Using research to shape and improve NHS services – join the SDO Network The Service Delivery and Organisation (SDO) Network supports NHS managers to use research to improve and develop the services they manage. •
and new NHS managers to support them in developing leading-edge services.
• Member services include: events which bring together the latest learning from research and the experiences of front-line NHS managers, action learning sets, chief executives forum, academic fellowship placements and support in conducting and sourcing the latest research. • Membership is free, join the SDO Network today.
“Managers need to have a far greater awareness of research if they are truly to Mike Cooke, Chief Executive, Nottinghamshire Healthcare NHS Trust
“Exposure to research strengthens managers’ ability to successfully innovate.” Ron Kerr, Chief Executive, Guy’s and St Thomas’ Foundation Trust
SDO Network is funded by SDO (Service Delivery and Organisation Programme) which is part of the National Institute for Health Research
issue 6 summer 2010
healthcare manager inside heads up:2 What you might have missed & what to look out for Leading edge: Jon Restell inperson: Angela Daly, West Midlands inpublic: North Devon Hospice
letters & comment:8 Lynn Faulds Wood calls for better screening and testing for people at risk from cancer
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.
Mentoring: helping others to help themselves Interview: Nicola Sturgeon Staff wellbeing: the key to boosting productivity? SDO: making best use of research
regulars:20 Legal eye: are you fit to work? Tipster: mental toughness MiP at work: Yorks & the Humber, Shropshire
Welcome to the sixth issue of healthcare manager, the magazine from Managers in Partnership, the trade union organisation for health and social care managers. In the week after the election, Harold Wilsonâ€™s line about a week being a long time in politics was especially apt. We now know the general outlook for the health services, but await the detail. The Westminster government only directly decides health policy for England, but its control over the distribution of public funds for the rest of the UK will affect health policies there too. In this issue we talk to Nicola Sturgeon, the Scottish Cabinet Secretary for Health, about the future for healthcare in Scotland and the UK. We know managers will need to draw on inner strength to get through the tough times ahead. We look at ways to boost your mental resilience and keep up to speed with the latest thinking on wellbeing. We look at mentoring to support career development, and hear about SDO, our partner organisation, which keeps managers in touch with the latest research on health care development and organisation. And of course we have all our regular features. Marisa Howes Executive editor
issue 6 | summer 2010 | healthcare manager
heads up what you might have missed and what to look out for
MiP representatives elected to the FDA national committee
Andrew Cheeseman has been elected as the second representative for Wales on
Pay protection for NHS staff who have transferred to Agenda for Change since 2004 comes to an end on 31 March 2011. This does not apply to Scotland where different provisions apply. The arrangements made for staff on pay protection is set out in section 46 of the NHS Terms and Conditions Handbook. In particular, paragraph 46.26 states: ‘As soon as possible during the period of protection, the skills, knowledge and role of staff subject to protection will be reviewed to establish whether they could be reassigned to a higher weighted job or offered development and training to fit them for a higher weighted job.’ The NHS Staff Council have issued guidance on this and local partnerships have been advised to make sure these provisions are
For further information follow link at www.miphealth.org.uk/hcm
MiP’s national committee in the by-election held in March this year. Andrew is based in north Wales, and will provide an excellent complement to the other Wales representative, Samantha Crane who is based in south Wales.
issue 6 | summer 2010
Marisa Howes firstname.lastname@example.org
ISSN 1759-9784 published by MiP
Tom Barker, Judy Butler, Lynn Faulds Wood, Gerry Hassan, Marisa Howes, Tom Jones, Helen Mooney, Alison Moore, Jon Restell, Craig Ryan.
Craig Ryan email@example.com
All copy © 2010 MiP or the author. Opinions stated are not necessarily those of healthcare manager or MiP.
Broglia Press, Poole
Art Director James Sparling
Design and Production
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considered for staff whose pay may decrease when the national protection ends. If you are still on pay protection following assimilation, you should make sure you discuss your situation during your personal development review.
Agenda for Change pay protection to end
MiP vice chair Rosie Ilett and national committee member David Cain (both pictured right) were recently elected to represent MiP on the FDA executive committee. Under the founding agreement between FDA and Unison, MiP, as a national section of FDA, is entitled to representation on their national executive committee.
Second MiP national committee member for Wales
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NHS Pension Choice Remember the NHS Pensions Choice exercise is being rolled out across the country during 2010 and 2011. If you joined the NHS pension scheme before 1 April 2008, you may have an important choice to make about your pension. If you are being transferred under TUPE to an employer who does not provide membership of the NHS Pension Scheme, your current employer should ensure you are offered your pension choice before you are transferred. For details visit the NHS Pensions website at www. nhsbsa.nhs.uk/pensions and click on ‘Your Pension Choice’. healthcare manager is sent to all MiP members. All weblinks mentioned are at www.miphealth.org.uk/hcm
leading edge Jon Restell, chief executive, MiP Now is a good time to be a manager in the health service. Please do not adjust your set! Give me a chance to explain. It’s true that even a quick scan might leave the most optimistic spirits crushed. Job losses and staff insecurity, spending cuts, services and standards threatened, pay freezes, pension reviews, hostility towards management, and on and on it goes. Who would choose to manage in this grim environment? The answer is no one. But the professional response of managers to the new landscape has been deeply impressive. They have neither rushed to the barricades nor thrown in the towel. Instead they are working out how to steward their staff and services through the next five years of often unknowable difficulty and danger. They know instinctively that it’s much easier – although never easy – to manage when cash and staff are flooding through the door. Now is the time to show what management is worth and embrace the biggest challenge of their careers.
Just rewards MiP is again supporting the NHS Leadership Awards in 2010. The awards were launched last year to celebrate leaders in the NHS and the vital role they play in the drive to improve quality in services and to make change happen. The 2010 awards featured seven categories recognising excellence in leadership, including the award for
“The professional response of managers to the new landscape has been deeply impressive. They have neither rushed to the barricades nor thrown in the towel.” Watching them at work, here are six things the best managers are doing: 1. Being positive. Being more visible than ever. Giving leadership to other staff and reassuring them that we can keep quality services and good values, such as diversity and equity. 2. Bringing staff into the loop and seeing colleagues as part of the solution to all problems. They are harnessing partnership working with unions, forged in the good times, and which is needed more than ever in the bad. 3. Looking after themselves. Thinking about their own jobs and wellbeing, and preparing
mentoring, which was sponsored by MiP. MiP chief executive Jon Restell said: ‘The quality of the nominations last year was tremendous and very inspiring. All three finalists were of the highest calibre. They displayed great leadership in sharing their expertise and learning with others and helping to develop the leaders of tomorrow.’ The finalists are interviewed in our feature on mentoring on page 10.
themselves mentally and physically for the pressures ahead. They know if they don’t care for themselves, they can’t care for others. 4. Saying plainly how it is: you can’t save money in the public sector without job losses. They are brushing up their communication skills and ditching management euphemisms for job losses and cuts. 5. Planning for a range of futures and getting themselves and others ready to chop and change. They live and breathe the maxim: ‘plans are useless, but planning is essential’. 6. Saving money the right way and for the right reasons. They believe we can get more for the same or less. But they also know the difference between an efficiency saving and a savage cut is often time, and they are fighting to carve it out. To me these managers are little short of heroic.
Three new categories have been added to the awards this year, NHS Board, Community Leader and Newcomer of the Year. Nominations for the awards have now closed and judging will take place over the summer, with the awards being presented in the autumn. For more information see the website at: www.nhsleadership awards.nhs.uk.
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Facelift for ‘inflexible’ KSF Unions and employers are drawing up plans to overhaul the Knowledge and Skills Framework (KSF) after the NHS’s flagship staff development scheme was heavily criticised in an independent report by the Institute for Employment Studies (IES). The review, commissioned by the NHS Staff Council and published in April, said the KSF was too complex, little understood by staff and insufficiently responsive to local needs. ‘Five years after the principles of KSF were set out, the gap between the intended policy and the actual practice was unacceptably wide,’ said the IES. It recommended that the framework should be simplified, strengthening the links with appraisals, and that NHS organisations should be able to customise it to meet their own needs. ‘An increasing number of trusts are modifying, or
even abandoning the KSF. Without changes, this trend will undoubtedly continue,’ said the report. The growth of foundation trusts and the devolvement of commissioning powers rendered a ‘uniform’ NHS model
‘outmoded’, it added. The review was ordered after the NHS staff survey found that in 2008 only 64% of staff received an appraisal, which is mandatory under the KSF, although this figure rose to 69% in 2009. Karen Jennings (pictured), UNISON national secretary for health, said the NHS Staff Council was working to implement the IES findings. She said the work was crucial to ensure that all NHS staff can ‘exercise their contractual right to access to learning and development opportunities, and organisations will be able to benefit from a better trained, more motivated workforce that is equipped to deliver a high-quality service.’ She urged all NHS organisations to continue to implement existing KSF procedures and ensure all staff have an annual appraisal and an agreed personal development plan.
MiP national conference 2010
Managing in a cold climate Wednesday 24 November 2010, Congress Centre, London WC1B 3LS, 10am-4pm Whether you are frontline or backroom, or somewhere in between, you will be affected by the efficiency savings signalled by the new government. These are challenging times for everyone involved in healthcare planning and delivery and MiP’s conference will consider what the future holds for healthcare managers. We will have a top line-up of speakers and lively debate, with some light relief as well. Put the date in your diary and look out for further details and the invitation, which will be coming soon.
helping you make healthcare happen
issue 6 | summer 2010 | healthcare manager
inperson Angela Daly: D irectorate manager, West Midlands Regional Genetics Service
Angela Daly is a relative newcomer to the NHS. Having worked in higher education for 24 years, she left her post as head of financial support at Birmingham University at the end of 2004 to help establish the National Genetics Education and Development Centre – a Department of Health funded centre based at Birmingham Women’s Foundation Trust. In 2007, she became directorate manager at the West Midlands Regional Genetics Service, also part of the same trust. Angela works as a ‘general business and operations manager’ for the service – ‘the biggest integrated genetics service in the NHS’, she says. The laboratory carries out over 40,000 genetic tests each
year and the clinical staff look after 8,500 patients. The service is largely funded through its block contract with the 17 primary care trusts across the West Midlands, but the laboratory also carries out tests for private consultants and hospitals, and has contracts with healthcare institutions nationally and internationally. ‘I am in charge of much of the operational management of the service, the governance and the service redesign,’ explains Angela. ‘My role is to act as the interface between the aspirational ideas of the service and the corporate needs of the trust.’ The laboratory currently employs 160 scientists, technical and support staff, providing a comprehensive
“My role is to act as the interface between the aspirational ideas of the service and the corporate needs of the trust.”
range of genetic tests, and 75 clinical consultants and support staff in the clinical service. In 2008-9 the service processed over 45,000 samples; of these 25,000 were tested using molecular genetic techniques and 20,000 were tested for chromosomal anomalies using cytogenetics. Its services include prenatal testing for at-risk pregnancies, postnatal testing for conditions such as developmental delay and infertility, and specific testing for a variety of syndromes and single gene disorders. Oncology services include cancer diagnosis, monitoring of disease status and post-transplant monitoring. The tests help to provide accurate diagnosis and optimise treatment of genetic disorders. ‘At the moment we, along with the rest of the NHS, are facing having to implement large cost improvement plans without detriment to patient services, so we are focusing on LEAN methodology for our back office functions,’ says Angela. Angela’s job involves interacting with many different parts of the trust. ‘If I wasn’t doing this job, the clinical staff would be doing a lot more in terms of administrative work – which I think they still do too much of – when they want to be focussing their work on patients. So it’s my job to try and get that balance right,’ she explains. Angela says it has taken some time to adjust to working in the NHS. Not having access to live budgetary and management data which is updated daily is a big hurdle. ‘The NHS is driven by the need to cross the t’s and dot the i’s one thousand and one times, which indeed it should be, but that does mean it is less business-orientated.’ However, she says that what she loves about the NHS is that once staff become a part of it they become staunch defenders of it. ‘There is an unwavering dedication to providing the best to patients and my job is to do that and support others to do that.’ Helen Mooney issue 6 | summer 2010 | healthcare manager
New online reporting tool for NHS staff survey While gearing up for the 2010 NHS staff survey, NHS organisations should be working in partnership to address problems identified in the 2009 survey. And now there’s a new online tool to help you identify the key problem areas for your organisation. Developed by the advice centre at Aston Business School, the tool creates two types of bespoke reports. These will help trusts to refine their results and develop programmes to address particular problems.
The NHS staff survey –
The 2009 survey showed a general improvement in staff satisfaction, but there is a lot more work to be done. With cutbacks looming, some essential for organisations may not see the staff survey and follow-up work as a improving the priority, but research has established the clear positive relationship between staff engagement and satisfaction, and patient outcomes and quality of quality of care.
The Social Partnership Forum has produced case studies showing how four NHS organisations have made progress on tackling issues identified by the staff survey: ■ Blackpool, Fylde and Wyre Hospitals Foundation Trust on tackling workplace stress ■ Oxleas NHS Foundation Trust on improving staff satisfaction and staff engagement ■ NHS Plymouth on tackling harassment and bullying ■ Somerset Partnership NHS Trust on improving the quality of appraisals
Trust comparison report The comparison report shows how your trust scored on each of the key findings in comparison to others. You can compare your results with trusts of a similar type – such as foundation trusts or children’s hospitals – or those in a particular geographical area. You can also see which comparable trusts in your area are doing relatively well so you can learn from their experience.
The case studies are available from the SPF website: www. socialpartnershipforum.org A report from the Institute of Employment Studies, ‘Why the NHS staff survey matters’, commissioned by the Department of Health, sets out the business case for the staff survey. It is available from our website www.miphealth.org.uk/hcm. Trusts can use these case studies to inform their own programmes to improve conditions for staff. Working in partnership with staff representatives to tackle these issues sends a strong signal that you are serious about engaging with them.
Time series report The time series report shows how your trust scored on key findings over the last three years, so you can see which areas have deteriorated or improved and identify areas for action. You can also see whether actions you have already taken have improved staff satisfaction – for example, if you have developed and implemented a programme to tackle bullying and harassment, you can see if it has had any impact on staff experience. The results for key areas in your trust’s
Review of senior managers’ pay 6
report can also be broken down to the level of individual questions, enabling you to drill down to find the particular problems that need to be addressed. ‘One area of general concern identified in the survey is the strong view that senior managers do not act on feedback from staff,’ said MiP chief executive Jon Restell ‘This tool will help them to work in partnership with the trade unions to identify
MiP has welcomed the Prime Minister’s announcement of a review to ensure fair pay for senior managers in the public sector, to be headed by Will Hutton of the Work Foundation. Jon Restell, MiP chief executive, said: “We have long argued for a complete overhaul of the way executive pay is set
issue 6 | summer 2010 | healthcare manager
the major areas of concern to staff, develop a programme to tackle them and report back to staff on progress.’ Following a pilot scheme at a number of trusts, the online tool has now gone live. Information about how it has been sent to staff survey leads in all NHS organisations. For more information contact the NHS staff survey advice centre on 0121 204 3131 or email@example.com.
in the NHS, including limits on top salaries in relation to average salaries. This is all money from the public purse and we must have an open and fair process. ‘The review will not have an easy task, though. On the one hand, the pay of senior managers must stay in touch
with the rest of the healthcare team, as broadly it is now. On the other hand, the NHS needs to compete for the best managers. Will Hutton and his two colleagues will have to try to square this circle. We look forward to seeing the remit of the review and are keen to contribute.’
“We are specialists in palliative care and education, the skills we have are critical to our success.”
North Devon Hospice
North Devon Hospice was founded in 1981 by local people who saw a need for specialist care for people with lifethreatening illnesses in North Devon. After three years of planning and fundraising, the organisation recruited its first home care nurse, and for the next three years the hospice operated a community nursing service from a small terraced home in the centre of Barnstaple. In 1987 the day care service was added and six years later the hospice
moved to its present site at Deer Park in Newport. In 1998 the Diana, Princess of Wales wing was opened, primarily to house the extensive complementary therapy service the hospice offers. In 2005, the organisation admitted the first patient to its new seven bed in-patient facility. The hospice cares for local people affected by life-threatening illnesses. This includes providing care for patients and support for their loved ones. However, in order to provide such essential
come to die and sees its role as not just ‘putting days into your life, but putting life into your days’. Its aim is not just to make patients feel better physically, but to feel better emotionally and to not waste the time they have left. Lester says the hospice is very keen to develop its role in the community and its relationship with the local NHS. ‘We want to promote our role as specialists in palliative care and education, the skills we have are critical to our success,’ he explains. ‘The local primary care trust currently makes a grant to us for our services but one of our challenges will be to be contracted by them with a tariff in future,’ he admits. The hospice has developed a ‘jigsaw’ strategy for itself which includes information, staff and services, the hospice has to volunteers, awareness, raise over £3m every year. education, partnerships Gordon Lester, chief execu- and community care. Lester tive at the hospice, says the says that the hospice knows organisation has achieved it must work very closely a lot in the last 27 years. with the NHS in future. ‘We ‘We are remarkably well are looking to make sure supported by the local that our jigsaw pieces fit community and we have alongside those of North engaged more and more Devon Healthcare Trust people in our work,’ he to complete the picture says. of care provided to local The organisation puts a people. The challenge is to lot of work into organising get them to invest in our events and last year it ran services, as well as for us to the English National Sheep- develop relationships with dog trials, raising £80,000 other agencies and charifor the hospice. The charity ties to provide the best end is keen not to be seen as of life care for the people of just a place where people North Devon.’ HM issue 6 | summer 2010 | healthcare manager
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.
to the editor
Women into Leadership I am writing to invite women in MiP to our Women into Leadership conference on 23 September 2010 at Central Hall Westminster in central London. FDA has teamed up with Westminster Explained to organise this exciting event for women working in the public sector. It is a unique opportunity to examine the
challenges women face in getting into, and progressing through, leadership roles in the public sector. Whether you are looking to move into a leadership role, or are currently in a senior role and looking to progress, this conference will tackle: ■ current
and future challenges for women in senior roles; ■ how to be an effective leader in challenging
Better healthcare communications by design Patient-centred communications have taken an innovative step forward with the launch of MyKidney. org.uk, a website aimed at providing information for kidney patients. The project was devised by Kidney Services at Guy’s and St Thomas’ Hospitals and created by Projector Design. ‘We know from talking to patients that they want better information about their conditions, but it has to come from an authoritative and trusted source’, said Stephen Masters, creative director at Projector Design. ‘Guy’s and St Thomas’ is a world leader in kidney healthcare and has a wealth of information they wanted to share with patients. The chal-
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circumstances; to deal with balancing a leadership role with a fulfilling life outside work; ■ comparisons with working lives in other sectors and what we can learn; ■ and how to overcome the specific issues of visibility and confidence which have been identified as the main barriers to women’s progression to the most senior roles. ■ how
lenge was to design an online resource that worked for both patients and health professionals’. ‘The idea for websites such as this is to make complex information accessible to a wide audience’, said services manager Ian Haig. ‘Empowering patients with chronic diseases to better manage their conditions is one of the biggest tasks facing the NHS. But to achieve that, we have to provide the information and resources to help them.’ Projector focused on usability and designed every aspect of the website around their needs. ‘Feedback from patients has been
Speakers include Department for International Development permanent secretary Minouche Shafik and cabinet secretary Sir Gus O’Donnell. For further information and to register visit www. womenintoleadership.co.uk. Ro Marsh National Equalities Officer, FDA
fantastic’ said Ros Tibbles, Service Improvement Lead for Kidney Services. ‘They love what we’ve created so far and now want more’. The website is at www.mykidney.org. uk. For more information contact info@ projector.co.uk.
“I believe we’re in danger of frightening people, and we should be filtering the signs and symptoms that drive people to their GPs.”
Lynn Faulds Wood
TV presenter and founder of Lynn’s Bowel Cancer Campaign.
All too aware? Is any publicity good publicity? With bowel cancer, have we gone from virtually no publicity to too much of the wrong sort? And what about screening? Are we going fast enough? And are we reaching the less well-off? Take awareness. I know to my cost how neglected this common cancer used to be. When I presented the BBC’s Watchdog programme 19 years ago, I had never heard of it. I could easily have believed GPs who told me that my subtle rectal bleeding was ‘nothing to worry about at your age’. But something made me keep pushing – perhaps being the mother of a two-year-old – and nearly a year later came the shock diagnosis of Stage C bowel cancer. For five years, I had the awful feeling that I might not live to see my son grow up. Since then I’ve spent much of my time trying to stop others experiencing something similar. In 2010, there is much more awareness of this preventable, curable cancer, which affects one in 18 people and one in ten families. But is it the right sort of awareness? GPs are inundated with people with bowel problems – it’s one of the biggest reasons for surgery visits. And with seven million rectal bleeders every year, and millions more experiencing prolonged tummy upsets, it’s easy to see why. A recent cost-
benefit study found that diagnosing bowel cancer and bowel conditions costs about £¼bn a year. I believe we’re in danger of frightening people, and we should be filtering much better the signs and symptoms that drive people to their GPs. Twelve years ago I helped to produce the world’s first evidence-based symptoms advice, thanks to a great database my charity supports in Portsmouth hospitals. NICE adopted the idea of promoting a research-based set of signs and symptoms – but it’s not the Holy Grail. Better awareness of key symptoms will prevent only a minority of deaths and we should not over-promise what it can achieve. Our charity (www.bowel-cancer.tv) is now working on a home computer checker which we hope will enable the public to make better decisions about when to go to their GP. It may take years of piloting to prove its worth – in the meantime we should tread carefully with the advice given. Investigating symptoms is another key area where some services could do better. There is overwhelming evidence that most people visiting their GP with persistent bowel symptoms, especially those over 50, should be offered a blood test for anaemia – but does this happen often enough? More than one in ten bowel cancer sufferers in primary care have anaemia and no symptoms, and
blood tests are relatively cheap. Let’s hope the new government also invests more in flexible sigmoidoscopy. We helped to fund research via the Portsmouth database, which showed that a “flexi sig” should be the first test given to people with key symptoms of bleeding and persistent change of bowel habit, especially those over 50. Research published in the Lancet in March showed that a “flexi-scope” could make a major contribution to saving lives. Rectal cancer is a particularly nasty disease which affects more men than women and at a younger age. This 14-year study found that almost half of rectal cancers and a quarter of sigmoid cancers could be caught with appropriate screening. We need to extend the screening programming to “hard-to-reach” groups. The NHS cancer screening website is comprehensive but is it people-friendly enough? When I launched a three-minute symptoms line (0870 24 24 870), with two slots on breakfast TV to promote it, the line received 156,000 attempted calls on its first day. And what about a recorded screening line that tells people how to do the “poo” test? The biggest selling paper in this country is The Sun – we need to keep its readers in mind with everything we write and do. They’re our patients of tomorrow
Views expressed are those of the author and not necessarily those of healthcare manager, or MiP. issue 6 | summer 2010 | healthcare manager
Having a mentor can give momentum and depth to your career, and the strength and tools to manage problems when things get rough. And, as Alison Moore found out, the benefits are mutual.
Not so long ago the closest NHS staff might get to career development would be a chat with their boss who might, if they were lucky, look out for opportunities to interest them. But as the NHS becomes more professional in developing and promoting staff, there’s a growing interest in mentoring. Many SHAs now have mentoring schemes giving potential leaders and managers the opportunity to meet someone who will take an interest in their career, give advice at times of difficulty, and encourage them to become more self-reflective. Managers emerging from the NHS’s graduate management scheme are encouraged to seek mentors to help guide them as they tackle their first ‘real’ jobs. But mentoring takes many forms. SHA schemes tend to be quite formal, often with a ‘contract’ between mentor and “mentee”, and some sort of formal matching process. But the winner of last year’s Mentor of the Year award – part of the NHS Leadership Awards and sponsored by Managers in Partnership – started mentoring after he was approached by other black and minority ethnic (BME) doctors for 10
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career advice. Dr Laweh Amegavie was the first nonwhite consultant at St Helens and Knowsley Teaching Hospitals trust in the early 1990s and was seen as a role model by many other healthcare professionals. Informal advice eventually led to a more structured system where he meets with mentees – generally junior doctors and new consultants – regularly, either before or after normal working hours. Initially, Amegavie was seen as a trailblazer for BME doctors but, as his reputation as a dedicated mentor grew, he
“You are not telling them what they should go and do. I’m saying what are the options you should consider?” Laweh Amegavie of St Helens and Knowsley Teaching Hospitals Trust
was approached by doctors from all backgrounds. ‘I have tried to focus not only on high fliers, but I also have people who are struggling,’ he says. ‘As far as the trainees are concerned it can be anything from educational problems, to relationships with colleagues; if they want to take on new roles they may not know how to go about it – it’s finding out what their objectives are.’ Amegavie has mentored more than 50 people and says only a couple of relationships have not worked out. ‘The most important thing is being a good listener and that people find you easy to get on with,’ he adds. ‘You are not telling them what they should go and do. I’m saying what are the options you should consider.’ Many mentoring schemes try to mix people from different departments, organisations and even professions. ‘We get a lot of feedback that people really value that time with someone who is not part of the leadership structure in their organisation,’ says Becci Martin, who runs the NHS North West mentoring scheme and was a finalist in the NHS Mentor of the Year competition. This outside view may encourage mentees to come up with innovative ideas, she says. For Advita Patel, who works for Manchester Mental Health and Social Care trust, discussions with her mentor led to a change in career direction from IT to communications and marketing; she went on to do a part-time MA in marketing. ‘They really gave me a clear focus,’ she says. ’It is really good to talk to someone who is not involved in your everyday life.’ She has now become a mentor herself. In the West Midlands, Dr Jagdeesh Dhaliwal brought together healthcare professionals from different disciplines in a primary care leadership and mentoring group aimed at improving services. It is designed to be ‘truly inclusive – not GP dominated’ and encourage synergy between the widely
“Someone said they wanted to set up a new cost accounting system... but they really wanted a better relationship with their boss” Dr Jagdeesh S. Dhaliwal, Director & Honorary Associate Clinical Professor, University of Warwick
differing participants, he says. The 60-strong group involved a pyramid structure with 10 leadership coaches who each mentored a small number of participants from different backgrounds. While the mentees may have started off with specific problems they needed to resolve in their own organisations and disciplines, it soon became obvious that there were common issues: areas such as interpersonal relationships and managing difficult people came up regardless of the professional background of the mentee. ‘Someone said they wanted to set up a new cost accounting system in their organisation but really they wanted a better relationship with their boss,’ says Dr Dhaliwal, another finalist in the 2009 competition. There seems to be a tremendous demand for mentoring – and no shortage of experienced managers willing to help. NHS London, which is now setting up a region-wide scheme, recently asked people prepared to mentor to get in touch: 200 did so in the first two weeks. Although anyone in the region can request a mentor, the NHS North West scheme puts some limitations on who they can choose: an admin assistant,
looking to take the first steps on the management ladder, can’t choose a chief executive, for example. Martin, who is also a mentor, says this prevents some individuals being bombarded with requests to mentor. Mentees can apply online, specifying criteria, and are then matched with a shortlist of three potential mentors. They can choose after discussing their needs with all three. However, some schemes are more targeted. NHS London ran a mentoring for diversity scheme which focused on BME staff and specified that they should be at Agenda for Change grade 8b. Other schemes will accept anyone who has a managerial or leadership element to their role, or who aspires to become a leader. Mentoring needs a more professional framework than a chance conversation in a corridor. In the North West, potential mentors get training before issue 6 | summer 2010 | healthcare manager
Ben has been a mentee during his time on the graduate management scheme and in his first two jobs. He works as a divisional accountant in family care at East Lancashire Hospitals Trust and now has two Ben Roberts, 29, mentors – a PCT chief executive and an SHA finance director. mentee ‘I’m just coming to the end of my first 12 months in post. I have moved to a new patch with new people so that was a little daunting – it’s a different culture and organisation,’ he says.
On the receiving end
‘For me, getting a mentor was an automatic decision. On the management scheme, we were fast-tracked – we had to go into an area, pick up the skills and run with it. Because you are moving on quite quickly, you don’t always get to work through any challenges. Mentoring helped me look at some of the issues that had arisen. ‘There are quite a few challenges in my current organisation around performance and finance. That’s where the mentor comes in – when you have had a bad week, they give you support, and an objective perspective. For me that’s a real bonus; it helps me to see the bigger picture. It pulls you out of the moment and helps you to refocus.’
they join the scheme and have access to top-up training and masterclasses. A formal qualification for mentors is being developed. Mentors also need to create a challenging atmosphere in which mentees can examine their own actions, beliefs and behaviours. That doesn’t mean encouraging a macho, ‘heroic’ form of leadership. Dhaliwal explicitly does the opposite, using examples of effective leaders with a more consensual style, such as West Midlands SHA chair Elizabeth Buggins. Dhaliwal argues that sometimes mentees may get most from a mentor who they don’t have much in common
with. ‘A situation where you are with someone who has a completely different style, who sees things from a completely different perspective, and may even rub you up the wrong way, can be incredibly fruitful,’ he says Some potential mentors have fears about controlling the relationship: will they get calls in the evenings and weekends, for example? Dr Amegavie admits he finds it hard to say no to mentees and often ends up working on a Sunday. But his mentees obviously value his commitment and willingness to see it as open-ended. In the North West, ethics and the need for confidentiality are addressed in mentors’ and mentees’ training and they are encouraged to agree a framework for the relationship – which can include times and method of contact. Often, mentees must show commitment: with Dhaliwal’s leadership sessions, participants who didn’t turn up might not be able to continue.
“People really value that time with someone who is not part of the leadership structure in their organisation.” Becci Martin, head of NHS North West mentoring scheme
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So what difference does mentoring make? Martin says it aids career development, helps people to embrace changes and deal with challenging situations. As a mentor, she has seen her mentees grow in confidence and then move on to better jobs. ‘We tell people to ask for a mentor before they need one. They can give you the tools and strengths to manage difficult situations,’ she says. In the long term, she believes mentoring managers can lead to better services for patients. Participants on Dhaliwal’s course were unanimous that it had impacted on them personally and five out of six felt it had led to changes for patient services. He can point to individuals whose careers have benefited considerably – one becoming a medical director, and another, a podiatrist, who went on to chair their PCT’s professional executive committee. ‘A lot of people say they now feel on a launch pad for being able to do other things,’ he says. Amegavie has mentored other BME staff who have gone onto consultant and even clinical director roles. And for mentors, there is the personal pleasure of helping someone and seeing them progress in their career; contact may continue for some years, either because the mentees want further advice or simply because they want to keep in touch on a personal level.
With the smoke finally clearing after the Westminster election, Scottish health secretary Nicola Sturgeon spoke to Gerry Hassan about Scotland’s separate road to NHS reform.
There is no British NHS, but four separate systems in England, Scotland, Wales and Northern Ireland. These have become more disparate in how they operate since devolution, with the English NHS shaped by competition and increased fragmentation, and the Scottish by partnership and prioritising equity. The Scottish Cabinet Secretary for Health, Nicola Sturgeon, is also Deputy First Minister in the SNP minority government and MSP for Glasgow Govan. She has been a rising star in the nationalists for twenty years and still hasn’t quite turned 40. She has been in charge of Scotland’s health since the SNP took office three years ago. Widely seen as a capable and successful minister who understands her far-ranging remit, she is advancing a progressive agenda which will have to adapt to these uncertain times of public spending constraint. Sturgeon sees the English system as very much shaped ‘by competition and markets’, which are less relevant to Scotland’s different traditions and needs. Scotland also lacks the think tanks and policy advisers who drove the English NHS into such an ap-
proach. ‘Given our size and geography, a market-led approach just wouldn’t work,’ she says. ‘I don’t quite know how you compete for services in the farthest corners of Scotland.’ ‘Health’, she points out, ‘is 99.9% devolved, and of that 99.9% there are some areas where power is devolved
“Health will always be political, but we have quite a broad consensus in Scotland. Even the Tories don’t argue for an English model of health care delivery.” but we choose to co-operate on a UK basis, like pay negotiations’. She says the Holyrood government has a good relationship with the UK Government, noting that ‘they have been making interesting comments on wanting to take action on alcohol pricing’. The SNP minority administration is still unable to get cross-party support to promote this public health measure
through the Scottish Parliament. At the same time there is ‘such a divergence between Scotland and England on the structure of the health service and how it is managed’, Sturgeon says, which means that ‘even if there is a difference between Andrew Lansley and Andy Burnham, the difference between Scotland and England remains huge’. She points out that ‘health will always be political, but we have quite a broad consensus in Scotland. Even the Tories don’t argue for an English model of health care delivery’. She argues that the Scottish NHS works as an integrated single system without ‘the market-based, internal competition England has’, but acknowledges there is no room for complacency. ‘The proof is in the outcomes, in reduced waiting times, in our recently published Quality Strategy which will have much more measurements on patient outcomes.’ These are difficult times for public services across the UK and Scotland. Ten years of growth in Scottish spending saw massive increases in the Scottish block, which funds the Scottish Government, and, with it, health spending. Some see these ten years (eight with Labour-Lib Dem coalition governissue 6 | summer 2010 | healthcare manager
INTERVIEW MICHAEL BOYD
“There has to be a quality of managers there, particularly when we are going through such a process of change.” ment) of increased public spending north of the border as leading to an avoidance of hard choices. The new UK Conservative-Lib Dem Government has announced cuts of £6.2 billion from public spending. According to Sturgeon, there is uncertainty as ‘we don’t know the extent of the cuts this year. We don’t know if they will fall disproportionately on reserved areas which will lessen the impact on Scotland, or the impact on Barnett consequentials [the Treasury formula under which Scotland’s share of public spending is calculated].’ But Sturgeon projects a quiet optimism, observing that ‘this year we 14
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have secured a real terms increase for health, against a real terms cut for all. We think it is important to do that, and we will strive to keep real terms increases for health if the coalition government keeps to its promises.’ Scotland, like everywhere, is looking for savings and to safeguard ‘frontline services’. ‘Every penny health boards make in efficiency savings’, says Sturgeon, ‘they will keep. We don’t take it back’. She says that ‘it is for boards to determine how they reinvest those monies; there isn’t a central definition of frontline services’. The Cabinet Secretary is keen to confirm the value of good manage-
ment. A lot of thinking and care has gone into managing this difficult period via ‘succession planning’ and ‘service redesign’, and managers have played a key role. ‘I don’t believe managers are not important’, says Sturgeon. ‘There has to be a quality of managers there, particularly when we are going through such a process of change.’ Sturgeon says, ‘Managers in Partnership have a role to play in building the capacity of managers in Scotland’ and that she can help by reducing insecurity. Even in this financial climate, the SNP government still has ‘a commitment to no compulsory redundancies’ which is ‘really important because it is giving people an assurance that their own job is not under threat,’ she adds. This may give some solace, but MiP members in Scotland were unhappy about the reversal of recent pay decisions by the SNP government. For the Cabinet Secretary, the national system of performance pay is ‘a process of senior manager pay which works well’, and there was a need to pay attention ‘to senior managers pay given the financial climate’ and to impose pay restraint. Like other NHS managers, those in Scotland work with a range of partners, and one of the main ways is through Health Boards and local authorities working together in Community Health (Care) Partnerships (CH(C)Ps). In recent times, in the largest Health Board, NHS Greater Glasgow and Clyde, huge problems have arisen with the City Council. This conflict has been building for years, involving differences in personnel, cultures and values. Sturgeon sees the problem clearly as one in which ‘the Health Board have done all the right things’ and the arrangement has ‘fallen apart because the council reneged on an agreement to devolve resources and responsibilities’. The Health Board, according to Sturgeon, came forward with £500 million in resources, but the council only provided half this. Although it is still unclear what the final outcome will be in Glasgow, the Cabinet Secretary
still sees this model, developed by the previous Labour-Lib Dem administration, as worthy of support. One of the current policy planks of the SNP for the Scottish NHS is partly elected Health Boards. How does this avoid institutionalising the status quo, as people get involved to keep their local services open? It is a risk Sturgeon recognises, but dismisses. ‘We are piloting this in two areas [Fife and Dumfries and Galloway]. In one of them we have 71 candidates and in the other 61. Reading through the candidate biographies, it’s not 71 or 61 people from one group or interest, it’s a broad range of people’. She is sceptical about the ‘John Reid’ question – where Health Boards are used by local politicians to campaign against the health decisions of their own party or opponents – and sees huge potential in the boards. ‘We could revolutionalise our health services. We elect people to run our schools, so why not for our hospitals and health services?’ She believes that ‘Health Boards are seen as foreign lands’ by the public and elected boards can help ‘break this down’ and encourage ‘people living in communities, not health professionals’ to make difficult decisions. Despite this and previous Governments’ best endeavours, Scotland’s public health is among the worst in Western Europe. Research shows the substantial scale of ‘the Scottish effect’ (Scottish public health outcomes adjusted for socio-economic differences with England) and ‘the Glasgow effect’ (ditto for Glasgow in relation to Scotland). Sturgeon acknowledges the need for ‘an approach involving health prevention, CHCPs, the emphasis on smoking, alcohol and obesity, along with early years’ intervention’. Then there is ‘Glasgow Centre for Population Health’s excellent wealth of work and materials, and [Chief Medical Officer] Harry Burn’s research looking at how the brain is affected by stress, which challenges perceived wisdom’. How do we bring about change? How do we shift away from the all-
powerful medical model – which has so many powerful advocates – which dominates much of our discussions in public and private? The answer Sturgeon says is in attitudes and cultural change and long-term horizons that move beyond policy and election cycles. ‘It is difficult for politicians – as it will be 20 years before anybody gives you any credit – and we think in fouryear cycles’. Shifting behaviour and attitudes requires a more grown up and subtle approach, she says, including ‘the media changing how it reports health’. This on a day when First Minister’s Questions was dominated for the second week in a row by health, with Alex Salmond, First Minister and Iain Gray, Leader of the Labour Opposition, disagreeing on the scale of health cuts and who is responsible. The tone in such exchanges is never edifying, and the mutual antagonism
clear, but somehow in this context, Scotland has to preserve its different traditions and values, while beginning an honest conversation about the public spending realities and the challenges ahead. No one ever said life was going to be easy or dull for Nicola Sturgeon. ‘We are inching along, not going fast enough, but in the right direction,’ she claims. Having already supported MiP by speaking at the union’s first Scottish Parliamentary reception in February 2010, Sturgeon continues to feel that there is a central place for NHS managers in delivering services and change, with ‘trust’ and a sense of ‘ownership’ central to this for managers and other stakeholders across the NHS in Scotland
Gerry Hassan is a writer, commentator and thinker about Scotland, the UK, politics and ideas.
issue 6 | summer 2010 | healthcare manager
HEALTH & WELLBEING
Can we boost productivity and quality by making the NHS a better place to work? Craig Ryan spoke to Dr Tim Anstiss, whose Changing Minds project aims to do just that in London.
Some managers may not feel it’s their job to make people happy, but there is strong evidence that happy workers are more productive, loyal and creative, attend better and give more discretionary effort. This has been recognised for a while, but the recent report by Steve Boorman was the first serious attempt at an NHS-wide strategy to boost performance by improving the health and wellbeing of staff. Boorman emphasised that organisations that make staff health and wellbeing a priority showed ‘improved patient satisfaction, stronger equality scores, better outcomes, higher levels of staff retention and lower rates of sickness absence’. In London, unions and employers are working together to put Boorman’s report into effect. ‘We discuss how to put the health and wellbeing of NHS staff on the map and ensure it gets equal priority alongside other all the other proposals jockeying for position,’ says Jo Cooper, MiP national officer for London. One of the fruits of this approach is the 16
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Changing Minds programme being run by former occupational health doctor Tim Anstiss. Funded by the London Social Partnership Forum and strongly backed by MiP, it aims to train 1,000 NHS staff this year in working together to create better workplaces where people can flourish and reach their potential. Each NHS organisation in London can send ten to 15 people on the course during 2010. ‘So far, we’ve had 150 people, including HR directors and directors of OD, a couple of consultants, directors of nursing, radiologists, porters and security people,’ says Anstiss. ‘Steve Boorman’s report highlighted the omnipresent issues of sickness absence, staff wellbeing and improving productivity and performance, and the need for more supportive and collaborative management styles,’ says Cooper. ‘I’m personally very interested in Tim’s work and hope MiP members will sign up for one of his courses.’ While most post-war psychology focused on what’s wrong with people – depression, anxiety, drug and alcohol problems – the emerging science of
‘positive psychology’, on which the Changing Minds programme is partly based, looks at what’s right with people – wellbeing, thriving, happiness, engagement, life satisfaction – and how we can get more of it. ‘In the NHS you’ve got highly-trained, compassionate, intelligent people, who really get the values of the NHS, but sometimes management alienates them and pisses them off,’ says Anstiss. ‘My opinion and that of others is that productivity and wellbeing would increase if some managers took six months off. It may not be the manager’s fault, but their style is commonly authoritarian. I’m very interested in how you help managers develop a more humanistic, participative and engaging style.’ You might need an authoritarian style sometimes – in the operating theatre or the theatre of war, for example – but in most public-sector settings a more guiding and consensual style yields better results. ‘Some managers have never been trained like that, or they have a very authoritarian manager themselves, and that harassing, performance-driven
HEALTH & WELLBEING
“Sometimes people have to think a long way back to remember feeling good at work... and that’s tragic.” style cascades down,’ says Anstiss. There is a continuing gulf between management theory and practice. Physicians and nurses have embraced evidence-based approaches, but ‘management is all over the place,’ he adds. ‘Sometimes people have to think a long way back – even to a previous job – before they can remember feeling really good and really strong at work,’ says Anstiss. ‘And that’s tragic. Its suggests… we’re making them do things which don’t tap into what they’re naturally good at.’ Changing Minds also aims to reduce behaviour that can produce ‘toxic workplaces’, where disengagement and depression can quickly take hold (see box). In America this has become known as the ‘no asshole’ rule – which aims to eliminate some types of people from the workplace altogether. ‘I don’t agree with that, because I’m not into labelling,’ says Anstiss. ‘We all engage in some of those behaviours some of the time, but some people engage in a lot of them a lot of the time. Our aim is to change work climates by reducing the prevalence of some of these toxic behaviours.’ Bullying and harassment are still alarmingly common in the NHS – in the 2009 staff survey more than one in six staff said they had experienced it from their managers or other staff. A 2007 survey by Towers Perrin found that only 12% of public sector workers were ‘highly engaged’ with their work, while 22% were ‘disengaged’. People who are disengaged at work are at increased risk of depression and anxiety. ‘I worked in occupational health for seven years and I’ve seen a lot of people whose mental health problem was simply down to the way they were treated at work,’ says Anstiss. ‘The style of management they were exposed
The Dirty Dozen
12 behaviours which contribute towards toxic workplaces
1. Personal insults 2. Invading someone’s ‘personal territory’ 3. Uninvited personal contact 4. Threats and intimidation – verbal and non-verbal 5. Sarcastic jokes and teasing used to deliver insults 6. Withering e-mails 7. Status slaps designed to humiliate 8. Public shaming 9. Rude interruptions 10. Rolling Eyes 11. Dirty looks 12. Treating people as if they are invisible For more information on the Changing Minds project visit Tim Anstiss’s website: www.appliedwellbeing.com.
to was literally making them sick. It’s a crying shame that some managers allow environments that actually generate illhealth in NHS workers.’ Studies in America show this to be a particular problem in healthcare. The NHS ethos is different, but it still has a largely hierarchical management structure which owes much to the clinical processes of diagnosis and treatment. Anstiss says the NHS needs to create less hierarchical organisations, where people feel valued and respected, rather than picked on, ignored and told what to do. ‘You still know who’s the boss, but the hierarchy is less emphasised. People don’t have to pay so much attention to the threat from the inside and can focus more on doing good work. ‘Culture eats strategy for breakfast,’ he warns. ‘If your culture is poor, you’re just not going to get your strategy implemented. But one great strategy could be simply to improve the culture.’ By helping individuals to flourish and getting the culture right, Anstiss thinks it may be possible to create a virtuous circle. ‘We know things can get worse and worse. Teams and organisations can and do go on a spiral of decline; my guess is there probably is a science of creating virtuous circles and upward spirals. That’s a real task for leaders.’ This is one of the reasons the programme is called Changing Minds. ‘We need a change in the mindsets before we get a change in the skills and the behav-
iours,’ says Anstiss. ‘We know that depression can knock out some of your brain functioning… It may well be that positive psychologies do have a positive effect, they may rewire and change the brain over time in a good way.’ But is it also possible to make people overly self-conscious and push out beneficial forms, such as honesty, frankness, and passion? Anstiss is alert to the danger. ‘Generally speaking, if you’re respected and liked things are going to get better. But the manager should be the judge of which style to use in which situation. I want to increase management’s choices… I don’t want to stop them causing discomfort for some people sometimes, when that’s the right thing to do.’ In the end, the skilful manager needs to build a balanced team. ‘To build a strong team, I need people whose strengths will balance my weaknesses,’ Anstiss says. ‘But people don’t tend to like working on their weaknesses. Nor does it lead to big improvements in performance. Organisations would be happier and more productive if they played to people’s strengths rather than worked on their weaknesses.’
Craig Ryan is a freelance writer and associate editor of healthcare manager. For details about the London workshops contact email@example.com.
issue 6 | summer 2010 | healthcare manager
The SDO Network helps NHS managers to make better use of research and build links with researchers. Network manager Tom Barker explains how it works.
The National Institute for Health Research Service Delivery and Organisation programme (NIHR SDO) was established in 1999. It aims to improve health outcomes by commissioning research evidence that improves practice in the organisation and delivery of healthcare, and by building research capability and capacity among those who manage, organise and deliver services – improving their understanding of the research literature and how to use research evidence. As well as commissioning new research, the NIHR SDO is interested in stimulating ‘knowledge mobilisation’ – the interactive exchange of researchbased findings and ideas between researchers and managers – and ‘absorptive capacity building’ – improving local capacity to access and use management research within the NHS. A key agent for knowledge mobilisation is the SDO Network, hosted by the NHS Confederation. The SDO Network helps managers to better engage with research by organising interactive events, developing local learning sets, facilitating placements and acting as a knowledge broker. 18
issue 6 | summer 2010 | healthcare manager
The SDO Network’s members have access to a range of services customised to meet the needs of senior, operational and new NHS managers. The SDO Network provides a way to work and reflect on the latest research with colleagues, peers, academics and leaders from the private sector. Management fellows One way of stimulating knowledge mobilisation is by funding SDO management fellows. Management fellows are drawn from the local NHS and are attached to SDO-funded research teams. The aims of these fellowships are threefold: first, to improve the quality and relevance of the research itself, through greater managerial involvement; second, to develop capacity among managers for using research evidence; and third, to encourage greater linkage and exchange between researchers and practicing managers in healthcare management. Nine of these fellowships have so far been funded. The SDO Network supports learning through these fellowships to ensure the spread of good practice and to enhance professional networks for knowledge mobilisation.
Interactive learning events The SDO Network’s interactive learning events provide a platform for leading academics to present their latest research on key issues facing the NHS, focusing on the implications of their findings for healthcare managers. These events also involve NHS managers who have successfully implemented service improvements and give service users an opportunity to provide their perspective on change. At our workshops managers can discuss with their peers how to best use research to improve health services in their own organisations and create action plans for initiating changes. At
“The SDO Network helps managers to better engage with research by organising interactive events, developing local learning sets, facilitating placements and acting as a knowledge broker.”
recent learning events, held in London and Nottingham, delegates heard from researchers, service users and leading managers about how to improve acute psychiatric services. Chief executive forums The SDO Network hosts two regional forums for chief executives, each looking at how current research evidence can support them to deliver their business priorities. Each forum meets two evenings per year, inviting researchers to present and discuss their research findings on a current issue and providing an opportunity to influence future research commissioning plans. Connecting the NHS management and research communities The SDO Network brokers communication and relationships between NHS organisations and health service researchers to improve the
quality and relevance of health service research for the NHS; develop capacity in the NHS managerial community to access, appraise and use research evidence to inform decision making; and encourage greater engagement, linkage and exchange between research and healthcare management. We provide a ‘matchmaking’ service between network members and SDO project teams, finding the right NHS organisations to take part in and inform academic research. Our annual research conference, run in partnership with the Health Services Research Network, brings together NHS managers and researchers to examine and discuss new and emerging evidence. Influencing future research priorities Members can influence the future NIHR SDO research commissioning programme by meeting with SDO researchers and managers at workshops
and seminars. This includes discussing their priorities with programme directors at chief executives’ forums and through periodic opportunities to join research commissioning panels. Signing up to the SDO Network The SDO Network is hosted by the NHS Confederation and sits alongside the NHS Confederation’s Health Services Research Network, which represents the health services research community, providing a national voice for all those involved in this specialised research area. These relationships enable us to forge strong ties between the NHS management and research communities
Tom Barker is SDO Network Manager Membership of the SDO Network is free to NHS organisations. To join and to find our more about the SDO Network, please see the SDO Network website: www.nhsconfed.org/SDONetwork, or email SDONetwork@nhsconfed.org.
issue 6 | summer 2010 | healthcare manager
legaleye The new “fit notes” could lead to challenging exchanges between employers and employees. The traditional ‘sick note’, or medical statement, was replaced on 6 April by the statement of fitness for work or ‘fit note’. This means that GPs can advise that employees are either ‘not fit for work’ or that they are fit for work subject to changes in working practices. If GPs think someone is fit for work without any conditions, they will simply not issue a new medical certificate. The new note will still be required as evidence for claiming sick pay after seven days’ absence. The four types of changes to work which GPs can advise would mean someone is fit to return to work are: ** A phased return to work ** Altered hours ** Amended duties ** Workplace adaptations There is also space for the doctor to provide more information on the employee’s condition and how it may affect what they can do. The new medical statement is
“GPs may not have any occupational health expertise and may not have a comprehensive understanding of an individual’s job.”
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intended to support people with health conditions, or those who have been injured, in getting back to work earlier than under the old system. Thompsons support that aim in principle. It is always better to help people back to work than to have them off sick. Most people recognise the therapeutic value of returning to work as soon as possible, as long as it does not make their condition worse. However, GPs often do not have any occupational health expertise and may not have a comprehensive understanding of an individual’s job. There is no suggestion that GPs will receive training in how to better recognise industrial diseases or other work-related conditions. And their judgement about whether the employee may be fit to return, and the suggestions they make about the alterations the employer should implement, will be based solely on the patient’s condition and ability to properly explain the nature of their job, rather than any knowledge of the job itself. Clearly the employer, in consultation with their employee, is best placed to decide what changes they can make to facilitate a return to work. As the TUC has said, this is likely to introduce some challenging dialogue between the employee and the employer. The danger is that some employers may take someone back before they are ready, or even coerce them with threats of pay cuts or dismissal on capability grounds –
even though it may have been work that caused the employee’s absence in the first place. It is the employer’s responsibility to carry out a risk assessment, to correctly implement GP advice and to monitor compliance with fit notes. Employers should also update their absence arrangements, return to work schemes and occupational sick pay schemes. But there is no compulsion on employers to make the adjustments – even if the suggested adjustments are appropriate. Many people remain on sick leave because employers fail to make adjustments to enable them to work again and this voluntary approach is highly unlikely to change that, or to tackle the issue of longterm health and wellbeing. Employees will of course still be able to raise grievances about the risk of injury, failure to make adjustments and breaches of the Disability Discrimination Act, and this should focus employers’ minds if they want to avoid a claim for personal injury or discrimination. The fit note must not be used to force employees back to work too early or to accept a pay cut. The TUC recommends that union reps ensure they have procedures in place to deal with issues that arise as a result of the changes to the medical certificate and which could result in grievances
Tom Jones Thompsons Solicitors
Executive Aspirations? Judy Butler on how to prepare for the challenge of a board-level role. Many managers aspire to a seat on the board, but it is a often a large step up, and the knowledge, skills and leadership styles required are different to those that earned the promotion in the first place. Executives carry responsibility for both their specific functional or operational areas and the broader organisation. They must visibly lead the organisation’s agenda, ensuring the vision and strategy meet the needs of patients and the workforce, and are communicated in a way that clinicians and managers can understand and apply to their own positions. This requires a strong executive team where all members contribute effectively to robust discussions, grasping diverse issues quickly, challenging and being challenged to ensure the right decisions are taken.
In this environment, tough and seemingly intractable problems must be dealt with – they cannot be passed upwards. Executives set standards in the workplace by what they do (or don’t do) and how they do it. Their behaviour and choices at key, often difficult moments will always be scrutinised by the workforce and external stakeholders and will affect how they and the organisation are viewed. These important roles are not easy. Becoming a good executive is as much about attitude as ability. It takes resilience and a great deal of emotional intelligence. It is about soliciting and paying attention to feedback, listening as much as talking, negotiating where needed and not shying away from tough situations. Should you still choose to take on this challenge, how can you prepare?
eep abreast of national, regional and K local issues on healthcare ** Attend a public board meeting to observe the issues, the standards and style of business ** Shadow a current director and attend internal meetings where possible ** Champion and get involved in an organisational project ** Present a paper to your own executive team ** Find a mentor to discuss the role with (see page 10) ** Seek ongoing coaching and development to gain feedback and enhance your personal style **
Judy Butler is a senior consultant with Coalescence Consulting Limited: www.coalescence.biz
Tipster: Mental toughness With major health service cuts looming, now is the time to develop your mental toughness. This will give you the physiological edge to perform at maximum potential, deliver results against the odds and deal unshakeably with the challenges to come.
Be confident Have confidence in your ability and you will prepare yourself for success and to deal with setbacks.
Stay focussed Develop the ability to concentrate on the task in hand and resist distractions – this helps prevent mental collapse when the going gets tough.
Accentuate the positive Make the most of apparently grim tasks. Think about situations that make you feel frustrated, rushed or intimidated, or cause you to lose focus,
and turn those negatives into positives.
Pick yourself up Look at failure as a stepping stone to success. Play to win rather than worrying about making mistakes. If you don’t succeed this time, learn from it. Think about how you could have achieved a better outcome.
Keep motivated Finding motivation is easy – keeping it is a challenge! Keep notes of your goals and success stories around you. Surround yourself with positive people who encourage you in tough times.
Practice composure Once you are in control of yourself, you are less nervous and more able to take control of your situation. The clearer your thoughts, the better your decisions.
Be courageous Seize the opportunity to take brave actions. Look for opportunities to take control, even if it’s something you’ve never done before.
Develop resilience All these will help you develop resilience and see your goal through to the end.
issue 6 | summer 2010 | healthcare manager
MiP AT WORK
MiP maps out programme for PCTs Shropshire
Left to right: Jon Restell, Pete Lowe, Jo Chambers, PCT Chief Executive, and Paul Draycott, Director of OD and Workforce
MiP has been building its membership in West Midlands. We visited a number of organisations in the region to meet managers and employers to recruit members and help to boost partnership working. MiP chief executive Jon Restell and national officer for recruitment Martin Furlong joined national officer 22
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for the Midlands, Pete Lowe, on a visit to Shropshire County PCT. They met with managers and members of the executive team, including chief executive Jo Chambers and Paul Draycott, Director of Organisation Development. Among other things, they discussed plans for road shows to promote the benefits of trade union
membership for PCT staff. Speaking after the visit, Jon Restell said: ‘MiP wants to do several things for its members in PCTs. First, support them through the cuts in management costs in the pipeline, and the resulting job losses and re-organisation. This a key job for any union and one we know we can do well. ‘Secondly, there are some big issues with terms and conditions for managers who continue their careers in new structures. Directors’ pay remains a mess and we are plugged into the PWC job evaluation exercise, which we lobbied hard to save from the chop. We will also conduct a major survey of PCT and SHA directors in the summer which will form the core of our evidence to the Senior Salaries Review Body in November. Many managers already work crazy hours and their health and wellbeing will need attention as the service demands “more for less”. ‘Thirdly, there are some important messages that need to be heard from the managers working in both commissioning and provider arms, about the quality of commissioning, particularly around localism and future relationships with providers, and the quality of services after the transfer of community services to new organisations. ‘Getting our work right on all three fronts is why we valued the day we spent at Shropshire County PCT. It was great to have the time to listen carefully to excellent, dedicated managers like Jo and Paul and to test our ideas with them. We hope to keep the contact up with another visit in the autumn.’
15274 MiP Rec 213x110 ad:Layout 1
Meeting the post election challenge
Page 1 WORK MiP AT
These are uncertain times.
Yorkshire and the Humber In Yorkshire and the Humber, national officer Jane Carter and national committee member Robert Quick have organised two meetings to launch the Yorkshire and the Humber MiP network. The theme for these meetings is ‘Challenges for NHS managers, post election’. ‘This will be the first opportunity for members of MiP in this region to get together,’ said Jane. ‘We are holding the meetings in two different locations to maximise the opportunities for members to attend. It gives them the chance to meet me and Robert, as well as networking with each other. ‘MiP members have valuable expertise and knowledge which we can share with each. We have serious matters to discuss, but all members and potential members will receive a warm welcome, and we’ll have a chance to get to know each other better at the informal drinks receptions after the meetings.’ If you are an MiP member or thinking of joining, and would like to attend one of the meetings, contact Jane Carter at j.carter@ miphealth.org.uk
Reduce the uncertainty, join MiP. One thing is for certain in such times, you need support. MiP is the UK’s only trade union organisation that solely represents healthcare managers. We provide an influential voice, personal support and employment advice, management skills and access to leadership networks.
Yorkshire and the Humber
Our experienced team of employment professionals is on hand to offer one to one confidential advice, negotiation and representation and fast access to legal resources.
Challenges for NHS managers, post election
Join MiP today. Visit www.miphealth.org.uk/membership/whyJoin.asp
MiP Network Meetings
July 13, 2010 | 5.30-7.00pm NHS Employers, Leeds July 14, 2010 | 5.30-7.00pm, Rotherham Hospital NHS Foundation Trust
issue 6 | summer 2010 | healthcare manager
Send your cuttings, anecdotes and overheard indiscretions (delicately handled) to Celticus at backlash@ healthcare-manager.co.uk or follow Celticus on twitter @Celticus_UK.
by Celticus WronG NUMBEr!
More pen-pushers than the private sector Claims that the NHS has become a top-heavy bureaucracy bloated with managers and administrators were two-a-penny during the election campaign and have scarcely abated since. This is a persistent fallacy about the NHS. In fact, according to official NHS figures only 3.6% of NHS staff are managers, with a further 8.7% made up of admin and clerical staff. The latest Labour Force Survey shows that 15.4% of UK employees are managers and another 11.3% work in admin jobs. The NHS actually has a lower proportion of managers than any economic sector, except for agriculture and fishing. Wrong Number! exposes misleading statistics used to attack people who work in the NHS.
He also wrote glowingly of our island: ‘At last a nation where healthcare is a right and carrying a semiautomatic machine gun is a privilege, instead of the other way round.’ Sadly, not as true as we’d like it to be.
Opponents of President Obama’s healthcare reforms have now trained their sights on blocking the appointment of Dr Donald Berwick (pictured) as head of the US staterun medical insurance schemes, Medicare and Medicaid. What’s got up their noses is Berwick’s professed admiration for the NHS. Speaking at the 60th anniversary celebrations two years ago, Berwick told his audience: ‘I am not a cynic. I am romantic about the NHS; I love it.’ 24
There might be a slight flaw in the criminal ASBO handed out to Christopher Dearlove banning him from seeking NHS treatment unless he is ‘genuinely ill’. Mr Dearlove, a homeless man who is apparently an ‘expert’ in faking symptoms of serious illness, has used more than 70 aliases to fool NHS staff into admitting him to hospital. He is now banned from every NHS hospital in the land. And if he breaks the terms of his ASBO? He could get up to five years in one of Her Majesty’s less hospitable institutions.
Whose cats are fatter? Much alarm among our friends at the Mail, the
issue 6 | summer 2010 | healthcare manager
Telegraph and the Sun, at the ‘revelation’ that a number of NHS bosses were among the 170 public sector ‘fat cats’ earning more than our new prime minister. But they’re hardly in the big league when it comes to executive pay. Are we really saying Sir David Nicholson isn’t worth £250,000 for running the £90bn NHS but Reckitt Benckiser chief executive Bart Becht earns every penny of the £92 million remuneration he gets for making Strepsils cough sweets and Veet shaving foam? Or that Chief Medical Officer Sir Liam Donaldson
isn’t worth a thirtieth of the £6.6 million paid to Michael McLintock, a director of Prudential, which just lost £450m on an abortive takover deal?
Nominate your Tweet of the Summer
Dozens of NHS organisations are making use of the Twitter social networking tool to send out health messages and to keep the public, NHS colleagues and media up to speed on what’s going on. So to encourage this, Healthcare Manager is offering a bottle of something French and fizzy for the best Tweet by an NHS body over the summer. Send your nominations to Celticus by email to the address above or by tweet to @Celticus_UK. Closing date 31 August. Winner announced in the next issue.
What’s in a name? Quite a lot in the NHS. Celticus’s campaign against verbosity in NHS nomenclature starts here. It’s bad enough that almost every hospital has to have NHS Foundation Trust stuck on the end of its name, but what do you do with something like ‘Smethwick & Oldbury Commissioning Alliance (SOCA) and Wednesbury and West Bromwich (WWB Clusters)’, whose address on the HCM database also runs to a further SEVEN lines? How does this make us look to the outside world? Send your most circumlocutory examples to Celticus and we’ll see if we can pare them down (just don’t try using the twitter address).
“ Doctor Doctor! ”
Big Difference Company’s Arts and Health programme
Designing and developing projects which tackle issues including: -
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In schools, prisons, youth settings or health scenarios the programme reaches out to provide unique ways of using comedy and laughter to address serious issues, where traditional solutions can fall down – Russell Coughtrey, Culture, Media and Sport, Government Office East Midlands
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