Management matters - NHS Confederation/media/Confederation/Files...Management Matters 3 Time for a fresh debate The NHS is one of the biggest organisations in the world.In many local

Management mattersHow NHS managers are making a difference

3 Time for a fresh debate Foreword by Gill Morgan,

NHS Confederation Chief Executive

Why does management matter? Why management has become increasingly

important in the modern NHS

Who are today’s NHS managers? The diverse roles and backgrounds of

NHS managers

How are managers making a difference? 12 case studies that show how managers are

improving patient care

Where next for NHS management? How we can support and develop NHS leaders in

the future

4-5

6-7

8-28

30-31

Management Matters

Contents

2

Management Matters 3

Time for a fresh debate

The NHS is one of the biggest organisations inthe world. In many local communities, the NHS isthe biggest employer. Significant additionalresources are being invested to support thebiggest ever reform of the way services aredelivered.

Any commercial organisation on this scale, and withthis change agenda, would be expected torecognise the value of high-quality management.Yet the contribution of NHS management is oftenoverlooked, or even derided. At worst, NHSmanagers are dismissed as an army of bureaucrats.Some commentators seem caught in adisingenuous debate where on the one hand it isclaimed there are too many managers, but on theother the NHS is exhorted to improve the way it isrun.

The NHS Confederation believes there needs to be abetter understanding of what managers actually doand their contribution to improving services forpatients.

This report is part of a drive to challenge the mythssurrounding NHS management, and to show thereality of committed, talented and hard-workingindividuals who make a real difference to thepatient experience.

It is not just the Confederation that believesmanagement matters in the NHS.The Commissionfor Healthcare Improvement and the AuditCommission have both recently reported thatmanagers are making a direct contribution toimproving patient care, and that the quality ofmanagement is generally high, though thinly spreadand facing outstanding challenges.

The case studies in this report are further evidenceof the crucial role that NHS managers play. Frompractice managers working to achieve same-dayappointments, to chief executives leading multi-million pound projects that will modernise hospitalcare, all are tasked with the same mission – toensure high quality services for patients and toimprove public health.

Of course, there can be no room for complacency.NHS management needs to raise its game stillfurther if we are to transform the service. Now is thetime to move the debate forward to look at how wecan more effectively support and develop NHSmanagers in delivering the biggest public servicereforms in recent history.

We invite you to take a fresh look at whymanagement matters.

Dr Gill MorganChief ExecutiveNHS Confederation

One of the toughest

management jobs in the world

• 1 million treatments every 36 hours• 300 million primary care consultations

a year• 1.3 million staff• £55 billion budget• £2.3 billion IT investment • Biggest hospital building programme

in NHS history

Management Matters4

Why does management matter?

A happy triumvirate once ran the NHS. Inhospitals, the medical superintendent ruledsupreme while matron regimented nurses andpatients alike in starched, serried rows and thehospital secretary busied himself with tediousadministrative chores. GPs, as 'independentcontractors', went about their duties untouchedby any managerial superstructure.

It is a picture of perfect order and harmony, in whichgrubby bureaucratic preoccupations were neverallowed to impinge on the purity of clinical decision-making. Medicine, nursing and management eachknew its place and unfussily combined to offer aservice which acted unerringly in the patient’s bestinterests. It is, of course, almost total fantasy.

Under-managed

The truth is that throughout much of its history theNHS has been chronically under-managed, a factorthat has acted against the long-term interests of itsdoctors, nurses and patients.

During the reign of the medical superintendent,individual consultants' decisions dictated the shapeof services. Clinical services were strictly off-limitsand regarded as unsusceptible to 'management'.Those making decisions had little interest incontaining costs. Immune to external scrutiny,services were often inefficient, and lengthy waits touse them were meekly accepted as inevitable.Services were organised for the convenience of theprofessions not the patients using them.

Circumstances are different in the 21st century.Patients no longer deferentially accept what it suitsprofessionals to provide; they want a say in how,where and when services are delivered. Politicalpressure for change demands responsive andflexible organisations.

Modern medicine is capable of things undreamedof a generation ago. In the medical superintendent'sworld, patients undergoing hernia operationsexpected to stay in hospital for 10 days; today theymay be discharged after six hours. Marshalling asystem to enable that – and dozens of other similaradvances – to happen without a hitch calls formanagerial acumen more sophisticated than theold triumvirate could ever provide.❛‘The Audit Commission has

recently reported realimprovement in some parts ofthe service and found a verystrong link to the quality ofmanagement in place. It iswrong, as some do, to claimthat the NHS is over-managed’James Strachan

Audit Commission

❛‘Organisations which providehealthcare must be well-led and well-managed. Leadership iscrucial. Management does matter.’Sir Ian KennedyCommission for Healthcare Audit & Inspection


The failure to take management seriously persistedthrough many years of NHS reform. Even in the1980s, Sainsbury’s chief executive Roy Griffithsfamously remarked in his health servicemanagement inquiry that 'if Florence Nightingalewere carrying her lamp through the corridors of theNHS today, she would almost certainly be searchingfor the people in charge'.

Making a difference

There has been a revolution in NHS managementsince then.The Commission for HealthcareImprovement (CHI) and the Audit Commission haveboth recently highlighted the difference goodmanagement is making to patient care. CHIcommented on the number of strong, able leadersin the service, while the Audit Commissionconcluded that 'the key to improvement has beenthe better management of resources'.

Far from the image of an army of bureaucrats, thereports show that NHS managers are tackling thethings that matter to patients: from reducing theamount of time spent waiting to see a GP, todeveloping new services in the community thatavoid unnecessary hospital stays.

Today, clinical care and management areincreasingly integrated. Good management requiresa sound understanding of clinical processes. In turn,many clinicians recognise they need to developtheir own management and organisational skills toprovide an efficient and effective service to patients.

We have come a long way from the world of themedical superintendent, but the debate on how werun our health service has yet to catch up.Without excellent management throughout theNHS, clinical staff will lack the support they need,with neither time nor space to reflect on theirpractice and nurture new thinking.

Management in the NHS must be recognised not asa force for oppressing the legitimate concerns of thehealthcare professions, but as a means of enablingthem to deliver first class care to patients.

6 Management Matters

Who are today’s NHS managers?

Grey men in suits? Bean counters? Bureaucratsfrustrating clinicians? This is the image that isoften portrayed of NHS managers.

The reality is that NHS management consists of awide range of roles that make a real contribution toimproving patient care.

Diverse skills

One of the key myths of NHS management is thatthere are two very distinct tribes: managers andclinicians.

In fact, the senior management team in NHSorganisations is made up of a combination ofmanagers with non-clinical backgrounds, and thosewho have clinical qualifications.

At board level in NHS trusts a medical director andnursing director sit alongside the chief executive.In primary care trusts (PCTs) a GP is a key member ofthe board and also chairs the professional executivecommittee made up of a range of clinicians whooversee the day-to-day running of the organisation.

Below board level there is a similarly diverse groupof staff with management responsibilities. Full timenon-clinical managers – like commissioningmanagers or facilities managers – work alongsidedoctors and nurses who combine managementresponsibilities with their professional roles.

In hospitals, for example, nurse managers play a keyrole in ensuring the smooth running of the wardwhile still providing direct patient care.

Solihull Primary Care Trust

Solihull PCT directly employs 1,050 people, inaddition to working with over 700 family healthservice staff. It has a total of 23 senior managers.

At board level there is a chief executive, sevenexecutive directors, including the director offinance and the medical director, an associatedirector of nursing and a GP who chairs theprofessional executive committee.The board alsoincludes a chair and 5 non-executive directors.

13 senior managers report to the board,including the head of occupational health, thepharmaceutical advisor and the head of familyhealth services.

Over half of the senior management team have aclinical qualification.

Homerton University Hospital NHS Trust

Homerton University Hospital NHS Trust employs1,700 staff, and has a total of 19 senior managers.

At board level there are 6 executive directors, 3of whom have clinical backgrounds, a chair and5 non-executive directors.

There are 13 managers who report directly tothe board.This includes 4 general managers, 2 ofwhom have clinical backgrounds, 4 clinicaldirectors and 5 senior nurses who all combinetheir management role with their clinicalresponsibilities.

++ 3% of NHS staff are managers or senior managers ++ 4p in every pound

7Management Matters

Diverse roles

While there are many managers who have day today involvement in the provision of patient care,there are also managers in core functions likefinance, HR and IT that play an equally crucial role inimproving our health service.

Every NHS board has a finance director, backed upby a finance team who are responsible formanaging a budget of £134 million for an averagetrust, and £180 million for an average PCT.

The NHS is often the largest local employer. HRdirectors are overseeing one of the biggestrecruitment drives in the health service’s history aswell as the new Agenda for Change agreementwhich will modernise pay and conditions for overone million NHS staff.

At the same time, £2.3 billion is being invested tooverhaul the NHS IT infrastructure. Ensuring thesenew systems really transform services will dependon the skills and expertise of IT managers and theirteams.

And NHS project managers are now tasked withdelivering one of the largest hospital buildingprogrammes in the world – not to mentionrefurbishing 3,000 general practice surgeries by2004.

of NHS expenditure is spent on management costs ++

Who are tomorrow’s NHS managers?

The NHS runs a general management trainingscheme which brings young talented people intothe NHS as well as offering a route into seniormanagement for those with clinical andprofessional backgrounds in the service.Thescheme has just been ranked number one forgeneral management by the UK Graduate CareersSurvey.

In 2003 there were 4,300 applications for 90places. Over the past five years, women havemade up three-quarters of the trainees and 6.7per cent have been from minority ethnic groups.

There is also a major drive to bring in experiencedmanagers from other sectors.The LeadershipCentre – part of the Modernisation Agency – hasrecently launched a national Gateway toLeadership programme which provides a fast-track introduction to NHS management.

❛‘NHS managers deserve ourbacking for their contribution tothe improvements already underway. And they deserve oursupport as they face thechallenges ahead.’Lord Hunt of Kings Heath

Management Matters8

How are managers making a difference?

The role of NHS management is clear – toensure health services are efficient and effectiveand responsive to patient needs.

This requires new ways of doing things, not justmore of the same. New ways of organising services,to put patients’ needs first. New ways of working, toensure the skills and abilities of NHS staff are put tobest use. And new relationships across the NHS,with local government, and the voluntary andprivate sectors.

Managers at all levels in the service are squaring upto the challenge of delivering this change agenda atthe same time as ensuring existing services aredelivered to high standards.

The NHS Confederation believes there are five keyareas where NHS management has a crucial role toplay in delivering a modern health service.The casestudies in the following pages illustrate how thesefive challenges are being met in practice.

Improving patient careand the patient experience

Good management has thepotential to make a majorcontribution to how patientsexperience the NHS. Many of thethings that patients complain aboutneed management attention to putthem right.

This means that managers must focus on effectivesystems that enable clinicians to provide highquality care. But it also means paying attention tothe other things that affect how people feel aboutthe service they receive – from the quality ofhospital food to the standard of GP premises.

Re-organising services around the needs of patientsrequires managers who can challenge the

traditional way in which care has been provided, toencourage innovation and new thinking. And itneeds managers who can effectively measure howthe service is performing to focus the organisationon how things can be improved.

Turn to page 10 for an example of how a hospitalin Taunton has transformed its orthopaedic care bylooking at the service from the patient’s perspective.

Creating an environment where staff can do their best

A key task of any manager is to lead,motivate and develop their staff. In theNHS, the diverse skills and professionalbackgrounds of staff make this aparticularly challenging task.

Management expertise can add realvalue to the delivery of clinical servicesand deal with the problems of poorly designedprocesses that still make it difficult for doctors andnurses to do their jobs.This is perhaps the areawhere the biggest improvements for patients canbe made.

Managers need to have real leadership skills toencourage and inspire frontline staff who are oftenworking under real pressure to do their best forpatients. And good management plays a crucial rolein ensuring that staff are equipped with the skillsthey need to do their jobs well.

Turn to page 16 for an exampleof how training and support forstaff has turned around anambulance trust in Bedfordshire.


Ensuring the best use of resources

With record investment going into the healthservice, NHS managers more than ever are taskedwith achieving maximum value from every pound.The drive for efficiency is important both inensuring the service offers value for money, as wellas maximizing the number of patients who receiveNHS care.

In a service still suffering from shortages of doctors,nurses and beds, this means making toughdecisions about how to make best use of cliniciansscare time, and tough choices about where toallocate resources in the face of competingpriorities.

Turn to page 18 for details of how SouthBirmingham PCT has chosen to invest in acommunity-based service for heart failure patientsrather than concentrating funding on hospital care .

Planning for the future and leading change

If the NHS is to meet rising publicexpectations and changing patientneeds, NHS managers need to be aheadof the game. It is their job to set acompelling vision for the future, and toprovide clear leadership, enabling staffto focus not just on the here and nowbut on the changes that will deliverbetter services over the longer-term.

Turn to page 22 to see how PCTs in GreaterManchester are collaborating on a project todevelop one-stop health and social care centreswhich will transform future health services.

Working with others toachieve more together

Patients want fast access toconvenient, high quality carewithout having to find their wayround the system. A keymanagement task is to work withother parts of the NHS – and withlocal government, the voluntary andprivate sector – to integrate servicesacross organisational boundaries.

Improving people’s health, not just health services,also requires NHS managers to work across thewhole community to tackle the root causes of ill-health.

Turn to page 26 for an example of how a team ofhealth and social care professionals from differentorganisations in Hounslow are delivering a seamlessservice for patients.

The case studies in the following pagesshow how NHS managers are respondingto this challenging agenda.

The managers featured are not just one-off examples.They are a reminder of thecommitted and talented NHS managerswho are working with their teams to makea real difference to patient care.

Improving patient care and the patient

Sally OliverGeneral Manager,Taunton & Somerset NHS Trust

Patients undergoing hip replacement operations inTaunton now enjoy a streamlined passage throughthe system where once they were beset withunnecessary administrative obstacles. A project toclear away the clutter that had accumulated aroundthe admissions and in-patient process has broughtshorter hospital stays, fewer cancelled operationsand fewer readmissions.

“It was surprising how difficult it was for patients toget into hospital,” says Sally Oliver, general managerfor trauma and orthopaedics at the town’s MusgrovePark Hospital, describing the typical patient journeythe project team discovered when they traced it.

“We mapped the process on a piece of wallpaper,pinned it up and left it for a few weeks,”says JennyPickhaver, lead physiotherapist and the project'smanager.“It opened a lot of people’s eyes. Everybodyin the team admitted nobody knew the whole story.

“It had no doubt once been a fair system. But it hadjust evolved. If you set out to design it you'd neverdo it like that,” says Sally.The results were inefficientprocedures which led ultimately to operating slotsbeing missed and the service struggling to meettargets.

Now, quick simple solutions combined with long-term change have enabled the orthopaedic serviceto reduce length of stay by two days, halvecancelled admissions and discharge 21 per cent ofpatients within seven days compared with nine percent previously.

Solutions

Relatively straightforward changes like relocating anadmissions clerk within the department broughtimmediate gains. Revamping the pre-operativeassessment clinic – after asking patients why theydidn’t turn up – raised attendance to 100 per cent:more congenial surroundings and a convenienttime were the secret.“They sound like relativelysmall details,but it's often those that cause the mostfrustration and hassle,” says Jenny.

Better preparing patients for what to expect hasmade a real difference.They are now given a rangeof leaflets and a timetable explaining each stage oftheir seven-day stay.“You’ll hear a patient say, comeon – I should be up today,” says Sally,“and that’sbrilliant.”

Dynamic management underlies the project'sachievements. As part of the South West regionalspecialty partnership programme, it was able tofund protected time for Jenny to act as projectmanager and create space for the eightmultidisciplinary team members involved tobrainstorm ideas.

Management Matters10

++ Additional investment will allow an extra ❛‘All organisations, whetherpublic or private, are hugelyreliant upon first classmanagement skills. Wemust not denigrate theimportant contribution thatexcellent management canmake in providing the rightenvironment forprofessionals and staff ’Digby JonesConfederation of British Industry

Managers making a difference

experience

They consulted widely and visited other trusts forideas they could ‘Taunton-ise’. Building effectivecommunication networks has been crucial.

“We very much felt all sorts of people, whetherclerical workers or clinicians, knew what needed tobe done,” says Jenny.“But there had been no forumfor them to express their ideas. Early gains, such asproviding a new blood pressure monitor for a clinic,helped win colleagues' confidence.

“That sends the message that if you come up with a

sensible idea the managers will try to do whateverthey can to sort it out,” says Sally.

Team members are now in demand throughout thetrust for help with change management.“It’s knownthat we do deliver,” says Sally with pride.“And thewhole thing has been great fun to do.”

Medical director Peter Cavanagh adds:“The teamhas set an example to the trust on how redesignwork can improve the patient experience andenhance staff’s working lives.”

‘The teamhas set anexample tothe trust onhowredesignwork canimprove thepatientexperience.’

Smoothing the journey:Sally Oliver


41,000 hip replacement patients to be seen each year ++


Improving patient care and the patient

Farida MalikHealth PartnershipDevelopment Manager,Newham Healthcare Trust

In the London Borough ofNewham, 61 per cent of thepopulation are from ethnicminorities.

Newham Healthcare NHS Trust’sbilingual health advocacy serviceis a key part of ensuring thathealth services cater to the needsof this diverse community. FaridaMalik runs the advocacy service.

“Our aim is to overcomelanguage and cultural barriersand to support communities tomake better use of healthservices.We deal with people who speak very littleor no English. My team has 37,000 face-to-facecontacts with patients, in 40 different languages,every year.

Access

“Health workers cannot carry out any intervention ifthey cannot talk to the patient. Without us, a largenumber of our community would not haveappropriate access to secondary care. Doctorswould not be able to diagnose what is wrong withpatients, and we could not do any surgery withoutinformed consent.”

Farida’s team regulary attends consultationsbetween health care workers and patients. It hasalso developed services for hearing impairedpatients by providing sign language interpreters.

“We work in partnership with clinicians and areaccepted as part of the team. Health advocatesensure that clinicians can respond to patients’needs. Patients benefit as they are reassured theirproblems are being explained clearly and correctly.”

Mike Gill, the trust’s medical director, comments:“The advocacy service is invaluable. It provides aninterpretation service, but it also supports patientsin negotiating their way around health services andhelps reduce cultural barriers.

“From the clinical perspective that means we aremore likely to make the right decisions aboutdiagnosis and treatment and those decisions aremore likely to be both accepted and understood byour patients.”

‘Health advocates ensure that clinicians can respond to patient’s needs.’

Breaking through the language barrier: Farida Malik



experience

Carole BrownPractice Manager, Doncaster

Practice manager, Carole Brown, has been workingwith her team in Doncaster to dramatically cutwaiting times.

Following a process of staff consultation and carefulplanning the team analysed data on patientdemand and took time out from running thesurgery to look at how they could reorganiseservices to meet it.

As a result, the practice has overhauled its bookingsystem. Established clinics remain bookable inadvance but for most patients a routineappointment can now only be booked 48 hours inadvance. Nearly a year on from implementation, thebenefits have been profound.

“We have done away with the situation wherepatients have to wait up to three weeks for anappointment. Now we aim to see patients the sameday,” says Carole.

A major improvement has been the reduction inpatients who do not attend which has fallen byabout 60 to 70 per cent.

“We now have more time to implement changeswhich we wanted to implement but never had timeto think through,” says practice nurse PamelaParsons.

As a result, nurses have now trained to do cytology,which has taken away some of the work fromdoctors.The practice plans to train reception staff ashealth care assistants. And the nurses’ schedule isbeing changed to include minor illness clinics,making better use of their time.

Teamwork

Dr Shabbir Ahmad, senior partner at the surgery,notes that he spends less time dealing withfrustrated patients. And staff uniformly agree thatthe surgery is now a better place to work.

Reflecting on the changes, Carole says:“The biggestsense of achievement is that this has been a teameffort. I initially sowed the seeds and have workedhard to motivate the team but change has beenachieved by everyone working together.”

‘… nowwe aimto seepatientsthe sameday’

Shorter waits:Carole Brown

Creating an environment where staff

Trudie DaviesService Improvement Facilitator,Leeds Teaching Hospitals NHS Trust

Ward 26 at Leeds General Infirmary is proving to bea popular place to work in the NHS. Once a tenth ofits nursing posts were vacant. Now there are novacancies, staff are queuing to work there andsickness absence has plummeted.

“People used to dread coming to work on thestroke unit because it's such hard work,” says TrudieDavies, a service improvement facilitator within theTrust’s performance improvement team who hasbeen instrumental in this transformation. But sincethe unit reorganised gains for staff – as well as forpatients – have raised morale beyond anyexpectation.

Tailored care

As a sister on the unit,Trudie realised on herfirst day that it lacked a system. She proposedthat instead of all nurses being involved in theward round, she made that her role,“to giveeverybody a break and to keep the consultantand ward staff happy”.

“We started to tailor care around what wasneeded, and changed the way we worked. Itstarted off so that we could make our lives

easier. As our lives got easier it gave us space to getour heads above the water and think about whatwe really wanted to do,” says Trudie.

Meanwhile, enthused by this early managerialsuccess, she undertook the Royal College ofNursing's leadership course.“I started to look at theservice from a different point of view – not just anursing perspective but a strategic one.”

‘One 68-year-oldman who wascared for on Ward26 describes histreatment as“absolutelywonderful”.’

Makingliveseasier:TrudieDavies



can do their best

Soon more opportunities appeared.“The trustinvested a lot of faith in me and I was given a lot ofautonomy in running the ward.”

New skills

Matron Sue Jones says Trudie became adept atusing her leadership skills to win resources whichenabled her nurses to develop their skills. Forexample, staff nurses trained to carry out swallowtests on stroke patients, then trained other nurses todo this too. Previously, hard-pressed junior doctorshad had to do the tests, and some patients wereoverlooked. Switching the responsibility meantpatients benefited, and nurses had the satisfactionof acquiring a new skill.

Sisters now manage the ward beds and haveincreased turnover by 30 per cent. Central to this arethe ‘bed meetings’ instigated by Sue, which havebecome forums for exchanging ideas anddiscussing problems.

“Sometime you’re quite isolated on a ward as a G-grade,” says Trudie.“You don’t know what’s going onabove you.”The bed meetings help combat that, asdo weekly meetings with medical staff to brief themon any changes.

Leading lights

As the staff nurses took on new roles, the unitneeded cover for them. It turned to its healthcareassistants. An F-grade nurse spent two days a weekfocusing on developing their role. All have passedNVQ level 2, and some are now aiming at level 3,“…which is fantastic from our perspective becausethey are very much leading lights among thehospital's healthcare assistants,” says Sue.

The unit has saved money since adopting thechanges.“Healthcare assistants at level 3 are far

better budget managers than a ward sister,” saysTrudie.“So we’ve saved a lot on stores andcontinence care.”

Empowering people and valuing them as a teamhave been important lessons, she says, as she hasshifted from nursing to management. And thepatients’ verdict? One 68-year-old man who wascared for on Ward 26 after he suffered a strokedescribes his treatment as “absolutely wonderful”.


++ 73% of hospitals now have specialist stroke units, up from 45% in 1999 ++

❛‘We need to facilitate teamworking between nurses,doctors, managers and everyonein the health care team in orderto transform services forpatients.’Dr Beverly MaloneRoyal College of Nursing

Anne Walker Chief Executive, Beds & Herts Ambulance& Paramedic Service NHS Trust

Complaints about the three-star Bedfordshire andHertfordshire ambulance service now come almostas a shock to Anne Walker. In her three years as itschief executive she has seen them fall by two-thirds.But in her early days there she found they gave hergreat insight into what she had to do.

“There was rarely a complaint that didn’t tell you anawful lot about what needed to change,” she says.

Anne quickly realised it was a dysfunctionalorganisation with a hierarchical command-and-control structure that failed to develop its staff.“People were very used to being told what to do.The amount of independent thought, action anddecision-making was quite limited.”

Though the organisation had already undergone alot of change, it had not been implementedproperly. Local healthcare partners regarded thetrust as closed and secretive. And it was failing thepeople it was meant to serve, managing to reachonly 45 per cent of category A calls within eightminutes when the target was 75 per cent.

Streamlined

Today, response times exceed that target.The trusthas secured extra resources for new vehicles and 25per cent more staff. Patient surveys reveal highlevels of satisfaction, and six community healthcouncils sit around the board table.

“We have moved from being a pretty dysfunctionalset-up to one that is streamlined, very keen to begood and with a much more flexible, supportiveapproach to staff,” says Anne, who joined the NHS23 years ago as a graduate trainee.

It has meant enormous change for staff, but it hasall been achieved without anyone invoking thegrievance procedure, let alone industrial action.“It’sgood management that's brought about thischange. It isn't a fairy wand or anything else. It’s lotsof good, sensible management,” says Anne.

Re-engineering

Meeting response-time targets meant re-engineering the entire system. Anne hiredconsultants to help, and reviewing the trust'shuman resources department was an early priority.

“That got to the heart of a lot of things. It was allabout how the trust treated staff.”

Where previously ambulance headquarters hadmade plans and imposed them regardless of localcircumstance, Anne devolved responsibility – for

++ £34 million is being invested ❛‘There is no doubt that goodmanagement is essential if wewant to see an effectiveworkforce in the NHS, able todeliver better patient care.’Dave PrentisUnison


Creating an environment where staff

devising rotas, for example – to localstations. Managers had no experienceof staff involvement like this.“They had been oncourses but come back and thought,‘how do Imake that happen in this organisation?’We wantedtraining tailored to the issues here.”They got it.

There was less resistance to change than scepticismthat it would last.“They feared I’d leave and they'dbe left in a mess,” says Anne.“But now we've passedthe point of no return.We'll never go back to wherewe were because everything has changed.”

Reflecting on the transformation, she says:“I didn'tcome in and write a consultation document puttingeverybody's job at risk then expect performance toimprove.

“I did work out where there were problems and Isorted them out – putting some people in postswhere they got more development and training.You have to care a lot about the people who workfor you. By that I don't mean being soft, I meanbeing tough.”

She knew it had worked when a staff member toldher recently:“Anne, I bet nobody has told you, butit’s different now – and it’s much better.”to improve ambulance response times ++

‘It was all about how the trusttreated staff ’

17Management Matters


can do their best

Reflecting on

success:

Anne Walker


Ensuring the best use of resources

Keith PoyntzDeputy Director of Commissioning,South Birmingham PCT

In many ways the two halves of Keith Poyntz’s 25-years in the NHS are worlds apart.The first half hespent in a hands-on clinical role as an operatingtheatre practitioner.

The second, after successfully completing the NHSManagement Training Scheme, saw him hang uphis scrubs and turn to commissioning as a newcareer.

But for Keith – now deputy director ofcommissioning at South Birmingham PCT – thechange of direction doesn’t feel too severe. In fact,he says, understanding the way services are viewedand prioritised within hospitals has been a positivebenefit in one of his recent projects to totallychange the shape of treatment for thousands ofheart failure patients across south Birmingham.

Up until 18 months ago, heart failure patients in thisarea faced a wait of six to 12 weeks on anoutpatient waiting list to see a cardiologist. Duringthis time, their condition could deteriorate fast withbreathlessness and lack of mobility adding to theanxiety of waiting for diagnosis and a propertreatment plan.

But back in 2001, the picture for these patientsbegan to change. As coronary heart disease (CHD)commissioning lead for primary care groups in thesouth of the city, Keith was focusing on the thennewly-published CHD National Service Framework.

“A lot of the emphasis in these early discussions wason investing the resources in secondary careprocedures, not on longer-term treatment for heartfailure or rehabilitation,”explained Keith.“Yet insouth Birmingham alone, there are around 8,000patients with heart failure – a disease which can besignificantly improved with the right medication,patient education and treatment plan.”

Blueprint

Heading a working group, including cardiologistsand GPs, Keith knew he wanted to think seriouslyabout investing £350,000 in a community-basedservice which would not only benefit these patients,but would, in essence, pay for itself throughreducing emergency hospital admissions.

++ Statin prescriptions for heart disease

Career of two halves:

Keith Poyntz



“The evidence base was there from other centres,albeit not from such a community-based setting. Bymaximising patients’ care through medication andeducation, they were improving health outcomesand keeping people out of hospital."

Eighteen months on, and following a successfulpilot of the service in 2002, a Birmingham-wideblueprint for heart failure has been implemented inthe PCT.

Already covering half of the GP practices in the area,the service currently runs from a hub in the acutetrust and two centres in the community. Using GPswith a special interest and specialist nurses theclinics are already making a quantifiable differenceto patients:

• 100 per cent of patients are being seen by theclinic within two weeks of GP referral, comparedwith the six to 12 week wait for an outpatientappointment

• The new clinic takes as little as one hour todiagnose patients and set up treatment andfollow-up plans

• Patients can arrange appointments which areconvenient to them and closer to home

• Patients can discuss their treatment in detail withthe specialist nurse.

Bureaucracy-free

Dr Naresh Chauhan, a GP in South Birmingham’sRiverbrook Medical Centre who worked with Keithto set up the service, said:“This is a bureaucracy-free,friendly and personal service for patients. Patientsappreciate being given the time to discuss theirtreatment with the GP and specialist nurse.”

A strong advocate for rapid intervention in thecommunity, Dr Chauhan added:“One of my patientswas becoming progressively breathless and waseven having trouble walking into the surgery.Withintwo weeks of his assessment at one of the heartfailure clinics, he was mowing his lawn.That speaksfor itself.”

rose by a third to 16.5 million last year ++

‘This is a bureaucracy-free,friendly and personal servicefor patients’❛

‘Any well-run health system willneed managers whose role is tomake the best use of clinicians'scarce time.’Dr David GreenCivitas

Bill StevensonOrganisational Development Director,Peterborough Hospitals NHS Trust

Working smarter, not harder, was PeterboroughHospitals Trust’s approach to cutting waiting timesfor cataract surgery. In the process it unitedoptometrists, GPs, nurses and surgeons to devise aninnovative, award-winning service of nationalrenown.

It also succeeded in shrinking waiting times from 12months to between six and eight weeks.

Peterborough’s one-stop service for people needingroutine cataract operations enables optometrists torefer them direct for surgery.“Someone taking theirmother to the high street optometrist with an eyeproblem can come out with a date and time forsurgery in hospital,”explains Bill Stevenson, thetrust’s organisational development director, whowas a driving force behind the scheme.“They can'tbelieve it.”

Formerly, a visit to the optometrist would have beenfollowed by one to the GP, at least another tooutpatients, a third to a pre-op clinic beforeadmission for surgery, then finally another trip for afollow up. Now patients complete a health checkquestionnaire which is discussed over the phonewith an ophthalmology nurse before the operation.After surgery they are discharged within an hour.“Patients love it,” says Bill.

Enhanced service

The surgeons are able to treat virtually all cataractsas day cases, while the optometrists – benefitingfrom extra training and accreditation by theconsultants – feel part of the team and have thesatisfaction of being able to offer an enhancedservice. Nurses too are using their skills to the full.

Excellence brings diverse rewards. Peterboroughwas able to access capital to build a self-containedtheatre, reception and garden for day-case eyesurgery patients.“None of that was on the agendawhen we started, but managerially we have beenable to take advantage of the opportunities.”

Much painstaking preparation laid the groundworkfor the service. Bill spent nine months visiting GPpractices and chairing meetings between theoptometrists, GPs and surgeons.“I said we're settingup this joint project to worker smarter, not harder, inthe interests of our patients and staff.”

Culture change

It was hard work and at times felt as if it was goingnowhere, Bill admits.“Getting the ideas isn’t difficult.Making them happen is. Change is the hardestthing I’ve come across in the NHS.”

But one by one he won converts.“Then it gotprogressively easier. Once you start the dialogue,opportunities begin to appear. All projects havedifferent difficulties, but most are around askingpeople to do something they've never done before.

‘Someone taking theirmother to the high streetoptometrist can come outwith a date and time forsurgery. They can'tbelieve it.’


++ Fast-track surgery centres could provide 30,000 cataract operations by


“It’s about handling people and gradually changingthe culture of the organisation. It takes time.”Thekey to doing it successfully is trust.“You've got to bein the organisation and be known so that peoplelisten to you,” says Bill, who has been atPeterborough for 12 years.“We have a team herethat has the trust of surgeons, GPs and optometrists.You have to demonstrate that it's helping you all towork and develop each other’s skills.”

For the future, the hospital is examining thefeasibility of offering a similar service to glaucomapatients and extending post-operative assessmentby telephone. After 30 years in the NHS, Bill declares:“I’m enjoying myself more now than I've ever done.”

2004 ++

Smart work: Bill Stevenson talks toLiz Hawkes, assistant generalmanager for surgery atPeterborough

❛‘Managers and cliniciansshould not find it difficultto work together in theircommon aim: the careand safety of patients.’Professor Carol BlackRoyal College of Physicians



Trevor PurtProject Director,Manchester, Salford & Trafford LIFT

As project director of the Manchester, Salford andTrafford Local Improvement Finance Trust (LIFT),Trevor Purt has been responsible for bringingtogether six PCTs, three local authorities, anambulance trust and the private sector.

His project, the largest of the first six LIFT pilots inEngland, puts private firms in partnership withprimary health services to develop a newgeneration of one-stop shop health and social carecentres in Greater Manchester. Life expectancy inthis area is the shortest in England, with 27 of the 33Manchester wards in the top ten per cent mostdeprived in the country.

“This project has beenlikened to knitting fog.But from being behindtime when I joined inJanuary last year, we havenow achieved or betteredour target milestones,procuring our privatepartner earlier than wefirst anticipated.Thebiggest difficulty wasengaging ten differentorganisations with different cultures andmanagement. It was exceptionally challenging toget everybody to work to agreed deadlines but weachieved it.”

Around £60 million is to be spent on the initial setof schemes with an expected £200 million to bespent over the first five to seven years of the 25-yearproject.

++ 184 new one-stop primary care



‘We arelooking at howwe canintegratecommunityservices toprovide a newway ofdelivering carein cutting-edgebuildings.’

❛‘Professional, effectivemanagement in healthcare isas much a public duty as inany other critical service.’Maurice ChengInstitute of Healthcare Management

“The aim is to integrate differing services under oneroof, and not just from within the NHS – taking usaway from the old view of the GP surgery. Withlocal authority involvement we can includehousing and benefit offices, social services and evenlibraries.Third parties could provide services suchas crèches, coffee shops, internet cafes andsupermarkets.

“We are looking at how we can integrate communityservices to provide a new way of delivering care incutting-edge buildings. It will blur the boundaries ofprimary, secondary and community care and enableus to plan services, take a step back and look atexactly what facilities patients need and where.

Trevor has worked hard on consultation with localpeople who have been able to influence not onlythe services going in to these buildings, but theirlocations as well.

“It has given us a completely new view of therelationship between the community and serviceproviders and enabled us to promote socialentrepreneurism and local ownership. Shares in theLIFT company are now devolved to trusts for thelocal community.”

Common ground

“LIFT is such a necessity because nationally less than40 per cent of primary care premises are purpose-built, half are either converted houses or shops, 80per cent are too small and 70 per cent need repair. Ifservices are put under one roof in good-qualitypremises, people can work together moreeffectively in a much better environment.”

Edna Robinson, chief executive of Salford PCT said:”We looked to Trevor to provide really strong co-ordination of what was a complex range ofstakeholders with a diverse range of needs. Heneeded to find common ground, draw out the keysocial and healthcare challenges and then marketthose to the private sector to attract a high-gradepartner.

“He had to keep us on time, on track and on target.He made it simple, professional and possible, whileensuring it never lost its emotional core ofregenerating a complex inner-city health service.”

centres were established between April 2000 and December 2002 ++



Future vision: Trevor Purt

Steve PhoenixChief Executive, Adur, Arun & Worthing Primary Care Trust

Working with others for the benefit of all has beenthe abiding principle for Steve Phoenix.

In addition to meeting the health needs of almost250,000 people on the West Sussex coast, thePrimary Care Trust manages specialistcommissioning for all 15 Surrey and Sussex PCTs,administering an annual budget close to £350million.

Steve, who first joined the NHS in 1980 as an HRspecialist and has held director-level posts for morethan ten years, began his partnership working soonafter his appointment by linking with the chiefexecutive of the local acute trust.

Integration

“I believed patients would be best served if wealigned the energies of the two organisations.Wecreated a degree of vertical integration with theacute trust, for example, by creating three jointdirectors of estates and facilities, HR and informationsystems and technology. We developed a strategyabout partnership and integrated working that wasdesigned to focus on delivery of what was neededfor the population.”

Steve also chairs a joint management body whichbrings together the PCT, the acute trust, socialservices and the specialist mental health and socialcare trust.

“Organisational boundaries are irrelevant as far asthe public is concerned.The the views andaspirations of different organisations should not,under any circumstances, get in the way ofproviding what is right for patients.We must live,breathe and mean this approach, not just say it.”

Vision

Steve has also taken a leadingrole in the creation of Vision2010 – a multi-agency strategyin which senior frontline staffand the relevant agencies askthemselves ‘What do we wanthealth care locally to look like in2010?’

“There are lots of initiatives and funding around, sowe must harness them to serve people best.Governments, organisational boundaries and chiefexecutives all come and go, but people still needcare and treatment.

Working with others to achieve more


++ Primary Care Trusts are now

‘Organisationalboundaries areirrelevant asfar as thepublic isconcerned.’


together


“We are working to get all the organisations excitedabout new ways of doing things, re-shaping thehospital, a new future for primary care in the light ofthe new GP contract and getting social andcommunity care to support people in their ownhomes more effectively. ”

Steve adds,“People are very enthused by the picturethey are helping to paint.That would not have beenpossible two years ago without this much greaterlevel of trust and commitment which has grownout of the determination of local leaders to make areal difference. For the PCT that means soundmanagement, shaped by local clinical priorities anda focus on the needs of people.”

Open process

The PCT has also resolved along-running problem overwhat to do with twocommunity hospitals inRustington andLittlehampton, which, in spiteof their committed staff, wereinadequate and out-dated.

“Efforts to do something havebeen going on for about 20years. says Steve.“Everyoneagreed there should be a newhospital but half wanted it onone site and the rest on theother. We have devised acombination of beds andcommunity servicesintegrated around anintermediate care model.

“The plan has gone downvery well, partly because ofthe open process we

committed to.We established a reference groupincluding any interested party that thought itshould be involved.We had monthly meetings, theysaw all the working papers and we spent a lot oftime talking about the options.

“We try to adopt that approach to every thing wedo. It is about the responsibility of leaders to set thevalues of the organisation. People must see that youhave integrity, that you say what you mean and youmean what you say. If you make a commitment, youhonour it.That is what I have been trying to do and Iwant people in the organisation to do.

“We are seeing the rewards of that approach. Peopletrust us, they don’t always like the decisions we havemade, but they trust us to do the right thing. Part ofour responsibility is for people to see our values, notwritten down on some glossy card, but throughwhat we say and do and how we behave every day.”

Partnershipapproach:Steve Phoenix

responsible for spending 75% of the NHS budget ++

❛‘People with long termconditions want and needdifferent sections of the healthservice to work together asone. Without high qualitymanagement this rarelyhappens.’Paul StreetsDiabetes UK

Sarah HooperRADIATE Team Manager,Hounslow PCT

Sarah Hooper is responsible for leading a multi-disciplinary team working with older people toreduce unnecessary hospital stays and smooth thetransition from hospital to home.

Based at West Middlesex University Hospital,RADIATE (Rapid Assessment and Diagnosis andTreatment for the Elderly) works with patients agedover 65 to ensure they can maintain theirindependence for as long as possible.

The team is made up of 23 health professionalsincluding nurses, occupational therapists,physiotherapists, speech and language therapists,psychologists, social workers and some consultantmedical time.

Diverse

Sarah, RADIATE’soperational manager, isresponsible for bringingtogether this diversegroup employed by thehospital, the local primarycare trust, as well as socialservices.

“Managing a team ofpeople with skills rangingfrom nursing topsychology can becomplex,” says Sarah.

Sarah works closely withthe professional leads whoare responsible for the clinical supervision of theteam. “We meet on a regular basis so I can gaintheir valuable professional input.”

RADIATE takes between 80 and 90 referrals a monthfrom GPs, district nurses and social workers, andfrom patients discharged from A&E. Sarah is workingwith colleagues to develop a single point of accessfor all intermediate care referrals. This will ensurepatients receive the right services as well as freeingup GPs’ time.

Pilots are also under way for a single assessmentprocess to eliminate the duplication of patientinformation and ensure that each service has accessto accurate, up-to-date records.

Sarah is justifiably proud of the team’sachievements: “Our ultimate goal is to catcheveryone in the community before they needemergency care. However, right now our aim is towork across the PCT and with West MiddlesexUniversity Hospital to ensure that as many olderpeople as possible can be successfully rehabilitatedinto their own home and, with our help, maintaintheir independence.”


Working with others to achieve more

‘Our ultimate goal is to catch everyone in thecommunity before they need emergency care’

Proud of her team:Sarah Hooper

Hari SewellDirector of Social Care, Camden &Islington Mental Health & Social Care Trust

A key part of Hari Sewell’s job is ensuring thatservice users have a real say in how the trust is run –so it genuinely meets their needs.

“There has been a long tradition of service usersplaying an active role within the organisation. Overtime that role has developed from being on theperiphery of things to something more robustwhere there are clear expectations from staff aboutuser involvement.

“The Government’s approach to mental healthalready provides a framework for involvement intreatment and care, so we are focusing oninvolvement in the business of the organisation,which is less well-defined at national level.”

Hari feels that service users have warmed to theopportunity to influence how services are providedon an ongoing basis, rather than relying on one-offconsultations.

“We co-opt service users on to committees and wealso have a user advisory group which provides on-going input into the whole life of the care trust.Wehave a programme where users interview otherusers about their experiences and we find we get adifferent response to what a professional mightget.”

The trust is now looking at how it can more effectivelyinvolve users in monitoring service standards, and indecisions about service configuration.

“More than 100 people have been involved sincethe trust was established of which a core ofbetween 30 and 40 are significantly involved.Theirdiagnoses cover the full range of conditions such asschizophrenia or depression.

“Having service users involved in absolutelyeverything keeps us focused all the time on why wedo what we do. For me that isfundamentallyimportant.”



together

Givingpatients a say:Hari Sewell ❛

‘Rethink’s vision is for ahealth service that givespeople with severe mentalillness a real say in their care,with high quality serviceswhich help them recover afulfilling life. This visioncan't be realised without first-class management.’

Cliff PriorRethink

Dr Sue AllanPEC Chair, Ealing Primary Care Trust

Dr Sue Allan is a GP in a five-partnerpractice in West London. But she is alsochair of Ealing Primary Care Trust'sProfessional Executive Committee (PEC),responsible for overseeing the day to dayrunning of the PCT.

Sue works closely with the trust chair andchief executive to ensure that localprimary care services meet the needs ofthe 350,000 people served by the PCT.

“GPs can bring a fresh approach tomanagement by suggesting differentways of doing things because they come at it froma different angle,” says Sue.

Prevention

Until recently, Ealing’s doctors lacked a screeningservice to detect signs of osteoporosis. Sue workedto secure the support of clinicians and managers toestablish two local centres. “Now we can scanpatients in at-risk groups and prevent its onset withtreatment. It has the potential to make a significantdifference to people’s lives.”

Sue is also working to create a permanent pool oflocum doctors.“With 180 GPs there is alwayssomeone wanting cover. Not only does it give us adedicated reserve familiar with the patch but wecan use it to encourage GPs to get more involvedwith either clinical or managerial work in the trust.It can free up a doctor with special interests to runclinics, or allow a GP to lead a project.”

Despite the difficulty of juggling her responsibilitiesas a GP and as a PEC chair, Sue finds the role arewarding one. “There are frustrations, but mixingclinical practice with management can also be thebest job in the world.”


❛

Working with others

‘A real strength of PCTs is thatthey put GPs at the heart of themanagement team. Supportingdoctors in managementpositions and encouraging closecollaboration betweenmanagers and frontline staff isthe key to delivering betterpatient care.’Professor David HaslamRoyal College of GPs


❛The Royal College of Nursingwelcomes and supports the NHSConfederation's 'ManagementMatters’ campaign. Leadership andeffective management are key toquality patient care.❜Dr Beverly MaloneRoyal College of Nursing

❛All organisations, whether publicor private, are hugely reliant uponfirst class management skills. Wemust not denigrate the importantcontribution that excellentmanagement can make in providingthe right environment forprofessionals and staff ❜Digby JonesConfederation of British Industry

❛Organisations which providehealthcare must be well-led andwell-managed. Leadership is crucial.Management does matter.❜Sir Ian KennedyCommission for Healthcare Audit & Inspection

What is the future for NHS management? See overleaf

The modernisation of the NHS requires increasesin the number of doctors, nurses and beds, butas the NHS plan recognised, this will not beenough on its own.There is a need to streamlineand change the way services are provided, newstaff roles need to be developed and a hugeprogramme of investment in information,buildings, and equipment is needed. All of thisrequires high quality management.

This report has highlighted twelve examples of howgood management can make a difference.They arejust a tiny sample of the many managers who arehelping clinical staff to deliver services moreeffectively and directly improving the patientexperience.

There is good evidence from recent studies thatsenior NHS management is comparable in qualityto managers in the commercial sector. But there isno room for complacency.The NHS Confederationbelieves we must do more to effectively supportNHS managers and develop the skills needed tomeet the challenges ahead.

Developing the people

Promoting new skillsProperly applied management expertise can addreal value to the delivery of clinical services but thisrequires new skills in how to create well managedsystems. Managers need to understand clinical work– not so they can interfere or dictate to clinicians,but so they can help nurses and doctors to do theirjob.Training and education is a part of this butmanagers also need on the job learning andsupport from their peers.

This needs to be accompanied by a focus ondeveloping other key skills that are essential totransforming services, including strategic planningand more effective use of increasingly complexinformation systems.

Attracting clinicians into leadership rolesBecause so many of the changes the NHS needsrequire an understanding of clinical processes weneed to find more ways to attract clinicians intomanagement positions.

Clinical managers know that their management rolecan have just as much of an impact on patient careas their clinical work, and this is an importantmotivating factor for taking on these roles. But westill need to find more ways to make these positionsattractive, and to provide clinician managers withappropriate training and ongoing support.

Supporting middle managersThere is a growing recognition that we need toinvest in top quality senior management. But theNHS also needs high quality leaders and managersat other levels of the organisation.

The NHS has tended to undervalue its middle andjunior managers. In fact, these staff often have someof the most crucial but stressful jobs because theyhave to balance the requirements of seniormanagers with those of their clinical colleagues.Thiscan be made more difficult because of thedifference in status and career stage between somemiddle managers and consultants.

We need to look at what could be done nationally,regionally and locally to better support middlemanagers.This should include tailoreddevelopment programmes and networking andpeer learning opportunities across the public,private and voluntary sector.

Where next for NHS management?


31

Developing the job

Promoting effectivenessThe jobs we ask NHS managers to do must berealistic.There is still a tendency to set people huge,if not impossible, tasks and then become impatientwhen there is not a very rapid change.

There is no point in developing leadership andmanagement skills and capacity if the environmentin which leaders practice undermines theireffectiveness. Unless this is addressed many of theresources put into management developmentcould be wasted.

If individuals are not delivering then this needs tobe tackled, but the process needs to be fairer,ensuring that individuals are not blamed where thewider system is the problem. It will be harder tocreate a culture of putting the patient first if we areunable to look after our own staff.

Setting better targetsManagement without the engagement of clinicianswill fail to deliver change. But managers will find ithard to engage their frontline clinical staff if theperformance management regime does notconnect to the realities of their everyday life.

Tough targets for delivery are important. But thenumber of targets needs to be reasonable andmany more of them must be developed locally sothey relate more closely to the patient experienceand front line staff views of service quality.TheDepartment of Health has made progress in thisarea but there is further to go.

Unleashing innovationFinding the time to develop new ideas and workingpractices is essential in a rapidly changing NHS.Managers need to have access to funds that allowstaff to look beyond the here and now to developthe innovations that will deliver better services overthe longer-term.This requires a culture whereexperimentation and risk taking are activelyencouraged.

Clinicians and managers also need the opportunityto learn from best practice in other parts of the NHS,and elsewhere, to ensure that successfulinnovations can spread across the service.

Taking the agenda forward

The Confederation believes that action in theseareas would help NHS management to fully realiseits contribution to transforming the NHS.

We need to focus on developing both the peopleand the jobs as two sides of the same coin. And weneed to do this as part of a fresh debate about thedifference good management can make toimproving patient care.

❛Modernisation of the NHS andthe delivery of the NHS Planconstitute not only the biggesthealthcare project in the world,they add up to the toughestmanagement task as well.We need the best managers to dothis. We need to draw them fromwithin the NHS, whether from clinical or fromadministrative backgrounds. We need to bring infrom the outside people with different skills andwith different experiences.Most importantly, we need to train, develop andsupport all of our staff so that they can make themaximum contribution and ensure weget real value from the new investment.❜Sir Nigel CrispNHS Chief Executive


The Confederation brings together theorganisations that make up themodern NHS across the UK.Workingwith our members, we are anindependent driving force totransform health services and healthby:

• influencing policy and the widerpublic debate

• connecting health leaders throughnetworking and informationsharing.

Published by the NHS Confederation© NHS Confederation 2003Designed by Atlas Media GroupISBN 1 85947 096 3

For further information on theConfederation’s Management Matterswork, contact the Public Affairs teamon 020 7959 7240.

Further copies can be obtained from:

NHS Confederation Publication Sales

Tel 0870 444 5841

NHS Confederation1 Warwick Row, London SW1E 5ERTelephone 020 7959 7272Fax 020 7959 7273E-mail [email protected]

Registered Charity no. 1090329

The NHS is one of the largest organisations in the world.Significant additional resources are being invested to supportthe biggest ever reform of the way services are delivered.

Any commercial organisation on this scale would be expectedto recognise the value of high-quality management.Yet thecontribution of NHS leadership and management is oftenoverlooked.

This NHS Confederation report challenges the mythssurrounding NHS management and shows the reality ofcommitted and hard-working individuals who are making areal difference to patient care.

Documents

Management matters - NHS Confederation/media/Confederation/Files...Management Matters 3 Time for a fresh debate The NHS is one of the biggest organisations in the world.In many local