cover1_hcm26 final front.pdf
issue 26 summer 2015
CELEBRATING MiPâ€™S FIRST TEN YEARS
plus STAFF ENGAGEMENT Line managers are the key TAKE CARE The new NHS pension scheme
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 26 summer 2015
healthcare manager inside heads up:2 Leading edge: Jon Restell inperson: Steve Harrison, Sheffield Teaching Hospitals NHS Foundation Trust inpublic: Guy’s and St Thomas’ NHS Foundation Trust, London
comment:9 Kim Hoque: Strong unions are good for employers as well as staff
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.
NHS funding: Meeting the productivity challenge MiP 10th birthday: Key players look back on a decade of standing up for managers Staff engagement: why line managers are crucial Pensions: How the new scheme affects you
regulars:20 Legal Eye: The low-down on settlement agreements Tipster: How to give a compelling talk MiP at Work: Ten years of MiP
Welcome to this special issue of healthcare manager, the magazine from Managers in Partnership, the trade union for health and care managers MiP was formed in June 2005 and this issue focuses on what we have achieved and the challenges ahead. We hear from some of our key stakeholders about MiP’s contribution and how they see our role developing in the future. We also look back on some of MiP’s achievements and how we have helped members. In this issue we have features on the key issues for MiP and our members in the years ahead. Daloni Carlisle reports on staff engagement and the critical role of line managers in making it work. Anita Charlesworth, from the Health Foundation, argues that the NHS has to deliver microeconomic changes to realise its productivity potential. And Dale Walmsley, from First Actuarial, explains the new career average NHS pension scheme and how it will affect members transferring in. We also have our regular features, including a legal update on settlement agreements. I hope you enjoy this issue. Do contact us if you have any news or views on these or any other issues. Marisa Howes, Executive editor
healthcare manager | issue 26 | summer 2015
heads up what you might have missed and what to look out for
MiP’s 10th anniversary conference Wednesday 18 November 2015, London
This will be a special conference for MiP – marking ten years of speaking up for health and care managers. It promises to be a lively event, with high profile speakers including politicians, policy makers and commentators from across the health economy, and will again be chaired by Channel Four News’s Victoria Macdonald. At the conference we’ll keep banging the drum for respect for NHS managers and their essential role in the healthcare team. We’ll be
issue 26 | summer 2015
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ISSN 1759-9784 published by MiP
Design and Production
All copy © 2015 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
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comparing the different models of service delivery in the UK and we’ll be getting underneath the rhetoric about productivity savings. What are they? Where can they be achieved? What is the role of trade unions? One thing we do know is that they won’t be achieved without skilled and dedicated managers making sure they are effective and don’t harm patient care. We’ll also debate the challenges facing health unions, and MiP in particular, as we face the threat of a
Iain Birrell, Daloni Carlisle, Anita Charlesworth, Kim Hoque, Marisa Howes, Helen Mooney, Alison Moore, Lis Paice, Jon Restell, Craig Ryan, Dale Walmsley.
healthcare manager | issue 26 | summer 2015
further squeeze on managers’ pay and conditions and changes in trade union legislation. And we’ll have our regular features – masterclasses, the network café and exhibition area, with some special features to mark our tenth anniversary. MiP members attend free of charge, and the conference is CPD certified, so book your place now. To register and for further details visit: www.mip-conference.org.uk
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leadingedge Jon Restell, chief executive, MiP
he last Parliament was dramatic for the NHS and its workforce, particularly – but by no means exclusively – in England. Think unprecedented flat funding, Francis, Lansley’s disastrous re-disorganisation, pay restraint and the first pay strike in decades, pension scheme reform and, in our end of the trench, one in six managers made unemployed. With all this going on, it’s an amazing achievement for the NHS to maintain its position with the British public and in world rankings of healthcare systems. The workforce, including those staff who are managers, deserve great credit. It’s been no mean feat, especially for line managers, whose approval ratings from staff have gone up. So after the storm, the calm? Not on your nelly. NHS providers in England are predicting a deficit of £822 million for 2014-15, with foundation trusts ending the year in deficit for the first time. NHS England is pressing ahead with its vanguard programme of new care models. The lid is being lifted on the Pandora’s Box that is DevoManc. “Productivity” has pushed aside “integration” as the policy buzzword of choice, as people try to get their heads round savings of
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“The bleeding away of management talent must stop. There is no way that one manager trying to do the job of four is anything other than dangerous for patients.” £22 billion, and arguably more as new gaps in social care funding appear. In Whitehall, the continuity of top personnel is welcome – as it should be everywhere in the NHS – but there is no sign yet that Jeremy Hunt will give or even seek any room for manoeuvre on pay. MiP’s campaigning will try to find solutions to these challenges by bringing the manager’s voice to the debate. Our urgent message is that there’s nothing doing without respect for NHS managers. From before the general election, MiP has been making the practical and political point that managers are essential for good patient care. So are other support staff. The bleeding away of management talent must stop – there is no way that one manager trying to do the job of four, or 25% vacancies at board level, is anything other than dangerous for patients. And managers’ skills will be needed if the NHS is
to deliver a cost improvement programme you can see from space. It’s time for politicians to change the weather around the workforce and management. Changing the weather means: ■■ treating managers as essential members of the healthcare team and ending the disproportionate rundown of support staff ■■ a serious discussion with unions about the relationship between sustainable care models (and productivity) and sustainable and fair pay systems for all our employees, including senior staff ■■ creating an NHS-wide workforce strategy that radiates real warmth in terms of reward, engagement and wellbeing – people want serious fun at work – and training and education ■■ co-production of the highest order on all big strategic decisions – not a sprinkling of partnership parsley on the same old dish ■■ tackling over-regulation and excessive targets to strike a new balance between freedom and challenge so people feel able to do a good job ■■ no further national re-disorganisation, no matter how desirable it may look on paper. Most of all it means fresh thinking and courageous behaviour. We’re ready, is everyone else?
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healthcare manager | issue 26 | summer 2015
Fit for Work scheme needs commitment from everyone
New skills programme for care staff
In January, the government launched Fit for Work, a new voluntary service for employees who have been off work for more than four weeks due to illness or injury. The government claims the scheme, to be run by US-owned firm Heath Management Limited, will help reduce sickness absence by helping workers to get back to work more quickly. It wants all employees who are off work for more than four weeks to be referred to the Fit For Work service by their GP. They will be assessed by an occupational health professional who, if the worker agrees, will look into the reasons why they have been unable to return to work. Employers can also refer workers to the service after four weeks of absence, but
only with the consent of the employee. Following assessment, usually by telephone, the Fit for Work service will draw up a return to work action plan to be agreed by the worker, employee and GP. “If it works, and it’s not seen as a way of forcing people back to work before they’re ready, it will be a good thing,’ said TUC health and safety policy officer Hugh Robertson. “The TUC’s concern is that employers may not know what to do with the advice they’re given and, also, that they may try to get people back before they’re ready.” “It could be a really good scheme but it needs commitment from everyone,” he added.
and trust in the doctors and nurses caring for them. Satisfaction with cleanliness continues to improve, with 69% of patients saying their room or ward was ‘very’ clean and a further 28% saying it was ‘fairly’ clean. The overall results showed little change from the last survey in 2013. Professor Edward Baker, deputy chief inspector of hospitals at the CQC said that while most patients were satisfied with their experiences in hospital despite the pressures facing the NHS, there was still room for improvement. “The survey demonstrates the significant variation between the best and worst performing trusts. The results match the findings from CQC’s inspections which highlight the variation between trusts, and even between services within trusts. “I strongly urge senior staff to review their results to see where improvements can be made as every patient deserves to receive the best possible care,” Prof Baker added.
Skills for Health has launched an e-learning programme to help care workers qualify for the new Care Certificate, which came into effect in April. Developed jointly by Skills for Health with Skills for Care and Health Education England, the Care Certificate aims to give care workers the introductory skills, knowledge and behaviours to provide compassionate, safe and high-quality care. The qualification was a key recommendation of the 2013 review of the non-regulated health and care workforce by Camilla Cavendish. The e-learning programme meets the educational requirements of the Care Certificate and includes 15 compulsory standards on such topics as “privacy and dignity”, “awareness of mental health and dementia”, “fluids and nutrition” and “equality and diversity”. Care staff must undergo practical assessments at work to qualify for the certificate. New staff will be expected to earn the certificate after around 12 weeks of employment, and existing staff can be credited with the certificate if employers judge that they have already achieved the required levels of experience and competency. The scheme will be extended to student nurses working in the NHS from 2016. “We wanted to make sure this wasn’t just a tick box exercise, it has to be about observed practice,” said Cavendish. “The timeframe for completion shows this is something serious – if you expected people to do it in a week then it wouldn’t be taken seriously.”
For the full results of the 2014 CQC survey, visit: bit.ly/ hcm2607.
For further details visit the Skills for Health website at: bit.ly/hcm2608
Further information is available from the TUC website at bit.ly/hcm2606.
Steady satisfaction with NHS hospitals The vast majority of hospital patients in England are satisfied with their care but many remain concerned about staffing levels and want more support when leaving hospital, according to the 2014 survey from the Care Quality Commission. The CQC’s 12th survey – based on replies from 59,000 in-patients at 154 hospital trusts in England – found that 84% rated their overall experience at seven out of ten or higher, while one in four rated it ten out of ten. Over three quarters (77%) of people said they were “always” well looked after during their hospital stay, but over 40% said they suffered delays on leaving hospital, with most delays caused by having to wait for medicines. Almost a fifth said they left hospital without enough advice about additional equipment or adaptation they needed at home. In a further sign of the staff shortages hitting the NHS, over 40% of patients said there were “sometimes, rarely or never” enough nurses on duty, although eight out of ten said they “always” had confidence
healthcare manager | issue 26 | summer 2015
Steve Harrison, head of quality improvement, Sheffield Teaching Hospitals NHS Foundation Trust “In the NHS there’s a lot of rhetoric about ‘We need to do things better for patients’, but in the past it’s often been a political or top-down movement. The people best placed to make the improvements are the front line staff, who understand how it works and how to make it better,” says Steve Harrison, head of quality improvement at Sheffield Teaching Hospitals NHS Foundation Trust. Steve has worked in the NHS for the last seven years having previously worked in the retail sector. The bulk of his current job involves running the Sheffield Microsystem Coaching Academy – a joint venture between the trust and the US-based Dartmouth Institute for Health Policy and Clinical Practice. The Academy is the first of its kind in the UK. Launched in 2012 with funding from the Health Foundation, it aims to coach clinical teams across Sheffield to bring about change from the bottom up. Steve explains that the Academy works to improve quality of care for patients in Sheffield by developing improvement coaches, who work with frontline teams to put quality improvement at the heart of everyday clinical care. Steve or one of his trained coaches has gone into over 80 different ‘microsystems’, including hospital wards and GP surgeries. Some of the results include reducing patient waiting times in the renal outpatients department at the Northern General Hospital and shortening the average length of inpatient stays for respiratory medicine patients. And the trust’s sexual health clinic has gone from having to turn away 45 patients a week to making sure everybody gets seen.
Steve won the Coach of the Year title at the 2014 NHS Leadership Recognition Awards, sponsored by MiP. He says: “Heading the coaching academy, I’m responsible for building quality improvement capacity within the trust so that staff and teams can become more efficient and effective at delivering patient care.” Steve says his previous retail experience, including manSteve Harrison receives the 2014 NHS Leadership award for coach of the aging store year from Ade Adepitan MBE and MiP chair Zoeta Manning. openings for clothing outlet Gap, has been useful in his work work with and help individual frontfor the NHS. “The way you improve line clinical teams to identify and things is by working with people make changes to their ways of workwho do the job to understand what ing in order to improve patient care. the changes need to be. As coaches, Since its inception the Academy we went where the energy was has also developed a course to help within the trust, where teams in falls NHS managers understand the and in cystic fibrosis were keen to role of coaches and how they can change the way they worked for the help and support the work of their benefit of patients. organisations. “There is a contrast between ownSteve’s advice to others thinking of ership and buy-in and it’s crucial setting up a similar programme is to that frontline staff take ownership of start small. “Go where the energy is, the system change they are investing where people want to make changes in,” he adds. and you will gain momentum from Every six months the Academy generating good news stories for enrols a group of staff from the trust patients.” on a six-month training programme to become coaches in system manHelen Mooney agement. The coaches learn how to
Phillip Tull Photography
“We went where the energy was within the trust, where teams were keen to change the way they worked for the benefit of patients.”
healthcare manager | issue 26 | summer 2015
Respect for Managers
Busting myths about NHS managers meet their needs. The five big myths debunked: ■■ NHS managers are unnecessary – only doctors and nurses are needed Oh dear! Does anyone really think that the 21st century’s technologically-driven healthcare, focussed on improving outcomes, quality and patient safety can be delivered without proper systems, appointments booking, record keeping and safety checks? These are just some of the vital jobs done by NHS managers. ■■ There are too many NHS managers Not if you look at the data. The mythbuster gives the facts to tackle this fallacy, including information from the King’s Fund report which concludes there is “a good deal of evidence that [the NHS] may be undermanaged”. ■■ NHS managers are faceless bureaucrats Out of date! Many board meetings are held in public and NHS managers, many with a clinical background, are often an integral part of multidisciplinary teams – so far from faceless to their colleagues.
The HSJ/MiP management mythbuster has proved popular with NHS managers throughout the UK. Written by Andy Cowper, it tackles head-on the five big myths about NHS managers — their role, numbers, visibility, accountability and pay — and gives you the facts to counter the fiction. The mythbuster was launched in March, to coincide with the official start of the election campaign, because we knew the NHS would be centre stage in the election debates and politicians would be quick to jump on the manager-bashing bandwagon. Politicians often acknowledge the importance of managers in private, but fail to stand by that view in public, helping to perpetuate myths about lazy, hazy managers. We decided to help politicians get it right by debunking these myths. We sent the mythbuster to all political parties and 6
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key policymakers and commentators, and used it to challenge statements by politicians and the press. Sadly, our mythbuster will still be needed for the foreseeable future. Negative political rhetoric damages morale and retention, and gets translated into policies that undermine good management. Look no further than endless, often pointless, restructuring exercises and pay freezes targeted at managers. We will be reminding everyone that managers are an essential part of the NHS team. Take away the manager and clinicians will find it difficult to get on with their job. Take away the manager and you will not be able to reconfigure services to meet growing demand and quality standards in the face of financial constraint. Take away the manager and patients will find it more difficult to navigate the complex health system and access services that
■■ NHS managers are unsackable, unaccountable and poor quality Oh, the hollow laughter in the senior management community at the idea that they are unsackable! Perceptions that managers are “unaccountable” don’t match the reality for many of constant criticism by politicians and the media. ■■ NHS managers are not worth the money they’re paid Perceived rises in very senior managers’ pay are a statistical misconception. Average salaries have changed because the NHS has got rid of a significant number of middle-tier managers. The HSJ/MiP management mythbuster is available on the MiP website at: www.miphealth.org.uk/home/ RespectForNHSManagers.aspx.
inpublic Guy’s and St Thomas’ NHS Foundation Trust, London Guy’s and St Thomas’ NHS Foundation Trust is part of the wider Kings Health partners, an academic science centre whose aim is to support innovation and research in improving healthcare. In recent years the trust has turned the spotlight firmly on to partnership working with its staff, with a keen focus on staff health and wellbeing. The trust works closely with union representatives, including MiP’s Jo Spear. Helen Gordon, the trust’s joint deputy director of workforce, says that, having worked in a number of different NHS organisations, the partnership working at the trust is the best she has experienced. “Dino Williams is the staff-side chair and branch secretary of Unison and has a place on the trust’s management executive, which oversees workforce issues, so that really gives staff-side a strong voice,” she explains. The trust has a number of different strands of work that contribute to forming a real partnership with staff. These include its Passport to Management programme, developed to support line managers. This is part of a working partnership between the workforce directorate and the staff side aimed at improving sickness absence rates. The trust is also about to launch its Showing We Care About You programme, which concentrates on improving the non-pay benefits the trust can offer to staff, including providing help and counselling on financial well-being through the London Credit Union. Gordon says that she is also “very proud” of the trust’s work on the Five Ways to a Healthier You programme, which shows that keeping staff happy at work is a very important factor in improving patients’ experience of care.
The programme includes helping staff to achieve better physical and mental health through interventions such as smoking cessation programmes, cognitive behavioural therapy and on-site gyms. The trust has also recently turned its attention to the role many of its staff play as carers at home, and the additional support they need. “There is a huge unmet need in the support we provide for staff as carers, such as flexible working, and this ties in with the work the trust has been doing on dementia and care for older people in general,” explains Gordon. Dame Eileen Sills, the trust’s chief nurse and director of patient experience explains that the impact of Barbara’s Story – the organisation’s now famous dementia training film – also helped to highlight the role of many staff as carers. “We wanted to raise the level of awareness about older people, vulnerable adults and dementia, and through Barbara’s Story, which was seen by our 13,500 strong staff, we got the key messages across,” explains Sills. “We created a raised level of awareness amongst the workforce… and in a way we gave them permission to talk about kindness.” Gordon says that “Barbara’s Story” helped the trust to “unlock issues for staff as carers for people with dementia and offer them practical support”.
“We created a raised level of awareness amongst the workforce… and gave them permission to talk about kindness.”
She adds: “A lot of it is about advocacy and helping them to develop creative solutions to juggle their jobs with their caring responsibilities.” In March the trust also opened the Older Person Frailty Unit as a pilot, with a multi-disciplinary team led by physicians specialising in elderly care, who assess older people as early as possible upon attending accident and emergency. The express aim of the unit is to give older people “the right care, in the right place, first time” and to maximise patients’ independence. Gordon sums up how she sees the trust’s relationship with its staff: “I think that through much of the work we do and the relationships we have built with staff we can really start to make a difference across the piece which will make a difference to patients because our staff are role models.” Helen Mooney healthcare manager | issue 26 | summer 2015
Helen Russell goes on Tour
to the editor
Letters on any subject are welcome. Please send to firstname.lastname@example.org or to 8 Leake Street, London SE1 7NN. We may edit letters for length. Name and address must be supplied, but you may ask for them not to be published.
Thanks to Helen Russell for her great work at MiP covering Pete Lowe’s absence during the election. Pete has now taken up the MiP Midlands reins again – and Helen is gearing up for her next challenge. She is one of only two women chosen to join former England and Crystal Palace footballer, and cancer survivor, Geoff
Thomas to ride the entire route of this year’s Tour de France in aid of Cure Leukaemia. A small team will cycle the route one day before the pros, aiming to raise over £1m. From 3-25 July Helen will cycle over 3,300km, including seven mountain stages and cobbled roads, covering an average of 100 miles a day for three weeks – no mean feat!
All money raised will go towards the life-saving work carried out at the Centre for Clinical Haematology (CCH) at the Queen Elizabeth Hospital, Birmingham (QEHB), where Geoff was treated by Cure Leukaemia founder Professor Charlie Craddock. If you’d like to donate, visit Helen’s Just Giving page at www.justgiving. com/HelenRussell-LeTour.
MiP national committee elections for 2016-17
Championing health and care managers MiP will be holding elections in the autumn for its new national committee to take office from 1 January 2016. These are interesting times for health and care managers and MiP. As a member of MiP’s national committee you can play a key role in shaping our policy to ensure it reflects our members’ needs and aspirations relating to service delivery, management skills and workplace relations. You will also be involved in shaping our recruitment and organising strategy and will be the main link between members in your region and the union nationally. The rules for the election, together with the terms of reference of the national committee will be posted in the Get Involved section of our website (miphealth.org.uk). Details of the nomination process will be sent by email to members. New committee members will be elected for a two-year term to represent geographical constituencies as shown. 8
healthcare manager | issue 26 | summer 2015
Each old NHS region in England except London (East of England, East Midlands, North East, North West, South Central, South East Coast, South West, West Midlands, Yorks & Humber)
Timetable for elections to MiP national committee for 2016-17 Nominations open Nominations close Elections open Elections close Results announced New committee takes office
28 August 28 September 12 October 9 November 18 November 1 January 2016
Contact your national officer (listed on our website) for further information or telephone Marisa Howes on 020 7121 5167.
NHS 24 staff do an outstanding job I am writing about your recent report on NHS 24 (Healthcare Manager 25, Spring 2015), which we believe was misleading about our performance. NHS 24 is Scotland’s national telehealth and telecare service and we provide a first point of contact for the population of Scotland during the out-of-hours period when GP surgeries are closed. We have been providing this service successfully in Scotland for more than ten years and have taken more than 17 million calls from patients in that time. In April 2014, NHS 24 changed its telephone number to the free-to-call, easyto-remember number 111. We had planned for an initial increase in call volumes, which after the first few months, we expected to level out. The move to the new number has been very successful and we have in fact seen a sustained increase in calls from members of the public seeking help and advice during evenings and weekends. On average, we now handle 20% more calls than we did previously and we have increased our staff numbers in order to manage this demand. Our highly skilled and dedicated staff work extremely hard and our patient satisfaction rates are very high (92% overall). We experienced high volumes of calls during both the busy festive and Easter holiday weekends and our service coped very well with this demand. NHS 24 staff continue to do an outstanding job in delivering support to patients in Scotland. John Turner Chief Executive, NHS 24
comment Kim Hoque,
Professor of human resource management, Warwick Business School
A strong union voice is good for employers and staff In the wake of the Conservative’s general election victory, trade unions are likely to face some difficult years ahead. The most obvious manifestation of this is the proposed toughening of the UK’s already tough strike laws.
These proposals mean that ballots in favour of industrial action will only be valid if at least 50% of those eligible to vote take part. Additionally, in the essential services (health, fire, education and transport) 40% of all those eligible to vote will have to vote in favour. Estimates suggest that nearly three quarters of the strike ballots held since 2010 would not meet these thresholds. Francis O’Grady, the TUC’s general secretary, has said this will leave unions with no more power than Oliver Twist when he asked for more. However, what appears to have been lost in recent debates is a consideration of the positive influence unions can have both for employees and employers. Academic research has demonstrated that unions bring benefits in terms of improving workplace health and safety, reducing gender and ethnicity wage gaps, improving equality and family friendly practices, and raising training levels, for example. A key route by which unions engender such benefits is via what is termed “collective voice/institutional response” effects, whereby unions raise their members’ collective concerns with managers, who then respond by mak
“Unions can improve workplace health and safety, reduce gender and ethnicity wage gaps, improve family friendly practices, and raise training levels.” ing changes to workplace practice. This, of course, requires unions to have a degree of bargaining power, otherwise there is no reason why managers should either listen or respond to them. If this bargaining power is reduced via tougher strike laws, the ability of unions to engender these benefits will be severely diminished. Added to this have been recent attacks on reps’ rights to time off for union duties — for example, cuts to union facility time in government departments and Eric Pickles’s warning to councils to reduce paid time off. While this has been cast as a straightforward cost to the taxpayer, it must be remembered that unions will only have positive collective voice effects if their reps have the time to listen to their members’ concerns and bring them to the attention of managers. This is demonstrated in new research I recently conducted with John Earls of the Unite trade union, Nick Bacon of Cass Business School and Neil Conway of Royal Holloway, pub-
lished in the journal Economic and Industrial Democracy. Based on responses from 3,087 Unite finance section members employed across 174 companies, we found that perceptions of job content, work-life balance and job-related stress are more favourable where an on-site union rep is present. Importantly, this difference is explained almost entirely by the greater sense of collective voice that on-site union reps engender. This benefits employers as well as employees – prior research having established that higher job quality reduces quit rates and absenteeism – and by raising job satisfaction it can boost productivity. However, if union reps’ ability to voice collective concerns is curtailed, their ability to influence these outcomes positively disappears. In short, we need to move beyond the dogmatic and ideological view that unions represent a cost to the taxpayer and a drag on economic efficiency and take into account the wealth of evidence highlighting the positive social and economic effects that unions and on-site union reps can (and do) have. Only then will we see sensible, informed debate over how the activities of trade unions should be regulated in the future.
For further information on the research visit: bit.ly/hcm2605. Views expressed are those of the author and not necessarily those of healthcare manager or MiP. healthcare manager | issue 26 | summer 2015
Anita Charlesworth says the future of the NHS depends on delivering microeconomic changes not just funding increases.
Simons Stevens, the head of the NHS in England, recently argued that that “there are viable options for sustaining and improving the NHS over the next five years.” Public attitude research suggests that the overwhelming majority of the public certainly hope that he is correct. Almost nine out of ten adults in Great Britain support the principle of a tax-funded NHS — free at the point of use and based on need not ability to pay (see, for example, the Health Foundation’s 2015 report Public Attitudes to the NHS). But sustaining that service comes at a price. The funding shortfall facing the NHS in England is estimated to be around £30bn in real terms by the end of this decade. Some might argue that the combination of problems with services (last winter’s A&E difficulties, for example), ever increasing funding pressures and a fiscal deficit which is still around 5% of GDP – point to a model which has reached its sell-by date, and that the NHS cannot be considered sustainable. The reason Simon Stevens and others conclude differently lies in the potential for productivity improvement. The rate of future productivity growth across the NHS will be a crucial factor in determining whether the NHS 10
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“NHS funding depends on how we choose to spend our growing wealth and how far citizens value the output of health spending compared with that of other services.” is economically sustainable. Productivity growth will also almost certainly shape the political sustainability of the service. NHS England has estimated the additional funding requirement above inflation under three scenarios for productivity. It argues that by implementing the ambitious programme of service redesign set out in its Five Year Forward View, the NHS could deliver productivity improvements in the range of 2-3% a year, and thereby reduce the additional real-terms funding requirement from £30bn to £8bn in 2020-21. Although the NHS in England delivered productivity improvements of just over 2% a year for the first two years of the previous parliament, maintaining productivity growth at this rate to 202021 would represent an unprecedented level of health service productivity improvement for such a long period.
There is evidence that the NHS has some scope for catch-up productivity savings and input cost savings (for example with the price deal negotiated for prescription medicines), however there is no evidence that productivity at this rate could be sustained in the medium term. Health care provision is relatively labour intensive and it is therefore likely that productivity growth will be slower in this sector than in the economy as a whole. Over the medium term, wages in the health sector would still need to rise in line with those in the whole economy. This would lead to what is known as “Baumol’s cost disease” where the cost of health services rise relative to other sectors of the economy that are less labour intensive. Continuing to improve the productivity of the health service is also important for our overall economic performance. In 2012, the UK devoted 9.3% of GDP to health, matching the OECD average but below many of the UK’s European partners. While economic growth is necessary for additional health spending, it is almost certainly not sufficient. Clearly it also depends on how we as a society choose to spend our growing wealth, and decisions about this depend not just on productivity but also social welfare – how far citizens value the output
Luke MacGregor/PA Wire
Up to the challenge? Jeremy Hunt, Carron Weeks, divisional head of nursing at Homerton University NHS Foundation Trust, Simon Stevens and George Osborne.
of health spending compared with that of other services. In the medium to long-term health service productivity is likely to be closer to its longer-term trend of between 1% and 1.5% a year. In this case, government expenditure on health would have to increase more rapidly than GDP growth. From an economic point of view there is no inherent maximum level of spending on health. While this is not necessarily a macroeconomic problem, it is most certainly a fiscal problem. Health spending in the UK is comparatively modest by international standards, but the share of spending which is funded by taxation is comparatively high. In 2012 publicly funded health spending accounted for 84% of UK health spending compared to 72.3% across the OECD. However, in a tax funded system, pressures on health spending have clear implications for the fiscal stance. Health care now accounts for almost one pound in every five pounds of government spending. Just sustaining,
let alone improving, the quality of care while delivering fiscal balance is one of the major challenges facing the government. This may lead some to conclude that the problem with the UK is not the total amount spent on health but rather the heavy reliance on public health funding. In its paper Health Care Systems: Efficiency and Institutions (2010), the OECD examined the performance of different health systems. It concluded that “no broad type of health care system performs systematically better than another in improving the population health status in a cost-effective manner”. Moreover, they conclude that “big-bang reforms” to health care systems are not warranted. Rather they advocate that countries should look to increase the coherence of their health policy by adopting best policy practices within a similar system and borrowing the most appropriate elements from other systems. The big challenge for the NHS over the coming years is how to maximise
its productivity improvement. NHS England has mapped out new models of care delivery which aim to deliver this but, as governments have found for the last 30 years or so, the right policy mix to unlock the productivity potential of the NHS has proved somewhat elusive. We have had a range of initiatives targeted at incentives, sanctions and support for the NHS. Some have been evaluated, often with mixed results, but others have not. What is clear is that there is no single silver bullet to improve productivity, and that successful policy will involve the skilful deployment of a range of tools. The macroeconomic challenge presented by rising health funding pressures is easy to overstate – but the microeconomic challenge of designing and delivering a system which continues to improve and delivers maximum health gain for taxpayer spend is much, much greater.
Anita Charlesworth is chief economist at the Health Foundation. healthcare manager | issue 26 | summer 2015
MIP: THE FIRST TEN YEARS
To mark MiP’s tenth birthday this summer, key players in health and social care talk to Alison Moore about their experience of working with the union and its contribution to the NHS.
CHRISTINA McANEA Head of health, Unison I think MiP is now well established with a good reputation for the support it offers members. It’s seen as the voice of managers in the NHS and a place they can get support. It has done a great job in tackling some of the myths around managers and demolishing them. Many of the issues managers face are familiar to other people across the NHS but many managers have felt that other unions would not give them the level of dedicated support they needed. Often managers are left to take the blame for what’s happened. Yet managers have to deal with multiple challenges around workforce, safety, quality and finances. Now, more than ever, managers and senior managers need a union that will stand up for them. The rhetoric we’ve heard from the Tories around bureaucracy and having too many managers does not make managerial jobs in the NHS sound very attractive. I hope MiP can change that. 12
healthcare manager | issue 26 | summer 2015
ROB WEBSTER Chief executive, NHS Confederation The NHS is made up of people – everything we do should be about how we provide our teams with all they need to deliver great care. Over the next few years we have to lead 1.4m people in the NHS to deliver a different and better service. This will take leadership in the local system as well as in each of our organisations.
We need to try to harness the energy of everyone in the NHS and we have to provide leadership at all levels. We need to have the right conversations and partnerships – and that includes between employers and staff side. I think strong relationships are at the heart of everything we do. That’s where MiP comes in, playing a leadership role in that environment so that we can have those great conversations about where we are going and share intelligence about where we are. The NHS Confederation takes a constructive approach – we are tough on the issues rather than being tough on the people we work with. And we focus on how to tackle the
MIP: THE FIRST TEN YEARS
issues to get to a better place. I think that is where MiP is coming from as well. Their support for NHS managers is really welcome and the work they are doing on respect for managers and mythbusting is essential. ZOETA MANNING MiP chair We were created because there was a recognition that senior managers needed specialist support rather than a general union. We’re filling a gap but we’re still evolving. But that is in the context of the NHS changing as well – it used to be a job for life but it’s not now. Managers are quite often used as a political pawn. We don’t get recognition for what we do. There’s a tendency in the press to sensationalise and talk about extremes of pay, for example. The NHS would not be here without good managers and, compared with many other systems, it’s very lean on the management side. Yet the Government continues to abuse us and does not give us any recognition for providing a great service. MiP has argued for managers’ contributions to be recognised. MiP has a role in supporting individual members as well. Managers need to be held to account like everyone else and, like everyone, they don’t get it right all of the time. But it’s important to have someone to represent you and to put it into context. We have good relations with our HR colleagues and can put things to them for our members such as challenging them on procedures being followed. Our network of link members is crucial. At the national level, we are the voice for managers. We work with a lot of other organisations to improve training and opportunities for them. We have been very active around the NHS Race Equality Standard and we
“MiP has been instrumental in advocating and legitimising our work. As an organisation, it’s very open to ideas. The benefits of working with MiP have been enormous.” – Geoff Rowe want it to be not just a standard but to have sanctions behind it. Things have changed over the last few years and will continue to change. Our members are now in local authorities, the third sector and the private sector and we need to follow them to ensure they have a voice. We know that resources are really tight and we need to work better together. That will benefit patient care and outcomes. ANDRINA HUNTER Service manager for health improvement and inequalities, NHS Greater Glasgow and Clyde and Inverclyde Council, and MiP committee member I started life as a dietician and was heavily involved in the British Dietetic Association. As I went through my career and moved into wider public health, I was looking for a union which could represent me in my new role. A colleague who was involved in MiP suggested I joined. It offered me support as a manager rather than in my clinical role. I stood for national committee last year and I’m one of two Scottish members on the committee. England has seen so many changes recently that quite rightly what is going on there has taken up a lot of the national committee’s time.
But moving forward, Scotland will need to have a much stronger voice and it’s time to develop that. With the whole integration agenda, MiP will have to think about whether managers working outside the health service can join. How does MiP continue to support managers across diverse services as a whole range of different structures come in? There are challenges but also opportunities in terms of recruiting members. GEOFF ROWE Chief executive, Big Difference Company We first met MiP through some work we had been doing for Unison. We talked about possible collaborations – we work in areas around communicating health messages in a creative way, working with performers and comedians to deliver messages and engage people. Since that initial contact, we have done numerous things with MiP. I think they like us because what we do is innovative and risky and a different way of communicating. I think the traditional model of a trade union is marches and rallies with placards and shouting. That can work and is part of the mix, but so is engaging in a different way. We’re just coming to the end of a UK-wide series of seminars, which MiP has sponsored, where we work with managers to give them a toolkit to engage patients. I don’t think it’s too much of an exaggeration to say people are fearful of being involved in risk taking. MiP’s role has been instrumental in terms of advocating and legitimising the work our organisation does but also the type of work we do. As an organisation, it’s very open to ideas. The benefits of working with MiP have been enormous for us as an entry into the world of health. It showcases our work. MiP also sponsors our “Doctor, Doctor” healthcare manager | issue 26 | summer 2015
MIP: THE FIRST TEN YEARS
programme which works with patients. ISAAC JOHN Chair, health and social care black and minority ethnic network I think the main MiP contribution has been supporting the network. It has sponsored our recent EMBRACE awards and has been involved with events since we started working with them. At their annual meeting they have provided us with a free stand to make contact with members and give information away. MiP is a way to bring people together. The position with senior BME staff is still very poor. As a network chair, I don’t know anyone from a BME background who is a chief executive of a trust at the moment – there were one or two in PCTs, but they have gone. In our view, the important actions are for NHS organisations to adopt and embed our 3 EMBRACE Pledges – to increase BME appointments at senior level; improve the quality of BME staff experience in their workplaces; and implement good practice and celebrate diversity. DAVE PENMAN General Secretary, FDA The success of MiP demonstrates how unions can collaborate and work together without that requiring a formal union. It’s an alternative way of working together which does not threaten the identity of individual unions. MiP is both a voice for senior managers and offers high quality support around employment issues. It absolutely delivers for managers. In many ways trade unions are 14
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defined by difficult times not by good times. It’s how they react when their members are facing difficulties which is important. The last ten years have been a challenge for MiP but the next ten will be even more challenging! We constantly have to evolve and make sure that, as the challenges change for members, how we support them reflects that. MiP is very good at that – it’s very in touch with its members. It has found its niche. I think Jon [Restell] has been very vocal around the staff case under very difficult circumstances. Members need to have their voice heard in what can be a very crowded marketplace. MiP has gone from being invisible to being part of the infrastructure. MiP is also part of the FDA family. With four people from MiP sitting on our executive committee, MiP and its members are contributing to the broader FDA debate. ANDREA SUTCLIFFE Chief Inspector, adult social care, Care Quality Commission What’s really important for MiP – and Jon Restell has been a fantastic advocate – is raising the profile of the importance of management. It’s an area which tends to be denigrated and under-valued in the public sector and I think MiP have led the charge in challenging these mis-conceptions. The importance of management and leadership is something that we have recognised at CQC in the five key questions that we ask all services – one of which is ‘is the service well led?’ What’s important is that an organisation with a reasonable tone of voice and evidence base is able to articulate the positive contribution that managers can make. It’s important for MiP to celebrate the success that good leadership and good managers can have. I do think there’s a challenge for
MiP in how it copes with tackling poor managers. None of us benefit from tolerating poor behaviour and discrimination. The other challenge is supporting managers in the health service to operate effectively in a new and different world. I think that world is one of integrated systems, the need for improving interpersonal relationships and partnership working. There will need to be less focus on defending your own institution. Managers sometimes think they have cracked integration if they are talking to the local authority but they need better communication with social care providers and to think how they truly work with and respond to the concerns of people who are using these services. A lot of work has been done on this and I think MiP could have a role here. DANNY MORTIMER Chief executive, NHS Employers As an HR director, I found MiP a really good organisation to work with. I saw the support they were providing to members and it was always of a very high quality and members valued this. I’ve never quite understood the idea that if a colleague is in a senior role they don’t benefit from this sort of representation and collective voice. Partnership working is a vital part of the NHS. MiP are a strong voice in the discussions and we very much respect Jon [Restell] and his team. For the individual members of MiP, the Five Year Forward View will bring opportunities but also change. I already see MiP and other trade unions committed to a proper engagement on this. The people that MiP represent are important and central to the service. They are at the sharp end in terms of pressure on the system. There is a lot more we all need to do to support middle managers as well.
Staff engagement is now a big ticket item for NHS organisations, but too many are still just going through the motions, says Daloni Carlisle.
Have you looked at the NHS staff survey results for your employer lately? Did you know that organisations scoring highly for staff engagement tend to have lower levels of patient mortality, use their resources better and deliver stronger financial performances? Or that engaged staff are more likely to have the emotional resources to show empathy and compassion, despite the pressures they work under? Or that this, in turn, leads to higher patient satisfaction and more patients reporting that they were treated with dignity and respect? If all of this is old hat and you have been encouraged to look at your organisation’s staff survey results, the chances are that staff engagement is on the agenda where you work. If not, perhaps you should start asking questions. Staff engagement is now a big ticket item for all NHS organisations. The CQC now includes it in inspections. The King’s Fund, NHS Employers and the
Social Partnership Forum all have work programmes promoting staff engagement (see resources box on p17). Yet staff engagement scores appear to be slipping. Last year’s NHS Staff Survey showed the first drop for many
years – from 3.71 to 3.70. As Steven Weeks, Head of Staff Engagement for NHS Employers, says: “This was the first year it has slipped back. It shows that staff engagement needs to improve.” MiP chief executive Jon Restell is
more robust. “Yes staff engagement has been accepted as a strategic issue but it still does not have the primacy in strategic thinking and it’s not centre stage. I’m not sure how much practical implementation there is and that’s a worry.” Perhaps this is because staff engagement has been tried and found to be hard. So recently attention has begun to turn in a new direction: line managers. Weeks explains: “The focus for staff engagement to date has principally been on HR professionals and it has been viewed as an HR issue. Now we are seeing more evidence of support for line managers, particularly first level supervisors, helping them to incorporate a more engaging approach as part of their role.” This makes sense, says Weeks, when you consider that around one third of NHS staff have some kind of supervisory role and are therefore effectively leading teams. Dilys Robinson, who leads on employee engagement at the Institute healthcare manager | issue 26 | summer 2015
Case study: Ipswich & East Suffolk and West Suffolk CCGs Back in the old PCT days, Ipswich and East Suffolk had some serious issues with poor staff engagement. Now, says MiP national officer George Shepherd, it is “head and shoulders above anywhere else – a real standard setter”. It’s a transformation wrought by partnership working. There is a monthly a “great ideas” group that has led to some real improvements for staff such as quiet zones at lunchtime and “lunch and learn” sessions as well as improvements in IT and telephony. A health and wellbeing group has introduced yoga, pilates and monthly free fruit. All new staff meet the chief executive. Staff are encouraged to do good works, giving time and donations to charities. And it works, as measured by above average NHS staff survey results and low sickness absence among the 220 employees. Amanda Lyes is the chief corporate services officer for the combined Ipswich & East Suffolk CCG and West Suffolk CCG and is the driving force behind much of the staff engagement activity. Partnership with the staff side is key to success, says Lyes. “We meet every other month and we have an open dialogue. Real issues are put on the table and we may disagree but we always reach a conclusion.” The staff side get the heads up on any issues that might affect members, such as reorganisations, even if these never come to fruition, she adds. “The meetings are very open, inclusive and transparent. They’re well attended because the staff side reps feel it is worth their while coming – and these are busy people with busy working lives.”
for Employment Studies, explains where line managers fit in. “They are incredibly important for all sorts of reasons,” she says. “They are responsible for implementing the policies that the trust leadership wants to happen. They have to motivate their teams, explain the rationale and performance manage their teams to make things happen. I 16
healthcare manager | issue 26 | summer 2015
RCN regional officer Mike Kavanagh, Amanda Lyes and MiP National Officer George Shepherd signing the partnership agreement between the trade unions and the combined CCG in 2012.
Shepherd agrees. “This is proper engagement using principled negotiation,” he says. “It works for both sides. They tell us what’s coming up and we would never go off and bad-mouth the CCG without giving them an opportunity to deal with an issue.” It is not easy to achieve this level of partnership, he adds. “It requires patience, trust, understanding, skill and yes, giving way sometimes. There are people who say that giving way is weakness and who do not want to be seen as partners with employers. I would say that is short sighted. In a partnership, you are in a much stronger position to engage when there is a formal consultation.” For more case studies, visit the Social Partnership Forum website: www.socialpartnershipforum.org/1111
do think that sometimes that link is not fully understood by trusts.” Equally, line managers can feed information back up the line – whether that’s ideas from their teams or concerns. “It’s an incredibly important role that is not recognised in many organisations, not just the NHS,” she says. Recently, NHS Employers
commissioned the Institute for Employment Studies to work with line managers in seven NHS trusts with poor engagement scores on the NHS staff survey. Over the course of two days in each location, more than 90 line managers were introduced to the theory and practice of staff engagement. While the course itself was very much
about accentuating the positive, some worrying negatives did emerge. In several trusts line managers had never seen their organisation’s staff survey results. “In one place they were absolutely appalled by them. They had no idea that they [the scores] were that bad,” she says. While the line managers themselves loved their jobs and loved the NHS, they often felt completely uninvolved by their organisation. They felt they were not consulted, their ideas were not sought or valued, they had no influence over decisions, and were left playing catch up with policy changes that were not explained before they were changed. Again. Weeks adds: “We’re not criticising line managers. Organisations need to look at how they can support their line managers to manage in a more engaging way and give them the time and space to do that.” The IES report will be out soon and Robinson says it will have a very simple message. “My message to line managers is that you are really, really, really important. My message to senior managers is that line managers are really, really, really important.” Restell agrees: “Dame Carol Black [the Department of Health’s workplace health tsar] was recently asked what single investment she would make to improve the NHS. She said she would invest in line management development.” But Restell sees precious little of this in practice. Training budgets are falling, he says, there are growing staff shortages and the ability of employers to give time out to line managers to engage with staff is limited. The irony is that giving line managers that time and capability could be the solution to employers’ problems. “If no one addresses this, it starts to build up some really big operational problems,” Restell says. He argues that the case for proper staff engagement is even more pressing at a time of service change. “What I see from the devolution in Manchester to the changes stemming from the Five year Forward
“Staff engagement needs to be part of structural change or it will fall flat on its face. It is not difficult to involve staff in strategy and it works, but it requires a complete change of mindset.” View or local employers redesigning services is that it is being dealt with structurally,” he says. “Staff are seen to be an obstacle or a barrier. “But staff engagement needs to be part of this broader piece or it will fall flat on its face. It is not difficult to involve staff in strategy and it works, but it requires a complete change of mindset as well as time and space to do it.” For its part, MiP, as part of the Social Partnership Forum, is promoting partnership working with employers (see case study). MiP is also providing a new style of training programme for union reps, delivered by freelance trainer Simon Snashall. “It’s a two day course in principled negotiation,” he says. “It’s not about positional bargaining but finding solutions, win-win situations.” He works not just with union reps but also with a wide range of NHS managers from chief executives down. These are the negotiating skills needed for partnership working as well as staff engagement, he adds. “People go back into their workplaces and look at engagement with their members of staff in a different and principled way, not results based but relationships based.” This emphasis on line managers cannot be the whole solution to staff engagement, as Professor Michael West, senior fellow at the King’s Fund and the CQC’s adviser on staff engagement points out. “There is something worrying about the nature of the discourse being had about engagement,” he says. “If it is reduced to consulting staff on policies or their opinions
Staff engagement resources
Promoting partnership working in the NHS, Social Partnership Forum: www.socialpartnershipforum.org/1111 What is staff engagement and why is it so important?, King’s Fund: bit.ly/hcm2601 NHS Employers Staff Engagement resources, including information on CQC inspections: bit.ly/hcm2602 Review of Staff Engagement and Empowerment in the NHS, King’s Fund: bit.ly/hcm2603 Line managers: the missing link in staff engagement, NHS Employers: bit.ly/hcm2604 Engage for Success: www.engageforsuccess.org
on things that affect their jobs, then it misses the point.” For West, there is a much wider point about leadership. “This is about the extent to which people feel the organisation is fair, that it does not discriminate, that their voices are heard, that the leaders adopt a leadership approach and have a compelling vision, that compassionate caring is lived and not just parroted, that people feel they are being enabled to make changes to the way work is delivered.” That’s all measured by the staff survey. What’s worrying West – and others – is how little attention so many organisations pay to what the numbers tell them.
Daloni Carlisle is a freelance writer specialising in health and social care.
healthcare manager | issue 26 | summer 2015
The new NHS pension scheme opened for business in April. Dale Walmsley explains how it could affect you.
On 1 April 2015, a new NHS Pension Scheme opened up in England and Wales. The same changes apply to the separate schemes in Scotland and Northern Ireland. But what has changed? And who is affected? Here we discuss the introduction of the new scheme and its implications for pension scheme members. For simplicity, we have referred to pensionable pay as “pay” throughout – although pensionable pay does not include bonuses, expenses or overtime pay. Change in structure The old scheme is known as a “final salary” scheme. This means that all benefits earned are based on a member’s final pay at retirement (or leaving NHS employment). This scheme has two sections depending on when a member joined – the 1995 Section and the 2008 Section. The new scheme is known as a “career average revalued earnings” scheme (or CARE scheme). Pension earned is based on pay earned each year throughout a member’s career, rather than just the final pay. How does CARE work? Pension in the new scheme is earned at a rate of 1/54th of pay each year. Without any type of defence against 18
healthcare manager | issue 25 | spring 2015
inflation, pension based on pay earned years ago would lose value. To overcome this, pension is increased by the annual increase in Consumer Prices Index (CPI) plus 1.5% each year between the time it’s earned and retirement. The table below illustrates this based on starting pay of £20,000 (with annual increases of £2,500) and CPI of 2%. For example, the pension earned in 2015/16 is equal to £20,000 × 1/54 = £370. This amount of pension is then increased at the end of the following year by CPI + 1.5% (3.5% in this example) – that is, £370 × 1.035 = £383. Pension continues to build up in this way with a total annual pension after five years of £2,466. Change in Normal Pension Age The term “Normal Pension Age” (or NPA) is the earliest age at which a member can take their benefits without them being reduced for early payment. The NPA in the old scheme is fixed at 60 for the 1995 Section (or 55 for members with special class status) and 65 in the 2008 Section.
In the new scheme, there is no fixed NPA. Instead, the NPA is the member’s state pension age (with a minimum of 65). This means the NPA will be between 65 and 68 depending on when each member was born (the younger the member, the higher the State Pension Age and therefore the NPA). The state pension age will be reviewed at least every six years. If State Pension Age were to rise, the knockon effect would be a higher NPA in the new NHS Pension Scheme. All service in the new scheme would be linked to this higher NPA. Protection for members All pension earned in the old scheme will be protected by retaining its links to both final pay and the scheme’s fixed NPA. Members will move to the new scheme on 1 April 2015 unless they are covered by either of the types of protection discussed below. This means that many members will have both benefits in the old scheme and in the new scheme which can be taken together or separately. There are two types of protection
Pension earned during year
Pension from previous years with CPI +1.5%
Total pension at end of year
NPA 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 DATE OF BIRTH for members in the old scheme on 31 March 2015: ■■ Members of the old scheme have full protection if they were within ten years of their NPA on 1 April 2012. These members will not be affected by the changes as they will retain membership in the old scheme until retirement (unless they opt out – see below). ■■ Members of the old scheme have tapered protection if they were between ten and 13½ years of their NPA on 1 April 2012. These members will stay in the old scheme for up to seven further years – the older the member, the longer they will remain in the old scheme – before eventually moving to the new scheme. The diagram above illustrates which members, by date of birth, are covered by protection. Although protecting their old scheme pension is advantageous for members of the 1995 Section, this is almost never the case for 2008 Section members. Because of this, there will soon be a one-off chance for all 2008 Section members covered by either full or tapered protection (that is, those born
before September 1960) to opt out of protection. Cost of the new scheme Members pay monthly contributions at a fixed percentage of pay. There are seven tiers of contribution rates ranging from 5% to 14½%, with higher earners paying a higher rate. These tiers will be reviewed and may change in April 2019. Members gain from tax relief on their contributions. For every £1 of contribution paid into the scheme, basic rate tax payers will give up 80p of pay with the remaining 20p funded by Government. Employers pay contributions equal to 14.3% of pay. Salary sacrifice There are several salary sacrifice arrangements in place across the NHS (childcare vouchers, lease car schemes, etc) which exchange salary for other benefits – reducing levels of pay. As pension earned in the old scheme was linked to final pay, members could pay contributions on lower pay up to retirement then cease sacrificing salary in order to have all of their benefits calculated on a higher pay. As pension in the new scheme is based on each year’s pay the impact
of salary sacrifice is to reduce pension earned, albeit with lower contributions paid. Annual Allowance The Annual Allowance is a limit on pension savings a member can build up in any one year (currently £40,000), above which a tax charge may apply. It may be breached by higher earners but also by members with long service who receive a significant pay increase. Stopping a salary sacrifice arrangement can have the effect of a large pay rise which may have the unintended consequence of breaching the Annual Allowance. Members of either scheme must take care when starting or stopping salary sacrifice. Keeping track in the future Going forward, all members will be able to keep track of their pension by looking at their Total Reward Statements and Annual Benefit Statements. This article discusses many important issues but more detailed information can be found on www.nhsbsa.nhs.uk/ pensions.
Dale Walmsley is a pensions adviser with First Actuarial.
healthcare manager | issue 25 | spring 2015
“If you are seeking to enter into a settlement agreement, it is important to know the facts about how you should proceed.”
Two years after “compromise agreements” morphed into “settlement agreements”, Iain Birrell advises on the key aspects to consider. Two years ago “compromise agreements” were renamed “settlement agreements”. Despite the new name and some changes to how such agreements work, employees and managers should feel assured that the process has not been drastically altered. But the second anniversary of the change does provide a useful opportunity to remind ourselves of what settlement agreements are and what you should be aware of before considering whether to enter into one. Settlement agreements were established as a means of providing certainty to an employee and an employer. They are legally binding agreements setting out the terms and conditions agreed between both parties on the termination of a contract of employment or when an employment dispute needs to be resolved. An employee typically accepts a sum of money from the employer for agreeing not to bring legal claims against them. If you are seeking to enter into a settlement agreement, it is important to know the facts about how you should proceed. In signing a settlement agreement, an employee needs to understand that they are specifically waiving certain legal rights to make a claim against their employer in an Employment Tribunal. The agreement needs to address the issues of wages, bonuses, and accrued but untaken holiday pay. To protect employees who may be unaware of their legal rights, the law states that settlement agreements are not legally enforceable unless they meet certain minimum requirements: 20
healthcare manager | issue 26 | summer 2015
the agreement must be in writing the agreement must relate to ‘particular proceedings’ i.e. particular complaints that the employee may have the employee must find a relevant independent adviser to provide advice about the terms and effect of the proposed agreement and, in particular, any restrictions on an employee being able to take a grievance about the employer to a tribunal the adviser must be covered by professional indemnity insurance the settlement agreement must state that the legal conditions regulating settlement agreements are satisfied
If the agreement does not meet these legal requirements, it will not be considered valid and an employee remains in a position to pursue a claim against their employer. The specific terms in a settlement agreement depend on the circumstances of the particular case in question. It is, however, typical for settlement agreements to include clauses dealing with the following: ■■ the date the employment was terminated ■■ the settlement package, including
when payment will be made and by what method the parties’ understanding of the tax position a tax indemnity from the employee a reminder of any restrictive covenants or confidentiality obligations in the contract and the agreement the employer’s contribution to the cost of obtaining independent advice on the terms of the agreement
Not all claims can be settled by means of a settlement agreement. It isn’t possible to settle a claim that relates to statutory maternity, paternity and adoption pay or claims under the Agency Workers Regulations 2010. Typically, an agreement won’t compromise an employee’s accrued pension. Usually there is a clause dealing with personal injury claims either stating that the agreement does not affect any personal injury claim that the employee may have underway or signing away the employee’s right to pursue claims for injuries of which they are already aware. Above all, it is essential that when employees are offered a settlement agreement, they should very carefully consider what the consequences of signing such an agreement are. Coming to this decision is best done with the advice of a lawyer and more advice or information can be obtained from your MiP national officer.
Iain Birrell is an employment rights lawyer at Thompsons Solicitors. Legaleye is not intended to offer legal advice on individual cases. MiP members in need of personal advice should immediately contact their MiP rep.
How to give a great talk Lis Paice gives her tips for engaging an audience and keeping them interested. Have you ever been giving a presentation and realised that you weren’t holding your audience? Smartphones and tablets lighting up, eyes glazing over? It is a horrible feeling. Giving a presentation is a great opportunity to get your ideas across – but not if people aren’t listening. So how can you give a talk that will engage your audience? I have been giving talks for nearly 40 years and have learned a few ways of getting people to pay attention. Whether your audience are work colleagues, members of your Board, or the audience at an international conference, if you can engage them, your chances of informing and influencing them will be so much the greater. There are eight elements to a great talk: Impact, Credibility, Engagement, Content, Relevance, Evidence, Action and Motivation.(And remember, everyone loves ICE CREAM!)
1 IMPACT Start your talk with an arresting thought, phrase or story relevant to your message. Ideally it should highlight the problem that your talk is about solving. Prepare your opening lines carefully so that you start off with confidence.
2 CREDIBILITY Explain why they should listen to you on this topic. Do you have relevant experience? Are you an expert in the field? Or are you coming with fresh eyes? Maybe you have completed a survey or reviewed the literature. People don’t want to know a lot, but they do want to know why they are listening to you and how much weight to give to your opinions.
3 ENGAGEMENT As soon as it is feasible, get the audience to do or say something as individuals. The reason for this is that people pay much
you find yourself creating slides dense with information, consider how these will land with people. Nothing is more offputting than having slides that can’t be digested in the time allowed. It doesn’t help to apologise that the slide is “busy” or explain that you don’t expect the audience to be able to read it. Resolve never to put up a slide that you have to apologise for!
5 RELEVANCE Make it clear why what you have to say really matters to this audience, right here, right now.
6 EVIDENCE Tell them how you know what you are telling them and what makes you think it’s true. Be honest about any doubts you may have or weaknesses in the data.
7 ACTION more attention once they have done some thinking for themselves and participated in sharing the thinking. With a small group and enough time, you might ask people what they already know about your topic or what experience they have had of the issues. In a larger group you could ask for a show of hands in response to questions you throw out. Even with a very large audience you can get people participating by asking them to turn to a neighbour and share thoughts or experiences for a few minutes.
4 CONTENT When you prepare your content, don’t just think about what information you have to offer. Think about who will be in the room and how you would like them to behave differently as a consequence of hearing your talk. Those changed behaviours are your educational objectives. Tailor your content to make sure that what you tell them has implications for this change. If
Understanding is useless unless it informs some sort of action. What does this mean for each individual? What is it you think they should do differently as a consequence of listening to you? You might make this an opportunity for interaction – what action do people think should be taken? What might they resolve to do?
8 MOTIVATION What would happen if they did those things? Who would benefit? What would be different? If you can engage your audience in these ways your presentations will be more interesting, more inspiring and a lot more fun. And you will not have thrown away a priceless opportunity to influence others to take action. Lis Paice is a professional management coach and chair of the North West London Integrated Care Pilot.
healthcare manager | issue 26 | summer 2015
MIP AT WORK
MiP 10th ANNIVERSARY
Reasons to be cheerful Marisa Howes reviews some of the ways MiP has supported managers over the past decade. MiP launched in June 2005, with about 4,000 members transferred from Unison and FDA, the partner unions which set up this unique joint venture. A survey at the time found that three out of four managers said their organisations faced major restructuring over the next two years. More than four out of five believed that ministers, the media and the public did not understand their roles, and nearly 90% thought that employment protection for managers would become more important. Sounds familiar? Ten years later, we’re still being reorganised, managers are still misunderstood and employment protection is becoming even more important. The only thing that’s changed is the size of our membership. Despite huge cuts in NHS managerial jobs, MiP’s membership has steadily grown to 6,000 members. As we celebrate our tenth anniversary, here are ten ways in which MiP is winning for our members. 1. Expert representation Every year, over 25% of our members contact MiP for advice and representation on employment matters. We have won thousands of pounds in compensation for members subjected to unfair treatment and helped thousands more get a fair outcome when their organisation has gone through restructuring. Like Jenny, who needed 22
healthcare manager | issue 26 | summer 2015
help with a complicated TUPE transfer after her trust lost a service contract. We ensured she was treated fairly, and retained her professional status and level of income. MiP provides expert advice and representation on pay and grading. Recently, we successfully appealed against the grading of members working in a clinical network and won them substantial sums in back pay.
MiP represents members wherever they work, including the private sector. Members like John, an HR director headhunted by a global consultancy firm. When he was unfairly subjected to disciplinary proceedings, MiP resolved the issue at partner level, getting John’s suspension lifted immediately and sorting out other issues without going through formal processes. We pride ourselves on the feedback we get about our unique blend of expertise and empathy.
2. Legal support At MiP we try to find informal solutions when employment relations break down. But employment lawyers Thompsons provide expert legal advice and representation when necessary. We refer settlement agreements to them for independent advice, so we’ve been keeping them busy lately! Thompsons also provide representation at tribunal cases. In 2010, we went all the way to the Court of Appeal to uphold successfully a chief executive’s claim that the NHS had wrongly forced her trust to withdraw her compensation payment. 3. Representation in collective grievances MiP national officers and link representatives will pursue collective grievances on behalf of groups of members unfairly treated by their employers, and our action often results in improved employment practices and joint working. In one acute trust in the North West, employment relations had broken down. Managers felt they were not valued by the employer and that their jobs were at risk. Our MiP national officer gained the support of the staff side, put our members’ grievances to the chief executive and resolved them to our members’ satisfaction. MiP’s influence remains strong and valued within the trust. 4. Local partnership working Local partnerships have gone from strength to strength as MiP’s active
MIP AT WORK
membership has grown. We’ve signed formal partnership agreements with many employers, including Ipswich and East Suffolk and West Suffolk CCGs (see page 16). We’re working with Doncaster and Bassetlaw Trust to develop a management skills programme. And in Sussex, we worked with Unison to set up a partnership forum to harmonise working practices so that everyone in the county now works to the same policies and procedures.
rs ge na
5. National partnership working MiP chief executive Jon Restell sits on the Social Partnership Forum and chairs the working group oversee-
ea lth. o
ing the implementation of key policies and agreements, including widening access to the NHS pension scheme. MiP played a key role in discussions on implementing the Lansley reforms and getting the best possible outcome for managers. We use our influence on partnership forums in the newly created arms-length bodies to achieve fair outcomes for managers – like ensuring a better deal for people made redundant following the organisational changes in NHS England. We played a major role in shaping the learning agreement in NHS Property Services. MiP also drafted Health Education England’s policy on appraisals and incremental progression, which became a model of good practice for other organisations. 6. Negotiating for managers MiP plays a key role in negotiations.
Following the industrial action over pensions in 2011, MiP with the other health unions gained considerable improvements in the new pension scheme, including a higher accrual rate and Fair Deal for outsourced staff. MiP is the only health union to give evidence to the Senior Salaries Review Body, which makes recommendations for very senior managers’ pay. In Scotland, we have regular discussions on executive pay, and in Wales we feed into the national partnership forum on senior managers’ pay and conditions.
part in whatever way suits them – from being the eyes and ears of our national officers to sitting on local partnership forums and representing individual members. Some of our link members now sit on national partnership forums, like those for NHS England and the Health and Social Care Information Centre. 10. Listening to members From the outset, MiP has had a special relationship with its members. They have direct access to their national officers if they need advice or representation. We hold extensive
7. Influencing policymakers As our membership has grown, so has our influence. At national level, Jon Restell puts the managers’ viewpoint to key policymakers and stakeholders on issues such as the regulation of managers and the Workforce Race Equality Standard. We have similar meetings with policymakers in Northern Ireland, Scotland and Wales. Jon is regularly quoted in the Health Service Journal and other national media. For the general election, we joined with the HSJ for our Respect for NHS Managers campaign and published our NHS Management Mythbuster, a hugely popular vindication of NHS managers. 8. Developing managers’ skills MiP delivers a range of masterclasses and seminars for managers. We ran successful seminars with Big Difference Company on patient voice and personal resilience. We hold masterclasses on topics such as presentation skills, CV writing and NHS pensions, and run employment rights surgeries. We held our first national conference in 2007 and it has gone from strength to strength, attracting many high-profile speakers and experts. And in 2009 we launched this magazine to bring you indepth analysis and views on healthcare policy and workforce development. 9. Building our link networks Our many active members have been instrumental in raising our profile and recruiting members. We now have over 150 link members, playing their
discussions with our members on local and national issues. In 2007 we hosted a packed summit at Walsall stadium for members affected by the restructuring of Primary Care Trusts and SHAs in England. In Wales last year, we met with members to discuss the pay offer and consulted via an online survey. In 2010, we took a roadshow around the country so that Jon Restell and our chair, Zoeta Manning, could meet members to discuss their priorities for MiP. We survey members regularly on issues such as pay and the NHS pension scheme, as well as developments like the Francis report, and we conduct an annual survey about our own performance. These are just a few examples of the ways in which MiP is speaking up for health and care managers. We look forward to our next ten years.
healthcare manager | issue 26 | summer 2015
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk.
romises to “ring-fence” NHS spending ring hollow when the NHS has to pick up the pieces from cuts to other services. A particularly egregious example comes from Canterbury, where mental health nurses patrolling with police cut the number of people being sectioned by 30%. The “street triage” scheme has now been cancelled due to police budget cuts. Meanwhile, Allied Healthcare, a subsidiary of “silver services” provider Saga, pulled out of providing elderly care, also blaming funding cuts. Writing off £220m losses, Saga admitted the business was literally worthless. All this makes the Queen’s Speech pledge to “secure the future of the National Health Service by integrating health and social care” sound more like a threat than a promise.
At the sharp end
ndaunted, Chancellor George Osborne swung his newly sharpened axe again, lopping £200m off public health budgets. It’s dubious for the Treasury’s integration
enthusiasts to justify the cuts as “non-NHS spending” just because the budgets are controlled by councils. But it’s just rank stupidity for the Department of Health to claim they won’t affect “frontline services”. Didn’t they read Simon Stevens’s recent comments that “obesity is the new smoking”? Don’t they know that most public health services are commissioned from cashstrapped NHS providers? Public health services aren’t just frontline, they’re the very front of the frontline.
inisters moved to scrap weekly A&E waiting time targets, after they were missed for 32 of the last 33 weeks. Figures will now be published monthly, reducing the Jeremy Hunt embarrassment factor by a whopping 77%. Hunt is also scrapping nurse staffing targets and ending NICE research into safe nurse-to-patient ratios, a key plank of the Francis report. Ministers say such “mechanistic” targets don’t work, but were remarkably reluctant to share this thinking with voters before 7 May.
eremy Hunt also announced another review of NHS executive pay, demanding explanations from anyone paying top dollar – i.e. more than
healthcare manager | issue 26 | summer 2015
the PM’s salary. While NHS pensions and benefits are in their sights, the Department of Health overlooks the many perks Mr Cameron trousers alongside his £142,000 salary, including a central London pad (handy for the office), a substantial country pile, several kitchens, free food and drink, luxury transport and a pension that isn’t so much gold-plated as 24ct all the way through. Just last year, Hunt dismissed a “generalised rule” linking NHS pay to the PM’s package. “Where an NHS manager is doing an outstanding job, I’ve absolutely no problem with them being paid outstandingly well,” he said. We see no reason to disagree now with his wise opinion then.
Knife to skin
ews from Nottingham, where dermatology services are said to be on “a knife-edge” following the 2013 takeover by private provider Circle Health. According to an independent review, which described the changes as “an unmitigated disaster”, six of 11 consultants at the world-renowned Nottingham Treatment Centre refused to transfer, leaving the firm to shell out £1.8m a year to six locums, some of whom aren’t even qualified in dermatology. According to the HSJ, Nottingham University Hospitals Trust was blocked from setting up its own dermatology service
by a legal challenge from Nottingham CCG, which awarded the Circle contract. Let’s not forget that amid all this internal wrangling a world-class NHS service has been destroyed.
The receptionist will see you now
et’s finish on a positive note. When journalist Carol Gould rang her GP complaining of back pain, she had no idea her life was in danger. But the receptionist suggested she take a troponin test, which revealed troponin levels 100 times higher than normal. Carol was having a so-called “silent heart attack”, and is now recovering following the removal of a potentially lethal artery blockage. Too often we fail to appreciate how the whole team, including “admin” and “support” staff, contribute to safe and effective healthcare. As Carol wrote in her blog (bit.ly/hcm2609), “had my GP’s receptionist not suggested I have a troponin test, I would not be here to write this piece”. So hats off, please, to Tena Gray of Little Venice Medical Centre in west London.
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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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Published on Jun 22, 2015