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Living Room to Board Room: a new approach for SCT

Discussion Paper

1. Introduction Our Trust has undergone many changes and developments over the recent past and we must now tackle further challenges to provide high quality care to patients and service users that is both affordable and effective. This is within an NHS and social care system that faces financial constraints at both the local and national level. However, rising to these challenges brings opportunities to develop the Trust and not only secure our place as a dedicated NHS provider of community services but also achieve a strong reputation for providing the best services possible. We have an opportunity to both describe and deliver services through “the SCT way” This document is aimed at introducing some ideas and to seek your views on these ideas, along with any comments you may have on how to strengthen the Trust and our services to patients. Based on the discussions arising from the suggestions outlined here, there will be a formal consultation on specific proposals to strengthen our ability to provide the best care possible for patients and the people of West Sussex and Brighton and Hove. This discussion document suggests a new approach for the Trust in which services are delivered with devolved responsibilities and accountabilities as close to the patient as possible. It seeks to describe how we can create a new culture. We want to build on what works well, and to empower clinicians, practitioners and managers to deliver flexible services, - responsive to local need and aimed at achieving the best possible outcomes for the communities we serve. Developing a new culture and approach to delivery across the Trust, will involve a shift in leadership style, systems and structure. We want to create the rights skills, capabilities and capacity across the Trust to ensure that together, we achieve our vision and goals. With you we want to develop a culture and structure that enables us to deliver services our patients and their carers’ value, that our partners believe in and our stakeholders respect. Ideas and suggestions are presented here for discussion and to inform the next stage developments.

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2. Rationale for the next stage of a new approach Last year’s wide-ranging review of the Trust’s clinical delivery functions has gone some way towards supporting the organisation and preparing for Foundation Trust status. However, we must now accelerate the concept of localising care planning and solutions by underpinning locality teams along Clinical Commissioning Group (CCG) boundaries and aligning with acute provider catchment areas. One way of achieving this is by developing stronger clinical leadership at local level. We need leadership arrangements that offer better support to services that in turn will be commissioned differently from April 2013. We also need to support the organisation’s objective in delivering the best care we can for patients by becoming a Foundation Trust in 2014. We need to establish a new model and style of leadership that will better support the Trust in achieving its objectives and provide the highest quality and standards, and is sustainable both clinically and financially. Equally we need to find affordable ways of providing business management and support services as close to the front-line as possible, while ensuring consistency and quality of those support services. We face a very dynamic environment and can only excel if we take the next steps in developing our leadership, accountability frameworks, assurance processes, culture, and behaviours. These elements are critical to our success as a Trust and will need to be embedded in the Trust alongside any structural changes to ensure we achieve our goals. 3. Suggestions for discussion, Living Room to Board Room: A new approach 3.1 Culture One of the results of new staff starting employment with any organisation is the opportunity it affords to look at things with new and fresh eyes. The Trust has recently employed a number of new senior and other leaders and they have taken this unique one-off opportunity to observe, ask questions and listen to what people say about how things work in the Trust. This includes what works well, what doesn’t work so well, what past experience has taught us and what kind of organisation do we want to be. The suggestions in this paper are based on these reflections and are offered for further comment and discussion from all interested parties across the Trust. What is very clear is that we have highly motivated, enthusiastic, passionate, committed and caring staff. We should be very proud of this and grateful to them for all that they do for patients, service users and colleagues, despite all the challenges they face. However whilst there are many examples of people and places where there is an enabling, empowering, supportive and smart approach to what we do, it is not universal.

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Equally there are many examples of excellent practice, patient focused care, integrated and effective service provision focused on the service user, commissioner’s requirements and codes of practice and where people regularly go the extra mile. However this is neither consistent nor universal. These points are not unique to SCT and are a challenge to many large and complex organisations such as ours. There are a range of initiatives and activities in place to address some of the Trust’s challenges and the drive to sort out some of the difficulties is recognised and respected. It is recognised and accepted that people come to work in the NHS to do the best job they can and are very often motivated by the desire to make a difference through the privileged work we do. To support this, the Trust’s leadership has a duty to ensure that people have the tools to do the job, the systems and frameworks to enable them to perform, and the governance arrangements to ensure how we work is safe, effective and gives high levels of satisfaction. Often through circumstances beyond the control of any individual, historical legacies and the problem of finding time to ensure all the “ducks are lined up” and with all the best intentions, we find ourselves in a place where we need to embrace a different approach or we grind ourselves down. To illustrate this, the following describes some of the reflections made over the last couple of months and suggestions on where we might want to be universally, to ensure we can enable the Trust to thrive, for people to perform to their greatest potential and for patients to receive the best care. Reflections on existing state Indicators for ‘universal successful

state’ There is a feeling of “them and us” This is between some:

• Senior managers and frontline staff

• Frontline staff and corporate services

• Senior managers and middle managers

• Staff working in localities previously operating under old regimes: South Downs and West Sussex and Brighton and Hove

• Between different services and teams

Some staff talk of SCT as something that is separate to them and still have loyalties to previous non-existent organisations.

Differences in roles and responsibilities are valued and regardless of them “we work together as one” for the benefit of our patients and service users Whatever we do, where we work, whoever we work with, we are all colleagues and partners to each other in the Trust. Everyone needs to understand and believe how important their particular role is in the Trust and what’s expected of them. We are all SCT, we all work for SCT and can all make a difference to the success of our SCT.

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Some staff do not feel trusted, feel they can’t make decisions

Managers and clinicians at every level are able to make and delegate decisions and take leadership actions in an appropriate way People are trusted and supported to make decisions as they need to People are involved in discussions and decisions affecting them and if not possible they understand why not. i.e. “Nothing about me, without me” People earn levels of autonomy of practice based on competence, confidence and performance People are enabled to innovate, be creative with solutions to problems, coached to confidence, do what’s necessary within a clear framework to respond to need and be accountable for it Executive leadership sets management style, strategy and all aspects of performance management based on decisions made as close to the patient as possible. Sensible risk taking is rewarded and staff are encouraged to act, with speed, safely and flexibly

The Trust focuses on:

• The things that go wrong

• The areas where we are not doing well

• Quantity not quality

• Process not outcomes The Trust does not recognise all the things that go well and where we perform well Some staff feel we have a culture of blame and this creates fear

We seek out, celebrate and reward successes Quality Performance, Financial Performance and Activity Performance are the ‘legs of the stool’ that hold up the whole Trust and each has equal importance Our prime reason for existing is to provide safe, effective and patient-centred care and we work together to do this within the money we have available We provide care on the basis of outcomes for patients and service users and should always ask ourselves “So

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what” when undertaking any process work. We cut out waste, duplication, time delays and inefficiencies to ensure we get the most from the resources we have Recognised high performance is the norm and individuals and teams are supported to perform The link between performance management, quality of service and patient and service user outcomes is inseparable. Quality is at the heart of what we do and is the driver for everything we do.

Some staff do not feel valued for their hard work and commitment to patients and their colleagues Some staff do not feel the Trust cares for them.

Staff feel valued for all the energy, hard work and care they provide and support they give Staff can recognise that the Trust cares about their health and well being, through its actions and visible demonstrations

Change is driven by the need to save money

Staff understand their role in improving services for patients and service users and how that contributes to the ‘health’ of the Trust, in terms of working more effectively and economically so that as much money as possible is ploughed back into patient care

The Trust has lost confidence in itself Staff are clear about their role and responsibility in relation to decision making, working with stakeholders, their level of accountability and scope of practice There is a clear strategic direction for services and the Trust, which is understood by all employees and what their contribution is to the Trust’s success Recognition nationally for the work of the Trust A sense of professionalism and calm and controlled excitement across the Trust’s staff

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Achieving this kind of cultural and organisational change will take time but there are things we can do to begin to build on what works well and ditch what doesn’t. The following sections suggest some practical changes that will begin this process and tie in with the planned work of Muir Gray during this summer.

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4. What is Living Room to Board Room?

4.1 “Living Room to Board Room” is a term used to describe the community services equivalent of the “From Ward to Board” approach to good governance and assurance. The Ward to Board programme was “about turning the spotlight firmly on to reviewing clinical quality, and putting patients and how they experience health care at the heart of an organisation’s work.” The Kings Fund, 2009 This concept of Living Room to Board Room in SCT adopts some of the best practice from the Ward to Board programme but also addresses the particular circumstances evident in the Trust. It is based on the following set of premises:

• That everything the Trust does and all the staff in it, is focussed on the same overall vision and objectives.

• There is consistency in how we do things across the Trust.

• There is clear accountability, information flows and two way communications throughout the Trust.

• That what happens on the front line is in line with what happens at the Board.

• There is a clear line of accountability and it is held as close to the patient as possible.

• There is clear understanding of roles and responsibilities.

• There is a framework that recognises the autonomy of staff, local accountability and delegated responsibilities which will release some of the central control in a managed way.

• Levels of autonomy are earned based on delivery of all aspects of performance.

• A clearly understood and owned leadership model is in place that speaks to the goals, objectives and values of the Trust.

• There is a clear structure for clinical and professional leadership and service delivery is clinically led.

• Performance expectations are clear and people are supported to deliver and also held to account.

• Quality of care is the “golden thread” that runs through all we do.

• Increasing the speed and quality of decision making, reducing the culture of many meetings and any central control style and enabling a coaching and facilitative approach.

• Ensuring the balance and focus is correct for Support Services between support for external/corporate work and operational delivery.

• People’s expected behaviours, style and attitudes are clearly articulated and ensured.

• Establishing the “SCT way” of doing things, as the “how” we deliver services, to a consistent and recognisable standard across the Trust, regardless of “what” we are delivering.

• The strategic direction, relationships and objectives, corporate operating frameworks, assurances, standards, and overall steer for the Trust is clearly articulated, translated and delivered for use.

In this way, the Board is assured the Trust is delivering its duties in the five areas of governance effectively. These are:

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• Clinical Governance

• Financial Governance

• Corporate Governance

• Research Governance

• Information Governance It will be important to connect lead roles and responsibilities for the different elements of governance from services through to the Board. This will both ensure appropriate support for individuals and strengthen the line of accountability through the Trust.

4.2 It is suggested that as many frontline staff and services as possible will be managed and professionally led as locally as possible. 4.3 The local services would, where possible, be aligned to CCGs and services managed locally would be those that are specific to the local geographic area. They would be mainly focused on services commissioned by the CCGs from 2013. The services and their leaders would earn the autonomy to lead, make decisions and deliver developments through delivering performance in line with commissioner requirements and Trust’s strategy and accountability framework. This would ensure as many decisions as possible are made in a timely way, locally and as close to the patient and commissioner as possible. The Trust sets the standards and provides corporate infrastructure and governance support to enable the local services to work effectively. The services would be clinically led. 4.4 For those services that are either non-CCG commissioned services or specialist services, a delivery model based on what works best and best practice will be discussed. They could be structured around professional networks or uni-professionals and are likely to be commissioned by specialist/national commissioning bodies or the local authority. 4.5 Establish dedicated and stronger links between corporate support staff and operational delivery leadership and staff. 4.6 Accountability and responsibility of clinical delivery staff would be strengthened and enable corporate expertise to support and enable performance at local level.

4.7 Implement a clear Accountability Framework that determines the roles, responsibilities, competencies and level of accountability for each level of manager/leader in the Trust. This would also make clear what the scope of decision making is and the boundaries that each manager can operate within without recourse to escalation and clarify those areas where escalation is appropriate.

4.8 A clinical and professional leadership model that supports the new approach. A suggested clinical and professional leadership model is described in the attached Appendix A. This will need to be seen as part of the overall management of service which will include the importance of workforce and general management functions.

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4.9 Standardise templates for reporting throughout the Trust, enabling reports to be easier to write and to read and provides consistency. Adopt outcome based reporting as default model.

4.10 Corporate lead roles for Executives, Directors, Operational Managers & Non Executive Directors to be confirmed, providing clarity of responsibility for Trust staff and external stakeholders.

4.11 Produce and share widely the Annual Cycle of Business for Board & Executive, Board Sub-Committees and any group which has a need to meet regularly. This will demonstrate a degree of openness and a “no surprise” approach to planning.

4.12 Implement a streamlined assurance committee structure, focusing on Board assurance. 4.13 Introduce monthly Service Level Performance Review meetings, including local risk register and balanced scorecard reporting on quality, finance, contracted activity and transformation –this will be triangulated and projected retrospectively initially and projected at a later stage.

4.14 Each service to produce an Annual Plan which will be agreed with the Executive and monitored by them monthly. This and the development shown above will inform a “framework for escalation”, demonstrating indicators that are at variance to the plan and will therefore be escalated to the relevant Board sub committee and the Board.

4.15 Trust Service Line Reporting develops alongside local and specialist service reporting.

4.16 Trust Board meets in public recognising it is not a public meeting. Quality to feature as the “golden thread” that runs through the Board meetings and it receives assurance through the work of the sub committees, who in turn receive their assurance through the Services Performance Review meetings.

4.17 Agendas in assurance framework are determined by the clinical delivery agenda first and then the regulatory framework. 4.18 Governance to be split into its five components and leads and work-streams follow these functions.

4.19 There is a clear distinction between assurance and scrutiny and “running the Trust” through its executive functions.

4.20 We introduce account management with stakeholders.

4.21 The Board Assurance Framework reflects the model described, presenting the top risks to the Board but in context of the assurance framework throughout the Trust.

4.22 Leadership: We need to have the right approach and delivery of leadership to ensure we achieve the kind of culture we need to be successful. Establishing a

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relevant and clear leadership model throughout the Trust will have an impact on many of the universal successful state indicators described above. One model that could be relevant and appropriate to the Trust at this present time is the model supported by Unipart PLC, but is equally applicable to an NHS community trust. This is shown below:

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Assurance Framework

*with the proviso that Executives pay enough attention to detail to ensure immediate improvement should anything critical go off track.

4.23 Names and symbols can give powerful messages and some suggestions that reflect this model and the message we want to give can include:

• The Executive Directors Management Team has already been renamed the Executive Leadership Team (ELT).

• The wider EDMT has already been renamed the Wider Trust Leadership Team (WELT) and will include deputies of directors, along with Heads of Services and business unit leads.

• A Trust Leadership team (TLT) will also be established to include clinical leads or their representatives.

• ELT and ultimately other managers to operate from “drop off points” across the Trust and not have dedicated offices.

• Name badges, uniforms, signage, notice boards, presentation and public facing material, documents that guide practice, logos to reflect a consistent SCT look.

4.24 Introduce planned “Back to the Floor” programme of senior leaders working alongside staff to add to engagement and understanding. 4.25 Ensure informal and impromptu opportunities exist for staff and the Trust leadership to engage in discussion and debate about issues affecting the workforce.

Process & Design

Continuous Improvement

Value Added

Vision & Strategy

Successful State

Executive*

Senior Leaders

Local Leaders

Frontline Staff

Time Spent

20%

80%

20%

Proposed Leadership Hierarchy

80%

20%

80% 80%

20%

80%

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5. Principles for successful NHS performance that need to be adopted, owned and demonstrated by the Trust.

• Take the longer-term view.

• Create an “SCT way” of doing things.

• Empower clinical leaders.

• Always start with the customer (the people who pay the bills, the commissioner) – then quickly followed by the consumer (the patient or service user). After establishing the commission the first time, the 3-way relationship (with the provider as the third party) is tied in to happen at the same time

• Engage staff – accountability and involvement.

• Create a culture of continuous improvement – solve problems at own level where appropriate; don’t rely on outcomes from escalation up the organisation or into the centre.

• Learn from the best.

• Create our own way of doing things.

• Create a knowledge management factory (this can be a centre of learning and best practice).

• Enable the Trust to improve faster than the best.

• Really understand the value of what we do.

• Stop constant changes of direction and introducing new initiatives and incentives.

• Coach as well as manage – coach first and manage where coaching is not working or appropriate.

• Work on cross-organisation systems.

• Enable and empower people.

• Right skills, right place, right speed - no exceptions. 5.1 The chart below illustrates a model that could enable clearer understanding of the Trust’s intentions and make it relevant for staff through to the front line.

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6. Questions for discussion Some suggested questions are:

1. Should this be our direction of travel? 2. What are the benefits and risks to the Trust? 3. What do you agree or disagree with? 4. What other suggestions would you make to address the points raised in this

paper? 5. What will success look like?

6.1 Process for discussions on this document This is very much a discussion paper and we genuinely want to get the views and comments of as many staff as possible. It is important to say that this is not a formal consultation on proposals; it is an opportunity for a wide-ranging discussion on a variety of suggestions. The suggestions are inevitably likely to result in some organisational change Discussion on these suggestions will start with the circulation of this document to all staff on Friday, 24 August 2012. All staff are invited to read, consider, debate, raise questions and comment on the document, individually or collectively through regular team meetings and briefings and we will try to arrange for one of the team to come along to facilitate these discussions. Additionally there will be three ‘open conversations’ to be held at Crawley, Brighton and Bognor. These will take place over the next few weeks and we will advise you of

Board Senior

Leaders Local

Leaders

Cascades to… Cascades to… Cascades to…

Work through the Trust with the organisation’s vision and how staff deliver it at every level: staff in turn then shape the vision back to the Board

Initiates and sets vision

- high-level - generic

Ownership Framework: Senior Leaders translates the vision with their staff, such that their teams understand how they contribute to this

Decide how they deliver the Senior Leaders’ vision. Translate it into language directly related to their service(s)

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dates, times and places as soon as we can. The conversations will be facilitated jointly by Graham Nice, Chief Nurse, Richard Curtin, Executive Director of Operations and Julie Hall, Director of HR and Organisational Development. We also very much welcome feedback in a variety of other ways. Please send your feedback on the contents of this document to any of those listed below by telephone, by email or in person. We will also be opening a generic email account for you to send responses to and will advise you of that address as soon as we can. Graham, Richard and Julie will then collate and consider feedback from staff and publish a formal consultation paper which will incorporate feedback from the discussion period. In order to respond to your feedback and to issue the formal consultation paper, we will need to have your feedback by Friday, 28 September 2012. We very much look forward to hearing from you and to having the discussions to ensure Sussex Community Trust continues to provide excellent clinical services and is a great place to work. You can contact us on:

• Graham Nice, Chief Nurse: 01273 696011 ext 1807, email graham.nice@nhs.net

• Richard Curtin, Executive Director of Operations: 01273 696011 ext 3692, email richard.curtin@nhs.net

• Julie Hall, Director of HR and OD, 01273 696011 ext 3415, email julie.hall16@nhs.net Graham Nice, Chief Nurse Richard Curtin, Executive Director of Operations Julie Hall, Director of HR and Organisational Development. 24th August 2012

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Appendix A SUGGESTED CLINICAL AND PROFESSIONAL LEADERSHIP MODEL FOR DISCUSSION 1. Context for clinical and professional leadership for the Trust. The terms clinical and clinical leadership are short hand for the leadership of all clinical (medical, dental, nursing, AHP and healthcare scientist staff) staff. An explicit approach to clinical leadership is required to:

• create a clinically led organisation, units and culture as described in the Health and Social Care Act 2012

• ensure the practice needs of the professionally registered staff are met,

• ensure that clinical involvement and engagement in service delivery and business development decisions is acknowledged and valued throughout the Trust,

• strengthen the management and business systems. This approach is absolutely not intended to undervalue the contribution of any other staff groups, regardless of whether they provide direct care or not. Currently many staff that provide direct care to patients are not required to be registered with a professional body to be able to practice. However, it is acknowledged that as internal clinical leadership is strengthened, staff that support registered staff will benefit from these developments.

The Trust needs high quality management talent to deliver our business, working in partnership with confident and strong clinicians that supports, not constrains and that doesn’t reinforce tribalism but does enable a modern, strong professional identity and voice in decision making. It is not possible for all general managers at all levels to always have a comprehensive grasp of all the clinical issues being experienced by all their staff working in different professions. Equally it is not always compatible for an individual who demonstrates excellent clinical leadership qualities to also be an excellent manager of services. Sometimes both sets of qualities do come together and a leader with both clinical leadership qualities and general management qualities emerges. The Trust supports this approach where it is demonstrable. The Trust needs the best of both worlds and a way of working that reflects the culture we aspire to with talented individuals and teams of clinicians, managers and support staff, leading the services to success. We need to manage for performance in a joined up way with arrangements that are explicit, which also attracts people to come and work with us. People need to know their work is varied and interesting and that they have opportunities to develop their competencies.

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How any leader works is also important and requires a skill set, knowledge and experience appropriate to the care and service environment. Research has shown that effective leadership styles are changing and can be summarised as follows:

• “Heroic” leadership has had its day

• New model of “engaging leadership”

• Leader as servant and partner

• Leadership as a social process

• The “soft stuff” is the hard stuff. (Alimo-Metcalfe, 2008) 2. Leadership in SCT These points apply equally to a leader who has a clinical background or not. The same research attempted to articulate what clinical leadership would look like and what the aims of effective leadership are, i.e:

• Engaging the human spirit

• Building shared visions

• Recognising everyone’s strengths, contributions, aspirations

• Bringing humanity and humility in through the front door

• Being open minded and curious

• Being transparent and open

• Believing that people are not the problem….but part of the solution! Delivering service and health improvements through leadership passion, purpose, people and performance needs to be incorporated into our leadership model. Clinicians and non-clinical managers both have a key role in informing and managing change, developing services and the Trust’s agenda. Clinicians’ positions throughout the organisation, their contact with patients and users and frequently, management responsibilities, gives clinical leaders the ability to bring an informed balance to the strategy and operational delivery of SCT services. General managers skills in leadership, process management, problem solving, performance and outcome management, people management, complex change management, strategy, and knowledge management are also critical if the Trust is to achieve its strategic objectives. This balance and challenge is captured in the following requirement:

• Be innovative and manage risk

• Think long term and deliver results now

• Cut costs and improve staff morale

• Reduce staff numbers and develop team work

• Be flexible and respect the rules

• Collaborate and compete

• Decentralise and retain control

• Specialise and be opportunistic

• Provide low cost and deliver high quality

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As SCT has a team and integrated focus to its service delivery this and a locally empowered accountability framework will need to be the approach in the services. It is therefore essential that multi-disciplinary, multi-agency, integrated working continues to be strengthened and roles develop in an integrated way, regardless of whether services are line managed through a uni-professional or general management route. In summary the Trust’s leaders need to:

• provide strong leadership across professional and organisational boundaries

• think creatively and work collaboratively to overcome obstacles to service changes and health improvement

• exhibit leadership behaviours that are consistent with the leadership qualities and create an enabling culture for managing complex change

• deliver on the services and the Trust’s strategic objectives (Concept adapted from Young, Leadership Consultant, Scottish Government Health Directorate.) 3. What is a clinical leader/clinical leadership? There is currently no clear, definitive and consistent definition of clinical leadership however the simplest and most pragmatic definition of clinical leadership could be:

“putting clinicians at the heart of shaping and running clinical services, so as to deliver excellent outcomes for patients and populations, not as a one-off task or project, but as a core part of clinicians’ professional identity.” (Building clinical leadership across London, 2008) Strong clinical leadership enables:

• clinicians to achieve greater visibility, influence and accountability at every level of the organisation.

• clinicians to have a full and active role in meeting our aim to achieve a clinically led organisation, as described in the Health and Social Care Act 2012.

• clinical involvement and engagement across all our service areas

• patient focused evidence that any particular service is safe and delivering best practice

4. Clinical leader role The services will be led by a clinical leader who will carry the accountability for the service. This would take the form of 4 key responsibilities;

i Ensure the clinical voice, regardless of profession, in the service is heard in decision making

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ii Ensure clinical engagement and involvement takes place iii Evidence that the patient facing service is safe and delivering best practice. iv Accountability for the overall performance of the service

For the service accountability role, the clinical leader would report to the Executive Director of Operations through a solid line, with a dotted line to either the Chief Nurse or Medical Director, depending on the individual’s profession. The clinical leader would be a senior clinician who can demonstrate the ability and competencies to deliver the 4 responsibilities and these should be incorporated into the individual’s job plan/job description. This post should be competed for and back filled as necessary. It is worth reiterating again the importance of strong and senior general management, clinical leadership and workforce management all working together, sharing the responsibility for the service. Although the following descriptors propose principles, values and ethos for clinical and professional leadership in the Trust, they also underpin general management leadership. Principles, values, ethos that underpins clinical leadership in SCT:

SCT values all its staff

Small team culture enables local voices to be heard

Taking calculated risks should be the norm

All Band 5 and above clinically registered staff are clinical leaders

Challenge current or poor practice

Each professional group should have named people who are recognised as leaders in specific areas of practice

Clinical leadership is an organisational practice that works in tandem with general management

Board level clinical leadership must be in place

A clinical forum/fora is required that has voice and influence

SCT believes effective clinical leadership impacts positively on patient care

Clear routes from clinicians to the board must be in place

Partnerships, pursuing excellence, learning from each other, taking personal responsibility and offering high quality personal service are key to clinical success.

Clinicians add valuable perspective to delivery functions

Clinicians engagement in service design, planning and changes is essential and should involve front line practitioners and managers of clinical services

Clinical standards in services provided are needed to ensure high quality care for service users

5. What is professional leadership? Professional leadership, in the context of SCT, is the defined arrangements the organisation has in place that enables staff belonging to a specific profession to fulfil their professional duty of care (or equivalent) and maximises their engagement and

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involvement in the business of the service by capitalising on their skills, knowledge and experience.

It also enables:

• individual professional groups to achieve greater visibility and influence at every level of the organisation.

• professional groups to have a full and active role in meeting our aim to achieve engagement across all our service areas

• evidence that any particular service provided by professionally registered staff is safe and delivering best practice

Professional leadership must facilitate this whilst supporting the professional identity of each professional as long there are professional registration bodies that require people to full duties according to their respective Codes of Practice.

This is different to clinical leadership, which is more generic and ensures involvement, engagement and direction of all the clinical/professional groups in the running of the business.

One is not more important than the other; they are both an important requirement of an effective organisation and sit very comfortably together.

6. What is a Professional Leader?

The following is a composite of the requirements of a professional leader.

Role model Advocate for the profession Has a proper place, position power

Professional expert Professionally up to date Disseminates new practice

Facilitates professional direction

Translates service objectives from professional perspective

Professional advisor to managers on professional boundaries and scope of practice

Professional pioneer Brings professional best practice evidence to decision making

Brings professional input into education, training and development

Advises on complex cases

Brings professional contribution to integrated delivery

Provides peer support and challenge

Is profession specific Has a strong sense of profession specific governance

Provide advice on interpretation and implications of national and local policy on the profession

Brings a profession specific resource for SCT

Co-ordinates profession specific meetings as required to support professional and service developments

Ensures profession specific policies are developed as required e.g. relating to a specific procedure

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SCT currently employs the following direct, patient care (separately registerable) professionals: 1. Nurses

2. Physiotherapists

3.Occupational Therapists

4. Dieticians

5. Podiatrists

6. Speech and Language Therapists

7. Dentists

8. Psychologists

9. Doctors

10.Pharmacists

11. Clinical Engineers

Together with their respective support staff, they make up the bulk of the Trust’s workforce who will be managed within the services.

7. The Professional lead role.

There should be specific named professional leads for each of the Trust’s professional groups, who would work in any of the services but would have Trust wide responsibilities to advise on service line profession specific issues. (Acknowledging the need for developing cross professional, integrated team working around patient and user need and each registrants duty of professional practice according to their registration body)

To cover each of the registered staff groups the Trust would need a minimum of 10 professional leads.

The role would undertake 3 key responsibilities;

i Ensure profession specific advice is available to service leadership teams and facilitate professional direction through the Trust professional advisory groups.

ii Advising on complex cases, act as role model to their profession iii Ensure profession specific documents that guide practice are in place.

For the professional lead element of their role, the professional lead would report to either the Chief Nurse or Medical Director, depending on the individual’s profession. The Professional lead should be a senior clinician who can demonstrate the ability to deliver the 3 responsibilities and these should be incorporated into the individuals job plan/Job description.

The professional lead will be required to create networks which capitalise on the skills and knowledge owned by senior clinical and practice staff across the services. 8. Conclusions

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The Trust and therefore each service or group of services should have clinical leadership focusing on patient and service user needs at its heart. “Clinically led” will mean an accountable clinician at the head of the service as the single accountable officer. In this context it is interpreted as meaning that activity undertaken within the service and on behalf of the Trust is clinically led, i.e. has clinicians at the heart of the business, working alongside patients, users and carers and being involved in strategic and operational decision making, solution creation and leading teams and work programmes. Clinicians are accountable for their own clinical practice and the Trust sees all clinicians taking accountability for service and change that affects clinical practice by working alongside general managers and others to ensure the best outcomes are achieved for the patient, staff and the Trust. The Trust believes building clinical leadership from the service user and patient through to the Board is the most effective way of ensuring a clinically led organisation that is patient focussed. Those clinicians and others who have the most contact with patients have a duty to serve them to their greatest ability and the Trust through its leaders and managers has a duty to support them and ensure systems and infrastructure is ultimately making a difference to the care we provide. Creating this culture and embedding it into practice will require structured organisational development work. Creating a framework for clinical and professional leadership will enable:

• clinicians to achieve greater visibility and influence at every level of the Trust.

• clinicians to have a full and active role in meeting our aim to achieve effective clinical engagement and involvement across all our service areas

• evidence that any particular service is safe and delivering best practice

• work with the general manager when he/she needs specific professional advice/support

9. Recommendations The Trust will have 3 Advisory Groups to address the Trust wide clinical and practice agenda and bring that steer and advice into the services, i.e.:

� Nursing Advisory Group � AHP/HCS Advisory Group � Medical and Dental Advisory Group

The Chief Nurse and Medical Director retain board level professional accountability for Nursing, AHPs, Health Care Scientists, Medicine, Psychology and Dentistry. Each of the clinical and professional leaders are managerially accountable to either their line manager or the service manager and professionally accountable to the Chief Nurse or Medical Director.

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This framework will strengthen clinical and professional leadership across SCT. However, more than a set of written suggestions is needed to make effective clinical leadership, engagement and involvement a reality across the Trust. A Trust wide programme would be commissioned to involve staff to build on successes, address areas for development and bring any proposals into a reality. Suggested Programme title: “Building Clinical Leadership across SCT” Scope:

• Set out clear working definitions for ‘Clinical Leadership’ in all significant contexts

• Identify and describe the real and perceived issues preventing the demonstration or development of clinical leaders and strategic clinical leadership capabilities across SCT and address them

• Identify and evaluate current local, regional and national initiatives aimed at improving clinical leadership

• Identify residual areas and suggest outline solutions to address those issues, including: resourcing, matrons role, outcomes and impact on University status.

Graham Nice, Chief Nurse Richard Quirk, Interim Medical Director 21st August 2012