomics England website: genomicsengland.co.uk
David Small, joint director of the East Lothian Health and Social Care Partnership said: “This is a major step forward in the overall process to build a new community hospital in East Lothian. The new building will bring an overall increase in capacity from what is currently available locally and some services provided outside of East Lothian are likely to move back to the county once it’s completed.” Colin Sloey, NHS Lanarkshire Director of Strategic Planning and Performance, said: “Monklands Hospital is the subject of ongoing investment to ensure that all facilities in the hospital are able to support the ever increasing levels of demand for specialist acute clinical care and meet the highest standards of treatment and care now, and in future years.” healthcare manager | issue 23 | autumn 2014
COMMENT
comment Nikki Joule
Policy manager, Diabetes UK
Wake up to the diabetes crisis The recent report in the British Medical Journal that a third of adults in England could be at high risk of Type 2 diabetes made for very shocking reading. There are already 3.8 million people in the UK living with diabetes and this is projected to rise to five million by 2025.
That’s not all. The rising tide of Type 2 diabetes is fuelling record rates of debilitating complications such as blindness, amputation and strokes, and is placing huge financial pressure on the NHS, which spends £10bn annually on diabetes. This is why it is imperative that the Government responds seriously to the huge challenge this presents. A good place to start would be preventing people from getting it in the first place; unlike Type 1 diabetes, Type 2 is largely preventable. The NHS Health Check is doing an important job in taking the first step of identifying people at high risk of the condition, but implementation of the programme still needs improving. Less than half the eligible population received a check last year. This means that opportunities are being missed to identify the many millions of people who are now at high risk. Once identified, it is vital that thesepeople are given intensive interventions to help them make lifestyle changes – such as losing weight and being more active – that can help to reduce their risk. The National Institute for Clinical Excellence (NICE) recommends this
healthcare manager | issue 23 | autumn 2014
“The Government needs to start tackling the root causes of Type 2 diabetes urgently.” but while there are a number of programmes in place, provision is patchy. Public Health England and NHS England need to be clear about where responsibility lies for commissioning intensive lifestyle behaviour change programmes and provide more guidance. But this isn’t enough. The Government needs to urgently start tackling the root causes of Type 2 diabetes, which are obesity, poor diet, and lack of exercise. The voluntary approaches to improve the health of the nation, such as the Responsibility Deal, are just not working. The Government should take a robust approach to regulating the food and drinks industry so firms are incentivised to make healthier products that are lower in fat, sugar and salt. We also want the Government to urgently consider making healthy food more accessible and unhealthy food less attractive through taxation and other financial measures. Schools should also be used to educate and normalise healthy eating in children and families. The Government’s School Food Plan (www.schoolfoodplan.com), which promotes healthy eating in schools, will help achieve this,
but we would also like to see free school meals available for all children, not just infants. Sadly, for some children, a school meal will be their only balanced nutritional meal for the day. Healthy eating and nutrition lessons should form part of the national curriculum to encourage healthy eating habits later in life. As well as making healthier eating easier, we need to make active lifestyles more accessible. Town planning should encourage cycling, walking and offer plenty of green spaces. Once diagnosed it is also essential that people with diabetes get the care and support they need to manage their condition and reduce the risk of devastating and costly complications. All people with diabetes should be getting the NICE-recommended checks, such as checks on feet, eyes and kidneys, that can help to identify problems early, as well as quick access to specialists if complications do arise. Diabetes can often be a demanding condition to manage. This is why education programmes that give people the knowledge and motivation to manage their condition are also essential. But only a small fraction of people with diabetes are offered them, despite strong evidence that they can improve lives and save money. As the numbers continue to rise this is a crisis that the Government must open its eyes to.
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Views expressed are those of the author and not necessarily those of healthcare manager or MiP. 9
NHS FINANCE
David Ellcock introduces the Future-Focused Finance initiative, which aims to transform the management and understanding of finance in the NHS.
The NHS in England spends £98bn a year on looking after patients. That’s around £186,000 a minute. How can we do our best to ensure we’re spending that much of taxpayers’ money in the best way we possibly can? That’s the question that’s at the heart of “Future-Focused Finance”, an initiative launched by the NHS Finance Leadership Council (FLC) in early 2014.
The FLC brings together the heads of finance from the five organisations now leading the NHS – NHS England, the NHS Trust Development Authority, Monitor, Health Education England, and the Department of Health – along with the president of the Healthcare Financial Management Association (HFMA). The FLC established the Future-Focused Finance initiative to reinvigorate NHS finance by setting a work programme covering six key areas under three strategic themes. The securing excellence theme looks at how finance departments can work in the most effective and efficient ways possible; its two action areas are focused on creating “best possible value” and ensuring “efficient systems and processes” are 10
in place. The knowing the business theme takes in “close partnering” – working to bring finance departments closer to clinical and managerial colleagues – and “skills and strengths”, which will recommend best practice in personal and professional development for finance staff. The final theme, fulfilling our potential, will ensure that the working environment in finance departments across the country is the best that it can be by focusing on making finance a “great place to work” and ensuring that “foundations for sustained improvement” are in place. Each of the six work areas is headed up by a senior NHS professional. Five of the six are being led by finance directors, with the sixth, “close partnering” being led by a medical consultant. So far, so laudable: but what are the aims of Future-Focused Finance? In the simplest terms, it’s about “making people count”, a strapline inspired by a Merseyside GP’s comment, during the early days of the initiative, that “It’s about time that NHS accountants stopped counting beans and, instead, started making people count.” It’s about ensuring that everyone who works in finance (in every role at every level), those we work with to deliver services and the patients and commu-
nities that use and support those services have a better understanding of finance and its place in the NHS. Best Possible Value This area, lead by Caroline Clarke, director of finance at the Royal Free Hospitals NHS Foundation Trust, will develop practical guides to help NHS finance teams, in collaboration with nonfinance colleagues, make difficult decisions about what gives the best value for patients in four key areas: investment or disinvestment, service delivery, allocation of funding, and innovation and risk. The guides will provide methods to account for outcomes, quality and experience, as well as cost, when making decisions. The first will be published before Christmas 2014, with others to follow during 2015. Efficient Systems and Processes This action area, lead by Bill Shields, director of finance, Imperial College Hospitals NHS Trust, will produce a maturity model, setting out world-leading practice for a range of financial activities, along with a measurement tool to enable finance teams to assess themselves against the model and a range of methods to allow teams to make improvements. Once finance healthcare manager | issue 23 | autumn 2014
NHS FINANCE
teams begin to move towards using best-practice models in their basic processes, this will free up their time to concentrate on the vital area of working more closely with non-finance colleagues to improve services even further. We aim to have the whole suite of products available before the end of 2014.
Skills and Strengths This area, lead by Richard Alexander, director of finance, University College London Hospitals Foundation Trust is about ensuring that finance staff can develop the skills they need to deliver a truly future-focused finance function. This means giving staff access to products that will allow them to think about their individual development at times that suit them – not simply as part of the annual appraisal cycle – and in ways that reflect 21st century working practices. Discussions will be held with HR practitioners and software developers to ensure that the products are as up-to-date and accessible as possible. Great Place to Work The aim of this action area is to ensure that finance departments can become places where people are happy to work. Lead by Cathy Kennedy, deputy chief executive at North East Lincolnshire CCG, the team began with two very visible projects: asking finance directors across the country to support the principles of Future-Focused Fihealthcare manager | issue 23 | autumn 2014
NHS England
Close Partnering This area is lead by Sanjay Agrawal, consultant in respiratory and intensive care medicine, University Hospitals of Leicester NHS Trust. The team are developing a 360-degree feedback tool to allow everyone who works with NHS finance teams to provide information on how finance services are viewed and valued. The tool will be completed and introduced into individual departments by November 2014. This will help to increase engagement and understanding between finance staff and other colleagues from early 2015. Finance and non-finance staff from the Birmingham area take part in a group exercise in March 2014, as part of an initial engagement event for the Future-Focused Finance initiative.
nance by signing a public declaration, and offering 20 organisations the opportunity to be involved in a pilot assessment by The Great Place to Work Institute. Close to 150 directors have signed the declaration and over 40 applications were received for the 20 places on the pilot scheme. The team working on this action area are now considering 11 other pieces of work, including the development of coaching and mentoring services and providing career and role models for finance staff at all levels. Foundations for Sustained Improvement The final action area includes developing a communications hub for Future-Focused Finance – www. futurefocusedfinance.nhs.uk – which has already attained over 1,400 registrations. The team, lead by Mark Orchard, director of finance for the Wessex area at NHS England, are working to develop the finance
function’s presence on social media. A network of “value makers” has been established to drive forward the aims of Future-Focused Finance at local level. The team’s thoughts are now turning to the development of a foundation to house the work of the Future-Focused Finance initiative and ensure that it continues and becomes a truly embedded part of the NHS finance function. Future-Focused Finance involves a significant range of work and aims to be transformational. We will know that the initiative has been a success when NHS finance staff are at the heart of the service, providing the support and information that clinical and managerial colleagues need to deliver an excellent service to our patients.
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David Ellcock is programme manager for Future-Focused Finance at the Department of Health. For further details visit: futurefocusedfinance.nhs.uk
11
INTERVIEW: KEVIN FENTON
With squeezed funding and the obesity, ageing and mental health “time-bombs”, public health has never been higher on the NHS agenda. Alison Moore speaks to Kevin Fenton, the influential national director of health and wellbeing at Public Health England.
It’s hard not to be impressed by Kevin Fenton. Physically, he is a towering presence, a head above those around him, but in addition a keen intellect and an ability to deliver have made him one of the top public health doctors on both sides of the Atlantic. And he is still in his mid-40s.
Fenton’s route to becoming national director of health and wellbeing at Public Health England (PHE) has been a fascinating one. He was born in Glasgow, where his parents were studying, but moved to Jamaica when he was two. His schooling and undergraduate years were spent there – giving him the wonderful experience of growing up by the Caribbean Sea but always knowing he was born in Europe, he says. Fenton is passionate about diversity. Working in the USA, he was aware of being in a much more visibly diverse environment – not just in terms of race, but also gender and sexual orientation – than in the UK. “It is time for us to reflect on why this is happening. What is it about leadership that is not attracting the diversity that we need and how do we create opportunities.” Fenton came back to the UK with a 12
scholarship to study public health on a registrar programme. “My love and passion for public health began in medical school and was a direct consequence of being taught by passionate young leaders in public health,” he says. The impact of the context of people’s lives on their health was also immediately apparent to him. “Making that connection early on influenced my choice to become involved,” he says. “That early time in Jamaica was instrumental.” Since then he has worked for the Health Protection Agency in the UK and the Center for Disease Control (CDC) in the US, where his responsibilities included TB and sexually transmitted diseases. He worked under both the Bush and Obama administrations and describes that time as “both personally and professionally transformative for me”. He saw the impact of different political regimes on the public health agenda, but the strengths of the CDC remained its scientific rigour, its emphasis on evaluation and commitment to advocacy, he says. He came back to the UK in 2012 to join PHE. So what lessons does he draw from his time in the US about the
differences between over there and over here – apart from the obvious one of funding systems? One striking difference is scale – both geographically and in terms of population, he says. But there is also the broader context in which public health is delivered. “We have amazing assets that we did not have in the US – the NHS, a robust voluntary sector and a more supportive political context around public health,” he says. “All of these reassure me that we have the tools and infrastructure to do great things.” Likening PHE to the American CDC, Fenton points out that, for the first time, England has a national public health agency which brings together aspects such as tackling and monitoring infectious diseases and the big issues of obesity, mental health and cardiovascular health. He sees the shift of public health responsibilities at local level to local authorities as an opportunity to address some of the wider determinants of health, such as housing and leisure. “The root causes of many health problems are embedded in our society; the environment we live in, the food supply, our behaviours, psycho-social factors and the impacts of health inhealthcare manager | issue 23 | autumn 2014
INTERVIEW: KEVIN FENTON
“We have amazing assets that we did not have in the US – the NHS, a robust voluntary sector and a more supportive political context.”
equalities that exist across the population. So the shift in public health responsibility towards local government provides us with an amazing opportunity to improve the public’s health. “As part of this shift, public health’s voice is both present and increasingly impactful. Whether in informing deliberations by Health and Wellbeing Boards, or influencing local clinical commissioning decisions – public health practitioners have a unique role to champion quality, effectiveness and health impact while keeping the focus on population health and health equity. “At the national level, PHE’s partnership with the NHS is strong, informing and influencing the NHS’s commissioning of public health services, commissioning of specialised and highly specialised clinical services and, more generally, helping broaden the traditional focus on individual treatment and care to include prevention and population healthcare. Here, the public health contribution aims to maximise value and equity for populations and the individuals within them.” “There are huge opportunities there that we did not have in the US. We should be thinking about leverage,” he adds. “We are going to have to have a conversation with members of the public about what they can do about their own health. Health starts in the home, it starts with what we eat, with physical activity that we have done, socialisation and how we engage with the older population.” Fenton believes the NHS had provided a robust infrastructure for health healthcare manager | issue 23 | autumn 2014
in the last 60 years, but wonders if the dominant position of the NHS in the national psyche has disempowered people in thinking about their own health. “That’s a conversation that we now have to have,” he says. “It is a conversation that Public Health England is poised to create and support. Getting into that space is exciting and challenging. It’s exciting because it can unlock so much potential for us when it comes to having an empowered population that understands their contribution to their health and wellbeing.” Fenton concedes there is often a
level of “British scepticism” about shifting public behaviour in this way. “[But] Who knew that we would get to the level of smoking that we have? Who knew that we would see this generation drinking less and using fewer drugs? We are beginning to see a levelling off in the rate of the obesity epidemic. There are signals that encourage me.” But changing behaviour is never easy. Does Fenton believe public health practitioners now have a better idea how to achieve it? “I think we have a very good grasp of the evidence base,” he says. He identifies three elements: having a shared 13
INTERVIEW: KEVIN FENTON
“Change4Life has enjoyed considerable success and unparalleled levels of engagement since its launch in 2009...nearly two million families have joined the campaign.”
vision of what needs to be achieved; leaders who back this; and the tools needed to deliver. “You have to have leaders – Duncan Selbie [chief executive of PHE] and Simon Stevens [NHS England chief executive] – who are singing from the same hymn sheet. They bring leverage. It’s also [about] aligning political leadership, local leadership and the leadership of the voluntary sector.” While not denying the financial constraints facing many of these partners, he suggests solutions have to be found: “Is it a matter of doing more or is it doing things more smartly? You can align to get more synergies,” he says. People remain highly sceptical about using public policy tools to drive change in people’s lives – do we really know how to engage with people well enough to change their behaviour? Fenton says that some campaigns, such as Change4Life, have been demonstrated to be highly effective. “The ultimate aim of our campaigns is behaviour change; we want everyone to take steps towards leading a healthier lifestyle. PHE’s flagship healthy living campaign, Change4Life, helps families to eat well and move more, by providing them with tools and support to make small manageable changes that 14
can have a big impact. “Research has shown that individuals who are supported to make small manageable changes to improve their eating and exercise habits have a much greater chance of success compared to campaigns that encourage sweeping changes which can be overwhelming,” he says. “Change4Life has enjoyed considerable success and unparalleled levels of engagement since its launch in 2009. It now has more than 200 national partners and nearly two million families have joined the campaign.” Some of these initiatives are small but significant: Smart Swaps, for example, focuses on making one like-for-like swap in everyday eating and drinking to reduce calories, fat or sugar – replacing sugary drinks with no added sugar or diet ones, or water, for example. There are also opportunities for new ways of engaging with people, such as using apps to monitor diet, where Fenton is leading a programme of work on digital health. There is considerable public involvement in this kind of work through the use of panels, says Fenton. “They keep us grounded. We look at how we engage members of the public.” The big challenge is not working with sections of the public who are already
thinking about their own health, but to work with those who are disengaged, people who may already be on the wrong side of health inequalities and may struggle to associate their own lifestyles with increased risks of ill health. The Change4Life campaign was aimed at working class families, Fenton points out. “The tools that we have developed, the message, the partnerships, are aimed at [social classes] C2, D&E. We are very mindful of not worsening inequality.” PHE has been trying to drill down into what people actually understand by health inequalities, says Fenton. “What does that mean for the man and woman in the street and their families. How do we not speak above communities? Language is really key.” PHE has also been working with Michael Marmot’s team at University College London, looking at what local partners can do to take on board some of the key recommendations of the 2010 Marmot review of health inequalities in England (which included a living wage and concentration on early years, for example). Looking at all these challenges, is there one which really keeps him awake at night? “Nothing really keeps me awake. We have a new system, new relations, partnerships. It is really critical that we identify the ways that we want it to work and that we act quickly and decisively so that we don’t fall back into previous ways of behaving. “Can we move faster to get these new values inculcated, to drive impact in the system, to think about the new delivery system – but most of all can we do that within a shrinking budgetary environment? “What are some of the choices and trade offs we will need to do? That for me is a challenge. It is one that no one of us will bear – it is a collective and systemic leadership challenge. And the current cadre of leaders both in Public Health England and NHS England are up to the challenge.”
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healthcare manager | issue 23 | autumn 2014
RACE EQUALITY
New NHS England chief Sir Simon Stevens has promised to get serious about race equality in the NHS. Debbie Andalo goes in search of action to match the warm words.
Clive Clarke describes the reality of being one of just an estimated 6% of top NHS managers who come from a black and minority ethnic (BME) background. Clarke, deputy chief executive at Sheffield health and social care NHS Foundation Trust, says: “There is no doubt about it that I have to work harder, I have to prove myself every day. And I also have to prove myself to the black community. It’s a pressure and a responsibility, but I am prepared to take that.” Clarke, who became an NHS manager at the age of only 28 and a director within six years, hopes he will ultimately be judged on what he has achieved and not the colour of his skin. “You don’t think that you can make a mistake, every decision I make has to be scrutinised. And if you are the only black face in the room, when you open your mouth to speak all eyes are on you. I always feel that I’m representing more than just me. At the end of the day I will be judged on a number of things but I want to be judged on achieving good quality services and not my colour – I want it to be first that ‘Clive helped contribute to this’, and then that ‘Clive is black’.” Clarke’s rise to the top has been a healthcare manager | issue 23 | autumn 2014
“If you are the only black face in the room, when you open your mouth to speak all eyes are on you.” Clive Clarke deputy chief executive at Sheffield health and social care NHS Foundation Trust
swim against the tide. A report published by Middlesex University academic Roger Kline in April found that in London the number of NHS trust board members from a BME background was 8%, which is 2% less than eight years ago. The figure for chief executives and chairs was even worse – down from just over 5% to 2.5%. Nationally, according to Kline, the statistics are not any better – 6% for senior or very senior managers, with the number of executive board members predicted to be well below the 7% recorded in London. His report, The Snowy White Peaks of the NHS has been a wake-up call to the NHS to look again at race equality in the workplace. Kline says: “The new [NHS England] chief executive Simon Stevens actually gets it. He’s serious about it.” The figures in the Kline report come ten years after the landmark ten-point race equality plan by the then NHS chief executive Nigel Crisp. That plan, delivered under the Labour government, was designed to turn the tables on a white-dominated NHS senior workforce by supporting and mentoring existing BME staff, as well as improve care for BME patients. Crisp, now Lord Crisp, who has described the Kline figures as 15
RACE EQUALITY
A criminal waste of untapped talent Zoeta Manning, chair of MiP, is determined to make sure the NHS takes real action to tackle race discrimination. Zoeta became an MiP representative after the union supported her in a case against a former employer who was discriminating against her. “Thanks to the support I received from MiP I came out a stronger woman, and determined to challenge race discrimination,” says Zoeta. “MiP has supported me and other black staff in individual cases and works with the Health and Social Care BME Network to promote race equality. We welcome Simon Stevens’s commitment to tackle this issue, and we welcome the race equality standard and look forward to contributing to its development. “It’s an important statement of intent, but I think we need more than that. MiP wants to work with employers on practical steps to tackle discrimination and promote fairness. We need to make sure recruitment and promotion procedures are fair and transparent and do not exclude BME staff. We need to support line managers through training and development to help them improve their performance management, appraisal and development of their teams. “And we need to support more leadership development for BME staff – there’s masses of untapped talent out there. To continue to waste it would be a crime.”
“depressing,” rejects the suggestion that his plan failed. He says: “The plan was successful in some regards such as the creation of Breaking Through [the NHS leadership development programme for BME staff] which worked with many people and changed some attitudes. We set up an independent review panel chaired by Trevor Phillips which did one annual review and showed that there was some progress. The plan wasn’t subsequently followed through, so didn’t have the long term impact we wanted.” Surinda Sharma, who was Crisp’s equality and human rights tsar and is now chair of the Health and Social Care BME network, believes they did make progress and refers to the mentoring relationships between 1,200 BME junior staff and directors or chief executives which were created under the scheme. He says: “It was all about people saying ‘I’m committed to this – I’m a role model.’ Nigel was passionate about this, but when he left in 2006 that commitment wasn’t there.” Sharma says for things to change there needs to be ministerial lead: “They need to take a role in this and say that this is important. I don’t think that people are deliberately going out and discriminating. But if you recruit in the same fashion and in your own image, and are happy to put in people with whom you have worked in the 16
past, what hope is there to bring in new talent and new people?” Kline’s confidence in Sir Simon Stevens’s commitment to tackling the race issue is not misplaced if one looks at his track record since taking over from Sir David Nicholson in April. One of his first promises was to tackle the “lamentable” lack of BME managers running hospitals. In July, the Equality and Diversity Council of NHS England, which he chairs, drew up a strategy in response to the Kline report, which is now out for consultation until November. The council wants a workforce race equality standard written into the NHS contract from April 2015. The intention is that the standard will be taken into account by the regulators – Monitor, the Care Quality Commission and the Trust Development Agency – when deciding whether a trust is well led as part of the inspection regime. The standard will be linked to a number of indicators such as access to training and development, promotion opportunities and staff grades. The standard is also expected to consider the number of BME staff who are undergoing a disciplinary or grievance procedure. Last year research by the Royal College of Midwives (RCM) found that 60% of midwives disciplined in London were BME, even though they account for just
32% of the local midwife population, and more BME midwives than nonBME midwives were likely to be suspended. The RCM’s head of the southern region, Pat Gould, says: “That may be about management processes and cultural issues in the way that certain groups respond to the investigatory process. We don’t know if it’s a discriminatory or cultural issue – it’s multi-faceted.” The RCM is due to update its research this November. Gould, like others, argues that having a diverse workforce is fundamental to improving patient outcomes. “It goes hand in hand with providing culturally sensitive care and compassionate nursing,” she says. The Equality and Diversity Council is also proposing that the existing NHS Equality Delivery System (EDS) – a voluntary “toolkit” or framework which helps trusts meet their legal equality obligations for their workforce and patients – becomes mandatory. Dr Habib Naqvi, senior equality manager at NHS England, who is responsible for the EDS, says: “The most common question we get asked about the EDS is: why isn’t it mandatory? While it helps organisations meet their legal obligations, we want to make sure that organisations go beyond that and improve their organisations on a continuing basis.” While the EDS addresses the wider healthcare manager | issue 23 | autumn 2014
RACE EQUALITY
equality agenda – which includes gender and disability – Naqvi says it is the new standard which could have the biggest impact on workforce race equality if the proposal to include it in the inspection regime is agreed. Kline welcomes these proposals. “Trusts will be able to use the standard to get over the different treatment of non-BME and BME employees,” he says. Research Kline carried out last year found that a white shortlisted candidate is 1.75 times more likely to be appointed than a shortlisted BME candidate. “This new standard means that trusts will have to demonstrate that they are closing that gap. The hope is that closing the gap won’t only be dependent on goodwill, because goodwill doesn’t work,” he adds. NHS Employers says trusts are likely to support the proposals provided they can be achieved within existing “mechanisms”. Its head of diversity, equality and human rights is Paul Deemer, who is also a member of the Equality and Diversity Council. He says: “There wasn’t a consensus at the council meeting, but there were probably around 40 people in the room representing quite a range of organisations, so you are never going to get a consensus in that way. I don’t think there is a reluctance from trusts to make this mandatory. Most trusts will welcome this as long as it aligns with the existing system – so long as they aren’t asked to do something new, they will approve it.” Deemer admits that trusts may have taken their eye off the race equality ball in the last 18 months because of reorganisation, and many BME managers may have been lost to the NHS when primary care trusts were abolished. But he was unable to give an explanation for why the BME senior and executive workforce figures are so low. “I’m not sure. It’s quite a mystery healthcare manager | issue 23 | autumn 2014
“There have been very few development opportunities offered. I see the same consultants being put forward all the time.” Dr Alfa Sa’adu Medical Director, Ealing Hospital NHS Trust
“If you recruit in your own image, what hope is there to bring in new talent and new people?” Surinda Sharma chair of the Health and Social Care BME network
because in the last 10 years, as well as the equality plan, we have had the Equality Act in 2010 and logically this should be happening across the piece, but something has gone wrong.” The NHS Leadership Academy – the organisation devoted to creating the chief executives and NHS directors of the future – worked with Kline on his research and accepts that there is under-representation of BME leaders in the health service. Its statistics illustrate that the picture is changing. It says 22% of all NHS staff are BME, and last year 23% of graduates on its graduate training scheme were BME (an 11% rise compared to the previous year). Some 22% of the academy’s own staff are also BME. The academy runs a “Ready Now” programme – a development scheme for senior BME staff with aspirations to become executive directors. Some 137 were recruited last year when it was launched. One of them was consultant geriatrician Dr Alfa Sa’adu, who referred himself to the scheme after he twice failed to get beyond the shortlist for a medical director post at his Hertfordshire trust. Sa’adu, who went on to join the Top Leaders programme and is now medical director at a hospital in Ealing, says: “I reached the shortlist but was never picked. There have been very few development opportunities offered to me in the NHS. I don’t know why that is. I see the same consultants being put forward all the time – usually white men, and if it’s not them it’s usually white women. “I think it’s because of an unconscious bias – they look for people that they are comfortable with. The leadership programmes have been a very positive experience – once you get networking, people look beyond the fact that you are a black man. You’re not seen as an angry black man – you are seen in a completely different light.”
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CONSULTANTS
Transferring knowledge and a timely exit are the hallmarks of using consultants effectively, advises Joe McGarry.
While the UK economy has finally outgrown its 2008 pre-crisis peak level and is expected to grow by approximately 3% in 2014, the public sector continues to face significant cuts in funding. As a result, public sector leaders are having to reduce spending by focusing their organisational resources on the most critical and important activities, and by looking at new ways of doing more with less. This is happening in parallel with unprecedented levels of change in a number of areas, particularly health, where there is a need for additional capability and capacity in order to deliver the necessary changes and realise the anticipated benefits. So with these challenges, is the use of external consultants ever justified? It depends on the challenge. Consultants, used correctly, can be the catalyst to ensure a change programme finishes on time, within budget and realises the anticipated benefits. They can bring capabilities that an organisation doesn’t normally need, thereby filling a gap for a temporary period of time. They can also share their experience and skills from a breadth of industries and organisations to help equip the client organisation with a fresh perspective. However, if they’re used poorly the 18
relationship between client and consultant is often seen as parasitic – an outcome that is good for no one, least of all the client. So, how can public sector organisations maximise value for money from external support as part of a balanced resource mix? While specific requirements for external support vary significantly, there are four steps that public sector leaders can consistently take to gain maximum value from their consulting engagements:
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time. Some organisations are so used to deploying consultants, they forget to ask whether their own staff already have the internal capability to undertake sustainable change, or whether it should be developed as a permanent in-house capability. Large-scale transformation usually requires some form of external expertise and support, but make sure you always exhaust your own talent pool before hiring externally. 2. Choose the right consultancy for you There are a multitude of players in the UK consulting industry and, while the scale of a project or its geography sometimes dictates a shortlist of consultancies, for the vast majority of support needs there is a valid alternative that is being increasingly recognised: this is to hand-pick your “dream team” from
1. Are you ready to engage consultants? Before bringing in consultants you should be clear how you will get best value from the ensuing relationship. In the first instance, you should be sure you actually need external support. If you don’t know the answer to this question, perhaps it’s not the right healthcare manager | issue 23 | autumn 2014
CONSULTANTS
“Hand-pick your ‘dream team’ from your own people and experienced consultants from smaller, specialist companies.“
smaller, specialist companies to create the optimal, collaborative “eco-system” from your own people and experienced consultants. Small often equals focus, and focus equals real value. So, you are sure you need a consultant and you have decided whether you will get best value from a big or small firm. Meet the applicants and ensure they are the right fit. Ask probing questions, such as: ■■
How will you deliver sustainable change? It will be immediately obvious which ones have delivered this and rolled their sleeves up to work collaboratively with clients.
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When is it appropriate to ‘be cruel to be kind’? On the one hand you want your consultant to be collaborative and intimate; on the other, you want them to be objective and distant. It’s a delicate balancing act – ask them how they manage it.
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What don’t you do well? Probe for a bit of integrity and humility. Listen for those who are candid enough to concede their limitations; those who claim to be “all things to all people” are too good to be true.
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How do you plan to exit? Look at the consultant’s marketing materials; they will no doubt abound with rhetoric about their “focus on knowledge transfer to clients”. Genuine consultants passionately believe it to be a true indicator of their success. They will want to work themselves out of a role by developing people within the client firm.
healthcare manager | issue 23 | autumn 2014
3. Embed knowledge transfer into your delivery plan
Once you have selected your consultants, it’s time to build your expectations for knowledge transfer into your plans. ■■
Agree your knowledge transfer objectives: It is important to agree the objectives of knowledge transfer in order to align expectations about the types of knowledge sharing and the commitment required from all parties to make sure it happens by the end of the consulting engagement.
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Define the knowledge transfer approach: Identify the consultants who will be responsible for transferring knowledge during the engagement and those staff who will be recipients. Make sure all these individuals know their roles and what is expected of them.
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Embed the plan and monitor progress: Ensure knowledge transfer activities are embedded within the delivery plan and monitored as a standing agenda item at engagement management meetings.
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Handover: At the end of the engagement, hold a final handover meeting to review whether the knowledge transfer objectives were achieved, and consider what lessons were learned about your approach and the results.
4. Know when and how to stop the support Generally, you will receive real, credible benefit from your client-consultant partnership. However, you need to recognise the right time to stop the engagement, either because it has achieved what you set out to do, or because you know (or at least sense) that you are not receiving what was promised. It is important to recognise when you are not receiving the support you need, and to know what to do about it. Some of the signs that you might not be receiving the right support include: ■■ All your consultant does is argue with you ■■ All your consultant does is agree with everything you say ■■ Your consultant does all the presentations ■■ You spend more time discussing the consultants’ contractual arrangements than delivery of the project ■■ Your consultant spends more time criticising the ‘as is’ than helping to develop or deliver the ‘to be’ ■■ Your consultant has ‘gone native’.
When you start to see these signals, immediately consider whether you are receiving the value you originally expected and challenge the consultant to address any gaps you identify. Fundamentally, any consultancy should be thinking as much about their exit as delivering what you have engaged them to do. Real value only comes from a genuine combination of the two.
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Joe McGarry is health sector lead at Moorhouse. For more information, visit www.moorhouseconsulting.com.
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LEGAL MATTERS
legaleye Jo Seery explains recent changes to employees’ right to request flexible working. Since 30 June 2014, employees in England, Scotland and Wales who have been continuously employed for at least 26 weeks have had the right to ask to work flexibly. The key changes are: ■■ The right to request flexible working has been extended to all eligible employees, not just those with caring responsibilities for children and dependants. ■■ The previous procedure has been replaced with a duty on the employer to deal with requests in “a reasonable manner”. ■■ There is no statutory right of appeal after a request has been refused. ■■ There is no statutory right to be accompanied by a colleague when discussing a request with an employer. ■■ Employers can treat a request as withdrawn if the employee fails to attend two meetings to discuss it. The right to request is just that – a right to ask to work flexibly, and not a right to work flexibly. Employees can ask for a change in their working hours, for example from full time to part time, and to work from home. Requests must be dated, made in writing and state that it is a statutory request. Requests must detail the effect, if any, the proposed change would have on the employer, and how it could be dealt with. It must also confirm if the employee has made a previous request and, if so, when. Employees can only make one request within a 12-month period, starting from the date they made the
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application. Employees who want to return to work on a flexible but temporary basis – for example, following a long period of sickness absence – should check their employers’ capability or ill-health policies and contact their union representative. How should an employer respond? The new changes place a general duty on employers to deal with flexible working applications in a “reasonable manner” and notify employees of their decision within three months, unless agreed otherwise. “Reasonable manner” is not defined, although ACAS’s code of practice on flexible working recommends that employers: ■■ Consider the request and discuss it with the employee as soon as possible ■■ Allow the employee to be accompanied and tell them this prior to any discussion ■■ Inform the employee of their decision in writing as soon as possible ■■ Allow the employee to appeal against the decision While there is no statutory right to be accompanied or to appeal against the employer’s decision, tribunals can take the ACAS code into account when considering whether an employer has acted in a “reasonable manner”. Grounds for refusal The grounds for an employer to refuse a request remain unchanged. Employers can refuse an application for one of the following reasons: ■■ Burden of additional cost ■■ Detrimental effects on the ability to
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meet customer demands Inability to reorganise work among existing staff Inability to recruit additional staff, detrimental impact on quality or detrimental impact on performance Lack of work during the periods the employee proposes to work Planned structural changes
This gives employers a great deal of scope to refuse a request, particularly as they do not have to explain their reasoning. However, government guidance (www.gov.uk/flexible-working) advises employers to explain why the relevant business reason applies. Although there is no statutory obligation, the ACAS code recommends that employers notify employees of their decision in writing, in order to “avoid future confusion on what was decided”. Employers who fail to do this are also likely to find it more difficult to defend a claim. In summary, employers have considerable scope to refuse requests for flexible working on business grounds, but should follow the ACAS code to avoid being deemed to have acted unreasonably when assessing a request. Most health service employers have flexible working policies which improve on the legal minimum. Check your HR policies for details and consult your MiP officer if necessary.
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Jo Seery is an employment rights solicitor at 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 23 | autumn 2014
TIPSTER
Unconscious bias Dan Robertson shares his top tips on how to avoid unconcious bias in your decisions at work. I was recently asked to speak at an NHS conference on the subject of unconscious bias. Unconscious bias is currently a hot topic in the world of diversity and inclusion management. For me there are three key questions we need to consider: What is unconscious bias? How do our biases affect management decision-making? And fundamentally: what can we do to control our biases? The science of unconscious bias Over the last few decades new research has shed light on the workings of the human brain and the concept of unconscious bias. According to the psychologist Daniel Kahneman, there are distinctive patterns in the errors people make. Understanding these patterns helps us to shed light on the nature of human biases. As Kahneman says, while we think that most of our decisions and behaviours arise in the conscious part of the brain, research suggests otherwise: our automatic impressions and intuitive judgements of people take place at the unconscious level. Neuro-psychologists tell us that these judgement processes are actually built into the very structure of the brain’s neurons and that unconscious biases arise partly because of the way we are socialised and our later life experiences. A key bias that affects decision-making in an organisational context is affinity (or “like me”) bias. This leads us to favour people who are like us.
healthcare manager | issue 23 | autumn 2014
The impact of unconscious bias on organisational decisionmaking Research by the Employers’ Network for Equality and Inclusion (ENEI) in 2012 found high levels of unconscious affinity bias in three key areas: 1. Work allocation: Managers are much more likely to allocate stretching projects to people like them. 2. Feedback: Managers are more likely to provide critical feedback to people like them and less likely to do so to those in their “out-groups”. 3. Informal mentoring and sponsorship: Managers are more likely to offer informal advice and mentoring support to people who belong to their existing social networks. These processes have been shown to favour majority groups in an organisation’s talent pipeline. Our research supports the findings of Greenwald and Banaji, in Blindspots: Hidden Biases of Good People, that bias is often a result of “helping”. Putting in a good word to a senior leader or inviting “in-group” colleagues to those key stakeholder meetings, both result in higher levels of visibility for people ‘like me’. Research studies have stressed the impact on recruitment – managers from a Western background are more likely to recruit candidates with Western sounding names. Reducing the impact of unconscious bias: ten top tips My work with organisations focuses
“Our automatic impressions and intuitive judgements of people take place at the unconscious level.” on addressing individual and group level bias. At ENEI we run programmes aimed at changing behaviour and removing the barriers that many groups face when progressing into leadership. Here are 10 tips on how to reduce the impact of unconscious bias in your organisation: 1. Be open about your biases and encourage others to reflect on their personal biases – get tested! 2. Create accountability in the chain of command: Ask your direct reports, “How are we doing on our diversity and inclusion objectives?” 3. Act as a role model for inclusive behaviour. 4. Ensure you have robust scoring systems set up at interviews. 5. Create project teams with difference in mind. 6. Treat people as individuals – get to
know them on multiple levels. 7. Allocate a piece of work to someone outside of your trusted circle. 8. Openly challenge biased decisionmaking in people management
processes – such as performance reviews and other “blind-spots”. 9. Actively sponsor someone who is different from you. 10. Create culture change by focusing on the long-term perspective rather than quick fixes. Dan Robertson is diversity and inclusion director at the Employers’ Network for Equality and Inclusion (ENEI). For more information email Dan.robertson@enei.org.uk or visit www.enei.org.uk.
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MIP AT WORK
REDUNDANCY
MiP secures fair redundancy pay for members With NHS employers under pressure to cut back on redundancy payments, MiP is receiving many more calls from members having problems getting their entitlements. MiP associate officer John Bancroft dealt with one such case, which took more than a year to settle. James, an executive director who had worked in the NHS for 30 years, contacted MiP in summer 2013, having received notice of redundancy in April. His employer did very little to identify any suitable alternative employment for him and he was unable to find anything suitable within the NHS. In mid-June, James found a job in the private sector and informed his employer that he would be starting his new job the day after he was made redundant. His employer argued that James was deemed to have resigned and therefore not entitled to a redundancy payment. That’s when he contacted MiP. MiP’s John Bancroft (pictured) met the employers and argued that James had complied with the legal requirements, made every attempt to find suitable alternative employment within the NHS and was entitled to his redundancy payment in line with the NHS terms and conditions. “As the date of redundancy approached, we had still not heard back from the employer,” John recalls. “So, after discussion with James, to bolster our claim, I obtained legal advice which confirmed that he had not resigned and was entitled to redundancy payment.” Despite this, discussions with the employer continued until March this year, when MiP lodged an appeal on James’s behalf. At this point the employer accepted liability but, because of the sum involved, they had to get approval from the Trust Development Authority. 22
“This case shows the pressure that employers are now under to avoid their contractual obligations to staff.”
“Job done, I thought,” says John, “but no, the TDA sat on it for months, contributing to James’ stress and anxiety.” John pursued the case on James’s behalf, writing to the TDA, via James’s employer, warning them that we would take the case through
the civil courts if they did not allow the payment to be made, and that our claim would include compensation for the stress and anxiety caused by the unacceptable delay. “The threat of civil action swung it,” says John. “They agreed to the payment going ahead, and James finally got what was owing to him and kept his preserved pension rights. But it took us over a year to win an open and shut case. I think it shows the pressure that employers are under now to avoid their contractual obligations to staff. I’m delighted we were able to help James get a fair outcome by using our access to expert legal advice, negotiating skills and our tenacity.” James said: ‘I am very grateful for the support and guidance I received from John and MiP throughout the 13 months leading up to and following my redundancy. It is such a relief to have secured my redundancy payment and I will always recommend to managers that they join MiP. From my perspective the NHS needs to take a long hard look at how it treats its employees when it is making them redundant and treat them with greater respect and dignity than I encountered.”
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Even if you think your contractual entitlements are clear, you may still need expert, confidential advice and help to ensure you are treated fairly. MiP provides that support. If you’re not a member already, join today. You can join online: www.miphealth.org.uk or ring Laura on 020 7121 5146.
healthcare manager | issue 23 | autumn 2014
MIP AT WORK
Coming soon: NHS Pension Choice 2 When does Choice 2 take place? All four UK nations will offer Choice 2, but at different times. In England and Wales, the exercise begins in September 2014. Eligible members should receive letters from NHS Pensions by 30 November at the latest. The last date for Opting-In to Choice 2 is 31 March 2015. In Scotland, Choice 2 is expected to begin in April 2015 and to last for three months. The timetable for the Choice 2 exercise in Northern Ireland is not yet known.
If you are in the 1995 section of the NHS Pension Scheme and were younger than 50 (45 for special class members) on 1 April 2012, you will soon be offered Choice 2 – a chance to reconsider whether you would be better off moving from the 1995 to the 2008 section of the pension scheme. Why would I want to reconsider? Under the new NHS Pension scheme being introduced in April 2015, the age at which you can retire without a reduction in benefits (your “normal” pension age) is going up, and will be the same as your state pension age. If members had known this at the time they made their original Pension Choice, some may not have chosen to stay in the 1995 section because their retirement intentions would be different. The pension benefits you earn up
to 1 April 2015 will still be calculated on your final pensionable salary at retirement. So if you are currently in the 1995 section, and do not have full protection of your pension rights, but now intend to remain working in the NHS past age 60 (55 if you have special class status), you may benefit from transferring to the 2008 section because it has a higher accrual rate.
How can I make an informed choice? The letter from NHS Pensions will provide information to help you decide, and further information will be published on the NHS Pensions website (www.nhsbsa.nhs.uk/pensions). MiP will be providing briefings for members during the coming months.
FDA Portfolio: Giving MiP members great value MiP members now have access to a wide range of benefits thanks to our partner union, the FDA. They have introduced a new portfolio containing money-saving discounts and offers which include legal support for personal matters such as wills and family law, financial advice and discounts on items such as holidays, leisure activities and shopping, as well as savings on insurance. FDA has engaged a professional service provider, Parliament Hill Ltd, rather than negotiating the individual offers. Parliament Hill Ltd provides similar packages to other trade unions and professional organisations and is well placed to provide good value for MiP members as well. The various offers are available through the FDA Portfolio portal, where you can also use the online savings calculator to see how much you could save. MiP members can access FDA Portfolio by logging into the members’ area of the MiP website and clicking through to FDA Portfolio. If you have problems logging in please contact us on 020 7121 5146. Legal advice is provided by Slater and Gordon, who have a long history of working with the FDA. As well as a dedicated phone line for legal advice and accidents, they provide discounted legal help in areas such as family law, property and wills. For more information contact Slater and Gordon direct on 0800 916 9026. MiP members continue to have access to the various benefits available through Unison Plus – see the Unison website for details: www.unison.org.uk Terms and conditions apply to all benefits. See FDA Portfolio website for details. Offers subject to change without notice. Insurance is subject to underwriting.
healthcare manager | issue 23 | autumn 2014
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backlash
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
by Celticus
Safety in numbers
S
hould it really take a freedom of information request to prise from the CQC figures showing that there have been 802 “unexpected” deaths in private hospitals since 2010? Given that private patients who develop life threatening conditions are usually handed over pretty sharpish to NHS hospitals (some 6,000 have been transferred since 2010 – 2,000 as emergencies), this looks high. But as the Centre for Health and the Public Interest, who obtained the figures, point out, we can’t tell how high because private hospitals are exempt from the rigorous reporting requirements on NHS hospitals. As many private hospitals are now NHS providers, commissioners and the public have a right to know just how safe they are.
private income for all NHS providers in England inched up from from 0.68% of total income in 2011-12 to 0.7% last year. Definitely only creeping then, although decide for yourself whether it’s “creeping privatisation” or, as HSJ editor Alastair McLellan calls it, “creeping nationalisation”.
Failings mutual
Squeezed out
S
It’s a London thing
LAMB: “LOOK TO HINCHINGBROOKE FOR INSPIRATION.”
t’s no surprise that leading London hospitals have racked up their income from private patients since the government lifted the cap in 2012. But who would have predicted that the move would have almost no effect across NHS England as a whole? While the likes of UCLH and the Royal Brompton showed increases of almost 40%,
ou only need to turn to Cambridge’s Hinchingbrooke Hospital for inspiration,” enthused health minister Norman Lamb in July, as he launched a new drive to persuade NHS organisations to go mutual. Sitting alongside fellow enthusiast Francis Maude, Lamb went to on to extol how “letting
I
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frontline staff take ownership of their services” would lead to “higher quality and more efficient public services”. He might have first checked his own department’s recent staff survey, where Hinchingbrooke came out below average for “staff engagement”, and in the bottom 20% for job satisfaction, staff “witnessing potentially harmful errors, near misses or incidents” and a range of other indicators. Hardly inspirational. And someone could have told Norman that Hinchingbrooke, as part of Circle Health, is majority owned by a hedge fund, not its staff. Hardly mutual either. Facts, eh?
“Y
erco announced it was pulling out of NHS clinical services work having piled up losses of almost £18m. The company said “delivering improved service levels” and “meeting performance obligations” will cost it another £3.9m. Serco is renowned for its ability to squeeze juice out of the most unpromising lemons, so if they can’t make it work, there probably isn’t much profit to be made. With Virgin also rumoured to be losing money on its NHS contracts, how long before other major players come to the same conclusion? Perhaps, after all, there is no magic market dust
that private providers can sprinkle on NHS services to turn less into more. They find it just as tough as everyone else. Providing quality healthcare on a frozen budget is hard work, not easy pickings.
Economies of sale
W
ith some trepidation, we wade into the murky loch of the Scottish independence referendum campaign (on which, despite the name, Celticus has no opinion at all). President Alex’s claims, during his victorious TV clash with Alistair “No Thanks” Darling, that the “privatisation agenda” in England threatened the Scottish NHS puzzled many, given Holyrood’s unfettered control of NHS policy. It’s a bit convoluted, so pay attention: privatisation, says Salmond, will reduce public spending on health in England, eventually reducing Scotland’s own funding through the machinations of the mysterious Barnett Formula. Salmond must be one of the few opponents of privatisation confident that it will actually save public money. And privatisation is not unknown north of the border either. Forth Valley Hospital, for example, has been operated by Serco since 2010 and spending on private healthcare services by NHS Scotland has risen 57% in the last three years.
healthcare manager | issue 23 | autumn 2014
e
insuranc
holidays
The added va lue of membership
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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.
EE i P S FR R M ER B FO EM M
MiP national conference 2014
managers matter Wednesday 19 November Congress Centre, London WC1B 3LS keynote speakers include
conference chair
Dr Dan Poulter MP Minister Department of Health
Rt Hon Andy Burnham MP Shadow Secretary for Health
Karen Lynas Deputy Managing Director Leadership Academy
Simon Stevens Chief Executive NHS England
Zoeta Manning Chair MiP
MiP’s 2014 conference takes place just six months before the general election, and no doubt NHS managers will be in the political spotlight again. This year’s conference will focus on managers as leaders, developing and delivering high quality efficient health care and how they develop and nurture leaders at all levels in their organisations. Delegates will also be able to quiz policy makers about their plans for the NHS in 2015 and beyond – and to challenge the myths about managers being a drain on resources. The conference will be chaired by Victoria Macdonald from Channel 4 News and other speakers include: • • •
Jon Restell, Chief Executive, Managers in Partnership Dr Annie Ingram, Director of Workforce, NHS Grampian Lis Paice, Chair, NW London Integrated Care Management Board
• • •
Dr Nav Chana, Vice-Chairman, National Association of Primary Care Jacqueline Docherty DBE, Chief Executive, West Middlesex University Hospital NHS Trust Gill Bellord, Director of Employment Relations and Reward, NHS Employers
places are limited: for more information and to register online go to
mip-conference.co.uk or telephone 020 7592 9490 helping you make healthcare happen