HCM21_COVER final front.pdf
issue 21 spring 2014
ANDY BURNHAM PUTTING CARE BACK TOGETHER plus LEADERSHIP Not just for bosses HEALTH SPENDING Good for jobs and growth
helping you make healthcare happen
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.
issue 21 spring 2014
healthcare manager inside heads up:2
What you might have missed & what to look out for Leading edge: Jon Restell inperson: Dr Anna Barnes, associate director, Brighton & Sussex University Hospitals NHS Trust inpublic: Wester Hailes Healthy Living Centre, Edinburgh
Alex Jackson on improving hospital food
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.
The health economy: good for jobs and growth Interview: Andy Burnham, shadow health secretary Leadership: building networks for change Complaints: how the NHS is learning from mistakes
Legal Eye: Government weakens TUPE protection Tipster: Getting ready for a job interview MiP at Work: Dealing with budget cuts in Wales
healthcare manager | issue 21 | spring 2014
Welcome to the spring issue of healthcare manager, the magazine from MiP, the specialist trade union for managers working in health and social care. We are delighted to have an interview with Andy Burnham. The shadow health secretary sets out his prescription for the NHS in the coming years and he’s got some positive things to say about managers. A year after the Francis Report, we take a look at two of the key areas in which he made recommendations for improvement. Richard Vize discusses the state of leadership development in the NHS, and Jenny Sims reports on how the NHS is dealing with patients’ complaints. It’s never been a strong point for healthcare organisations, but there are some examples of good practice. Finally our editor, Craig Ryan, looks at some interesting research which turns the argument about health spending on its head, finding that increased investment in healthcare can actually aid economic growth We also have our regular features, including a legal update on the latest changes to the TUPE regulations – something we all need to know about. I hope you enjoy this issue. Do let us have any news, views or comments. Marisa Howes Executive editor 1
heads up what you might have missed and what to look out for
Patient Information Conference 2014
NHS fails to keep up with silver surfers
Thursday 1 May 2014 St John’s Hotel, Solihull.
The 9th Annual Patient Information Conference, run by the Patient Information Forum is a great conference to attend if you communicate with patients and the public about their health. With four confirmed keynote presentations, from NHS England, Care Quality Commission, National Voices and Healthwatch Suffolk, and indepth sessions on key areas such as health literacy, different formats of information, informed consent and the provision of information in primary care, no stone is left left unturned on this year’s agenda.
Healthcare providers are failing to keep up with the demand from Britain’s techsavvy senior citizens, who increasingly want to access healthcare services online, according to a new survey by technology consultants Accenture. The survey, published in February, found that 55% of people aged 65 or over wanted to use internet technology to manage their healthcare, but only a third of providers could
offer the facility. Online scheduling was the most popular service among over 65s who used online technology, with 77% wanting to book healthcare appointments this way. Electronic appointment reminders (69%), E-prescription refill requests (64%) and online access to health records (60%) were also popular. According to the Office for National Statistics, internet use among the over 65s more
than tripled between 2006 and 2014, and 27% are already using the internet to track or manage some aspect of their healthcare. But only 8% were able to access their own health information online. ‘Just as the older generation is turning to the internet for banking, shopping, entertainment and communications,
they also expect to virtually manage certain aspects of their healthcare services,’ said Aimie Chapple, Accenture UK’s managing director for health. ‘To meet the needs of an ageing population, health systems need to expand their digital options and help them track and manage their care outside their doctor’s office.’
Craig Ryan email@example.com
issue 21 | spring 2014 ISSN 1759-9784 published by MiP
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Richard Arthur, Marisa Howes, Alex Jackson, Liz McCarten, Helen Mooney, Alison Moore, Jon Restell, Craig Ryan, George Shepherd, Jenny Sims, Richard Vize.
Please visit www.pifonline.org.uk/2014-conference for more information or to register. Early bird and PiF member discounts apply (if you are a PiF member you must be logged in to the website to get your member discount).
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healthcare manager | issue 21 | spring 2014
leadingedge Jon Restell, chief executive, MiP
he NHS Constitution’s third pledge to staff is ‘to provide support and opportunities for staff to maintain their health, wellbeing and safety’. There is a tendency to see this pledge as more for the benefit of staff than for patients and NHS organisations. The benefits for organisations are usually described only in terms of reduced legal liability or the sack-loads of cash to be saved by reducing sickness absence. This is all wrong. MiP argues that staff wellbeing is much more than a “nice to have”: the psychological wellbeing of staff is essential to their focus on the job and to high performance. If wellbeing is tightly linked to performance (which for most NHS staff means how well they care for people), then we should be worried that in the 2013 NHS staff survey in England only 44% of staff said their organisation takes positive action on health and wellbeing, and 39% said they have felt unwell because of work-related stress. On
Stephen joins the MiP team MiP is delighted to welcome Stephen Smith to our team. Stephen will look after members in the South Central area of England (Berkshire, Buckinghamshire, Oxfordshire,
“Staff wellbeing needs to have much higher priority in responding to Francis. It is not just an optional extra in a system under strain.” top of that, 68% reported that they had attended work in the previous three months despite not feeling well enough to perform duties. High levels of “presenteeism” are not a success story – they hugely increase the likelihood of poor management, poor work and poor care. Good managers understand the link between performance and wellbeing. They give it priority. An encouraging feature of the NHS staff survey is that, while senior managers – rightly or wrongly – get it in the neck, people do rate their line
Hampshire and the Isle of Wight) and North West London. He joins MiP from the teachers union, NASUWT where he worked for 13 years. ‘I am enjoying representing MiP members who do such a tough job managing the delivery of health and care services in the face of increasing demand and financial con-
healthcare manager | issue 21 | spring 2014
managers. Overall, 69% said their manager helps them with difficult tasks, 72% felt supported in a personal crisis and 65% were satisfied with the support they get from their immediate manager. Staff wellbeing needs to have much higher priority in responding to Francis than it has so far. It is not just an optional extra in a system under strain – it is the path to sustainable, compassionate care. Good line management is vital for staff wellbeing, and the quality and capacity of line management also needs much higher priority. Great managers nip problems in the bud, but our love affair with kick-ass, transformational or highly personal leadership often obscures the value (and skill) of day-to-day management, which is steady, incremental and distributed throughout an organisation. MiP champions staff wellbeing and the great line managers who support it – and urges others to do the same. So please, take the time to care for yourself and for your team.
straints,’ said Stephen. ‘I’m travelling round the area, getting to know members and employers. And I’m getting my head around a whole new bunch of acronyms!’ If you work in his area and need advice or representation, contact Stephen on s.smith@ miphealth.org.uk or telephone 07852 154038. 3
New advice for managers on carers, disability and time off
The equality and diversity group of the NHS Staff Council has published new guidance for employers on flexible working for carers, disability and dealing with requests for time off. The group, which includes representatives from employers and trade unions, works to promote the equality and diversity agenda within the NHS and regularly issues guidance on good practice on a range of employment issues. Guidance on flexible working for the NHS explains the statutory rules on the right to request flexible working and advises managers on good practice in meeting the needs of carers working for the NHS.
Guidance relating to disability for the NHS is designed to help organisations meet their duties under the Equality Act 2010. It highlights good practice advice for managing disabled staff in respect of sickness absence, carers leave and redeployment. Guidance on dealing with requests for time off provides managers with good practice advice on dealing with a range of sensitive time off request issues – including fertility treatment, surrogacy and adoption. All these documents can be downloaded from the NHS Employers website at www.nhsemployers.org.
NHS Equality, Diversity & Human Rights Week 12-16 May 2014
Co-ordinated by NHS Employers and supported by MiP, the third NHS Equality, Diversity and Human Rights Week will be a national platform for NHS or-
England gets first ever workforce plan Health Education England (HEE) has published its first ever workforce plan for England, promising to invest more than £5 billion a year in training and development for the NHS workforce. HEE chief executive Ian Cumming (pictured) said the plan would set out the investments HEE would make in education and training programmes from September 2014. ‘Workforce planning is about ensuring that the NHS has the people we need when we need them,’ he said. ‘With over 1000 different employers across the private, public and voluntary sectors employing 1.3 million people in over 300 different types of jobs, workforce planning cannot be left to individual organisations. It is only through a collective approach we can hope to deliver what patients need now and in the future.’ The plan is built upon
ganisations to showcase their work and commitment to creating a fairer, more inclusive NHS for patients and staff. The event brings together work and best practice from across the NHS, helping organisations to shine a light on their achievements and priorities. This year’s theme will be the power of networks and how social media can bring about change and bring people together to share concerns and support each another. The Personal, Fair and Diverse (PFD) campaign will be incorporated into the week of events and we are encouraging
13 local plans drawn up by Local Education and Training Boards, which bring together the needs of local frontline employers. Cumming added: ‘Whilst most NHS staff are busy meeting the patient demand that walks through the door, it is our particular responsibility to plan for the future: to ensure that we have enough supply to meet future demand, whilst avoiding excess over supply, which would result in unemployed skilled people and a waste of taxpayers’ money.’ The workforce plan is available from the HEE website at www.hee.nhs.uk.
individuals to join the campaign by becoming a PFD champion. The PFD campaign specifically highlights the individual contributions made, day-in and day-out, to deliver NHS services that are personal, fair and diverse. For further information or to download a communications toolkit visit www.nhsemployers.org
healthcare manager | issue 21 | spring 2014
inperson Dr Anna Barnes, associate director of governance, Brighton & Sussex
“There is a lot of evidence now that shows that buildings can have a real impact on patient experience.”
University Hospitals NHS Trust
Dr Anna Barnes describes her role as being responsible for the ‘systems and processes’ for the capital development of the 3Ts — teaching, trauma and tertiary care — at the Royal Sussex County Hospital in the Kemptown area of Brighton, which forms part of Brighton and Sussex University Hospitals NHS Trust. Right now, her job essentially involves overseeing the demolition of the existing hospital buildings, some of which are over 200 years old, and the construction of a new hospital on the site, which will also provide a new home for the Hurstwood Park Regional Centre for Neurosciences. The trust’s proposed ten year scheme is currently awaiting final approval from the Treasury. ‘I ensure that there is board healthcare manager | issue 21 | spring 2014
assurance, oversee the programme planning, working with contractors, and address the principle risks and issues,’ explains Dr Barnes. She says her role has also meant developing an art strategy and setting up an artists’ programme for the new hospital and making sure key stakeholders have a voice in preserving the heritage of the site. ‘When we were in the design stage I took a very active involvement in working with patient and public groups to design the building,’ she says. ‘There is a lot of evidence now that shows that buildings can have a real impact on patient experience, this is not just about good design but also about the emotional intelligence of a building,’ she adds.
The Brighton scheme will also see the trust expand the Sussex Cancer Centre by developing a new Chemotherapy Day Unit, increasing the radiotherapy service and doubling the number of beds on the oncology ward. The trust will also expand its facilities as a major trauma centre and build a landing pad for the Kent, Surrey and Sussex air ambulance. ‘We are also replacing all our elderly care wards so that the new inpatient beds will all be single rooms and are being designed with sea views, and we are going to rebuild and replace the site’s rooftop garden,’ she says. Dr Barnes says that her job is to ensure that the proper procedures are in place for designing and building the new site and that the trust can demonstrate that it is getting value for money. ‘It is very important that we justify how we are spending the £420m public donated capital for this project.’ And what if Dr Barnes’ job did not exist? She says that it would be ‘very hard to run the project smoothly. Although people in the private sector could come in and offer the same expertise, using them would not be very good value,’ she believes. ‘I am also quite often the person who asks how the patient would experience something that has been proposed.’ Dr Barnes has been in charge of working through a plan to realise the benefits of the project which include improving access, patient experience and staff morale and ensuring better access for people who do not live in the area. Helen Mooney
To whom it may concern Rob Gee of the Big Difference Company wrote and performed this poem at the MiP annual conference in November. I’ve never been known for my attention span; in fact my husband thinks I’m gormless, but I’m losing my memory one story at a time; And at the moment I’m getting away with it in a forgetful kind of way. I’m trying to keep things in the front of my mind and I’ve only left the gas on a couple of times so far, that I’m aware of today. Now it just so happens that I spent a good chunk of my life working as a nurse in dementia care, so although I’ve no idea where it is my brain’s going, I’m under no illusions as to what’s waiting when it gets there, So I’d thought I’d better write this letter for later on in my dementia, and if you’re the sorry sod who’s reading it, then my arse is your career.
You can swear in front of me and I probably won’t mind; and don’t worry if you’re careless now and again, as long as you’re gentle and kind. You can even take the piss a little if you like, ‘cause I’ll be giving you plenty of mine, But don’t treat me like an embarrassment even when I’m embarrassing, just keep me nicely medicated and clap your hands when you see me singing.
Have your say on Talent for Care The consultation on Talent for Care, the national strategy for developing NHS staff in bands 1 to 4, closes on 24 March 2014. Figures suggest that 60% of care in the 6
And please be patient with my husband. We’ve been married since 1953 and every pore in his body is going to want to stay with me; and although he’ll be full of anger and pride, he’ll be quietly going to pieces inside, so try and involve him with everything as much as you can because he does try his best and he’s only a man. So thanks in advance for all your hard work and dedication. I hope I can make you smile as my senses slide, and I hope that I’m a model patient.
I have half a sugar in my tea and I’m very partial to custard. I can’t abide fisherman’s pie, especially if it’s pre-digested.
Please don’t manhandle me, unless I hit you first Try and make sure I have clothes that fit me and don’t worry about being a brilliant nurse. Just give me a lie in now and again, and if I’ve filled my nappy but I appear quite happy, change the other people first.
I’m aware the fact I’ll lose my memory won’t stop me feeling things emotionally, so smile a lot, have fun and lie to me, and when I final lose it all, just give me somewhere soft to fall, so I can decompose with a modicum of dignity; and if you have an ounce of compassion, try and slip me the occasional whiskey. I think that completes the briefing. I wish you well in all you do, and if you’re ever in my position, I hope someone does the same for you.
NHS is delivered by 40% of staff with 5% of the budget for education and training. As shapers of education, planners and deliverers of care, managers can do much to change this and improve opportunities for this part of the healthcare team. MiP strongly supports the Talent for Care initiative. The Talent for Care document sets out Health Education England’s current thinking about development for healthcare
support staff and seeks views on how to improve education and training, promotion opportunities and qualification and certification.
Downland the consultation document and further details about the campaign from: eoe.hee.nhs.uk/ our-work/1to4
healthcare manager | issue 21 | spring 2014
“The centre ensures that local communities have access to all the services they need.”
Wester Hailes Healthy Living Centre, Edinburgh Opened last summer, Wester Hailes Healthy Living Centre is situated in a deprived part of Edinburgh. The £12-million centre is a joint project between NHS Lothian and Edinburgh City Council and serves as a hub for providing health and social care services for local residents. Peter Gabbitas, who is joint director of health and social care for NHS Lothian and the council, explained that the idea took several years to get off the ground. ‘GPs and other health professionals working in the community in this area originally put in a bid for National Lottery funding to develop the centre, but when they didn’t win the funding they still pressed on and thought it would be a good idea for this demanding and challenging area,’ he says. The centre is home to the Wester Hailes Medical Practice which includes eight GP consulting rooms, one training consulting room and five nurse consulting and treatment rooms. NHS Lothian also provides a wide range of community health services from the site, including physiotherapy, learning disabilities, midwifery, podiatry and dentistry. There are four general dental rooms and one special needs dental room as well as a dental x-ray room, a recovery room and a local sterilisation unit. Council services including health and social care, children and families, and criminal justice are run out from the centre. The community-based voluntary organisation, Wester Hailes Health Agency, is also based in the building, offering therapeutic services and classes, such as counselling, massage and relaxation, as well as group activities such as walking groups and exercise classes. It also runs satellite projects such as the Wester Haven cancer support project, a ‘Time Bank’ for volunteer exchanges and Edible Estates, which helps the community get involved in local green space activities such as food growing. healthcare manager | issue 21 | spring 2014
Officially opening the centre last December, Scotland’s health secretary Alex Neil, said: ‘We want everyone in Scotland to have access to the best facilities on their doorstep. That is why we are investing in building projects, like this Healthy Living Centre, which allow staff to work in the best possible surroundings and ensure local communities have access to all the services they need in purpose-built, modern facilities. The local community made their own contribution to the centre through the youth outreach project, Street Arts. The project worked with a group of 84 young people to create the Healthy Living Centre Mural, which now takes pride of place in the main foyer of the centre. The three-storey development has been delivered in partnership with Hub South East Scotland using accommodation and land owned by Edinburgh Council.
Gabbitas explains: ‘Costs are shared between the council and the NHS depending on how much space each take within the building. At the moment 66% of the building is occupied by the NHS and 34% by the Council and one of the key components of that is a fairly large, salaried GP practice on the ground floor.’ The centre is the second partnership scheme between Edinburgh Council and NHS Lothian and Gabbitas says that two more are in the planning. ‘This is becoming the standard model in Scotland and opportunities to join up capital assets is becoming much more the norm.’ ‘There is a strong policy view around integrating health and social care services and a key step to achieving this collaborative working is to locate staff together,’ adds Gabbitas. Helen Mooney
NHS CHANGE DAY 2014
Thousands take part in world’s largest healthcare social movement
In Trafalgar Square, with the Royal Voluntary Service and Deputy Mayor, Victoria Borwick, urging Londoners to pledge an hour for volunteering; top right, Birmingham Children’s hospital; bottom right, Paediatrician Dr Damian Roland, one of the founders of NHS Change Day, ‘collared and blocked’ on a spinal board.
Thousands of staff, patients and supporters of the NHS joined forces for NHS Change Day – the largest display of collective action in the history of the NHS. Nearly 400,000 pledges were registered on the NHS Change Day website – from healthcare assistants, clinicians, chief executives and graduate trainees, members of the public and staff working across health and social care. Pledges ranged from the simple, such as promising to show appreciation for the work of NHS staff by smiling and thanking them more, to the innovative, such as helping terminally ill children relate to the cycle of life by growing and nurturing seeds on the ward (pictured, top right). A number of NHS staff used the day to experience first-hand some of
the experiences their patients go through. Pledges received covered almost every aspect of NHS care including: ■■ A midwife, moved by the care experiences of her own disabled daughter, who pledged to do all she can to get basic sign language included in nurse training ■■ A surgical team who pledged to make sure every child waking after surgery is greeted by their favourite cuddly toy ■■ An NHS doctor who pledged to spend an hour ‘collared and blocked’ on a spinal board to understand better how his patients feel (see picture) ■■ A 14-year-old cerebral palsy sufferer who pledged to campaign to persuade staff to try harder to communicate with patients themselves, rather
than their family or carers. Liam Kennedy, Transformation Manager at Wexham Park Hospital, and one of the ‘changemakers’ behind the success of the movement, said: ‘Change Day has tapped into the energy and enthusiasm that is out there, but often overshadowed by the pressures of the day job. It has empowered people to think “yes, I can make a difference” and then go out and do it.’ MiP gave its support to Change Day, pledging to encourage managers to take some time to look after themselves and their team at work. This will strengthen our teams and help us all deal with the daily pressures of delivering high quality care in the NHS.
‘The pledges are inspirational, showing just how innovative and enthusiastic healthcare workers are,’ said MiP chief executive Jon Restell. ‘Change Day has got members of the healthcare team talking within and across organisations – sharing ideas ranging from simple changes in behaviour to more complex changes in service design. This is how to change NHS culture.’ Jon has made his own pledge to deliver four seminars around the country to help managers share good practice in patient engagement and build resilience (see p23 for details). It’s not too late to register your pledge, go to www.changeday.nhs.uk
healthcare manager | issue 21 | spring 2014
comment Alex Jackson
Co-ordinator, Campaign for Better Hospital Food
Opening Pandora’s box Hospital food in England is often poor quality, lacking in nutrition and made to the lowest standards of production. This is widely known, even among those with no personal experience of it themselves, and has immediate ramifications for patients and their families.
At least one in every ten meals served to patients are returned to the kitchen uneaten and six out of ten patients rely on their families to bring them food because they won’t or can’t eat hospital food. A 2010 survey by Consensus Action on Salt and Health found that hospital food served to children is often so unhealthy that it could not legally be served to them in school. The reasons for this are not financial. NHS statistics show that the taxpayer spends £1 billion a year on hospital food, with some trusts spending up to £12 on meals for each patient every day. This is more than enough to pay for excellent food at every mealtime, and prompts us to ask where a large part of this money is going. It’s clearly not being invested where it should: on high quality produce from the best (potentially local) suppliers and skilled catering staff. During the last 20 years, and in response to the public and media criticism of hospital food, the government has issued a plethora of voluntary guidance intended to improve the standard of patient meals, costing the taxpayer more than £54 healthcare manager | issue 21 | spring 2014
“Improving the quality of hospital food will, at the very least, help to lift patients’ morale and provide patients with much-needed nourishment.” million in the process. This guidance has been largely ignored, or adopted only for a short time, because it was not made legally binding. In the rare instances where this guidance has been adopted, hospitals are preparing and cooking fantastic meals but the same high standards aren’t being achieved everywhere. Just because some hospitals are getting it right doesn’t mean that the rest will follow. History has taught us best practice does not spread by itself. Setting standards for food served in England’s public sector institutions is not unusual or rare. Meals served at non-academy schools have to meet nutritional standards and food served in prisons and government departments has to meet ‘Government Buying Standards’, which are a mix of nutritional and environmental standards. There is no reason why the same successful solution cannot be applied to improving patient meals.
Improving the quality of hospital food will, at the very least, help to lift patients’ morale and make mealtimes something to look forward to. It will also provide patients with much needed nourishment and ensure that taxpayers’ money is spent on sustainable farming practices, which benefits everyone by helping to create economies of scale for better quality produce. There is a wealth of evidence to show that higher quality patient food is no more expensive to buy than lower quality patient meals. Even if this were not the case, the NHS could make huge savings by improving the meals served on our wards. Spending more can sometimes cost less. For a start, serving better hospital food reduces food waste which, according to nurtrition charity BAPEN, costs the NHS £144 million each year to dispose of and is likely to reduce hospital spending on expensive nutritional supplements. We should all be calling on the government to set legally binding standards for patient meals to drive up quality and ensure that taxpayers’ money is spent on hospital food which is good, rather than harmful, for our health, for the environment, and for our economy.
For further details visit: www.hospitalfood.org.uk, email email@example.com or follow @betterNHSfood on Twitter.
Seeing healthcare as a burden to be funded blinds us to its potential as a productive source of economic growth, argues Craig Ryan.
Healthcare is expensive. People are living longer and treatments keep getting more sophisticated and costly. In the US, healthcare consumes 18% of national income (GDP). In the UK it’s only half that, but it’s rising fast, especially as a proportion of shrinking government spending. In France, Europe’s biggest healthcare spender, it’s gone from 7% of GDP in 1980 to almost 12% today. Healthcare is a drain on the economy. A worthwhile drain, but a drain nonetheless. But is this the right way to look at it? Why is healthcare seen as a dead cost and not as investment? In fact, why do we see healthcare as something we have to spend money on in order to be productive, and not as production itself? We don’t say construction costs 6.7% of GDP, we say it contributes 6.7%. The same goes for transport, agriculture, leisure or culture. Perhaps this is because people like their cars, their food, telly and going to the theatre. No one likes going to hospital or being told to eat salad. Perhaps it’s also because – in Europe at least – most healthcare spending comes from the government and is financed by taxes on other economic activity. But if healthcare is not exactly a prod10
uct like any other, it’s a product all the same. It’s something people want. And like other economic activities, it creates jobs, pays wages, and supports a long chain of suppliers (everything from paper merchants to computer programmers – hospitals are in the market for almost everything), stimulates investment and encourages workers to acquire new skills. People are organisms, they get sick, and they need treatment. Just as they need somewhere to live, ways to move about and protection against risk. Healthcare is just as much production as building houses, making cars or providing insurance. Tonio Borg, the European Commissioner for Health, says he wants ‘to shift the still widely held perception of health expenditure as primarily a “cost” rather than an investment, and to pass across the message that health contributes to
“Why do we see healthcare as something we have to spend money on in order to be productive, and not as production itself?”
inclusive economic growth.’ In the depths of our 21st century great depression, NHS funding was seen as part of the problem, rather than part of the solution. But healthcare spending can be a highly effective way of stimulating a dormant economy. Research published in Globalization and Health last year by a team of researchers, including Professor Martin McKee of the London School of Hygiene and Tropical Medicine and University of California economist David Stuckler, calculated the “multiplier effect” for different forms of government spending among 25 EU countries from 1995 to 2010. They found the multiplier for healthcare was 4.32, compared to an average 1.61 for all government spending. This means that for every £1 spent on healthcare by government, GDP grew on average by £4.32 once all the knock-on effects had worked their way through the economic system. This is a much better return than for defence (where the multiplier was actually negative), housing, industrial support or even “social protection” like unemployment benefits. Only spending on education and environmental projects matched the power of healthcare as an economic stimulus. Why? Firstly, in advanced economies healthcare manager | issue 21 | spring 2014
at least, most of the money is spent at home — healthcare workers generally work where the services are provided. This is why the multiplier for defence spending is usually negative: most of the money gets spent on expensive imported equipment (although our big defence industry means this is less true for the UK than many others). The UK, with relatively large medical equipment and pharmaceutical industries, is wellplaced to take advantage of healthcare’s capacity for economic stimulus. Secondly, healthcare remains relatively labour intensive. Around 5560% of the NHS’s £110bn budget goes on staff costs (the Department of Health won’t disclose exact figures). Health and social care, particularly for the very young and the very old, is a people business. In one of those paradoxes in which economics abounds, healthcare’s low productivity means it is good at creating jobs. You need to employ a relatively large number of extra people to achieve a given increase in output. Furthermore, many of these jobs are relatively low paid. Lower paid people tend to spend their wages rather than saving them, and are less likely to spend them on foreign holidays or imported cars. Of course, money spent on healthcare is money not spent on something else. The government could, as Keynes facetiously suggested in the 1930s, pay people to dig holes and fill them in again. In a slump, this would be better than nothing. But if we’re going to spend money creating jobs, we might as well spend it on something worthwhile, which will bring long-term economic benefits when the recession is over. Investing in healthcare services, public health programmes and research can increase labour supply, productivity, skill and education levels, and reduce inequality, poverty and the cost of sick pay and welfare benefits. This helps to offset the undoubted tendency for healthcare costs to rise faster than general prices. This is why the European Commission designated healthcare as “growthhealthcare manager | issue 21 | spring 2014
friendly” spending and made investment in public health a cornerstone of its “Europe 2020” ten-year economic growth strategy. The Commission’s paper, Investing in Health said: ‘Health is a value in itself. It is also a precondition for economic prosperity. Investing in people’s health as human capital helps improve the health of the population in general and reinforces employability, thus making active employment policies more effective, helping to secure adequate livelihoods and contributing to growth.’ None of this means a blank cheque for healthcare services. Much as spiralling house prices do nothing to solve the housing crisis, simple inflation in healthcare costs does nothing to improve health outcomes or bring longterm economic benefits. The US spends almost 50% more on healthcare than anyone else, but with decidedly mediocre results. Costs keep rising, but the returns — better treatments, better survival rates, a healthier population — lag far behind. The European Commission recognised this in its 2012 survey, The Quality of Public Expenditures in the EU: ‘The relatively large share of healthcare spending in total government expenditure... requires more efficiency and cost-effectiveness to ensure the sustainability of current
health system models. Evidence suggests there is considerable potential for efficiency gains in the healthcare sector.’ Professor Michael Stople of Kiel University, Germany, a leading expert on Europe’s healthcare economy, believes Europe’s ageing population and its relatively low level of investment in healthcare research, means healthcare has a major role to play in reviving European economies. ‘In the aftermath of the financial crisis, the growing size of Europe’s elderly cohorts is boosting the social rate of return on health-related public-good investments at a time when the borrowing costs of many European governments are at record lows,’ he says. ‘With sufficient translation of health improvements into longer, more productive working lives, Europe’s currently depressed economies can thus be supported in returning to sustained long-term growth and in generating the additional tax revenue that will eventually help governments balance their books.’
Craig Ryan is a freelance writer and associate editor of Healthcare Manager. Read Craig’s blog at: www.craigryan. eu/blog
INTERVIEW: ANDY BURNHAM
In 2015, Andy Burnham could become the first health secretary to return to the job since Neville Chamberlain in 1931. He spoke to Alison Moore about what he’s learned and his emerging plans for the NHS.
Health is set to be one of the battlegrounds of the next election and, if shadow health secretary Andy Burnham has his way, the public will have a clear choice between two very contrasting visions for the NHS.
On the left is a whole-person integrated care approach, with health and wellbeing boards taking the lead in commissioning, and the NHS as the preferred provider. And on the right – Burnham argues – a government pursuing privatisation and running down the service, while trying to avoid talking about a re-organisation that was its decisive act in respect of the NHS. ‘There has to be a proper debate in 2015,’ he says. ‘I think with Mr Hunt you have to strip away the spin and look at the facts – look at the path on which the NHS is set by the coalition. ‘In my view the market is not the answer to 21st century healthcare. That, in the end, is the big choice. Spin only takes you so far: you have to look at the basic vision and philosophy.’ Burnham obviously hopes this argument will win support within the NHS; one of his key messages is that Labour will repeal the Health and Social Care Act. But the reality is much more nu12
anced. Yes, the act will be repealed but that does not mean the structures it created will all disappear or that we go back to the world of primary care trusts. There will be no reset to 2009. But nor will there be a whole new set of organisations. ‘We don’t want new structures… [and] the sheer waste of resources and energy that they put people through by scaling down PCTs and creating CCGs,’ says Burnham. He seems to have grasped the potency of this issue to alienate NHS staff who want a degree of certainty and stability rather than another top-down reorganisation. The Oldham commission — created by Labour to look at whole-person care — recommended that CCGs retain most commissioning functions, with the possibility that health and wellbeing boards (HWBs) could take over some commissioning work in the future. Although Burnham is opposed to privatising commissioning support units, he’s never advocated outright abolition. Burnham, who was speaking to Healthcare Manager before publication of the Oldham report, said: ‘I would like to see the health and wellbeing boards becoming pre-eminent. I’ve no objection
to GP involvement in commissioning but GP domination and control of commissioning is a bad thing. In the end it is bad for the profession. It muddies the waters in terms of public trust,’ he says. ‘People will say, is the GP doing this because it’s best for me or is it a money thing? It mixes money and medicine. ‘For me CCGs have not emerged as the powerhouse we were promised. It feels more top-down, more NHS England driven, than it was before. There is confusion about what some of these organisations do. ‘What I want is the right people in the right place and I don’t think that is the case at the moment. We’ve seen a hollowing out of expertise – it feels like there has been a weakening of people working on the ground and the NHS has become more remote.’ He cites the rebuilding of a surgery in his own Leigh constituency that has been bogged down waiting for approval from NHS England, when it could have been approved more locally. ‘I’m not necessarily saying, “recreate the strategic health authority”, but I think a regional perspective has been missed.’ He sees integrated care as the salvation of the health service, as he argues it is better for the patient and cheaper, healthcare manager | issue 21 | spring 2014
INTERVIEW: ANDY BURNHAM
“What I want is the right people in the right place and I don’t think that is the case at the moment. We’ve seen a hollowing out of expertise.”
although Nuffield Trust chief executive Andy McKeon recently said its research on integrated care initiatives showed no evidence of lower costs. ‘I believe the future is integration and the fuller and deeper it is, the more successful it is likely to be. Barriers to integration and collaboration need to be completely removed,’ Burnham says. ‘I think there is no doubt that it will produce savings. If you reduce unnecessary hospital admissions of old people that has to be better. What I would not want to do is say that integration solves everything, but it takes you a hell of a long way down the path. It is just the right thing to do.’ This will require dropping any ‘silobased’ divisions between the NHS and local government. ‘It’s not possible for people to work in glorious isolation,’ he warns. healthcare manager | issue 21 | spring 2014
This whole-person care would see physical, mental and social care united in a single service with the emphasis on keeping people healthy at home. But social care remains a difficult conundrum for all political parties. While everyone sees it as key to caring for people at home, few want to bite the bullet and fund it. Labour has been no exception to this, and Burnham says the party is ‘still wrestling’ with the right funding mechanism. However, he suggests there is ‘logic’ in shifting resources from the acute sector towards preventative care in the home. ‘If you look at Torbay, they are providing social care of a higher standard than anyone else in England,’ he says. ‘In a whole-person care model more social care would be provided because it is preventative and funded by that transfer from acute care.’ He suggests there are inefficiencies
in the system which could be eliminated under an integrated system: 15-minute care visits are ‘pretty worthless’, he says, and visits from multiple professionals can be a waste of resources. One of the consequences of failing to support people in the home is that large sums are spent on hospital admissions. ‘It’s inefficient and very bad in human terms.’ But Burnham is not in a position to promise additional funding overall for the NHS. ‘I can’t work on the basis that I’ve been promised all kinds of money. I have to see that we are getting the best that we possibly can for the money; I don’t think we can look people in the eye and say that at the moment. If we ever reached that point, then a debate on the right level of funding could follow,’ he suggests. He firmly believes that closer links to 13
INTERVIEW: ANDY BURNHAM
“There is always an argument to be had about the right level of management but no one wants the NHS to be under-managed.”
local authorities will help, and supports the switch of public health to councils. ‘I’m pretty clear that we have to link healthcare to the broader determinants of health if we are to tackle the challenges that the 21st century brings. We have to... link health policy properly to housing, leisure, planning, education.’ Burnham’s guarded approach is perhaps the result of occupying the health secretary’s chair in 2009 and 2010 and experiencing some of the difficulties it brings. But his rejection of the market as a solution to the NHS’s problems is steadfast - he sees the private sector as having a supporting role. The Oldham report has suggested that section 75 - seen as opening up clinical services to competition - should be abolished and replaced with regulations supporting the development of whole person care. NHS staff are looking for ‘hope’, he says. ‘That’s what I want to give people — hope that an NHS based on enduring values and philosophy can prevail’. But that does not mean no change. ‘The NHS is still a 20th century treatment model. We urgently need to bring it up to date and rethink it for the 21st century,’ he warns. ‘All parties are guilty of using NHS managers as a scapegoat, but when this government came 14
in they really denigrated NHS managers. It made me bristle. I know so many completely decent, committed public servants who work in NHS management. ‘There is always an argument to be had about the right level of management but no one wants [the NHS] to be under-managed.’ He is also critical of what he feels is the government’s desire to run down the NHS. ‘The NHS has just basically been battered for three, now four, years. And the consequences of that are beginning to be felt.’ The current financial situation is ‘a very difficult picture’, he says. ‘I have conversations with many people going around the country and I hear that the less painful savings have been made… balancing the books will start to require some very painful decisions.’ He points to A&E performance, with many trusts missing the 95% target for waiting times of four hours or less – despite the target being relaxed from 98% by the government – and the tendency to see this through the prism of a “winter crisis”, whereas it has become a year-round problem. ‘I think A&E is the barometer, it is telling us that there are severe problems in the system,’ he says. Mid-Staffs, of course, remains a
tricky subject: Burnham is still reviled by some from the town for not ordering a public inquiry into the failings at the trust when he was health secretary. He insisted on an independent inquiry, he says, with the chair having the option of asking for witnesses to be compelled to attend. He claims the department advised him that the trust was too fragile to survive a public inquiry. ‘My construct was designed to help it get better and get to the bottom of what had gone on,’ he says. ‘All the way through I have not opposed any efforts to get to the truth but always thought it had to be balanced with the potential impact on the hospital.’ He recently met campaigners from the Support Stafford Hospital group. ‘I think everyone has an obligation to Stafford in terms of what they have been through,’ he says. ‘The thing that I came away with was that you have a three-year public inquiry followed pretty much straightaway by a hard-nosed administration process. What DGH in the country could survive that combination without support?’ While refusing to commit himself to what structure or organisation should provide health services in Stafford, Burnham is clear that it will still need ‘the basic functions’ of a DGH, and is critical of the ‘straitjacket’ administration process which has now lead to the dissolution of the trust. ‘The people of Stafford deserve nothing less than a safe and sustainable hospital,’ he says.
healthcare manager | issue 21 | spring 2014
The NHS is banking on better leadership to deliver the cultural transformation demanded by Francis, says Richard Vize.
Leadership has been identified as the cause of NHS failures and the cornerstone of the solutions. Intolerance of management shortcomings since the Francis Inquiry has led ten trust chief executives to resign, while thousands of managers and trainees have been undergoing leadership development in pursuit of high quality, compassionate care.
In his final report last February into the failings at Mid-Staffordshire NHS Foundation Trust, Robert Francis QC laid bare repeated leadership failures at the root of the collapse in quality in parts of Stafford Hospital. The board ‘failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities’. Leadership failures were everywhere – surgery, A&E, nursing, the primary care trust and the strategic health authority. Francis called on the government and the health service to strengthen the recruitment, education, training and support of NHS leaders, as well as warning that the increased autonomy of NHS organisations under the coalition government’s reforms made them ‘more susceptible to the healthcare manager | issue 21 | spring 2014
vagaries of local leadership’. His recommendations included establishing a “leadership staff college” to provide leadership and management training for potential senior staff and promote a culture which values high standards of ethics and conduct. Five months later, the report by NHS England medical director Sir Bruce Keogh into 14 trusts with persistently high mortality rates repeatedly highlighted the need for effective leadership, particularly in ensuring high quality urgent and emergency care services, and in the care of frail
and elderly patients. Then in August Don Berwick’s (pictured, left) review of the Francis report for the government called for the NHS Leadership Academy – the answer to calls for a leadership college – to designate a set of safety-leadership behaviours to be used when hiring, appraising, developing and promoting leaders. The behaviours he cited represent a daunting challenge for any manager. They include: insist upon transparency; hear the patient voice; master and apply modern improvement methods; lead by example with a compassionate and learning approach; and infuse work with pride and joy. Top of the list is ‘abandoning blame as a tool’. In case anyone had not got the message that NHS leadership was under-performing, a survey of managers published in November by the Chartered Management Institute, found that a third of respondents from health and social care considered their own manager ineffective. Health and social care employers invested substantially less in management and leadership development – £1,075 per manager compared with £1,414 across all sectors. 15
Centrally, the NHS has made various attempts to deliver leadership programmes, through vehicles such as the NHS University, the NHS Leadership Centre and the NHS Modernisation Agency. The current NHS Leadership Academy was established in 2012 at the height of controversy about both the quality of care and the coalition’s health reforms. The importance being attached to leadership training can be measured by the Academy’s huge budget – £63 million in 2013-14 rising to £69 million next year. Managing director Jan Sobieraj says: ‘The academy was forged in the light of a devolved system and the first Francis report in 2011, so it was very much in everyone’s minds about the culture and climate shift needed around quality, compassion and so on.’ What marks out the current wave of health service leadership development from initiatives in other parts of the economy is that it is attempting to equip staff to change the culture. It is trying to move NHS leadership away
“It is very hard to change other people, but you can behave differently yourself, and that allows people to make different choices about how they respond to you.” 16
from the caricature of relentlessly pursuing centrally-set targets to a style which engages and empowers staff and is focused on patients and quality care. ‘We do development, not training. We are into changing people’s behaviours and the way they approach their leadership,’ says Sobieraj, stressing the importance of elements in their programmes such as inspiration, communications, engagement and care improvement. Giving managers – often in the foothills of seniority – the skills and confidence to change the culture of their organisation sounds an almost impossible task. The risk is that the everyday demands of work will soon obliterate their training. Programmes run by organisations such as the NHS Leadership Academy and the King’s Fund address this in four ways. They support managers in working through challenges they face in their own workplace rather than studying theoretical examples; they have a strong focus on understanding their personal behaviour and how that affects the behaviour of others; they encourage managers to reflect on their experiences and how they might have done things differently; and they provide managers with both formal and informal support once they return to work. Sarah Goodson, a senior consultant for the King’s Fund leadership development programmes (pictured, left), says: ‘The psychology evidence is that it is very hard to change other people, but you can behave differently yourself, and that allows people to make different choices about how they respond to you.’ Ganesh Sathyamoorthy (pictured, above right), assistant director for partnerships and business development for the NIHR Collaboration for Leadership in Applied Health Research and Care for North West London, was on the King’s Fund’s Top Manager Programme. It involves five weeks of
emotionally demanding residential training over six months and costs almost £11,000. Sathyamoorthy says: “The great thing about that programme is that it doesn’t teach you to be a better leader, it teaches you to be a better person. ‘This was about getting you to understand yourself and the emotions of others and how you choose to achieve your aims and objectives.’ Sathyamoorthy believes that the focus on self-awareness helps managers avoid burning out: ‘You need to value yourself if you’re going to value other people. People can work really hard all the time to provide a good service, but that can begin to burn them out and without knowing it they begin to provide a worse service to patients.’ Scott Watkins, currently a project support manager in the dermatology department at South Devon Healthcare Foundation Trust and nearing the end of the NHS graduate management scheme, values the reflective approach of the training: ‘They get you to reflect on what has happened in the day and see them as things to work on.’ He contrasts this with his perceptions of Mid Staffs staff ‘carrying on automatically without ever reflecting’. After completing formal training, managers are routinely encouraged to run their own learning sets, meeting informally every few months to share successes and frustrations and refresh what they have learned. Some learning sets have carried on for many years. healthcare manager | issue 21 | spring 2014
David Brindle (second from left) presents the Southern Health Going Viral team with their Guardian Innovation Award.
While the NHS Leadership Academy alone has thousands of people going through its programmes, these numbers are dwarfed by the total NHS workforce of 1.3 million. Simply working through layers of managers would never be enough to bring about the cultural change the NHS needs if it is to meet the challenge laid down by Francis. To tackle this, leadership development is exploiting ideas rooted in social media. First, managers and clinicians are being chosen for programmes not just on their seniority but on perceptions of how influential they are in organisational networks. Then, once they are back at work, they are expected to spread the skills and insights they have gained to others. While the NHS remains strongly hierarchical, it is increasingly understood that leadership can be exercised at any seniority. This was powerfully reinforced when Julie Battilana and Tiziana Casciaro tracked 68 NHS clinical change programmes. They wrote in the Harvard Business Review last July that “change agents” who were central to their organisation’s informal networks had a clear advantage, regardless of their formal position, in making change happen. In particular, people who were able to bring together disconnected groups could make a dramatic difference. This networking approach to leadership and change underpinned healthcare manager | issue 21 | spring 2014
the winning entry in the Guardian’s Healthcare Innovation Awards for leadership last September. Southern Health NHS Foundation Trust – one of the largest mental health and learning disability trusts in England – was formed from a merger and has 9,000 staff working across 150 sites in five counties. Promoting a consistent leadership culture could hardly be more difficult. While many of its facilities perform well, the Care Quality Commission has ordered rapid improvements at Antelope House Hospital in Southampton and Slade House in Oxford. The trust’s Going Viral leadership development programme selects staff according to the influence and responsibility they have rather than simply their seniority. ‘It is open to anyone… either managing or in a position of influence,’ says organisational psychologist Carolyn Bogush from consultancy Talent Works. Once they have completed the programme, ‘the challenge is how are you going to take this back?’. Around 800 staff have participated so far. Local investment in leadership development varies hugely. Trusts who fail to find money for leadership development may soon find themselves under pressure from the Care Quality Commission. Its hospital inspection regime is built around the five “domains”, one of which is “well led”.
There are few black and minority ethnic NHS managers, particularly at the most senior levels. Sobieraj believes the lack of diversity goes some way to explain the perennial problem the NHS has with adopting new ideas: “There is a link between the need to value difference and the need to transform and innovate. We need a much broader range of, experiences, perspectives, backgrounds.” The academy is trying to make NHS management more diverse: 28% of the 2013 graduate scheme intake classified themselves as BME while 64% were women. Among its other programmes around 20-28% of trainees are BME. In coming years, NHS managers may find that the path to cultural change is eased by the drive to recruit staff with the right values. Health Education England, which was established in 2013 to oversee workforce training across the health system from nursing to dentistry, is encouraging employers to recruit staff who can demonstrate values such as listening to the patient and focusing on quality. Values are central to the Leadership Academy’s graduate management training scheme. Caitlin Marnell, general manager for children’s medicine at the Bristol Royal Hospital for Children, completed the scheme in 2012. She said it promoted ‘compassion, leadership, quality, sustainability – I think it was very much in line with the values of Francis’. ‘For example, there was a strong emphasis on the patient experience, walking through pathways and emphasising the value for managers in talking to patients.’ Marnell is now working on a project to give patients a greater voice: ‘The values have definitely stayed with me. The training has changed the way I deliver my job.’
Richard Vize is a freelance writer and former editor of the Health Service Journal. 17
Handling complaints has never been an NHS strength but, post-Francis, things are beginning to change, says Jenny Sims.
Francis who? After the scandal at Mid Staffordshire and the widespread publicity for Robert Francis QC’s public inquiry, it’s hard to believe that, a year on, any manager anywhere in the NHS could be unaware of the name.
Yet at the opening of the health select committee’s inquiry into NHS complaints handling in February, Labour MP Ann Clwyd said she had been shocked to discover some NHS managers hadn’t even heard of Francis. A second shock, for Clwyd at least, was that ‘NHS complaints managers don’t seem to talk to each other’. Clwyd says that good practice and concerns still aren’t being shared enough – contrary to the recommendations of Francis and many other inquiries. ‘There have been enough reports whose recommendations have been ignored, including the Royal Commission I served on in 1979. It’s time for action,’ Clwyd told the committee. Since the death of her husband, Owen Roberts, ‘like a battery hen’ in a caged hospital bed in December 2012, Clwyd has received thousands of letters, emails and calls from patients and their families complaining or expressing concerns about the NHS. She told committee chair Stephen Dorrell he 18
would know when things had improved ‘when the letters stop coming’. Last year, Clwyd and Professor Tricia Hart, chief executive of South Tees Hospitals Trust, lead a national review of NHS complaints handling for the Department of Health (known as the ‘Clywd-Hart review’). It called for a radical reform of complaints handling, but found many examples of good practice to share across the NHS. Leading from the top Leadership from senior management is crucial. Central Manchester University Hospitals NHS Trust assigns a senior executive as a ‘critical friend’ and independent patient advocate in complex cases. The advocate helps patients to navigate the system and find out whether mistakes were made. In May 2010, the trust set up a Complaints Review Group (CRG), modelled on a similar group at Sheffield Teaching Hospital. The Manchester CRG is always chaired by a non-executive director of the trust and other members of the group include an associate medical director, the director of nursing (adults), a public governor, and a complaints manager and a case officer fm the Patient Advisory and Liaison Service. Nursing director Cheryl Lenney told
“There have been enough reports...It’s time for action.” —Ann Clwyd MP Healthcare Manager: ‘All complaints are triaged and very serious and/or complex cases are escalated to the chief nurse or director of nursing (adults) who may decide a specific handling response. Feedback on the scheme is anecdotal at the moment but it has been very positive, regardless of the outcome of the complaint or concern.’ healthcare manager | issue 21 | spring 2014
The trust is reviewing its entire complaints system, looking at ways to develop a formal feedback mechanism and better ways to learn from complaints and integrate feedback into practice. Lenney admitted ‘there is no evidence as yet’ of a reduction in complaints. ‘But we are in the process of introducing a 24/7 PALS line to see if we can address more concerns in real time, in line with the Clwyd-Hart suggestions,’ she said. Listen and support St. Christopher’s Hospice in south London has concentrated on ‘sensible and easy-to-instigate practices’ that improve communications and help patients and relatives to complain or give feedback. Though the hospice has only 48 beds, it operates a 24/7 community service and on any one night can be responsible for 800 patients at home. Responding to criticism of their out-ofhours services, the hospice found that simply changing the wording in their patient leaflet, substituting ‘urgent problems that can’t wait until morning’ for ‘emergency’, cleared up a lot of misunderstandings and cut complaints. Penny Hansford, the hospice’s director of nursing, told Healthcare Manager the hospice prides itself on supporting staff. ‘Our staff are not afraid to tell us about their concerns,’ she said. By encouraging staff to speak up, senior managers can be prepared for most problems which arise, deal with them early, and mostly prevent them from escalating into complaints. Inspire confidence Patients and relatives need to have confidence that senior managers treat their opinions seriously. Birmingham Heartlands Hospital has a Patient Services desk in the foyer, and ‘tell us what you think’ posters and leaflets are prominently displayed. All complaints must be acknowledged within three days and answered within 25. ‘Good communication is absolutely essential to managing complaints sensihealthcare manager | issue 21 | spring 2014
tively,’ says Margaret Mitchell, deputy head of patient experience at Birmingham Heartlands. ‘Centralising the complaints process has certainly helped achieve this. We have also found that having one person who is independent of the service overseeing complaints has been well-received, as people feel there is someone who is truly impartial that is independently reviewing their concerns.’ Mitchell warned it would be very difficult to reduce the number of complaints, but it would be possible to introduce measures to help manage people’s expectations and create an open and honest culture. ‘Sometimes it’s a case of knowing how to sensitively tell someone, “I may not be able to give you the answer you want or are looking for”, but make them understand their complaint has been heard and is being addressed.’ Heartlands provides in-house training and holds regular team meetings to discuss processes and identify improvements. It also offers access to clinical psychologists to provide support and advice when dealing with sensitive complaints. ‘A good complaints manager should have knowledge of root cause analysis tools and strong project management skills,’ said Mitchell. ‘It’s also important to empower complaints managers to challenge the decisions that were taken or ask awkward questions without fear of reprisals,’ she says. Put things right ‘Every complaint is an opportunity to put things right,’ says Dame Julie Mellor, the Health Service Ombudsman. But her own organisation has ironically been criticised by patients groups who believe it investigates too few of the large number of complaints it receives. Mellor has produced a five-year plan and is promising to increase the number of cases she investigates. ‘We want to lead the way to make the complaints system better by driving forward openness, accountability and transparency in our public services. By investigating more complaints we can help more people and share learning
“We want to make the complaints system better by driving forward openness, accountability and transparency.” —Dame Julie Mellor from mistakes and failures to improve quality,’ she said. ‘The overall number of complaints we have been receiving has been rising as [we are] working to make it easier for people to find and use our service,’ Mellor claimed. ‘This has included raising awareness of our work for everyone, and helping people who find it hard to complain to contact us.’ But Ann Clwyd thinks simply increasing the number of complaints investigated isn’t the answer. She has asked the select committee to consider the case for regional ombudsmen. She has also suggested that the Independent Complaints Advocacy Service be given more scope and better branding, and could possibly be absorbed into HealthWatch at local level. The Health Committee will publish its report and recommendations in the summer. ‘I hope it will bring about real change, and not gather dust like so many reports in the past!’ said Clwyd.
Jenny Sims is a freelance writer and editor specialising in healthcare.
legaleye Richard Arthur updates you on what the government’s recent changes to the TUPE Regulations mean for healthcare managers. New regulations amending the Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE) came into force on 31 January. TUPE, which implemented the EU Acquired Rights Directive, is supposed to give safeguards to employees when a business or undertaking is transferred from one owner to another. However, government amendments have considerably weakened these vital workplace rights for hundreds of thousands of workers across the country.
In the NHS, where services are commonly outsourced to private sector providers or various types of non-public organisations, it is vital that healthcare managers understand how the amendments to TUPE affect them and their staff (see ‘North East Essex considers terminating contract with CSU’, Health Service Journal, January 2014). The main changes are: ■■ Allowing terms derived from collective agreements (those agreed between employers and trade unions or worker representatives) to be re-negotiated after just one year provided the overall package is no less favourable ■■
Removing entitlement to public sector collective terms negotiated in the future — especially future pay awards Allowing employers to count pretransfer collective redundancy consultation for the purpose of redundancies after the transfer Making it easier for employers to change terms and conditions, and dismiss employees in connection with
a transfer (especially where there is a change of workplace) Aside from changes affecting redundancies, the amended regulations will apply to all TUPE transfers from 31 January 2014. In short, the changes will make it much easier for employers to drive down working conditions and make staff redundant following a transfer. The changes have been lambasted by the TUC, which has warned that they will encourage workplace
disputes. The government originally intended to go even further in amending TUPE, but provisions to make it easier for employers to dismiss staff before a transfer even takes place, and another to restrict the circumstances in which a dismissal would be unfair, were defeated. Pensions are not covered by TUPE Regulations but an interesting related development is the Treasury’s recent approval of plans for workers transferred out of the NHS under TUPE to retain
their NHS pensions, even if they are subsequently transferred to another provider in the future (see ‘Private Sector wins access to NHS Pension’, Health Service Journal, December 2013). Moreover, non-members transferred out of the NHS will be able to join the scheme at a later date. The onus will be on the private employer to offer such staff the NHS pension. However, the advantages for employers of offering the NHS pension means most employees’ pensions will be protected in practice. This is a significant victory for healthcare professionals and offers some consolation in light of the amendments to TUPE. Previously, private sector organisations bidding for NHS contracts were only required to offer a ‘broadly comparable’ pension to that offered to NHS staff. Crucially, employers are still legally required to consult with employees in the event of a TUPE transfer and trade unions therefore continue to play a key role in engaging with employers and protecting the interests of their members. Unions can ensure that there is a written recognition agreement in place, strengthen contractual rights by ensuring that any negotiations on terms and conditions are settled and agreed before the transfer, and can make sure that collective agreements are incorporated into the employment contract.
Richard Arthur Head of Trade Union 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 21 | spring 2014
Just the job Some people find job interviews easier than others, but you can increase your chances with thorough preparation and a positive approach. Liz McCarten explains how.
DO YOUR RESEARCH
and always use ‘I’, not ‘we’, to make sure it’s clear that you did the work.
This is crucial. If you don’t have a thorough, recent understanding of the organisation you are approaching, this will show at the interview and you may appear uninterested and detached — hardly the mark of a great candidate. Read as much as you can about your potential employer, assessing any websites you use for bias or inaccuracy. Find out about the interview panel if you can, so you can tailor answers to their interests and areas of expertise.
7 BE HONEST This applies to the whole application process. If you over-claim, it’s quite possible you will be found out, especially if people in the new organisation are be familiar with your current role and may know your colleagues. Equally, don’t understate your involvement in projects or your qualifications and expertise.
8 DON’T ASSUME
2 WILL YOU FIT IN? Find out as much as you can about the organisation’s culture — there’s no point jumping from an uncomfortable role to an unbearable one. Ask around discreetly and if alarm bells start ringing, make sure you listen.
3 PREPARE THOROUGHLY If there are reasoning tests or presentations, practise them in advance so that you are familiar with the format. Look at the job description to make sure you cover all the major points during your interview.
4 BE YOURSELF An interview is a two-way process. It’s not something that is done to you. Ask questions if you don’t understand a question or there’s a subject which merits two way discussion — but don’t try to catch the interviewers out with tough questions.
5 BE CONFIDENT
It’s easy to feel an interview is an ordeal and the odds are stacked
healthcare manager | issue 21 | spring 2014
against you. While the selection process is obviously competitive, it is also an exchange of views between two parties. You have been invited to talk about your expertise and expectations and you have the chance to appraise the organisation and decide whether it matches your expectations. Remember that an interview is a business meeting – an opportunity for you to promote your unique blend of skills and experience to someone who has chosen to listen to you.
6 SELL YOURSELF That doesn’t mean rushing to say as much as possible. In fact, you should never speak for more than 90 seconds on each answer as the interviewers will stop listening after that! Use specific examples in your answers to questions
Just because you wrote something on an application form or referred to it indirectly, don’t assume that people will remember. They will have probably have had only a short time to look at CV or application form again before meeting you. If it’s important, make sure you make a specific and clear reference to it. Examples could include skills which you don’t use in your current job but which are important for the role you are applying for.
9 TURN UP! Check and re-check the details of your interview — the date, time and place. Leave lots of time, especially if you have to travel far. It’s best to arrive quite early, identify and check the building in question, then go for a coffee (but not three!) around the corner. Good luck! Liz McCarten provides advice to MiP members on personal development. Email her on l.mccarten@miphealth. org.uk
MIP AT WORK
Budget cuts hit terms and conditions in Wales MiP is consulting members in Wales about potential changes to their terms and conditions. MiP has been closely involved in partnership discussions with Unison and the other health unions, the Welsh government and NHS employers to address the current funding shortfall within NHS Wales. Health boards have been told that they must make 4-5% savings every year for the next three years to meet the financial challenges, and health minister Mark Drakeford has indicated that 1% of this must be met from staffing budgets. The proposals on the table include changes in sick pay, incremental progression and mileage rates. Proposals for very senior managers include a further pay freeze, a link between performance and pay and discussions about a job evaluation scheme.
The proposals mirror the changes already introduced for the NHS in England, apart from the change to mileage rates, although the Welsh proposals are limited to the next three years. The biggest saving would be achieved by reducing sickness absence levels. Wales currently has the highest sickness absence levels in the UK – 1% above the worst levels in England. A reduction of just 1% in sickness absence would achieve savings of £10 million over three years. The unions are now consulting their members about the proposals. The health minister has made it clear that if we cannot reach a national agreement on achieving savings, then ‘it will become difficult to resist calls to allow NHS organisations powers to develop local terms and conditions…’ In other words, there could be a move to local
bargaining. In seeking support for the proposals he has reiterated his commitment to protecting jobs in the NHS in Wales. MiP is using an online survey to consult members in Wales over the proposals. If you don’t receive an email with a link to the survey by 28 March, please contact MiP on info@miphealth.
Learning through good practice MiP is running a programme of events around the country to help managers develop their skills and resilience and to hear about their concerns. As part of our commitment to NHS Change Day, the MiP programme will include four half-day seminars exploring three themes from the Francis Report: the need for NHS organisations to be learning organisations; the need to develop effective patient and staff 22
engagement and the need for effective team working. Participants will also discuss ways to develop the personal resilience that managers need to deliver challenging work programmes. MiP has joined with Big Difference Company to host these seminars, which are free to attend and open to all health and care managers. They will be facilitated by MiP’s Jon Restell and consultant Linden Rowley. To register or receive more healthcare manager | issue 21 | spring 2014
MIP AT WORK
org.uk or ring 020 7121 5146. We will also be holding a meeting for members during the consultation period. Your responses will help us to make sure the managers’ viewpoint is taken into account in further discussions about the proposals. MiP national officer Andy Hardy (pictured) said: ‘These proposals will have a particular impact on managers, so I want to make sure your views are taken into account. Any changes that are agreed and the further efficiency savings at health board level will have to be implemented in partnership with the trade unions. ‘I want to make sure MiP members’ voices are heard in those discussions. I will continue to represent your interests in the national discussions and at the local board discussions.’ You can help us during these negotiations by becoming an MiP link member in your organisation. Our link members act as our eyes and ears and help to make sure that managers’ views are taken into account at local level. It would be great to have more link members in Wales. If you think you can help in any way, or if you would like more information about being a link member in Wales, please contact Andy Hardy on firstname.lastname@example.org.
Further information about the proposals is available on the MiP website: www.miphealth.org.uk.
information email Anna Peavitt at email@example.com Dates for the seminars are: Thurs 27 March: LEEDS Tues 29 April: EDINBURGH Wed 25 June: BRISTOL Wed 24 Sept: SOUTHAMPTON The rest of the programme is under development. Check your emails and the MiP website for details. If there is a topic you think we should cover, email us at firstname.lastname@example.org.
healthcare manager | issue 21 | spring 2014
Blasts from the past What should you do if an ex-employer contacts you about something that happened when you worked for them? MiP national officer George Shepherd offers some advice.
At MiP we are getting a steady stream of queries from members contacted by former employers about events that occurred while they worked for them. This could have been a few weeks or a few years ago. This can be very stressful, especially in the current climate. Having spoken to several members in this situation, I sought a legal opinion from our solicitors. Of course, every case is different, but we established some key principles from the legal advice we received. So what happens if you are questioned about your actions in a previous role? Depending on the terms of your employment contract, there may be no legal obligation to respond to a former employer’s questions. However, in some circumstances it may be in your best interests to cooperate with their inquiry in order to give your perspective on the issues. For example, if there has been criticism of the way that waiting times were recorded, then you may want to provide an account of your actions and views about the process. This
may also influence media reporting of the events. Furthermore, if the matter escalates and you are subsequently required to provide information to a regulatory body or the police, then it may be beneficial to have your account on record at an early stage. There are no hard and fast rules here, so do discuss it with your MiP national officer before you decide how to respond. If there is an official investigation into events that took place while you were working there — an inquiry by a regulatory body into service standards, for example — and the investigators contact you, you may be required to give evidence. Again, you should talk to your MiP national officer before you respond. We can obtain legal advice if necessary. If there is a criminal investigation, for example into fraud, you must cooperate with the police investigation. In these circumstances contact your MiP national officer for advice. Finally, what happens if your new employer hears about allegations against you in a previous role and tries to dismiss you on grounds of trust and confidence? Again, MiP is there to provide expert advice and representation, including legal representation if necessary. If you are changing employer, whether you are staying in the NHS or moving to the independent or voluntary sector, or if you become self-employed working in the healthcare sector, MiP can and will continue to represent you. So do make sure you keep up your MiP membership — just let us know where you have moved to.
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
Careful what you wish for
anks have become the latest high street operations to be offered up by ministers as models for the NHS, joining the likes of McDonald’s, EasyJet, Starbuck’s and Virgin. Impressed by the spread of online banking, health secretary Jeremy Hunt used his speech to the Health and Care Expo in March to extol how ‘the retail banks have actually cut a third of their costs by persuading us to do all the work that they used to do’. But isn’t the point of having a “model” that you try to emulate the best aspects, not the most annoying bits? Do we want to end up with RBS’s risk management, Virgin’s timekeeping, EasyJet’s standards of comfort, McDonald’s nutritional values and Starbucks’ sense of civic responsibility?
Facts and fibbers
KIP deputy leader Paul Nuttall showcased his expert knowledge of the NHS on BBC’s Question Time in January. ‘It’s stuffed with managers,’ he told viewers. ‘For every nurse, there’s two managers.’ Latest NHS statistics actually show nine nurses for every manager, but Mr Nuttall rarely troubles with the facts. He’s also claimed that the NHS is ‘the second largest employer in the world’, that 24
UKIP ATTACKS NHS MANAGERS
“There’s one right behind me, isn’t there?”
working mums ‘can hardly breast feed’, that ‘Brits fear all immigrants, regardless of where they would come from’, and even that he doesn’t want to succeed Nigel Farage as UKIP leader. Most fancifully of all, Nuttall claims to represent the people of the North West in the European Parliament, but has bunked off more than half the votes and a spectacular 54 out of 56 committee meetings.
ed faces at NHS England after a satirical video portraying NHS information chief Tim Kelsey as Hitler went viral. The YouTube clip, ‘Tim Kelsey discovers care. data is in trouble’ , placed a subtitled rant from “Mr Kelsey” about the care.data,
er, hiccup, over a scene from Downfall, the celebrated German movie about Hitler’s demise. Worse followed. Kelsey’s boss, NHS England chief David Nicholson, was among the first to retweet the link and rumours even circulated that the video was to be shown at the NHS England board meeting this month. Nicholson later apologised, saying, ‘Sorry, this is what happens when you give an old bloke with an over-developed sense of humour new tech.’ Kelsey took it all in surprisingly good heart. ‘I don’t think anyone in this debate is a fascist,’ he tweeted.
Ps have become the latest recruits to the government’s fight against terrorism. As part of
the multi-agency “Prevent” initiative, NHS England has told CCGs to appoint a “lead” to train staff to spot potential terrorists lurking on their practice lists. Sounds like a tricky assignment. Would-be suicide bombers are unlikely to be overly concerned about their health, and even less likely to share their plans with their doctor. And identifying the outward symptoms of “radicalisation” is getting harder all the time. Even MiP chief executives have beards these days.
No smoking blues
elticus has finally resolved to give up the weed. Having dutifully attended the “Stop Smoking Clinic” at our local health centre, I came away clutching a prescription for nicotine patches and spray. Straight to the nearest pharmacy, who refused to fulfil the prescription because – being written on what one used to call a photostat – the form was “the wrong colour”. Another branch of the same chain (its name rhymes with that of the Queen’s bank) declined to hand over any Nicorette because ‘this type of prescription is only valid at a Level 2 pharmacy’. Pharmacists often know more than one gives them credit for, but that didn’t extend to knowing what a Level 2 pharmacy is. Only to what it isn’t. It’s enough to drive one back to the fags.
healthcare manager | issue 21 | spring 2014
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Itâ€™s not just doctors who make it better.
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Magazine for Healthcare Managers in the UK. Exclusive interview with Andy Burnham, shadow secretary of Health.