Healthcare Manager Winter 2014

issue 24 winter 2014

healthcare manager

DAME JULIE MOORE “WE CAN’T JUST KEEP CUTTING” plus GENE GENIE Is the NHS ready for genomic healthcare?

HOW TO BE FABULOUS Tips for managers

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issue 24 winter 2014

healthcare manager inside

heads up:2

What you might have missed & what to look out for Leading edge: Zoeta Manning inperson: Jayne Thomas, Ashford & St Peter’s Hospitals NHS Foundation Trust inpublic: Scottish Ambulance Service

comment:9

Paul Farmer: Experience on the ground will test the Forward View’s promises on mental health

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

MiP conference 2014: In pictures Interview: Dame Julie Moore, University Hospitals Birmingham Trust Genomics: Mapping the future of healthcare Raising concerns: Creating an open culture

regulars:20

Legal Eye: new rights for shared parental leave Tipster: How to be a fabulous manager MiP at Work: Getting a good deal for managers

backlash:24

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

I can’t believe we’re getting our 2015 MiP calendar mousemats already!

This year’s revives our favourite slogan – we ♥ NHS managers. It sums up our campaign message for the coming year. In Leading Edge, MiP chair Zoeta Manning outlines our new campaign for recognition for the great work that NHS managers do. As the general election approaches, MiP will fight back against unfair criticism and demand respect NHS managers.

Speaking of great work – our interviewee is Dame Julie Moore, one of the few women to run a university trust. She’s got some challenging views about how the NHS is organised and much more. We’ve also got a feature on the Human Genome Project, which could revolutionise healthcare. It’s mind-boggling, as Craig Ryan finds when he talks to its enthusiastic champions. And we’ve got a report on dealing with concerns at work (aka whistleblowing), with examples of good practice, as well as our regular features and pictures from this year’s MiP conference.

Finally, best wishes for the festive season and a happy and healthy new year from the MiP team.

Marisa Howes, Executive editor

healthcare manager | issue 24 | winter 2014

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HEADS UP

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

Wirral wins 2014 staff engagement award

Flu Fighter campaign enters fourth year The NHS Flu Fighter campaign is now entering its fourth winter, and most local campaigns are already well underway.

The staff-facing campaign, run in partnership between the NHS unions, including MiP, NHS Employers and Public Health England encourages all NHS staff to protect themselves and their families by having the seasonal flu vaccination. Last year’s successful campaign saw the uptake among NHS staff increase from 46% to 55%.

It’s always a pleasure to celebrate the great work being done by the healthcare team, and once again MiP and Unison sponsored the HSJ award for staff engagement. We had a very strong field of entrants, and the winner was Wirral University Teaching Hospital Foundtation Trust. The judges said their strategy was “a powerfully impressive, evidence-based programme to bring about positive change through staff engagement.” MiP chair Zoeta Manning (second from right) joined Unison health group chair Roz Norman (far right) and the BBC’s Nick Robinson (far left) to present the award.

healthcare manager

Associate Editor

issue 24 | winter 2014

Craig Ryan editor@healthcare-manager.co.uk

ISSN 1759-9784 published by MiP

Design and Production

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, Stefano Cagnoni, Paul Farmer, Marisa Howes, Zoeta Manning, Helen Mooney, Alison Moore, Charlotte Moore, Derek Mowbray, Jon Restell, Craig Ryan.

healthcare manager | issue 24 | winter 2014

Print

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

NHS Employers have provided trusts and other NHS employers with a variety of resources including a communications toolkit, clinical evidence and letters to staff from national organisations, a variety of new and old case studies, a range of flu fighter posters and digital resources such as web banners and screensavers.

The Flu Fighter campaign also gives support, advice and guidance on improving the vaccination uptake of healthcare workers through regular email updates, latest news articles, workshops, webinars and networks.

For more information email the campaign team at flufighter@ nhsemployers.org or visit the Flu Fighter website at www. nhsemployers.org/flu

healthcare manager is printed on uncoated paper with vegetable-based inks. The paper is FSC approved and the cover wrap is biodegradable.

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.

HEADS UP

leadingedge Zoeta Manning, MiP chair

I

’m chair of MiP because I believe that NHS managers matter and we deserve respect.

My day job is as a commissioning manager in a clinical commissioning group. My managers, colleagues and my team value the contribution that managers make – the clinicians, especially the GPs, know what we’re good for. We get things done, put the business cases in, bring home the bacon.

So, despite all the manager-bashing that goes on, the ill-informed stereotyping that gets dished up about us, I never feel the need to apologise for what I do. Because I know the rest of the NHS team respect me and my colleagues.

They know managers are driven by the same NHS values as everyone else, doing what we do for the good of patients and the community we serve, and they know we work hard. When I tweeted that, as a protest about our shabby pay award, I was leaving my laptop

“Respect comes when we invest in the skills, culture and diversity of NHS management.”

in the office, it became news. I couldn’t remember the last time I had not taken work home with me – I thought I’d lost a leg!

Respect is important to me at work and it is important to me in the public debate about the NHS too.

It’s why the MiP committee has decided we will team up with the Health Service Journal to tackle head on unfair attacks on managers in the upcoming general election campaign, wherever they arise in the UK. Traditional manager-bashing peaks at this time. It’s wrong and we won’t be taking it on the chin.

Respect for managers also comes

when the government respects the whole workforce, of which we are a part. It’s why MiP continues to call for the government to intervene to sort out the pay dispute.

I work for a great employer, one that innovates and cares for its staff. But the demands on us and the way we work to meet them are just not sustainable in the long run. Our well-being and therefore our ability to do the best job for the public will be compromised.

It’s why MiP calls on the NHS leadership to stop arbitrary cuts to running costs and avoid another national structural reorganisation like the plague.

Respect comes when we invest in the skills, culture and diversity of NHS management. It’s why MiP won’t stop campaigning on all three issues.

Managers matter. So let’s celebrate the fact, stick up for ourselves and tell our personal stories about the direct impact of our work on patients and staff.

FDA Portfolio: Giving MiP members great value

MiP members now receive the wide range of benefits offered by our partner union through FDA Portfolio, including discounts and offers on legal support, financial advice, insurance, holidays, leisure activities and shopping.

Legal advice is provided by Slater and Gordon, who offer discounts on help with family law issues, property and wills, and a dedicated phone line for legal advice and accidents. For more information contact Slater and Gordon direct on 0800 916 9026.

To access all these offers and see how much you can save, log on to the members’ area of the MiP website and click through to FDA Portfolio. If you have problems logging in please contact us on 020 7121 5146.

MiP members also have access to benefits through Unison Plus. See www.unison.org.uk for details.

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 24 | winter 2014

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HEADS UP

Public Health

MiP member Ruth Atkins, who works as a communications manager at Central Southern Commissioning Support Unit, became the first volunteer in Europe to test a possible Ebola vaccination in trials carried out by Oxford University in September.

Asked why she had taken the brave step to try out the vaccine Ruth, a former NHS nurse, said: “I volunteered because the situation in West Africa is so tragic and I thought being part of this vaccination process was something small I could do to hopefully make a huge impact. I heard about the trial on the radio while driving home one evening, when Professor Adrian Hill asked for volunteers for the vaccine research project he is leading.”

Ruth was approved for trial vaccine following rigorous health screening and experienced no side effects. “It felt no different to being vaccinated before going on holiday,” she said.

The candidate vaccine targets the “Zaire” species of Ebola currently circulating in west Africa. As it uses a single Ebola virus protein to generate an immune response and does not contain infectious material,

WELLCOME TRUST

MiP member becomes first Ebola volunteer

the vaccine cannot infect recipients with Ebola.

Professor Adrian Hill, Director of the Jenner Institute said: “Witnessing the events in Africa makes it clear that developing new drugs and vaccines against Ebola should now be an urgent priority.

It’s tremendous that so many people have worked hard to make this trial happen in a short time, and I am enormously grateful to those volunteers who have come forward to take part.”

For more information, see the CQC website: www.cqc.org.uk.

MiP 2015 subscriptions Members who joined MiP after 1 June 2005 pay MiP subscriptions, as set out in the table. Members who transferred from FDA or UNISON to MiP on 1 June 2005 (founding members), pay the relevant rate of the partner union from which they transferred.

MiP subscriptions are proposed

by MiP’s management board, in consultation with MiP’s national committee, and approved by the FDA annual delegate conference.

All subscription rates shown in the table come into effect on 1 January 2015. All subscription enquiries should be made to info@ miphealth.org.uk.

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Member benefits As a member of MiP, you get access to a number of discounts and benefits negotiated by our partner unions, including legal and financial advice, through FDA Portfolio (see page 3) or through Unison Plus (see inside back cover).

Tax relief on MiP subscriptions As a healthcare manager, you may be entitled to tax relief on your MiP subscriptions in the same way as members of other professional organisations. For more information log into the members’ page of the MiP website: www.miphealth.org.uk

healthcare manager | issue 24 | winter 2014

Band Part Time PT A PT B Full Time A B C D Management trainee FDA founding members A B C D E

Annual basic salary

Monthly Subscription

up to £25,750 £25,751-£39,238

£20.85 £22.90

£39,239-£61,800 £61,801-£72,100 £72,101-£82,400 Over £82,400

£25.60 £29.00 £31.25 £33.80

£10 per annum £15,501-£33,500 £33,501-£47,000 £47,001-£70,500 £70,501-£88,000 Over £88,000

UNISON founding members Over £35,000 BAND K

£13.20 £25.55 £27.90 £30.25 £33.05 £22.50

HEADS UP

inperson

“Managers are important because they manage the business side so that the clinicians can look after patients.”

Jayne Thomas, business manager, medicine and emergency services division, Ashford and St Peter’s Hospitals NHS Foundation Trust.

Jayne Thomas started working in the NHS part time as a mature student 17 years ago and “never left”.

Her job, as the business manager in the medicine and emergency services division at Ashford and St Peter’s Hospitals NHS Foundation Trust, is a newly created post with a wide-ranging role.

Jayne is in charge of everything from making sure that the trust’s cost improvement plans are realistic and assessing the impact they will have on patient care to GP engagement to strategic recruitment and retention of trust staff. ‘It’s my job to focus on the business side of how the trust is run. I look after the shop and watch the pennies,” she explains.

“My role is new as the trust board realised that the director of operations was being pulled in too many different directions, which made it impossible to do all of them well.”

Jayne says she concentrates on business development, which encompasses both finance and working with those in governance management to look at the quality of the services the trust delivers to patients.

She is in charge of the annual divisional business planning exercise, which assesses how much money is needed to run services. “Where the budget does not match, then it’s my job to make it fit, so that may mean changing services or the skill mix,” she says.

Her job also incorporates recruiting and retaining staff. “We can recruit but we can’t necessarily retain staff because people are attracted to London, so we’ve had to do some international targeted recruitment,’ Jayne explains. She is currently examining the possibility of setting up a social committee for the 300 plus staff that live on the trust’s site, to try and make working at the trust more attractive and less isolating.

Jayne says managers play a key role in the NHS services because without them clinicians would not have time or support to deliver services properly. “Managers are important because they are there to manage the business side of running NHS organisations so that the clinicians can look after patients,” she explains.

A qualified hairdresser, Jayne worked for two years at NHS Employers before moving back into the NHS frontline to become a healthcare manager at East Cheshire Trust and then a business development manager at Lancashire Teaching Hospitals, before taking up her current job.

“What I like about my current role is that it really focuses on business development, which is quite forward thinking in the NHS. There is a business manager in each of the trust’s divisions.”

A Unison member since she joined the NHS, Jayne joined Managers in Partnership when she came back into the NHS in 2011 as a healthcare manager. She is currently an MiP link member at Ashford and St Peter’s and says that she is “privileged and proud” to be part of the NHS and sees it as part of her job to try to help protect the NHS, its staff and what it stands for.

Helen Mooney healthcare manager | issue 24 | winter 2014

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HEADS UP

Engagement

Children’s friends and family test launched

From 1 April 2015, it will be compulsory for all children and young people receiving NHS care or treatment to be offered a suitable version of the Friends and Family Test (FFT). Picker Institute Europe have collaborated with Barts Health NHS Trust to test a range of child-friendly versions of the FFT to find out which format will work best for children and young people.

Research revealed that the question format used with adults was not suitable for younger audiences. Cognitive tests found that the preferred choice for children featured ‘Monkey’, a knitted character from the Monkey Wellbeing brand, and colour-coded smiley faces to illustrate the response options.

The test is being piloted in two trusts, Barts Health NHS Trust, which is the largest NHS Trust in the UK, serving a population of 2.5 million in east London and beyond, and Southampton Children’s Hospital, part of University Hospital Southampton NHS Foundation Trust, one of the largest teaching trusts in the country.

Once the pilot is completed, the Picker Institute’s children and young people’s FFT materials will be freely available to download from www.pickereurope.org.

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healthcare manager | issue 24 | winter 2014

Veterans

Welsh veterans service gets thumbs up Veterans NHS Wales, the specialist service set up to meet the health needs of military veterans in Wales, has been successful, but needs to do more for women veterans and ex-military offenders, according to a national review of the service by the Welsh Government.

The service – the only one of its kind in the UK – has provided care to more than 1,100 veterans since it was set up in 2010, the review found. The Welsh Government has recently invested an additional £100,000 in the service, which provides dedicated support for the emotional and mental health needs of military veterans, including dedicated veterans’ therapists in each health board area.

But the report found that only “a low number” of women had used the service and identified “the Welsh prisoner veteran population as an area of potential unmet need”. It also found that some veterans had experienced unnecessary delays in using the service.

Health and social services minister Mark Drakeford (pictured) said: “In recent years we have worked with partners in the NHS, the third sector, Ministry of Defence and the military to develop initiatives and policies to ensure

veterans’ and serving personnel’s physical and emotional needs are met. We can be proud of our work, particularly in relation to mental health services for veterans in Wales.”

Phil Chick, head of mental health development at Public Health Wales, added: “Whilst the review identified… delays for some veterans accessing the service, we’re pleased to see that veterans are satisfied with the service and the treatment they’ve received. It’s gratifying to see that improvements have been made to reduce waiting times since the report was published.”

For more information on Veterans NHS Wales, visit: www.veteranswales.co.uk.

Integration

Consultants need to get out more Consultants should spend more time outside of hospitals, working in the community and primary care services, according to a new report by the influential King’s Fund think tank.

Research based on six detailed case studies concluded that “specialist knowledge is too concentrated in hospitals to the detriment of patients, whose increasingly complex needs should be treated closer to home”. The report calls for hospital consultants to develop new roles working in multidisciplinary teams with GPs, community health practitioners and social workers, and training other healthcare professionals to provide specialist services closer to people’s homes.

It also called on national and local commissioners to develop new funding models to encourage the development of community services. “Current incentives, like Pay-

ment by Results, can act as a barrier to developing integrated care by incentivising activity in hospitals,” warned the report.

“Our research uncovered great examples where hospital consultants working with their colleagues outside hospital has improved patient care,” said King’s Fund research fellow Ruth Robertson.

“Implementing this new way of working is a challenge when budgets are constrained, the acute care workforce is focused on delivering consultant cover in hospital seven days a week, and general practice is functioning under severe pressure. However, doing so offers enormous benefits to patients and brings the vision of a more integrated NHS that bit closer,” she added.

The report, Specialists in out-of-hospital settings: findings from six case studies, is available at www. kingsfund.org/specialists.

HEADS UP

inpublic Scottish Ambulance Service As the frontline of the NHS in Scotland, the 4,500 staff of the Scottish Ambulance Service (SAS) provide an emergency service to a population of over five million people across the country’s mainland and island communities.

According to chief executive Pauline Howie, the service responds to life-threatening emergencies on average within six-and-a-half minutes. She explains that the service is working towards delivering the Scottish Government’s vision for NHS Scotland, in which “everyone would be able to live longer, healthier lives at home”.

“A key aspect of this work is our 2020 strategy, which aims to take more care to the patient by delivering clinically safe treatment pathways so that they can remain at home, whilst receiving the most appropriate care,” says Howie.

Howie says the SAS avoided trips to hospital for 77,399 patients last year, by using enhanced triage techniques, with more clinical advisors in ambulance control centres, along with consultant or GP led clinical decision support for paramedics. This enabled paramedics to “use their clinical skills and training to treat patients safely and effectively in their homes, as well as closer collaboration and integration with primary and community care teams,” she explains.

The SAS is currently working on the 3RU initiative (“Resuscitation Rapid Response Unit”), which targets cardiac arrests occurring outside of hospital. The award winning model, a partnership between SAS and emergency medicine consultants and cardiologists, has been piloted in Edinburgh and was extended to Glasgow in October. 3RU has resulted in significantly improved survival rates and will soon

be rolled out across the country.

Howie says that the SAS board and the executive team monitor and review progress against key performance indicators on an ongoing basis. The service operates with five geographic operational divisions that deliver care in line with national policy and standards, developing local models that are most appropriate for the communities they serve.

They are supported by operational management teams for ambulance control rooms. In addition, the SAS national risk and resilience department manages major emergency planning and operates three teams across the country who are specially trained and equipped to respond to major incidents.

In Lanarkshire, the SAS is developing a unique multi-disciplinary partnership with paramedics, NHS geriatricians, nurse practitioners, physiotherapists, occupational therapists and psychiatric nurses which is seeing more elderly patients being treated safely at home, in a bid to improve their quality of recovery

and reduce unnecessary admissions to A&E. And in April the SAS launched the first national retrieval service for critically ill NHS patients in Scotland.

Known as ScotSTAR, it brings together the three transport and retrieval services for newborn babies, children and adults.

Howie says the key to delivering innovative services is “developing and engaging” the workforce. “We have created new roles for staff, extended their skills, provided leading edge equipment and technology for them to use, and created a culture based on openness and learning.”

The Service has also developed a community resilience strategy, which saw the setting up of over 100 Community First Responder teams across Scotland, comprising over 1,000 volunteers who have been trained by specialist Scottish Ambulance Service community teams to provide basic medical care while the ambulance is on its way.

Helen Mooney healthcare manager | issue 24 | winter 2014

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HEADS UP

Obituary

Ray Rowden: a passionate and robust manager and trade unionist Ray Rowden’s recent death from pancreatitis at the age of 62 will have been felt by countless people, in many walks of life. Many of us will be feeling the debt we owe him.

Ray was a man of multiple identities: nurse, NHS manager, civil servant, campaigner, writer, policy adviser, educator, political confidante, trade unionist (including ten years as a consultant caseworker for FDA and then MiP), ballet nut, businessman. And others.

The showier side of Ray’s personality did not obscure a deadly serious purpose, and indeed was often used in its service. He was in the vanguard of those who saw that management in the NHS was changing and had to change; that the era of the pure administrator-servant – the ‘suits’ as he called them – was over. Managers in the future would have to take stands on behalf of patients, seize greater professional autonomy, show more leadership and become more business-like.

His reforming zeal at a watershed moment arose in part from his work to change attitudes towards mental health and his experiences as a clinician: Ray was one of those nurses propelled into management by outrage at the shocking and degrading treatment of patients. His concern for the development and dignity of the individual was exceptional. It was amply demonstrated by his passionate, caring and robust advocacy and support as a union rep when someone came a cropper and needed a friend.

If I can see a thread running through Ray’s life, it was a desire to help people achieve their potential. Before it was common currency, Ray was coaching people. Wherever this sprang from, Ray had a positive, direct personal impact on me and many other people. Our horizons were stretched, our self belief strengthened and our lives enriched. That’s not a bad legacy for anyone.

My thoughts – and those of my colleagues at the FDA and MiP – are with Ray’s partner, Tom, and his daughters, Helen and Liz. We look forward to celebrating Ray’s life.

Jon Restell, MiP chief executive

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healthcare manager | issue 24 | winter 2014

letters to the editor

Letters on any subject are welcome. Please send to editor@healthcare-manager.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.

Why I went on strike for fair pay NHS workers last went on strike for pay 32 years ago – just after I joined the NHS as a finance trainee. Now, as then, the debate continues about how much taxpayers’ money to spend on the NHS. The NHS is one of the most efficient and trusted healthcare systems in the world. People are given care according to their needs, irrespective of their means. For many staff, working for the NHS is a vocation and they care deeply about what they do.

But that ethos has been progressively undermined by the cost-cutting. With 70% of NHS costs being staff related, the logic is to cut pay. This leads to pay freezes, dilution of the skill mix and reductions in “management costs“, all of which undermine the energy of the NHS workforce.

I knew that if I went on strike, I could cover everything I needed to do in advance. Other professional groups targeted areas to avoid putting patients at risk, so I had no fears for patient safety. I decided to strike, not to inconvenience my employer, but to demonstrate how strongly I disagree with government policy.

The government appears to have singled out NHS staff for harsh treatment. The independent NHS pay review body was the only review body the government ignored completely, and the majority of NHS staff will get no cost-of-living increase at all. And not just this year — NHS staff pay has lost 12% to 15% of its purchasing power since the last general election.

Despite the rain on 13 October, time passed quickly on the picket lines. Supporters provided flapjacks and fruit, and passing motorists sounded their horns in support. We distributed leaflets explaining the NHS pay issues, and wished passers-by “Good Morning”. We met some bemusement but no hostility.

I went on strike because I am dismayed at relentless reorganisation and market testing which destroy morale and organisational memory. I want to work in an NHS with a collaborative ethos, where decisions are driven by patients’ needs and quality is always paramount.

I went on strike because NHS workers are bearing the brunt of the government’s rhetoric and dogma, and are being portrayed as a cost rather than a benefit. And finally, I went on strike for a properly funded, publicly provided NHS. Ultimately, I hope, that will benefit the wellbeing of our nation – and all our pockets.

Update your details

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Please make sure we have your correct home address, work address, employer, job title and preferred email address. Log in to the members’ area of the MiP website and follow the prompts. Alternatively, please email us at info@miphealth.org.uk.

COMMENT

comment Paul Farmer

Chief executive of mental health charity Mind

Good intentions, but it’s experience on the ground that counts The NHS Five Year Forward View restated many of the ambitions set out two weeks earlier in Access to Mental Health Services by 2020, a five-year plan aiming to make “parity of esteem” between mental and physical healthcare a reality.

The most significant commitment is that, from next year, we will have waiting times and access standards for mental health for the first time. As well as being an important and muchneeded move, the introduction of waiting times is symbolic, representing the first real step towards parity. Until now, people accessing mental health services have not had the same right to timely treatment that we all expect if we have a physical health problem. So this is a landmark moment.

However, positive as we are about the leaps and bounds at policy level, our enthusiasm is tempered by the reality of services on the ground. While the Department of Health and NHS England lay the groundwork for a better future, this does nothing to help people who need support right now. Historic underfunding for NHS mental health services, compounded by cuts over three consecutive years, mean people are struggling to access the care they need. Both the Forward View and Achieving Better Access make it clear that many planned improvements require additional funding and, in so doing, have thrown down the gauntlet to the next government to keep up the pace of change.

“We need to see much greater investment in preventative programmes if we are to tackle soaring demand for services.”

Not that lack of funds is the sole excuse for poor services. Despite financial constraints, some areas nevertheless manage to run fantastic services: people get the help and support they need, when they need it, and are treated with respect and dignity. A common theme in good quality care is better integration of service, and it’s good to see the Forward View make this a priority.

We are starting to see joint-working at a local level as part of the “crisis care concordat”, which brings together mental health services, ambulance trusts, primary care, the police, local authorities and the voluntary sector to ensure that people in mental health crisis get safe, speedy access to the right support.

Better integration is needed within the NHS too. At the moment there is a tendency to treat physical health and mental health separately, though they often go hand in hand. Every contact with health services should involve a mental health component, to make sure that the mental health of those with long-term physical conditions, for example, isn’t being neglected. The only way to deliver truly patient-centred

care is to develop services in collaboration with those who use them, so it’s positive that the Forward View envisions greater involvement of the public in service design.

The voluntary sector also has a wealth of expertise on delivering frontline services, but we have suffered as a result of NHS reform and funding cuts.

The Forward View recognises the value of the sector to the health service – we are as much a part of the solution as anyone else.

Elsewhere, the Forward View made much of the need for greater focus on preventative health initiatives to reduce the burden on the NHS, and the need to do this for mental health as well as physical health. Our own investigation, released in October, revealed that the bar is set very low: local authorities are spending on average less than 1.5% of their public health budgets on preventative mental health initiatives, with some spending nothing at all. We need to see much greater investment in preventative programmes if we are to tackle soaring demand for services.

All in all, our confidence is growing that the NHS has serious intentions to improve mental health care and move towards parity over the next few years.

As ever, the proof will be in the experiences of people with mental health problems and the impact on their quality of life.

.

Views expressed are those of the author and not necessarily those of healthcare manager or MiP. healthcare manager | issue 24 | winter 2014

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MIP ANNUAL CONFERENCE 2014

All photos: Stefano Cagnoni

This year’s MiP conference on 19 November had a real buzz. The theme – managers matter – was pressed home by delegates and echoed by the speakers.

We had great debates covering leadership, fair pay and the future of the NHS. And this year delegates gave instant feedback through interactive voting.

We’re delighted they felt more optimistic by the end than at the beginning of the day.

Pictured clockwise from top left around the view of the conference floor: speakers take their seats; Karen Lynas, NHS Leadership Academy Deputy MD chats to a delegate; Dame Jacqueline Docherty,

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healthcare manager | issue 24 | winter 2014

CEO West Middlesex with chair Victoria Macdonald; MiP chief exec Jon Restell; Andy Burnham, Shadow Secretary of State; MiP chair Zoeta Manning; Dan Poulter, Minister for Health; Simon Stevens, NHS England CEO; delegates enjoy the debate; Nav Chana, NAPC Chair; a delegate casts her interactive vote; Katherine Rake, Healthwatch England CEO; Annie Ingram, NHS Grampian Workforce Director (top);Gill Bellord, NHS Employers, Employment Relations Director; Claire Sullivan, CSP Director of Employment Relations.

Photos and presentations are available on the conference website at: www.mip-conference.co.uk.

MIP ANNUAL CONFERENCE 2014

healthcare manager | issue 24 | winter 2014

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INTERVIEW: DAME JULIE MOORE

Dame Julie Moore, one of the few women to run a university trust, is outspoken about changing the NHS. She talks to Alison Moore about funding, building local partnerships and her hopes for the next generation of healthcare professionals.

Those who work in the NHS know that not all chief executives are grey suited men. But, even so, Dame Julie Moore stands out. Not only is she one of the few women to run a major teaching hospital, she is the only person to appear on three Health Service Journal “power lists”: the top 50 chief executives (the only woman in the top 10), the lesbian, gay, bisexual and transgender role model list, and the top 100 clinicians (she trained as a nurse).

Moore is also particularly outspoken about the need for fundamental change in the NHS and the difficulties facing different parts of the service.

“For [teaching hospitals] in particular the money is getting squeezed ever harder…everything is adding up to quite significant pressure,” she warns.

“We can’t keep cutting and cutting.

It’s time for a fundamental redesign but we must not clutch at straws. I think care in the community is the right thing to do but I’m not sure that it’s much cheaper. I have never seen admission avoidance work. Ever.”

Moore, 56, has been running University Hospitals Birmingham Foundation Trust (UHB) since 2006. Its flagship 12

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Queen Elizabeth Hospital – the first new hospital in the city for 70 years – opened in 2010. On the face of it, the trust is one of the NHS’s success stories. But its latest board papers show that life is generally getting tougher: UHB’s surplus is less than planned and cost improvement measures are running below target.

Ironically, some of these challenges result from the trust’s good reputation and patients’ willingness to choose it for both elective work and emergency care. This results in a difficult balancing act between the tertiary work which provides more than half the trust’s income – and which can only be done locally – and secondary work, which could be done at many hospitals across the West Midlands.

This was the thinking behind the trust’s controversial decision to stop accepting some elective referrals from outside its immediate catchment area.

“We just could not get the tertiary work in,” says Moore. “We had to cancel liver surgery which could not be done elsewhere. We needed to make our decisions based on clinical need.”

And, as she points out, money is not necessarily following patients – the extra patient in A&E will only be paid for at 30% of the tariff. Not only is that

bad for the trust, but as some of the hospitals in the surrounding area are on block contracts, CCGs are paying twice for services. “I just don’t think we can carry on like this,” she says.

“Because of the way we are configured at the moment it’s not a good thing to have a good reputation.

“Our A&E was designed when we were seeing 65,000 a year,” Moore explains. “It was built for a maximum of 81,000, and this year we may top 102,000. And when we take patients from outside the area, who are in for a while, we have no way into their social care.”

The trust is having to build relationships with many local authorities to ensure timely assessment and discharge. It is also working with CCGs on managing demand. But, although she praises Birmingham’s CCGs, she warns they sometimes struggle to see the bigger picture: “Commissioners are too small to see over the boundaries, they [only] see what happens in their own areas.”

The hospital is already supporting 500 more inpatients than planned, with two wings in its old hospital building – now supposed to house “back office” functions — reopening to accommo-

INTERVIEW: DAME JULIE MOORE

“We can’t keep cutting and cutting. It’s time for a fundamental redesign but we must not clutch at straws.”

date an extra 450 patients. Another 52 are being given hospital-level care at home.

The environment in the old hospital is not ideal, Moore admits, but sees no other way of meeting the demand. And the position seems unlikely to improve in the short to medium term. One of the city’s other trusts is planning to cut beds, and the uncertain future of the Alexandra Hospital in Redditch has already driven some patients towards Birmingham. Longer term, it’s possible the trust will acquire an additional site to do some of the “cold” work, she says, perhaps with a minor injuries unit.

But Moore also thinks much wider changes in the health economy are needed to cope with the financial and performance pressure. “NHS England and commissioners need to be permissive around letting organisations try new things – that is what I liked about the Five Year Forward View,” she says.

One example is Moore’s proposal for larger teaching hospitals to support smaller DGHs by sharing specialist teams. “I feel a lot of sympathy for some of the smaller hospitals where they don’t have enough work to keep a team but are expected to provide that service. We need to think about how we are configured to meet that [demand],” she says.

Moore suggests a bigger team of specialists could rotate between the teaching site and the DGH, offering continuity of cover to smaller hospitals and ensuring that consultants get enough experience in certain procedures to keep up their skills. UHB has already made some joint appointments with Birmingham Children’s Hospital, but Moore thinks there are far more benefits to exploit. “We employ a team of respiratory consultants – about ten.

St Elsewhere’s might only need two.

We could employ 12 but make cer-

tain two were always out there. Call it a chain or hub or spoke or group – it makes sense.

“There is another problem for a lot of these small hospitals,” she adds. “If they spend 1% of their income on a certain service they get an arm rather than a whole person. They are buying in expertise that is proportionally more expensive. They lose economies of scale. That’s similar to what Francis found at Stafford. A lot of the places that were picked up in the Keogh process were small hospitals and were a bit isolated.”

Moore’s trust has been involved, at various points, in helping three such hospitals – Medway, George Eliot in Nuneaton, and Burton. Much of this help has been practical, such as access to the informatics department.

UHB remains actively engaged with George Eliot, which has gone from special measures to a “good” rating in healthcare manager | issue 24 | winter 2014

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INTERVIEW: DAME JULIE MOORE

under a year. “The issue there will be financial sustainability,” says Moore, “and that is an issue for the whole health economy. I don’t believe a hospital ever fails in isolation.”

She denies that Birmingham’s relationship with Medway was ever intended to develop into a “chain” structure, as some claimed. In any case, the distance between Birmingham and Kent would have made it a non-starter, she says.

But she still thinks local chains or groups of hospitals could offer a way forward. “When I was a child we had local corner shops. Then they died away and we had supermarkets. Now they are back, but as Sainsbury’s Local or Little Waitrose, with a more limited range of products at the same quality and price.

“That’s a trick we have to pull off with hospitals. How can we get the same high quality?” The answer might be some smaller hospitals linked to a bigger centre – “the same number of hospitals but fewer organisations,” says Moore.

This could help revitalise management, too: the role of hospital managing director could be less daunting and easier to recruit to than that of trust chief executive. “We have a big issue about where the next generation of chief executives are going to come from,” warns Moore. “Some people are saying they want to do something else with their lives. I was an executive director and you think you’re busy then, but being a chief executive is a step up. Some believe the extra money is not worth the trade-offs you have to make.”

She points to the complexities of managing the different professional groups, and the regulatory aspects and deeply political nature of a chief executive’s job. “There is so much political interest in it and that’s not going to go away. You can sit here and say the NHS should be depoliticised but I don’t think that’s going to happen when it’s publicly funded.”

She jokes that most women are “too 14

healthcare manager | issue 24 | winter 2014

“We have a big issue about where the next generation of chief executives are going to come from.” sensible” to take on running a big trust, and points to some of the personal sacrifices chief executives – men and women – have to make. “It’s not a job, it’s a way of life. Since I became a chief executive, a lot of the hobbies I used to enjoy, I have given up. I was out on trust-related work every night last week.’ Although anxious not to speak on behalf of all women, Moore points out that even today childcare falls disproportionately on women. To some extent, women are underrepresented in big NHS jobs for the same reasons as within other sectors.

Moore is also concerned about the need to train healthcare professionals for a world which may change radically during their working lives. “I think we need to think very carefully about how we will train the next generation of healthcare workers,” she says. “We need them to have flexible skills. We may need more generalists – we need to give generalism back the status it used to have. Generalism needs to be a specialism.”

And she warns against cutting back on training staff at times of financial stress, as this just “stores up future problems”. Britain needs to train the nurses it needs, she says, and she has previously suggested over-recruiting

nurses when good ones are available.

Birmingham has recruited sparingly from abroad and has tried to draw on existing links, such as those with the local Portuguese community, as well as its successful two-year international fellowship programme for doctors. “But I don’t think we should denude other countries of their healthcare professionals.”

Other looming challenges include the post-Francis regulatory changes, although she doesn’t expect the “fit and proper person” test, for example, to be too much of a burden, as her directors already get extended disclosure and barring service checks. Neither does she have a problem with the duty of candour, “because we have operated it for some years anyhow. We are very honest with patients when things go wrong,” Moore says.

But while admitting the coming winter is a concern, Moore highlights the contribution of NHS staff. “What never ceases to amaze me is how well the staff respond to challenges. Everyone is rising to the challenge of needing to become more efficient. What I don’t want to see happen is quality being compromised.”

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GENOMICS

The 100,000 Genome Project will put England in the vanguard of one of the most significant revolutions in medical history. But will the NHS be ready? Craig Ryan investigates.

What strikes you immediately about the 100,000 Human Genome Project is its scale. The numbers are big; like banking and astrophysics, the figures involved in genomics are mindboggling to outsiders. The science is big; whether it’s the biggest breakthrough since Lister’s antiseptics, Jenner’s vaccinations or Fleming’s penicillin, everyone agrees it’s a biggie. And the consequences for the NHS, for both clinicians and managers, are big too: so big, in fact, we can’t get them into focus yet.

“The Ancient Greeks diagnosed disease by looking at the stars and the movements of planets,” says Alastair Kent, director of Genetics Alliance UK and a member of the project’s ethics advisory board. “In medieval times they talked about the four humours, then we got onto germs and viruses, and now we’re looking at the molecular level. This gives us the opportunity to eliminate some of these really nasty conditions about which we’ve been able to do nothing since homo sapiens first appeared as a species.”

The project itself – “100KGP” seems to be the accepted acronym – aims to sequence 100,000 whole genomes by the end of 2017. This means capturing

“This gives us the opportunity to eliminate some of these really nasty conditions about which we’ve been able to do nothing since homo sapiens first appeared.”

ALASTAIR KENT Director of Genetics Alliance UK

the complete set of genetic information that makes up a human being — 3.2 billion “base pairs” of DNA. You don’t need to know what a base pair is to see that’s a lot of data.

Sequencing the first whole human genome took 13 years and cost £2bn.

Genomics England (GeL), the stateowned company formed to deliver the sequencing project, has three years and a budget of just £100m — although its partners, US genetics company Illumina and the Wellcome Trust, are investing another £190m in related infrastructure, technology and support services.

By any measure it’s a tall order.

“Don’t tell the politicians too much about it, but it’s a very challenging programme,” said chief executive Sir John Chisholm at GeL’s first public meeting at Barts Hospital in October. Yes, costs have fallen dramatically, but it still costs at least $5,000 to sequence a whole genome and analyse all the information. GeL is relying on a combination of technological progress and competition between sequencing companies to get costs down and the project over the line.

But the 100KGP is only part of a live process of experiment and transformation which will see research go hand in hand with implementing genomic healthcare manager | issue 24 | winter 2014

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GENOMICS

“If we think this is just about clinical genetics, we’ve got it wrong... this is about every clinician in the NHS.” IAN CUMMING Chair of the Health Education England

medicine within the NHS. At least, that’s the plan.

“I see it as very much a hybrid model that is both research and NHS transformation,” says Tom Fowler, Genomics England’s director of public health.

“Making use of the clinical information in our systems to make us a world leader in research, while also feeding directly back to patients who will feel the benefits.”

Ian Cumming, chief executive of Health Education England, which is leading on the huge workforce implications, says the sequencing project is just the tip of the iceberg. “I don’t think it’s over-hyped to say this is one of the biggest revolutions in the practice of medicine and healthcare that we’ve seen for many, many years. We’re going to see an ever increasing shift towards the personalisation of healthcare… My personal view is that within seven to ten years, the NHS will be sequencing the genome of everyone who wants it.”

Pharmacogeneticist Mark Bartlett, managing director of Geneix, which works with NHS hospitals on using genomic data, agrees. “That’s the way it’s going. It will be a resource to be mined at the point of care. So if a 16

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patient comes in with a difficult diagnosis, that whole genome can be looked at… The doctor will be able to prescribe medication that is right for the patient, not just for the disease.”

An illustration of how genomics is moving, as Cumming puts it, “from bench to bedside”, is a prototype device, about the size of a shoebox, which can sequence a small part of the genome and deliver results in just 15 minutes. This allows doctors to identify, for example, familial hypercholesterolaemia, different types of diabetes or whether an infection is bacterial or viral — and, if bacterial, which antibiotic will work best.

“That’s where we’ll be, certainly in five years,” says Cumming. “And that’s why we’re trying to get ahead of the curve, and not do what we’ve perhaps done in the past, which is to have all sorts of new technology and new ways of working, and not have the workforce ready to use it.”

The NHS will certainly need more clinical geneticists and bioinformaticians but HEE’s education programme goes way beyond the specialist workforce. “If we think this is just about clinical genetics, we’ve got it wrong,” warns Cumming. “This is about every clinician in the NHS. “GPs are already telling me that they’re being asked for advice from patients who have had part of their genome sequenced and are going back to their GPs and saying, ‘what does this mean, doctor? Can you help me and talk me through it?’”

With its £20m slice of the budget, HEE is tendering a new MSc programme in Genomic Medicine, which Cumming expects to train about 500 people, and will fund some PhD and post-doctoral research. It will also offer more accessible training programmes, beginning with a two-hour online “Introduction to Genomics” course, open to all NHS staff.

The sheer volume of data is one of the biggest challenges. A single human genome will just about fit onto a standard hard disk, but is equivalent to millions of pages of text. All this has to

be analysed, the interesting bits pulled out and put into a format that working doctors can use – 100,000 times over.

And it’s not as if researchers are 100% sure what they’re looking for.

“It’s a kind of Rumsfeld scenario,” says Alastair Kent. “There are some things we know — that these mutations result in these outcomes. Then there are things where we’re reasonably confident that there’s a causal association between the genome and a particular event. And then there’s an awful lot of stuff we just don’t know — changes of unknown significance.”

One of Kent’s concerns is that patients who volunteer early for genome sequencing don’t get left behind as the knowledge moves on.

“We don’t want them to get a 1.0 version of the interpretation when a 2.0 version comes along in 12 months’ time,” he says.

Kent also questions whether NHS structures will be able to keep pace with the political momentum behind the research project. “You have the prime minister breathing down your neck if you’re on the board of Genomics England,” he says. “So they’re under huge pressure to deliver significant results very quickly. Our concern is that the short-term mechanisms will not be sufficiently robust to secure the sustainability of the project and transfer the knowledge into the NHS.” Trying to make sense of all the institutional architecture thrown up very quickly around the project is like trying

The prototype “genetics lab in a box” which can sequence part of the genome and deliver results in just 15 minutes.

GENOMICS

to nail jelly to the wall. In particular, many insiders question whether NHS England is nimble enough to drive through the implementation of genomic medicine within such a fragmented system.

“To be honest, it’s very difficult to get a sense of what’s happening on the ground with NHS England, beyond the fine words of the chief executive,” says a source very close to the project. “One hopes things are happening, but at the moment NHS England is so focused on achieving financial balance that other things have gone by the board.”

It may or may not be significant that no one from NHS England was able to comment for this article.

A common misconception is that genomic medicine is all about genetic diseases. But our DNA also determines how all types of disease affect us and how we respond to treatment. Rare genetic diseases are an important part of the 100KGP – ironically, with 5,000 different types identified, “rare” diseases are actually quite common – but the research will also include patients suffering from cancer and infectious diseases.

Sequencing the whole genome is very different to the limited form of sequencing which goes on at the moment, where scientists concentrate on a few genes known to be connected with particular conditions or diseases. At GeL’s public meeting,

Peter Johnson, chief clinician at Cancer Research UK likened it to going from the Mappa Mundi to Google Earth in terms of understanding the genetic make-up of people and organisms like cancer.

“This is not about… genetic inheritance, it’s about the changes that take place after birth and during life,” he said. Sequencing has already revealed many more genetic variations of cancer than expected. “There’s one particular type of lung cancer for which we have a blocking drug, which probably only affects 1% of people with lung cancer,” added Johnson. “So, in some senses everything’s becoming a rare disease.”

Concentrating initially on the “difficult” cancers with very low survival rates – lung, oesophagus, pancreas and brain — researchers will compare the DNA of the tumour to the patient’s normal cells, enabling the precise changes that cause the cancer to be detected.

But the most immediate impact is expected with the diagnosis and treatment of infectious diseases, says Fowler. “With TB outbreaks, for example, we can use this technology to understand the spread, the epidemiology behind it, and where it’s come from. And that leads to a lot more you can do.”

Back in 2012, genome sequencing was used to stamp out an outbreak of MRSA at the special care baby unit at Cambridge University Hospital, as

well as to identify and treat the individual carrier. It’s believed to be the first use of the technology to identify and eradicate an outbreak of an infectious disease.

Faster and more effective diagnosis will help to beef up the “value proposition” for genomic technology, particularly with often-sceptical commissioners, who will, ultimately, have to fund it. “It may well be already cost-effective to use this technology as opposed to the sort of diagnostic odyssey that patients often have to go through at the moment,” says Fowler.

Mark Bartlett admits the “genomics industry” may have been guilty of “over-promising” in the past, but insists there is a genuine sense of optimism about the 100KGP, despite the daunting challenges. “I’m actually very supportive of what Genomics England are trying to do. I think they’re taking a very realistic approach.”

But moving technology “from bench to bedside” has often been a weak spot for the NHS, as it has for Britain generally. The NHS will need strong leadership, more funding and a better sense of vision if the blaze of promise represented by the 100KGP isn’t to fizzle out in the day-to-day business of implementation.

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HEE’s two-hour online “Introduction to Genomics” course is open to anyone who works in the NHS. To sign up, visit: www.genomicseducation.org.uk/ courses/introduction-to-genomics healthcare manager | issue 24 | winter 2014

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RAISING CONCERNS

Robert Francis’s whistleblowing review aims to usher in a new era of openness in the NHS, writes Debbie Andalo. But an open culture will require skilled managers to balance competing priorities.

In January, Sir Robert Francis is expected to publish the results of his review into whistleblowing in the NHS. In the summer, Francis was clear about what he was setting out to achieve: “We need a culture where ‘I need to report this’ is the thought foremost in the mind of any NHS worker who has concerns – a culture where concerns are listened to and acted upon.”

It is an ambition shared by managers across the NHS but requires a culture change that may be difficult to achieve.

An online survey of more than 2,000 managers and clinicians by the King’s Fund, published in May, illustrates the scale of the challenge. Some 30% of managers questioned felt unable to raise concerns with their employer, and 60% said if they did speak out they were not confident that their worries would be dealt with appropriately.

But the figures do not tell the full story. There are trusts across the NHS which are leading the way, encouraging staff to speak up when things go wrong within a no-blame environment, and giving them confidence that their concerns will be tackled swiftly. Staff at Birmingham and Solihull Mental Health NHS Foundation Trust can email their chief executive John Short 18

healthcare manager | issue 24 | winter 2014

“If I can develop a culture that is open and gets people talking about incidents, we are less likely to become a Mid Staffs.”

JOHN SHORT, BIRMINGHAM & SOLIHULL MENTAL HEALTH TRUST

– anonymously if necessary – with any concern using a dedicated website.

Every “Dear John” message is read by Short and acted on by his senior team within seven days. Since the scheme was introduced the trust has gone from having an average number of reported incidents to fifth place in the national league table – an indication,

says Short, that it is helping to create an open culture.

“I see my job as being accountable for the organisation, and the organisation is about culture,” adds Short. “If I can develop a culture that is open and gets people talking about incidents, we are less likely to become a Mid Staffs.”

A similar “take it to the top” initiative was developed by the 5 Boroughs Partnership NHS Foundation Trust in Cheshire, Merseyside and Greater Manchester, where staff can participate in a real-time Q&A with the chief executive via the trust intranet. So far 17 sessions have been held, 30 issues raised including problems with pay and health and wellbeing. Significantly, 2,400 staff – 70% of its workforce — viewed the Q&A page in three days.

These two initiatives are among the examples of best practice promoted by NHS Employers as part of its commitment to create a more open workplace.

It has designed materials, including posters and payslip flyers, which managers can use in a local campaign on raising concerns. It has also put together a toolkit on engaging staff and launched an organisational development programme which invites managers to share expertise on how to bring about a more open culture.

Nyla Cooper, head of professional standards at NHS Employers, says:

RAISING CONCERNS

Whistleblowing Policy Chec

klist

conforms to legal to ensure that your policy The aim of this checklist is ures will need to suit the ce. Arrangements and proced requirements and best practi between large acute vary will which , organisation structure and culture of the isations. A good policy will: Trusts to small care organ Evident Y/N

Comment

ation Issue Yes In part No Explan of company expectations Provide a clear statement d staff that it is safe and about speaking up and remin up if they have a acceptable for them to speak asise that patient/ whistleblowing concern. Emph ount concern, that all service user safety is the param bad practice or workers have a duty to report isation wants to organ the that and t, mistreatmen arent culture where promote an open and transp , fully meeting its concerns can be raised safely Public Interest Disclosure responsibilities under the Act 1998 (PIDA).

- PIDA covers ‘workers’, Define the scope of the policy include all employees and a term which is intended to also consider if you want agency workers. You could to include volunteers. iour which constitute Describe the kinds of behav examples of the types of malpractice, giving specific it clear and distinguish concerns to be raised, to make nces. grieva from ing whistleblow rns with their Encourage staff to raise conce immediate manager. example if the concern is In more serious cases, for where the concern has about the line manager, or ger but it has not been been raised with the line mana designates an policy the ssed, properly addre as a senior manager ally appropriate person(s) intern concerns can be raised, with whom whistleblowing t. gemen mana of levels bypassing lower ion to report concerns In the NHS, there is also provis er Service Centre (Tel. 0207 to the DH via their Custom via link: form ct 210 4850, or using a conta ntact-dh/ ) http://www.dh.gov.uk/health/co 0800 028 4060. on Line Fraud er or the NHS Count

“Culture change is something which is long-term – we aren’t going to nip this in the bud the first time – but it’s about taking the learning. For example, if you are an organisation which has a very high level of cases that are reported, that doesn’t mean you are a bad trust, but shows that you have a very open culture and that you talk about the cases and look and learn.”

Some of the NHS Employers resources are based on the guidance for organisations written by the national Whistleblowing Helpline. Some 1,500 printed copies of the guidance have been requested since it was launched in April 2014, and an average of 350 copies are being downloaded each month. Set up by the government in 2011, the helpline has taken 4,000 calls and deals with an average of 50 a month from the NHS – double the number coming from social care. The majority of NHS callers are frontline staff and the most common concerns are staffing numbers or faulty equipment

— and particularly the effect these have on patient safety.

“By and large we don’t get calls from managers – they come to us for other things such as our training courses in whistleblowing Date and our policy reviews,” says Rosemary Crockett, the helpline’s policy manager. It has a checklist, against which trusts can judge their own whistleblowing policy. Three months ago it launched training courses for managers because it saw a need for them to feel more confident about dealing with concerns raised by staff. “Because whistleblowing doesn’t happen that often it’s difficult for managers to learn by experience; there is a knowledge and skills deficit in how to respond,” adds Crockett.

The two training programmes – an hour-long briefing and a two-and-a-half-hour workshop – both target operational managers such as ward sisters or team leaders, “the people who staff will come to when they want to raise a concern,” says Crockett. Since the schemes were launched, Crockett has worked with 12 trusts, who are given practical tips such as how to distinguish a whistleblowing issue – something being disclosed in the public interest – from a staff grievance or employee dispute.

If there is to be a new culture of openness in the NHS it will have to run through the organisation from frontline staff to the board. That means, according to MiP chief executive Jon Restell, that if an employee raises a concern with a manager which the manager cannot resolve – such as understaffing or broken equipment – he or she has a responsibility to take it to the next management level. “Managers have to take the concern up the chain and if the board can’t deal with it then you have to

“An open culture is created by balancing quality, money and operational targets and putting them all together.“

challenge the system,” Restell says.

But a key barrier in creating that open culture is the conflict between dealing with a concern and meeting budgets and targets. “There is a tension in managing the quality issue; whistleblowing has to be seen in the context of that tension between quality and operational targets, adds Restell.

“The assumption is that creating this culture is straightforward, but I don’t think it’s that simple – it’s a culture which is created by balancing quality, money and operational targets and putting them all together.”

Restell is adamant that many concerns about performance or behaviour should be dealt with on the ground by line managers and should never become a whistleblowing issue: “It’s about having a dialogue about good behaviour and good practice and asserting professional standards. But we need to give people the confidence to take that person to one side and be able to say, ‘I don’t think you should have done that’.”

But for any whistleblowing system to have the confidence of NHS managers it has to be seen to be just. “There is this fear that if you raise a concern it will blow up in your face,” says Restell.

One of the simplest ways to create a more just system would be to ban the word whistleblower from the outset, he suggests. “The word whistleblower puts you outside of your own organisation – it is still associated with heroic qualities, which for most people would be terrifying.”

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healthcare manager | issue 24 | winter 2014

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LEGAL MATTERS

legaleye Charlotte Moore explains the new rights for working parents to take shared parental leave.

The Shared Parental Leave Regulations, which came into force on 1 October 2014 as part of the Children and Families Act, usher in a new concept in the statutory rights of parents to take time off to look after their children. It is vital that healthcare managers know how the new rules will affect them and their staff.

The new system applies to parents whose expected week of childbirth is on or after 5 April 2015, as well as adoptive parents who have been matched for adoption on or after that date. The leave must be taken within the first year after the child is born or matched, and employees are entitled to benefit from all the terms and conditions of employment that would have applied if they had not been on leave, except for remuneration.

Under the new system: ■■

■■

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■■

■■

20

Mothers will still be entitled to 52 weeks maternity leave but can decide whether to take it as maternity leave or as shared parental leave.

Mothers can choose to end their maternity leave after the initial twoweek compulsory period.

Mothers will no longer need to wait until their child is 20 weeks old before their partner can share leave.

Working parents can decide how they would like to share the remaining leave.

Parents can convert the mother’s entitlement into parental leave and pay, which both parents can share, either separately or at the same time.

healthcare manager | issue 24 | winter 2014

■■

An employee is entitled to return to the same job if they take 26 weeks leave or less in total. If they take more, and it is not reasonably practicable for them return to the same job, employers can ask them to return to a similar one.

Eligibility To qualify for shared parental leave, employees must meet the eligibility criteria and then follow prescribed notice requirements. Each parent must satisfy a two-stage test.

First, they must show they have been economically active and have worked for 26 of the previous 66 weeks, and earned at least £30 per week for at least 13 of those 66 weeks.

For the second stage, the employee must show that they have worked for six months at the start of the 15th week before the child is born or matched for adoption. To qualify for pay, they must have earned more than the lower earnings limit (currently £111 per week) in the eight weeks leading up to the 15th week prior to the date of childbirth or matching.

Leave curtailment notice At some point between the 11th week before the baby is due and nine weeks before the end of shared parental leave, the mother must give her employer a written leave curtailment notice, stating when she wants her maternity leave to end. The parents can give notice to their employers that they want to opt into the shared parental leave system.

Notice of entitlement and intention Not less than eight weeks before the start of the first period of leave, the mother must give her employer a written notice specifying the dates of any statutory maternity leave she intends to take, as well as the dates of the shared parental leave that she and the other parent intend to take. Her partner must also give their employer notice of their intention to take parental leave. They must both sign declarations that they meet all the eligibility criteria for shared parental leave.

Giving notice of a period of leave At least eight weeks before the start date, employees must provide their employer with a written period of leave notice, setting out the start and end dates of each period of shared parental leave requested. They can vary those periods on three occasions.

The parents can ask to take the leave in one chunk or in discontinuous periods. If they ask to take it continuously, the employer must allow them to take leave as requested. However, if they request discontinuous periods, employers can propose alternative dates or refuse the periods requested.

If the parties cannot agree within two weeks, the employee can either withdraw their request or take the leave as a single period.

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Charlotte Moore is an Employment Rights Lawyer 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.

TIPSTER

How to be a fabulous manager Derek Mowbray on what it takes to be the kind of manager everyone looks up to.

1 FABULOUS MANAGERS KNOW THEIR STAFF WELL, AND VICEVERSA

interest in those who approach them.

Intelligent kindness comes from a deep interest in others.

It’s a manager’s job to persuade others to do things they might not wish to do, without causing distress. This means being attentive to others, understanding their behaviour and adapting your own so that people are receptive to your requests. If successful, your people will reciprocate, but they need to know you just as well as you know them.

5 FABULOUS MANAGERS ARE TRUSTWORTHY

2 FABULOUS MANAGERS DELIVER Managers have to deliver on any promises or agreements they make.

This doesn’t mean delivering products and services at any cost — it means delivering them without avoidable stress.

Managers who successfully deliver make themselves and their people feel great, and this adds to their motivation and sense of psychological wellbeing.

3 FABULOUS MANAGERS ARE ATTENTIVE Attentiveness is the most important attribute and behaviour. It means paying attention to surroundings, to opportunities, to changes on the horizon, but most importantly, paying attention to other people. If people feel you are attentive towards them, they cannot avoid being attentive back. They feel good about you, and you will be able to persuade them to do (almost) anything.

4 FABULOUS MANAGERS ARE APPROACHABLE Over one million people in the UK health services have a manager, so it’s vital that everyone feels able to approach their manager and discuss anything with her. Managers who demonstrate intelligent kindness are much more approachable as they already expect to be approached, and want to take an

Trust means not having to second guess the motivation of others. Where trust exists, people take the behaviour and actions of others at face value. Gaining trust requires managers to be open about everything they do, including their mistakes. Conceal nothing; reveal everything!

 FABULOUS MANAGERS LOVE DIVERSITY Fabulous managers are curious and inquisitive. They love to find out about other peoples’ experiences and their take on problems and issues. The more diverse your people, the wider and deeper the range of intelligence you have to draw on. This also makes you a more interesting manager yourself.

7 FABULOUS MANAGERS ENJOY HUMOUR AND FUN Fun and humour reduce the risk of suffering excessive stress. People need to enjoy their work and workplace to be able to perform consistently at their peak. Having fun at work is an essential ingredient of peak performance.

8 FABULOUS MANAGERS ARE PROFESSIONALS It’s a sad fact that only about one third of managers have received any training in management. It’s critical that managers are seen as being competent in their job and in how they interact with their people. Competent and professional managers are like gold dust; without causing distress, they make an enormous difference to the performance of their people and organisation.

9 FABULOUS MANAGERS HAVE CLEAR ETHICS Managers are role models; they are watched all the time. When managers demonstrate ethical decision making and behaviour it is enormously attractive to their people. Most of us like ethical people and respect those who live their core personal values.

 FABULOUS MANAGERS KNOW WHAT THEY’RE DOING It’s essential for managers to know what they’re doing before they can persuade others to do anything. If people simply don’t have confidence in their manager, the process of management can break down completely. Managers should always nurture their people, and help them to develop the skills, knowledge and experience that enable them to know what they’re doing, and how to do it well.

 FABULOUS MANAGERS STAY CALM Anxiety spreads anxiety. It also means you’ve lost control of yourself. Remaining calm means you have control over yourself in most, if not all, situations.

Being calm in challenging situations is hugely attractive to others who may feel uncertain. Remaining calm also enables you to think through the challenge and use your resilience.

Derek Mowbray is Director of the Management Advisory Service and visiting professor of occupational psychology at Northumbria University.

healthcare manager | issue 24 | winter 2014

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MIP AT WORK

RESTRUCTURING

More churn at NHS England Marisa Howes reports on MiP’s negotiations over job losses at NHS arms-length bodies.

Staff in the new arms-length NHS bodies in England have barely got their feet under the table before hearing they are being restructured already! The Department of Health has told the new bodies they have got to shave 15% off their running costs and reduce the number of very senior managers by 20%.

MiP is again playing a key role in partnership discussions about restructuring in the new bodies – including NHS England, Health Education England and NHS Property Services – making sure our members’ voices are heard and looking after their interests.

MiP wants to ensure that the change policies and selection processes are fair, and to save many of our members

from having to go through appeals or grievances for unfair treatment.

MiP national officer Jo Spear (pictured) leads the trade union group in discussions with NHS England.

Speaking about the organisational alignment programme, under which NHS England proposes to make 300 people redundant, Jo said: ‘We worked hard on key HR issues such as the consultation exercise, redundancy pooling and slotting-in criteria, ensuring they are as fair and open as possible.

Our goals are to save jobs, help people with redeployment and push back against different treatment of senior managers.

PARTNERSHIP

A victory for common sense in King’s Lynn Partnership working between MiP’s George Shepherd and Unison prevented an increase in car parking charges for staff at Queen Elizabeth Hospital.

MiP officers often get involved in negotiations with individual employers to represent the interests of our members. A few months ago, MiP national officer George Shepherd joined with the Unison branch to persuade the chief executive at Queen Elizabeth Hospital (QEH) in King’s Lynn not to increase car parking charges for staff until at least after the next election.

QEH wanted to increase staff parking charges to help reduce the trust’s deficit, and had been in discussion with the trade unions since January.

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healthcare manager | issue 24 | winter 2014

The trust eventually announced its intention to bring in a tapered increase in charges – with staff earning over £17,500 a year being charged 50% more, and a massive 80% increase for those earning more than £45,000.

As the proposals hit MiP members hardest, the Unison branch secretary, Darren Barber, who chairs the staff side, asked George to join him in negotiations with the employer. George worked with Darren to put the case against increasing the parking charges, pointing out that staff had suffered a cut in take home pay in recent years, due to the pay freeze and increases

in pension contributions. They argued the proposed increase would result in a further erosion of staff’s disposable income and have a detrimental impact on morale.

As the talks were stalling, the unions held staff meetings during the summer to gauge opinion about what action to take. Following these meetings, they invited the trust’s executive team to attend a staff meeting to explain why they were insisting on the increase. The chief executive himself turned up, saw the number of staff and the strength of feeling, and immediately announced that

16332 MIP ad 213(h) x 110(w):Layout 1

“The pace of this change is deeply concerning and it will further disrupt the focus of people on services,” she added.

“And we don’t yet know what the recently unveiled Five Year Forward View means for future staffing requirements.

NHS England should ease off the accelerator until these requirements are clearer. Otherwise we’ll lose highly skilled and dedicated staff unnecessarily.

“No matter what, with the other unions we will continue to work in robust partnership with the employer nationally and regionally over these very complex changes. We’ve done as much as possible to tell members what’s happening and get their views. Our members’ feedback is invaluable and directly informs the lines we take, so please do let us have your views and concerns.

31/8/10

13:11 Page 1 MIP AT WORK

These are uncertain times.

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To give feedback or raise queries about the change programme, email us at feedback@miphealth.org.uk.

MiP is sending regular email updates to members in NHS England about the programme. If you do not receive these, your membership record may be out of date, check your details online through the members’ area of the MiP website: www.miphealth.org.uk.

Reduce the uncertainty.

Join MiP. One thing is for certain in such times – you need support.

MiP is the UK’s only trade union organisation that solely represents healthcare managers.

the increases in charges would not go ahead.

Speaking after the announcement, George Shepherd said: “I was delighted to work with Darren on this issue and it’s great that the chief executive listened to reason. For most of our members, driving to work is not a luxury; it’s the only option available. So they really didn’t need a hike in parking charges on top of an unfair pay freeze and increased pension contributions. This is a victory for common sense.”

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We provide an influential voice, personal support and employment advice, management skills and access to leadership networks.

Our experienced team of employment professionals is on hand to offer one-to-one confidential advice, negotiation and representation and fast access to legal resources.

Join MiP today. Visit www.miphealth.org.uk/joinus

helping you make healthcare happen

healthcare manager | issue 24 | winter 2014

23

BACKLASH

backlash

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

by Celticus

Bank charges

H

ealth minister Dan Poulter’s appearance at MiP’s November conference left many delegates scratching or shaking their heads. He launched a lengthy attack on nursing agencies, whom he accused of “ripping off the NHS” by charging up to three times the cost of a staff nurse. My guess is that hospital managers don’t need to be told this. One delegate asked for advice on recruiting nurses in Essex during a pay freeze.

“We’ve got a toolkit for that, if you’re having problems managing your bank,” was the minister’s less-thanhelpful response. Poulter went on to claim (twice) that the government’s NHS reforms had saved £6.4bn.

We tried, but as we went to press, neither the DH nor the Conservative Party had produced any evidence for Poulter’s claims.

Losing count

M

inisters can’t even agree among themselves how much they’ve “saved” the NHS. Poulter mentioned £6.4bn in a written Commons answer in September, although his accompanying figures showed only cumulative costs of £1.7bn from “restructuring” to April 2014. In the Commons on 15 October, Poulter claimed the reforms had “stripped

24

out £5bn-worth of bureaucracy” while, in the same debate, Treasury minister Andrea Leadsom stuck to £6.4bn. Health secretary Jeremy Hunt chimed in with a more modest £1bn. As ever, the King’s Fund may shed some light on what they’re up to. Its report, The NHS productivity challenge, found that two-thirds of the savings they identified came from squeezing hospital tariffs and freezing pay, and only 3% from administrative costs.

Lower than low

I

t’s not just NHS staff whose sacrifices ministers are claiming credit for. At the Queen Elizabeth Hospital in Woolwich, cleaners, porters, catering staff and security guards – GMB members, employed by facilities management firm ISS – have been striking over poverty pay and a “two-tier” workforce at the hospital.

healthcare manager | issue 24 | winter 2014

ISS employees are paid less than NHS colleagues doing the same work, and receive lower overtime rates, holiday and sick pay. ISS boasts that it “supports the principle of the Living Wage”, but its staff at QEH are paid between £7.10 and £7.32 an hour, way below the London Living Wage of £9.15.

The company says its Living Wage pledge only applies to staff working “on its own estate” which, as ISS is an outsourcing company, seems a pretty empty promise.

Lost leaders

F

irst Mark Newbold from Heart of England, then Tony Bell from Chelsea and Westminster – two widely-respected leaders forced out following critical CQC reports. Are “resignations” the only response we have in the NHS to criticism? Can we afford to lose such leaders, when more than a third of trusts have empty seats on their boards, 10% have no finance director, and the NHS Leadership Academy says candidates are reluctant to take boardlevel posts because of job insecurity. On average, acute chief execs last just two years and three months; in community trusts, it’s a ludicrous 16 months. And these are average figures – many don’t even last that long.

How can we expect leadership to flourish in this environment?

Golden turn

P

erhaps we need more “turnaround” specialists like Donald Muir, a consultant who is so productive that Barts Health paid him more than £1m in eleven months. It’s not precisely clear what Muir, a former cost-cutter at Rangers FC, did to earn £3,577 a day – four times the pay of Barts’ chief executive. But whatever it was, he did a lot of it: the trust says he worked 283 days, at an average of over six days a week.

Let’s just hope the “turnaround” at Barts stays turned longer than the one Muir engineered in 2011-12 at Brighton and Sussex, which now faces a CIP (aka cuts) of £32m, and expects a £3m deficit this year.

Cheers, Ray

C

elticus was deeply saddened to hear about the death of MiP stalwart Ray Rowden (see page 8). I first met Ray almost 20 years ago, when he was a leading light in the NHS managers section of the FDA, a forerunner of MiP. Ray had a rare gift for making public service and trade unionism exciting, and the enthusiasm and sense of mischief he brought to work (and partying) was infectious. As many others found, I didn’t have to see Ray very often for him to make a lasting and inspirational impression on me.

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