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need for the ENB and the CNAA together to sponsor a series of workshops around the country designed to familiarise college lecturers and nurse tutors with the different procedural requirements and expectations entailed in academic and professional validation. However,

the complexities and difficulties experienced in conjoint validation are also an expression of more profound divergences in philosophy and approach between the two sectors. The recent decision by the ENB to embrace the idea of peer review as an integral part of the validation

process and to establish a register of specialist visitors has been widely welcomed in HE.

However, I believe that the board will need to modify further its highly centralised approval procedures, particularly if Schools of Nursing are to be linked ever more closely to accredited HE institutions that may well be awarding their

own degrees and diplomas within the next few years.

Secondly, we must recognise that the impact of

the proposals contained in the NHS White Paper ‘Working For Patients’, together with the con-

sequences of the ideas expressed in Working

Paper 10, are likely to make HE institutions more hesitant in becoming involved in new collaborative ventures with DHAs. HE institu- tions are rightly concerned at the proposed

transfer of responsibilities for the funding of nursing and paramedical education to regional health authorities. On the one hand, it is not clear that the close relationships that have developed between colleges, Schools of Nursing and DHAs will be able to be recreated at the level of the RHA. On the other, the majority of HE

institutions will be extremely reluctant to partici- pate in yet another system of competitive tender- ing in an attempt to secure education and

training contracts from regions. Finally, we have to recognise that the plans to

create an internal market within the NHS are

also likely to undermine the enthusiasm of HE institutions for participating in major new initi- atives in nursing education, at least during the

transitionary period. At the present time, many of the costs of expensive clinical and community

placements, together with the associated costs of teaching and supervision in these placements, are ‘lost’ within the system. Whether these

hidden educational subsidies will continue in the future is uncertain. The thought that, in a few years time, independent hospital trusts could be

insisting that higher education corporations cover the full costs of clinical and community

placements is likely to deter rather than encou- rage future collaborative ventures in the field of

nurse education.

District general manager’s perspective

Chris West

You will all know the real tragedy is that a and we saw with the graph of one going down,

number of us have known for something like 12 the graph of the other going up at the same years about the projected decline in the number period of time. There was a real anxiety, about

of school leavers taking place now and on how we can maintain adequate Community

through the early part of this decade. I can Nursing Services particularly with this underly-

remember as an Area Administrator in Wiltshire ing demographic problem. Then overlying that

being dumbfounded when we looked at the demographic trend was the greater shift of care demographic trends on school leavers and then into the community in a number of areas and I looked at the manpowerlwomenpower retire- could not see how we were going to cope. The ment rates particularly in community nursing real tragedy was that almost 12 years passed

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before people started to address the problem seriously and take action.

So first of all there is the issue about demogra- phic trends. The NHS will not be able to compete effectively for school leavers, not least because it really does have quite a poor image in society. As an employer it is not viewed as an organisation that pays well, that rewards people well, that has a good organisational culture, has good modern facilities, and I have to say I don’t think that the image of particular professional groups within the NHS is helped by strip cartoon adverts in newspapers. It does not help to create the right sort of professional image; the image of our organisation its staff are proud to belong to, and so encourages others to hold it in esteem.

Secondly, the White Paper is, of course, a major pre-occupation for us all, but particularly for senior managers as we try to realign our organistions to cope with the changes ahead. Traditionally for the last 42 years the NHS has been a supply driven organisation. The service has been provided to society, albeit with the best intentions that the producers think appropriate. There has been relatively weak internal loyalty within organisations but a very strong loyalty between professional groups within a common profession, very strong professional bonding. The way that resources have been deployed is to contain costs not necessarily to secure effective services or an effective use of those resources. Also there has been a general lack of organis- ational focus, and a complete lack of any sense of corporate objectives. Now the future is going to be different. It is going to be a customer driven organisation and a very informed and increas- ingly informed customer.

Traditional professional loyalties will dis- appear and what will come much more to the fore is loyalty to the organisation within which people will work.

Professional staff will have far greater authority to change the mix of resources and services than they have ever had in the past and a much greater responsibility over the deployment of resources. The organisation also, in the way that services are delivered at field/ worker level, will be much more flexible, much more adaptive and subject to much more

rapid change. There will be much more intoler- ance from the customer and if one looks at the way the Great British public really does in some cases accept quite poor standards of service that, I am quite sure, in the new age of consumerism will not be acceptable in the future. We will all be subject to much greater challenge. 1 have talked about demography and the declining workforce and the greater competition for school leavers but there are also other consequences of the demographic trends. There will be a smaller workforce, smaller than the one million people employed in the NHS at present. My personal guess, would be that it would be about three quarters of a million by the end of the decade. Capital substitution will come in to an increasing degree and that, in itself, will impose a greater skill requirement on professional staff.

A better educational base will be needed for all staff in order to meet their full responsibilities and I’m remembering one of the more inter- esting statements I’ve heard within the last 12 months about health care in the USA is that it is commonly accepted that anybody who has been graduated or completed their education for more that 5 years, their knowledge is now completely obsolete, and they have to go back through a re-educational programme. That sort of renewal process will be placed on all our professional staff. And above all, if we are going to compete effectively in the recruitment market we need to market the educational opportunities which we are offering, and we won’t be able to compete effectively if we are offering an appren- tice type education as opposed to the sort of broad based education that is given in an insti- tute of Higher Education like a polytechnic.

Another major area of change is information technology (IT), and it was interesting to listen on the ‘news’ this morning that British Telecom is going to be making something like 30 000 managers redundant. Just over 2 weeks ago it was 3500 people from BP who were being made redundant. The NHS is estimated to be at least 15 years behind modern industrial organisations in its application of IT. The consequences of IT are that we are going to have flatter organis- ational hierarchies if we are going to have hierarchies at all. It may be circles rather than

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pyramids and I feel more comfortable in many respects with that type of organisational struc- ture. But we are going to have flatter organis- ations and organisations which through the

introduction of IT to and responsibility strip out whole levels of managerial hierarchy, and give

much greater autonomy to field workers bring- ing them much closer to top managment levels. The consequences will be more authority, more resources, more responsibility for the deployment of those resoures and a greater

responsibility for setting service standards expli- citly. That can only be done if we recruit staff with a good intellectual capacity and we give

them a broad based education.

THE IMPORTANCE OF PROJECT 2000

Increasingly sophisticated health care tech-

nology and greater openness in our society exposes us all to ethical dilemmas; it challenges

the fundamental values that we have. Abortion was perhaps the first area - the

1967 Act. Secondly issues of tissue transplan- tation and thirdly, issues arising from embryonic

research. A rote-learning education will not equip

anyone to face the challenges to their basic

beliefs and the values that will arise in health care. The issue of ‘burn-out’ in high-tech areas is known to us all. Burn-out, disillusionment, disaf- fection and alienation will incur to an increasing degree unless people have the educational base to underpin their values and to understand fully

the challenges that they are facing. The NHS has

its joys, sorrows and challenges and they are not going to decline, they are going to increase quite markedly, and in coping with these changes we need to ensure that all our staff, particularly key field worker professional staff, have a broad based education and understanding with which they can cope with these challenges.

One thing that we can be confident of for the future is that it is totally unpredictable and is going to be the subject of sustained change. There are three ways of dealing with changes;

with huge computers and 700 staff and a vast amount of expenditure and I don’t think that way has proved itself to be particularly successful in the past.

The second way is to adopt is a Laissez-faire

attitude and say ‘well look we’ll just have to face the future as it unrolls before us and do the best we can’. And that is not going to be good enough either.

And the third way and its interesting that this is the way that the most successful Japanese companies face the future is they concentrate on acquiring key strategic assets. And the most important strategic asset available is the best

people. To concentrate on acquiring the best people and educating them and training them to the highest possible standard and continually

putting them through a renewal process, that way you stand a chance of coping and surviving. 1 think Project 2000 provides that base for our largest and one of the most important areas of manpower.

So let me summarise why I think Project 2000 is important. First of all because of the White

Paper. Secondly, because of the rising tend of consumerism in our society. Thirdly, because of the organisational change that we face as a result

of IT. Fourthly, because of the declining man- power and capital substitution coming in with new equipment, new technology and so on

replacing much of the existing manpower prac- tises that will inevitably require a better skilled, more highly skilled workforce with greater tech- nical skills.

In addition the greater leadership role that will be given to care providers. For that we need

to offer an education and training environment to compete successfully with that which is being offered by other employers. We need to provide an educational base that is enabled to be renewed progressively at least every 5 years.

Finally we need to provide a base from which people can be developed to cope with the unpre- dicatable future and continual change.

And there is one last reason that I would like to give and it’s about effectiveness and personal effectiveness. Now you will all have heard of Peter Drucker. Last year 1 had the privilege of

the first is to let the strategic planners get to work going along to a conference to which he was

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speaking and the theme of the conference was ‘The Effective Executive’. In fact the notion of the effective executive can be applied equally to any other category of employment. At the end of the day conference we went off into our work groups to define what makes an effective execu- tive and came back for ‘report back session’. Peter Drucker - in his 80s - sat there quietly listening and the points that were made were - b e good at listening, think how you would like to be treated by your boss, subordinates and the stakeholders in the business, accept there is no conventional wisdom, but one has to be pre- pared to listen; that an organisational objective should be to facilitate change; have clear objectives; have controlled enthusiasm; beware of ‘CV-itis’.

All-these points were made and this little old man sat there listening to it all and then he very quietly, in his mid-European accent said, ‘I am a

very old consultant, I’ve been consulting for 50 years. I’ve seen a lot of effective executives. Not one of them has the qualities you describe. Most of the very effective ones do not listen. Most of the very effective ones are rude and aloof. They have only one thing in common. They make extraordinary demands on themselves - they set examples and that is the most important thing. Organisations are managed, not by cleverness, but example!

I think if we are to ensure that our organis- ations employ people and motivate them to be effective then for me, in respect of Nursing 2000 is the only way that that will be done, by equiping staff to set high standards; to make extra- ordinary demands on themselves; to set out- standing examples and above all to provide a health service to the nation of which we can be proud.