The caring profession

Sue Hodgett, chief executive of the Institute of Healthcare Management, on the challenges ahead for the sector.

The never-changing and ever-changing issues being faced by health and care managers will radically shift following the global financial crisis of 2008-2009. The lasting impact on public borrowing brings pressures to which no one is immune.

The old chestnuts where managers have always been the Aunt Sally profession, fielding the flack when directed change is imposed, having to manage the day job of delivering service as well as keeping one eye on organisational goals, another on the patient and having to develop a third eye to implement national imperatives locally are the issues that have always been part of the job.

However, the new world, the world of the cold (financial) climate, will require a very different mind set. The expectation of productivity improvement as resource diminishes and significant demographic change and improved technological advances will be a major shift after the period we have enjoyed of unprecedented growth - now comes unprecedented austerity. The process of delivering normal efficiencies will not be enough. Radical step changes will occur when planning and delivering how services are provided and by whom.

Despite the above assumptions, there is still some muddy thinking about what lies ahead - we have some of the brightest and the best working in the public sector who surely can do some accurate predictions and modelling of the way forward. The habitual way of communicating is to avoid clarity and real honesty - spinning the words that give an up beat message for what will no doubt be a difficult era.

So let’s have some honesty. Our assumptions about managers and administrators taking a real hit in this down turn in terms of employment needs to be spelt out. Then we can start to be clear about what we really need in a manager and how we ensure we keep the best, providing development opportunities, being clear about career paths. Individuals need to differentiate themselves from others and identify their skills that are going to contribute to the solution of the next era.

Of course one of the biggest obstacles for managers is the prejudice against them - the real old chestnut! - that parallel universe between clinicians, who rightly look towards the patient and their Royal College as their focus and managers who look towards the organisation and the department, but all of these dimensions of delivering service are valid and important.

It’s how we define a common gaze / focus for all employees.

Prejudice can be inbred at an early part of anyone’s career, so redefining this has to be left to individual experience - a good manager and a good clinician have vital parts to play in delivery - it’s finding a way to respect and support diverse roles in a complex environment.

Upping the pace on integrated care must be a priority. Historically and currently, the pace of change across the country has been turgid. The devolved nations have put this as a priority for their care pathways and shown this through their new structures. But, speaking to managers who are managing the care sector, the flow of information is both disabling the patient as well as the organisation. We have excellent technology, what we are asking for is not rocket science, it’s all about communication, detail and timing. It’s probably not a good idea to even touch on the investment that has already taken place to improve records for patients!

Workforce is both an issue and an obstacle! The new era will need a high degree of commissioning competence, which would include a need to improve understanding of the costs and benefits of
local services if they are to reduce spending and drive improvements and productivity.

Commissioning needs to be clarified and strengthened at every level. There has already been a lot of work identifying competences for commissioners and training so hopefully that investment will pay off. Unfortunately, there is a view that, ‘Commissioning is currently a transaction where people who don’t know what they are buying, buy from people who don’t know what they are selling or what those services deliver for consumers’

So focussing on client / patient needs requires a radical re-think, with a model that requires a different way of working, both from an integrated governance point of view and an integrated operational way of working. There are still many opportunities to grasp when working across sectors, with local authorities, social care and health. This would include working with the voluntary sector and independent sector, a service that is valued by patients, offering them support which is missing within other sectors. This should work on a collaborative basis and need not be a battle ground, where historically the only common conversation was about money, not individual people.

So how do we address these issues and overcome the obstacles?
• PCTs will have to take a leadership role for whole system change and the response to the challenges ahead.
• Ensure the meaningful engagement with staff and users as part of the process of change.
• Resist reverting to the other ‘old chestnut’ of command and control working - this offers a resistance for buy-in and both patients and staff are far too well informed these days to agree to this way of working.
• What incentives are deliverable?
• Involve the regulators, with more clarity of the role they play in facilitating this step change.
• Be honest.

To quote the mantra of the Obama administration, ‘don’t waste a crisis’. Where we are about to find ourselves as managers could be the catalyst in making bold and brave shifts in service configuration that have been discussed for years, but not materialised - courage is needed. This is a real opportunity to drive through changes in workforce patterns that will deliver effective care in the future.

But… lets not be distracted by another reorganisation. This is much more that that.

Polly Toynbee recently wrote a scathing attack on the NHS re-organisation disease and the creation of a muddled market, but also stated that it is money and good management that make the best councils, schools and hospitals and I agree.

If the actual freezing weather we have experienced this winter has led people to be able to deliver Husky racing in Sherwood Forest, ice racing on the fens and curling championships in Scotland, then the cold climate that awaits us in the public sector should provide ample opportunities for change for the better - embrace!