(contains facts, not gossip, unlike MBC’s blog)
(contains facts, not gossip, unlike MBC’s blog)
“Measures to improve the leadership and workforce of the NHS
We welcome the Department’s increased focus on improving its workforce planning in the NHS. However, we note concerns that planning will be concentrated in the Department. In our recent report on Workforce Planning we recommended that SHAs have a key role in this area. The Department should ensure that regional NHS employers are given a role in identifying future workforce requirements. “
“It is widely recognised that the quality of leadership in the NHS must improve and we welcome the Department’s ambition to do this. However, we note the following concerns about its proposals:
● There is undue reliance on new institutions such as the Leadership Council; we note that previous attempts to improve the quality of management and leadership in the NHS by introducing new institutions such as the NHS University have failed;
● The Department’s approach is over-centralised; and
● The emphasis on medical leadership is important; however, we are concerned that at present many doctors are put off becoming senior managers. We therefore recommend that more training and support be given to those who wish to take on senior management responsibilities. “
“It is unfortunate that the NSR does not place more emphasis on the importance of recruiting and developing better managers. Over many years this Committee has heard concerns about the quality of management in the NHS which witnesses to this inquiry echoed. Some managers lack the analytical skills or motivation to handle and interpret the wide range of performance and routine administrative data, such as HES, that they have to deal with. With the introduction of PROMs and other quality related measures this issue is becoming ever more important. We therefore recommend that the Department address the issue of weak management skills in this area with urgency. Senior NHS management, clinical and non-clinical, should acquire analytical skills which will enable them to understand the products of expensive and increased investment in clinical and cost effectiveness data. This should be a central component of their annual appraisals, and in the case of clinicians, linked to their systems of performance related pay (Clinical Excellence Awards). The pay and promotion prospects of managers should be linked to their skills, in particular their ability to analyse and use data. “
” Speaking at the launch, attended by representatives from a variety of Basingstoke’s leading businesses including Motorola UK’s new chairman Graeme Hobbs, (OK) was Common Purpose founder and chief executive officer, Julia Middleton.
A founder and former member of independent think tank Dermos, Ms Middleton spoke about her views on responsible leadership in uncertain times.She said: “I would suggest that we need more leaders who are prepared to look outside their own space and run the risk of being known as interferers – people who will look at issues that are not their own and not just stick to what is written on their business card.”
“Quality’, wrote Lord Darzi in his recent Next Stage Review of the NHS, ‘is improved by empowered patients and empowered professionals. There must be a stronger role for clinical leadership and management throughout the NHS’.
As the report acknowledged, compared to leading healthcare organisations such as Kaiser Permanente in the US, the NHS has very few clinicians in leadership roles – a fact fast being seen as a rate-limiting step to achieving quality of care. A raft of measures to encourage its development has been proposed, but will they be effective? Is this a new dawn, or merely a false beginning?”
“2007 was a watershed for the medical profession. Sir John Tooke’s Inquiry into Modernising Medical Careers called for the profession to speak with a coherent voice and to define the role of the doctor. The profession heeded that call. This is the current consensus on the ever evolving role of the doctor. It has been developed in consultation with the undersigned organisations, patient groups and those medical and lay delegates who attended the Role of the Doctor Conference in October. The statement builds on much recent work by the signatory organisations and should be seen in the context of the Duties of a Doctor as defined by the GMC in Good Medical Practice.
The Consensus Statement on the Role of the Doctor
Doctors alone amongst healthcare professionals must be capable of regularly taking ultimate responsibility for difficult decisions in situations of clinical complexity and uncertainty, drawing on their scientific knowledge and well developed clinical judgement. The doctor’s role must be defined by what is in the best interest of patients and of the population served.
Based on the definition of the role of a medical doctor proposed by the International Labour Organisation it is agreed that:
Doctors as clinical scientists apply the principles and procedures of medicine to prevent, diagnose, care for and treat patients with illness, disease and injury and to maintain physical and mental health. They supervise the implementation of care and treatment plans by others in the health care team and conduct medical education and research.
All healthcare professionals require a set of generic attributes to merit the trust of patients that underpins the therapeutic relationship. These qualities include good communication skills, the ability to work as part of a team, non judgemental behaviour, empathy and integrity. In addition to possessing these shared attributes doctors must be able to:
assess patients’ healthcare needs taking into account their personal and social circumstances
apply their knowledge and skills to synthesise information from a variety of sources in order to reach the best available diagnosis and understanding of the patient’s problem, or to know what steps need to be taken to secure such an outcome
support patients in understanding their condition and what they might expect, including in those circumstances when patients present with symptoms that could have several causes
identify and advise on appropriate treatment options or preventive measures
explain and discuss the risks, benefits and uncertainties of various tests and treatments
and where possible support patients to make decisions about their own care.
The nature of these core requirements emphasises the need to select those with the appropriate attributes for training. Medical undergraduate education must provide a strong grounding in relevant science and in clinical practice as well as providing opportunities to develop an appreciation for research. Doctors must have the ability to assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles and be capable of dealing effectively with and of managing uncertainty, ambiguity and complexity. They must have the capacity to work out solutions from first principles when the pattern does not fit. All doctors must be demonstrably committed to reflective practice, monitoring their contribution and working continually to improve their own and their team’s performance.
Doctors must all be committed to playing a part in the education and support of the next generation of medical practitioners and of facilitating the advancement of evidence based practice.
The doctor needs to be capable of assessing and managing risk; this requires high level decision making skills and the ability to work outside defined protocols when circumstances demand. Doctors must also be able to make informed decisions about when supportive care is more appropriate for the patient than intervention.
The doctor must possess the ability to work effectively as a member of a healthcare team, recognising and respecting the skills and attributes of other professions and of patients. Patients with long term and disabling conditions are particularly likely to be experts in their own condition and should be supported to keep as healthy and independent as possible.
All doctors have a role in the maintenance and promotion of population health, through evidence based practice. Some will enhance the health of the population through taking on roles in health education or research, service improvement and re-design, in public health and through health advocacy.
Notwithstanding the primacy of the individual doctor:patient relationship, the doctor must appreciate the needs of the patient in the context of the wider health needs of the population. For all doctors the patient must come first but they will achieve this in different ways and in different settings. As the critical decision maker with responsibility for significant health resources the doctor must be capable of both management and leadership and of taking ultimate responsibility for clinical decisions. Within a world where the capacity to treat is growing but financial resources are finite, doctors have a duty to use resources wisely and effectively and engage in constructive debate about such use. They should ensure that their own and others’ skills and knowledge are deployed to best possible effect.
Doctors have a key role in enhancing clinical services through their positions of responsibility. Some will move on from clinical leadership and management to leadership roles within organisations at various levels – service, institutional, national and international.
The role of the doctor is changing and will continue to change alongside the needs and expectations of patients. Patients are increasingly better informed and act as partners in their own healthcare. The doctor serves as advisor, interpreter and supporter in this endeavour.
This statement has the support of:
The Chief Medical Officers of England, Scotland, Wales and N Ireland, The Academy of Medical Royal Colleges, The Association of UK University Hospitals, The BMA, COPMeD, The GMC, The King’s Fund, The Medical Schools Council, NHS Employers and PMETB
Published December 2008
“It is amazing just how far the Demos team have ‘moved on’ from their days ‘upholding’ Marxism to embrace the ideology of the right, any old post-modern cobblers, big business and the shadowy connianvances of think tanks. Demos has spawned all manner of parasitical children. Take the example of Common Purpose (CP). This was started by Demos trustee Julia Middleton. It has been around for sometime but gained a great deal of funding with the advent of New Labour and its service towards business elites. Initially money was put in by David Bell, the Chairman of the Financial Times (and the Millennium Bridge Trust). CP is another strange organisation, a kind of secret society for careerists. Again the board has some mysterious figures presiding including Lord Dahrendorf, the chairman of the right-wing Ditchley Foundation and Prof. Laurence Martin of the like-minded Royal Institute of International Affairs. “>
“I shy away from that insanity, those things but these people are right into it and therefore it needs to be confronted. All my talk of cabals in the last year is only the surface issue. The real issue is the craziness coming out of Bavaria, Zurich, Paris and New York, not to mention London.
Very easy to spot – diffuse light blues blending into diffuse yellows in their headers, sun symbols, meaningless drivel as taglines, e.g. securing the future today and other balderdash like that. Their pages are slick and businesslike and they use feelgood terminology about “bringing people together” and so on. Second Life, the U.N. and Common Purpose are examples.
On the surface, it’s all about management, leadership and the new technological revolution but the rhetoric behind it is exactly the same which Agatha Christie wrote of in N or M [Dodd, Mead & Co., 1941] .
It’s the same old story – pinpointing likely people in positions of authority or who are likely to be, tweaking their egos by showing them and by associating them with snippets of the elite which controls the government of the nations, how they’ll be part of the crack leadership group sweeping away mismanagement and inefficiency and so on and so on. An example of one of these Brave New Worlders:”
“Visionary leadership or new-fangled management?
CP’s offer of visionary leadership training to enable the new managers to understand and negotiate the layers of organisational complexity in the new modern world significantly pre-figures the debate pending on the future of democracy and pre-empts any discussion that might be had about who we want leading us (if, indeed, we want that at all). The imagined community, with communal power at its centre, vanishes with the introduction of specially trained leaders appointed by nobody, who will sniff out where the “real power” in communities lies and act accordingly, having co-opted, relegated or sidelined opponents who are not specially identified and trained leaders.
Now here’s the thing. I can’t easily locate balanced debate on this subject, which puzzles me. The ‘pro’ people seem to assume that there’s nothing more than training involved. The ‘antis’ are sure that it’s all about indoctrination and control. I want to find out more about who’s involved with Common Purpose and what they think they’re getting out of it.”
“Will Regional Assemblies be formally abolished under the proposals just announced?
Regional Assemblies are voluntary organisations and therefore it is not within the power of government to abolish them. However, Government will give the Regional Development Agency (RDA) and the Local Authority Leaders’ Board joint responsibility for the regional strategy, including its drafting, implementation plan and monitoring of its delivery. As a result, the key regional planning functions of the Regional Assembly will pass to the RDA and Local Authority Leaders’ Board. Other residual functions will also pass to successor bodies as required and the need for Regional Assemblies will end. We will repeal any relevant legislation and transfer any funding to successor bodies.”
EXTRACTS FROM EXECUTIVE SUMMARY
“Even when backed by clear evidence, new technologies and practices inch their way too slowly through the vast web of structures that make up the National Health Service. !is is one of the reasons ourstandards often fall below those of comparable countries. Data collected by theWorld Health Organisation shows that
premature deaths from causes that are preventable with prompt and effective healthcare are higher in the UK than Germany, Canada, Australia and France. A lack of MRI and CT scanners can lead to long waits for diagnostic tests, while shortages in radiotherapy equipment are a factor in our comparatively poor cancer treatment. Among European countries, the UK is consistently below average in the adoption of new drugs for the treatment of certain common cancers. And within Britain, too, there is an unjustifiably wide variation in outcomes of care – the postcode lottery.
The final report of Lord Darzi’s review of the NHS, High Quality Care for All, published in June 2008, addresses the need for more and better information about clinical performance and examines ways to strengthen existing incentives to improve practice. But the work could be bolder about reducing costs, reforming procurement systems and simplifying the 40 plus organisations that have been created to improve rates of innovation.”
PROBLEMS DRIVING INNOVATION AND SPREADING NEW IDEAS ACROSS THE NHS
Organisational capacity for innovation and adoption
“The public service history of the NHS may mean that managers do not focus on the success of their organisation. NHS managers are not judged by how innovative they are or even necessarily by how far they improve services for patients. They are judged by how well they stay within their budget and meet the tasks demanded of them, such as the latest central government target or National Institute for Clinical Excellence (NICE) directive. Thinking of new ways to meet the needs of patients is not a priority – indeed current structures may even discourage it.
The health and social care systems are hugely complex, with messy lines of communication and spheres of responsibility, which encourage power struggles and bunker mentalities. As a result the barriers to the successful implementation of new technologies are greater in the NHS than in our other public services. Successive waves of NHS restructuring have not removed these barriers.
The landscape for procurement is heavily fragmented – the UK healthcare market consists of 426 NHS trusts, ten evolving or actual regional purchasing groups (known as collaborative procurement hubs), the NHS Purchasing and Supply Agency (PASA, created to provide procurement guidance to trusts), six private healthcare organisations, 11,000 healthcare suppliers and two nonpharmacy wholesalers.
These organisations buy and sell goods and services worth about £21 billion a year. Improving the effectiveness of their trading relationships and using contractual mechanisms to stimulate innovation require more attention, but despite its centrality in the spread of new technologies, procurement was neglected in the Darzi review……
SPENDING RESOURCES IN THE WRONG AREAS
“The UK spends over £8 billion a year on innovating, refining, piloting, evaluating, appraising and diffusing new healthcare ideas, including annual public sector spending of approximately £2.7 billion. But our research suggests that £2.4 billion is spent on the creation of new ideas, £0.1 billion spent on the adoption of these ideas, £0.06 billion on appraisal of these ideas and £0.15 billion on the spread and implementation of ideas. In other words, nearly 16 times more is spent on invention than diffusion. !e discrepancy between spending on creation and the appraisal of innovations is striking – the latter receives just 2% of the total public funds. Funds are too heavily weighted towards creation. After all, ideas are of no use if they are not applied. And the alphabet soup of organisations created by the Government to assist hospital trusts lacks a clear, joined-up strategy for spreading these ideas.”
POOR LEADERSHIP AND RISK AVERSION
“The capacity for innovation in NHS organisations suffers from an endemic aversion to taking risks. A study of change capability in the NHS by the Office of Government Commerce in July 2006 gave the NHS a score of only two out of a possible five points for seven out of nine categories assessed.
The NHS got low scores in the use of change management methods, staff development approaches and change leadership. Blame for failure outweighs the reward for success. Leadership has been described as being predominantly about “survival in a heavily orchestrated world”. Managers in the NHS tend not to act like leaders – engaging staff with the core mission of improving services for patients, and creating a collaborative, innovative environment for organisational development. Instead they focus on meeting directives and managing a budget. If an initiative is not demanded from above, then its financial and managerial burden is not balanced by any reward for success; failure, on the other hand, meets with immediate censure. And even if there is a potential financial or reputational gain, past experience of the difficulties in managing change and realising benefits contributes to extreme caution in assessing risks.”
“The outstanding leader sets a vision for the future, drawing on their political awareness of the health and social care context. This political astuteness and their vision for the future is underpinned by Intellectual flexibility. Coupled with Drive for results, this sense of Seizing the future is key in inspiring and motivating others to work with them.
Seizing the future
High performing leaders ACT NOW to shape the future. They are motivated to take action to achieve a radically different future – one in which health services are truly integrated and focused on the needs of patients.
Features of this quality include:
● Making the most of current opportunities to bring about improvements that are of benefit to staff, carers or patients.
● Being able to interpret the likely direction of changes in the health service and beyond – using their political astuteness.
● Using their insights into the broad strategic direction of health and social care to help shape and implement the approaches and culture in their organisation, and to influence developments across the wider health and social care context.
● Underpinning their vision and action with a strong focus on local needs.
● Being prepared to undertake transformational, rather than just incremental, change where this will achieve service improvement.”