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Using research to shape and improve NHS services – join the SDO Network The Service Delivery and Organisation (SDO) Network supports NHS managers to use research to improve and develop the services they manage. • The Network offers a range of services customised to the needs of senior, middle and new NHS managers to support them in developing leading-edge services. • Member services include: events which bring together the latest learning from research and the experiences of front-line NHS managers, action learning sets, chief executives forum, academic fellowship placements and support in conducting and sourcing the latest research. • Membership is free, join the SDO Network today.

“Managers need to have a far greater awareness of research if they are truly to have an effective dialogue with clinicians.” Mike Cooke, Chief Executive, Nottinghamshire Healthcare NHS Trust

“Exposure to research strengthens managers’ ability to successfully innovate.” Ron Kerr, Chief Executive, Guy’s and St Thomas’ Foundation Trust

To find out more and to join, see our website or contact tel 020 7074 3438

SDO Network is funded by SDO (Service Delivery and Organisation Programme) which is part of the National Institute for Health Research

issue 1 february-march 2009

healthcare manager inside heads up:2 What you might have missed & what to look out for

Leading edge: Jon Restell In public: Imperial College Healthcare NHS trust In person: MiP member Amrit Kaur

letters & comment:8 Rebecca Wood, Alzheimer’s Research Trust

published by

Managers in Partnership 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’s second conference David Nicholson on leadership Interview with Sir Bruce Keogh

your job:18 Management trainees: under threat? Career development: time to move on? MiP at work: maternity policy Legal eye: workplace hazards


I am delighted to introduce the first edition of healthcare manager, a new magazine from Managers in Partnership (MiP), the trade union organisation representing managers in health and social care. We think this magazine fills a gap in the market, giving a voice to managers who are often an invisible and easily-dismissed part of the team making healthcare happen. This is your opportunity to read about and comment on the issues affecting you as a manager or a trainee, wherever you are in the UK. Each issue will contain in–depth features going behind the headlines bringing you a fresh perspective on healthcare. In this issue we hear from David Nicholson about his vision of leadership and Sir Bruce Keogh about developments in clinical leadership. It will also focus on how to be a good manager and on your career, whether you want to move up the career ladder or step off it, with tips and advice, case studies and a legal roundup. The magazine will only thrive if it reflects your views, the managers in the health services. So do contact us with your news and views – good, bad or just plain funny – as long as it’s not libellous! Marisa Howes Executive editor

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


research, practical initiatives, expert seminars and publications kicked off with the report, Seeing the Person in the Patient, published in December. It Healthcare think tank identified two practical The King’s Fund has initiatives to be piloted in launched ‘The Point of 2009: ■■ Schwarz Centre Rounds, Care’, a major new developed by the Kenneth programme for researching, testing and B Schwarz centre in sharing new approaches America, provide a monthly one-hour session for all to hospital care by staff to discuss the working with patients emotional and social issues and their families, staff arising from patient care. and hospital boards. Currently being piloted at Dr Jocelyn Cornwell, the the Royal Free, Hampstead. programme director, said: ‘Staff come to work wanting ■■ Experience Based CoDesign uses ideas from to provide good care for design – in which users are their patients, but today’s hospitals are often vast, the a central part of the process pressure of work is intense, – to involve patients and and in these busy “medical staff in improving the factories’” good care can all experience of using hospital services. Being piloted at too easily get squeezed Guy’s and St Thomas’s, and out.’ King’s College. The programme is founded on the belief that all staff – including managers, admin and support staff – should be To download a copy of the first involved in transforming Point of Care report visit: patients’ experiences. The ongoing programme of

Health Bill

healthcare manager

Executive Editor


Marisa Howes

Tracey Adamson, Daloni Carlisle, Judith Gledhill, Marisa Howes, Helen Mooney, David Nicholson, Jon Restell, Craig Ryan, Rebecca Wood.

Seeing the person in the patient

issue 1 | february-march 2009 published by MiP All copy © 2009 MiP, or the author. Opinions stated are not necessarily those of MiP.

Associate Editor Craig Ryan

Bill of rights? The Health Bill, published in January, will be making its way through both Houses of Parliament this spring. The bill, which received its second reading in the Lords on 4 February, will set up the new NHS Constitution and enable trials of top-up payments. The bill also introduces quality accounts, meaning organisations will have to publish more information on their performance as part of the drive towards local accountability.  The Department of Health said top-ups would be made possible by ‘enabling the piloting of direct payments for healthcare, within the wider programme to pilot personal health budgets. Personal health budgets are part of a range of policies designed to personalise NHS services, including care planning and patient choice.’

Print Art Director

Broglia Press, Poole

James Sparling

Advertising Enquiries Design and Production Lexographic


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020 7014 3680

MiP national organiser Marisa Howes said top-up payments were a tough call. ‘On the one hand they seem to undermine the principal of equal treatment, on the other, would you deny the extra treatment to someone you loved? Personal health budgets may sound like an administrative nightmare, but shouldn’t patients be able to control their own budgets?’ What do you think about top ups and personal budgets? Send us your views by email to editor@

healthcare manager is sent to all MiP members. If you would like to join see page 23. Cover image and p12-13: © Andrew Wiard 2008 Printed on paper from FSC forests using vegetable-based inks. When done please recycle.

All weblinks mentioned are at


leading edge Jon Restell, chief executive, MiP As 2009 starts, people are debating leadership in the NHS from dozens of angles. Negatively, with MPs slating the ability of PCT managers to deliver Darzi, the under-representation of black and minority ethnic people in top jobs, and the Rose Gibb case going to court (with MiP’s support). Positively, with David Nicholson’s leadership agenda, spelt out by him in this magazine, in the document Inspiring Leaders: Leadership for Quality, and in discussions about the NHS Constitution. If you see leadership and management as critical to better health

Work/Life Balance

Time out on working hours Until now, working time regulations only worried the health services in relation to junior doctors. But if a move by the European Parliament to end the voluntary opt-out for workers in the UK is successful, NHS employers will soon have to address the long hours culture for managers as well. In December, MEPs voted by 421 votes to 273 to make substantial changes to the existing directive, including an end to the individual opt-out from the 48-hour working week, and a move to include all “on-call” time as working time. MiP’s survey of members last summer found that more than half of respondents worked between 41 and 48 hours per week, with a

and social care, you must welcome the above, even the negative stuff. If healthcare management didn’t matter much, it wouldn’t matter much if PCTs were up to the job, if there were any BME people at board level, or if chief executives were held responsible for quality. We can flip this criticism into a positive acceptance of the important role of leaders and managers in making healthcare happen. MiP will back the Nicholson agenda to the hilt. We will help BME staff challenge the NHS over race equality and support the national BME conference on 5 June.

disturbing 22% working over the 48-hour limit. MiP chief executive Jon Restell said: ‘If the NHS is serious about promoting healthy workplaces, it needs to get its own house in order by tackling the long hours culture and promoting a healthy worklife balance.’ But relief may be some way off. The Parliament has equal decision-making powers on this legislation with the Council of Ministers, but unless the Council accepts all the amendments, discussions will continue between the two institutions with a view to finding agreement before the next European Parliament elections in June 2009. Full report of the MiP health managers survey:; Details of proposed amendments to the working time regulations at

We will argue for fairer and more objective accountability for managers and leaders. This is not just big picture: MiP makes no apologies for robustly supporting any individual member who seeks fair and open accountability or race equality. Finally, leaders and managers are a valuable resource. They deserve the same care and attention to their pay, conditions, career development and working environment as any other health workers. Valuing staff includes valuing leaders. That’s why we will champion the NHS Constitution until our voices go hoarse.


Transforming community services The Department of Health has published guidance for PCTs on transforming community services. The guidance states there is no national blueprint and change must be locally driven. But it does set out a framework of guiding principles which should inform the process. ‘No-one could fault these, as long as PCTs do adhere to them,’ said MiP chief executive Jon Restell. ‘Of particular note, the document emphasises the need for early and continued involvement of staff, trade unions and stakeholders before any decisions about service provision are made.’ The guidance reminds organisations of the need for good workforce practice and stakeholder engagement, and clearly states that early

engagement with staff and trade unions is central to success. MiP members can use these guidelines to ensure that they are properly involved in the decision making process. MiP and the other health unions have produced a guide for staff to help you make sure that PCTs follow these principles. It is available at, with a link to the DH guidance.

Coming up

NICE guidance on long-term sickness At the end of March, the National Institute for Health and Clinical Excellence (NICE) is due to publish public health guidance for primary care trusts and employers on the management of long-term sickness and incapacity. The guidance will be available at

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Making healthcare happen – on DVD! MiP has produced three new videos showcasing innovative projects which embody the spirit and principles of the NHS Constitution: ■■ the Sandyford sexual health clinic in Glasgow, which has transformed its services and is going from strength to strength ■■ the Positive Mental Attitude Football League – an innovative approach to mental health in East London (pictured) ■■ the Breast Unit at

Pilgrim Hospital in Lincolnshire, where staff have implemented the Breakthrough Breast Cancer service pledge to improve the patient experience. These projects show the whole healthcare team at its best – managers working with clinicians, therapists, admin staff, service users and local communities to provide dignified healthcare. They should inspire others to set up similar projects or try new ones. Take a look at the case studies for yourself at: makinghealthcarehappen.


Careers boost for healthcare science The UK’s four healthcare departments have published proposals to transform career structures for the 55,000-strong healthcare science workforce. The consultation document Modernising Scientific Careers: The Next Steps sets out a vision for ‘a world class healthcare science workforce delivering high quality NHS patient care in a variety of settings and as part of multi-professional teams’. In England, it is part of the workforce implementation plans resulting from Darzi’s Next Stage Review and A High Quality Workforce. It claims to offer a more consistent, flexible and transparent career structure for healthcare science workers, with benefits for patients, employers, health commissioners and staff. Under the new model, the current 40-plus entry routes 4

into training would be streamlined into more clearly defined stages of training and career pathways provisionally designated as “Healthcare Science Assistant”, “Healthcare Science Practitioner” and “Healthcare Scientist”. Individuals will be able to progress through the stages – potentially up to Consultant-Scientist – by gaining the relevant qualifications and experience and competing successfully for available opportunities. Progression into management will also be available. Describing the Modernising Scientific Careers (MSC) programme as “bold and ambitious”, Professor Sue Hill, the Chief Scientific Officer, said: ‘The healthcare science workforce plays a crucial role in making the benefits of 21st century science and innovation an everyday reality for NHS patients. The MSC proposals will help them deliver further improvements to patient care by ensuring they can achieve their potential in their future careers, and that their important contribution is more widely recognised.’ Professor Hill also said

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Healthcare Healthcare science staff are employed in Science some 50 disciplines across the NHS within life sciences (e.g. pathology, genetics, Workforce

embryology), physiological sciences (e.g. audiology, ophthalmology, urodynamics) and physical sciences and engineering (e.g. nuclear medicine, clinical engineering, diagnostic radiology).

Accounting for approximately 5% of the NHS workforce, they make a key and often unique contribution to patient care through: ■■ Delivering the diagnostics and investigations which underpin 80% of all clinical decisions ■■ Developing and using technology to improve care ■■ Finding scientific and technical solutions to support high quality care in a range of settings employers needed to improve workforce planning, to better match supply and demand and optimise the skill mix in response to changing patient demands and service models. ‘More broadly based training is intended to give trainees a wider knowledge and skills base, potentially enabling them to work competently and flexibly across a wider range of disciplines. ‘We very much welcome the views of all those with an interest in delivering high quality

care to patients and in how healthcare scientists can make their full contribution.’ The UK-wide proposals were developed in detailed discussions with nearly 3,000 stakeholders throughout the four countries. The consultation period continues until 6 March 2009. The consultation document and electronic response form is at: Tracey Adamson


inperson Amrit Kaur: a member of MiP, works as a divisional human resources manager for the integrated medicine and accident and emergency departments at Barnsley Hospital Foundation Trust in Yorkshire.

“MiP can influence national political decisions about things that affect every one of us.”

Amrit has worked at the hospital since October 2005 having previously worked for ten years in HR in Florida. ‘My role is to ensure the HR department provides an effective, professional and strategic HR service to the trust and is seen to add value to the business units and to the managers and employees. ‘Enabling and supporting managers in the planning and shaping of their workforce…is key to ensuring a positive impact on service delivery and direct impact on the patient experience.’ Amrit joined MiP in August 2007 and says it is the first time she has been a member of a trade union. ‘I was prompted to join by my line manager, Robert Quick, who is on the national MiP committee.’


Neil’s knighthood MiP member Neil McKay, chief executive of NHS East of England, was knighted in the Queen’s New Year Honours List for services to the National Health Service. Neil has spent his entire career as an NHS manager, entering his first ward as a trainee administrator in 1970. He has also run some

She explains that she was interested in joining MiP because it ‘specifically represents managers in healthcare. MiP also provides a strong management network and representation in terms of expert employment advice.’ ‘In this volatile economic climate MiP can influence national political decisions about things that affect every one of us, such as pensions, managerial accountability and pay.’ Amrit sees MiP’s national conference as invaluable. ‘The discussions about both employee engagement and the implementation of the NHS Constitution were really relevant to me.’ She would not hesitate to recommend that other NHS managers should become

MiP members. ‘For other HR managers, especially, there has been a period of change in the NHS over the last 18 months and getting support from MiP has been very helpful. I would recommend membership to others without hesitation. So is there anything that MiP could improve on? Amrit suggests that MiP consider holding quarterly seminars on key managerial issues. ‘Specialist lawyers often offer managers’ seminars on particular employment law subjects; perhaps MiP could do the same,’ she says. Helen Mooney

of the largest hospitals in the country, in London, Leeds and Sheffield, served as regional director for the Trent region, and deputy chief executive of the entire NHS. ‘I am delighted to receive this honour on behalf of the 125,000 staff in the region and the thousands of volunteers and carers who make this service work every day of the year,’ said Sir Neil. Keith Pearson, Chair of NHS East of England, said: ‘It is fitting that in the sixtieth

year of the NHS the Queen should see fit to award one of the highest honours she can bestow on a public servant who has been pushing forward the NHS for well over half its existence.’ Everyone at MiP and healthcare manager would like to congratulate Neil on this very well deserved award.

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Alan Clarke

MiP committee members and staff were saddened to hear of the death in January of Alan Clarke, an active member of MiP’s interim national committee. Alan had been battling cancer for some time but friends and colleagues thought he was winning. He had been talking to MiP chief executive Jon Restell about doing project work for MiP just before he died. Alan started his working life as an auxiliary psychiatric nurse at Lea Castle Hospital, where he joined NUPE. He was appointed a NUPE area officer in the West Midlands in 1978. As education officer, he pioneered the Return to Learn scheme with colleagues in the Workers Education Association. He was particularly proud of this achievement, which provides access to learning for those failed by the education system first time around. Later he moved into local government, rising to be chief executive of Watford council. He also spent time as a consultant in organisation development before returning to the NHS. His last job was at Barking and Dagenham PCT, where he was for a time acting chief executive. He joined MiP when it started in 2005 and became a valuable member of the interim national committee. Alan kept his talent and commitment to mentoring and developing staff throughout his career. He cared passionately about public services and their role in tackling inequality. As a manager and a trade unionist he strove to ensure that staff were treated with dignity and respect. Above all, he was devoted to his family, and our thoughts are with them at this sad time. MH


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Making the business case for equality Health service managers should stress the business case for diversity at the top of NHS organisations according to a new report from the NHS Institute for Innovation and Improvement. The report, snappily entitled Access of BME Staff to Senior Positions in the NHS, found that people from black and minority ethnic (BME) backgrounds were still significantly under-represented among senior NHS managers. In 2007, 8.3% of senior managers were from BME backgrounds compared to 12.1% of the working population. Researchers compared data from four Strategic Health Authorities (SHAs) – London, West Midlands, East Midlands and Yorkshire and Humberside. While ethnic minority people were under-represented in all SHAs examined, London was the least reflective of its BME population, with 15% of its senior managers coming from BME backgrounds, compared to 40% in the working population. Yorkshire and Humberside, with 6.5% BME senior managers, was the most representative of its working population (8.3% BME). MiP chief executive Jon Restell said: ‘Yet again, the NHS’s poor record at senior levels is under the spotlight. While there has been some improvement in middle

National NHS BME Network Conference

management, NHS organisations must do more to remove the barriers that hinder BME staff progress. They should listen to their BME staff to really understand the reasons for under-representation and implement effective measures to break down those barriers.’ Among the organisational barriers identified by the report were racially biased recruitment and selection procedures, the undervaluing of overseas qualifications and experience, and formal and informal networks which tended to exclude BME people. BME people were better represented in the middle ranks, making up more than 10% of middle managers. ‘This suggests that there may be a pool of talent of non-white staff at middle-management level available to increase the proportion of non-white senior management, but which would appear to be hitting a glass ceiling,’ the report said. The report urged managers to make the business case for diversity, by stressing benefits which include reduced health inequalities, more responsive and appropriate service delivery and a high-quality and well-motivated workforce. CR

In July 2008, with MiP’s support, the South East Coast BME Network published its ground-breaking report into race equality in that region. In response to the feedback, the network is organising a national conference to establish an independent national network of BME staff in the NHS. MiP is pleased to be sponsoring this conference, which takes place on Friday 5 June at the Novotel London West. For further information and to register contact Larisa Wallis, Secretary, South East Coast BME Network on


inpublic Imperial College Healthcare NHS Trust In October 2007 Hammersmith Hospitals Trust and St Mary’s Hospital Trust merged to form Imperial College Healthcare NHS Trust. It is now the largest trust in the country and has taken the lead in creating the UK’s first academic health science centre. MiP represented members during the merger and has gained over 40 new members since the trust was formed. The creation of academic health science centres is now government policy. Academic health science centres have been formally endorsed as being key to innovation in the NHS, a move pioneered by Imperial. The managerial structure of the trust means that each clinical specialty, such as cancer or medicine, has a clinical programme group board led by a clinical director rather than separate ones for healthcare, research and teaching. Imperial is applying to become a foundation trust and if successful will be the first such integrated organisation to achieve foundation status. Steve Smith was appointed chief executive of the trust in 2007 and is also principal of the Faculty of Medicine at Imperial College London. He says: ‘Healthcare is changing and we want to be at the forefront of helping

“The trust aims to spend £12m over 3 years to attract the world’s best researchers and clinicians to the centre.” patients benefit from it. The hope is that the new centre of excellence will mean that hospitals will no longer have to compete for patients to keep specialist services open.’ The trust aims to spend £12m over three years to attract the world’s best researchers and clinicians to the centre.

Smith says the organisation is a ‘genuine attempt to integrate’ the work of the university and the NHS. ‘In the past you had the NHS sitting on one side delivering the health service, and on the other side the universities delivering research and education, and while they might be close they have never been integrated.’ The university and hospital take joint decisions on professional appointments and funding. Claire Perry, previously chief executive of University Hospitals Lewisham Trust, was appointed as managing director of Imperial last year. The organisation’s latest project is pioneering two

new ‘super surgeries’ at Charing Cross and Hammersmith Hospitals to complement existing emergency care provision. The new super surgeries will be led by GPs and based alongside the accident and emergency departments at both hospitals. They will provide initial assessments of selfpresenting patients with urgent care needs, and treatment for people whose condition is best treated by a primary care specialist such as a GP or nurse practitioner. In addition, the super surgeries will build their own lists of registered patients and provide high-quality planned primary care. HM

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Letters on any subject are welcome. Please send to 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 to not be published.

to the editor

Good luck with the new magazine... Breakthrough Breast Cancer congratulates the MiP on the launch of its new magazine. As well as providing space for opinion and debate it will give charities like Breakthrough the opportunity to understand more about the issues facing healthcare managers and at the same time enable us to share ideas and examples of best practice with a key audience for us. We look forward to working with the MiP on future editions of the magazine. Maggie Alexander, Director of Policy and Campaigns, Breakthrough Breast Cancer

The launch of healthcare manager represents a maturing of the work of Managers in Partnership, the FDA-Unison joint venture which has successfully provided representation for senior managers in the NHS since 2005. It is important that members are kept in touch with their union through effective communications, and this publication is a vehicle that can do just that. I wish the magazine every success. Jonathan Baume, General Secretary, FDA

I am delighted to welcome this first issue. It is a symbol of the success of the joint-union working and commitment that established

MiP Knowledge Exchange Don’t reinvent the wheel This is by far the most interactive and useful site that I have ever had the pleasure of being part of. Assistant Adult Directorate Manager.


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and sustains MiP. Health managers face tough times with spending on public services under pressure and your decisions on allocating resources coming under greater scrutiny. Good communications are vital to keep members informed and connected to MiP. Healthcare manager will help to build and unite a vibrant organisation that remains relevant to the membership. I hope you enjoy reading it, that you find it useful and that you contribute to its future success. Dave Prentis, General Secretary, UNISON

Congratulations to MiP on the launch of healthcare manager. I hope you continue to put

MiP has teamed up with Knowledge Exchange (KE) to provide free access to the leading online community for UK health and social care managers. It’s part of our commitment to promote good management values and best practice. You can access KE through the MiP website. Almost 7,000 managers use Exchange to ask for advice and share information. You can ask about specific issues, like dealing with violent patients, ask for documents, such as equality schemes or job descriptions, and share information about your current projects or events. In Viewpoint, you can post your reactions

forward the particular MiP viewpoint, which will ensure the magazine is lively and provocative. I look forward to contributing and continuing to work in partnership with MiP to develop and improve health service delivery. Steve Barnett, Chief Executive, NHS Confederation

We wish you success on the launch of your new magazine. It provides a welcome new opportunity for managers to have their voices heard. We look forward to reading it and to contributing our views, and to continuing to work in partnership with MiP. Alastair Henderson and Sian Thomas, Joint Acting Chief Executives, NHS Employers

to challenging and often controversial opinions from our guest contributors. Recent topics include academic science centres and race equality. KE also provides: online services to help your team or network;  the latest UK health management news;  access to the latest research through our partners, the HSRN and SDO networks. 

Why not join today? Visit the MiP website at



“The NHS may not survive another 20 years unless dementia care and research is improved.”

Rebecca Wood

Alzheimer’s Research Trust

Defusing the dementia time bomb Dementia is the most important medical challenge of our time. It afflicts 700,000 people – a number expected to double within a generation – and already touches nearly half of us, through friends and family members. The economic costs are huge, threatening the very existence of our health and social services. The cost of caring for those with dementia is currently £17 billion in the UK, more than the cost of heart disease, cancer and strokes combined. In our ageing society, this figure is likely to triple to £50 billion within 30 years. A coalition of leading scientists with ties to the Alzheimer’s Research Trust (ART) recently issued a stark warning that the NHS may not survive another 20 years unless dementia care and research is improved, and this will require a vast increase in research funding. As a research charity, we understand that the answers to this epochal social and economic challenge will come from science. Last year we funded over £3 million-worth of world-class research into Alzheimer’s and related dementias in a wide range of areas. We do not know the causes of Alzheimer’s, and there are no fully effective treatments, so we are deliberately taking a multi-pronged approach, exploring every promising avenue of enquiry. We are funding more

dementia research than ever before, with each study bringing us closer to an accurate picture of dementia. Over the last ten years, for example, scientists discovered some of the processes occurring in the brain that cause the symptoms of dementia. It is thought that brain cells first lose the ability to communicate with each other, before becoming damaged and then dying. We know that two proteins build up in Alzheimer’s brains, forming plaques and tangles. There’s now a great deal of evidence that this buildup, and the damage it causes to brain tissue, is central to the development of the disease. ART-funded research is underway to find out how and why these proteins accumulate, and how we might stop them. Our research has not, however, been restricted to the development of new drugs and vaccines. We have also examined the aspects of diet and lifestyle which may contribute to the risk of developing Alzheimer’s. Scientists have shown that eating a Mediterranean diet can lower a person’s dementia risk. Moreover, we have established a link between vitamin B12 and dementia, and are investigating whether fish oils could slow down dementia. We have made progress, but we urgently need to boost research funding

now to find ways to tackle dementia, as our patron Sir Terry Pratchett highlighted during his recent trip with me to meet the Prime Minister at 10 Downing Street. Dementia research receives just 3% of the government’s medical research budget, compared to 25% for cancer. We urgently need more balanced funding between the major health problems of our society. The Alzheimer’s Research Trust, funded entirely by the public, continues to invest in world-class dementia research. Unfortunately, we have to turn down two out of every three potentially promising projects that approach us for support. If we can delay the onset of dementia by just five years, we could halve the number of people who die with the condition. This will have a huge impact – it will ease the economic burden of the disease, and, more importantly, improve the quality of life for hundreds of thousands of people. Investing in research now is the only way to defuse the dementia time bomb


Rebecca Wood is chief executive of the Alzheimer’s Research Trust.

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How the Arts can help drive forward changing attitudes in health


issue 1 | spring 2009 | healthcare manager


Informative, interactive and fun. That’s some of the feedback on MiP’s second national conference, held in November. Over 200 healthcare managers met to discuss questions like: How do you put patients first when designing health services? And how can staff get fully involved in service development? Ben Page (left), from Ipsos Mori, chaired the conference and kept the pace moving. Angela Coulter, from the Picker Institute set the scene with some facts and figures about the patient experience, followed by lively debate in panel discussions

and speed networking. In the afternoon David Nicholson held a Q&A session on topics such as leadership, diversity and NHS funding. John Ryan, from Leicester Comedy Festival used comic relief to highlight serious facts about men’s health. Rosie Ilett (right) from MiP’s national committee closed the conference, saying she was proud to be a healthcare manager and proud to be a member of MiP. Keep a lookout for details of this year’s conference being held on Thursday 25 November at the Congress Centre in London. photos © Andrew Wiard 2008

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David Nicholson, chief executive of the NHS, outlines his bold scheme, setting up a national Leadership Council and launching the NHS National Leadership Awards, explains the motives behind it and why he believes it is essential for the future.

The Next Stage Review established a shared vision of an NHS that has quality of care at its heart – quality that spans safety, effectiveness and the patient experience. This has given us a common language, a way of talking about quality across the system, focused on improvement for the benefit of patients and service users. Providing high quality care is a source of professional pride, energising and motivating all NHS staff, clinical and non-clinical alike. It requires professionals to be empowered to make the daily decisions that improve quality, combined with a new and stronger accountability to the people that the NHS is there to serve. Greater freedom, enhanced accountability and empowerment of staff are necessary in the pursuit of high quality care, but they will not get us there on their own. Making change actually happen takes leadership. That is why fostering and developing leadership today that recognises the importance of high quality care is central to our expectations for the future NHS. 12

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The final report of the Next Stage Review, High Quality Care for All (HQCFA) recognised that there are many routes to excellent leadership. While not claiming to have all the answers, it identified core elements essential for those leading change to be clear about, to inspire teams to go beyond traditional boundaries for patients. Those using health services expect everyone in the NHS and beyond to work together to give them the high quality, integrated care they need and want. It is from the following elements that leadership for quality will emerge: ■■ Vision: What quality improvements we are trying to achieve and how they will benefit patients and local communities. ■■ Method: How we will make change happen – the management method we will use for implementation, continuous improvement and the measuring of success. ■■ Expectations: what the difference will mean for people, the behavioural change that will be necessary and the values that underpin it. Good leaders already exist in many parts of the NHS, but making this the standard will require a significant shift

in both our thinking and our actions. Where are we now? Although there is a long tradition of leadership development in parts of the NHS, we know that we need to do more to realise the ambitions we have to embed leadership for quality across the system. We need to recognise that in the past we have not systematically identified,


“Making change actually happen takes leadership.”

nurtured and promoted talent and leadership. While we have fantastic and talented leaders across the NHS, to take us to the next stage we need to improve the overall quality and quantity of our leaders, equipping them with the skills to make our vision a reality. Where do we need to be? We want to see an NHS that values both leaders and leadership. The challenge is to have a leadership culture that frees up staff to be accountable to the communities we serve; one that prizes evidenced-based continuous improvement. We will only be able to achieve this by firstly creating the right conditions for this to happen. To realise this it is clear that the expectations we have of leaders are fundamentally changing both in what we need to achieve and how we go about our business. In return for this, however, there will be more development and support available to help leaders advance their skills, experience and careers.

he diversity of both the wider workforce and the communities we serve. How will we get there? The findings from our research into large-scale change programmes from across the world shows that the way we lead change must be consistent with four principles: ■■ we must work together to “coproduce”, working with you on the design and development of leadership solutions; ■■ by applying the principle of “subsidiarity” we will be clear what needs to be done at what level, and will endeavour to ensure that the role of the regions and local services is the key way improvement in leadership capacity and capability will be led; ■■ we need to value “clinical engagement and leadership” in order to make real change – this will call for a system where leaders demonstrate the change principles through what we do, not just what we say; and

we must pull in the same direction. We recognise if we are going to make change happen then we will need to achieve greater “alignment” between expectations, policies and practices.


These principles have been applied in developing our approach to leadership, and they are principles we expect all NHS leaders to apply. Our approach to Leadership

We also recognise that in order to truly respond to our communities, it is essential that our leadership profile is broadened to reflect t issue 1 | february-march 2009 | healthcare manager



Development. Leadership is a responsibility at all levels across all parts of the NHS system. We have worked closely with a range of stakeholders on our approach to leadership development, and this coproduction, building on the energy generated by the Next Stage Review, is an important part of our approach. We have developed a Talent and Leadership Framework which, crucially, says that leadership development must start with every individual in healthcare. We all have a personal responsibility to continuously learn, seek development and career opportunities, spot talent and support the development of others. Organisations play a key role at a local level in developing the leaders that we need in order to commission and provide high quality services. Successful organisations create and foster conditions for talent and leadership development. They create the culture, systematically assess leadership and talent needs, develop improvement plans through their Boards of Directors or Governors, and ensure the profiles of their leaders reflect the communities they serve. In a system where leaders frequently move between organisations and sectors, employers also have a key role as stewards of talent and leadership ensuring we all have a range of aspiring leaders to choose from when filling new opportunities. All organisations are also responsible for participating in leadership improvement efforts across their region. Strategic Health Authorities play a key role at regional level. They foster investment and collaboration to support leadership development, assuring themselves that the right conditions are in place across their regions for improving talent and leadership development. SHAs will also add value at a regional level through the commissioning and provision of development programmes for senior leaders. Inspiring Leaders: leadership for quality, the guidance for NHS talent and leadership planning, is designed to support SHAs in this role. 14

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NHS The awards website will be online with information about the Leadership categories and the nominations process from Monday Awards 2 February, when you will be able to register your interest. The site goes live on Monday 2 March when peer-to-peer nominations open.

Finally, our role at national level is to create the right conditions and incentives, set standards and advocate improvement with a strong national voice for change. The National Leadership Council is being created to underpin and champion the new priority being attached to leadership in the NHS, to ensure that the system supports high quality leadership and to challenge it where it does not. Through the National Leadership Council we will continue to work with a wide range of stakeholders to build advocacy for improvement. The overall purpose of the council is to build a strong culture of leadership for health and model the importance of how leaders and leadership is valued. For example, at a national level, value will be added through investment in leadership development within the undergraduate and postgraduate curricula as well as development for the top NHS posts, and setting standards for the development of leadership for quality certificates. The council will focus on five priority areas: Clinical Leadership, Top Leaders, Board Development, Emerging Leaders and Inclusion. To recognise the ongoing efforts to improve leadership across the system, the council will also host the NHS Leadership Awards Scheme, which is designed to spread best practice and foster and recognise the best leaders for today and tomorrow. MiP has played a key role in designing this awards scheme, as part of a group of stakeholders and partners. Nominations for the seven categories of awards will be sought from March through to mid-May, and the awards

ceremony will be held in conjunction with the Chief Executives’ Conference in autumn 2009. What this means for all of us. This approach to leadership reflects the shared purpose, values and principles of the new NHS Constitution. Developed through joint-working with patients, public and staff, the Constitution reminds us of the core values of the NHS: respect and dignity, commitment to quality of care, compassion, improving lives, working together for patients, and everyone counts. It also sets out a commitment to engage and involve staff in the decisions that affect them. The ambitions it sets out can only be realised through mutual recognition of expectations and responsibilities. As the Constitution says: ‘We put patients first in everything we do, by reaching out to staff, patients, carers, families, communities, and professionals outside the NHS. We put the needs of patients and communities before organisational boundaries.’ To ensure that it remains true to the Constitution and to the vision established in the Next Stage Review, the NHS will require exceptional leadership to bring about the significant improvements for patients we are seeking to achieve. We all have a role to play in realising these ambitions for improving leadership across the NHS, and we look forward to working closely and collaboratively with you on this in the future


“Inspiring Leaders: leadership for quality”, the Guidance for NHS Talent and Leadership Planning, is designed


As NHS medical director and director-general of informatics for the Department of Health, Sir Bruce Keogh is one of the health service’s key clinical leaders. He tells Helen Mooney about his plans to develop clinical leadership and why the service will always need professional managers.

Sir Bruce Keogh is best known for spearheading the publication of mortality rates on the web in July last year, allowing patients to compare the performance of trusts on a set of procedures. In doing so, Keogh broke a major taboo, by showing that patients could be given access to outcome measures without the world crumbling. Keogh is urbane, quietly spoken and determined. His aim is to try to spread a culture of openness about quality in the NHS. As medical director, he has been charged with managing the clinical delivery and clinical outcomes of the health service; as NHS chief executive David Nicholson puts it, ‘championing clinical engagement throughout the service’. A lot rests on Keogh’s shoulders – he is accountable only to Nicholson and not to the chief medical officer for England, Sir Liam Donaldson. Keogh is a former clinical director for cardiothoracic surgery at the Heart Hospital, part of University College

London Hospitals Foundation Trust, at which he remains professor of cardiac surgery. As one of its commissioners, he led the Healthcare Commission’s work in publishing the mortality and survival rates for individual heart surgeons and hospital heart surgery units throughout the country. One of Keogh’s next big tasks is tackling the clinical leadership conundrum by getting more clinicians into management roles. ‘Good leadership is about engaging people around you. I have never known something not happen in a hospital when everybody wanted it to happen,’ Keogh says. He points to recent research carried out by healthcare consultancy McKinsey and the London School of Economics which showed that hospitals with the highest number of clinical leaders scored 50% better on key measures of organisational performance. However, Keogh is wary of lumping leadership and management together. ‘Not all leaders are good managers and not all managers are

good leaders, you can be a very good leader without being a good manager,’ he explains. Doctors in particular, he says, have many allegiances and allegiance to the organisation they work for often comes at the bottom. ‘If you take clinicians in hospitals and look at their allegiances, first of all it is to their profession, their second allegiance is to their speciality, for example if they are a dermatologist or a cardiologist, thirdly it is to the department in which they work, fourth

“Good leadership is about engaging people around you. I have never known something not happen in a hospital when everybody wanted it to happen”

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“The NHS is not good at talent spotting managers like the private sector would do – especially amongst its clinical staff.”

it’s to their hospital and fifth to their trust. The NHS is this magic dust that joins it all together.’ Keogh says the end result of this is that clinical leadership can take many forms. Clinicians can be leaders because of their clinical excellence, their innovative skills, because they are good academics, good trainers and developers of standards, or because they are effective managers. ‘Becoming a manager is not critical to your success as a doctor or nurse necessarily,’ he adds. Keogh is candid about why the NHS has so far failed to get more clinicians – both doctors and nurses – into management and leadership roles. ‘Clinical leadership should be expanded in the NHS; the problem is how we develop that,’ he says, ‘There are loads of doctors and nurses in the NHS, so why are there so few of them in management roles?’ Keogh warns that that there are multiple hurdles in the way of expanding clinical leadership. ‘There is a problem in the lack of vision to engage and attract them; the selection process into nursing or medicine seeks different attributes to people who might be leaders and managers; incentives are not structured for clinicians to go into management – there is quite low job security at the top and there are heavy financial disincentives; there is not a well-defined career path for managers compared to clinicians and often if you want to become a manager you have to organise the training yourself.’


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SIR BRUCE KEOGH: LEADERSHIP Department of Health plans for new management and leadership qualifications for clinical leaders. Level 1

Basic management training for newly appointed consultants, ward managers and business managers

Level 2

Further management training for heads of departments and clinical directors

Leadership for Quality Care Level 3 certificate

Keogh has been in the NHS long enough to know that one of the other big problems in trying to attract clinical staff into management is the opinion of colleagues and peers about people making the switch. ‘There is the cultural perception that people are going to the dark side and often clinical staff don’t understand the value of the eyes of some, although this is getting less, if you go over to the dark side you also lose some of your clinical credibility.’ According to Keogh, the Department of Health (DH) plans to encourage more clinical staff into NHS management by improving management training for clinicians. Doctors and nurses will soon be able to gain qualifications in general management and leadership. They will be able to train for a ‘Leadership for Quality Care’ certificate set to be launched by the DH in the next couple of months. The certificate will allow staff to train at three different levels, from basic management skills to the skills required for board-level posts (see box above). Coupled with this, the DH is also developing a clinical leadership fellowship programme for specialist registrars which will give them six to 12 months of management experience. ‘We will be encouraging trusts and SHAs to take that forward; we have been in touch with trainers and postgraduate deans and they seem enthusiastic,’ Keogh says. The government is also aiming to set up a series of Masters programmes for NHS

Aimed at staff hoping to move up to board level and become medical directors or directors of nursing

management. ‘It will be up to SHAs to commission this locally from their local universities and we [the DH] will match the funding they put into this,’ he explains. Keogh also wants training on the structure and management of the NHS to happen at the beginning of the careers of clinical staff, and to be integrated into the general curricula. ‘When I was training I only remember one lecture about the NHS as a system and the management of it,’ he admits. ‘We need to get this in early so people understand how the NHS works as a system, so when people come out of nursing or medical schools they don’t feel disenfranchised.’ Keogh says that clinical leadership training in the NHS has not been nurtured, is not part of the core curriculum and is not easily connected to the day-to-day job. ‘The NHS is also not good at talent spotting managers like the private sector would do – especially amongst its clinical staff.’ Keogh says he is confident that despite this things can change and some of the proposals in the NHS Next Stage Review go some way towards that. Again he comes back to the point that training is as much an issue for those at senior levels as for those who are just entering the profession. ‘There are a number of clinical service leads, medical directors and the like who have been appointed because they are good folk or are getting towards the end of their career and have got good credibility, but they have quite often found that once they

take on the managerial position they are not as well-equipped as they thought, and that they have not been trained adequately enough for the managerial role,’ he says. The government has pushed the issue of clinical leadership high up the agenda recently. Keogh explains that this is because there have been so many obstacles to its development in the past. However, he warns that general professional managers must not be forgotten. ‘There is a risk and we must not forget that clinical leaders come from one professional group and the other very, very important group is the professional managers. Ultimately, there will be a small tranche of clinicians who work as highly effective managers but this is also about teamwork and this will mean working with professional managers.’ He wants to sing the praises of general managers and wants to make sure they continue to feel valued in the job they do. ‘We have got a fantastically bright, young and energetic group of managers in the NHS at the moment and we have to engage with them as well,’ he says. Let’s hope this continues to happen


If you’d like to comment on this article please email

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Trouble on the training ground? The NHS graduate management scheme has been running for 52 years. But does Lord Darzi’s drive for more clinical managers pose a threat to the NHS management trainee? Daloni Carlisle investigates. Right about now, a few hundred graduates and assorted NHS professionals will be preparing themselves for a leadership challenge – the chance to experience a day in the life of an NHS manager. They got through rounds one and two (online psychometric testing and an interview) of the application process to join the multi-award winning NHS graduate scheme. They will find out on 20 March whether they have succeeded, when a maximum of 220 applicants will receive a letter that could be a passport to future NHS leadership. Alternatively, it could be a passport to two years of being seen as an arrogant elite by other NHS workers before watching all the plum jobs go to a new breed of clinical leaders. Kate Lobley, who took over leadership of the course when she joined the NHS Institute for Innovation and Improvement last autumn, paints a rosy picture. ‘So many ex-scheme members are in places of enormous power and influence,’ she says. The scheme, which has been running for 52 years, is hugely over-subscribed – and expects to be even more so in August 2009 when it opens for the next round of applications. It offers students a two-year programme with a mixture of job placements in the NHS and academic study leading to an externally recognised professional qualification at Master’s level. Currently it offers four specialisms – finance, human resources, general management and the newest, informatics. ‘The HR people come out with the 18

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Chartered Institute of Personnel and Development’s qualification, the finance people get a financial qualification and so on,’ says Lobley. ‘But alongside this academic component we run skills and knowledge components related to healthcare, and each graduate gets an induction to the other three specialisms. It is an integrated approach to develop leaders for the future who have real foundations and understanding. ‘There is no problem finding placements for students on the scheme,’ she says. ‘One of the things that make it so successful is the support from the service, not only in terms of placements but also in terms of the recruitment process which is currently run for us by NHS chief executives and human resources directors.’ The scheme’s future looks secure after Lord Darzi’s Next Stage review gave it the thumbs up in summer 2008, along with the NHS Institute’s two other leadership courses, Breaking Through (aimed at black and minority ethnic

candidates) and Gateway to Leadership (aimed at attracting senior talent from outside the NHS). But Lord Darzi has also suggested setting up a new clinical management course to develop doctors’ management skills and offering them financial incentives to move into management. Couple this with development of the academic health sciences campuses, and their emphasis on clinical leadership, and a question arises: are the days of the general manager numbered? Absolutely not, says Sian Thomas, joint acting director of NHS Employers. ‘There is absolutely a need for the NHS to have a scheme that brings graduates into the NHS directly from completing their degree. If we don’t, then graduates will go to other sectors and we will fall behind. We need to keep promoting the NHS as a good employer.’ Ken Jarrold, an NHS Management Training Scheme alumni and director of

“So many ex-scheme members are in places of enormous power and influence. We develop leaders who have real foundations.” Kate Lobley, head of building leadership capacity


“The NHS has invested a lot of effort into the scheme but I am not sure we get follow-up.” Jon Restell, Chief Executive MiP

the consultancy Dearden agrees. ‘The service will always need general managers of high calibre who are likely to be coming in via the training scheme and I don’t think this [the Darzi clinical management agenda] will have any great impact on that,’ he says. He thinks it more likely that managers will increase their involvement in what has traditionally been seen as clinical territory – for example in waiting lists, quality and safety. ‘There will be more emphasis on quality and safety than in my day,’ he says. ‘So informatics, professional clinical engagement, greater emphasis on working with the voluntary sector or local government, all these will come to the fore. People leaving the scheme in future may not even work for the NHS but may work in the voluntary sector or a local authority.’ However, Jon Restell, chief executive of MiP, has questions about the NHS graduate leadership scheme. It is not that he doesn’t see value in the scheme – he belives it is excellent – but he has questions about the way it engages with the service, the range of people it is recruiting and the way its alumni are supported. ‘There is a hostile if unjust perception in some quarters of the people on the scheme as overly confident, arrogant and intolerant of the way NHS staff do things,’ he says. ‘They are viewed as young Turks, particularly by clinicians. ‘On the other hand, people on the scheme say that doctors view them as

Why did you join the scheme? I’d done some work in the NHS after graduating, so understood the huge challenges to deliver better services. If I was on a supermarket’s graduate scheme I’d be judged on whether I could sell more baked beans. I love that at the end of the day in the NHS I’ll know I’ve succeeded if I’ve helped support clinicians to change people’s lives. What is it giving you? A combination of training for technical skills and leadership development and some really interesting placements. By the nature of the placements, graduate trainees get a lot of interesting project work, and much more exposure to senior managers – which is really good for development. Is it attracting the right people? I think so – although I suspect we’re the wrong people to ask. Was it tough to get a place? Yes – and bound to get even tougher as the private sector “milk round” cuts back in recession and more existing NHS staff join Paul Leake is the scheme. a National Financial Would you recommend it to next year’s graduates? Management Definitely. It’s a perfect opportunity to get qualifications and Scheme experience in an area that actually makes a real difference to trainee peoples’ lives.

“bean counters”’, he adds. ‘It would take an extremely skilful management trainee to avoid such nicknames. So I have to ask whether we are giving them enough support.’ Neither Lobley nor Thomas recognise the picture he paints, although all three agree on one of the solutions: the need to target recruitment on as diverse a range of people as possible, including people from black and ethnic minorities, doctors and other clinicians. ‘I met a group of trainees a few weeks ago,’ says Thomas. ‘Out of 150, only two were clinicians. I would like to see more clinical in-service candidates coming through and more clinical people. ‘I think blurring the boundaries would be useful,’ says Restell. ‘It might lead to better understanding and acceptance of management as a resource that needs to be trained and developed, and is needed by the service.’ Lobley agrees, but warns that widening the scheme’s intake must not come at the expense of quality. ‘The scheme is absolutely wedded to quality and in the past we have not

recruited the full 220 because we have not had candidates of the right quality,’ she says. Restell’s other criticism is what he sees as a lack of support for alumni. ‘The NHS has invested a lot of effort into this scheme but I am not sure we get follow-up on what happens to them afterwards,’ he says. Given concern about the number of candidates that top jobs are currently attracting – NHS chief executive David Nicholson recently admitted that most chief executive jobs attract only one – this has to be a valid point. Again both Lobley and Thomas agree. ‘I don’t think we fully realise the potential of the alumni,’ says Lobley. ‘In terms of driving improvement and providing individuals with the opportunity to keep up their skills, we ought to provide as much support as possible.’ So, passport to a rosy future or two years of unrewarded hard slog? You tell us. Write to healthcare manager with your views and experiences


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Your own next stage review Planning a career move? healthcare manager spoke to career development expert Karen Johnson about what you should do when you feel it’s time to move on. ‘Focus on the job after next, on where you’re really heading,’ says Karen Johnson, managing director of career development consultancy Coalescence. ‘Generally, people look to do more of the same. Even if they’ve got nagging doubts, they tend to just rewrite their CV and apply for jobs, rather than developing an action plan and finding out about the different opportunities available.’ Johnson advises people to think about the role they want to be applying for in three to five years time. ‘That enables you to work back into the next job move by looking at how you can fill the intervening gap in terms of skills, knowledge and experience,’ she says. ‘Often this can broaden out your thinking and take you to a very different place than if you go down the traditional route.’ Alternatively, look to build on what you’ve already achieved. ‘Think about what you really enjoy about your current role and what you’d prefer not to be doing,’ says Johnson. ‘It’s about moving away from saying, “I want to be a director of something”, and looking at where your skills lie, at what’s your experience is going to give you. ‘You should focus on your achievements – where you really feel 20

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you’ve made a personal mark – and the things you feel you haven’t achieved yet, without linking it to a specific job at this stage. Think about where you can stretch your skills across or diagonally up. Then think about who can give you more information, who might give you an opportunity to shadow, do a project or a placement.’ You’ll also need to look at things that might stop you getting there. These can be obstacles within yourself (e.g. lack of confidence), obstacles relating to your

“It’s about moving away from saying ‘I want to be a director of something’, and looking at where your skills lie.” present environment or the environment you want to move into (e.g. timing your move to fit in with local changes or national initiatives), or obstacles stemming from other people (getting the right references and support). ‘You should end up with a list of what’s essential in your new job, what’s desirable and what you really don’t want,’ adds Johnson. ‘So when you look at an advert or think about an opportunity, you will know if it’s right for you and what you need to do to get there.’ Then you can dust down your CV and start looking for that next job. And

Tipster: Every time So your employer wants you to move on? MiP shares tips on how to go out with style. 1 Be prepared

At least once before you collect your retirement clock, you’re going to be told, ‘thanks but no thanks’. Join a trade union or professional association and get insurance now. 2 Zip it!

Say as little as possible when you are called in for the chat. 3 Me first

Disobey your instincts and experience; put your self-interest first. For doubters: “Me First” in this situation is good for patients and staff in the long run. 4 Listen & understand

In meetings, listen and remember to say as little as possible. Make notes. Say, ‘All I want to do at this stage is listen and understand what’s happening.’ 5 Another meeting

Always ask for another meeting to discuss the situation. Avoid setting a date. 6 I love you

This is the big one. Be polite, exude confidence and smile. It’s painful but will pay dividends later. 7 The great escape Don’t storm out. If you didn’t take notes, write down afterwards what you think you heard. Stay at work but prioritise – use that phone and get help.


we say goodbye…


8 OK, you have to leave

Leave, but get permission. Keep working unless told to clear your desk or if you think you might do something stupid. 9 What do I want?

This is critical. Work out what you want now and in the future. What’s your bottom line? You need a reference point for all your decisions. 10 Get advice & support Take advice from an expert and objective adviser. Read your organisation’s relevant policies. Rely on support from colleagues, family and friends, but remember they may be angrier than you. 11 Negotiate

Negotiate on your own unless it’s complete meltdown. Find out what’s on offer and if that’s final. Keep control of the timetable – take time to work out what you want. Keep a checklist of options (e.g. pay off, gardening leave, another job, CPD, early retirement, good reference etc.)

12 Leaving pose

Leave with dignity and celebration. Exude confidence. Give leadership to those you leave behind. You might want to work with them again.

Make a pre-emptive strike against workplace hazards The law says employers must carry out risk assessments to identify workplace hazards and evaluate the extent of the risks involved. But too many wait until a risk is brought to their attention, or someone is injured, before doing something about it. Thompsons Solicitors recently won a claim in the Court of Appeal on behalf of a union member which should remind all employers of the importance of properly timed risk assessments. In Allison vs London Underground, a repetitive strain injury (RSI) claim for an underground train driver, the court ruled it is wrong for employers to wait to carry out risk assessments until after a hazard is brought to their attention. Employers have a duty to assess risks regardless of whether any potential hazard has been brought to their attention, the court said. The claimant developed tenosynovitis in her right wrist from using the “dead man’s handle” on Jubilee line underground trains. Her employer knew there was a risk of work-related upper limb disorders from

using the handle, so when designing the Jubilee Line trains it consulted some experienced drivers and experts, including an ergonomist. But when two drivers suggested changing the design of the handle to make it more comfortable to hold, ergonomists were not consulted. The new handle was given a ‘chamfered’ end but drivers were not told how to hold it. Many drivers found the chamfered end a comfortable resting place for their thumb. But this led to the claimant developing RSI. Only after it became clear that the handle had caused the condition did LUL instruct drivers in the correct way to hold it. The appeal court said the employer should have known new or redesigned equipment needed to be risk assessed, and employees trained in using it. Risk assessments should be ‘a blueprint for action’ and it was not enough to provide training after the risks were known


Judith Gledhill, head of personal injury at Thompsons Solicitors.

NHS casebook An NHS trust clerk who developed back pain after years of sitting in an unsuitable chair at work is pursuing a compensation claim. The case reveals the trust’s failure to act even after she reported that her workstation was causing the pain. Occupational health carried out an assessment and agreed the claimant’s workstation was unsuitable. But nothing further was done. Even after moving offices, the same style of furniture was used and risk assessments were not carried out. Occupational health advised the claimant to order a new chair, but she struggled to get the request agreed. Months passed and the claimant developed pains in her neck, shoulder, hip and legs. She received physiotherapy and was off work for several weeks. She eventually found another job with another NHS trust where the workstations were properly set up. But the impact of her former employer’s failures have been longlasting. Still unable to do day-to-day things like housework, her compensation claim is likely to be substantial.

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Partnership in practice The Health and Social Care Information Centre Maternity Policy MiP works in partnership to improve working lives for managers. Julie Stroud and Katharine Robbins share the MiP link role at the Health and Social Care Information Centre and sit on the joint negotiating committee. A lot of what they do is common sense. Management and staff representatives have a common purpose – to improve working lives. They may, of course, disagree about how to achieve that, but then find a solution through discussion. MiP members can raise issues with the link members, and they take them forward through the committee. When new policies are developed, MiP members are consulted and Katharine and Julie can check with MiP, using their expertise

about legislation and good practice to inform responses. Recently, the Information Centre updated its maternity policy and MiP fed in comments. Most of these were acted on, such as clarifying the procedure for return to work. Julie also suggested producing an aide mémoire to answer frequently asked questions. Jacqui Sproat, HR business partner, was happy to collaborate. They met with staff who had recently been on maternity leave and listened and learned from staff experience. The aide mémoire clarifies who needs to do what when and how to claim benefits like childcare vouchers and allowances for those not entitled to statutory maternity pay. The result is a user-friendly guide which should make life less complicated for pregnant staff, their managers, and of course HR. So everyone should benefit from this little bit of partnership work instigated by MiP. If you want to know more about becoming an MiP link member, contact your national officer, or phone Marisa Howes on 020 7551 1167


Extract from the Health and Social Care Information Centre Maternity Policy Aide Mémoire


Who should inform HR and when? The line manager as soon as the member of staff informs them. HR will then arrange a health and safety officer to carry out a personal risk assessment for them. Do I have to do anything before I return to work? Prior to your return to work you would need to discuss with your manager your reporting instructions for your first day back. On your return you and your manager must complete a payroll change form to end your maternity leave period and reinstate your salary. These are available on the Intranet.

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Regional Briefing

Wales 2009 will be a year of upheaval in Wales as many NHS bodies are reorganised and new Local Health Boards (LHBs) set up. Some senior managers could face redundancy while many more may be forced to move to new employers. Some new organisations may be up and running as early as June. MiP is supporting members in Wales every step of the way. Shortly before Christmas, MiP members met with officers and lawyers at a special meeting in Cardiff to discuss the changes. Finding suitable employment was the key concern of most members, with many rightly worried about having to accept jobs that are unsuitable or not commensurate with their status as directors. ‘Although status is important, there

Some of the issues raised by MiP in response to members’ concerns about the re-organisation of the NHS in Wales An ‘extended employment scheme’ and/or clearing house for displaced managers Why managers facing redundancy are not being given prior consideration for new CEO posts Why jobs were advertised before the second stage consultation had been completed Treatment of people in unaffected organisations who still find themselves at risk of redundancy How to frame the ‘pools’ from which candidates for new posts will be drawn


helping you make healthcare happen MiP is a new kind of trade union organisation set up to represent the interests of managers in the UK’s health services. As the NHS has grown, the role of healthcare managers has become more complex, and MiP provides services tailored to help you make healthcare happen and to pursue your personal goals.

are no black and white answers,’ says MiP chief executive Jon Restell. ‘But MiP believes that a board level post carries a widely accepted career status, which employers must consider when assessing alternative posts in new structures. ‘MiP supports changes that will improve healthcare for the people of Wales, even if they affect the job security of our members,’ added Restell. ‘But there is a real risk of these changes being pushed through too quickly, with good practice and even legal duties being swept away in the urgency. This will damage the effectiveness of the changes and will be challenged robustly by MiP.’ Members needing advice on the changes in Wales should contact MiP national officer, Andy Hardy (a.hardy@ A confidential advice note will be available from MiP head office

This magazine gives you a flavour of some of the work we do to promote the interests of healthcare managers: 

We work in partnership in the workplace, regionally and nationally to put forward the particular viewpoint of managers;

We represent our members’ employment interests, individually and collectively, for example, during major reorganisations;

We organise conferences and seminars so that you can hear directly from key players in policy development and meet and share experience with colleagues across the UK;

We promote good management practice and provide guidance on this.

Join MiP today, and you will join a network of over 5,000 healthcare managers. To join online, and for more information about MiP, visit our website at, or complete and return the slip below to Billy Turner, MiP, 8 Leake Street, London SE1 7NN.


I wish to join MiP

The use of assessment centres to select new postholders

Please send me further information

Consultation with MiP about the contracts, pay and conditions of the new posts


Clarification about the position of people seconded between affected organisations


Access to Agenda for Change (AfC) redundancy terms for people who do not have AfC contracts Ensuring grievance and appeal procedures comply with statutory and occupational standards and involve some degree of external objectivity.


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Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@

backlash Overheard…

‘Whilst I am open minded, my father was most distressed that a gay man was next to him and all his gay friends came to visit. So when are we going to have same sexuality wards?’

by Celticus

Counting Beans According to the Daily Mail (11 December), the cost of NHS ‘bureaucrats’ (that’s you) rose to £1.3 billion in 2007/8. The Mail’s story was lifted from a ‘study’ by the Conservative Party, who derived the figure by adding up numbers from the annual reports of PCTs and SHAs Even if the figure is accurate, the 8.1% rise over two years is almost all down to inflation (7.5% over the same period) and far lower than the overall growth in NHS spending (around 21%). So the proportion of spending on these ‘bureaucrats’ has actually fallen significantly. The only other taker we could find for this non-story was the Plymouth-based Western Morning News – owned by the Daily Mail

Group. Furthermore, the Conservative Party’s press officer in the South West region is Duncan Sandes, a former journalist for – you’ve guessed it – the Western Morning News. Good to see such a shining example of joined-up working.

Mixed messages Mr Secretary Johnson is threatening to fine the 15% of trusts with remaining mixed-sex wards if they haven’t got rid of them entirely by 2010/11. But Celticus can’t help wondering that, if hospitals are operating at 98% bed occupancy, the Department is going to have supply managers with a pretty sophisticated crystal ball if they’re going to get the male/female ratio dead right every time.

Phrase Book

DeepDive (n., vb.) A sort of 21st century version of the once-fashionable ‘awayday’, deep diving involves ‘Hot Teams’ working rapidly and intensively on a particular problem. According to consultants Deloitte, who own the US trademark, the DeepDive™ ‘is a combination of brainstorming, prototyping, and feedback loops merged into an approach that executives can use with teams to help develop solutions for specific business challenges.’ The good news is that deep diving can be done in as little as half a day with no need to book a hotel on the Costa del Sol. Otherwise known as: ‘immersion development’, ‘problem solving’, ‘a meeting’.


issue 1 | february-march 2009 | healthcare manager

Wrong number!

Your 10% pay rise ‘Health bosses collect 10% pay rise’, Daily Mail, 27 January No Mail reporter was willing to put their name to this. The ‘10%’ figure has nothing to do with ‘pay rises’. It was arrived at by comparing the average salary of trust chief executives (and only chief executives) this year with last year. This figure rose from £133k to £146k. Ergo, they all got 10%. Never mind that they won’t be the same people. Never mind they won’t even be the same jobs. Or even, in some cases, the same organisations. Shame on you, ‘Daily Mail Reporter’, whoever you are! Wrong Number! exposes misleading statistics used to attack people working for the NHS. Send your examples to

Or are hospitals with empty beds going to turn patients away because they’re the wrong sex? And what will our friends in the press make of that?

A case of misunderestimation? Red faces all round when it emerged that BMA chair Dr Hamish Meldrum’s own GP practice had won a contract to run a Bridlington polyclinic. The BMA’s ‘Support Your Surgery’ campaign has vigorously opposed the new clinics, with Hamish himself condemning them in lurid terms at last year’s BMA conference. Now, a slightly sheepish Hamish says: ‘The BMA’s

stance was slightly misunderstood…I agree that the way some colleagues put out information was alarmist.’ Such colleagues presumably include the ‘Save our Surgeries’ campaign (note the subtly different name), which insists polyclinics ‘will lead to the demise of your family surgeries and your healthcare will be run by companies with their own profits coming before your needs’. This is despite more than 70% of polyclinic contracts going to GP consortiums like Dr Meldrum’s. ‘I am aware people will try to make political capital out of this,’ Hamish ruefully told the BBC. He’s not wrong there.


Using research to shape and improve NHS services – join the SDO Network

opinion DID YOU KNOW Rebecca Wood Alzheimer’s Society

Thompsons is the most experienced trade The Service Delivery and Organisation (SDO) Network supports NHS managers to use research to improve and develop the services they manage. • The Network offers a range of services customised to the needs of senior, middle and new NHS managers to support them in developing leading-edge services. • Member services include: events which bring together the latest learning from research and the experiences of front-line NHS managers, action learning sets, chief executives forum, academic fellowship placements and support in conducting and sourcing the latest research. • Membership is free, join the SDO Network today.

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or visit issue 1Solicitors | february-march manager 03 Thompsons is regulated2009 by the| healthcare Solicitors Regulation Authority

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The Service Delivery and Organisation (SDO) Network supports NHS managers to use research to improve and develop the services they manage. “...