Transcript of "Health Select Committee Evidence Dec 2011 "
Health Select Committee Inquiry into Education, Training andWorkforce PlanningDecember 2011Contact:Petra Wilton Philippa TuckerDirector, Policy & Research Public Affairs Managerpetra.email@example.com firstname.lastname@example.orgTel: 0207 421 2708 Tel: 0207 421 2723
Executive SummaryThe Chartered Management Institute (CMI) welcomes the Committee’s timely inquiry intoeducation, training and workforce development in the health sector. CMI has consistently calledfor a much greater emphasis on leadership and management skills development in the NHS,and is encouraged that this important subject is now gaining more attention.However, we believe that much work is still to be done if the Government is serious aboutachieving its Quality, Improvement, Productivity and Prevention (QIPP) efficiency targets andintroducing a completely new structure of commissioning, education, training and workforcedevelopment at the same time.We very much welcome the creation of the National Leadership Academy, the successor bodyto the National Leadership Council, but urge Government to pick up the pace in itsimplementation so that the achievements of the National Leadership Council are not lost. Weare also keen to learn more about the new arrangements for education and training, and howthe new structure will deliver much-needed improvements in leadership and management skills,both for clinical and non-clinical managers, particularly in terms of demonstrating what goodmanagement and leadership looks like.With the crucial recommendations of the Mid-Staffordshire inquiry keenly anticipated in the firsthalf of next year, the pressure is on Government, NHS employers and staff to raise the bar interms of leadership and management skills, so as to deliver improved patient care and to allythe public’s perception of alarming variations in care standard levels, particularly at the acutehospital trust level.1We look forward to working with Government and its agents towards better leadership andmanagement skills at all levels, and in all professions, throughout the NHS.About the Chartered Management InstituteThe Chartered Management Institute is the only chartered professional body in the UKdedicated to promoting the highest standards of management and leadership excellence. CMIsets the standard that others follow.As a membership organisation, CMI has been providing forward-thinking advice and support toindividuals and businesses for more than 50 years, and continues to give managers andleaders, and the organisations they work in, the tools they need to improve their performanceand make an impact. As well as equipping individuals with the skills, knowledge and experienceto be excellent managers and leaders, CMI’s products and services support the development ofmanagement and leadership excellence across both public and private sector organisations.Through in-depth research and policy surveys of its 90,000 individual members CMI maintainsits position as the premier authority on key management and leadership issues.CMI has an extensive network of approved centres around the UK, which are authorised todeliver our qualifications. To date there are 680 centres, many of which are FE or HEinstitutions, including Oxford University, Edinburgh Napier University and London South BankUniversity. Many leading employers are also registered CMI Approved Centres, such as VirginAtlantic Airways, National Express UK and PriceWaterhouseCoopers. We also work closely with1 See, for example, the recent media coverage of problems at Barts and the London NHS Trust(http://www.bbc.co.uk/news/uk-england-london-15983985) 2
leading business schools to develop our research and knowledge of the management andleadership profession, including Cass, Warwick, Henley, Cranfield and Ashridge BusinessSchools.We offer our qualifications to a wide range of learners through a flexible system of credit basedlearning units, which allows learners to study at their own pace, and in manageable chunks. Wealso develop new qualifications in response to the needs of employers, such as the CMI Level 3in Neighbourhood Management and the CMI Level 5 Diploma in Leadership for Health andSocial Care and Children and Young People’s Services.CMI conducts a wide range of activities in the health sector. We have around 3,000 members inthe sector, and work with a range of NHS employers to deliver skills training, eg. qualifications,coaching and mentoring and accreditation services. Some examples of our clients includeNottingham University Hospitals NHS Trust, the General Medical Council, the Royal College ofPhysicians and the Heart of England NHS Trust, Birmingham.1. Workforce development: prioritising leadership and management skillsImproving leadership and management skills ultimately saves the NHS money, as problems andmistakes are avoided and efficiencies gained. For example, the NHS Institute for Innovation andImprovement estimates that its work has potentially saved the NHS £6bn over the last fewyears. Therefore all NHS managers, whether clinical or non-clinical, should have the opportunityto develop and professionalise their leadership and management skills. By doing so, they will bebetter equipped to deliver the ambitious reforms being introduced by the Government.We therefore urge Government and NHS employers to place a much greater emphasis onimproving the leadership and management skills of staff, both clinical and non-clinical. Much ofthe Government’s reform programme (including integrated care pathways, clinicalcommissioning groups, any qualified provider and the QIPP efficiency programme) will dependon these skills for success. We therefore continue to encourage Government to place a greateremphasis on leadership and management skills as part of the education and training agenda forthe NHS.While we understand that the Government is limited in its powers to compel employers toprioritise these skills, we believe much more could be done by Government to encourageemployers and individuals to improve their leadership and management skills. We areencouraged that others are now beginning to join our call for leadership and management skillsto be put on a professional par with clinical skills (for example, the King’s Fund2, and variouswitnesses to the Mid-Staffs Inquiry3).However, the slow progress in establishing the new Leadership Academy (see page 5) and thelack of detail regarding Health Education England’s (HEE’s) responsibilities in this area are2 The King’s Fund are working on a Review of Leadership in the NHS, which will be launched in May 2012. Several oftheir senior executives, including CEO Chris Ham, have recently highlighted the need for Government to supportleadership and management skills more, for example see Chris Ham’s blog, Is good NHS management a waste ofmoney? dated 29.11.113 For example, see HSJ article from 27.10.11 (Mid Staffs inquiry hears calls for regulation of managers) or theGuardian article, “Doctors are the best hospital managers, study reveals”, dated 19/07/11 3
frustrating for those wishing to raise leadership and management skills in the NHS. Much moretime and resources need to be invested in this area if Government are to succeed intransforming the NHS structure, introducing clinical led commissioning and achieving the QIPPefficiencies at the same time.2. High and consistent standards of leadership and management education andtrainingAlongside the lack of policy emphasis on leadership and management skills, CMI is alsoconcerned that there are no professionally accredited standards for leadership andmanagement development in the NHS, although we welcome the Department of Health’s recentlaunch of a Leadership Competency Framework. The code of conduct for NHS managers iswidely criticised as insufficiently robust in terms of professional standards, ethics andaccountability, as the findings from the first Mid-Staffs inquiry revealed.We would therefore strongly recommend that a voluntary system of leadership andmanagement accreditation be introduced, so that managers who have undertaken accreditedmanagement and leadership development, whether it be a full-scale diploma or bite-sized unitsof on-the-job learning, are recognised and rewarded for their skills by employers. TheLeadership Framework also needs to be much more embedded in managers’ work, eg. viainduction programmes, appraisals and reward programmes.We have recently contributed to a pilot programme to accredit training programmes in the NHS,which was carried out by the National Leadership Council, and which was very successful. Weare also planning a research project in the New Year to help further demonstrate the value ofaccredited learning to employers and individuals, the findings of which will hopefully facilitate thewider introduction of accredited learning in the NHS.We are also concerned that under the current system, much of the leadership and managementeducation and training which is carried out is not accredited, meaning that no national standardsare maintained from Trust to Trust, profession to profession and around the UK. In a clinicalprofession this would be unacceptable – but management and leadership development is oftenneglected by employers, and staff are left to become “accidental” managers when they arepromoted.Unaccredited learning is not necessarily inferior, but given the current pressures on budgets itwould surely be better for the training which does take place to be recognised and benchmarkedas meeting national professional standards, ensuring better value for money for the employerand greater commitment to study from the learner.From our own research and employer feedback, we have identified the following benefits ofproviding accredited learning: 4
For all types of management qualifications, a clear majority of employers agreed that productivity gains, staff attraction rates and professional reputation are improved4 81% of managers disagreed that offering qualifications causes a high turnover among qualified staff5 Learning is made more attractive to employees and thus encourages uptake and commitment to the development programme The employer’s reputation is improved, thereby supporting recruitment and retention of staff Minimum standards of competence are established, against which managers and leaders can be measured High-flyers are identified, thus supporting talent management programmes A more strategic approach to leadership and management development can be taken, enabling integration with career frameworksAccredited leadership and management learning also promotes social mobility, so that thosewishing to take a professional qualification can do so without facing significant barriers to entrywhich exist in some professions. Through providing higher external recognition of thedevelopment programme, accredited learning can improve the confidence and engagement ofthe learner.Contrary to some perceptions, accredited learning does not have to involve a significantcommitment to study, or time away from the workplace. With the introduction of Qualificationsand Curriculum Framework, many leadership and management courses can be taken in units,delivered via distance learning or “blended learning” (ie. a mixture of face-to-face and distancelearning). This makes them more attractive to learners and employers alike.Accredited learning could play a significant role in helping to restore trust in the quality ofleadership and management in the NHS. Whilst no patient would wish to be operated on by asurgeon who did not hold full medical qualifications, surely no taxpayer would wish to hand oversignificant public funding and management decisions (which could affect peoples’ lives) to anunqualified manager.3. Infrastructure for professionalising leadership and management skillsAs mentioned above, the transition from the National Leadership Council to the NationalLeadership Academy is slow and complex. There are many workstreams which the NLC hasembarked on which must be completed. In addition, there appears to be a significant shift instaff, with NLC staff returning to their “day jobs” and new staff being recruited to the nascentLeadership Academy. Although we accept that the establishment of the Academy is likely totake time, we are frustrated by the slow rate of progress and the lack of information about itsstructure, remit and responsibilities, although we very much welcome its overarching objectives.4 “The Value of Management Qualifications, - The perspective of UK employers and managers”. CharteredManagement Institute, 20075 Ibid 5
Once in place, we would like the new Academy to have a greater role in endorsing andpromoting standards for clinical and non clinical leaders and managers, rather than fullydevolving responsibility for development to employers, which may lead to uneven skillsdevelopment. We believe that the Leadership Academy’s role should be to establish bestpractice standards of leadership and management, and to promote the uptake of these toemployers, who remain responsible for staff development.We keenly await the findings of the current Mid-Staffs inquiry, and hope that they will includesome specific recommendations around how Government can encourage employers to ensurethat their staff have the necessary leadership and management skills that meet agreed nationalstandards. This will protect patients from another tragic example of the results of poorleadership. 4. Role of Health Education England and Local Education and Training BoardsWe would welcome more information from Government on the role and remit of HealthEducation England in terms of its responsibility for leadership and management skillsdevelopment, and how it will avoid duplication of this responsibility with other bodies, such asthe National Leadership Academy and the Faculty of Medical Leadership and Management.We are also unsure as to how the new NHS local education and training boards will relate toHEE; whether HEE will have the power to make recommendations about professional standardsand training; and how both bodies will relate to local employers (acute hospital trusts, privateproviders, voluntary sector organisations, GPs and public health workers), the education sector,the deaneries and the Royal Colleges.Where possible, we would also encourage these new Government bodies to work with existingprofessional bodies to ensure the appropriate promotion of learning across all sectors and toprevent costly duplication.There is much valuable work going on at the various Royal Colleges, and at the new Faculty ofClinical Leadership and Management, to develop leadership and management capabilities forboth clinical and non-clinical managers. Other health sector bodies such as the General MedicalCouncil have also issued advice on management skills for doctors6. We would expect theNational Leadership Academy to have a role in co-ordinating this work and working withappropriate professional bodies so as to avoid duplication and confusion for learners. 5. Formulation and development of curricula for cliniciansWe would like to see a greater emphasis on leadership and management skills in medicalcurricula. We welcome the recent establishment of the Faculty of Medical Leadership andManagement, and we are hoping that the Faculty will work with the Royal Colleges to embedmanagement and leadership skills earlier on in a clinician’s career.6 http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp 6
We also hope that as part of the revalidation process, leadership and management skillsdevelopment will be one of the core competences evaluated and monitored – particularly withthe introduction of clinical commissioning groups, which means that GPs will need much greaterleadership and management skills. 6. Whole systems approach to enable multi-disciplinary leadershipAn important objective of the Government’s overarching public sector education and trainingstrategy should be to share learning and best practice across different parts of the public servicenetwork. As a professional body working across all sectors, we believe there is an essential rolefor the transfer of best practice and case studies in terms of improving leadership andmanagement, especially in times of severe financial constraints. For example, we work withorganisations in the health, education, local authority, police, and defence sectors and canhighlight some excellent examples of innovation and best practice.A shared approach to leadership and management is also important in terms of integratingservice delivery, which is a particularly important challenge in the NHS. The need to have clearintegrated care pathways, which may involve a commissioning care group (CCG), an acutehospital trust, social services, voluntary sector care providers and the patient’s relatives, will bean increasing challenge in the NHS over the next decade. By providing open management andleadership programmes to managers from all these sectors, they are able to develop a sharedunderstanding and approach to management challenges. This in itself helps to break downunnecessary boundaries across different service providers and can promote the effectivepartnership working that underpins many complex care pathways.A whole systems approach7 to leadership and management development would also reduceduplication and improve value for money. We have heard anecdotally from learners in the NHSthat they receive unaccredited leadership and management training from one employer, only tofind that when they change jobs they have to undergo very similar training from their newemployer. This is not only a waste of valuable development budgets, but also wastes valuablestaff time which could be better spent dealing with patients. 7. ConclusionDuring this Inquiry the Committee has a good opportunity to raise the importance of leadershipand management skills of NHS staff with Government and key stakeholder representatives. Wehope its members will stress the importance of raising leadership and management skills in theNHS to Government witnesses and will probe them for answers to the queries we have raised inthis paper.7 http://www.nationalschool.gov.uk/downloads/wholesystemsgopaper.pdf 7