Clare Chapman – speech at NHS Employers
3 November, 2009
The public has trusted us with their well-being and in many cases their lives and the biggest investment in health to date since the NHS was founded.
In return – you are doing a fantastic job and making the difference for the people who matter most – public, patients and staff. Satisfaction levels for all these stakeholders have improved over the past year and it’s not surprising when you look at the fantastic achievements you have pulled off.
You have improved things that really matter to patients:
(Film)
- Safety and quality - by reducing Health Care Acquired Infections like MRSA - down 74%. A huge achievement
- Access to services when patients need them most. Achieving the 18 weeks target - in reality many of you are exceeding it and it’s more like 8. Once upon a time this was inconceivable.
- GP access and addressing inequalities
- Offering choice of where and when patients are treated
- Helping people to live longer healthier lives
From people like Barry, a coal miner, who became a health trainer after suffering a heart attack and now helps local people.
To Liverpool PCT that has gained the commitment from local people to lose a millions pounds – just to be clear – we are talking fat, not money!
You have no idea how much you are appreciated.
You have also improved things that really matter to staff:
And this is important because of the proven link between the experience of staff, the experience of patients, and overall performance.
Many of you have clearly listened to what your staff are telling you - not only in your staff surveys but in your daily, face to face contact. The result has been improved staff satisfaction nationally this year. I really acknowledge those trusts that are taking great care of both patient and staff satisfaction.
There are three trusts I’d particularly like to honour because of their achievements:
But just as importantly, I’d also like to acknowledge the hundreds of trusts and teams across the country that have improved their staff results this year. If you have been involved in this improvement – a personal Thank You.
Now that the NHS Staff Survey measures how we are doing against the staff pledges in the NHS Constitution, we can say more confidently than ever that its results help to predict the delivery of High Quality Care for All.
This is why we are going to make it much easier for the public and staff to access these survey results though our website.
Having access to this information will help our patients decide whether they think ‘this sounds like a great place to receive treatment’ and new staff to decide whether they think ‘this might be a great place to work’.
Everyone - make sure you input to the survey - we want to hear what you have to say.
Leaders - make sure that teams are encouraged not only to listen to what staff have to say but also to take action in response.
I also want to acknowledge that your achievements for staff go way beyond the staff survey. Over the past year we have also worked together on initiatives that will bring sustainable improvement to our service:
- To create Talent and Leadership Plans for all regions - including significant new investment in leadership development
- Taken the first close look at staff health and wellbeing - through the Boorman Review
- Invested in the further development of Social Partnership with the National Social Partnership Forum launching the first ever website to share best practice
- Played your part in the current climate - investing in over 5000 new apprentiships
- Used the new pension flexibility - to enable Social Enterprises
- Established the National Leadership Council and the Equality and Diversity Council and of course
- The NHS Constitution - shaped by you, patients and the public - no other public services sector has gone this far.
Congratulations to you and your team - all this helps to bring us yet another step closer to the vision of Lord Darzi in HQCFA.
(Slide) “High Quality care is care where patients are in control, have effective access to treatment, are safe and where illnesses are not just treated, but prevented.” Lord Darzi
Thank you again for the part each of you have played -
I know it’s been hard work .
In preparing for today - I thought about what might be on your mind at the moment…
I’m assuming that top of mind might be…the challenges and change ahead, such as….
How do we meet the challenges we were already planning for, such as our ageing population and addressing the burden of lifestyle diseases?
And
- Is it possible to do all we need to with efficiency savings of £15-£20bn between 2011-14?
- What will the future look like?
- What will our workforce look like in future?
- What are the trade-offs likely to be between pay increases, numbers of staff, and new ways of working?
- What about jobs and roles?
Doing this and meeting the quality and productivity challenge at the same time.
There’s no doubt we have never met a challenge of this scale before - but neither have we invested or achieved so much either. Our foundation is strong. We now need to accelerate our improvement.
Evidence points to 5 things as important:
(Slide)
- Changing Mindsets – really believing quality and value can go hand in hand
- Getting on with it now – changing the shape of services takes time
- HR playing its part – we have a unique role and can set the tone
- Working across boundaries – fostering partnerships and integrating services
- Making wellness - everyone’s business
1. Changing Mindsets – really believing quality and value can go hand in hand
Often the biggest obstacle in any organisation - and the NHS is no exception - is the culture and mindset on what is possible can hold us back.
One of the cultural issues we still have to tackle, for instance, is the view in the NHS that quality automatically means more costs.
Quality and value can and do go hand in hand. Improving what and how we do things, getting it right first time – reduces mistakes and waste and improves quality.
Reducing HACI has already saved more than £143m and vastly improved safety and quality of care for patients.
2. Getting on with it now - changing the shape of services takes time
Services wrapped around the need of patients, delivered right first time and closer to their homes.
The recommendations in Lord Darzi’s High Quality Care for All made it clear that personalised services with care delivered closer to home in a way that acknowledges an aging population and radical breakthroughs in disease management and technology, creates the need to change the shape of services – regardless of the economic slowdown.
We wouldn’t think of trying to stage the Olympics without years of preparation. The NHS is no different.
We have 11% growth built into our budgets until 2011 but after that we need to be ready to deal start achieving significant efficiency savings. If we are to type of change does not happen overnight which is why we need to make best use of the little time we have and get on with making improvements now.
3. HR playing its part - Towards healthy organsations and setting the tone
‘60 years on from the founding of the NHS, we need a different relationship with our health service, one that makes it clear how the NHS will meet the expectations of the patients, the public and its staff. We need a service that listens and responds to the needs of the people it serves’.
No one is pretending that it is easy and there are plenty of examples in both the public and the private sectors where the relationship between management and staff is part of the problem rather than the solution.
Given our ambitions - HR leaders have a big and important job to do. To establish best practice, help teams to plan and also help leaders to effectively and properly manage the process of change for staff and their organisations.
We know that what we need is an atmosphere of trust, commitment and pride that is most likely to lead to openness for change. The HR professionals I meet as I go around the country are really up for this. Your role is to make sure that change is well planned and well managed for everyone.
It is not easy I know. When I’m faced with difficult decisions I always think back to what matters to public, patients and staff and the NHS Constitution.
They should guide our thinking.
The good news is – we have done this work continuously – we just need to do more.
There are numerous examples I could have chosen from where Trust and Health Economies have been able to achieve both Quality and Efficiency but the one I want to share with you is the ‘Making it Better’ initiative from Greater Manchester.
Background:
- Purpose was to make NHS services in Greater Manchester better for babies, children, young people and their families
- This involved moving services closer to home so that where it is safe more children and mums can receive care either at home or in the community
- Emergency services for children remained in Acute A&Es but overnight services for children and maternity would move to fewer, larger units with highly specialized staff and higher staffing levels.
- Consultation with the public was one of the biggest in the history of the NHS given that the proposals impacted all 10 Acute hospitals and multiple PCTs
- Proposals were approved by the Secretary of State in 2007
Achievements – to enable the improvement in services:
- Making it better – for roles, opportunities and training. For example - there were 10 new community nursing teams, new rotation opportunities for staff in both acute and community settings so they could maintain and learn new skills and the introduction of resident shift working consultants to increase the availability of expert care for patients.
- Making it better – stability of employment framework. This was introduced across Greater Manchester to give staff flexibility and help them move across organisations and importantly to give them some certainty about future employment during the transition. PCTs also facilitated the development of cross-boundary working mechanisms to enable the development of new teams and expanded services.
- Making it better – Greater Manchester HR Strategy. Organisations collaborated on this across boundaries to ensure that staff were treated equitably and consistently as the changes were implemented. Also to ensure that staff impacted by the reconfigurations had choices on where they could work.
It wasn’t all plain sailing – there were tensions on the way – but the commitment to partnership working at every stage has ensured – that was and is key.
Can we ‘bottle’ what worked in Manchester?
Clinically based
Solutions were developed in partnership to get to a ‘fair deal’ between patient, public and staff
Mobility was enabled across health and social care
People were flexible and prepared to do things differently
Contract issues were addressed and
Redundancy was minimised
The other thing to take away is that the transformation in Manchester has taken quite a long time – yet another reminder that if were going to get the best answers for patients and staff we really need to be getting on with the planning changes now.
So we have a great opportunity as HR professionals to set the tone – and the HR professionals I meet are absolutely up for it. HR directors frequently tell me about the fantastic talent in their teams – this is your opportunity to shine.
WE can use this to shift the mindset and show our colleagues that the ‘soft stuff is actually ‘the hard stuff’ and getting right is really important if we are going to deliver.
So what does the service want from us, from HR? The Work Foundation has just completed some research which says staff was us to be:
(Slide)
- Custodians of our staff pledges,
- Champions of fairness and integrity, ensuring decisions and systems are designed with the values inherent in the NHS
- Innovative contributors to healthy organisations
- Expert, reliable and available providers of HR services
We’ll know that we’ve succeeded if the compact between leaders and their staff in 3 years time is stronger rather than weaker as a result of what we’ve done and most importantly how we have done it.
4. Working across boundaries
We can only wrap services around the needs of patients – if together we are prepared to wrap ourselves around the services.
We have to cross the boundaries, integrate our services and our thinking. We can no longer think in terms of primary care - secondary care or social care as if they are in distinct boxes. Clearly sometimes they will be. However, the vast majority of health and care could and should be delivered closer to home in way that makes sense to people.
One example is:
Wakefield Integrated Substance Misuse Services ICO –
• One of the 16 integrated care pilots
• Project led by a GP
• Partnership of NHS, third sector and wider stakeholders - breaking down traditional barriers
• One aim was to reduce the number of admissions to hospital
• Making measurable improvements in the care for substance misusers and offenders
• Creating integrated pathways that are both personalised and cost efficient
• Also taking primary care medical and integrated drug treatment provision into New Hall and Wakefield prisons
• Staff worked alongside service users to agree how to improve success focussing on recovery, reintegration and reduction in health inequalities
• Allows care provision to be maximised at its lowest intensity, by having the right staff, with the right skills, in the right place
• Staff engaged and keen to think out of the box – which resulted in initiatives such as mental health services at football grounds
‘You couldn’t do this job without very close partnerships. How can you get health right for a homeless person if you don’t sort out their housing? Where do hospitals send appointment letters? It’s my role to manage the health needs of some of the most ‘chaotic’ clients, but do this within the wider context of their substance misuse and lifestyles.’
Karen Jordan, Wellbeing Nurse
5. Making wellness - everyone’s business
- For our patients and our staff
- Prevention is better than cure - in every respect
- Healthy, motivated staff can - and will - deliver better services for patients
- Healthy people - will have fewer health problems
I want to take a few moments to consider in a bit more detail on staff well-being. This is very important to me since - going back to the Olympics analogy - we are in a marathon not a sprint and we will need resilience and good health to see us through.
If we are asking patients and the public to take good care of their health - we must lead by example. The potential benefits are enormous.
Sustainable quality and productivity can only be delivered by a healthy and engaged workforce.
(Slide)
- The NHS currently loses 10.3m working days each year due to sickness absence
- This costs £1.7bn a year
- A reduction of one third would save over half a billion pounds - £555m
…and will benefit staff. Reducing absence is good for staff and we know work is good for overall health.
Staff ill health is a serious barrier to high quality patient care - over 80% of NHS staff surveyed said their health affects the quality of the patient care they deliver.
We’ve already seen the evidence of the link between performance and well-being
(Slide)
- Mild and treatable conditions are responsible for over two-thirds of sickness absence:
- Depression, anxiety, stress-related mental health problems
- Musculosketal conditions
- Cardio-respiratory conditions
The challenge in the current climate - could be that staff, worried about job and financial security, could suffer greater levels of stress-related ill health.
York case study
- The Centre for Occupational Health and Wellbeing at York Hospital invested £100k to provide staff with a team including a nurse, physiotherapist and counselors
- Previously quarterly absence rates were 5.13%, costing £3.7m
- Now the number of long-term sickness absences is reduced by more than 40% with sick pay costs cut by £200k
I’d point to 2 things:
1. The NHS Constitution; and
2. Leadership
“The Constitution enshrines the guiding principles of the NHS….it is a vision of which Nye Bevan could be proud. For the first time we have a document that lays down clearly the rights and responsibilities of both patients and staff”.
(Slide)
Karen Jennings,
Head of Health, UNISON
"For the first time ever the NHS Constitution pulls together all of the rights for patients - embedded in 13 different pieces of legislation and also the rights of staff and makes it a legal requirement for Trusts to show ‘due regard’ to these rights, responsibilities and pledges. The Constitution will need to be renewed at least every 10 years through thorough public and staff consultation and the Secretary of State will need to update Parliament every three years on progress. This gives the NHS great consistency of purpose. "
Leadership is also fundamental to the time ahead. Leadership is therefore fundamental
I believe that what we are about to embark on is the next major development in healthcare - therefore there is a real opportunity for leaders to demonstrate their value like never before.
The NHS is internationally held in high regard.
Because of how we deliver, how we design, and what we stand for.
People around the world watch what we do, and we have a leadership role.
In the face of modern challenges, our leadership has never been more important.
Leadership is critical to working across boundaries - which is central to the changes ahead.
Leadership is also critical to reconciling the pressures that public services are under with the shared values that are inherent in the NHS. We are only just beginning to grasp the importance of leadership. It’s critical now that we keep focused on our vision of being spoilt for choice when it comes to appointing great leaders.
We need to provide opportunities for aspiring leaders too. That means more focus on spotting talent and providing them with experience and training needed. We are investing £20m through the National Leadership Council.
Most important is that we see commitment in the boardrooms throughout the NHS. Board members have the responsibility to make this a reality on the ground. So can I ask you to make sure it happens?
It’s a huge cultural shift (Slide)
- Only 44% of all staff felt that healthcare professionals and managers worked well together
- Only one third of staff felt managers encouraged staff to suggest new ideas
- Only a quarter felt their managers involved staff in important decisions
- While over 90% of NHS staff work in teams, only 39% felt they worked in well structured teams, with clear objectives and opportunities to review and reflect on performance
That means consistently listening, responding and empowering
Remember Hoover discounted James Dyson's idea of a bagless vacuum cleaner as unworkable and would never take off - let’s not make the same mistake. (I know it’s more than vacuum cleaners at stake here - but it’s the principle).
There is a really important role here for Social Partnership Forums to foster real partnership and engagement
We’ve strengthened this approach nationally with the creation of a National Stakeholder Forum and a Social Partnership Forum with NHS Trade Unions. Their role is to ensure there is discussion, debate and involvement by partners in the development and delivery of policy that impacts staff.
A good example is: Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust created savings of £21m while improving care and maintained staff morale. They did all three a year earlier than target.
Their learning and advice is:
Partnership working needs to be part of the culture
HR professionals need to step outside their comfortable boundaries and contribute their expertise in the delivery of patient services through true integrated planning
Really engage staff in improving service delivery - the people doing the job every day always know how it could be improved and what needs to be done
And avoid:
Concentrating on financial cuts but emphasise improvements to patient care
So as leaders - and counselors to your local leaders - look at your staff surveys and absence rates and talk and listen to your people.
It’s no coincidence where we have good leadership and staff satisfaction - patient care is better, absence rates are lower, and you have a platform to innovate and reshape.
As leaders you will be pivotal to what I believe is the next big advancement in healthcare. This is a fantastic opportunity to demonstrate your value like never before.
Closing Message
My message to you therefore is simple:
Take care of the NHS - take care of ourselves and each other
We have seen the value and the importance
Let’s ensure we are resilient
Provider Organisations
Take care of the public, patients and staff
Equip staff to challenge the status quo and leaders to support them.
Equip patients and communities to shape services and hold you to account (look to PCTs as customers).
Equip social partnerships to address the hard choices - where job design, ways of working and contracts get in the way.
PCTs
Take care of your local population
Commission services based on patients needs.
Enable movement to maximise employment and minimise redundancy
When you commission services - your commissioning people.
Staff and staff representatives
Engage in these plans because you will be pivotal in shaping them. So speak up.
Local leaders
Listen. Take care of your people. Begin your planning by engaging now at every level. You need their support and more their ideas to make services better. Lead by example.
Clinicians
Please play an active role in leadership and in developing these plans – because you know what works for patients.
HR specialists
Your role is critical - both in advising managers but also supporting staff through this challenging period.
Directors of Communications
Your internal communications has never been more important.
Chief Executives
You must lead your board and ensure you consider the future as a team – with your partners, patients and staff.
Thank you for all that you have achieved and for preparing us for the future.
Some of our challenges are the same and others are new. We must harness the talent, experience and commitment in this room.
(Slide)
Trust - that where each of us makes a promise - we will keep it
Trust - that we will make decisions in the best interests of patients and staff
Trust - in the ideas of others and be open minded to their potential
Trust - in our ability as the NHS to change and meet the challenges ahead
Can we be trusted to make that difference, to rise to the challenge?
Yes. I believe we can, and we will.