NewsletterEditorial by Jon Glasby and Ross Millar Volume 19 No 2

In this issue:A Letter from Vancouver 2

A Letter from Melbourne 3

Reforming health and social care in China 4

Facing the challenges in improving our health

care systems 5

Postgraduate programmes 6

Projects update 9

Events 11

People at HSMC 12

Stop Press: HSMC is to host EHMA 2014 Conference on 24 - 26 June 2014 – see p.11

Health Services Management Centre

Focus on international networksFor many people, HSMC is seen as part of the broader NHS family and as a critical friend tohealth and social services. Most people reading this editorial will already know quite a lotabout what we do in the UK – and there are the usual updates on our teaching, researchand events later in the newsletter. However, HSMC is also very active globally, and thisedition of the newsletter focuses more on some of our international links and networks.We feel this is crucial to our work in the UK for 4 main reasons:

1. The NHS is so large and complex that itcan often be difficult to look outside ofwhat we do on a daily basis for goodpractice lessons from elsewhere.However, learning from other systems iscrucial (particularly as many othercountries are grappling with the sameissues as us). Indeed, ‘broadeninghorizons’ is a key theme of our new NHSLeadership Academy programmes (seep.8), and the ability to look for evidence ofwhat does and doesn’t work in othersystems seems an important source ofexpertise when working with everydayissues in UK health and social care.

2. At the same time, the NHS and social carehave incredible experience and expertiseto contribute to other countries – and sosuch learning needs to be two- ratherthan one-way. We’re really proud of theNHS, and there’s lots of scope to sharegood practice with other systems and tomake a contribution globally as well asnationally.

3. When policy makers do look abroad fornew approaches they often look to theUS first and foremost, and they cansometimes be guilty of identifyingapparent success stories and trying toimplement wholesale here. In line withHSMC’s role as a critical friend to thehealth and social care community, we feelthat this is an overly-simplistic approachto policy transfer, and that deeperunderstanding is required to be clearabout the contextual factors that makesomething work/not work and the extentto which such approaches might be

appropriate in a very different UK context.This requires the ability not just to identifyapparent good practice, but also to askdifficult questions and consider whatpotential success factors and barriersmight exist if such interventions wereadopted here. There is also a key role inmaking sure that lessons are sought fromany system that might have something tooffer, not just from the US (where thereare a number of high profile good practiceexamples, but where the system as awhole has many flaws). Later on in thisnewsletter, Harvard’s Prof. JohnMcDonagh makes similar points when hehighlights the problems that the US systemfaces and compares US with UKapproaches (see p.5).

4. Whilst there are lots we can learn fromelsewhere, detailed international links canalso identify situations where there arefew easy answers. This can befrustrating for policy makers keen to find away forward, but can also be veryliberating for local leaders andpractitioners. Often there are no ‘magicsolutions’ and other systems arestruggling with the same problems as us.Although this can feel initiallyunderwhelming, having confirmation thatthe things we find hard are sometimesjust genuinely difficult can help to putcurrent challenges in perspective. If itwas easy, then someone would havesolved it by now, and the fact that no onehas can be a helpful lesson in itself.

In this edition of the newsletter, we hearprimarily from colleagues working in andwith different health systems. These areoften our own staff visiting or temporarilybased in different countries, but can also behonorary members of the HSMC team whoare a crucial part of our internationalnetworks. Articles include ‘letters’ back toHSMC from colleagues overseas looking atdecision-making and priority-setting inVancouver or adolescent mental health inMelbourne; the current health reforms inChina; and insights from our new HonoraryProfessor, Harvard’s John McDonough. Weare also delighted to be the founder memberof the Universitas 21 (U21) healthmanagement and organisation group (seep. 9) and to be hosting the 2014 EuropeanHealth Managers’ Association (EHMA)Conference (see p.11).

HSMC will always continue to be part of theNHS family and to focus primarily on UKservices – but we hope that ourinternational networks continue to add valuein our mission to promote both ‘rigour andrelevance’ in health and social care.

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A letter from Vancouver: insights into Canadian disinvestmentTom Daniels

Dear HSMC,

I have now been in Canada for just over two weeks and have already given the first presentation of myresearch into ‘Public Involvement in Health Disinvestment Decision Making.’ Having arrived fresh from theairport I was asked by our former colleague Stirling Bryan to give a presentation of my PhD findings (so far) tothe University of British Columbia’s Clinical Epidemiology and Evaluation group. Like any true Englishman in aforeign country I began my presentation with an apology - as this was the first departmental presentation I hadattended, let alone presented at, I wasn’t sure exactly what was expected. However, I needn’t have worriedas the issues we’re facing in the UK seem to have uncanny parallels with debates in Canada.

I began by explaining what I considered disinvestment to be (the withdrawal, reduction or retraction of healthservices), before considering how decisions to disinvest are made and whether or not the public can or should be involved. Involvingthe public can deliver instrumental, communitarian and educational benefits, but it can also lead to a protracted decision-making processand there is no guarantee of public objectivity or knowledge and understanding. In addition to this, research has shown significantvariation in the extent to which the public actually want to be involved in disinvestment or priority setting decision-making.

My presentation then moved on to discuss the research that I had carried out looking into the attitudes of health professionals and thethree distinct perspectives my study has uncovered. These are ‘advocates of involvement’ (those who are fully behind publicinvolvement), ‘cautious supporters’ (those who support involvement but recognise that it can have limitations) and ‘freedom of choice’(those who support public involvement but believe that the public should have the ability to choose whether or not they take part). Iconcluded my presentation by noting that each of the shared perspectives showed support for public involvement and that there wasno clear point of view suggesting that the public should not be involved in disinvestment decision-making. I also suggested that furtherresearch should be carried out to establish what these findings meant in practice before asking the audience for their views onwhether this research could be repeated in Canada. The discussion that ensued highlighted a number of points which may be ofinterest to UK researchers and practitioners.

Whilst the Canadian economy is in a much stronger position than the UK and much of the rest of Europe, Canada is still facing similarhealthcare funding difficulties. Discussion about disinvestment, however, has been far more limited and indeed it was suggested that‘disinvestment’ was too negative a word to use in Canada, and that I would have to find a new term to define and describe servicechanges and cutbacks. Another potential difficulty was that I may struggle to identify enough healthcare professionals withdisinvestment experience to take part in the study. Whether this was a flippant comment or not, it could be the case that, as explicitdisinvestment is still rare in Canada, those individuals who have taken part may not recognise their involvement in disinvestment or maynot be aware of the decision-making process.

Whilst disinvestment may be a new concept within Canadian healthcare, the notion of priority setting has become well developedacross all Canadian provinces over a number of years. By definition, disinvestment is a form of priority setting; it involves tough choicesbetween cutting and continuing funding. In the English context, disinvestment decisions, particularly around hospital closures or EDdowngrades, have often caught the attention of local and national media but in Canada, either because of the implicit way in which theyhave been carried out, or the euphemistic ‘priority setting’ banner under which they have been taken, these kinds of decision havepassed off fairly quietly. It isn’t that they haven’t been taken, it is that they have been taken slowly or incrementally or that they haven’tbeen publicised in the same way as they may be in England and there has therefore been less of an impetus for public involvement.

In the UK, decision makers and the public have become accustomed to the language of austerity and we are reminded on a daily basisof the need to tighten our belts. The Coalition government may have come to power promising to protect the NHS and maintain its budget,but a number of apocalyptic financial forecasts, allied with a spate of high profile quality scandals, have refocused the public’s attentionand there is now a palpable feeling that “we can’t go on like this.” The time is ripe for service change and disinvestment. In Canada,however, talk of austerity is far from the lips of those in power and it remains alien to the public and decision makers - this is anotherreason why my study may require a significant overhaul before a Canadian rollout.

I hope that the clinicians and academics that attended my presentation learned something. I hope that, if nothing else, they went awaywith an understanding that public involvement in disinvestment decision-making is not necessarily a yes or no question; there are otherconsiderations and other concerns that should be borne in mind when designing a process. As for me, I came away having learned farmore from the discussion and questions than I could ever have hoped. I have gained a good understanding of Canadian thoughts ondisinvestment, and the state of public discussion across the provinces and I have gained the confidence to rewrite my study for aCanadian audience. Having written and delivered the presentation, and reflected on the discussion, I am now left with two naggingquestions - is the UK ahead of or behind Canada in its health disinvestment practice? Are we grasping a nettle now that the Canadianswill be forced to grasp in the future, or with more implicit, slow-paced priority setting in the past could we have steered clear of thelanguage of disinvestment altogether?

Yours sincerely,

Tom

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A letter from Melbourne: providing mental healthservices for adolescents and young adultsSarah-Jane Fenton

Dear HSMC,

Comparative health policy research is a developing field at HSMC. Increasingly, links and joint researchprojects are being established with Universities overseas. PhD researchers are also being supported todevelop innovative research in multi-site, international contexts. It is an exciting time for interdisciplinarycollaborations that help elucidate key issues common to health systems, in the search for pragmatic evidenceand research-based solutions.

I am one of a number of PhD students who are looking at health services research in a comparative context.The research I am undertaking explores mental health policy and the delivery of mental health services to older adolescents and youngadults, those who are between sixteen and twenty-five years of age. The research is comparative between Australia and the UK, withthree field sites in the UK (in Scotland, Wales and England) and three sites in Australia.

Currently in the UK, a complex picture is presented in relation to adolescent mental health and mental health policy generally. Strides havebeen made in relation to developing Early Intervention services in the UK. These services have been founded based on a strong clinicalevidence-base from research into practice, and as a policy response to problems with service transitions. However, practice remainssubsumed within CAMHS (Children and Adolescent Mental Health Services) and AMHS (Adult Mental Health Services). Policy has, inpractice, meant that groups of young adults aged 16-25 fall through the gaps in care arrangements and do not receive adequate, orsometimes even any, mental health services.

The opportunity to look at Australian policy and systems that are arranged slightly differently (in part because of the federal system)could offer unique insights into the many layers of policy and how this impacts on service. Through qualitative interviews with staff,patients and policy makers, the study examines whether young people falling through the gaps who are at a vulnerable stagedevelopmentally in terms of mental health, are consequently negatively affected by the present policy framework. The choice ofAustralia for comparative analysis centres on the pioneering work in the field of mental health done academically and practicallythroughout the 1990s. For example, models of early intervention that target this age group specifically were developed synchronously inAustralia and the UK during this period. Research into early intervention generated reciprocal practice learning that significantlycontributed to service developments in this area. Australia has also been particularly instrumental in their articulation of young people’sneeds in national health policy. The comparison does not involve service evaluation or directly comparing clinical skills or individualservice outcomes; rather it focuses on the policy and practical settings through which these services are delivered, the barriers to carethat young people face and the implications this has for them and for wider society.

The research is focusing on the ways in which policy sculpts mental health systems and services in the different country contexts. Toaid the comparison between the UK and Australia, the experience of service users will be used to highlight both gaps and strengths inpolicy and service arrangements. This study hopes to better understand what improvements should be adopted in each setting and viceversa as well as how policy creation, implementation and transfer affects people experiencing mental illness and disorder. This work iscrucial at a time where wellbeing is increasingly appearing in policy agendas alongside mental disorder as a policy objective in its ownright. With heightened economic pressures and scarce resources it is important to examine how policy, and consequently services, fitthe current needs and demands of populations.

There is much to be gleaned from taking an internationally comparative perspective and using policy as a lens through which to viewpractice. Not only can this lens illuminate the difference between models, but there are also useful lessons to be learned from a federalsystem like Australia as we move post-devolution to a quasi-federal system in the UK. The management of patients and equity of accessto services across national borders is but one of the related issues. Different funding structures and the impact that these have onpolicy and practice also make research in international contexts exciting, with policy change and transfer shaping knowledge in bothdirections.

I’ll be in touch over the coming months as I arrive in Melbourne and the Australian component of my data collection begins in earnest.

Yours sincerely,

Sarah-Jane

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Reforming health and social care in China

It has become awidely held viewshared bypoliticians,academics andjournalists that the21st century will becharacterised as

‘Asia’s century’. These perspectivessuggest that as the axis of political andeconomic power moves increasingly fromWest to East, China is emerging as theglobal superpower. Jacques (2012), forexample, argues that current trends suggestthat China ‘will rule the world’ with a newand distinctive brand of modernity. This newworld will not simply be a continuation ofWesternisation but will represent a newparadigm experienced in economic, politicaland cultural terms.

Whilst the growing power and influence ofChina brings opportunities, friends andenemies, such rapid growth also brings withit many of the social and economic problemsthat often characterise the industrialisationof nation states. Increasing societalpressures associated with growinginequalities, urbanisation and the demandsof an ageing population mean that China, likeeverywhere else, is looking for solutions tosome of the intractable welfare problemsfacing the world today: how to managepopulation demands with ever diminishingresources.

Over recent years, the Chinese governmenthas been undertaking significant reforms ofhealth and social care to meet these welfaredemands and dilemmas. These reformshave been summarised by Yip et al (2012)who suggest that China’s 3 year reformplan, launched in 2009, marked the firstphase towards achieving comprehensiveuniversal health coverage by 2020. Thereform proposals have centred on thefinancing of healthcare together withpriorities for prevention, primary care andredistribution of finance and humanresources to poor regions. Reflecting onthese developments, Yip et al (2012)suggest that there has been impressiveprogress towards universal insurancecoverage. However, they also point to theimplementation difficulties being encounteredin the translation of funding and insurancecoverage into cost-effective, high quality

To look at how approaches to reformcould be improved and developed for thebetterment of service users and society

To achieve these objectives, HSMC and thePeking Health Science Center will be hostingseminars with case studies of how differentreform policies have been introduced in therespective countries. We plan to visit Beijingin July 2014 to contribute to a seminar thatfocuses on reforms to improve theperformance of hospital care. In November2014, we will invite colleagues from Beijingto a seminar that will focus on reforms toimprove and integrate the primary andsecondary care interface. We hope theseevents will further develop relationshipsbetween the two institutions and facilitate awider network for policy and practiceacross the UK and China, building on theexisting relationship between the Universityof Birmingham and the city of Guangzhou(see http://www.birmingham.ac.uk/international/guangzhou/about/index.aspx), as well as look to facilitatefurther collaboration between universitiesthat include Guangzhou Medical University,Sun Yat Sen University and FudanUniversity.

References

Jacques, M. (2012) When China rules theworld: the end of the western world andthe birth of a new global order (2nd ed.).London, Penguin Books.

Yip, W. C-M., Hsiao, W.C., Chen, W., Hu, S.,Ma, J. and Maynard, A. (2012) Earlyappraisal of China’s huge and complexhealth-care reforms, Lancet, 379, 833-42.

Ross Millar

services. Yip et al (2012) conclude thatwork is still to be done in relation toproviding effective incentive structures,improving hospital governance anddeveloping appropriate regulatoryarrangements if China is to realise itsambition of a universal health system.

When we compare these developments toour experience in England, we find cleardifferences between the organisation anddelivery of these health and social caresystems. However, these recentdevelopments in health and social carereform across China also point to similaritiesbetween the countries as both turn to ‘quasimarket’ approaches to improve theirhealthcare systems. These reform effortsare being documented individually, yet acomparative focus on how reforms such asPayment by Results have been introducedremains a significantly underdevelopedissue.

Over the next 12 months, HSMC hasreceived funding to develop and enhance alearning network for the study of health andsocial care reform across England andChina. Our funding intends to build on anearlier visit to Peking University HealthScience Center in Beijing back in October2012 by myself, Robin Miller and HelenDickinson, and is intended to look to developcommon areas of research interest. Thelearning network will have the followingaims:

To analyse, assess and explain thenature and impact of quasi marketreforms in health and social care systems

To analyse what lessons can be learntfrom how policies and practices ‘transfer’across contexts

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Facing the challenges of improving our healthcare systems

Harvard’s Professor John McDonagh is a new honorary member of staff at HSMC and is part ofthe team delivering the new NHS Leadership Academy Nye Bevan programme - see p. 9

At the HarvardSchool of PublicHealth in Boston,Massachusetts,we are proud topartner with theUniversity ofBirmingham and

other academic institutions to support theNHS Leadership Academy and its mission toimprove the quality and patient focus ofhealth care delivery in England. This is afundamental moment of opportunity forEngland and the U.S. Though our systemsdiffer in crucial ways, both sides face somesimilar and compelling challenges.

The key difference between our systems isguaranteed coverage. Since the creation ofthe NHS in the late 1940s, Great Britain hasprovided full access to essential medicalservices for all your people, with no costbarriers. In the United States, more than 60years later, we are still fighting to create thatguarantee and assurance. The passage ofthe Affordable Care Act (ACA/Obamacare),signed by President Barack Obama in Marchof 2010, is our major opportunity toovercome this societal disgrace. Of all theleading advanced nations, the U.S. is theonly one that permits our citizens to sufferfinancial ruin because they or a familymember gets sick. Indeed, less advancednations such as Mexico, Turkey andThailand are ahead of us in establishinguniversal access.

The British established a national healthsystem in the aftermath of the terriblescourge of World War II, when citizensolidarity and unity were quite high. Thatsense of solidarity has never been asstrong in the U.S. and has weakenedconsiderably in the last 30 years aslibertarian cultural and political instincts havebecome much stronger. So even though theACA is now more than three years old, thefighting is hardly over.

The conflict is especially intense right nowas we head toward January 1 2014 whenthe new system of guaranteed coveragecomes into full effect. ACA opponents wereunable to repeal the law in our Congress,

unable to get our Supreme Court to declare itunconstitutional and unable to removePresident Obama from office. So they arenow engaged in a political guerilla war todefund and derail in any way possible. It isthe last gasps of a wealthy and entitledopposition. Brits should take pride that yoursystem guarantees access to medicalservices regardless of race, ethnicity orclass. The differences could not be moreprofound.

Yet, both our systems face seriouschallenges in providing high quality andpatient-centered care to all those in need ofmedical attention. In the U.S., we are awareof the quality challenges that have come tolight because of the failures at Mid-Staffordshire Hospital in recent years.We know that, most often, these kind ofproblems are systemic and not simply anaberration at one or a few institutions. Therecent Francis and Berwick reports fromearlier this year confirm that systemicreforms are essential to guarantee not justaccess but quality, patient-focused care aswell.

Since the late 1990s, with the release oftwo landmark reports from the U.S. Instituteof Medicine, To Err Is Human and Crossingthe Quality Chasm, the systemic flaws andshortcomings in American medicine havebecome a national conversation. Prior to therelease of these reports, public opinionsurveys showed Americans’ confidencethat we had ‘the best quality medical care inthe world.’ The work of U.S. foundationssuch as the Commonwealth Fund havedemonstrated conclusively that the quality ofU.S. medical care is mediocre at best whencompared with the systems of otheradvanced nations, including Britain’s.American medical care excels the best atspending exorbitant amounts of money forpoor results. For every dollar we spend onmedical care, the second most expensivenation (usually Norway, Germany orSwitzerland) spends about 65 cents. Britsspend less than 50 cents for every dollarwe spend in the U.S. And our quality ismediocre as compared with our peers, andwe fail to provide coverage to all ourcitizens.

That is why the Affordable Care Act, inaddition to seeking universal coverage in theU.S., also prioritises the reform andimprovement of our medical care deliverysystem. The law does this in a variety ofways:

By moving away from a reimbursementsystem that rewards medical providersfor the volume of services provided andtoward rewards based on quality andvalue

By creating new organisational structuressuch as Accountable Care Organisationsto promote patient-centered care and totake responsibility for patients beyond theinstitutional walls

By re-designing primary care through thecreation of Patient Centered MedicalHomes

By penalising hospitals with very highrates of preventable readmissions andhospital acquired infections, and muchmore

Dr Donald Berwick, who has advised theNHS over about ten years, is the developerof a medical reform concept known as theTriple Aim. The goal of health system reformmust be to: 1. Improve the patientexperience of care; 2. Improve populationhealth; and 3. Lower the per capita cost ofproviding medical services. It is fair to saythat these three goals are the motivators ofthe system reform efforts included in theACA. Improvement is a journey, not a race.The Triple Aim is now extending over theglobe, because in truth, the challenges weface in the U.S. and in Great Britain, arechallenges faced by health systems aroundthe world, everywhere. Increasingly, weunderstand how much we can learn fromeach other.

We look forward to supporting efforts toimprove and sustain the National HealthService.

Professor John E McDonough, DrPH, MPA,is Director of the Center for Public HealthLeadership at the Harvard School of PublicHealth and a new honorary Professor atHSMC.

John McDonough

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Postgraduate programmes

HSMC welcomed a new intake of studentson 30 September 2013. The departmentdelivers a number of UK-based Mastersprogrammes as well as contributing to anumber of interdepartmental programmes.

HSMC offers an MSc in Healthcare Policyand Management with optional specialismsin Commissioning, Quality and ServiceImprovement and Integrated Care. Theprogramme consists of:

a)Four core modules: Health Service Management Health and Healthcare Policy An Introduction to Organisational

Development in Health and Social Care Public and User Involvement in Health

Careb) Two optional modules which are selected

according to specialism if a specialisttrack has been selected (20 credits each)

c) Dissertation/Research Project

The programme is designed for seniormanagers, clinicians and policy makersworking in or with health care and socialcare organisations, or with an interest indeveloping their careers in this direction.

All of HSMC’s Masters programmesemphasise the application of theoreticalperspectives to current policy and practicein the NHS and other health care systems,and are explicitly designed to supportprofessional as well as academicdevelopment. The majority of our studentsstudy part-time (over 2 years) whilstworking in the health service or a relatedfield, although we do have a number of full-time students studying on our UK-basedprogrammes, and completing theirqualification within 12 months.

HSMC staff bring their wide knowledge ofUK and international health systems (gainedthrough research and consultancy activities,as well as their own professionalexperience) to their teaching and tutorialsupport for students. This emphasis ismaintained throughout all of ourprogrammes, from the choice of titles forassignments and the topics selected fordissertations, through the involvement ofpractitioners and policy makers in teachingactivities. While some students choose toconcentrate on theoretical dissertationtopics, many students carry out empiricalstudies, often related to their own place ofwork or area of professional expertise.For further information contact Kate Vos:c.j.vos@bham.ac.uk

Postgraduate Certificate for CCG leadsAfter discussions with local GPs working inCCGs, HSMC has designed a new PGCertificate in Healthcare Commissioning(jointly badged with NHS ClinicalCommissioners) which was launched inJanuary 2013. It builds on previoussuccessful programmes such as the MSc inHealthcare Commissioning delivered for NHSLondon and NHS West Midlands; the UK’sfirst MSc in Public Service Commissioning(delivered jointly with the Institute of LocalGovernment Studies); and a series of localand regional commissioning developmentprogrammes delivered throughout thecountry. Aimed at both clinicians andmanagers, previous participants have givenconsistently positive evaluations, and statethat these programmes help those incommissioning roles to understand whatcommissioning is, where it has come from,where it might be taking us and how to do itdifferently and better.

Based on three 5-day modules, theprogramme consists of:

Strategic Commissioning Decision-making and Priority-setting Procurement and Market Management

For further information contact Kate Vos:c.j.vos@bham.ac.uk

New Masters specialism inintegrated careIn 2013 HSMC introduced a new MScspecialism in integrated care. Alongsidebroader inputs around health servicemanagement, health care policy,organisational development and patientinvolvement, the programme will focus inparticular on the skills, knowledge andconcepts necessary to work successfullywith people from different professionalbackgrounds and with partners fromdifferent parts of the health and social caresystem. Key topics will include currentbarriers to integrated care, the benefits ofworking together, the governance ofpartnerships, the outcomes of integratedcare and the importance of organisationalculture.

For further details, contact Kate Vos:c.j.vos@bham.ac.uk

HSMC hosts University ofMelbourne teaching programmeIn November 2013 HSMC hosted theUniversity of Melbourne’s InternationalPublic Management module, which is anelective module of the Masters in PublicPolicy and Management run by theMelbourne School of Government. Themodule was led by Helen Dickinsonwho recently left HSMC to take up arole as Associate Professor in the newMelbourne School of Government.

Staff from HSMC and Inlogov wereinvolved in teaching on the module,which seeks to provide students with asense of what the major challengesand dilemmas are in the design anddelivery of health and local governmentservices in a UK setting. Students alsohad an opportunity to meet University ofBirmingham students at an eveningevent and had the chance to hear fromDr Mark Newbold, Chief Executive ofHeart of England Foundation Trust. Thefinal day of the week-long module wasspent visiting Birmingham City Councilwhere students met senior officers andpoliticians.

Discussions are currently in placeabout the possibility of developing aninternational public management moduleat the University of Birmingham in thenear future which will involve studentsfrom Birmingham and Melbournelearning together.

For more details about the MelbourneSchool of Government see http://government.unimelb.edu.au/

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James Taylor, MScHealth CareManagement (2008)My last update includednews of a successfulcompletion of the LondonMarathon in 2011, which

was then followed by completion of theMarine Corps Marathon over in WashingtonDC later in the same year. I then took up anew professional challenge in late 2011,moving back to the East of England, where Iundertook the NHS Graduate Scheme(General Management) between 2001 and2003, as Programme Manager at CambridgeUniversity Hospitals NHS Foundation Trust -to manage the set up of the Major TraumaCentre at Addenbrooke’s Hospital, as part ofthe East of England Major Trauma Network.When the initial programme of work aroundthe Major Trauma Centre completed in Aprilthis year, I took the opportunity to head outto Botswana to undertake a one week

project scoping visit as a volunteer with‘Addenbrooke’s Abroad’ - looking specificallyat opportunities to develop a collaborativelink project with the Botswana Ministry ofHealth, supporting the development ofEmergency Medical Services (EMS) in thecountry.

‘Addenbrooke’s Abroad’, is a charitableorganisation which was established in 2006in recognition of the benefits for patientsand health care professionals, bothoverseas and in the UK of engaging in globalhealth. Following the initial visit, plans arenow taking shape to formally develop theEMS link project, with a specific focus uponenhancing the clinical skills of multi-professional teams from both the hospitaland pre-hospital setting in caring for majortrauma patients. Major trauma, which islargely attributable to motor vehiclecollisions, is the second leading cause ofdeath in Botswana behind HIV/AIDS.

I continue to work at Cambridge UniversityHospitals NHS Foundation Trust, maintainingmy clinical practice as a Paramedic.Following research I undertook as part ofmy MSc in Health Care Management atHSMC, I have published work in the Journalof Paramedic Practice relating to leadershipand organisational change, and I’m a peerreviewer for the journal.

For more information on Addenbrooke’sAbroad, please follow the link below:www.act4addenbrookes.org.uk/Aboutus/Addenbrooke%E2%80%99sAbroadJames.taylor@addenbrookes.nhs.uk

James TaylorProgramme Manager, Cambridge UniversityHospitals NHS Foundation Trust,Addenbrooke’s

Where are they now?

Tom Duncan, MScHealth CareManagement (2013)After finishing my MSc lastDecember I went to workfor Careflight in theNorthern territory of

Australia, which was an amazingexperience. I am not sure I used many of myHSMC skills out there but it was definitelynoted that I was ‘medical director’ typematerial.

Whilst I was out there I got a job on theNational NHS Medical Director’s ClinicalFellow Scheme through the Faculty ofMedical Leadership and Management. Thisscheme, sponsored by Sir Bruce Keogh,enables 23 doctors to take time out ofclinical work and be immersed in the worldof medical leadership. I have been secondedto the National Institute for Health and Care

Excellence where I am working with variousteams across the organisation. The study Idid at HSMC has been invaluable in terms ofproviding a framework for understudyinghow organisations work in general but alsothe challenges in developing guidance forhealthcare systems, how to get theguidance implemented and barriers toimplementation.

I know that lots of people on the scheme arekeen to try and get some formalqualifications so I have been promotingBirmingham as a good course, whether forthe PG Cert or the full MSc.

Dr Thomas Duncan FRCAClinical Fellow, National Medical Director’sClinical Fellow SchemeNational Institute for Health and CareExcellence

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Postgraduate programmes continued

NHS Leadership Academyprogrammes launchedIn September we saw the launch of the NyeBevan (senior) and Elizabeth GarrettAnderson (mid-tier) LeadershipDevelopment Programmes. Delivered via aconsortium that includes KPMG, ManchesterBusiness School, National Voices and LineCommunications, both programmescomprise blended learning with a dedicatedVirtual Campus (VC), face to faceworkshops and action learning sets.Although details of both programmes areavailable online, the brief summary belowfocuses on the Anderson programme (andBevan will be profiled in future editions ofthe newsletter).

The Anderson programme consists of a 24month learning journey comprising eightstudy modules, and exploring theknowledge, skills and behaviours that areimportant for leading others when building aculture of patient-centred care within thehealthcare system.

Eighty-five per cent of this programme isaccessible on-line at any time of the day (ornight!) It takes as its focus the workparticipants are already doing and uses thisas the basis for their learning. Thecurriculum focuses participants’ attention onwhat is practical and works, and helps tolighten the study workload, as some of thelearning is within their day-to-day job.

There are many novel features to the VirtualCampus and these have been noticedimmediately by participants, some of whomthought they would just get presentationsand reading on-line, only to find poems,patient stories, vox pops, videos (immersivescenarios, talking heads, animations), work-based activities with their team and linemanager, as well as some traditionaltheoretical primers, and much more.

Some participants’ feedback on the virtualcampus:

“The resources on the Getting Startedsection of the Virtual Campus are thoughtprovoking and they are just the start!”“I am finding the VC really well presentedand well resourced. There is a vast amountof information to plough through. I really likethe way I can look back over things I havedone - much better than a lecture which isfor the most part gone except for a fewhandouts.”

“The videos have already started me tothink about my behaviours and the effect Ihave on others, so I am encouraged thisprogramme will enable us to be more self-reflective and conscious of our impact onour direct teams, wider organisations and,ultimately, the experience felt by patients.Feel assured this will be a very positivejourney.”

“All the videos were thought provoking insome way, but the most provocative thoughtfor today is ‘what’s it like to be on thereceiving end of me?’”

The other fifteen per cent of time is face-to-face learning in residential workshops andregional action learning sets. At the firstresidential workshop, we heard thatparticipants expected to just sit in lectures,so were rather taken by surprise that mostof their learning was experiential, interactiveand required them to engage in reflexiveactivities that focussed on intra-personaland inter-personal behaviours, as well asopportunities to experiment with doing things

differently, taking up different roles andlearning from others.

For HSMC, we continue to break newground through this work, both byaccrediting a leadership developmentprogramme of this kind and throughextending our use of blended and workbased learning approaches.

For those interested, the NHS LeadershipAcademy are about to reopen their site forapplications in the near future. If you areinterested, have a look at their web sitewhich tells you more about the programmeand how to apply:www.leadershipacademy.nhs.uk/grow/professional-leadership-programmes/elizabeth-garrett-anderson-programme/joining-instructions-for-the-elizabeth-garrett-anderson-programme/

Deborah DavidsonSenior Fellow

9 HSMC - Newsletter

Projects update

U21 Health Organisation andManagement networkProfessor Russell Mannion is co-directorwith Dr Helen Dickinson (MelbourneUniversity) of the Universitats 21 (U21)Health Organisation and Managementnetwork. This network has active membersfrom elite U21 universities based in NorthAmerica, Europe, Australasia and Asia andserves as an international forum fordebating, developing and undertakinginnovative research into all aspects ofhealth organisation and management,including comparative research acrosscountries and health systems. Key themesinclude topics such as health care quality;professional identities; organisationalincentives, rewards and cultures; patientchoice and public involvement; evaluation ofcommissioning practice and priority setting;and health system organisation andintegration. r.mannion@bham.ac.uk

Social welfare and disability rights inKorea

HSMC’s Jon Glasby has recently seen hisbook, which he co-authored with RosemaryLittlechild in IASS, on Direct payments andpersonal budgets: putting personalisationinto practice (The Policy Press, 2009)translated into Korean. He has since beeninvited to present to the 2013 InternationalConference of the Korean Academy ofSocial Welfare (KASW), the largest socialwelfare conference in Korea. His visitbuilds on strong links with Korea across thebroader School of Social Policy, with a long-running Policy into Practice MA for Koreancivil servants. While in Korea, Jon spokeabout challenges and opportunities inEnglish social care, with scope to compareand contrast experiences with speakersfrom the OECD, the US, Japan, China andGermany. He also met with the ChiefExecutives of disability organisations suchas the Korean Disabled People’sInternational, the Korean Disabled People’sDevelopment Institute and the KoreanFoundation for People with Disabilities.j.glasby@bham.ac.uk

Deepening our understanding ofquality improvement in Europe(DUQuE)Russell Mannion is part of a research teamfinanced by the EU 7th ResearchFramework Programme which is exploringthe effectiveness of quality improvementsystems in European hospitals. The study isbeing led by the Autonomous University ofBarcelona and also involves colleaguesfrom UCLA, and the Universities of Cologneand Utrecht. This study is using large scalequantitative data sets to assess the impactof organizational culture, professionalinvolvement and patient empowerment onquality improvement, patient safety andclinical outcomes. Data has been collectedfrom hospitals in the Czech Republic,France, Germany, Poland, Portugal, Spain,Turkey and the United Kingdom.r.mannion@bham.ac.uk

Developing new approaches to adultsocial careTurning the welfare state upside down? is anew policy paper from HSMC on the need todevelop new approaches to social care thatbuild more effectively on social capital andcommunity resources. Commissioned byBirmingham City Council, the report is basedon a review of Council websites across alllocal authorities in England and interviewswith key national stakeholders, social careleaders, user-led organisations and goodpractice examples. With the Care Bill beingdebated in Parliament, this generatedsignificant media and policy interest,appearing in a number of nationalnewspapers, on the BBC and on ITV. Forthe full policy paper, see:www.birmingham.ac.uk/hsmc-policy-paper-fifteenj.glasby@bham.ac.uk,r.s.miller@bham.ac.uk,j.lynch.1@bham.ac.uk

Iestyn Williams and Kate Warren are leadinga project to adapt the REACH game for theEnglish context.i.p.williams@bham.ac.ukk.s.warren@bham.ac.uk

Time to care: evaluating a model ofemotional support for nursesworking on acute wards in hospitalThis research project is examining thefeasibility of implementing a support system,based on the Samaritans’ model for theirvolunteers, into a busy ward environmentfor nurses. It is now nearing the end of the12 months funding and is at the stage ofcollecting data through interviews andsurveys, and compiling a report of findings.The three sites are all working to differenttimescales and so the final report will bepublished in early spring 2014.y.sawbridge@bham.ac.uk

Evaluation of the impact of high-intensity specialist-led acute care(HiSLAC) on emergency medicaladmissions to NHS hospitals atweekendsProfessor Russell Mannion is co-applicantwith colleagues from Birmingham MedicalSchool on a newly funded NIHR HS&DRproject which is evaluating an intervention toimprove the care of acutely ill medicalpatients admitted as emergencies to NHShospitals at weekends. This three yearstudy, led by Professor Julian Bion aims toevaluate the effect of specialist intensity ondifferences in quality of care betweenpatients admitted at weekends vsweekdays, and any effect of HiSLAC inreducing these differences.r.mannion@bham.ac.uk

Reaching economic alternatives thatcontribute to healthREACH (Reaching Economic Alternativesthat Contribute to Health) is a deliberativegroup exercise based on a board game,where citizens are asked to debate andprioritise a range of interventions thataddress the social determinants of health.The REACH game was devised anddeveloped by academics and policymakersin the United States. Dr Marion Danis fromthe National Institute of Health at the USgovernment presented the work here atHSMC in June. Following on from this visit,

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Projects update continued

Transatlantic collaboration fund

Yvonne Sawbridge successfully secured agrant from this fund to visit Chicago tospend time with Associate ProfessorSharon Mastracci at the University of Illinois.Her work centres on emotional labour inpublic servants in the USA, and hasuncovered the notion of emotional labour asa core competency that can be learned andrefined, with appropriate support. Duringthis trip Yvonne met with the Chief andAssociate Nurse Executives atNorthwestern Memorial Hospital (see photo)to discuss their approach to supporting staffas part of their Magnet HospitalAccreditation. This trip has helped cementrelationships with a view to developingcollaborative research projects andpublished articles to support and strengtheneach other’s work. Birmingham and Chicagoare also ‘sister cities’ with a range of linksbetween local government, local third sectororganisations and local Universities.y.sawbridge@bham.ac.uk

Learning for the NHS on procurementand supply chain management (SCM)Russell Mannion is currently undertakingwith colleagues from Birmingham BusinessSchool a literature synthesis funded byNIHR HS&DR which aims to understand thestrengths, weaknesses and gaps in existingtheories about procurement and supplymanagement in terms of its application tohealth care. The study brings together thecombined expertise of HSMC and theBusiness School, and will provide apractical guide for NHS managers andclinicians with responsibility for thecommissioning and procurement of healthcare services.r.mannion@bham.ac.uk

Dudley CCG evaluationHSMC are working closely with Dudley CCGto help them develop and evaluate theircommissioning approach - in particular theirmodel of integration. They are also

employing a research assistant as part oftheir intention to build upon the evidencebase for effective commissioning, and tohelp them overcome the theory-practice gapin their everyday business for the benefit oftheir population. Yvonne Sawbridge is theirinitial link, and the expertise of the HSMCteam will be utilised as appropriate. This isan exciting venture for both parties, withscope to translate new research rapidly intopractice.y.sawbridge@bham.ac.uk

ESRC-funded projectsCatherine Needham is leading on two newESRC-funded projects, one on evaluatingmicro-enterprises in social care and one onskills for the twenty-first century publicservant. The latter project is a KnowledgeExchange project with Birmingham CityCouncil.c.needham.1@bham.ac.uk

Patients’ Council evaluationRobin Miller and Hilary Brown areundertaking an evaluation of a Patients’Council within a low-secure unit for peoplewith a learning disability. This will explorehow patient-led initiatives can work within asetting in which people’s autonomy isrestricted.r.s.miller@bham.ac.ukh.i.brown@bham.ac.uk

Evaluation of the joint commissioningunit in WalsallHaving previously been involved in debatesabout the relationship between health andsocial care in Walsall in the mid-2000s,HSMC have been asked to carry out a newpiece of work exploring the impact andfuture development of Walsall’s JointCommissioning Unit (JCU) in an era of clinicalcommissioning. With public healthtransferring to local government, new CCGsreplacing former PCTs and the advent ofHealth and Well-being Boards, many JCUsaround the country are having to re-thinktheir previous role and remit. This projectbuilds on HSMC’s recent national evaluationof joint commissioning(www.birmingham.ac.uk/sdo-joint-commissioning)j.glasby@bham.ac.uk

Compendium of change managementapproachesRobin Miller and Deborah Davidson areworking with Dr Tim Freeman fromMiddlesex University on developing a

compendium of change managementapproaches for social care managers.Funded by the NIHR School for Social CareResearch, this research seeks to producean informative and practical resource formanagers seeking to improve front-lineservices.r.s.miller@bham.ac.ukd.c.davidson@bham.ac.uk

Integrated care ‘pioneers’HSMC’s track record of research, teachingand consultancy around inter-agencyworking was recognised when Jon Glasbywas selected as a member of the panelidentifying the government’s new integratedcare ‘pioneers.’

International keynotes for HSMCProfessorRussell Mannion gave the keynote addressto the annual conference of the PolishSociety for Quality and Safety in Health Careheld in Krakow, focusing on: Hospital boardgovernance of quality and patient safety:recent evidence from the UK and USA. Thepresentation drew on Russell’s work onorganisational culture and health care qualityas well as the findings of an NIHR study heis currently leading which is exploring thelinkages between board governance andpatient safety outcomes across all hospitalsin England. He was also the keynotespeaker at an international seminar on healthcare performance organised by theNorwegian National Knowledge Centre,Oslo, entitled: The governance of quality andsafety: lessons from the English NHS. Healso replied to the speech at the seminar bythe National Chief Medical Officer forNorway, Professor Bjørn Guldvog. Russellholds a five year appointment as VisitingProfessor in the Faculty of Medicine,University of Oslo and is involved in aresearch project assessing the developmentof integrated care services in Norway aswell as undertaking research assessinghealth care quality in Norwegian hospitals.r.mannion@bham.ac.uk

11HSMC - Newsletter

Developing a compassionateorganisation: an action learning setapproachRecent events such as the failures at Mid-Staffs and Winterbourne View have raisedserious concerns about the delivery ofcompassionate care in the NHS. In the past,recommendations and action plans have notbeen the solution - as similar failings recur.As all organisations reappraise their trackrecord to date, there is significant scope tolearn from existing practice, including:

HSMC’s action research to develop anapproach to systematically supportingnurses, using a model based on theSamaritans’ organisational programme forsupporting its volunteers

The Kings Fund is implementing SchwartzRounds as part of its Point of CareProgramme

A system of support known as‘restorative supervision’ has beenintroduced to health visiting services inthe West Midlands with impressive results

To build on such developments, a newaction learning set aims to enableparticipants to learn from each other in asupportive yet challenging environment.This involves four one-day events (the 1st

event took place on 5th December 2013),and each day will begin with a review of theevidence base and an update on progresswith implementation of a particular model. Ifplaces are available after 5th December,new members will be welcome, at areduced fee. For further details, pleasecontact Yvonne Sawbridge(y.sawbridge@bham.ac.uk) or emailEvelina Balandyte(e.balandyte@bham.ac.uk) to reserve aplace.

The European Health Management (EHMA) Annual Conference comesto Birmingham in 2014HSMC will be hosting the EHMA Annual Conference in June 2014. The conference - “Leadership inhealthcare: from bedside to board” - will bring together researchers, policy makers and practitioners todiscuss some of the key issues related to healthcare leadership as well as examine the approaches,roles and relationships that are associated with breaking new ground in leading service improvement.

The conference aims to provide interactive sessions and networking opportunities to discuss andengage with representatives from a variety of different health sectors from Europe and beyond.

If you are interested in attending EHMA 2014 please contact Ross Millar (r.millar@bham.ac.uk) orTracey Gray (t.gray@bham.ac.uk)

West Midlands Chairs and Non-Executive Directors’ Forum – free launchevent:Thursday 27 February 2014Following the reforms brought about by the Health and Social Care Act 2012, NHSChairs and Non-Executive Directors (NEDs) have often found themselves having torespond to a series of deep-seated challenges in difficult policy and financialcircumstances. Against this background, HSMC is proposing a new forum for Chairsand Non-Executive Directors across the West Midlands starting with an initial freeevening event to bring interested colleagues together to debate some of the key issuesand explore further the potential for such a network. Thereafter, HSMC will put togethera formal proposal for those Trusts that wish to subscribe to such a forum, with a seriesof regular evening events to be designed and delivered (perhaps 8 such events a year,as an example).

If you are interested in attending the free launch event, please contact EvelinaBalandyte email: e.balandyte@bham.ac.uk

Events

12 HSMC - Newsletter

People at HSMC

Partnerships for public health andwell-beingA new book on Partnerships for PublicHealth and Well-being has been publishedas part of HSMC’s Interagency working inhealth and social care series. Edited byHSMC Director Prof. Jon Glasby, the seriescontains books on children’s services,disability and learning disability – with a thirdedition of Jon’s ‘Mental health policy andpractice’ due to form the mental healthcontribution to the series in 2014.

Written by De Montfort’s Professor RobBaggott, the new book explores thecollaboration that is needed between arange of agencies and sectors if health andwell-being is to be improved. In contrast tomore traditional and more medically-focusedaccounts of public health, this textbookexplores the contribution that partnershipworking can make to achieving a broadernotion of health and well-being.

Very selected recent publicationsinclude:

Davies, H.T.O. and Mannion, R. (2013) Willprescriptions for cultural changeimprove the NHS?, British MedicalJournal, 346, f1305

Glasby, J. and Dickinson, H. (2013) A-Z ofinter-agency working. Basingstoke,Palgrave-Macmillan

Jacobs, R., Mannion, R. et al (2013) Therelationship between organisationalculture and performance in acutehospitals, Social Science and Medicine,76, 115-125

Lunt, N., Mannion, R. and Exworthy, M.(2013) A framework for exploring thepolicy implications of UK medical tourismand international patient flows, SocialPolicy and Administration, 47(1), 1-25

Needham, C. (2013) The boundaries ofbudgets: why should individuals makespending choices about their healthand social care? London, Centre forHealth and the Public Interest

Needham, C. (2013) Personalizedcommissioning, public spaces: the limitsof the market in English Social CareServices, BioMedical Central: HealthServices Research, 13, Suppl 1

Needham, C. (2013) ‘Personalisation: fromday centres to community hubs?’,Critical Social Policy (early view)

Powell, M. et al (2013): Has the BritishNational Health Service (NHS) gottalent? A process evaluation of the NHStalent management strategy?, PolicyStudies (DOI:10.1080/01442872.2013.798533)

We recently welcomed Helen Smart, MauvaHanson, Susan Davies, Lesley Richards andKieron Stanley to the newly formed NHSLeadership Academy administration team being led

by Tracey Gray.

Dr Laura Griffith was untilrecently a Senior QualitativeResearcher in the HealthExperiences Research Group atOxford and has just joined HSMCas a lecturer. Laura is ananthropologist whose research

interests include qualitative research into personalexperiences of health and illness (especially in thefield of mental health) and the provision of healthservices to address class, ethnic and genderinequalities.

Dr Karen Newbigging joinsHSMC as a Senior Lecturer inHealth Care Policy andManagement. Originally qualifyingas a clinical psychologist, Karenhas over 30 years’ experience inmental health. She has been

involved in commissioning, research, consultancy,postgraduate teaching and organisationaldevelopment and worked with a broad range oforganisations on system development. Karen’sspecialisms include implementation, equalities andepistemic justice, commissioning, personal agencyand service transformation in mental health andsocial care. She is the co-author of the recentSage publication Commissioning Health andWellbeing.

New Honorary Senior Research FellowDr Sandra Buttigieg, Head of the Department ofHealth Services Management, Faculty of HealthSciences at the University of Malta has beenappointed as an Honorary Senior Research Fellowat HSMC. Sandra is a medical doctor bybackground and has a PhD in management fromAston University. She visited HSMC as a visitingErasmus scholar in June 2013 and gave a verywell received seminar. Sandra will be developingcollaborative work with HSMC colleagues aroundhospital quality performance.

HSMC forms new link with HarvardHSMC is pleased to announce the appointment ofProfessor John E. McDonough as an HSMCHonorary Professor. Since 2011 John McDonough

has been Professor of Public Health Practice atHarvard School of Public Health and Director ofthe new Center for Public Health Leadership incharge of the School’s executive and continuingprofessional education programmes. Between2008 and 2010, he served as a Senior Advisor onNational Health Reform to the U.S. SenateCommittee on Health, Education, Labor andPensions. His specialty is U.S. health policy andpolitics, federal and state, and he teaches politicalstrategy for public health professionals.

Professor McDonough’s background reflects adiverse set of professional engagements ingovernment and public service, academia,advocacy and non-profit leadership with twosignificant stretches of service in government atstate and federal levels. Between 1985 and 1997he served as a state representative in theMassachusetts House of Representatives, andheld a variety of health policy responsibilities,including terms as chairman of the JointCommittees on Health Care and Insurance and,whilst in that role, was deeply engaged in manycommunity activities and organisations. Between2008 and 2010, he served as a senior advisor onnational health reform to the U.S. SenateCommittee on Health, Education, Labor andPensions (HELP).

Professor McDonough’s other experience includesworking as Executive Director of Health Care forAll (between 2003 and 2008), a Massachusetts’leading consumer health advocacy organisationwhich has a broad community-based membershipand stakeholder constituency where he played acentral part in the introduction of theMassachusetts health reform law in 2006. He hasalso held positions as an Associate Professor andSenior Research Associate in the SchneiderInstitute for Health Policy at Brandeis Universityand as the first Joan Tisch Distinguished Fellow inPublic Health at Hunter College, Roosevelt PublicPolicy Institute in New York City.

In late 2012 Professor McDonough was part of theteam that bid for and won the contract to deliver aseries of national leadership developmentprogrammes for middle-level and senior NHSleaders, in which he will be centrally involved inprovision. In particular, he will work alongsideHSMC’s Jon Glasby to co-ordinate all internationalinput and to help deliver the ‘broadening horizons’module of the senior leaders’ programme.

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