issue 17 spring 2013
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GETTING ON TOP OF DIVERSITY FRANCIS REPORT: WHERE NOW?
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Members of MiP have access to a range of benefits provided by our partner organisation through UNISONplus. More often than not, these benefits will be on an exclusive basis with leading companies. But it isn’t only excellent terms and value for money we look for in a potential Partner. The products or services they offer have to be among the ‘best in class’. They must share our values and deliver a high quality service, including straightforward call-handling and easy-to-navigate websites. On the UNISON website you’ll find full details of all the criteria we look for, before we award companies with our official Partner accreditation. All you have to look for when you are looking for a name you can trust is the UNISONplus logo. For more information visit www.unison.org.uk and click on the UNISONplus logo or call MiPLink tel 0845 601 1144. You could save the cost of your subscription many times over and guarantee yourself the value for money that you and your family deserve.
issue 17 spring 2013
healthcare manager inside
What you might have missed & what to look out for Leading edge: Jon Restell inperson: Gail Thomson, NHS Grampian inpublic: Bassetlaw Clinical Commissioning Group
letters & comment:8
Kevin Williamson: better housing for better health
features:10 published by
Managers in Partnership www.miphealth.org.uk 8 Leake Street, London SE1 7NN | 0845 601 1144 Managers in Partnership is the trade union organisation providing support and advice to senior managers in healthcare in the UK on employment matters, careers and management practice. We represent their views to policymakers, employers, the media and the public.
Coaching: Lis Paice on the mutual benefits of coaching Francis Report: we ask key commentators for their conclusions Interview: Andrew Goodall gives his views on integrated healthcare in Wales Diversity: initiatives to bring diversity to the top
Legal Eye: restrictive employement practices Tipster: how to respond to whistleblowing MiP at Work: dealing with workplace bullying
healthcare manager | issue 17 | spring 2013
Welcome to the spring issue of healthcare manager, the magazine from MiP, the specialist trade union for health and social care managers. As we go to press, we are just days away from the seismic changes that will take place in commissioning services in the NHS in England. This is causing major upheaval for thousands of managers, and there is concern that it may have an adverse effect on black and ethnic minority managers. We look at the current state of play. The restructuring doesnâ€™t seem to contribute much to the improvement of services that Robert Francis calls for in his report on Mid Staffordshire. We hear reactions to the Francis report from a number of commentators, including the Scottish and Welsh perspective. Speaking of Wales, we have an interview with Andrew Goodall, head of Walesâ€™s biggest health board, about their very different response to the challenge of meeting increasing demand with tighter budgets. We also have our regular features, including In Public, looking at one of the new Clinical Commissioning Groups set up in England, Legal Eye and MiP at Work. I hope you enjoy the magazine. Do let us have any views or news. Marisa Howes Executive editor
heads up what you might have missed and what to look out for
New guidance for Scottish appraisals NHS Scotland has published a new interactive good practice guide for performance management for executive and senior managers. In Scotland the performance management system supports the remuneration policy for Executive and Senior Managers, so it needs to be a robust process which ensures consistency and fairness. The guide is designed to support all staff involved in the performance management of senior managers, and help staff deliver their organisation’s objectives and achieve their personal objectives by providing a useful step-by-step guide to objective setting and performance appraisal. The guide was produced by a partnership group comprising representatives of chief executives, HR and OD directors and the health unions.
MiP national officer for Scotland Claire Pullar said: ‘We welcome the publication of this guide. It links performance management, objective setting and personal development to the overall Quality Strategy for the NHS in Scotland. At last we have joined-up thinking in this important area.’
Bridging the Gap The Whistleblowing Helpline, which provides free, confidential and independent advice for people working in the NHS and adult social care, has launched a campaign aimed at helping staff feel more confident about raising concerns at work. The ‘Bridging the Gap’ campaign aims to encourage a culture where all individuals feel safe to raise concerns and where managers are equipped to respond confidently and effectively. For more information telephone 08000 724 725 or visit visit wbhelpline.org.uk. See p21 for our top tips for managers handling whistleblowing at work.
issue 17 | spring 2013
Marisa Howes email@example.com
ISSN 1759-9784 published by MiP
All copy © 2013 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
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10% discount for MiP members Annual Patient Information Conference Thursday 2 May 2013 St Johns Hotel, Solihull
The eighth annual conference of the Patients’ Information Forum takes place at a time of growing pressure to make health information more accessible. Delegates will hear about important projects such as the new information on cancer screening, glean the lessons learned from information prescriptions and discover how to ‘build the case’ for information – bringing together the health, economic and patient benefits of providing information. Breakout sessions will explore the core topics of evaluation, cost effectiveness, dissemination and reaching your audience. MiP members get a 10% discount on the registration fee. So visit the PiF website for more information and to register: www.pifonline.org.uk
David Amos, Rosemary Crockett, Ryan Dunleavy, Marisa Howes, Helen Mooney, Alison Moore, Lis Paice, Jon Restell, Craig Ryan, Charlotte Santry, Kevin Williamson
© Timm Sonnenschein, Roy Peters Photography healthcare manager is sent to all MiP members. All weblinks mentioned are at www.miphealth.org.uk/hcm
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healthcare manager | issue 17 | spring 2013
leadingedge Jon Restell, chief executive, MiP
n the last two years I’ve spoken to hundreds of managers about Mid Staffs. They were united in shock, disgust and anger at the treatment of patients at Stafford Hospital. Few believed it was the tip of an iceberg, rather the worst example of the poorest performing hospitals. There was, however, little complacency. Most managers had gnawing anxieties about their own organisations, their ability to prevent a descent in standards under intense financial and operational pressure, their ability to challenge and change the system. This is why MiP welcomes the second Francis report. The detail needs debating, but Francis gives us a unique opportunity to develop a systemic culture of patient safety, care and dignity. MiP has argued strongly that three factors must be at the heart of the response to Francis: the culture of care (not its structure or even its regulation), staff engagement (clinicians, support staff and managers working well in teams) and patient voice (listening and responding to suggestions, complaints and representative bodies). Even if the government and other players get the response right, it will take excellent leadership and
“A profession means much more than having disciplinary sanctions after failure, but includes a spectrum of activity from education, registration, training, revalidation, and CPD.” management to deliver change. Ignore leadership, or reverse recent improvements in support for leaders, and the response will fail. One of Francis’s challenges is for us to value leadership and attend to its development and accountability much more than we have done. We should take on this challenge robustly. Francis sets out to support leadership and its importance. His thoughts in headlines are: Articulate the qualities of healthcare leadership. Acknowledge the complexity of management jobs. Bring some stability to leadership development, especially given the new and fragmented landscape. Start to control the quality of management, starting at board level, through a ‘fit and proper person test’. Consider the process of ac-
countability for managers. Keep regulation in the locker. Francis pulls back from regulation of managers, but he clearly approves of greater professionalisation. For him a profession means much more than having disciplinary sanctions after failure, but includes a spectrum of activity from education, registration, training, revalidation, and CPD. We need more professionalisation if we are to tackle the problem of talented managers being reluctant to take top leadership jobs in the NHS, which are surely among the best-paid and most interesting jobs in the public sector. Francis talks of the paucity of applicants (none at all for some director posts) and describes the tenure of chief executives as ‘shockingly short’. This is the result of a lack of respect for the role, a devalued package with patchy support, and poor tenure caused by weakly defined personal responsibility and the near absence of open and fair process. Sack first and then ask no questions often sums it up. We’ve got to do something about that. Francis does not provide all the answers but he sets out a leadership agenda which, if pursued properly, will help to change the culture.
Update your details Do we have your correct home address, work address, employer and preferred email address? Please take a few moments to check your membership records and make any necessary changes. Simply log in to the members’
healthcare manager | issue 17 | spring 2013
area of the MiP website and follow the prompts to update your details. Alternatively, please email us at info@ miphealth.org.uk.
Courtney Pine plays New social in support of the network to Mary Seacole Statue empower patients
Legendary jazz saxophonist Courtney Pine will play a special one-off show in support of the Mary Seacole appeal in Brixton, south London on 10 April. The show will feature tracks from Courtney’s latest album House of Legends and will be a unique chance to see this award winning artist in the intimate surroundings of Brixton Jamm. ‘This is a wonderful opportunity for me to support the appeal as I have been a long time supporter and it is great that all the musicians and the venue have waived
fees in order to make this happen,’ said Pine. Mary Seacole was voted the Greatest Black Briton in an online poll in 2004. Thousands of people recently signed a petition which successfully called on education secretary Michael Gove to reverse his decision to remove Mary Seacole from the national curriculum. The appeal is to raise funds for a memorial statue to commemorate Mary Seacole. For more information about Mary Seacole visit www.maryseacoleappeal.org.uk and visit www.brixtonjamm.org for more details about the Courtney Pine show.
A groundbreaking publicprivate partnership to develop a web portal to involve patients in the management of their care has won the accolade of ‘IT innovator of Year’ at the 2012 Health Investor awards. Cambridge Healthcare Ltd developed the portal, howareyou.com, in association with NHS East of England and the Department of Health. Through sharing information effectively with doctors, nurses, care workers and other patients, as well as family
and friends, the portal connects patients with each other and all those involved in their care and allows patients to remain in control of any decisions made. The award enabled the group to attract an additional £1m investment and the site was recently expanded to include the first ‘app store’ for healthcare apps for iPhone and other portable devices. ‘It is encouraging to see the portal gaining interest from a variety of groups particularly those campaigning for patient empowerment,’ said Cambridge Healthcare director, Alan Barrell. ‘While anyone is free to use it, the site is probably more relevant to those patients with long term conditions interested in learning more extensively about their health and how to manage it on a daily basis. Visit the portal at www.howareyou.com
Local boards gain from national cuts Funding for territorial health boards in Scotland will increase by 3.3% this year, but at the expense of a real terms cut in the budget for national services such as healthcare improvement and the Scottish Ambulance Service. The £256m increase in funding for the 14 territorial boards
is 1.3% above inflation, but funding for special boards will rise by only 0.2% in 2013-14, a fall of almost 2% in real terms. The Scottish Ambulance Service will see its budget rise by just 1% this year, while Health Improvement Scotland suffers a cut of more than 4%. Health Secretary Alex Neil claimed the Scottish
Government would ‘protect’ spending on health but expected all health boards to deliver further efficiency savings. ‘Despite a difficult economic climate, we know how important it is that we continue to invest in our NHS – that is why we have protected health spending so we can continue to
deliver a first class service to patients across the country,’ he said. While all health boards will be asked to make efficiency savings of at least 3%, a Scottish Government spokesman said non-patient facing health boards [are] being asked to demonstrate even greater efficiency measures’.
healthcare manager | issue 17 | spring 2013
inperson Gail Thomson, Unit Operational Manager for Obstetrics,
“If my job didn’t exist, I think there would be a fair bit more chaos than there already is.”
Gynaecology, Neonatology, NHS Grampian
Gail Thomson has worked in the NHS for the last 22 years, climbing the career ladder through clerical and administrative roles, and today she is in charge of the operational management of obstetrics, gynaecology and neonatology service across NHS Grampian. She admits that coming into the NHS at the age of 20 was just about getting a job, however she quickly discovered that the post gave her a lot of job satisfaction. ‘Even in a clerical role I felt that I was helping and making a difference to people,’ she says. Gail had spent the last ten years working as unit operational manager in paediatrics before taking on her new role last summer, in part she says because she wanted to help implement the recommendations of NHS Grampian’s two year maternity services review. Currently Grampian maternity services are managed separately in Aberdeen, Aberdeenshire and Moray. However, Gail explains that many women will use services in more than one area and the outcome of the review means work is now underway to have one Grampian-wide maternity service delivered in multiple locations. ‘We are now in the implementation phase [of the review], so my job also involves helping make the services we provide as local as possible to the community,’ she explains. Gail’s job involves a raft of general management tasks, including managing medical, clerical and midwifery staff, as well as balancing budgets and other financial work, and helping to run the specialist tertiary maternity hospital service for all of north-east Scotland. ‘Our
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population size might be smaller than some of those in England but that makes it even more important that we deliver a sustainable service,” she says. Her team includes a medical director, a head of midwifery and senior midwives in both neonatal and gynaecology. She is based in Aberdeen but the service covers a large geographical unit stretching up to Inverness, Shetland and Orkney. She admits that staff pressures are getting ever greater and that the service is now ‘paired back to the bone’ in terms of staff numbers. ‘I would say that I am constantly fire fighting and staff pressures are such that if one midwife is to go off then it can really throw the service, and my day-today job is about keeping the rota sustainable,’ she says. ‘Reductions in management mean that the NHS is a much more pressured place to work than it was even five years ago,’ she adds. In Scotland NHS organisations have been set the target of getting rid of a quarter of all managerial positions and Ms Thompson warns that the impact this is having on the time that clinicians are able to spend with patients is already evident.
‘If my job didn’t exist, I think there would be a fair bit more chaos than there already is. There needs to be somebody to have an overview and pull together and protect the time of the head of clinical services, and I think if clinicians had to do this it would not be the best use of anybody’s time.’ She warns cuts to management have simply piled more pressure on staff. ‘I can definitely see the pressure, the gaps in staffing and the problems it creates and the impact it has on clinical staff. In my view it is a false economy to take managers out of the system.’ Helen Mooney
Tribute to WWI hero
Liverpool’s Walton Centre Trust has opened a new ward named after Noel Chavasse, an army doctor who was the only person to win two Victoria Crosses during World War I. Four of Captain Chavasse’s descendants attended the opening of the new
ward by Major General Ewan Carmichael, director general of Army Medical Services (pictured above). The official naming of Chavasse Ward follows the neurological hospital’s tradition of naming wards after eminent doctors and scientists.
Major General Carmichael said: ‘It isn’t easy to win a Victoria Cross as it involves facing almost certain death while performing an act of courage. To do it twice is tremendous and Noel Chavasse is at the top of a very special group of people.’
MiP has confirmed the election of Zoeta Manning as its national chair. She replaces David Amos, MiP’s first chair, who stood down at the end of last year. Zoeta, who represents the West Midlands on the national committee, has just taken up a new role in Birmingham South and Central CCG. Speaking after her election
Zoeta said: ‘The NHS is 65 years old this year and it’s still going strong. It’s still the institution that British people are most proud of, but it has taken a battering over the past few months. Now more than ever, healthcare managers need a specialist trade union and MiP will continue to speak up for them and support them to keep the NHS show on the road.
Zoeta Manning elected chair of MiP ‘David Amos is a hard act to follow – but with his support and that of the rest of the national committee, I am looking forward to the challenge.’ Outgoing chair David Amos said: ‘I hand the MiP baton over to Zoeta confident that she will be an excellent chair, and that under her leadership MiP will continue to grow in numbers and stature. I had
the immense pleasure of chairing MiP from its birth through its formative years. Now is the right time to hand over to Zoeta, who can take us through the next phase of MiP’s development. She has great energy and enthusiasm and a deep commitment to the values of public service and of MiP.’
healthcare manager | issue 17 | spring 2013
inpublic Bassetlaw Clinical Commissioning Group Bassetlaw CCG is one of an élite group of eight clinical commissioning groups authorised by the Government in December last year without conditions. As a ‘wave one pathfinder’ the CCG will, from April, officially take over from the local primary care trust and become an authorised statutory NHS body, responsible for commissioning £140 million worth of services for its local population. Formed in April 2010 by a group of local GP practices, the CCG is unusual in having already begun its work before the Government had officially announced its decision to scrap PCTs. Bassetlaw’s chair Dr Steve Kell explains that local GPs were already aware that the PCT was under threat because of its small size, so they wanted to ensure there was a ‘strong clinical voice around clinical commissioning’. ‘We advised and worked with the PCT until January 2011, when we then started to work as one organisation with the PCT,’ Kell explains. ‘We were lucky because the PCT was really willing to let go and let there be clinical leadership,’ he adds. Kell says that one of the key drivers for the organisation is ensuring that there is a ‘focus on quality all the time’ in the services that are commissioned and provided for patients. ‘We are also transparent, so we are open about what we are commissioning and providing, and we are consulting more than ever with our local population.’ Dr Kell highlights a dementia summit held by the CCG earlier this year which brought together over 100 carers, professionals and partners including surgeries, hospitals, voluntary services and emergency services, and where the local population signed a pledge that Bassetlaw would become “dementia friendly”. However, the past year has been a ‘really difficult year for staff,’ Kell admits. ‘There has been a lot of change and uncertainty about where staff would be allocated. As a CCG we have a challenge in that we have a healthcare manager | issue 17 | spring 2013
“we are open about what we are commissioning and providing, and we are consulting more than ever with our local population.”
BCCG membership meeting
small team but at the same time this gives us more opportunity to be flexible and progressive and we don’t have a very hierarchical system.’ Kell says that while the CCG is not making extensive use of the support of South Yorkshire and Bassetlaw Commissioning Support Unit with which they have a contract, the CCG does have staff, through an ‘embedded staff model’, based in the unit. ‘I think in terms of commissioning support working well, the key thing is that staff working within those organisations also have a sense of responsibility for improving the service.’ And for the system to knit together well he says that the role of Health and Wellbeing boards will become increasingly
important too. ‘They will be the place where the oversight of CCGs, local authorities and the Commissioning Board locally comes together, it will be great if they can create a genuine governance model for this.’ Dr Kell says he is optimistic about how the new NHS system will work, with the caveat that organisations and individuals need to work to their own strengths. ‘I think clinicians have a real local understanding of local health needs but we have to see ourselves as part of a system. CCGs have not got all the power and clinicians working closely with managers will be really important, having one without the other does not work.’ Helen Mooney
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.
to the editor
A contractless payment system I can’t help but think that the NHS Commissioning Board is taking advantage (I could put it more strongly, but will refrain in the interests of politeness). To recap... during the current transition many poor colleagues have lost their jobs. We have, in the process, lost organisational memory, local intelligence and put at risk safe delivery of services. Many other staff have found themselves in positions they don’t want due to the insane alignment to years-old substantive job descriptions. A few colleagues find themselves lucky enough to have been promoted as part of this process, and good luck to them! However, what I find unbelievable (this is the taking advantage bit) is that staff ‘appointed’ as far back as October 2012 have still received no job offer, therefore have not accepted a job, therefore surely aren’t legally doing the job? Senior staff are now being expected to take on ‘on call’ responsibilities, as well as
increased accountability and risks without any confirmation of their new job or without seeing their new contract of employment. Can anyone think of another point in time where this would be acceptable? Many staff who find themselves promoted and commencing in post ahead of 1 April won’t apparently be paid at their new grade until 1 April, and only then will be paid retrospectively (this is of course only anecdotal) and only if they sign the new contract which has yet to be seen! Presumably they are so grateful to be in a job (albeit neither offered or accepted) that they are happy about this. Is it just me or is this surreal? It’s a jolly good job that the Commissioning Board Human Resources team are not on a payments-by-results agreement. Seriously though, can anyone give a view on the legality of the no job offer, acceptance or contract issue? name and address supplied
Croyde Bay – an unexpected pleasure Winning the raffle at the November MiP Conference was a real surprise. Discovering that I had won a stay in the UNISON Holiday Centre for four nights, I abandoned my usual February half-term idea of jetting off to Europe for a short break, and planned the drive to the coast of North Devon. Croyde Bay Holiday Resort was originally the NALGO Holiday Camp opened in the 1930s. But it is no longer the ‘hi-de-hi’ experience captured in the photography that adorns many of the bars and public areas – nostalgic pictures of bathing belles and knobbly knees competitions. With a recently developed Spa Hotel at the very centre of the complex, we stayed in a superb large and very comfortable en-suite room, with fullyequipped kitchen. The hotel boasts a reasonably sized (indoor) swimming pool with steam room sauna and jacuzzi, two restaurants and
two bars and private access to a fantastic surf beach. For us, the hotel was a fantastic base for visiting the local area, and in particular the lovely, quirky and slightly unusual town of Ilfracombe. It boasts ‘tunnel beaches’, impressive arts and the Landmark theatre centre and the spectacular, if slightly controversial, Damien Hirst statue – Verity, which towers over the harbour. This statue of a tall naked pregnant warrior woman, sword in hand, stood astride books has certainly attracted attention. The area around Croyde Bay is criss-crossed with tiny country lanes, inviting country pubs and spectacular scenery, breath-taking beaches, where, even in February, surfers are out on the waves ‘doing their thing’. For the less adventurous of us, coastal walking is certainly a pleasure to enjoy. MiP membership gives you a 15% discount, so for those members contemplating a ‘staycation’ this year, why not give Croyde Bay a try (www.croydeunison.co.uk)? Robert Quick Vice-Chair MiP National Committee
healthcare manager | issue 17 | spring 2013
comment Kevin Williamson
Assistant director, National Housing Federation
Better housing for better health and wellbeing Let’s celebrate: we’re all living longer. But, if things stay the same, we will struggle to cope – whether it’s with providing health and social care, or good housing. To compound the fact that we’re only building half the number of homes needed each year to keep up with new households, the current homes we live in aren’t equipped to care for us when we get older. And that’s a problem when, in just less than 20 years, the number of people over 65 will reach nearly 16 million.
Homes that aren’t adapted to suit older people can make their health worse, or if they’ve just come out of hospital, delay their recovery. Although there are plenty of good residential care homes for the elderly, many people prefer to stay in their homes, in a familiar setting surrounded by memories and a place where our friends and family can pop round unannounced. People like Beryl, 82, who had a long stay in hospital after having a large part of her stomach removed because of cancer. Thanks to a joint effort from Leicester City Council, the NHS and her housing association, Midland Heart, everything was prepared for Beryl’s return home – despite her not wanting to be ‘a bother’ – including plans for on-going care support and modifications to her home, such as a healthcare manager | issue 17 | spring 2013
shower seat to help visiting care staff with her bathing. With her housing support worker as the liaison point, the council’s social workers visited Beryl three times a day – reduced to twice a day after four weeks. They helped Beryl with hygiene and personal care, cooked her meals, made her drinks and helped her move about the house. After six weeks, when Beryl was coping better with day-to-day tasks alone, the council visits ended. But Beryl knew that, should she need any help in future, she would only have to call her housing support worker, who still visits Beryl to give emotional support and advice on benefits, housing issues, maintenance, as well as help with other correspondence. Beryl’s story demonstrates vividly how integrating good and adapted housing with social care services can dramatically improve health and wellbeing, and prevent the need for more care. And it won’t only help older people: it will bring independence to people with physical disabilities and provide a safe and secure environment for people suffering from mental illness. GPs, hospital staff and care professionals know this – they see evidence of it every day. Now we need a bigger effort from all of us to make this happen. And at a time when every penny counts, investing in specialist social housing
could save £639 million a year. In February, health secretary Jeremy Hunt announced the introduction of a cap on care costs based on the Dilnot report. This is a huge step forward and gives more certainty for people in meeting the costs of care, and will help care providers to plan the right services for those who need it. But this is only one part of the solution to our care crisis. Examples like Beryl’s show that by working with housing associations that provide specialist and adapted housing and housing-related support, councils and the NHS can ease the pressure on their budgets and free-up space in local hospitals and residential care homes. Since returning home, Beryl’s health and wellbeing has steadily improved. She has regained the confidence to get involved in activities outside her home. She got help with her finances and cleared her utility bill debts thanks to a trust fund. As Beryl was also eligible for more benefits, her income has increased and she can keep the heating on for longer at home to stay warm. This is how our country needs to look after its elderly. But above all else, because the local council, hospital and housing association worked effectively together, Beryl has kept her dignity. And no amount of spending can promise that. Views expressed are those of the author and not necessarily those of healthcare manager or MiP.
There’s more to coaching than just passing on your experience. But as Lis Paice discovers, it can be richly rewarding for both client and coach.
‘Learn something new.’ That was the message on the logo bugs handed out at MiP’s annual conference last November. It was one of the five ways to achieve happiness that were the subject of Professor Michael West’s inspiring keynote speech at the conference. (The other recommendations were: spend time with people you care about, exercise, live in the here and now, give and help others.) I recognised the truth of that. I had recently learned something new – I had learned to become a coach. I have to be honest and admit that I didn’t really expect this to require a lot of learning. I figured after 40 years in the NHS, coaching others to flourish in this environment would be right up my street. A doddle. I had probably developed all the skills I would need through intuition and experience. I had been around the block a few times and I had been a mentor to many younger doctors and managers over the years. I signed up to a course of training that would lead to a Certificate of Executive Coaching and Leadership 10
“What mattered was knowing how to create conversations in which clients are encouraged to think clearly and deeply about what matters to them.”
Mentoring. That sounded like a sufficiently impressive qualification to give me credibility as a coach. I went along to the ‘basic skills’ course without much enthusiasm, accepting it as a necessary ritual on the way to claiming my certificate and getting down to work. That was the beginning of a journey of discovery that was to prove full of surprises. The first surprise was that all the other participants on the course were
also experienced professionals. Clearly coaching was something people tend to take up later in their careers. For that reason, perhaps, when we got stuck into our first practical exercise in pairs, everyone approached it with confidence. The task was simple, to find out from your partner some action that they wanted to take, but had not yet managed to do, and to give them your best advice, based on knowledge and experience, about how to get it done. Noise levels rose in the room as people took up the challenge. I welcomed this opportunity to demonstrate my accumulated wisdom and was sorry when it came time to swap roles. In advising me about my issue, my partner came out with a list of things I had already tried, or would not try in a million years. He was actually quite irritating. The surprise was that it turned out he had found my advice just as irritating. No one in the room seemed to have enjoyed being advised and only one or two said they would now go away and do whatever it was they had discussed. A lesson there for doctors giving patients advice about healthcare manager | issue 17 | spring 2013
the lifestyle changes they should make. That was a great introduction to coaching skills, because it made everyone keen to discover what to put in the place of advice. We already knew the importance of developing rapport and listening attentively, but the idea of interrupting the flow quite frequently to summarise was new. It seemed rude, but in fact a brief summary of the main
Special offer for MiP members
points, using the client’s language, makes it clear that the coach has got the gist and allows the client to stop explaining and move on. Even more, just listening to an accurate summary of what they have just said, in someone else’s voice, can lead to a moment of insight for the client. So could some frank feedback on how they sounded and looked as they spoke, whether hesitant and self-deprecatory or confident and full of energy. We learned to ask more and tell less, our experience and wisdom coming through in the astuteness of the next question rather than in mini-lectures or sharing our favourite anecdotes. It was all very different from what I had expected. There were fewer set-piece exercises and techniques than I had expected, Lis Paice’s book about her although we did learn some of experiences – New Coach: these. There was more about reflections from a learning respecting, being nonjourney – is published by judgemental and recognising the McGraw Hill and is available to MiP members at 20% discount. resourcefulness of the client. It Visit www.mcgraw-hill.co.uk/ turned out not to be important html/0335246885.html and enter that I had specialist knowledge the promotional code TT13 at to offer. What mattered more was the checkout. knowing how to create
healthcare manager | issue 17 | spring 2013
conversations in which clients are encouraged to think clearly and deeply about things that matter to them, and not stop the thinking until they have reached a resolution about what they are going to do next. Easy to say, not so easy to do. I thoroughly enjoyed my ‘basic skills course,’ and once I had acquired the certificate went on to do a diploma. I now regard coaching as one of the main strands of my ‘portfolio career’ and have been struck by how much the skills I have learned doing this have been of use in the other things I do. Learning to coach made me spend time with clients I rapidly learned to care for. It forced me to live in the here and now, as I followed where the client led, responding in the moment. And it provided an opportunity to give something back, helping others by using my new skills. That makes four out of five of the ingredients for happiness, a rich haul! I can recommend it.
Professor Elisabeth Paice OBE, Chair of the North West London Integrated Care Pilot (NHS Partnership of the Year, 2012).
The Francis Report is widely seen as a damning indictment of patient care, so where now for the NHS? We ask twelve influential healthcare figures what they think of the Francis Report and its 290 recommendations.
Patrick GeoghEgAn Chief Executive and Executive Nurse, South Essex University Partnership NHS Foundation Trust
I was a bit taken aback that the report came out with 290 recommendations and I do think there is a lot of repetition in them. The recommendations have to be delivered by robust, strong, clinical leaders and if you give doctors and nurses 2,000 pages to read they will go blurryeyed. So we are trying to split it up into bite size chunks. There are three top priorities I think. The NHS needs to be a compassionate provider. It has to have the right culture and leadership, both clinical and managerial. However, I think the cornerstone of this is about courage. The NHS workforce must have the courage to stand up and be counted. We need to have a culture of courageousness, so that if staff see anything that is unacceptable they have a responsibility to whistleblow or raise it with their professional organisation or line manager. One question I would ask re Mid Staffordshire is: where were the senior doc12
tors and nurses? Why weren’t senior doctors asking why their patients were emaciated? Dr Linda Patterson Clinical vice president of the Royal College of Physicians
The first thing is for medical professionals to reflect on the standards of care that are given to patients. Patient experience needs to be regarded as just as important as clinical outcomes and this can be delivered through clinical leadership based on clinical values. There needs to be better team work-
“The NHS workforce must have the courage to stand up and be counted.” PATRICK GEOGHEGAN
ing between doctors and nurses on ward rounds to re-establish better communications. Consultants and junior doctors need to be aware of the holistic care of patients, not just medical outcomes, and all care should be compassionate and holistic. Being altruistic and compassionate should be basic professional values. Stephen Dorrell Chair of the Commons health select committee
The important thing is not to imagine that we go from a managerial to a [medical] professional culture and drop one for the other. What has been wrong in some parts of the system is that there has been an excessive focus on a limited number of areas; there is not a choice between professional standards and budgets and in the real world the NHS has to find a way of reconciling those. I think there is a new understanding of what it means to be a professional. Firstly, professional people need to be respected and their professional judgment on the best way to deliver care needs to be taken into account. But also healthcare manager | issue 17 | spring 2013
amongst professionals there has to be a more serious commitment to challenge practice and challenge standards. There needs to be a more open culture within healthcare providers for healthcare professionals to express their ‘divine discontent’. It needs to be something that is embedded, if not in the first day, then at least in the first week of training at medical or nursing school.
“This is also about training and support for all staff, including unregistered healthcare assistants and hospital porters. These staff must not be ignored.” CHRISTINA McANEA
ALEX NEIL MSP, Cabinet Secretary for Health & Wellbeing, Scottish Government
The standards of care highlighted by the Francis Inquiry were completely unacceptable. No patient should receive poor levels of care when they go into hospital. While there is no room for complacency, we are proud of the integrated, collaborative approach to healthcare in Scotland. Scotland is the first country in the world to implement a national patient safety programme across the whole healthcare system and this has resulted in a 12.4% national reduction in hospital standardised mortality ratios since 2007, and we are working towards a reduction of 20% by 2015. We are happy to share with other healthcare systems the lessons we have learned around a systematic approach to patient safety. Christina McANea Head of health at UNISON
Our message would be that the NHS needs to avoid kneejerk reactions. With 290 recommendations there has to be some prioritisation and it won’t be able to do healthcare manager | issue 17 | spring 2013
everything straightaway. Changing the culture takes a long time and in the meantime organisations need to make sure that they have got the right management structure in place. Managers need to listen and engage with their staff at all levels, and trade unions have a key role to play as a buffer between individual members of staff and organisations. They can support staff who are nervous about speaking out. This is also about training and support for all staff, including unregistered healthcare assistants and hospital porters. These staff must not be ignored, as they have a critical role to play in picking up the cultural effects on patients. There needs to be a culture of management that is about delivering effective and safe services rather than just being about protecting the structure of the organisation. Jeremy Taylor Chief executive of National Voices
The report needs to be seen as a very damning critique of what went wrong but it is not unique to one place and is an agenda for change. There is a need for a considered response [from Government] which sets out how the Francis recommendations will be implemented over time. It will not be done all at once and the Government
needs to go through each of the recommendations and ask whether they want to implement them or not and, if not, why not. The NHS must look at its accountability because bad stuff can happen and there are no consequences; it needs to look at its transparency because nobody seems to know what’s going on, and there is not a strong enough voice for patients and the public. The collective voice needs to operate in a different way and there needs to be patient leaders at every table. That is not the case yet. I think if there was a statutory duty of candour for all organisations this would have a powerful effect and organisations would have to come clean if they screwed up. The Francis Report deserves a fitting legacy and not to be sidestepped because it is too difficult. Peter Homa Chief executive at Nottingham University Hospitals NHS Trust
The Francis Report is a profoundly important report that each of us should carefully consider. The overriding requirement of the NHS is to ensure that patients are at the forefront of our practice and not institutional wellbeing. The regime of targets, whilst they have their place, has got to be broadened so that they focus on the humanity of care. We need to avoid dealing with the report through a myriad of action plans. This is about a consistent application of values to change the culture. We have to be clear about the values and behaviours of the staff we recruit to ensure they are fluent and sympathetic to the values of the NHS. There is a famous Hemingway quote: ‘We must not confuse action with motion.’ What we want is a profound set of actions to change the consistency 13
with which staff apply values and behaviours.
relationship with patients, the public and carers has to be radically transformed.
David Sissling Chief executive of NHS Wales
The general message we have taken from the Francis Report is that it represents a challenge and an opportunity for all parts of the system. There is a responsibility at all levels, at organisational level, at an individual level, and at a team level to provide high quality care. We already had a lot of the building blocks in place [in Wales] before the Francis Report but it has certainly caused us to review them. Reading the report you couldn’t help but be saddened and shocked by the scale of the failing, but we are determined to make sure that it will be used as a spur for action. Mike Farrar Chief executive of the NHS Confederation
The first thing is getting the balance right in future between external assurance on quality – I mean external to the hospital – and the responsibility within the hospital to make sure the organisation is doing absolutely everything it can to go the extra mile. It is [the hospital’s] job to make sure they have got the care and compassion, and the Government needs to address how… to create this culture within organisations. Secondly what does it take to get the right culture and how do we learn lessons from the best? This is about valuing staff and staff satisfaction, appraisal systems, asking questions about the quality of care, and it’s about organisations speaking the truth even when they are in difficulty. Thirdly, the whole orientation of the 14
Paul Corrigan Former senior health adviser to Tony Blair and adjunct professor of health policy at Imperial College, London
The main target [of the report] is culture and each of the 290 recommendations impinge upon a change of culture. Francis defines the problem quite early as defensive, in that the NHS and staff automatically react in a defensive way when anything is said about it, so it is not an easy culture to criticise. Unless there is some humility this will happen again. We need to have some humility about the fact everyone needs to be listened to...people have real experiences. I’m not saying all the [target] numbers should be ditched but since this is a public service we have to find new ways to listen to people. MiCHAEL West Professor of Organisational Psychology at Lancaster Management School
I think there are a number of issues, but picking out the number one, it is about culture. Culture is a complex concept and is like a cloud which is constantly evolving. [For] the NHS to have an active vision of high quality compassionate care that must be what people are focused on at every level, but very often the focus is on other issues. There must also be a fundamental set of goals and objectives at every level from the Commissioning Board executive team to the frontline. Staff as people have to feel valued and respected and treated with dignity
“The NHS and staff automatically react in a defensive way when anything is said about it, so it is not an easy culture to criticise. Unless there is some humility this will happen again.” PAUL CORRIGAN and we have to work hard to create this thing. When people see other people experiencing pain at some level they also experience it in certain conditions but this is more likely to emerge where people feel safe and positive and it is also about the norms within the organisation they are working. Dr Kim Holt Chair of Patients First
The main problem with patient care is about culture, with the NHS staff survey showing that one in four members of staff perceive they are being bullied, people are frightened to challenge poor standards. We have to find ways of ensuring frontline staff feel they can confidently raise concerns and feel supported. Francis talks a lot about honesty about what services organisations are able to provide and what they are not, and it would really support frontline workers if middle managers could say [to senior management] what they can provide safely and what they can’t. There also needs to be strong leadership at the top to model behaviours and a constructive dialogue – listening to each other’s opinions and not suppressing bad news. Hopefully, the Francis report will be a wake-up call that it is everyone’s responsibility to speak up.
healthcare manager | issue 17 | spring 2013
INTERVIEW: ANDREW GOODALL
Far from just revisiting the past, the Welsh NHS is reinventing the integrated healthcare system, as Andrew Goodall, head of Wales’s largest health board, tells Alison Moore.
If English health service managers ever feel a bit down about the constant criticism, the job uncertainty and the pressures of the system, there is an alternative. Across the Severn Bridge life is different – and, in some peoples’ view, better. And that difference is celebrated in Wales, although many of the issues the health system faces are the same as in the rest of the UK: an ageing population with more chronic conditions putting pressure on health services, the need to control costs, and how to deliver both accessible care and improved quality. Andrew Goodall has headed the Aneurin Bevan Local Health Board since the Welsh NHS was reorganised nearly four years ago. Like the other chief executives in Wales, he leads an integrated system, providing everything from GPs and dentists to acute hospital care. There is no provider-commissioner split – and therefore a lot of transactional features of the English system are lacking – and little use of private healthcare. Public health remains with the health boards, although they work closely with local authorities and other bodies. Even community health councils (CHCs) still exist – and are vocal. healthcare manager | issue 17 | spring 2013
“‘We are trying to show that we can deliver strategic change. We are dealing with culture.”
But far from being a throwback to a glorious past, the Welsh system faces all the same challenges as the rest of the UK in introducing change. Goodall has been lead chief executive on the South Wales reform programme which finished consultation at the end of 2012. Its proposals would see strengthened 24/7 services at some hospitals, while others would lose out. The massive reconfiguration exercise seems incredibly ambitious. Goodall talks about reducing the nine A&E facilities in South Wales to four or five. But he is clear that if solutions are not found to some of the issues, services ‘risk collapse’ – sometimes simply because they are short of one or two key doctors. But there are problems with ‘pump priming’ alternative services before old ones are changed or closed and the ability of the system to fund that. ‘It would be great to feel that no change was necessary in Wales… but that is not the view of managers and not the view of clinicians,’ he says. ‘Delivering change like this can never by universally popular but it’s important the process is recognised as fair,’ he suggests. ‘And the starting point is getting people to understand some of the pressures in the system such as around medical staffing and the impact 15
on quality. That can pave the way for a rational discussion. Clinical engagement and leadership helps here. ‘With our South West Programme, the case for change is articulated by clinicians across the organisations, the deaneries and the Royal College of Surgeons.’ The boards affected have taken a collaborative approach. ‘One of the advantages of Wales is that you can all fit into a room together,’ he says. ‘The one thing that we have to accept is that we can’t change the geography of Wales. We have to accept not just where we think patients go but where patients actually go. ‘We are not just embarking on a structural change we are trying to show that we can deliver strategic change. We are dealing with culture.’ His own area is almost a microcosm of Wales with its mix of urban and rural districts, and the Welsh valleys with their legacy of heavy industry and deprivation – and often chronic health conditions. Population and public health are important in the system, and he spends a great deal of his time working with other partners. The personal touch is important, Goodall says. He is ‘trying to create a relationship with people so they don’t just see me as a grey suit’. He insists that discussions are courteous – even when there are disagreements – and is keen on a consensual rather than confrontational approach. ‘Negotiating change by PowerPoint’ is not his style and he spends a lot of time engaging with people and organisations. He values the rational arguments for change but also tries to appreciate there is often an emotional response which has to be met as well. And he recognises the stresses managers at all levels are under. ‘It is a tough environment that we are expecting people to work in at the moment,’ he says. ‘We can’t expect exceptional performance if we don’t give the time for development.’ Unusually, he insists on the importance of middle managers in the organisation – the ‘engine room’, he 16
© Timm Sonnenschein, Roy Peters Photography firstname.lastname@example.org
INTERVIEW: ANDREW GOODALL
calls them – and the need to both support them and give them the right skillset. ‘It’s about reminding myself I was a middle manager once,’ he says. He believes there are key roles which can either make or break an organisation. ‘It can be an area of any organisation which simply feels overwhelmed. We have an obligation to make sure that we don’t assume that everyone is a great manager …we have
an obligation to skill up for the future. There is something about revisiting the basics of management.’ The careers managers can expect are also changing. Being a directorate manager in a ‘hard’ area such as A&E or orthopaedics is no longer an essential requirement to reach the top levels, and there is more focus on skills and competence rather than a ‘tickbox’ approach to experience. healthcare manager | issue 17 | spring 2013
INTERVIEW: ANDREW GOODALL
‘What are the leadership skills and competencies people need? In the post-Francis era, how do we demonstrate the values we are bringing to the organisation’s table?’ he says. ‘I’m looking for individuals who can fit within the integrated planning environment, deliver pathway-based approaches across teams, make change happen and bring the quality agenda to the fore.’ Change management skills – and managing change with frozen budgets – are vital and there is an increasing emphasis on the ability to work across organisations and beyond the NHS. Future leaders, he suggests, will have had a flexible career experience and will be used to working across traditional service boundaries. The pace of change is challenging for everyone, he admits. Achievements which would once have taken a decade to achieve, are rapidly followed by new initiatives, all of which require support from staff and CHCs and have to be underpinned by proper governance. ‘Everything is happening at the same time and we are not done,’ he says. At the same time, the political pressure in Wales is often sometimes even more acute than in England. Nearly half of the Welsh Assembly’s budget is spent on health and not surprisingly there is intense scrutiny of how and where it is spent. ‘It’s not a rare event at all for me to sit in front of these [Assembly] committees to talk about our performance. That could be seen as a negative but I think it’s a positive. We want to make a difference to health,’ he says. The Welsh NHS is also a major employer – with 76,000 staff – and a significant force for economic development in the country. ‘We have to think differently about how we procure. Do we make a difference by how we buy our fruit and veg?’ he says. So how does the Welsh system stack up against the English NHS? There is, Goodall suggests, a Welsh dynamic. ‘There are definitely some enabling characteristics, not least healthcare manager | issue 17 | spring 2013
“It is a tough environment that we are expecting people to work in at the moment... We can’t expect exceptional performance if we don’t give the time for development.”
around the structures. Having ten organisations in Wales does allow for closer working than the 35 we had at one time. But the danger is that we discuss things in a way that takes away some of the discipline required. We still need the discipline of tracking patient activity, making sure the monitoring is there. But we try to do it in a low key way rather than allowing monitoring to be an industry.’ The abolition of a commissioner/ provider split, has seen a move away from ‘pushing money around the system’, he says. ‘There has been a focus on workforce and creating a period of stability. Even with the big changes there was a focus on not losing the skills of the staff and taking people with us.’ As a result, redundancies are pretty much unheard of. NHS organisations’ ability to bring down workforce costs is severely limited, and in Goodall’s own organisation staff turnover has also reduced dramatically, which further limits his financial options. But that does not mean that the situation is static: 40% of Goodall’s staff have been through major changes to how or where they work, or to what they do. Staff have moved from delivering acute care into the community – sometimes with trepidation, only to find they loved it, he says. This demonstrates the pace and level of change the system is coping with, he cites the fact that when he arrived at the health board there were only two major ser-
vice changes which raised human resources issues. Within a year there were 35. But he warns against taking too much of an insular view, and insists Wales can learn from what’s going on elsewhere. The Francis report will be read in Wales – and Goodall says there is much that is relevant to the Welsh situation: particularly, the importance of the public sector ethos – which he obviously shares – and the value-based approach of getting it right for patients and communities. But he expresses concern about how the current debate on the NHS and individual accountability will affect future managers. ‘For us the Francis report is not about saying it’s the English system. It puts a focus on organisational values and how staff are supported – no health service can be immune to that. Francis is very salutary for all of us.’ He picks out making use of early warning signs and triangulating data as particularly important. But he insists that no system can achieve perfection on all standards. ‘We should be allowed to say when there is a problem… there are services in my organisation I want to improve.’ In many cases, there is a business case for improving quality, he argues. Goodall says he is imbued with the NHS ethos: his father was a chief ambulance officer and, after a law degree, Goodall embarked on a PhD in health service management at the Cardiff Business School. From there he moved into NHS management and became a chief executive in his mid 30s. He has lived in Wales most of his life and, though born in Liverpool, he is swift to point out he supports Wales at rugby. But many of his fellow chief executives have come from the English system. At 43, Goodall is in one of the top jobs in the Principality but says there is still plenty to challenge him in his current role. He jokes about the new pension arrangements meaning he will be working for another 25 years. It would be hard to believe that in that time he would not be invited to use his skills on an even bigger stage.
Amid growing evidence that NHS reforms are damaging opportunities for black and minority ethnic managers, some initiatives give cause for hope, says Charlotte Santry.
The warning signs were there. Last July, the NHS Commissioning Board was told that black and ethnic minority staff risked being ‘significantly disadvantaged’ in the transition to a new healthcare landscape. The board’s former transformation director, Jim Easton, said close attention needed to be paid to a possible ‘loss of opportunity for people from a range of backgrounds’. He was referring to the axing of primary care trusts, often seen as having relatively diverse management teams compared with other parts of the NHS. But concerns are also increasingly being raised about the apparent lack of ethnic diversity among management teams at the top of the new and emerging NHS structures. The executive boards of the NHS Commissioning Board, NHS Trust Development Authority, Public Health England and Health Education England – not to mention the Care Quality Commission and Monitor – are almost entirely white. This compares with the overall NHS workforce, in which nearly one in five employees have 18
“Some fear the ‘snowy peaks’ phenomenon is not just continuing but getting worse.” a BME background – significantly higher in some parts of the country. Some fear the ‘snowy peaks’ phenomenon, first coined by former NHS chief executive Sir Nigel Crisp, is not just continuing but is getting worse. ‘This happens every time there’s a major reorganisation in the NHS,’ says new MiP chair Zoeta Manning. ‘BMEs are always disproportionately affected. Given this has been the biggest reorganisation since 1948, it’s been horrific. ‘Looking at all of the main structures that have been established, the gains that we’ve made in recent years seem to have diminished.’ She blames the ‘old boy’s network’. ‘There are fewer jobs to go around and if you’re not in
that circle it’s even more difficult to get a job,’ she says. Isaac John, who chairs the Health and Social Care BME Network, shares Manning’s feelings. ‘People pay lip service to diversity but then bring in their own cronies and friends [to the new organisations] and forget they have a wider responsibility,” he says. Some have vented their frustrations using even stronger language. Towards the end of last year, the NHS was forced to defend itself against claims made by Hari Sewell, a former executive director of Camden and Islington Foundation Trust, that it harboured institutional racism. Sewell pointed out that only 1 per cent of chief executives came from BME backgrounds. Further fuelling anxieties, figures published in December by the Royal College of Midwives showed that 60 per cent of London midwives involved in disciplinary action were ‘black/black British’ – an ethnic group accounting for 32% of the capital’s midwifery workforce. The findings tallied with 2010 research by Bradford University that found BME staff were twice as likely to face disciplinary healthcare manager | issue 17 | spring 2013
action as white staff. Two years earlier, an investigation by the Health Service Journal across 231 organisations had found BME staff comprised 16 per cent of the workforce but were involved in 29 per cent of disciplinary cases and 34 per cent of capability reviews. This raises the question of how BME staff will fare as the NHS moves away from de facto automatic incremental rises, towards a pay system with greater emphasis on performance and disciplinary records. ‘To be honest, a lot of employers haven’t got the skills to deal with [appraisals] properly and implement it in a fair and transparent way,’ says Manning. But alongside this growing sense of unease are hopes that newer initiatives are starting to challenge what Trevor Phillips termed the ‘inverted pyramid that is white at the top and black at the bottom’. The Health and Social Care BME Network has established itself as a company limited by guarantee and is teaming up with groups across the public sector, including those representing black firemen and Filipino nurses. Their collective aim is to challenge the status quo and gain “strength in numbers,” says Manning, who sits on the network’s steering committee. One of the network’s main priorities is to support NHS staff – especially those in Agenda for Change bands 5 to 6 – to fulfil their professional ambitions. ‘Many people, especially nurses, just get stuck. For ten to twenty years they’re still on band 5,” says Dr John. He hopes the network will be able to roll out a scheme trialled in his own organisation, Ashford and St Peter’s Hospitals Trust, which helps BME employees to understand how their organisations work and who the main players are, and prepares them for interviews. At the same time, the scheme works with senior managers to jointly identify a diverse talent pipeline, and encourages boards to commit to providing opportunities for people in that pipeline. The network also hopes to be able to healthcare manager | issue 17 | spring 2013
Professor Carol Baxter CBE (centre), Head of Equality, Diversity & Human Rights at NHS Employers, and Maxine James, chair of the NHS Confederation’s BME forum, meet delegates at the NHS Confederation’s BME Leadership Forum event.
put members in touch with others who work in senior roles within their own organisations and “understand the internal politics”, explains Dr John. Additionally, the network is providing workshops on topics including disciplinaries and negotiating redundancies. It has proposed a roundtable event with chief executives to thrash out ideas about workforce diversity and is working with the Tutu Foundation, MiP and Care Quality Commission on a number of projects. Dr John hopes the network will continue to grow. ‘We encourage people to get involved if they want a positive change,’ he says. ‘What’s the point in sitting and moaning?’ Another tool that, it is hoped, will make an impact is the Equality Delivery System. Launched in 2011, it has been taken up by 95% per cent of foundation trusts, says Carol Baxter, head of equality, diversity and human rights at NHS Employers. The system involves setting equality goals, integrating them into business plans and measuring performance in a consistent way. Ms Baxter says: ‘The EDS has been an important mechanism in getting staff to hold NHS organisations to account. They have a range of questions to be asking their trusts about what they’re doing to address the issues.’
This should allow trusts to see whether they are “outliers” and if their equality plans contain gaps. An upcoming review of the system will address questions such as how data will be collated and shared, Ms Baxter says. Other developments are underway. A draft ‘commitment paper’ by the NHS Commissioning Board includes ‘diverse leadership and workforce’ as one of its five priority areas. The Equality and Diversity Council is due to relaunch this November. The NHS Confederation’s BME Leadership Forum is also championing increased diversity across the health service. Many people are pushing the Department of Health to release fuller data on how the reorganisation in England has affected different staffing groups. In a worst-case scenario, the widespread upheaval will be used as an excuse for inaction. But Ms Baxter is eager to remind the system that creating opportunities for BME staff has an added benefit. ‘I think that staff perform better when they feel included and have opportunities to develop and grow,’ she says. ‘Inevitably, staff will perform better – and that means patients’ outcomes will be better.’ . For more information about the network visit www.nhsbmenetwork.com
legaleye NHS employers are increasingly using ‘restraint of trade’ clauses to restrict managers’ employment choices, says Ryan Dunleavy. It’s a reflection of the economic climate that employers are increasingly attempting to make changes to employees’ terms and conditions. Union reps and employees themselves need to be vigilant in trying to prevent unacceptable contractual changes being imposed.
Attempts by employers to insert ‘restraint of trade’ clauses into NHS managers’ contracts are becoming more common. Employers in general are regularly trying to impose such clauses into employees’ contractual conditions, often by relying upon an express clause in contracts that reserves their right to amend the agreement. However, these clauses are not always enforceable. It usually depends on how they are exercised. For example, they cannot be used in a way that conflicts with the overriding duty of trust and confidence. A restraint of trade clause may be sought by an employer either to prevent an employee moving to a rival organisation altogether, or to restrict their activities when joining a competitor. Unless such clauses can be said to be reasonable, or in the public interest and not contrary to public policy, then they are not legal. An agreement placing restrictions on an employee after leaving their job may be reasonable if the employer has particular interests which merit protecting. These might include trade secrets or business connections. If an employee is in a position of seniority and influence, and likely to be able to 20
“a life-long restriction preventing someone working within a certain radius or for a certain employer is unlikely to be considered reasonable.” entice away clients or customers, then a court might say it is reasonable for the employer to seek to protect their business. In the NHS, for example, it might be reasonable to include a restriction of trade covenant to prevent doctors leaving a practice or hospital and taking their lists of patients with them. The restriction must be no wider than reasonably necessary to protect the employer’s valid proprietary interests. It must also be reasonable in terms of both area and duration. Seeking to restrain the trade of an NHS manager who leaves to work in another NHS Trust, or in the private health sector in another part of the country, would probably not be reasonable, depending on all the circumstances. A restriction within a radius of, say, three miles, might be reasonable in a rural area but probably not in a city. And a life-long restriction preventing someone working within a certain radius or for a certain employer or type of employer is unlikely in most cases to be considered reasonable by a court. Courts have been known to invalidate indirect means of restraining employees. In one case, two companies which manufactured similar products agreed that neither firm would employ a person
who had been employed by the other in the previous five years. But this agreement was so wide that it caught all their employees, not just those privy to trade secrets. It was therefore unreasonable. Whether a clause amounts to a restraint of trade will turn on the facts in particular circumstances. Although in some instances a restraining clause may be found to be unreasonable, courts have been known to uphold it by applying what is known as the ‘blue pencil test’ – simply crossing out words which make it unreasonably wide – as long as the clause still makes sense and the nature of the obligations are not altered. Where a change of contract or inclusion of a restraining clause has been imposed unilaterally and the employee has not been dismissed and re-engaged on the new terms, it is vital that they send a letter of objection/grievance to their employer without delay. Failure to do so may mean that they are taken to have accepted the change, with the result that no causes of action will arise. Attention should be paid to the wording of any objection letter. Any reference to the change being “accepted under duress’ will almost certainly not preserve the employee’s position in relation to causes of action or amount to an effective objection.
Ryan Dunleavy Thompsons Solicitors Legaleye is not intended to provide legal advice on individual cases, and MiP members in need of personal advice should immediately contact their MiP rep.
healthcare manager | issue 17 | spring 2013
Whistleblowing – how should managers respond? Whistleblowing – the reporting of serious wrongdoing at work in the public interest – is sometimes seen as a problem for managers. But in most cases, the concern will be managed well. Rosemary Crockett from the Whistleblowing Helpline offers some tips on how to respond positively if a member of staff raises a concern with you. CHECK OUT YOUR ATTITUDE Look at whistleblowing as a positive thing: it’s really a question of someone alerting you to a risk which may harm others, not someone making a personal complaint against the status quo. If there is an issue, you need to know about it so you have the opportunity to take corrective action at an early stage.
2 WHAT ARE THE ISSUES? Encourage the ‘alerter’ (whistleblower) to explain fully the evidence they have. What are the areas of concern – patient care, health and safety, financial malpractice, a criminal offence, clinical practice or competence? Who is involved and are there any witnesses? When did the event(s) occur, what happened or what do they think might happen? Actively listen to what the alerter has to say and avoid pre-judging the issue.
3 YOUR INITIAL RESPONSE Thank them for raising the concern, even if they seem to be mistaken. Do let the alerter know that they have the organisation’s support, and respect their concerns about their own position or future career. Respect confidentiality if it has been requested – do not reveal their name without consent, unless required by law. Give the alerter a copy of your organisation’s whistleblowing policy. You will need to follow the policy when deciding what to do next. Tell them about the next steps and discuss reasonable timeframes for feedback.
4 OFFER SUPPORT Whistleblowers can feel very stressed and isolated. Provide or signpost sources of support for the alerter, for example from a trade union, the Whistleblowing Helpline, employee assistance, counselling and/or HR.
healthcare manager | issue 17 | spring 2013
5 ASSESSING THE FACTS Assess what you have heard. Distinguish between facts and opinions. Keep an open mind – some things you may not want to believe, but don’t get defensive. Don’t let personal views influence your assessment of the issues; you need to keep an objective and balanced approach. Don’t dismiss the disclosure as exaggerated or trivial unless there is clear evidence to support this assessment.
6 DECIDE ON THE WAY FORWARD Assess how serious and urgent the risk is; whether the concern can be dealt with under the whistleblowing policy or some other procedure (such as a grievance); and whether it is desirable or necessary to refer it to, or seek help from, senior managers or a specialist function. Take appropriate advice, from HR for example, and decide on the way forward. Where there are grounds for concern, take prompt action to investigate. If the concern is potentially very serious or wide-reaching make sure another appropriate person instigates an investigation.
7 TACKLE THE ISSUES SQUARE ON Never attempt to ignore or cover up evidence of wrongdoing. Always remember that you may have to explain how you have handled the concern, and keep a record. Don’t ever penalise someone for making a disclosure that proves unfounded if, despite making a mistake, she or he genuinely believed the information was true.
8 FEED BACK Get back to the alerter so they know action is being taken – but bear in mind any rights or duties you may owe to other parties. If asked, put your response in writing.
9 CHECK ON THEIR WELLBEING Check back to see how the alerter is faring at regular intervals, to ensure they do not feel victimised or suffer any detrimental effects. The Whistleblowing Helpline provides free advice and support for workers, trade unions and employers. Visit wbhelpline.org.uk, call 08000 724725 or email email@example.com
MiP AT WORK
Parting thoughts Outgoing MiP chair David Amos says the NHS needs creative and innovative leaders more than ever.
“Middle management is the toughest job. I am in awe of people who do this job today.”
In my book, a valedictory (‘farewell wave’) ought to be about other people than just the writer. I have just returned from the memorial service in Baltimore for someone who inspired me throughout my career. Dr Steven Muller left Germany in the late 1930s as an eight-yearold Jew and was at Oxford with my late father. After a career as a child actor in Hollywood, advisor to JFK and successful conciliator at Cornell University during the 1968 armed student occupation, he became President of John Hopkins University and Hospital. Steve was incisive and 22
decisive, treated everyone equally, and needed no external pressure to encourage him to lead change, innovate and be creative. I started my NHS career as a general management trainee at Stafford General Hospital in the late 1980s and spent three months working in the marketing team at John Hopkins. In England, managing 25 porters, I learnt that command and control was fruitless and how vital professional porters were to delivering a great and efficient patient experience. Porters were in NUPE back then, and I learnt to do business with the branch secretary, especially when they worked to rule
one weekend and I had to cover the mortuary. Luckily, nobody died that weekend. After ten years in hospital general management, I have been a human resources director at two London teaching hospitals, and the deputy HR director (delivery) for the English NHS. Middle management is the toughest job; staff expect their general manager to sort out all their concerns, while the board expects them to deliver on organisational objectives. I am in awe of people who do this job today. I have always been a joiner and joined Unison when I was a senior civil servant, along with the health minister Philip Hunt – our forms personally handled by Bob Abberley. I will never forget the telephone call in 2005 from the newly appointed MiP chief executive asking me to chair the interim national committee. I had long wanted a vehicle to represent NHS managers, be their voice, protect them in difficult times and promote their professional development. MiP has become an established, noticed and listened-to feature of the healthcare scene in just eight years, with over 6,000 members, for which credit is due to the MiP staff and the incredible commitment of those who volunteer for the national committee and to be link members. If I could share some personal guidelines for today’s NHS general manager: ** Storm out of a meeting only once per job ** Try not to cry in the workplace healthcare manager | issue 17 | spring 2013
MiP AT WORK
Don’t put up with workplace bullying MiP national officer Pete Lowe describes how he helped an MiP member. Earlier this year, I was holding one of my regular employment rights surgeries when Roger came to see me. He works in an acute trust in the Midlands and was getting on fine until recently. He started suffering from stress, and was off work for three months with heart palpitations. When he described his situation it rang alarm bells and I thought he might be being bullied by a recent arrival in his department. When we discussed it further it all fell into place. The problem had started soon after a new temporary manager arrived in his department. Once we’d identified the problem, I could get on with helping him solve it. I have a very good working relationship with senior management and the HR team at this hospital, and know that they would Find friends to get consolation Have people who can be objective to guide you through the difficult times ** Remember that the NHS is statefunded and will be political ** Always keep the interests of patients and taxpayers in mind when taking decisions. With the Francis Report, it seems to have come as a revelation to some, but healthcare managers have always had to wrestle with how best to handle concerns expressed by staff, patients, and the people they meet. The best way of dealing with concerns is to draw on experience (quasi-evidence base), be brave (to ignore and challenge), use instinct (guess), and be totally ** **
healthcare manager | issue 17 | spring 2013
take any complaint from MiP seriously. I advised him to contact occupational health for support and to start keeping a diary noting any instances and the impact the new manager’s behaviour was having on his stress levels. Roger and I agreed it was best to try and solve the problem without lodging a formal complaint and agreed an action plan. As we were keeping it informal, we agreed it was best for Roger to discuss the matter with his manager on his own, although he did mention that he was getting assistance from MiP. I provided advice and guidance to Roger at every stage of the process, speaking to him every day to start with, and briefing him before each meeting. Roger met with his manager on three occasions over a four week period. As I expected, committed to diversity (treat everyone equally and don’t generalise). In more scientific terms, I would suggest a formula combining the following: 1. Parameters
(P) = criteria to measure the severity of the concern (patient safety, financial underperformance, staff safety, non-compliance with regulatory/corporate objectives, urgency) 2. Triangulation (Tr) = who else agrees, what is their view, what does the available evidence indicate, is there contingency? 3. Time (Ti) = opportunity cost, time available to consider the above, relativity of priorities
his manager listened and took his complaint seriously and agreed that the other manager’s inappropriate behaviour was causing Roger unacceptable stress. The manager ensured that the temporary manager was told that his contract would not be renewed. Roger was delighted with the outcome. We agreed to keep his case open and to review it after four weeks to ensure that the problem has been resolved. Now I’m not claiming that the mere mention of MiP’s name will get your problems sorted, but it certainly helped in Roger’s case.
If you have a problem at work, contact your MiP national officer who can give you one-to-one confidential advice and representation. Details are available on the MiP website. And if you’re not a member, you never know when you might need help, so join MiP today by visiting the website at www.miphealth.org.uk
P5+Tr5+Ti(a) = take immediate action (where ‘a’ equals available)
It would also be helpful if politicians could stop reorganising the system to meet some organisational-chart ideal, without letting the previous one bed down – whilst preventing leaders from taking steps to prevent and remedy concerns. Steve said in 1982 in Bonn: “universities that wholly conform to orthodoxy may lead people to believe that thinking is either unnecessary or dangerous. Well, thinking is in fact dangerous, but not as dangerous as not thinking.” I’ll go for that.
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
Tweet Box A selection of tweets
so.... I’m here to talk to you today about... um, hang on... I had it moment ago...
In a privatised, AQP, market driven (ie profits) NHS, who will care for those with long term chronic illnesses? @ClareRCGP
John Stillwell/PA Wire/Press Association Images
Nicholson dis-invites himself from many dinner parties by effectively saying ‘don’t employ redundant SHA/PCT execs’ @HSJEditor Are the messages for patient care being lost in the blame game of MidStaffs finger pointing? @BMJ_latest
IT’S BEHIND YOU!
The #Francis report is already my bible so I’ve finally found some common ground between me and the catholic church! @ShaunLintern
Francis vs Francis
HCM’s guide to separating your pontiff from the author of an in depth report into the lessons of MidStaffs
So we have a new Pope and 21 new national clinical directors on the same day. What a day for leadership. @MBirty @MBirty But which will last longest? @HPIAndyCowper
David Owen/Chris Huhne
Chairman Education and Training Committee Inner Temple
Ordinary of the Ordinariate for the Faithful of the Eastern Rites in Argentina
Called interests IN QUOTES Publications
to the Bar, 1973
by the Lord Almighty, 1969
Repatriation of Las Malvinas
“Excellent in all areas”
“Miserando atque eligendo” (Lowly, but Chosen)
Medical Treatment Decision and the Law
Corrupción y pecado: algunas reflexiones en torno al tema de la corrupción (Corruption and Sin: Some Thoughts on Corruption)
wig, white ruff
humble but with red slippers
Yes we should borrow to invest. But remember Groucho Marx “whenever you are on side of majority, pause & reflect” @Profalanmaynard good news England on course to have enough GPs... by 2030 @HSJEditor
Celticus is on paternity leave. Congratulations on the birth – normal service will be resumed next issue.
healthcare manager | issue 17 | spring 2013
Working together for you The Open University and Managers in Partnership have joined forces to encourage greater participation in health sector education and training. Between us, we offer a wide range of modules and qualiﬁcations to make a difference to your life, your career and the people in your teams. Whether you are an Administrator or CEO, Clinical Nurse Manager or Business Manager, there are a range of modules and qualiﬁcations that will help develop skills in areas of practice from policy interpretation to research. Our ﬂexible work-based learning ﬁts with busy work and home commitments. Modules are vocationally relevant based on cutting-edge research and learning materials, to ensure that what you learn today, you can apply tomorrow – making an immediate and effective impact to improving levels of care. Did you know? • UNISON/MiP members receive a 10% discount on many of our courses • Learning materials reﬂect the day-to-day practical issues involved in running a hospital ward or clinic.
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