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February-March summer 2009

healthcare healthcare manager manager

FOCUS ON RACE EQUALITY

BRITAIN’S GOT TALENT

...so why isn’t the NHS using it?

plus BIG DIFFERENCE COMPANY MAGGIE’S CENTRE KSF AND MUCH MORE INSIDE

helping make healthcare helping you makeyou healthcare happen happen www.miphealth.org.uk


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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 2 summer 2009

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

Leading edge: Jon Restell In person: Linda Semple, NHS Ayreshire & Arran In public: Maggie’s Centre, Dundee

letters & comment:8 Jeff Rodrigues on diversity challenges for management and unions

published by

Managers in Partnership www.miphealth.org.uk 8 Leake Street, London SE1 7NN | 0845 601 1144 Managers in Partnership is the trade union organisation providing support and advice to senior managers in healthcare in the UK on employment matters, careers and management practice. We represent their views to policymakers, employers, the media and the public.

features:10 Laugh until it stops hurting: arts and health Race equality in the NHS Knowledge and Skills Framework

your job:18 Management Trainees: a new online network Career development: take a sabbatical MiP at work: delivering training in Dudley Legal eye: resolving stress claims

backlash:24

Welcome to the second issue of healthcare manager the magazine from Managers in Partnership, the trade union organisation representing managers in health and social care. This issue focuses on race equality in the health services and how to achieve it. Despite the statutory duty to eliminate discrimination and promote equality of opportunity for staff and service users, experience and research show that it still isn’t happening. Why is that? We review the current situation, look at some initiatives to promote equality and get different opinions about the way forward. One development we are proud to support is the launch of a new national network of BME staff in the NHS. The national conference to launch the network is happening as we go to press, and it has certainly attracted a lot of attention. Finally, thanks to the many readers who complimented us on the format and content of the new magazine. It’s always good to have positive feedback. But we also want to hear your responses to our articles. And we want your news and views about what is happening in the health services. Marisa Howes Executive editor

issue 2 | summer 2009 | healthcare manager

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HEADS UP

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

Partnership

£500,000 up for grabs for partnership NHS organisations will now be able to bid for up to £40,000 to support partnership working at local level following the launch of the NHS partnership fund by the Social Partnership Forum (SPF). Any NHS organisation in England can bid for a share of the £500,000 fund to support projects where management and staff organisations work together to improve services and the working environment. Organisations should send completed bids for sifting to their SHA, who will submit up to five bids to a national panel to decide who gets the funding. The national panel will be made up of union and management representatives. Bids must be submitted by 30 June 2008.

healthcare manager issue 2 | summer 2009 published by MiP All copy © 2009 MiP, or the author. Opinions stated are not necessarily those of MiP.

‘Partnership is part of MiP’s name and our ethos,’ said MiP chief executive Jon Restell. ‘We play an active role in the Social Partnership Forum at national and regional level. We believe that all health service organisations can benefit from partnership working and encourage you to apply for funding to embed it in your organisation.’

EU health ministers will be asked this summer to approve a new directive on cross-border healthcare after proposals by Conservative MEP John

Bowis (pictured) were approved by the European Parliament. The draft directive will make it easier for patients to travel abroad for treatment they have been denied in their own country. The European Public Services Union, of which MiP is a member, opposed the current proposals because they could affect the NHS’s ability to set its own standards and decide who is eligible for treatment in the UK. Socialists and Greens in the European Parliament also opposed the draft directive when it was

Executive Editor

Contributors

Marisa Howes m.howes@miphealth.org.uk

Michael Banner, Yvonne Coghill, Marisa Howes, Linda Millband, Helen Mooney, Catherine Raynor, Jon Restell, Jeff Rodrigues, Craig Ryan, Suzanne Simmons-Lewis.

For details of how to apply visit the new SPF website at www. socialpartnershipforum.org

European Union

Directive threatens NHS power to determine treatment

Associate Editor Craig Ryan editor@healthcare-manager.co.uk

Print Art Director

Broglia Press, Poole

James Sparling

Advertising Enquiries Design and Production Lexographic production@healthcare-manager.co.uk

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issue 2 | summer 2009 | healthcare manager

020 7014 3680 adverts@healthcare-manager.co.uk

debated in plenary session at the end of April, insisting that national health services need a clear system of ‘prior authorisation’ before patients travel for crossborder treatment. ‘The socialists took a particularly hard line on prior authorisation, especially in relation to financial and other planning issues for national health systems, including the NHS,’ explained UNISON policy officer Guy Collis. He said prior authorisation was likely to remain the main sticking point when the draft directive is discussed by the Council of Ministers, who must approve the directive before it can become law. The Spanish government, which takes over the presidency of the European Council on 1 July, is expected to be more hostile to the proposals than the current Czech presidency. CR

healthcare manager is sent to all MiP members. If you would like to join see page 23. Cover picture: Richard Stubbs, head of business development at Doncaster and Bassetlaw Hospitals NHS FT. Printed on paper from FSC forests using vegetable-based inks. When done, please recycle.

Visit www.miphealth.org.uk/hcm for weblinks and more.


HEADS UP

leading edge Jon Restell, chief executive, MiP Leading MiP members in Scotland met recently in Perth to discuss MiP’s development. The energy at the meeting was exciting and the Scottish network is now finalising ambitious plans to recruit new members, promote the MiP brand and raise the union’s profile. Without a shadow of a doubt, the financial outlook for NHS Scotland is the starting point for our Scottish plans. The network identified three things MiP can do for managers in the next few years. First, MiP can help managers to meet positively and skilfully the professional challenges of managing and leading in a time of austerity. Managers are not civil servants awaiting political instruction; they have distinctive professional views of their own about how to deliver quality healthcare. The

Leadership

MiP supports NHS Leadership Awards MiP is supporting the NHS Leadership Awards to the hilt. The union is proud to be sponsoring the award for ‘mentor of the year’ and delighted by the number and quality of nominations received. Jon Restell, MiP’s chief executive, said: ‘We chose to sponsor this award because good mentors are worth their weight in gold. Mentoring embodies the spirit of partnership and MiP’s values: it is about sharing experience

“We want to promote the critical role of good managers and management in making quality services happen in tough times as well as good. The squeeze is not the time for managers to hide themselves away.” Scottish network will be the place for managers to connect, and share ideas about how to do their jobs well in the next few years. Secondly, MiP can help individual managers with advice and face-to-face

representation, as they tackle threats to their job security, pay (and – keep your eyes peeled – pensions) and employment conditions. Many managers also want advice on navigating more complicated career paths as a result of re-organisations.  Thirdly, MiP wants to get very clear messages from managers to the media, public and politicians of Scotland about what is happening and what is likely to happen to services as the money gets cut. We want to promote the critical role of good managers and management in making quality services happen in tough times as well as good. The squeeze is not the time for managers to hide themselves away. For Scotland, read Wales, read Northern Ireland, read England. The Scottish plans are MiP in a nutshell for the next five years.

and learning; it is about identifying and nurturing the talent we have in the NHS; it is about supporting diversity.’ Details of the award scheme for the NHS in England were announced by David Nicholson in his exclusive interview article in the first issue of healthcare manager. The awards will cover seven categories and aim to share best practice and foster good leadership. Judging starts in June and shortlisted nominees will showcase their work throughout the summer. The awards will be presented at a ceremony in London on 25 November. For more information see www. nhsleadershipawards.nhs.uk

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HEADS UP

Health Bill

Caps off? Ministers are deciding whether to try to overturn a Lords amendment to the Health Bill, which may allow some foundation trusts to earn more income from treating private patients. At the time of going to press, the government had yet to set a date for the first Commons debate on the bill, which will give effect to the NHS Constitution and enable trials of top-up payments. The Lords defied ministers by passing an amendment tabled by Baroness Meacher (pictured), chair of the East London Foundation Trust, which would allow ‘exceptions’ to the cap on the amount of private work foundation trusts can carry out. The amendment would

Equality Bill

Equality watchdog to sharpen teeth The new Equality Bill will transform the Equality and Human Rights Commission (EHRC), the government equality watchdog, from a campaigning group to a ‘modern regulator’, Trevor Phillips (pictured), the commission’s chair told the FDA conference last month. ‘We need to be modern and effective. In a sense, we need to be more Ofcom than Liberty, and more ACAS than Amnesty International,’ he said. Phillips said the bill, currently before parliament, together with wider changes in society, were ‘an enormous opportunity’ for the EHRC. ‘We are moving into a society where only 20% of the workforce will be white, male, middle‑aged, and non‑disabled in the next two years… It could be a chance finally to hard‑wire equality into employment prac‑ tices and public services.’ 4

allow ministers to waive the cap if it is ‘in the interests of the NHS’ to do so. Baroness Meacher claimed that Government sources had raised no concerns about the amendment but it is bitterly opposed by many Labour MPs who say the cap was a vital safeguard enabling them to support the foundation trusts. Backbench Labour peer Lord Campbell-Savours said the amendment was ‘a Trojan horse that could be used by a future government to completely undermine whole areas of the NHS’. Baroness Meacher claimed the amendment was an attempt to ‘level the playing field’ between different foundation trusts. ‘Some foundations have low caps, mental health trusts have a cap of nothing and some acutes have up to 30 per cent,’ she said.

The bill would introduce a new legal duty on all public bodies – including NHS organi‑ sations – to promote equality and eliminate discrimination on all grounds including religion, age, sexual orientation and class. ‘For example, when strategic health authorities are thinking about where to put new clinics, are we sure this will be as open to those who are less well off?’ said Phillips. ‘We do not want to be in the position of the teacher who says that all the children in the class can have apples, but then puts the apples on a shelf that only the tallest children can reach.’ Age discrimination in provid‑ ing goods and services would also be outlawed Phillips told delegates. ‘Older people who are denied access to health services will be protected for the first time in our history. ‘Our ambitious goal is to change our culture so that at‑ titudes and behaviours change, not just in response to ticking the commission’s boxes, but because we have a higher cul‑ ture of expectation within our services and within our private sector.’

issue 2 | summer 2009 | healthcare manager

Meanwhile we await the outcome of a judicial review of the way Monitor, the foundation trust regulator, has allowed some trusts to disregard some private income for the purposes of the cap.

“It could be a chance finally to hard‑wire equality into employment practices and public services.” Trevor Phillips Chair EHRC


HEADS UP

inperson Linda Semple:

“I have met other managers through MiP across the UK that I would not have met through my usual networks.”

Assistant director of performance, NHS Ayrshire and Arran

MiP member Linda Semple is assistant director of performance in the policy, planning and performance department at NHS Ayrshire and Arran in Scotland. She has been an MiP member for two years and says she has always been a ‘big union person’. ‘I don’t think there needs to be a tension between being in a union and being an NHS manager and I think the beliefs of MiP chime with a lot of NHS managers,’ she explains. ‘For me it is important to be an MiP member because it is important that NHS managers have a community which is built around the principles of a union. MiP puts across the point of view of managers and counteracts the “Casualty” view and the unfair representation of NHS managers.’ Linda says NHS managers in

Scotland are often dealing with different issues to their English counterparts because of the way NHS bodies are organised. Her organisation is both a provider – with two district general hospitals and a large community health service – and a commissioner of services. She thinks NHS managers need to have a discussion on developing a “code of ethics” similar to those in other professions and also wants MiP to develop much further in representing all four countries in the United Kingdom. ‘I think as a union it needs to reflect much more the differences between the countries in the UK because it is very difficult to get any information about what is going on outside England…We need more information and useful tools and tricks,’ she

Thomas to head NHS Employers After almost a full year without a permanent director, MiP member Sian Thomas has been appointed as head of NHS Employers, the body that represents NHS trusts in England on workforce issues. Thomas had previously been joint acting director in partnership with Alastair Henderson, who moves to the post of deputy director and director of operations. Thomas joined NHS Employers in 2005, on

says. ‘However, I have met other managers through MiP across the UK that I would not have met through my usual networks.’ Ms Semple explains that one of the key issues she is currently ‘struggling with’ is the relevance of Agenda for Change for senior NHS managers in Scotland. ‘It is stopping the brightest and the best from going into management. There are certain places in Scotland where some management jobs are one or two grades lower than they are in England and there is inequity at board level in some Scottish trusts,’ she says. ‘I would like to see MiP campaigning to ensure proper pay and conditions for senior managers other than through Agenda for Change.’ Helen Mooney

secondment from her post as HR director of Ashford and St Peter’s Hospital Trust. Thomas said her first priorities will be finalising a new contract with the Department of Health starting from April next year, and developing new services to benefit NHS Employers. ‘NHS Employers has achieved a great deal in the past four years and I know we can accomplish even more. Excellence in employment in the NHS is paramount to improved patient care and I look forward to playing my part in helping employers achieve this.’ Welcoming the appointment, MiP chief

executive Jon Restell said: ‘Sian is definitely someone we can do business with. She is a strong advocate for partnership working and respects the role of managers in the health service. I look forward to maintaining a close working relationship with her.’ Steve Barnett, chief executive of the NHS Confederation, the parent body of NHS Employers, said: ‘I am delighted to have appointed Sian…We had a strong shortlist but the panel were unanimous in believing that she demonstrated all the skills needed for this high profile and exciting role.’ CR

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HEADS UP

Public health

Check it before you wreck it! The NHS is to launch a new online service to help people assess their own health and wellbeing and that of their child. Developed by the Depart‑ ment of Health in conjunction with members of the public and health professionals, NHS Life‑ Check goes live in June as part the NHS Choices on‑ line service. All users need to do is answer a set of sim‑ ple questions about their lifestyle and NHS LifeCheck gives them confidential results and advice. There will be different tailored LifeChecks for peo‑ ple at different stages of life. Checks for babies and teen‑ agers are already up and

running. The teenage ver‑ sion, for 12 to 15 year-olds, includes a video and ques‑ tions in teenage slang to get over its message: ‘Check it before you wreck it’. A more sober version for peo‑ ple in ‘mid-life’ is currently being piloted.

The check produces a traffic light score on five different aspects of lifestyle – diet, emotional wellbeing, exercise, alcohol and smok‑ ing – together with advice on weight and access to further help online. Your healthcare manager

correspondent completed the ‘mid-life’ check (despite being two years and a week shy of the lower age limit) in under two minutes, but received decidedly mixed results. CR

Committee Elections

How to win friends and influence people – election of MiP national committee MiP will soon be inviting nominations to its new national committee. Arrangements for the elec‑ tions are being finalised and if you would like to play a key role in shaping MiP poli‑ cy and leading the union into the next decade, then keep a look out for notice of the election. Committee members will area Northern Ireland

1

Scotland

2

Wales

2

Seat Each English NHS region allocation (except London) by area London

6

seats

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1 2

be elected to represent the geograph‑ ical constituencies (see box, left) and will serve a two-year term.

Influencing people This is an exciting time to get in‑ volved in MiP – when the squeeze on public finances makes it even more important that our voice is heard. As a committee member you will play a key role in making sure MiP policy reflects the views of members. You may also represent MiP on public platforms and at meetings, talking about the issues that matter to MiP members, and making sure our values and opinions about good management and healthcare are heard and understood by employers, policy makers and the public. And putting our case for fair pensions

and fair pay for managers.

Timetable The interim committee will call for nominations during September with the elections taking place in October. The results of the election will be announced at our national confer‑ ence on 24 November and the new committee will start its term of office in January 2010.

Further details The rules for the election will be posted on our website by the end of July. We will then write to all mem‑ bers with the details and invite nominations. In the meantime, if you would like further information, talk to your national officer or con‑ tact Jon Restell on 020 7551 1145.


HEADS UP

inpublic

“This is a place for people’s health and well-being; it helps people feel like a person again instead of a patient.”

Maggie’s Centre, Dundee

The charitable centre run by Maggie’s on the site of Ninewells hospital – part of NHS Tayside – is an amazing building which offers cancer patients, their families and friends in the Tayside area access to a different environment during their treatment. Anyone affected by can‑ cer is welcome to drop in to the centre for a cup of tea and a chat with one of the centre’s information and support specialists, to browse the library or to access one of the courses designed to help people live with, through and be‑ yond the disease.  The purpose of the centre is to try to help people with cancer, their carers, family

and friends from across Dundee and Tayside to manage the physical and emotional impact of living with cancer. It was de‑ signed by Frank Gehry, architect of the famous Guggenheim Museum in Bilbao – the only building designed by Gehry in Brit‑ ain. It was opened in September 2003 by Sir Bob Geldof. Lesley Howells is head of the centre and a consultant clinical psychologist. She says the centre is the ‘most effective environment for supporting the emotional wellbeing of ordinary peo‑ ple facing the practical, emotional and family de‑ mands of cancer. ‘The building is amazing and something that

people would not come across in their everyday life…it is not an institu‑ tion, we are aware that for people with cancer, the majority of their experi‑ ence is in hospital, so we try and avoid hospital-like smells, signage and light‑ ing and have the smell of fresh flowers, coffee and toast instead – things peo‑ ple would associate with their own home,’ Lesley explains. Cancer patients are often signposted or referred to the centre by NHS Tayside staff and when they arrive at the centre Lesley says the ‘colour, light and views across the Tay’ mean that patients are ‘looking at “life” when they are poten‑ tially facing death.

‘This is a place for peo‑ ple’s health and well-being; it helps people feel like a person again instead of a patient,’ she adds. Claire Pullar, MiP na‑ tional officer for Scotland, previously worked as a clinician at Ninewells hos‑ pital and agrees that the centre provides an ‘escape’ for people who can be ‘terrified’. ‘The ethos of the centre is something that all NHS organisations can learn from. For people with a chronic or life-changing illness, it is a really good way of engaging them in a positive way, and the fact it is on an NHS hospital site means it is not forgotten about.’ HM

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YOUR OPINION

letters

Letters on any subject are welcome. Please send to editor@healthcaremanager.co.uk or to 8 Leake Street, London SE1 7NN. We may edit letters for length. Name and address must be supplied, but you may ask for them to not be published.

to the editor

China Trek: To Skilling up boldly go... I read with interest the Congratulations on this new magazine. It is interesting and entertaining. I was particularly interested in the comment piece written about the challenges facing policy makers in dealing with Alzheimers. Something needs to be done about this. Which is why I am off trekking in China in May to raise money for the Alzeimers Society. As MiP obviously cares about this too, will you sponsor my trek? Show us what partnership is about! Kath Ackah UNISON Worcestershire Acute Hospitals NHS Trust Branch

The editor writes: How could we refuse? MiP has sponsored Kath’s trek. We’ll report on success in the next issue.

inaugural edition of the new magazine and enjoyed the range of informative articles in this first issue. I found David Nicholson’s article on Leadership for Quality particularly thought provoking. Skills for Health, as the sector skills council for health, aims to help the whole of the UK health sector develop a skilled flexible and productive workforce to improve the quality of health and healthcare. We do this by acting as the authoritative voice on skills issues, through identifying and representing employers’ views on skills and workforce development, and by offering employers tested solutions and tools supported by expert and experienced staff. Our approach to this work

is congruent with the four principles described by David Nicholson, namely co-production, subsidiarity, clinical engagement and leadership, and alignment, as we recognise that large scale change in workforce and workforce development can only be achieved through partnership. Consequently, our tools and solutions are co-produced with local providers and commissioners of services and we ensure clarity with partners on what can be achieved at each level of the system. Working with local services and strategic regional partners, we develop their capacity and capability to effect sustainable change, whether in response to specific service redesign or broader systemic shifts. It is essential that we engage with, and involve,

not only those who provide services, (whatever their role) but also those who use or assure services, and that we identify and work with “champions” who can demonstrate the positive impact of the changes described. By doing this we also ensure that the “products” that we offer are truly representative of what the system needs and are based on expert evidence. Finally, we are fortunate to be positioned within the sector in such a way that we can translate policies into very real practical help, aligning expectation with action so that we can help employers deliver better, and improving, practices in response to demand. Further information on our work and how to contact us can be found at www. skillsforhealth.org.uk John Rogers CEO Skills for Health

MiP National Conference 2009: Quality through Partnership Tuesday 24 November 2009, Congress Centre, London WC1, 10am – 4pm

MiP’s third annual conference will take place at a time of heightened political interest in the health services. We may already have been through a general election. We may be in the run-up. Either way, all political parties want to claim they have the best model for health service improvement. So we’ll be inviting a panel of speakers from the political parties to come to set out their stalls and listen to you, the MiP members who make the health service work for local communities. So keep the date in your diary and look out for the invitation which will be coming out shortly. For further information email info@mip2009.co.uk.

helping you make healthcare happen 8

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OPINION

comment

“the BME minority is [now] a significant minority and, in one or two cities, a majority of the working population”

Jeff Rodrigues

Consultant in organisation development and change management.

Moving beyond minority interests At all levels – government, employer, trade union – policy relating to black and ethnic minority people has in the past been based on minoritarian assumptions. At around 6% to 9% of the general population, black and minority ethnic (BME) policy has been about how to be fair about the interests of ethnic minorities. In health, this has involved finding more complex ways to improve access to services, gaining access to ‘hard-toreach’ groups or dealing more effectively with the morbidities associated with ethnicity – CHD, diabetes, hypertension, blood disorders, and so on. In employment, the issues were – at least formally – about how to support minorities in being better represented in terms of income distribution and organisational hierarchies. Some BME trade union activists have been involved in a struggle for special status, such as black workers groups, with the espoused aim of helping the union create more representative structures. In significant ways, both management and unions have signally failed to achieve their espoused aims. Black people are still under-represented in the more powerful places in organisations, and trade union activists, working through the black worker groups where these still exist, have not delivered any significant change in the representation of black people in trade union leadership or the workplace.

We are now approaching a situation in which the BME minority is about to become a significant minority and, in one or two cities, a majority of the working population. Population projections are estimates, so health warnings about the data are appropriate: as the physicist Niels Bohr observed, ‘It is very difficult to make predictions, especially about the future’. That said, by the time of the next census in 2011, some 35% of London’s working population will be BME. In Birmingham, Britain’s second largest city, the figure is likely to be 52%, and in Leicester, 44%. It is also worth reflecting in more detail about the relative sizes of BME sub-groups. In London, which has the biggest UK clustering of people of African-Caribbean and African descent, the largest ethnic groups in the working population will be of Asian descent (Indian, Pakistani, Bangladeshi and ‘other Asian’, but excluding Chinese). The Indian sub-group will be the largest, African next, and then African-Caribbean. African-Caribbeans are becoming a minority within BME working populations and new issues about representation are emerging. What then are the implications for management and unions? BME people will contribute very considerable proportions of value creation and they will make disproportionate contributions to pensions and social

welfare spending consumed by a largely white older population. Will this not translate into greater purchase and leverage for claims to a share of institutional and organisational leadership? Will economic power not translate across to irresistible demands for ‘representation’ in all social spheres? What would be the point of ghettoised ‘black member’ groups in unions when 35% or more of the working population in some cities is ‘black’? How representative of the BME population are black worker group structures? Shouldn’t bigger proportions of black workers in unions translate across to representation in union structures and leadership in more confident and effective ways than the current performance of black workers groups indicate? Leaders in management and unions can try to win a place at the leading edge of developments by manifesting integrity, bravery and innovation in their approach to race equality or they can straggle on at the trailing edge and firefight all the way to ultimate defeat. What is now needed is serious and creative thinking that ends with a determined plan to make change and a refusal to make do with weak, pallid gestures

.

Jeff Rodrigues can be contacted at ssiconsulting@btconnect.com

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ARTS & HEALTH

How the arts help change attitudes in health

MiP works with Big Difference Company (BDC), who use comedy to deliver health messages. BDC, formerly known as the Leicester Comedy Festival, runs schemes across the UK and Ireland working with health authorities and PCTs on specific programmes for all ages such as men’s health, sexual health, smoking and healthy eating. Geoff Rowe, director, says: “It enables people to take risks. By dealing with often difficult-to-talk-about subjects you can address people’s nervousness through the instrinsic benefits of laughter.” Working with MiP “helps to open doors for us and validates our work,

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issue 2 | summer 2009 | healthcare manager

as well as coming up with creative solutions to certain healthcare issues,” he says. BDC works with professional comedians and uses workshops, stand up shows, theatre, sketch shows and seminars to provide a more creative backdrop to confronting health issues. MiP’s latest video shows BDC working with managers at Leicester City PCT to reduce the number of teenage pregnancies in Leicester. BDC helped local teenagers to write and perform a comedy sketch to get the message across. To find out more about what Big Difference Company does visit www. bigdifferencecompany.co.uk.


ARTS & HEALTH

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DIVERSITY IN THE WORKFORCE

The NHS is still failing in its legal obligations to promote race equality among its senior management. Suzanne Simmons-Lewis tries to find out why and what can be done.

The publication of the Macpherson report, which shone a spotlight on institutional racism in public bodies almost a decade ago, was seen as a defining moment in the progress towards race equality. The resulting duties for NHS organisations under the Race Relations (Amendment) Act 2000 were to promote race equality, develop their workforces to reflect their communities and ensure that policies and practices do not indirectly discriminate. But a number of high-profile reviews in the last year have exposed the NHS’s failure in this area. Most recently, the Healthcare Commission’s report Tackling the Challenge, published in March, found many NHS trusts were falling short of their legal obligations to promote race equality. A quarter of the 39 trusts reviewed failed to publish adequate and up-to-date workforce statistics as required by the Act, and while people from black and minority ethnic (BME) backgrounds accounted for 16% of the NHS workforce, they made up less than 10% of senior managers and just 1% of chief executives. Michael Parker, Chair of Kings College Hospital NHS Foundation 12

issue 2 | summer 2009 | healthcare manager

Trust, is one of a handful of BME staff in a senior NHS role. He points out that diversity at board level brings both financial and performance benefits, as he has seen in his own trust. ‘A diverse board is an effective board,’ he says. ‘In addition to the statutory requirements to have a nurse, doctor, accountant and chief executive, any perceptive chair will make sure that they have some key dynamics: a diversity of people, skills, cultures and characters. When this is in place, members should not hold their heads below the parapet. They will be able to celebrate the fact that they are there because they are different and their contribution will be different.

“We need to make the organisations attractive so people feel confident to apply.” Dr Wai-yin Hatton NHS Ayrshire and Arran

‘A board like this is more likely to be argumentative and I see this as a good thing,’ he adds. ‘If there is constructive criticism that facilitates a broader debate, it’s more likely to result in better decision making.’ According to a recent report by the NHS Institute for Innovation and Improvement, Access of BME staff to senior positions in the NHS, there are a number of common organisational and individual barriers to improving race equality at senior levels. Organisational barriers include racially-biased recruitment practices, particularly during mergers or restructuring, the undervaluing of


DIVERSITY IN THE WORKFORCE

relevant experience and overseas qualifications, and the institutional culture demonstrated through individual or group behaviour. Barriers for individuals include a lack of mentors and role models, being excluded from informal networks and communications, stereotyping and preconceptions about roles and abilities, and a lack of significant line management experience and challenging assignments. Dr Wai-yin Hatton, MiP member and chief executive of NHS Ayrshire and Race for Health

Arran, believes two specific barriers need to be broken down if more BME staff are to move into senior roles. Firstly, the individual mindset of BME staff needs to promote more positive attitudes to personal development and, secondly, organisations need to make themselves more attractive employers to BME communities. ‘Where organisational culture is concerned we need to make the organisations attractive so people feel they are confident to apply to them. For example, if you have a highly

The Department of Health’s ‘Race for Health’ programme aims to tackle health inequality in England, where on average BME communities experience worse health outcomes. The programme covers three strands: workforce, service delivery and commissioning. All 22 PCTs on the programme pledge to comply fully with the Race Relations (Amendment) Act and take action to tackle the four big drivers of race inequality in health – heart disease and stroke, mental health, diabetes and perinatal mortality. Trusts on the programme compare progress, test ideas and challenge each other, and benefit

transactional, non-people-oriented organisation, then people like me will not want to be involved with it…they may also be concerned with whether there are good leaders, or if the organisation has a discriminatory reputation.’ Dr Hatton says she is regularly approached by recruitment consultants trying to fill senior positions. ‘We have to look at why enough BME people are not going for these senior jobs… We should look at good practices within the NHS and promote these so the NHS is universally an attractive

from peer reviews and ‘Thinking Partners’ – a body of experts in equality and health and social care. Programme director Professor Helen Hally says: ‘Organisations that join see the benefits. Unless they really understand the equality and human rights agenda, there is no way they are going to be able to deliver on their corporate responsibilities. ‘It’s programmes like this that will increase the pace, and when people see the benefits of embracing the agenda, it could make for better commissioning, a better workforce and better social cohesion.’ Ealing Primary Care Trust joined

the programme in 2004, seeking to tackling health inequalities in Southall, where more than 75% of the population is BME. Southall has higher than average mortality rates – with coronary heart disease and strokes accounting for around 35% of deaths – as well a high prevalence of diabetes and tuberculosis. Stephen James, head of partnerships and diversity at the trust, says: ‘Working with our Thinking Partners around developing key performance indicators has helped us to get a detailed picture of health inequality which enables us to target services more efficiently.’

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DIVERSITY IN THE WORKFORCE

Brighton’s Commitment to Change

In December 2008, Brighton and Sussex Hospital Trust invited Dr Vivienne Lyfar-Cissé (pictured) to lead a transformational change management programme to address existing institutional racism. This followed a review by the South East Coast BME Network, which found that NHS organisations failed to meet their legal obligations on race equality mainly because of a lack of leadership, sustained commitment and adequate resources. Dr Lyfar-Cissé devised a programme, ‘Commitment to Change Agenda for Race Equality’, which allows BME staff to work in partnership with the trust’s executive team to addresses all the factors identified by the report. One of the objectives is to make delivery of the race equality agenda an organisational responsibility rather than an HR function. To facilitate this, the programme incorporates a Standard Operating Procedure (SOP), which provides a tool to:  Standardise the collection of race equality data from all departments within the trust  Manage performance on delivery of the programme  Drive improvement and cultural change  Engage staff at all levels in the organisation  Raise awareness of issues of concern for BME staff and patients/clients  Provide ownership of race equality data  Highlight and reward good practice  Address areas of concern  Identify gaps for education, training and support The workforce and service user data for each department will be analysed and an action plan drawn

employer to work for.’ There have been numerous national, local and internal initiatives designed to promote diversity in the NHS workforce in general and in senior positions in particular. But according to the NHS Institute there is little evaluation of their impact or success. Under the 2000 Act, NHS trusts must publish employment monitoring statistics by reference to ethnic group and the results of race equality impact assessments. But while there is a legal obligation to produce this data, enforcement is in the hands of the Equality and Human Rights Commission, and evidence of compliance is patchy. Dr Vivienne Lyfar-Cissé, principal clinical biochemist at Brighton and Sussex University Hospitals Trust and chair of the South East Coast BME 14

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up to address the issues identified. This process will be repeated four times a year, so the trust can monitor progress based on available evidence. Progress will also be reviewed by an independent Race Equality Commission, consisting of internal and external members, which will act as a critical friend by challenging the executive team to deliver on its race equality duty. ‘This programme provides the trust with an ideal opportunity to turn this situation around for the benefit ultimately of all people,’ says Dr Lyfar-Cissé. ‘It will not only ensure the trust delivers on its legal obligations, but also provide an opportunity to demonstrate that race equality is core business for the organisation.’

Network, found significant challenges and resistance when the network embarked on a survey of NHS organisations in the region to see how they were implementing measures to comply with the Act. A groundbreaking report, the Race Equality Service Review, written by Dr Lyfar-Cissé, was published in July 2008 with support from MiP. It was the first to use NHS race equality workforce data to gain a comprehensive picture of the widespread disadvantages faced by BME staff in one region. It found BME staff are less likely to be appointed from a shortlist, more likely to be disciplined, involved in a grievance, a bullying or harassment dispute, or to pursue a case through an employment tribunal. Building on its pioneering work, and with the support of MiP, the South East Coast BME Network hosted a National NHS BME Network Conference on

5 June in London. The conference presented fresh approaches to promoting racial equality and took soundings from delegates on developing an independent National NHS BME Network to drive forward the process of change. The Breaking Through (BT) programme run by the NHS Institute of Innovation and Improvement aims to ensure the NHS uses all its talents by identifying, developing and positioning managers from BME backgrounds into director-level opportunities. Its flagship ‘Top Talent Programme’, introduced in 2007, identifies talented BME staff from Agenda for Change band 8 and above. There are some early signs of success: from 2004 to 2007, only two staff out of the 400 on BT programmes gained director level positions, while three Top Talent participants have already


DIVERSITY IN THE WORKFORCE

achieved this since 2007. Yvonne Coghill, leader of the national BT programme, says Top Talent is different to other leadership programmes. ‘Managers can self-refer onto the programme. If accepted after our assessment, they are taken out of their jobs onto 18-month secondments two or three grades above their current role, which is quite a substantial level of time to have something on their CV. We ask for board-level support and highlevel mentors…The only thing we can’t do for them is to change the way people think in the NHS.’ The programme is gradually increasing in size; there are 24 participants in the second cohort and Coghill hopes this will increase to 35 in the third cohort. ‘The climate is right in the NHS for this,’ she adds. ‘There is real mood and move for good leadership…The programme has lots of senior level support and funding is good – each employer receives £60k to host a secondment.’ Richard Stubbs joined the first Top Talent cohort as head of business development at Doncaster and Bassetlaw Hospitals NHS Foundation Trust. As part of the programme, he negotiated his own placement as associate director of corporate Personal Questions: Michael Banner Equalities Consultant

“There is real mood and move for good leadership – each employer receives £60k to host a secondment.” Yvonne Coghill Breaking Through strategy at Derbyshire County PCT. He was also recently appointed to the board of the National Leadership Council, chaired by NHS chief executive David Nicholson. ‘I didn’t feel that my career was stalling, but Top Talent offered the kind of acceleration I felt I was capable of,’ says Stubbs. ‘It was the right vehicle for me. My experience on the programme has been very rewarding, particularly the protected development time.’ Dr Minesh Khashu, a neonatologist with Poole Hospital NHS Foundation Trust, joined the first cohort of the Top Talent Programme and is now on secondment as an associate medical director at the same trust. ‘The programme has helped me to network much better and given me

Working in and around the health service for ten years did not prepare me for being a patient. My third admission in a year was planned, and I recall the nurse going through the admission checklist. I was asked such questions as ‘Do you mind having your chest uncovered?’ and ‘would you object to being treated by a female nurse?’ The one I could have done without concerned my bowel movements: not only did I have to say when but, with the help of a handy chart, explain the structure. Embarrassed, I pointed in the general direction of the middle of the chart and hoped that would be the end of it. Five weeks into my stay, I was regularly hooked up to an IV antibiotic and almost camped out in the toilet. Following something like my fifth ‘trip’ that day, a nurse asked me if I had ‘opened my bowels’. The question implied that I had a choice in the matter – the last time I was able to exercise my prerogative over this function seemed an age ago: ‘So that’s a yes then, is it?’, she said.

exposure to a few senior people in the NHS,’ he says. ‘The coaching and mentoring has also helped. When I joined I was leading a particular service, but my current secondment role is more generic, so I am involved in the next level of management – it’s definitely a way forward.’ MiP chief executive Jon Restell said: ‘Everybody agrees that achieving race equality in the health service is a must do. The challenge is to make it happen in a period of reorganisation and public finance constraint. The barriers to change get raised even higher when belts are being tightened. But that is just when managers need to be courageous and stick with programmes such as Breaking Through and Brighton’s Change Agenda for Race

Later that week, getting better and increasingly bored, I looked through my notes and was surprised to find myself down as white and C of E. As a mixed-race, lapsed Catholic, I was not too impressed. I pointed this out to a Sister, who checked the information and sighed. ‘Sometimes staff get a bit embarrassed about asking patients about their ethnicity. Most haven’t been told why or how to collect it and feel uncomfortable asking what they see as a very personal question.’ So while some organisations accurately collect and use ethnic monitoring and patient profiling information to support their work, others have yet to do so. As for what constitutes a personal question, I think I speak for many when I suggest that there many more personal and embarrassing questions than ‘What is your ethnicity?’ A fuller version of this article can be read on the website www.miphealth.org.uk/hcm.

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SKILLS

Although fundamental to modernising the NHS, plans to boost the skills of NHS staff are often left on the shelf. Helen Mooney tries to find out why.

Ask any random group of managers what they think of the KSF… then duck! To put it mildly, it has not been an overwhelming success. But the NHS Social Partnership Forum is determined to resuscitate it and is commissioning an independent review this summer, and they want to hear your views. In January, the National Audit Office (NAO) published its report, Pay Modernisation in England:Agenda for Change which concluded that many

“The benefits that should have come with this new simpler system, such as more effective working, have not been wholly achieved.” Tim Burr head of NAO

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trusts have not fully implemented the Knowledge and Skills Framework ‘It was no mean feat transferring virtually all NHS staff onto a new pay system within a very constrained timeframe, and this element of Agenda for Change has been a success,’ says Tim Burr, head of the NAO. ‘On the other hand, the benefits that should have come with this new simpler system, such as more effective working, have not been wholly achieved. So the programme as a whole has further to go before it achieves the intended value for money for the taxpayer.’ KSF is a competency-based staff development framework which involves creating an outline for each post of the knowledge and skills required, an annual review to assess each postholder’s knowledge and skills against the outline and an agreed personal development plan for each employee based on the skills gaps identified at the annual review. Pay is not directly linked to the framework, although movement through two

‘gateways’ in each pay band is dependent on a satisfactory annual review. The NAO concluded that the KSF is viewed as ‘too complicated’ by trust managers and staff, which discourages some trusts from making the best use of the tool. By October 2007, only 41% of NHS staff had received a knowledge and skills development review in the preceding 12 months, and because of its slow implementation the Department of Health relaunched it in November 2007. In May last year, health minister Ann Keen wrote to all NHS organisations emphasising the need to use the KSF. By September 2008 the NAO found that the proportion of staff who had received a knowledge and skills review had increased to 54%. The NHS staff survey for 2008 suggests this figure may have increased again, with 64 per cent of staff reporting they had had an appraisal in the last year. Geoff Winnard, head of the Agenda for Change team at NHS Employers,


SKILLS

“I think that there remains a perception that the KSF is too complicated and this is a problem...its potential is huge but if there are barriers, we need to unlock these.”

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What the NAO recommends for KSF

Trusts should have a champion at board level to ensure all staff have annual reviews. The champion should ensure the KSF is used to contribute to wider organisational and service improvements through more productive ways of working

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Managers should have training to use the KSF effectively.

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Staff should have the time to participate fully in reviews.

Geoff Winnard, NHS Employers

says without full implementation of the KSF, Agenda for Change cannot be said to be fully implemented. ‘There remains a perception amongst some managers and staff that the KSF is too complicated and this is a problem...its potential is huge but if there are barriers, we need to unlock these.’ In a bid to analyse these barriers, the Social Partnership Forum – the partnership between the Department of Health, NHS Employers and NHS trade unions dealing with NHS working relationships – is commissioning an independent academic review of the KSF. Winnard says this will look at the ‘perceived and real barriers to implementing and using [the KSF] effectively.’ Ultimately, Winnard says all staff should have access to an appraisal process through the KSF. Jane Carter, who leads work on the KSF for MiP, agrees it needs to be simplified. ‘Trusts need to be doing this but we want to see more training on the KSF for senior managers who have to implement it.’ Jane says a lot of

“We want to see more training on the KSF for senior managers who have to implement it.” Jane Carter, MiP

work has already been done on understanding the obstacles to implementing KSF and managers need to put into practice. Training packages are available through MiP’s partner UNISON, which can help trusts understand the KSF and use it for their own staff. Each strategic health authority also has a KSF lead appointed to help trusts with implementation and the sharing of best practice across their patch. Helen Pottinger, KSF lead at NHS Yorkshire and the Humber, says trusts are at different stages of implementing the KSF. ‘Commissioning a Patient-led NHS held some organisations back a bit in terms of their work on this part of Agenda for Change. Some have got the impetus and the energy but others haven’t, and we need to work on that,’ she explains. Unsurprisingly, trusts that have maximised use of the KSF are those where management have been committed to making the system work, and staff and managers have received

adequate training and time to carry out the process. A small number of trusts have even integrated the KSF into their performance management systems, but the NAO found sharing of best practice to be ‘patchy’. Trusts that have implemented KSF are better placed to use the annual review to assess performance in carrying out important daily tasks, as well as to review the application and acquisition of knowledge and skills over the year. According to newly elected staff side chair of the national KSF group, UNISON national officer June Chandler, the goal is to achieve regular appraisals for every member of staff working in the NHS. ‘This is something we have never had before and, if nothing else, it is good human resources practice,’ she says. Chandler says trusts need to be pragmatic about implementing it and do not have to develop their own systems for it. ‘We need to put the spotlight back on the KSF and move it away from job evaluations... it is not going away.’ Carter echoes that view and wants more managers to get involved by having their say in the review. ‘It will take place over the summer,’ she says ‘and we want to make sure the managers’ experience and opinions is reflected in the report and recommendations. KSF is here to stay so let’s make it a really useful tool for healthcare managers.’ To find out more about KSF in your area, contact the KSF lead at your SHA

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YOUR JOB: TRAINEES

Talking shop

Take a s it’s good

Craig Ryan gens up on a new MiP-backed initiative to give trainees more professional support and access to the latest research ideas.

Doing voluntary work overseas can than damage your career. Catherine R volunteer health workers from the N

Trainees and new NHS managers often say they have a hard landing when they start working for real in the NHS. With little professional support, research and practical expertise on management problems can be hard to find. To help remedy this, MiP has teamed up with the SDO Network and MiP Knowledge Exchange to launch the Knowledge Network, a new online portal aimed at management trainees and new NHS managers. Managers can use the Knowledge Network to exchange ideas about problems, access the latest research and give feedback on what works and what doesn’t. ‘As a new manager, you often find yourself with a challenge and no idea how to begin developing a solution,’ says Yvonne Gruendler, strategic and service planning manager at Southampton Community Healthcare. ‘You feel like you’re reinventing the wheel. When people move on, they take their knowledge with them and there is nowhere for people to put down their experiences.’ She says that new NHS managers often find it hard to keep up with the latest research, despite many having a research background. ‘We want to practice evidence-based management, in the same way clinicians practice evidencebased medicine. But you can’t read everything and there is no knowledge sharing system for the wider NHS.’ When Yvonne did a placement at McKinsey’s, the leading management consultancy firm, she was impressed with their global knowledge portal. ‘It was fantastic; you could share information 18

issue 2 | summer 2009 | healthcare manager

with people all over the world. The NHS has nothing like that.’ The network, which will be formally launched at the NHS Confederation conference in June, will be run by the SDO Network, a part of the NHS Confederation dedicated to helping managers make better use of research. The SDO Network already runs a programme bringing managers and researchers together to talk about the latest research and how it works on the ground. ‘We realised there was a low level of awareness of research into the way services are managed and delivered,’ says Ganesh Sathyamoorthy of the SDO Network. ‘So we widened our remit to include “knowledge mobilization”. The Knowledge Network is one way of getting this dialogue between managers and researchers going.’ Knowledge Network users will be able to upload documents to the site with a commentary and give each a ‘star rating’ according to how useful it has been to them in their work. Managers will also be able to ask for advice and relevant research on the issues they are facing. While the service is aimed initially at trainees and new managers, any NHS manager is welcome to register and use the service. ‘We want colleagues to look at it and think how the wider community might be able to make use of it,’ says Yvonne. ‘It will only be good as the information on it – as good as what people put on it.’

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The Knowledge Network is at www.sdonetwork.net

Allowing a valued member of staff time away from the UK is a difficult decision. Will they return to work? Will time away affect their ability to do their job effectively? Will they lack motivation and commitment on their return? Although these are natural concerns, evidence suggests the opposite: VSO (Voluntary Service Overseas), an international development charity that works through professional volunteers, has found its former volunteers return to the workplace with expertise that


Your JOB: CAREER DEVELOPMENT

abbatical – for your health

enhance rather Raynor spoke to two NHS.

Oliver Jefferis Volunteer

enormously to my future career in the UK. I was involved in an enormous amount of teaching and had clinical exposure that someone who stayed in the UK could never hope to get. ‘I think there’s a lot of dissatisfaction in the UK with the NHS, but working somewhere like Malawi will make you appreciate so much more the resources that are available in this country, and will make you want to use them more efficiently. I’d say to a doctor who’s considering applying “go for it”; it’s only going to have a positive impact on your career in the future.’

them they couldn’t do it, because it’s never going to benefit the organisation when somebody’s sitting there feeling resentful that their development is not being fully supported. Besides, someone taking a sabbatical creates an opportunity for somebody else’s development.’ For further information on VSO’s work in health or to find out how a partnership with VSO could support staff development needs in your organisation visit www.vso.org.uk or email Graeme.Chisholm@vso.org.uk

.

VSO does not just recruit clinical professionals for its overseas health work. Volunteers also work alongside hospital managers and in Ministries of Health to develop structures that sustain a robust health system. So there are opportunities for professionals with skills such as staff development, hospital management, and resource planning to volunteer. Vicki Masters was working as an organisational development adviser for the NHS when she took a career break to volunteer with VSO. With a background in staff development and training, Vicki understands the situation from the point of view of both the volunteer and the manager. ‘If a member of my staff came and said to me, “I want to do VSO”, I’d be helping them to think where they saw their future career going and why they wanted to do VSO. I would of course be thinking about the challenges for the organisation but I wouldn’t say to

Simon Rawles/VSO Photo Library

they would not have gained in the UK and a renewed commitment to their UK career. Oliver Jefferis volunteered in Malawi through a joint scheme between the Royal College of Paediatrics and VSO, and during his placement was involved in both clinical activities and training. ‘If someone said to me that volunteering had been a waste of time I’d say ‘that’s complete rubbish,’ he says. ‘There are so many of my existing skills that were developed and I think my experience will contribute

“I’d say ‘go for it’; it’s only going to have a positive impact on your career in the future.”

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YOUR JOB: MiP AT WORK

Tipster: DIVERSITY

Partnership in practice

Yvonne Coghill, national programme lead at Breaking Through, shares her tips. 1 Board level support

Delivering training in Dudley

“MiP is in the unique position to be able to deliver for both managers and unions” Pete Lowe MiP National Officer

Essential if you want to get this show on the road. You need a board committed to the agenda and an executive director responsible for delivering on the legal and business case for diversity. 2 A diverse senior team Saying you are inclusive means nothing – you need to show it! 3 Values-based training Make it clear you support diversity out of conviction not just to avoid legal action. 4 A good mentoring scheme ...for staff at all levels. It’s an old one but great value in my opinion.

MiP represents members when they take a grievance or are subject to disciplinary proceedings. But as managers our members also have to deal with these cases from the other side. In either case, it’s not a pleasant place to be. Pete Lowe, MiP’s national officer in the Midlands, realised that training to promote a partnership approach could help managers and unions avoid going down that route and, if it was unavoidable, help them achieve the best outcome for everyone. Pete designed a training scheme to promote interaction, discussion and feedback, and Dudley PCT agreed to pilot it. Pete was joined by Jackie Garland, Dudley’s staff side lead, to deliver the training. Participants included representatives from the unions and professional organisations, as well as senior managers who undertake disciplinary or grievance investigations and hearings. Feedback on the course was universally positive. All participants scored it excellent or very good, with RCN rep Tom Lloyd describing the

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scheme as ‘overall a great exercise in the promotion of partnership working’. ‘A very worthwhile day with excellent facilitation and great learning methods utilised,’ said Gursharn Malhi, HR manager for Dudley. ‘I really enjoyed myself and developed some good networks.’ Elaine Campbell, a manager in Dudley added: ‘It was a very useful course. Facilitation from MiP is what is required when expecting a change in organisational culture.’ MiP and Dudley PCT are discussing ways to include the course in the PCT’s annual programme as mandatory training for managers and staff side representatives. Pete said: ‘This difficult time of health redesign and organisational change highlights the importance of working in partnership to ensure fairness and transparency. MiP is in the unique position to be able to deliver for both managers and unions.’ For more information about MiP in your area, or if you want to get more involved, contact your national officer or Martin Furlong at m.furlong@miphealth. org.uk

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5 Mechanisms for talent

spotting & career Tracking

Evaluate that mentoring scheme – make sure it is being used effectively in attracting talent and achieving results. 6 Up-to-date metrics & data Trust me, you can’t beat sound data for showing where the gaps are and for making the case for action. 7 Identify potential blocks ...having carried out step 6, carry out regular reviews to identify barriers in the system and work to remove the blockages; learn from others what works. 8 Opportunities for stretch

assignments

Allow staff to broaden their experience and test how they want their career to develop. 9 A fully supported network That also means allowing them the time and facilities to meet. 10 A culture of supporting &

developing staff

That’s what you’ll have once you’ve got steps 1-9 right!


YOUR JOB

legaleye Use our stress protocol to resolve claims without litigation Stress claims are notoriously difficult to win and the courts have made it increasingly difficult for employees suffering from work-related stress to successfully sue their employers. But the courts are not the ideal place to resolve a stress claim. In Hatton v Sutherland 2002, Lady Hale set out ‘16 practical propositions’ for determining stress cases. These propositions have resulted in very few cases succeeding since then. Claimants need to be protected from further stress in trying to proceed with cases where the facts do not meet the criteria set out in Hatton v Sutherland. The worker has to prove that workrelated stress is severe enough to have caused psychiatric illness and that the employer could have foreseen that this injury would result from their negligence. An employee must either report directly to their employer that they will suffer such an injury or get a medical adviser to report it to the employer. It is not enough to suggest the employer should have automatically realised the employee would suffer from stress as a result of their work. In all cases, the onus is on the claimant to alert the employer to their problems as soon as these arise. Recent court decisions have emphasised that, where possible, a negotiated remedy should be sought. The most successful outcomes are negotiated when the worker has spoken to their union representative at an early stage. Thompsons Solicitors and UNISON initiated a stress protocol in 2007, which is also available to MiP members

under our partnership arrangements. It allows members to get swift, detailed advice without a long and difficult interview with a solicitor. It also allows MiP to consider whether a negotiated remedy is more appropriate than legal proceedings. Under the protocol, the MiP national officer will first clarify the issues and whether they can best be resolved through negotiation. The officer will also give an indication about whether the case would have a reasonable chance of success in court. If the problem cannot be resolved at this stage, the member and the officer complete a questionnaire for Thompsons, who will advise MiP

directly on the merits of the claim. If there is clearly no possibility of making a claim and the case is turned down, MiP will explain the reasons to the member and inform them of the time limits should they decide to pursue the claim without union backing. If it has merits, the case will proceed as a normal personal injury claim with Thompsons obtaining medical evidence and commencing court proceedings as appropriate. Where cases proceed with MiP’s support, members do not meet any costs themselves.

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Linda Millband Thompsons Solicitors

NHS casebook: Hospital worker beats the bullies to win claim Llanelli Hospital Trust was ordered to pay damages to an information manager who suffered a nervous breakdown after being bullied and harassed for three years by her new boss. Nanette Bowen’s claim was dealt with under the UNISON stress protocol. Nanette, who worked at the trust for 28 years, said her life became hell in those last three years. Her boss prevented her from providing any information without his written consent, ordered her to complete a daily form so he could see what she was doing and removed her responsibility for hiring staff. He was aggressive when challenged, made sexual innuendos and banned her from attending meetings vital to her job. Nanette was signed off sick with stress and sometimes suffered panic attacks when she tried to return to work. At one point she was rushed to hospital with a suspected heart attack. ‘The NHS was my life. I had always felt great loyalty to the trust and worked to the best of my ability in everything,’ said Nanette. ‘I feel bitterly let down by the Trust, which did not do its best to support me when I needed it most. ‘My life has been ruined by what I went through during those three years. At this stage I cannot contemplate returning to any form of work and am still receiving counselling to help me control my panic attacks.’ Dave Galligan, UNISON’s head of health in Wales, said Nanette ‘had suffered terribly and the NHS lost a skilled and dedicated worker’ as a result of the trust’s negligence. ‘This case is a warning to employers that they need to listen to their employees’ concerns and act sooner rather than later, or face the consequences.’

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YOUR JOB: MiP ROUND THE REGIONS

Wales update Pace quickens in restructuring plans In April, NHS Wales announced the appointment of the six chief executives who will head the new Local Health Boards (LHBs) being established in June (see healthcare manager issue 1). NHS Wales are now moving on to appoint the next

“At a time when resources are scarce, we hope those changes will deliver improvement in care.” Sam Crane South Wales MiP link member

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tiers of management ready for the LHBs to become fully operational by October. ‘I look forward to meeting the new appointees to discuss their plans for the next tiers,’ said MiP national officer Andy Hardy. ‘I have raised a number of concerns with NHS Wales on behalf of our members and will continue to do so. ‘We want to ensure they deliver on their commitment to retain skilled staff and protect pay and conditions of services for our members who are undergoing massive change in Wales.’ MiP members in Wales are joining together to make sure their voices are heard in shaping the new organisations. Sam Crane, the newly appointed South Wales MiP link member, said: ‘The reorganisation of the NHS in Wales is to be welcomed to ensure more integrated service delivery for patients, their families and the professionals involved in delivering services. ‘At a time when resources are scarce, we hope those changes will deliver improvement in care. I look forward to working closely with Andy Hardy and the new organisation in supporting and protecting our members in every way through these times.’ MiP members in Wales can contact Andy Hardy on a.hardy@ miphealth.org.uk; or in North Wales contact Jim Keegan on j.keegan@ miphealth.org.uk .

Regional Briefing

Yorks & Humber Improving health through partnership The Yorkshire and the Humber Social Partnership Forum met in Leeds on 7 May for its third summit, entitled “Social Partnership for Improved Health”, with John Cafferty, UNISON regional contact officer for Yorkshire and the Humber in the chair. The event was well attended by management and staff side representatives from PCTs, acute and FTs, and the Ambulance Trust. Gill Bellord, NHS Employers, Jane Pawson, Department of Health, and Mike Jackson, NHS Trade Unions, gave a presentation on the development of the National Partnership Forum and key issues of the moment. This was followed by Tim Gilpin, director of workforce, at Yorkshire and the Humber SHA, reporting on the work of the forum over the year and looking ahead to 2009-10. The keynote speaker was junior health minister Ann Keen, who praised the work of the Social Partnership Forum and urged trusts to apply to the new partnership fund to support their local partnership work. Keen


YOUR JOB

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

said the NHS Constitution and staff pledges were ensuring that partnership working was central to the delivery of the best possible care for patients. She said the government was committed to ensuring the wellbeing and safety of staff and to ensuring everyone within the NHS feels valued. Keen then took questions on topics such as how to work in partnership in the difficult economic climate, how to protect the terms and conditions of existing and new staff when contracts are won by private contractors, and how partnership working can help investment in the NHS. This was followed by workshops on equality and diversity, staff engagement and the NHS Constitution, building trade union capacity and healthy workplaces. The outcome of these workshops will shape the Forum’s agenda for 2009-10. Speaking after the meeting, MiP national officer Jane Carter said: ‘It was good to see the minister supporting partnership work in our region, listening to our views and addressing our concerns. The partnership is now bedding in thanks to the input from MiP members. Once we agree the work programme we can really get stuck in to making a difference to health services in Yorkshire and Humberside.’

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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 www.miphealth.org.uk, or complete and return the slip below to Billy Turner, MiP, 8 Leake Street, London SE1 7NN.

I wish to join MiP

Please send me further information

Name Address

Email

For more information about MiP in Yorks & Humber contact Jane Carter on j.carter@ miphealth.org.uk

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

backlash by Celticus

A ‘furious’ Ben Bradshaw is on the warpath over payoffs to trust chief executives forced to leave their jobs. ‘There can be no rewards for failure in the NHS,’ the health minister told MPs. ‘We expect the whole of the NHS to understand that the public will not tolerate cosy deals when they have suffered from such abject management failure.’ It’s a shame Ben’s zero-tolerance policy doesn’t apply in other government departments. The Royal Bank of Scotland and Lloyds TSB, for example.

admin staff to do all of those secretarial jobs that, frankly, waste your time’. Would these ‘high quality’ staff be more of those ‘bureaucrats second guessing your judgements’ he denounced in the same speech? Surely Cameron’s putative health secretary Andrew Lansley can tell him that ‘every penny spent on wasteful bureaucracy is a penny less for patient care?’ Let’s hope Dave will stand by his new admin staff when columnists like Jemima Lewis start bleating about there being more penpushers than doctors.

Time wasters wanted

All in a day’s work?

Something wrong here. David Cameron won plaudits from last month’s RCN conference by promising nurses that his government would appoint ‘high quality

Following predictable outrage over revelations that the NHS is spending £273m on external consultancy not directly related to patient care, Backlash was pleased

Payback time

WronG NUMBEr!

More managers than doctors ‘How do you hold a system devised and run by 39,000 faceless managers (more than there are NHS doctors) to account?’ fumed the Telegraph’s Jemima Lewis, 18 April. The ‘more managers than doctors’ line gets trotted out regularly, but it’s hard to see where it comes from. The latest Department of Health statistics show that there were 133,662 doctors working in the NHS in 2008. Celticus’s best guess is that Lewis is misleading her readers by using the figure for consultants (34,910) as if they were the only doctors working in the NHS. And for the record, Ms Lewis, there aren’t 39,000 managers. There’s 40,000. And some of them are even human! Wrong Number! exposes misleading statistics used to attack people who work in the NHS.

to hear about Rob, one IT consultant who certainly earned his corn. Sauntering into work at a Sussex hospital, Rob was greeted by a flustered surgeon brandishing a theatre gown. ‘Are you the IT chap? Quick get washed and put these on NOW!’ Within three minutes, our techie was kitted out and rushed into the

Phrase Book

Knowledge mobilisation (n.) According to consultants TFPL (who know about these things) Knowledge Mobilisation means ‘harnessing the knowledge the organisation already has to improve its effectiveness and filling any critical gaps’. It’s a step beyond mere knowledge management (which consequently has now lost its capital letters) and typically involves combining external knowledge with knowledge that already exists within the organisation to create ‘new’ knowledge. The idea is that there are lots of people around who know stuff and we want them to share it with the rest of us. Knowledge mobilisation often involves slightly shady characters known as ‘knowledge brokers’, who act as ‘middle’ men and women between people who know and people who don’t. Formerly known as: ‘knowledge transfer’. Also known as: ‘learning’.

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issue 2 | summer 2009 | healthcare manager

operating theatre, to find a team of doctors and nurses surrounding a patient with his chest opened up. ‘That machine over there is a live link to another surgeon who’s guiding us through this operation,’ Rob was told. ‘And it’s just packed up!’ After two handshaking minutes of doing whatever IT guys do, Rob got the machine up and running and was ushered out to collapse in a cold sweat. Good work fella! How many IT consultants can say they’ve saved a patients life?

Need a shrink? Did you notice someone’s lopped an inch off the size of the Health Service Journal? Imitation really is the sincerest form of flattery…


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