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issue 20 winter 2013
healthcare manager inside heads up:2
What you might have missed & what to look out for Leading edge: Jon Restell inperson: Andrina Hunter, Inverclyde Community Health and Care Partnership inpublic: Ysbyty Ystrad Fawr, Gwent
Dr Gareth Morgan: ideas for care reform
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.
Photo feature: MiP conference 2013 Interview: Chief inspector of adult social care Andrea Sutcliffe Arts and health: how the arts are playing an increasingly effective role in healthcare Knowledge is power: access to high quality information is now a must for patients in a modern NHS
Legal Eye: new rules on disclosure and barring Tipster: Derek Mowbray boosts your resilience MiP at Work: learning through good practice
healthcare manager | issue 20 | winter 2013
Welcome to the winter issue of healthcare manager, the magazine from MiP, the specialist trade union for health and social care managers. This issue includes an interview with Andrea Sutcliffe, the CQC’s newly appointed chief inspector of adult social care. She talks about her plans to shift the emphasis of social care inspection so that patients’ needs and preferences always come first and shares her thoughts about achieving effective integration of care. We also look at the role of arts in health – both as therapy and as an important part of the healthcare environment, improving the experience of patients and staff. Sarah Smith from the Patient Information Forum puts the case for providing patients with better information, arguing that this in itself can be therapeutic. And a bit of therapy for managers: Derek Mowbray shares his tips for strengthening your resilience to deal with the challenges you face every day. Derek was one of the great speakers at MiP’s conference in November, discussing what makes a good manager and how effective patient and staff engagement can be achieved. Our photo feature gives a flavour of the event. Finally, I’d like to wish you all the best for a happy and healthy new year. Marisa Howes Executive editor
heads up what you might have missed and what to look out for
New guidelines on cutting sick leave
Scottish NHS team pic up IT award
The Key Information Summary programme has won the prestigious ‘Excellence in Major Healthcare IT development’ award at the UK eHealth Insider Awards 2013, the major awards for the healthcare IT industry. Co-ordinated by NHS National Services Scotland and developed by Atos, the Key Information Summary (KIS) allows important patient information to be shared between GPs
and healthcare professionals in many areas. It includes information on future care plans, medication, allergies, diagnoses, patient wishes and details of carers and next of kin. “The whole team is delighted to receive this award in recognition of all of the hard work and efforts made to deliver KIS for patients,’ said Dr Libby Morris, eHealth lead for primary care for the Scottish Government Health department. ‘We want to make a real difference to patient care and build upon this success as part of future improvements to patient information and how this is shared in the NHS and beyond.”
issue 20 | winter 2013
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Marisa Howes, Helen Mooney, Alison Moore, Gareth Morgan, Derek Mowbray, Victoria Phillips, Jon Restell, Craig Ryan, Sarah Smith, Linda Steele, Corrado Valle.
The NHS Staff Council has revised its guidelines on the prevention and management of sickness absence among NHS Staff. Produced by the Health, Safety and Wellbeing Partnership Group, a sub-group of the NHS Staff Council, the guidelines set out the best practice for developing sickness policies and advises organisations on how they can improve staff availability through effective management. The guidelines are based around five key principles: partnership working between unions and management; leadership from board level; a model of continuous improve-
ment; effective line management support; and access to competent advice. The new guidelines follow the 2009 Boorman review which estimated that sickness absence could be cut by a third, and £555m could be saved across the NHS, if interventions to prevent and manage sickness absence were implemented effectively.
Guidelines on the prevention and management of sickness absence are available from www.nhsemployers.org.
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healthcare manager | issue 20 | winter 2013
leadingedge Jon Restell, chief executive, MiP
iP is a strategic organisation that also operates in the here and now. In the last nine months MiP members have been talking about what the future means for you and the union, most recently at our annual conference on 27 November. A broad consensus is emerging about the big picture. The economy will continue to bump along, or near, the bottom. There will be no more money for public services (aside from the odd tactical sticking plaster around elections). Whichever parties form governments, none will depart from the general direction of health and social care policy. Demand will continue to grow even as resources shrink – and it will be the controversial yet essential job of public sector managers to square the circle. In response, we’re clear that our mission remains the same. We shall continue to represent you with your employer, individually and collectively, through our excellent team of paid national officers (our USP); we shall continue to speak up for managers in the media and with politicians; and
1% rise for some Scottish senior managers The Scottish Government recently announced a 1% pay rise for most Executive and Senior Manager grades in the NHS in Scotland. Under pay arrangements for 2013-14, healthcare manager | issue 20 | winter 2013
“MiP members should articulate what good healthcare management means before people who don’t understand management (and care even less) do it for us.” we shall continue to champion and spread great management practice and skills. But how we do these things may change. First, services and their managers are being outsourced at an ever-faster rate. We’re clear that MiP will follow members out of the NHS. The question for us is how does MiP – predominantly NHS-based – become more relevant to managers outside the NHS. Secondly, manager bashing will intensify, as politicians seek to create dividing lines in an area of consensus and the media seeks explanations for why things don’t work. We’re clear MiP will challenge the drip-drip ‘narrative of failure’ with a ‘narrative of success’. The question for us is, when
facts and figures don’t persuade, how can we tell the stories of successful managers delivering for patients. Thirdly, the attack on terms and conditions will go on, even though your real-terms earnings have already been cut by between 8% and 14% in the last three years. We’re clear MiP will resist, but we are fighting on so many fronts we must pick our battles. The question is what are our members’ priorities. Fourthly, in the year of Francis we don’t need reminding that when managers fail great suffering can follow. MiP members should articulate what good healthcare management means before people who don’t understand management (and care even less) do it for us. The question is how to take the first step. I’d love to hear your thoughts on these key issues. Take the chance to shape the future of your union. Finally, at the turn of another year, remember you are stars. The NHS remains the most popular public service, delivering high quality care, day in, day out, loved by the public and envied by the world. You make this happen. Celebrate.
all managers earning less than £80,000 a year will receive a basic pay rise of 1% unless their performance is rated as “unacceptable”. Managers earning more than £80,000 will receive no increase, and those earning just under will have their increase capped so that their new salary does not exceed £80,000. There will also be a performance related uplift of up to 4%. MiP national officer Claire Pullar said:
‘We welcome the first real pay rise for some managers for over 4 years, but this has to be seen in the context of increases in pension contributions, inflation and taxes which means many managers are still more than 20% worse off in real terms. It also leaves our members who earn over £80,000 without a rise in basic pay and we look forward to the Scottish Government putting this right in time for next year.’ 3
Mandate pledges equal status for mental health The NHS Confederation has welcomed the new mandate for NHS England which commits it to achieving ‘parity of esteem’ for mental and physical healthcare. The mandate, published by Health Secretary Jeremy Hunt in November, also sets objectives for better integration of services for older people and implementing the Government’s response to the Francis Inquiry. The Confed said the final version of the mandate was ‘more strategic and focused on outcomes’, following criticism that the draft version of the mandate included ‘a number of specific, unnecessary operational additions’. It particularly welcomed the Government’s recognition that improvements under the Vulnerable Older People’s Plan could not be delivered by primary care alone, but require an integrated approach
to out-of-hospital care. The mandate says NHS England will be involved in ‘removing barriers to integrated care and supporting the integration pioneers’. NHS England has also been given the objective of putting mental health on a par with physical health, and closing the health gap between people with mental health problems and the general population. ‘By March 2015, we expect measurable progress towards achieving true parity of esteem, where everyone who needs it has timely access to evidence-based services,’ says the mandate. Hunt claimed the mandate sets ‘an ambitious agenda to transform patient care’ but says the Government had ‘kept changes to an essential minimum to ensure the refreshed mandate remains strategic, outcomes-focused and affordable within NHS England’s budget.’ The Mandate for NHS England 2014-15 and associated documents can be downloaded from www.gov.uk. For details of the NHS Confederation’s response visit www.nhsconfed.org.
Commission probes maternity discrimination The Equality and Human Rights Commission has launched a major new research project into discrimination against pregnant women in the workplace. The commission says it has anecdotal evidence that many pregnant 4
‘Slimmer, more flexible’ equality scheme launched
NHS England has published a “refreshed” version of the Equality Delivery System, the toolkit launched in 2011 to help NHS organisations reduce inequality and implement the 2010 Equality Act. The new EDS, known as “EDS2”, follows an independent evaluation in November 2012. It includes a core set of outcomes and a more streamlined grading system, and encourages organisations to use it flexibly and to address key local health inequalities. NHS England says the
women continue to experience discrimination while on maternity leave, although no data has been collected on the issue since 2005. The investigation, to be funded by the Department for Culture Media and Sport (DCMS), will investigate employers’ practices towards employees who are pregnant or on maternity leave and employees’ experiences after returning to work. Mark Hammond, Chief Executive of the Equality and Human Rights Commission, said: ‘It is very concerning that in 2013 a number of women are still being
system is currently being implemented by the ‘vast majority’ of NHS organisations in England. Paula Vasco-Knight (pictured), senior responsible officer for the EDS, said: ‘Following its evaluation and further engagement, the EDS has been refreshed so that it is slimmer and more flexible to use and implement at local level’. NHS England chief executive Sir David Nicholson added: ‘The EDS is a toolkit to help all staff and NHS organisations understand how equality can drive improvements, strengthen the accountability of services... and bring about workplaces free from discrimination. I encourage NHS organisations to use EDS2 to make the difference that our patients, the public and the workforce need and deserve.’
The EDS2 documents can be downloaded from: www.england. nhs.uk.
disadvantaged in the workplace just because they are pregnant. That would be unlawful discrimination and needs to be tackled. ‘We will look at existing research, gather new evidence and carry out our expert analysis to establish the extent of the problem and advise on how best it can be addressed.’ The Commission proposed the project to the Department for Culture Media and Sport (DCMS) as part of a package of measures to address Equality and Human Rights, and culture secretary Maria Miller has confirmed the funding to support the project. healthcare manager | issue 20 | winter 2013
inperson Andrina Hunter, service manager health improvement, inequalities and personalisation, Inverclyde Community Health and Care Partnership Andrina Hunter’s job is not for the faint hearted. Created three years ago on the back of the merger of NHS Greater Glasgow and Clyde’s community health services with Inverclyde’s social care services, she says it is ‘very varied’ and, she believes, quite unique in Scotland. Andrina is the strategic lead for health improvement and inequalities, responsible for financial inclusion, welfare benefit and financial advice and, following last year’s Welfare Reform Act, she also leads on personalisation. Although she is employed by NHS Greater Glasgow and Clyde, she is also accountable to Inverclyde Council. Andrina admits that when she first took on the job, it was ‘pretty daunting’. But she says having responsibility for financial advice to the local population as well as tackling health inequalities has made a real difference in terms of health improvement. ‘When I started I knew very little about welfare reform and financial advice but I saw it as a real opportunity to take on something new. Inverclyde is a very deprived population so it has been really good to broaden the scope of the health inequalities remit and knowledge, as ultimately health inequalities will decrease,’ she explains. ‘One of the things about my role is that it is very varied. I can be in a meeting about smoking cessation and in the next meeting I will healthcare manager | issue 20 | winter 2013
be talking about the bedroom tax changes. I really like having this varied role,’ she says. Andrina has certainly had an interesting career within the public health field. Joining the NHS as a dietician in 1988, she admits that if someone had told her then what her job would involve now, she would not have believed them. ‘Other than when I started out as a dietician, every single position I have had has been brand new, it’s about taking opportunities when they present themselves, and about learning and understanding who your allies are and using the people that are around you,’ she says.
“It’s about taking opportunities and about learning and understanding who your allies are.”
Although all social care and health improvement services in Scotland are now moving to the integrated partnership model, Andrina is not aware of colleagues with a similar service remit and sees her job as ‘quite unique’. As the manager of a team of 55, she says being a successful manager is about having a ‘portfolio of management and leadership skills’. She is currently taking part in the Scottish government’s national Leading for the Future programme, which she says is about ‘really thinking about leadership skills and adapting your skills and style of leadership’. Andrina finds working in an integrated organisation both challenging and rewarding. ‘One of the reasons I like working in Inverclyde is that it’s a small area so it’s easier to build up good relationships and partnerships with a range of organisations,’ she says. ‘On the other hand the partnership still has two organisations with two HR and finance systems which can be a challenge.’ Despite this she ‘firmly believes’ in the partnership model and that things are moving in the right direction for improvement in health and social care. ‘I think one thing we really need to think about is how we better support communities to enable them to take responsibility for their own health and well-being.’ Helen Mooney
Celebrating good practice in the NHS At a time when the NHS workforce is under attack in the media almost daily, it is great to be able to celebrate the great work being done throughout the NHS to improve quality and productivity. MiP regularly supports awards for outstanding staff engagement and leadership, to help to spread good practice and recognise healthcare staff for their dedication and great teamwork. Here are some of the awards we have supported this year.
HSJ Award for staff engagement MiP chief executive Jon Restell joined Unison health group chair Roz Norman to present the HSJ award for staff engagement to Wrightington, Wigan and Leigh Foundation Trust. Their ‘WWL Way’ project has developed a range of partnership initiatives between managers and staff, encouraging
honest and open dialogue and achieving demonstrable improvements in culture, staff engagement and performance. ‘This and the other finalists were all powerful examples of effective staff engagement and its positive impact on productivity and quality of care,’ said Jon Restell.
EMBRACE awards MiP not only supported the Health and Social Care BME Network’s awards, but saw our own chair Zoeta Manning (pictured on the right with Carol Baxter, NHS Employers) presented with an award for her achievements in promoting diversity within the NHS workforce. EMBRACE is an initiative to encourage NHS employers to improve and implement race equality practices by making three pledges:
to increase BME appointments at senior level; to improve the quality of BME staff and patients’ experiences; and to highlight good practice and celebrate diversity. Speaking at the awards, former NHS “equalities tsar” Surinder Sharma said: ‘There is a lot of pessimism about the NHS these days but there is still a lot to be proud of... the awards are about thanking staff at all levels in the NHS for going the extra mile for patients.’
Carol Baxter, NHS Employers and Zoeta Manning, MiP Chair
NHS Leadership regional awards The newly formed NHS Leadership Academy has held regional recognition awards ceremonies to celebrate great leaders at all levels and across all professions who have improved people’s health and the public’s experience of the NHS and those leaders who we are truly proud to work alongside. MiP sponsored the regional awards for outstanding mentor or coach of the year, and our national officers attended the ceremonies to make the presentations. Speaking after the event in the Thames Valley and Wessex area, MiP 6
national officer Lianne Brooks said: ‘This has been a truly inspirational day. We have had the chance to celebrate the great work that NHS staff do day in day out to improve the service for patients. I was delighted to present the award for mentor of the year to Rosemary Chable at University Hospital Southampton – she is doing great work to support staff development in her trust.’ Every winner is automatically in the running for the National Award of the Donna Green, Chief Operating Officer, Basingstoke and North same category run by the NHS Lead- Hampshire NHS FT, one of the judges, winner Rosemary Chable ership Academy in February 2014. and Lianne Brooks, MiP national officer. healthcare manager | issue 20 | winter 2013
“The Health Board realised it was important to involve the public in planning the new hospital from the start.”
Ysbyty Ystrad Fawr, Gwent Three years in the building, Gwent’s newest hospital, the publicly funded £172-million Ysbyty Ystrad Fawr, run by the Aneurin Bevan Health Board, opened its doors to patients in 2011. Work began on a site just outside Ystrad Mynach, five miles north of Caerphilly, in autumn 2008, to build a 269-bed local general hospital to serve the people of Caerphilly County Borough. The new hospital was funded by the Welsh Government’s Clinical Futures Programme and was the biggest single NHS project in Gwent for 40 years. The area’s existing hospitals, including the Caerphilly District Miners’ Hospital, were closed, but the new hospital provides a much wider range of services than previously available in the area, including orthopaedic surgery and cataract operations. Local people can now get outpatient appointments, diagnostic tests and have some operations at the new hospital, when previously they would have had to travel to the Royal Gwent Hospital in Newport. The hospital was one of the first in the UK to provide all patients with single rooms, with ensuite facilities and flatscreen TVs. It also offers a 24-hour emergency centre, a mental health unit, a midwife-led maternity unit, a dedicated stroke unit, a children’s outpatient clinic and a range of rehabilitation facilities, including a hydrotherapy pool. MRI and CT scanning are also available, and the hospital hosts the community dental service and the GP out-of-hours service. Simon Davies, associate capital project director at Aneurin Bevan Health Board and project lead for the development explains that designing a hospital with single rooms for all patients meant taking care to ensure they did not feel isolated. ‘Whilst we realised that privacy and dignity were important, we also built in socialisation spaces, including dining rooms and day rooms, to make sure patients could socialise with each other and healthcare manager | issue 20 | winter 2013
with staff,’ he says. Davies says the Health Board put in a bid for funding under the Welsh Government’s Clinical Futures Programme, which had already identified a number of Welsh hospitals that were ‘well past their sell-by date’. The aim was to develop a hospital that provided a ‘peaceful environment’ for patients and aided their recovery, including enabling them to get a ‘good night’s sleep’, he adds. Davies says the Health Board realised it was important to involve the public in planning the new hospital from the start, and admits there were some concerns. ‘Some local people wanted to keep the Caerphilly District Miners’ Hospital, as it was funded by miners, but most wanted a new hospital. It’s the largest hospital to be built in Wales in 30 years and many local residents had been campaigning for it for 40 years.’ Nevertheless, some people were concerned about proposals for 100% single rooms at the hospital, Davies admits. To try to allay fears during the building
phase, the Health Board designed a ‘mock-up single room’ for people to visit so they could get a better idea of what the rooms would look like. Health Board staff were also heavily involved in the design and monthly visits to the site were organised for up to 30 staff at a time. ‘These visits really paid dividends,’ says Davies. ‘The staff really enjoyed going on the site with their hard hats and seeing how the building was progressing every month.’ He admits that single rooms meant new ways of working for staff who were familiar with four-bed bays, but they quickly became used to it. ‘It was a radical decision to build a new publicly funded hospital with all single rooms but it has really worked well,’ says Davies. And his top tip for other organisations doing the same thing? ‘Communication is key, it took time and effort but you really need to have a detailed communications plan from the start.’ Helen Mooney 7
NHS Change Day – 3 March 2014 I will create a weekly opportunity for all staff within our CCG to ask the question, “what have I done to help a patient this week?” Rebecca Patel
I will ‘re-humanise’ my practice of medicine by always using patients’ names when talking about them, as a constant reminder of their individuality. Laura-Jane Smith
I pledge to taste a variety of paediatric medications I prescribe to my patients. Damian Roland
I pledge to remember to ask if my more junior colleagues have had a chance to stop work for lunch or for a break. Kitty Mohan
MiP is delighted to swing its weight behind NHS Change Day 2014. We want to help to make it an even bigger success than last year by encouraging NHS managers to pledge to make a difference in some way. The first NHS Change Day on 13 March 2013 was a “game changer” that harnessed the passion, drive, commitment and innovation we see every day from NHS staff. It started with a single tweet that sparked a social movement and saw people make 189,000 pledges. Pledges had one thing in common – a desire to change the status quo and do something simple but different to improve care. Examples of pledges from last year are shown above. This year the goal is 500,000 pledges. Anyone can make a
pledge and it can be whatever you want: big or small, serious or fun. They add up to an enormous difference. Leaders and managers have a particularly important role to play in encouraging their staff to take part in Change Day and using their authority to support the movement. They can be an inspiration to others and empower them to change, and can even be a Kickstarter – a leader who encourages their staff to join them by making an ‘I will if you will’ pledge. For inspiration, go to changeday.nhs.uk and watch the video. The Change Day team has teamed up with MiP and is calling on all managers to think about what they can do for 2014. Next year Change Day falls on March 3, so go online at changeday.nhs.uk/ pledge and just do it!
You can make a difference 1 Change happens one person at a time but, if we can create common purpose, we can The first Change Day was a huge success. Here are the lessons Helen Bevan, part of the NHS Improving Quality Delivery Team, learnt from the experience.
quickly build a movement.
2 Being a healthcare leader isn’t related to hierarchy and you don’t even have to work in the NHS to be a healthcare leader. 3 Most healthcare organisations valued staff showing leadership during NHS Change Day. 4 NHS Change Day showed that leaders are most powerful as role models when they learn rather than teach or tell. 5 Resources for change are abundant but need to be activated through shared purpose and relationships. 6 Young and emerging leaders have a lot of the answers. 7 By having “leaders everywhere”, we can protect and preserve the basic principles of our NHS for future generations.
healthcare manager | issue 20 | winter 2013
comment Dr Gareth Morgan
NHS Wales Policy Lead for Older People
Opening Pandora’s box Picture the scene. A teenage boy is sitting listening to his favourite football team on the radio. He is surrounded by a plate of toast, a mug of hot chocolate and his loyal dog sits next to him with begging eyes. His team win the game, one of the most important in their history!
Thirty years ago, that boy was me. Recalling this gives me considerable pleasure, no doubt reinforced over the years by selective memory and sentiment. Many others will have comparable experiences and recalling them might, like mine, promote a warm sense of general wellbeing. Is there something wider that can be drawn out here? Perhaps, there are some circumstances we can recreate in our mind that makes us feel happy. Could I – and you – be so bold to create an image of our life in 30 years time? During my 70s, could I be sat listening to my beloved Everton surrounded by plates of toast? Perhaps. Will I be in good health? Hopefully! Will I be able to access a superb health and social care service? Focusing on health and social care reform in Wales, there are two important points to note. Firstly, it is within my gift to influence this development. What a motivation – the services that I will access are the ones I can help to develop now. Secondly, while I work for the services, I am also an individual, a tax-paying contributor to the public healthcare manager | issue 20 | winter 2013
sector and potentially a user of health and social care. If I am in touch with this duality, will I be better placed to have influence? This is a question for debate. My view is that if I retain my personal integrity and combine it with a professional approach, my ability to contribute positively is enhanced. I can speak in a clear, jargon-free style, avoiding platitudes, truisms and corporate rhetoric. Health and social care reform has been an issue since before my first day in NHS Wales. During my 20 years service, there have been reorganisations, strategies, reviews and more re-organisations supposedly justified by truisms (Integration is needed! Person-centred! Pooled budgets!) Health and social care integration feels like sailing to the horizon. There is a perception of overall progress but the end destination remains elusive. Proxy measures of activity are seen as success and ‘group think’ prevents critical challenge, reflective practice and real innovation. My solution is simple and would – I believe – be understood by the average person in the street. The first stage is – TIME OUT FOR CONSOLIDATION. We buy into the justifications for reform, such as financial pressures. If we took two to three years time out, we could solve discrete problems that might save money, such as improving fracture liaison services and boosting aspirin use.
The second stage is – ALIGN INCENTIVES AND PERFORMANCE. We keep trying to fix the health and social care system, assuming it is fixable. During the time out, a new system could be re-designed that puts service users – Mr and Mrs Morgan – at the centre. The third stage is – CREATE AN ARMY OF PRACTITIONER LEADERS. We need good, compassionate people to implement this aligned system. Our leaders need to be firmly grounded in common sense and able to work effectively across a wide range of different service sectors. I believe the general public would understand this model, expressed simply and concisely. I believe they would be interested because it affects them. I believe they would buy into the integrated model, seeing themselves as both co-owners and co-producers. Assuming I live a further 30 years in good health, my dreams may be realised. Should I need care, I would want it to be Gareth Morgan centred, co-ordinated and coherent. I would want to feel cared for but empowered. I would want to contribute fully and have options. What is your vision of the future? How will you get there? If leaders are said to deal in hope, let us open a Pandora’s box debate. Let’s all get started!
Gareth Morgan is policy lead for older people in NHS Wales.
MiP ANNUAL CONFERENCE 2013
MiP national conference: 27 November, London Andy Burnham and Stephen Dorrell; comedian Rob Gee; MiP’s Jon Restell; Chris Ham from the King’s Fund; Ombudsman Dame Julie Mellor; Unison’s Christina McAnea; MiP Chair Zoeta Manning with her sister Freddie; Rosie Ilett from NHS Gtr Glasgow and Clyde (right) with Sheila Burston from Diabetes UK; MiP vice chair Robert Quick (right) with David Dalton CEO at Salford Royal; Derek Mowbray of MAS, Dr Peter Lees from FMLM and Ann Radmore, CEO at London Ambulance; NHS Employers’ Gill Bellord with Dave Penman, FDA General Secretary; delegates in the network café.
all photos Maureen McLean
It was great to see so many MiP members, friends and colleagues at this year’s conference. The morning debate focused on how to achieve real patient and staff engagement, with Julie Mellor pointing out we have much ground to cover. In the afternoon Chris Ham led the debate about what makes a good manager and how to achieve accountability. No one thought regulation was the answer. We rounded off the afternoon with a discussion about the future of pay and conditions for senior grades in the public sector. Pictured clockwise from top left, conference chair Victoria Macdonald with MPs
healthcare manager | issue 20 | winter 2013
MiP ANNUAL CONFERENCE 2013
healthcare manager | issue 20 | winter 2013
INTERVIEW: ANDREA SUTCLIFFE
Andrea Sutcliffe’s appointment as chief inspector of adult social care was met with great enthusiasm in the NHS, which needs social care to take pressure off struggling acute services. She talks to Alison Moore about the toughest challenge of her career.
Quality social care is likely to play a key role in helping the NHS to treat more people out of hospital and, more immediately, to get through the coming winter. But ensuring that social care – both residential and services provided in patients’ homes – can be commissioned with confidence is a concern for the NHS. Poor social care is likely to result in more pressure on hospitals and poorer outcomes for patients, many of whom would prefer not to be in an acute bed.
So the appointment of Andrea Sutcliffe as chief inspector of adult social care at the Care Quality Commission was greeted with great enthusiasm from within the NHS. She had been chief executive of the Social Care Institute for Excellence for 18 months, and before that she led the Appointments Commission and worked at the National Institute for Clinical Excellence. She has only been in her new job a few weeks, but already the focus of inspection is shifting. Sutcliffe has spoken about a ‘mum’s test’ – ‘would this care be acceptable for someone I love?’ – and is recruiting people with experience of the care system to help with inspections. Inspections will focus on five questions: is care safe, caring, effective, 12
well-led and responsive to people’s needs? A new ratings system for social care will be in place in just over two years. Using covert monitoring has even been floated. ‘We’re very clear that we will be on the side of people using services and to see the work that we do through that lens. We are here to promote high quality, safe and compassionate care,’ she says. ‘We should see regulation as an inspiration to the sector to encourage improvement, celebrate what is good and use the powers that we have to eliminate what is not good. ‘One person does not do that. I have been very clear that I can only make this work in collaboration with other people across the sector.’ Sutcliffe says this collaboration should include service users, their families and carers, as well as providers, commissioners – who may be local authorities or NHS bodies – and national organisations. Sutcliffe’s appointment has been greeted with approval from many quarters; one commentator said he felt ‘strangely comforted and optimistic’ after hearing her speak. ‘The goodwill that I am getting in terms of coming into post has been remarkable,’ she says. ‘People are welcoming the focus, the clarity the CQC has provided… they are
clear they want a strong and robust regulator and a regulator who is all about improving services.’ On a personal level, she expects being chief inspector of social care to be the toughest job she has ever done, but adds that she has always wanted to make a difference for people who use the services. ‘It is about thinking through, is this good enough for the people I love? If it is, that’s great and fantastic, if not we need to do something about it. I think I can bring that sort of humanity to it,’ she says. She wants to move away from a tickbox approach in favour of a more holistic one which offers more assurance that care remains of a high standard when the inspectors aren’t there. ‘The reason why the “well-led” question is so important is that it will give us some confidence about the sustainability of what we see through the inspection process,’ she says. Having a registered manager in place is important – the absence of one for a long time may prompt tough action from the CQC – as is the support managers get through the corporate infrastructure, if a care home is part of a larger organisation. The role of the NHS in all of this is often that of commissioner – for example, CCGs commissioning beds in care healthcare manager | issue 20 | winter 2013
INTERVIEW: ANDREA SUTCLIFFE
“Thinking there is a structural answer to integration is barking up the wrong gumtree.”
homes to provide step-up or step-down care, or hospitals working with social care providers to provide packages of care on discharge from hospital. All of which means the NHS must be aware of what is available locally and conscious of what standards are like, and make sure it is happy for providers to care for often very vulnerable people. ‘I think there is a real responsibility on CCGs to develop an in-depth understanding about social care generally,’ says Sutcliffe. Some GPs absolutely get it. Some CCGs are doing a fantastic job healthcare manager | issue 20 | winter 2013
working with their local authorities and providers – but equally there are some places where that is a bit thin on the ground. I would expect commissioners, whether local authorities or CCGs to use the CQC information to inform what they are doing.’ But information needs be a two-way street with commissioners also having a role to play in feeding it back. One of the sector’s challenges is the sheer number of organisations involved: 18,000 residential homes and 8,500 providers of care in the home.
That makes it impossible for the CQC to do the sort of detailed risk rating that it recently carried out for NHS acute hospitals. Sutcliffe points out that GPs are very often aware of the care offered in local residential homes and CCGs, with their clinical input, are in a better position than PCTs. Integration is also top of the agenda for many NHS organisations, making joint working with social care providers important to deliver ‘seamless services’. But she does not see organisational integration as the answer; however organisations are structured there will always be a barrier somewhere. And even when CCGs and local authorities are working together, it is likely they will be commissioning from different organisations, including voluntary and private sector providers. ‘Thinking there is a structural answer to integration is barking up the wrong gumtree,’ she says. But she has some thoughts on developing successful integrated care. First, it needs clear understanding and a vision of what organisations are trying to do. Secondly, the roles and responsibilities of different bits of the system have to be clear to avoid people falling between the gaps. And that is where leadership comes in. ‘We have to make sure our leaders are buying into it and demonstrating by their behaviour and working together that they support leadership at all other levels,’ says Sutcliffe. Recognising that health and social care cultures are different is also important. ‘On occasions I have felt like an interpreter because I speak both languages!’ she says. There can be preju13
INTERVIEW: ANDREA SUTCLIFFE
“People need to have the training, support and development to meet the needs of the people they are caring for.”
dices towards different parts of the organisation and differing models of care. ‘If we ignore that we will come to grief,’ she says. ‘What can CQC do in terms of the levers that we have in the regulatory system to encourage it? I think that comes down asking questions that get to the heart of person-centred care.’ This includes asking about relationships with local authorities and information sharing around discharge, when the CQC is doing inspections. People who use services should also be asked how often they have to tell their story, and GPs need to be involved. She would also expect all parties to understand the importance of developing relationships across organisational boundaries and how this can improve patient care. Sutcliffe considers herself a ‘cheerleader’ for the social care sector and sees part of her job as highlighting good practice and encouraging its adoption more widely. She cites one care home manager who realised his residents had a high level of avoidable hospital admissions. He initiated talks with local primary care and mental health services, and looked at what could be done within the home to give staff greater confidence and the capability to avoid admissions. Such good practice needs to be identified and celebrated, she says. ‘This is a people business. It’s a really difficult job and we need to value it more than we do… people need to have the training, support and development to 14
meet the needs of the people they are caring for.’ Part of this lack of recognition of the value of the sector comes through in pay packets. Care work is notorious for near-minimum wages and the nowinfamous 15-minute visit. This can lead to high turnover and staff with experience being quickly lost to other jobs, which can turn employers off providing training. But some providers do have a good record on recruiting and retaining high quality staff, Sutcliffe says. They can offer lessons for the rest of the sector and Skills for Health has also done good work on fostering commitment from both staff and employers. Social care simply does not get the same airtime as the NHS, often getting media attention ‘only where there is a really awful scandal of the magnitude that Orchid View [a Sussex care home heavily criticised by the CQC after a number of residents died] demonstrated’, she says. ‘[But] we know that the vast majority of services are provided by decent caring people trying to do a good job.’ Does the approach of a winter which has been talked up as a test for both the NHS and social care keep her awake at night?
‘I get really worried about the impact of poor care in [the home care] setting. People are often very vulnerable, isolated and lonely,’ she says. Home care is more difficult to regulate and inspect, and she is obviously still wrestling with how best to do this. Going into people’s homes to see care being provided may be intrusive, and if the carer is the only person the patient sees regularly they may be more likely to put up with poor care and not raise concerns. Yet understanding service user’s experience has to be at the heart of inspection, and there may be less information about standards of care in the home than there is with residential care. Another area which causes Sutcliffe angst is doing the right thing when poor care is discovered. A kneejerk reaction would be to shut down the worst examples. But she argues that responses need to keep in mind what is best for the residents or those using the services, who will still require care, though not poor care. ‘We will take enforcement action when we need to, but in a way which supports continuity of care,’ Sutcliffe says. So will cases like Orchid View be spotted earlier once the changes to inspection go through? ‘I think we have a chance to make that difference,’ she says. ‘It’s not just [about saying that] this happens at CQC and it will all be fine. That’s not feasible… it has to be across the whole sector that we all take our responsibilities seriously.’
healthcare manager | issue 20 | winter 2013
ARTS & HEALTH
The arts are flourishing in wards, clinics and the community. Linda Steele finds how creativity is making a contribution to modern health care.
Heard the one about the man who went to his GP? No, Geoff Rowe hadn’t either, so he decided to do something about it. Knowing that men are far more likely to ignore symptoms of sometimes-serious problems, Geoff and a group of Leicester-based comedians devised stand-up routines about men’s unwillingness to talk health. ‘We called the show Hurt Until It Laughs and we toured the UK with it, playing in comedy clubs,’ says Geoff.
Geoff heads Big Difference Company, which works with health and local government on what is technically social marketing – spreading awareness and encouraging healthier lifestyles by engaging people. The ‘engaging people’ bit, as health managers know, is where many a health promotion plan can bite the dust. But Geoff and his colleagues are dab hands at involving people through the medium of performance, especially comedy. ‘There is a lot of talk about innovation and the patient’s voice in health services and this is a different way of engaging people,’ says Geoff. Hiring a comedian may not be top of every health manager’s to-do list but it can be the perfect vehicle for having healthcare manager | issue 20 | winter 2013
discussions and sharing knowledge about embarrassing topics, without anyone shying away. Ranking number 20 in the UK’s list of most deprived areas, Leicester has its share of ill-health common to disadvantaged inner cities. Managers have understandably been keen to find creative approaches to serious problems. The arts feature in healthcare in four distinct ways, according to Damian Hebron, director of the London Arts in Health Forum. In keeping with a tradition going back hundreds of years, many doctors have an arts element to their training. ‘Clod Ensemble runs theatrical workshops A visitor to the Horniman Museum. using masks to help Participatory arts provide social and doctors reflect on the way that they creative outlets for people who are interact with patients and how different mentally or physically unwell. Arts people bring different perspectives,’ therapies – drama, dance and says Damian, by way of example. 15
ARTS & HEALTH
movement, music and the visual arts – are therapeutic techniques employed by qualified specialists. Finally, the phrase ‘arts in the healthcare environment’ covers a range of art forms mainly aimed at improving the experience of patients and staff. One new creative venture between Leicester City Clinical Commissioning Group (CCG) and Big Difference Company is a healthy lungs project. Adults are encouraged to join choirs, the company is writing a song about healthy lungs and a mass choral event is being lined up as part of the city’s 2014 comedy festival. ‘The choir helps to educate, prevent and manage lung disease in an innovative way. Research has shown that singing can improve lung capacity and the strength of the lungs, helping them to work more efficiently,’ says GP Durairaj Jawahar, CCG chronic obstructive pulmonary disease lead. ‘If you invite someone to take part in an activity to improve their lung capacity, that sounds incredibly dull,’ says Geoff. ‘But ask them to sing in a choir, which does the same job, and they’ll come.’ Of course, going to choir practice may be far from the minds – and capabilities – of some hospital
“The arts have many proven health benefits, such as improved health outcomes, improved recovery rates and reduction in stress and anxiety levels.”
in-patients. In one of the UK’s largest trusts, University College London Hospitals (UCLH), if patients cannot make it to the arts, the arts come to them. Alongside artist-run ward workshops and one-to-one art sessions with children, older people and cancer patients, the Heritage in Hospitals scheme sees researchers and volunteers take artefacts from University College London museums to bedsides. Ancient Egyptian fertility charms, Greek perfume pots, and shards of ancient pottery, as well as animal skulls and geological specimens, have been handled and discussed by patients. Guy Noble, UCLH arts curator, says that patient surveys reveal the benefits. ‘Patients have an increased sense of wellbeing afterwards,’ he says. The emphasis is very much on improving the environment to make patients’ experiences better but it is a big plus, too, for healthcare staff to be in aesthetically pleasing and culturally rich workplaces; research has shown that this can have a positive impact on job satisfaction. ‘This is about saying we want the best the Brian Eno introducing his art and musical soundscapes at environment for our the Montefiore Hospital. patients; however, it
also benefits the staff,’ says Guy. Staff have also been the subject of artworks at UCLH. During the Seen Unseen residency, artist Frances Newman observed and drew the kind of staff whose behind-the-scenes labours allow the hospitals to function: laboratory technicians, domestic staff and porters. The physical result was a number of charcoal portraits of a largely unsung workforce going about its daily business. The intangible result was, according to anecdotal feedback, that often unnoticed staff felt valued in what they were doing. Arts thrive throughout the trust’s six hospitals, through concerts or artwork on the walls – new exhibitions go up every six weeks. With a budget last year from the UCLH Charity of £50,000, Guy still needs to raise funds elsewhere but is able to implement an extensive arts programme that he argues helps to shift the nature of the hospitals from a focus on sickness alone to cultural spaces in which wellbeing and health are promoted. ‘The arts have many proven health benefits, such as improved health outcomes, improved recovery rates and reduction in stress and anxiety levels. We have weekly concerts, for example, and there is evidence of the benefits of live music to cancer patients,’ he says. As Guy points out, research highlights the positive effects of music in healthcare, including: ■■ the encouragement of early mother and child contact, and reduced length of hospital stays in maternity services ■■ improvements in weight gain, oxygen saturation, feeding and crying, when mothers sang lullabies to their children in neonatal and intensive care ■■ a significant reduction in pain perceived by rheumatoid arthritis sufferers who listened daily to 20 minutes’ music ■■ reduced stress and blood pressure during certain heart screening and diagnostic procedures. Certainly, it was the calming effect of healthcare manager | issue 20 | winter 2013
ARTS & HEALTH
his musical soundscapes that led managers at the new Montefiore Hospital in Hove, East Sussex, to commission the internationally acclaimed musician and producer Brian Eno to create two ambient light and sound installations. The reception area hosts 77 Million Paintings for Montefiore, involving Eno’s ‘generative music’, which is an electronically created, ever changing musical soundscape. Quiet Room for Montefiore offers patients, staff and visitors a tranquil space to relax. ‘Over the last 15 years, research into the effect of the use of art and music on psychological, physiological and biological outcomes of clinical significance has provided mounting evidence that [their] use delivers beneficial treatment to patients,’ says hospital director Andy Wood. Increasingly, the arts are being integrated into the earliest NHS plans for new buildings and refurbishments, in line with national guidance. The Hope Building, part of Salford Royal NHS Foundation Trust’s £200m redevelopment programme, is one such initiative. Celebrated local artist Harold Riley was approached to act as adviser. He donated a substantial oeuvre and helped the trust to find the best places and colours to integrate the artworks into the healthcare setting. The artist visited the building during its construction to ensure that his work contributed to a healing and therapeutic environment for the renal dialysis, intestinal failure, intensive and emergency care patients and visitors who use the building. ‘As a lifelong Salfordian and great supporter of Salford Royal, he came up with the great idea of using his artwork as a legacy to us,’ explains Lindsay McCluskie, trust head of capital development. ‘We now have a collection of more than 500 Harold Riley prints throughout the building. These are particularly special to us and our patients and visitors, as many of these are photographs (old and new) and paintings of Salford. We were very healthcare manager | issue 20 | winter 2013
keen to have a personal feel to our art strategy and the feedback we have had has been wonderful.’ Not everything is on such a large scale. Yeovil District Hospital in Somerset have been running a photography competition that coincides with revamping a trauma and orthopaedic ward to make it more inviting, especially for people with dementia. The organisers hope that the competition will furnish plenty of images of local beauty spots, times past and people at work that may be helpful to patients whose memory is failing and who feel disorientated. Patients will also be able to choose the pictures that go by their bedside, to give them a say about their environment. Janine Valentine, dementia A portrait of a cleaner at UCLH. and elderly care nurse consultant for dementia, says: ‘Having Helen Shearn, SLaM head of arts photographs of places that patients strategy. recognise and also photographs from Journeys of Appreciation not only the past is a fantastic way to engage benefits patients but also the with people with dementia. We want to accompanying staff, who receive make their stay in the hospital as training and develop new skills in positive as possible.’ working creatively with people with Art is also woven into the care of mental disorders. ‘It’s wonderful to see people with dementia or serious our nurses taking patients and actively mental health problems by the South engaging and developing a nurseLondon and Maudsley NHS Foundapatient therapeutic relationship in such tion Trust (SLaM). Every month, a different, yet safe environment,’ says around 20 staff and service users visit nurse manager Geoff Ward. The next Tate Modern, Tate Britain, the Dulwich step, he says, is ‘embracing these Picture Gallery or the Horniman creative opportunities within normal Museum in south east London as part clinical practice.’ of Journeys of Appreciation. At the Department of Health guidance galleries, participants look at a (2007) states that the arts ‘are, and painting or sculpture and handle should be firmly recognised as being something related, such as a piece of integral to health, healthcare provision fabric in similar colours; at the and healthcare environments.’ Horniman, they hold an artefact. They SLaM’s art strategy has an even discuss the art and thoughts that it simpler message. It asks why the arts evokes. ‘This is part of the journey, for are important and, answering its own people who are acutely unwell, in question, says: ‘Because they help engaging with the community and people get well and stay well.’ connecting to new experiences,’ says
Sarah Smith argues that access to high quality information for patients is an integral part of a modern, efficient health service, not an optional extra.
It seems self-evident that everyone needs information to support the choices they make about their health and to help them make decisions about the treatment and care they want and need.
Without information, and the support to understand and contextualise it, we make choices blind. Shared decision making, self-care and self-management all need accurate, meaningful and relevant information to underpin them and, without it, these approaches simply don’t work. However, when we get information and support for our patients right, it can make a profound and lasting difference. Inform, communicate, support Information for patients works best when it is personalised, tailored to the individual’s specific needs, and available at the right time, in the right place and in the right format. But information also needs to be converted into knowledge and understanding, which means that effective communication with patients is vital to adding value to information and facilitating behavioural change. When it’s done well, information and the knowledge it brings can be a powerful tool. It can reassure and support, help people 18
to use services appropriately, and help them to understand and comply with treatment plans. The benefits of information are so powerful that some researchers have developed the concept of ‘information therapy’ and argue that information can be as important to health as any medicine, test or surgery. So, why is it that when it comes to information about health, our patients are so often let down? Increasingly, patients are expected to get involved in decision making about their care and to take more responsibility for their health. Yet often they have very little, or poor quality, information on which to base their decisions. The provision of information for patients and carers in the NHS is patchy; in many places it’s not routinely offered, given, supported or evaluated. If we were this relaxed about the way we give medicines, for example, we would all be in serious trouble. Information is a ‘must do’ Achieving patients’ active engagement and involvement in their healthcare has now become a key goal for policymakers and is central to government plans for the NHS. This includes ideas about shared decision-making, self-
care and self-management, and personalised care planning. Financial and service pressures also mean that patient engagement is now a necessary part of a more modern and efficient health service rather than a ‘nice to have’ extra. Information, and access to it, is now firmly embedded in health policy across the UK – including in the NHS Constitution and the Health and Social Care Act 2012 (in England), the Patient Rights (Scotland) Act 2011 and in professional codes of conduct. There is a focus on quality through schemes such as the Information Standard, and delivery channels for information via Information Prescriptions and NHS Choices. These are echoed via NHS inform in Scotland and NHS Direct Wales. The Power of Information, the tenyear information strategy from the Department of Health, published in May 2012, sets out a framework for transforming information within the NHS and establishing it in England as a service in its own right. Providing access to quality health information and support is crucial to unlocking what has been termed the ‘blockbuster drug’ of patient engagement. Patient engagement is vital to healthcare manager | issue 20 | winter 2013
help people manage their health, make informed decisions about their healthcare and reduce financial pressure on the health service.
Making the case for information The Patient Information Forum’s recent publication Making the Case for Information sets out the case for providing high quality information to patients and the public. It puts forward strong legal, moral, ethical and financial incentives for providing quality information to enable people to better manage their health and wellbeing and make fully informed decisions. These include: ■■ High quality health information has a positive impact on service use and health costs, patients’ experience of healthcare and patients’ health behaviour and status. ■■ There are good business reasons to justify the investment of more time, money and training in health information provision and support. These include positive impacts on service use and costs, substantial capacity savings, and significant returns on investment by increasing selfmanagement of long-term conditions. ■■ Providing patients with information helps to enhance patients’ experience of care. It also helps achieve goals in the other two quality domains – clinical effectiveness and patient safety. This is core business for the NHS and an important motivator for staff. It forms part of the statutory duty to improve quality – both a ‘must do’ and the right thing to do.
Better outcomes Engaging patients through the provision of high quality health information and support leads to better outcomes for patients through: healthcare manager | issue 20 | winter 2013
Treatment in line with patient preferences, better adherence to treatment and safer, more effective use of medicines Healthier behaviours Improved health, quality of life and psychological wellbeing Greater health literacy which leads to reduced health inequalities Fewer complaints, medical errors and expensive legal challenges.
A better patient experience Providing high quality and accessible health information also helps to enhance the experience of care through: ■■ Improved knowledge, understanding and recall of information ■■ Increased ability to share decisionmaking ■■ Greater ability to self-care and selfmanage conditions ■■ More realistic expectations about health outcomes ■■ Developing a better quality of life improved psychological wellbeing and less stress
Making patients more satisfied and engaged.
The business case If we fail to provide patients with the information and support they need, we compromise all three dimensions of quality care: patient experience, patient safety and clinical effectiveness. The NHS suffers through higher costs, lower efficiency and increased claims of negligence. We can save the NHS billions of pounds by addressing what the Kings Fund has termed ‘the silent misdiagnosis’ – the failure to fully inform and involve patients in decisions about their care. As an example, one analysis suggests that if 10% of GP attendances for minor ailments could be avoided through online self-care advice, the annual savings would be around £830m. Better health information can also help to reduce pressures on A&E departments, emergency admissions and the length of hospital stays. Failures in patient-doctor communications result in higher levels of complaints and more claims of negligence. At a challenging time for the NHS, it is therefore a financial, clinical and moral imperative to support patients with better information. To do otherwise will continue to compromise quality and waste scarce public resources. Health information for patients and the public needs some major, sustained investment and a co-ordinated and systematic approach to delivery. It needs leaders and champions in the NHS – people who understand just how important information is to all of us, and the difference it can make to individuals, organisations and communities.
Sarah Smith is operations director at the Patient Information Forum. Send any comments to operations@ pifonline.org.uk. 19
Victoria Phillips on what you need to know about changes to the rules on disclosure and barring. Recent changes to the Disclosure and Barring Service (DBS), which came into force in June 2013, will affect the way NHS organisations should recruit and manage staff.
Safeguarding children and vulnerable adults is expected to be at the forefront of your concerns as an organisation. Healthcare professionals, especially managers, need to be up to date with these changes because NHS organisations continue to be responsible for risk assessing positive disclosure of information. Healthcare managers should ensure that internal policies and procedures are updated, as the changes have significant implications for the way organisations manage DBS disclosures. Online Update Service goes live With the new online Update Service, DBS certificates are now ‘portable’, which means individuals can re-use their DBS certificate when applying for job of the same type and level. From June 2013, an individual applying for a certificate can subscribe to the Update Service for an annual fee of £13 (free for volunteers). Individuals need to subscribe within two weeks of the DBS disclosure’s date of issue. Once signed up, existing or prospective employers can – with the individual’s consent – carry out a free, instant check to find out if the information on the DBS certificate is up to date. Managers will need to: ** decide if the Update Service will be a requirement for all relevant posts ** determine if the employee or the organisation will pay the subscription ** establish how often to use online 20
status checking and the procedures for securing and recording an individual’s consent each time ** update internal procedures to securely receive and return disclosures (see below) It is important to emphasise to all staff the tight deadline for subscribing after the issue of a DBS disclosure. Conviction history question The new DBS record ‘filters’ out certain types of old and minor convictions or cautions. From May 2013, unless a person has committed more than one offence, the DBS no longer has to disclose all past convictions on DBS certificates. The filtering rules mean that managers can only ask an individual to provide details of convictions and cautions that your organisation is legally entitled to know about (i.e. only those that would be disclosed on a DBS certificate). It is now unlawful under the Rehabilitation of Offenders Act 1974 to take into account a conviction or caution that would not have been disclosed on the DBS certificate. For example, an adult conviction will be removed from a DBS certificate if: 11 years have elapsed since conviction; it is the person’s only offence; and it did not result in a custodial sentence. However, serious offences which relate to sexual offending, violent offending and/or safeguarding will still always be disclosed. Healthcare managers must ensure that applicants complete the revised DBS application form, where Question e55 requires the disclosure of any un-
spent convictions, cautions, reprimands or warnings. Applicant-only Certificates To allow applicants more control of their personal information, the DBS will no longer send a copy of the certificate to the employer or registered body, even if it includes criminal record information. Individual applicants should be asked to produce the original certificate. Without direct access to the DBS certificate it is essential to carry out adequate identity checks at the start of the application process. Managers may need to ensure appropriate arrangements are in place to securely receive and return disclosures. Given the responsibility involved in recruiting suitable individuals, managers may decide that identity/DBS checking should be a centralised rather than a local management function. How DBS changes will affect you Organisations will now have to rely on the applicant to apply for a DBS certificate and ensure that a copy of the original is provided to them. Although it is voluntary, the online Update Service may reduce the need for applicants to re-apply for a DBS certificate each time they change roles or organisations. This may reduce the costs of recruiting or rechecking staff.
Victoria Phillips Head of Employment Law 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 20 | winter 2013
Personal resilience Resilience is about being in control of yourself so you can form robust attitudes to the challenges you face during the day. Professor Derek Mowbray explains. REFLECT ON YOUR DAY
through. Your walk might be one dogwalk in length, or two or three for more complex issues.
A good way to put the working day to bed is to ask yourself what you have learnt. There’s nearly always something, but it often needs to be ‘dug out’ from the recesses of the mind. Write it down and keep it somewhere safe. This helps you to start relaxing and find the energy to do other things – domestic and recreational.
8 PLAN YOUR AFTERNOON List the things you can realistically achieve in the afternoon. This will help you to reassert control over your day. Being over-optimistic will only build up anxiety, making it harder to calm down after work. With a triumphant list of completed tasks, the day will feel worthwhile.
2 PLAN FOR TOMORROW In the evening, make a list of the tasks you expect to complete tomorrow in priority order (although the order may change). Then forget about the note until morning. This helps the brain to settle down and you to remain in control of your hectic life.
3 TALK TO YOUR BATHROOM MIRROR Tell yourself you’re going to have a brilliant day. Talking out loud overrides silent talk. It stops the imagination from thinking about things going badly and alerts the brain to things that are going well. If you’re worried about what people will think, lock the bathroom door!
4 MAKE A FLYING START Complete the first task on your list right at the start of the day. Avoid depression by not looking at your emails first, and procrastination by not going straight to the coffee machine and chatting to your mates. Completing tasks makes you feel great and feeds your sense of wellbeing. Then reward yourself with coffee and read your emails.
5 TAKE A MID-MORNING WALK
As far as possible, concentrate for 50 minutes each hour, then have a complete break for ten. Go for a walk,
healthcare manager | issue 20 | winter 2013
9 CONCENTRATE ON BREATHING
stretch yourself, get your circulation going. You’ll feel better able to concentrate for the next 50 minutes.
6 DO SOME ‘MINDFULNESS’ Late morning, sit somewhere quiet and spend five minutes absorbing all the sounds, colours, smells, textures and features around you. Concentrate on each one. ‘Mindfulness’ – means concentrating on the present and thinking only about things in your immediate vicinity. If you are tense or low on energy, it will help you to calm down and get back in control.
7 WALK AFTER LUNCH Try to eat something light and nutritious – but energising – for lunch. Afterwards, go for another walk to provide a refreshing break in the day. Take a friend and talk about anything but work. If you have a pressing issue to resolve, take a brisk walk to think it
Mid-afternoon, find somewhere quiet, close your eyes for five minutes and concentrate on your breathing. Don’t worry, it hasn’t stopped! Trying to keep your wandering thoughts on your breathing has a calming effect and helps you to get back in control.
TAKE A LATE AFTERNOON WALK This time, focus on tensing and relaxing your muscles so you start the relaxation process before you finish work. This helps you to end on a high, completing your tasks with energy to spare.
ENDING THE WORKING DAY Breathe in deeply, down to your diaphragm, for six seconds, hold your breath for twelve, breath out for six. Repeat for about five minutes, and continue when you can on your journey home. Deep breathing helps you to control any anxiety and tension that has built up during the day. You will feel much more relaxed by the time you get home. Derek Mowbray is visiting professor at the Universities of Northumbria and Gloucestershire, and director of the Management Advisory Service.
MIP AT WORK
Learning through good practice LEARNING ORGANISATIONS
Marisa Howes reports on a successful pilot seminar. This autumn, MiP joined with Big Difference Company to host a half day seminar in Birmingham to explore some of the themes that came out of the Francis Report and subsequent reports from Bruce Keogh and Don Berwick – how NHS organisations can ensure that they are learning organisations, learning from good practice within their own organisation and from that in other organisations. We brought together healthcare managers from across the West Midlands to share their experience and good practice in patient engagement and in building their personal resilience. Linden Rowley, from Big Difference Company, led the discussion on patient engagement. Participants gave examples of initiatives they have used to engage with patients and make sure their voices are heard in shaping and delivering services. They felt that in the past the emphasis has been on consultation rather than engagement – the NHS consulting after they have developed a model for care rather than involving
patients from the outset. It was felt that a new NHS culture would need to be a more open and inclusive culture, working with the communities they serve rather than just delivering to them. There was optimism that the new clinical commissioning groups may provide the opportunity to make changes, bringing in new ways of working and engaging with communities.
In the session on personal resilience, MiP chief executive Jon Restell outlined the techniques that can be used to develop your own resilience and that of the members of your team. The participants discussed the causes of pressure and strain that they have to deal with every day and the coping mechanisms they use (see Derek Mowbray’s
tips on personal resilience on page 21). The participants all felt that the seminar had been very worthwhile as it provided: ■■ a lot of practical examples, tools and learning points to take back to their workplaces; ■■ the opportunity to meet and network with managers from different organisations to talk about their experiences and share good practice ■■ just a half day away from the workplace, but providing food for thought and ‘tasters’ on topics that employers could cover in greater depth in their training. Following the success of this seminar, MiP will be rolling out the programme around the country in the coming year. We will also be hosting sessions to focus on other topics that members would like to hear about. The sessions will be publicised on our website and through emails to members – so do make sure we have your correct email address and keep an eye on the website for details.
Quality is everyone’s business MiP chief executive Jon Restell joined a panel of senior Northern Ireland trade union officials to participate in a ‘Question Time’ session at the 2013 IHM Northern Ireland Conference in November. 22
The session was chaired by Jim Fitzpatrick of the BBC Politics Show, and focused on the question, ‘If quality is everyone’s responsibility, whose fault is it when things go wrong?’ The panellists covered
a wide range of issues, including the increasing privatisation of the NHS and the role of the media in only highlighting bad news stories about the NHS. Jon spoke up for the role of the NHS manager, pointing
out that managers are key players in the healthcare team as they strive for excellence and to implement successful change programmes. The conference brought together managers from
healthcare manager | issue 20 | winter 2013
MIP AT WORK
All’s well that ends well TUPE
MiP national officer Corrado Valle describes how he was able to help a member right a wrong even after she had resigned from her job. MiP member Jean was transferred under TUPE to a clinical commissioning group earlier this year. Soon after the transfer, interpersonal problems with her line manager began to appear. Despite Jean’s attempts to resolve the problem, the relationship continued to deteriorate and Jean’s performance began to be called into question. The situation became intolerable and, without seeking advice from MiP, Jean resigned from the CCG after having applied for a new job in another NHS organisation. Jean was offered that job pending satisfactory references. The references provided by her former line manager on behalf of the employer were not satisfactory and the job offer was withdrawn. It was then that Jean contacted MiP for advice and support. We were able to obtain a copy of the reference and identified a clear bias against our member. We wrote to her former line manager asking for evidence for the assertions made in the reference
across Northern Ireland and international guests to discuss the reality of the everyday challenges facing health and social care managers in Northern Ireland to-day – to deliver integrated care and an ambitious transformation programme, whilst maintaining and improving on high quality standards in a climate of serious
and seeking redress. The former line manager failed to engage with us, and consequently we escalated the matter with the chief executive and the director of HR, explaining the situation, the employer’s legal duties and the potential consequences under
financial pressure. The speakers shared their experience in delivering significant change, discussed current evidence about integrated care and reasserted the importance of active engagement of multidisciplinary staff in the delivery of quality health and social care. Congratulations to MiP national committee
healthcare manager | issue 20 | winter 2013
vicarious liability. As we had a good working relationship with the senior management, we were able to engage in constructive discussions with the HR director, leading to an agreed reference which would be used in all future references for our member. Jean subsequently applied for another job and is now in post enjoying the challenges and the opportunities her new post offers. She is delighted with the outcome. I wish she had come to us for advice in the beginning but I’m so pleased we could help and that it turned out right in the end. If you think you are being treated unfairly at work contact your MiP national officer who will provide confidential advice and representation. See the MiP website for contact details for the officer in your area.
You never know when you might be affected by change or run into problems at work and need some confidential expert advice and assistance. So if you are not yet a member, join MiP today and get peace of mind. You can join online at www. miphealth.org.uk/joinus
member Brian Armstrong (pictured), who was presented with an IHM Quality Award for his work on the reconfiguration of adult general surgery.
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
England moves its London office in with the Department of Health in April 2014. With the lease up on NHSE’s Maple Street offices, staff will be exchanging the West End for Skipton House in the rather less salubrious surroundings of the Elephant and Castle, in the shadow of
inisters’ new ‘armslength’ relationship with the NHS didn’t stop Jeremy Hunt hitting the phones in November to upbraid hospital bosses whose A&E departments missed the government’s target for waiting times. Although Hunt’s calls were apparently ‘friendly and constructive’, many still feel the target (seeing 95% of patients within four hours) is counterproductive, not least because it measures the wrong thing. Walsall Healthcare NHS Trust probably more than most. Identified by Richmond House as one of ten ‘worst’ offenders, Walsall actually gets patients in and out of the door in an impressive average of 64 minutes – the fastest turnaround of any major A&E unit in England. A classic case, perhaps, of missing the target but getting the point.
hat arms-length relationship may get a little closer, as NHS
the unlamented Hannibal House, which once housed the NHS Executive. Eyebrows were raised by the £214,000 refurbishment of Maple Street with so short a time left on the lease, but NHS England claims the move will save more than £1m overall. Whether moving in with Jeremy Hunt’s civil servants will help NHS England ‘limit the powers of ministers over day-to-day NHS decisions’ is another question.
In England’s name?
he very name of NHS England still seems to rankle in Richmond
House. Back in March Jeremy Hunt wrote a terse letter to NHSE chair Malcolm Grant (pictured) accepting the new name (through gritted teeth you felt) but insisting ‘it does not mean NHS England will now become the headquarters of the NHS in England’. This autumn, publishing its mandate for NHSE for 2014-15, the DH couldn’t even bring itself to mention NHS England at all – pointedly referring to ‘the NHS Commissioning Board’ no less than 45 times in its 32 pages.
service. The planned merger of Bournemouth and Poole hospitals has been blocked, not by angry local residents, but by the Competition Commission and the Office of Fair Trading, whose chief executive Clive Maxwell says competition should work the same way in the NHS as in any other industry. Trust bosses say they’ve already spent £6m on lawyers’ fees alone, and stand to lose £14m a year if the merger doesn’t go ahead. And you thought competition was supposed to save the NHS money?
rivate healthcare groups and management consultants expect to do well out of the Lansley reforms, but the other big winners are corporate lawyers. Managers planning local services across England report facing increasingly aggressive legal claims as disgruntled providers try to prevent mergers, block contracts and even stop trusts working together to share best practice. NHS England chief exec David Nicholson even claims that competition law is being used to keep open a failing cancer care
ll’s not well with community services in Suffolk where, just a year after taking over the service, Serco finds itself with severe staff shortages and an investigation by local commissioners into ‘quality and patient safety’ issues. The firm, which sacked 137 ex-NHS staff a month after taking over the contract, has been forced to ask two local NHS organisations to supply nurses and physiotherapists on secondment. Not surprisingly, its requests were turned down. Serco is believed to have underbid local NHS providers by at least £10m and has admitted it expects to lose money on the three-year contract. The idea of a ‘loss leader’ is to wipe out your competitors, so having to go cap in hand to them for spare staff suggests this one may be leading nowhere.
healthcare manager | issue 20 | winter 2013
The added va lue of membership
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.
Itâ€™s not just doctors who make it better.
Managers are an essential part of the team delivering high quality, efficient healthcare. MiP is the specialist trade union for healthcare managers, providing expert employment advice and speaking up on behalf of the UKâ€™s healthcare managers. Join MiP online at miphealth.org.uk/joinus
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