Hsmc Newsletter Vol20 No1 April2014

8/12/2019 Hsmc Newsletter Vol20 No1 April2014

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Volume 20 No 1

Health Services Management Centre

Newsletter

Focus on tough choicesand new opportunities in acold scal climate


2/16

Some say thatnecessity is themother of invention,others that beinginnovative requiresresources. Whateverthe validity of thesecompeting claims,it seems clear that

we are entering intoa sustained periodof public sectorbudget constraintbrought about by botheconomic trends andpolitical decisions.

As a result, austerityhas cast a shadow over the planning,commissioning and delivery of services. Thispresents both challenges and opportunitiesto those working in the health and socialcare sector.

The challenge of resource scarcity has ledto the resurgence of the rationing (or prioritysetting) debate in health and social care.The pursuit of reasonable approaches torationing has long been a preoccupation ofHSMC. However this debate has evolvedas the health and social care landscape hasevolved, and HSMCs research and practicehas changed accordingly. For example, thecontroversial topic of decommissioninghas long been overlooked by social scienceresearchers. In this newsletter JennyHarlock explains how we have sought

to address this gap through a three-yearNIHR-funded investigation of the removaland/or replacement of NHS interventionsand services. The aim of this project isnot to make the case for decommissioningbut rather to understand what happenswhen it is attempted in practice, and whatdetermines success in its implementation.Kerry Allen further explores best practicein this area by considering lessons andlearning from recent care home closures.

The traditional pre-occupation of prioritysetting with a narrow range of healthcare interventions is also out-dated postMarmot, and HSMC is therefore pilotingand evaluating a novel public engagementinitiative for deciding between preventiveinterventions with Solihull Health and

Wellbeing Board. The REACH UK gameenables citizens to debate the merits of arange of programmes for improving healthand wellbeing. Katharine Warren, a publichealth trainee on placement at HSMC,describes project progress to date.

As well as necessitating dif cult choices,austerity arguably provides an opportunity

to think in new ways about old problemsand how they might be solved, in particularthrough the emergence of new servicemodels. In this newsletter Robin Miller andJennifer Lynch explain the move towards asocial capital and assets-based approach toservice planning and delivery in adult socialcare. Put simply, this means services thatbuild on and complement what people areable to do rather than making dependencyand helplessness a condition of support.Hilary Brown meanwhile explores the valueof Stroke Groups in facilitating recoveryand con dence and tackling isolationand loneliness for stroke survivors andtheir carers. Both articles make the casefor expanding the narrow preoccupation

Focus on tough choices and new opportunities in acold scal climate

Edited by Iestyn Williams and Jenny Harlock

2 HSMC - Newslettter

In this issue:Focus on tough choices and new opportunities in a cold scal climate 2

Decommissioning healthcare: early ndings from an NIHR study 3

Closing care homes: managing change for positive outcomes 4

Reaching Economic Alternatives that Contribute to Health (REACH)with Solihull Health and Wellbeing Board 5

Turning the welfare state upside down? New approaches to adultsocial care 6

Knowing the price of everything but the value of nothing -Placing a value on A Lifeline 7

Paying the Doctor 8

China crisis? 10

Postgraduate programmes 11

Projects update 12

Events 14

People at HSMC 16

with price as an indicator of the value ofinterventions in health and social care - alltoo easy in these nancially straightenedtimes. And nally, our newly appointedProfessor, Mark Exworthy, reviews thepervasive but largely unpublicised awardingof nancial bonuses to NHS consultantdoctors - to the estimated tune of over 500million per annum.

These articles are supplemented by ourusual project and news updates, includinga second contribution from Mark Exworthyre ecting on a recent health care trade visitto China.

Overall we hope that this newsletter, and thework of the department that it showcases,combine realism in relation to the nancialconstraints we are currently facing withcontinued commitment to quality andinnovation in health and social care.

[email protected] j.h arl ock@bh am.ac.uk


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Decommissioning healthcare: early ndings froman NIHR study

There are veryfew examples ofsuccessful attemptsto decommissionhealthcare servicesand/or interventions.Decisions to

decommission are often accompaniedby resistance from staff, negative media

attention, and an aggrieved local public.For these reasons decommissioning hasoften been overlooked by social scientists:it is seen as too controversial, too dif cultto implement, or simply a knee-jerkresponse to nancial dif culties. Yet as newtechnologies emerge, practices evolve, andpopulation needs shift, decommissioning ispart of a continuum of activities and skills(alongside re-commissioning) that thoseresponsible for planning healthcare servicesare learning.

HSMC is therefore undertaking a threeyear study into decommissioning thatis, the planned process of removing,reducing or replacing - healthcare servicesand interventions in the English NHS.The project is funded by the NIHR HealthServices Delivery and Research programmeand seeks to understand what happenswhen decommissioning is attempted inpractice, and what determines success inits implementation.

A three-round online Delphi study with thirtyinternational experts from policy, practice

and academia was conducted in the rstsix months of the project. The aim was togather expert opinion on the process ofdecommissioning, both as it should be doneand as it is currently carried out. The initialround comprised a series of open questionsasking participants to identify factors whichin uence decisions to decommission.Subsequent rounds then measured thedegree of consensus on considerations forbest practice for their implementation, basedon participants earlier responses. Theresults revealed a stark contrast betweenwhat experts reported should happen anddoes happen in practice.

There was strong agreement amongstparticipants that quality and patient safety,clinical effectiveness and cost effectiveness

should ideally inform decisions todecommission. However, cost/budgetarypressures, government intervention andcapital costs and condition (of buildings/maintenance) were cited as the top threefactors that actually do inform decisions todecommission in practice. These resultsmay not come as a surprise to some,given the nancial constraints and political

pressures that those in the healthcare sectorare facing. Yet participants stressed thatcost in itself is not an illegitimate reason todecommission. Rather, it is decision-makingbased on expectations of short-term costsavings (so-called salami slicing), insteadof a whole systems perspective focused onlong-term sustainability that was said to beproblematic.

Meanwhile participants emphasised thetime, resources and skills necessary tocollect, analyse and communicate theevidence for decommissioning decisions.Healthcare providers whether public orprivate are not used to collecting datato prove their unworth - indeed quitethe opposite in a competitive fundingenvironment - but basing decisionson a strong and robust evidence basewas amongst the top ve best practicerecommendations for decommissioning inour Delphi exercise.

When it comes to implementingdecommissioning, size would appear tomatter. Related research on disinvestment

and cutback management has suggestedthat incremental changes to practicesand services are likely to be implementedfar more successfully than large-scaleprogrammes of reform and/or reduction.

The results of our Delphi survey suggestthat this could indeed be the case:executive and clinical leadership werehighlighted as key factors in facilitatingprogrammes of change. Meanwhile qualityof communication, clarity of rationale forchange, and demonstrable bene ts werereported to be crucial by participants ifdecommissioning programmes are to be

seen as more than just another short-termcost-saving initiative, and gain the trust ofpatients, staff, and stakeholders.

The next stage of the study will explorethese issues in greater depth through fourcase studies of decommissioning processes.Previous investigations of decommissioninghave been heavily couched in the rhetoricof comparative health economics. Earlyevidence from our Delphi survey suggeststhere is a need to pay attention to thepolitical and organisational dynamics ofdecommissioning, and the project will

address both of these ambitions.

Decommissioning is likely to remain ahighly contested and challenging activity,especially in a context of austerity. Yetdecommissioning can be a planned processof healthcare modernisation underpinnedby improved patient experience, quality ofcare and patient outcomes. Our research sofar suggests that key to this is establishinga clear evidence base for decommissioningbased on both clinical and patientexperience, involving patients actively inplans and decision-making, and forecasting

potential impacts on the health (equalities)of the local population.

[email protected]@bham.ac.uk.

Jenny Harlock

HSMC - Newslettter 3

Protesters in front of hospital / by Labor Youth - ige an Lucht Oibre on Flickr (CC BY-NC-SA 2.0)


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Closing care homes: managing change for positiveoutcomes

In a challengedeconomic contextcare home closurescan occur for anumber of reasonsand take verydifferent forms.

Closures can often be sudden, connectedto a speci c emergency in a single home

or breach of regulatory standards. Marketfailure is also an inevitable risk in a privatesector dominant provider landscape.However care home closures are not alwaysabrupt and unforeseen; increasingly localauthorities are decommissioning carehomes as part of a planned process ofmodernisation and outsourcing.

The potential for negative consequencesfor the vulnerable people being resettledis easily imaginable in connection to carehome closures. In one of only a few studiesproviding insight into this topic for older

people, Scour eld (2004, pp. 511) pointsto the knock-on effects for extended socialnetworks and to the importance of thesemultiple stakeholders in providing support:

Minimizing transfer traumanecessitates an ongoing piece ofwork involving the whole systemaround the individual old personconcerned. This would include, forexample, friends, family, care staff,professionals and companions inthe home.

Against this background, this article drawson a recent HSMC evaluation and goodpractice guidance (Robinson et al., 2013;Glasby et al., 2011) to explore whethereffectively managed care home closurescan produce better long-term outcomes forresidents. It identi es some key principlesand practices behind effective closuremanagement that may be applicable acrossvarious closure scenarios.

Can the closure of care homes lead toimproved outcomes for residents? Basedon the ndings of a 3-year evaluation of the

modernisation of older peoples services inthe city of Birmingham, the best answer isYes, but. This study measured health-related quality of life of older residents at:

initial assessment (before closure andresettlement)

28 day review (28 days after resettlement) 12 month follow up (a year afterresettlement)

Because of the size of Birmingham, thiswas believed to be one of the largestclosure processes in Europe and the CityCouncil took the brave but unusual step ofcommissioning an independent evaluationso that lessons could be shared with otherareas contemplating similar changes.

Despite the received wisdom that care homeclosures can be damaging to older peopleswell-being, we found that many thingsstayed the same for our participants (despitethe fact that they were 12 months older andfrailer at the end of the study than at thestart). In some cases, indeed, outcomesactually improved and this seems amajor success story given the complexitiesinvolved. However, many older people, theirfamilies and care staff were angry and upsetpart way through the closure process perhaps demonstrating that service closurescan be distressing and emotionally chargedeven if the overall outcome is positive.

Contributing factors to the success of theclosure programme included:

A ded icated soci al work as ses smentteam: assessment provided the primarymechanism by which new services weredetermined and getting this right wascrucial to the health and well-being ofservice users, both short- and long-term.

A key strength of the process suggestedby all stakeholders was a dedicated groupof assessors, who were able to take thetime to get to know people well, meetfamilies, work alongside care staff andcarry out holistic assessments.Strategy and communication: havinga clear strategy and policy that could beeasily articulated to stakeholder groupswas seen as important. This aidedsubsequent communication and enabledthe closure programme to take place ona phased basis (which prevented rusheddecisions and overloading care staff andassessors). Being forewarned of potentialrisks and negatives was also seen asimportant, so that every possible stepcould be taken to overcome these. Thecommunications approach incorporatedan independent advocacy service forresidents and their families.

Above all, a key factor seems to be time foradequate planning and preparation. Thisincludes time to:

Put in place well organised, dedicatedand skilled assessment teams.

Involve all relevant parties (especiallyservice users) in decisions about futureservices.

Get to know people well and carry outholistic assessments of their needs.

Support service users, families and carestaff through potentially distressing andunsettling changes.

Work at the pace of the individual andgive as much time to explore futurearrangements as possible.

Help residents and key members of carestaff to stay together if possible.

Ensure independent advocacy isavailable.

Plan the practicalities of any moves andensure as much continuity as possibleafter the move has taken place.

Stay in touch with people and assess thelonger-term impact of resettlement.

Work in partnership with a range ofexternal agencies and key stakeholders,managing information and communicationwell.

While these are easier to achieve as part ofa long-term, planned process, such factorsare also important when an emergencyclosure takes place. Given that staff mayhave to respond in rapid timescales, it feelsimportant that there are accessible andpractical guidance and tools available andour subsequent national good practice guidehas sought to share our learning with others(see Glasby et al., 2011).

ReferencesGlasby, J., Robinson, S. and Allen, K. (2011)

Achi evi ng cl osure: Good pract ic ein supporting ol der people duringresidential care closures. Birmingham:University of Birmingham & ADASS

Robinson, S., Glasby, J. and Allen, K.(2013) It aint what you do its theway that you do it: lessons for healthcare from decommissioning of olderpeoples services. Health and Soc ialCare in the Community , doi: 10.1111/hsc.12046.

Scour eld, P. (2004) Questions raised forlocal authorities when old people areevicted from their care homes, BritishJournal of Social Work , 34(4): 501-516.

Kerry Allen



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6/16

Turning the welfare state upside down? New approaches to adult social care

As the implications ofthe Care Bill continueto be debated, adultsocial care is facingsigni cant dif culties.With major nancialand demographicchallenges, thesystem as a whole

feels as if it iscreaking at the seams

and maintainingeven the status quo(which many peoplefelt was not goodenough in too manycases) will be very

hard. As Councils gain new responsibilitiesand face massive cuts (described byone Council leader as the end of localgovernment as we know it), they will haveto make some very tough choices.

Against this background, a number oflocal authorities are actively consideringnew approaches which draw more fully onsocial capital and community resources.

For all the legislative changes takingplace, adult social care is still based onvery negative underpinnings, with peopleforced to highlight the things they cant dofor themselves in order to be eligible forsupport. Anyone with family support or keento stress what they can do for themselvesruns the risk of being penalised for not beingsuf ciently vulnerable and dependent. For

people on the receiving end this can feela very demeaning and disempoweringprocess especially if after a lengthyprocess you nd you are still not eligiblefor support. At best, it means that Councilstoo often fail to take into account peoplesexisting social capital and the communityresources they use on a regular basis;at worst it can ride roughshod over suchsources of support.

Now, in contrast, there seems a genuineappetite for a new and more assets-basedapproach which builds on what people canalready do for themselves. This does notmean that people with less social capitalwould lose out simply that Councilswould try to build on whatever support

already exists in individualsituations and communities,wrapping any formal servicesaround what already works forthe person concerned. Thus,a number of authorities areexploring mechanisms suchas timebanking, local area co-ordination and the development

of micro-enterprise. Councilssuch as Surrey are settingup user-led citizens hubs inhigh-street locations to provideadvice and peer support andencouraging staff to think aboutthe contribution social capitalcould make to meeting theneeds of the Taylor family (actitious but realistic family

created to help engage staffand service users in creativediscussion). The Shropshiresocial work pilot is led by acommunity organisation whichis pioneering approaches tore-ablement based on peersupport, with delegated authorityfrom the Council to spend small

weekly sums on formal services if needed inthe short-term. All round the country thereare sometimes small, but often powerful,examples emerging.

In many ways, such approaches take socialwork back to its community developmentroots, moving away from a more narrowfocus on care management. However,

making a strategic shift from a de cit- toan assets-based approach will not be easyand Councils cannot simply reduce formalservices and hope that social capital willsomehow make up the difference. Instead,we need a rm commitment to a new wayof working and then we have to reallymean it/be consistent when we say it. Thus,many authorities are reducing the number ofneighbourhood workers they employ, cuttinggrants to local community organisationsand/or trying to reduce the number of areaof ces they have, placing staff in large,central buildings many miles away from thecommunities they serve. These seem themirror image of what might be needed ifwe were serious about a more community-orientated approach.

In one sense, this sort of shift has beenpromised before most recently via thepersonalisation agenda. However, thecurrent nancial crisis has to be seen asboth a threat but also as an opportunity.While dif cult choices will have to be made,necessity could well be the mother ofinvention. Many authorities have always

been supportive of a more assets-basedapproach, but there have always beentoo many barriers. Now, many Councilsknow this is the right thing to do, but alsocannot afford not to potentially a powerfulcombination of drivers.

[email protected] j.l ynch [email protected] k

This article is based on a recent HSMCpolicy paper, Turning the welfare stateupside down, by Jon Glasby, Robin Millerand Jennifer Lynch, commissioned by andpublished in conjunction with BirminghamCity Council Adults and Communitiesdirectorate. A full copy of the policy papercan be found at www.birmingham.ac.uk/hsmc-policy-paper- fteen.

Robin Miller and Jennifer Lynch



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Knowing the price of everything but the value ofnothing - Placing a value on A lifeline

The above quote fromOscar Wildes LadyWindermeres Fan isgiven in response tothe question, What isa cynic? It strikes meas being a relevant

contemporary comment on the shift in recentyears to using performance information

as the main measure of the bene ts of ahealth and social care intervention. Thisseems particularly the case when it comesto those services which are intended to helppeople to self-manage their conditions byadopting a more psychosocial approach.Without outcomes that can be easilymeasured, counted and costed, suchservices are potentially vulnerable to cuts inthese nancially constrained times. This isparticularly unhelpful given the increasingnumbers of people living with long-termconditions, and the recognition that peoplewith long term conditions are two to threetimes more likely to be depressed than thegeneral population (Haddad M et al, 2009).

There are estimated to be over 15 millionpeople living with at least one long-termcondition in England (DH, 2013), 900,000of whom are estimated as living with theeffects of a stroke (Stroke Association,2013). A stroke is often life changing forboth the patient and carer as there canbe physical and cognitive impairment,fatigue, and behavioural and emotionalchanges. Psychological dif culties suchas depression and anxiety are commonlyexperienced (Hackett et al. 2005). Evidencealso suggests that this kind of psychologicaldistress may be long-term and may notmanifest itself for some time after theindividual has experienced a stroke (Chnget al. 2008).

HSMC has recently been involved in alongitudinal evaluation of a Third Sectororganisations approach to setting upsupport groups for stroke survivors and theircarers which has reiterated the vital rolethese groups play in a participants well-being. Third sector organisations have oftenbeen set up in response to the prioritiesexpressed by people with long-termconditions ful lling their mission enablesand indeed in many ways compels them totake a holistic view of peoples needs.

Our experience however is that this role isnot always valued by the decision makersbecause it is dif cult to put a price on whatthe groups can achieve.

Tackling loneliness and isolationIt is not uncommon for stroke survivorsand their carers to feel very isolated andleft on their own after they are discharged

from hospital. Stroke groups are seen byparticipants as a vital resource in terms ofdeveloping a support network. The simpleact of attending the group provides a senseof purpose and acts as a motivator to go onand do other things. For a number of thosewho live alone and have limited contactwith others, the groups were described as alifeline.

The groups were seen a safe place forparticipants to practise motor and speechskills as fellow members are likely to bemore patient and encouraging. Participantscan join in with activities and if they cantquite manage something as well as others,its an opportunity for humour rather thanembarrassment. In general, the abilityfor participants to talk about what hashappened to them and what they are goingthrough without embarrassment and feelingawkward about being different or the oddone out is empowering. Group members arealso a good source of encouragement foreach other and can provide hope that thingswill improve:

The support group is a major part ofkeeping me mentally well - sharingexperiences and recognising thatthere is life after stroke. It is easy toget down when you realise that lifeis irrevocably changed and you willnever go back to certain things youtook for granted. The group giveshope and you realise that there areother things to do - different, butequally valuable. (Stroke survivor)

Carers equally report that the groupsprovide them with an opportunity to refresh

themselves providing some light relieffrom the usual routine and responsibility ofcaring for someone, and their own sense ofisolation:

I was feeling very alone andneglected as a carer before I feltquite excluded from normal l ife.(Carer)

Metrics maniaOur evaluation highlighted the socialisolation experienced by stroke survivors,the vital role that support groups can play in

addressing this isolation and the importancethat the survivors and their carers placedon such support. Research drawn on by theCampaign to end loneliness http://www.campaigntoendloneliness.org/threat-to-health/ shows us that the effect of lonelinessand isolation on mortality exceeds theimpact of risk factors such as obesity, andhas a similar in uence as cigarette smoking(Holt-Lunstad, 2010). Loneliness canincrease the risk of many negative outcomesincluding suicide among older people(OConnell et al, 2004). The stroke supportgroups, which offer a means by which totackle the loneliness and isolation oftenfelt by stroke survivors and their carers,are surely therefore a useful preventativestrategy as well as a rehabilitative one?

However, interviews with professionalstakeholders highlighted differing viewsas to the overall purpose and approach ofstroke groups. Should they be informal,allowed to develop in line with the wishesof the members and have mainly socialbene ts? Or should they be more structuredwith the principle objective to promote the

integration of the individual back into thecommunity, thereby reducing the need forstatutory interventions?

We noted that because some stakeholdersstruggled to quantify the bene ts thatparticipants might gain, they did not alwaysrecognise the value of such groups.Management consultant and business guru,Peter Drucker, is often famously misquotedas saying, If you cant measure something,you cant manage it, which many havetaken as a maxim resulting in a sometimesin exible reliance on metrics to determinethe value of something. In the world ofhealth and social care commissioning,this has resulted in a proliferation of keyperformance indicators in contracts andperformance managing to the metric. But

Hilary Brown



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life for those who attend these groups isntabout measuring the number of times theyvisit their GP, or the number of contacts theyhave with social services, its about howthey feel about themselves and their abilityto carry on with what is important to them intheir lives.

A br oader v iew of val ueThe quote at the start of this articlecontinues: And a sentimentalist, my dearDarlington, is a man who sees an absurdvalue in everything, and doesn't know the

market place of any single thing. I trustwe are not guilty of being sentimental incalling for commissioners to think verycarefully about how they assess value.Instead of solely relying on KPIs on aspreadsheet, they need to get out and talk

Paying the doctor

With Paula Hyde andPamela McDonald-Kuhne*

In trying to nd20billion ef ciencysavings, the NHS will

nd it increasingly hard to balance risingdemand and continued public sector payrestraint. Pay is the biggest item in the NHSbudget and so, it is timely to re-assessthe state of pay in the NHS and especiallyamong consultants. Following a 2 yearpay freeze and the announcement of nopay increases in 2014 for staff eligiblefor progression-in-pay increment (BBC,2014), current developments (such asthe forthcoming new contract for doctors,reforms to Clinical Excellence Awards andthe prospect of 7 day working) seem to pointto a new settlement in doctors pay (DDRB,2013).

In 2011, there were over 47,000 consultantsin England which was the highest numberever equivalent to 4% of the NHSworkforce but 13% of the NHS budget.However, these are not evenly distributedwith particular shortages, for example, inaccident medicine and deprived areas (PAC2013; BMA 2014).

Stuf ng their mouths with goldThe story of NHS doctors pay has alwaysbeen highly political - with a big and smallp. Bevan, the founding minister of the NHS,described how he had to stuff doctorsmouths with gold to join the edgling NHS.Enoch Powell, another former HealthMinister, described:

the unnerving discovery everyMinister of Health makes at or near

the outset of his term of of ce isthat the only subject he is everdestined to discuss with the medicalprofession is money(Le Grand 1997, p. 14).

Likewise, Ken Clarke spoke of doctorsreaching nervously for their wallets whenhe mentioned health reforms. Latterly,attention has focused on the impact of the2003 contracts which saw pay increasesof between 24% (bottom of consultantspay band) and 28% (top) between 2002-03 and 2003-04 (NAO, 2013). As a result,doctors pay now attracts signi cant mediaattention. Newspapers (notwithstanding theirown political agenda) continue to reporton egregious examples of doctors pay(Donnelly, 2014).

Mark Exworthy


to people who receive the service and askthem how they would assess its value. Andwhilst these will not easily be compared orassimilated, this evaluation suggests thatthe ndings could provide a powerful sourceof evidence of real impact.

[email protected]

ReferencesCh'Ng, AM., French, D. and Mclean, N.

(2008) Coping with the Challengesof Recovery from Stroke: Long Term

Perspectives of Stroke SupportGroup Members. Journal of HealthPsychology , 13: 1136.

Department of Health. (2013)Improvingquality of life for people with longterm conditions . London: DH

Hackett, M. L., Yapa, C., Parag, V., and Anderson, C. S. (2005) Frequency ofdepression after stroke. Stroke , 36:13301340.

Haddad, M. et al (2009) Depression inadults with long term conditions 2:antidepressant and psychologicaltreatments, Nursing Times , 105(49-50):20-23.

Holt-Lunstad, JTB. and Layton, JB (2010)Social relationships and mortality risk:a meta-analytic review. [online] PLoSMedicine , 7 (7).

OConnell, H., Chin, A., Cunnigham, C. andLawlor, B. (2004) Recent developments:Suicide in older people, British MedicalJournal , 29: 8959.

Doctors reaching nervously for theirwallets?NHS consultants are paid in terms of basicpay, additional Programmed Activities, on-call supplements, Clinical Excellence Award(CEA), and other fees and allowances(DDRB, 2013). Three-quarters of their paycomes from basic pay. In the 12 monthperiod ending October 2013, consultants(non-locum) earned 88,088 (mean annual

basic pay) (HSCIC, 2014). If CEAs areadded, the median annual total earningsof senior doctors are 109,000 (2011-12). These awards range from 3,000 to75,000 per annum across 12 levels, arepensionable, are reviewed periodically butare rarely withdrawn. The overall cost ofCEAs is 500 million per annum (NAO,2013).

With a new contract in the of ng,assessments of the 2003 contract aresalutary. As the table shows, the results aremixed.


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Expected bene tof 2003 contract

Realised?

Limit increase inprivate practice

Realised. 39%of consultantsundertook privatepractice in 2012,down from 2/3 in2000 but in contextof rising consultantnumbers

Increase consultantparticipation

Realised

Increase consultantproductivity

Realised. Fall inproductivity slowedafter 2003 contract.

Improvemanagement ofconsultants time

Partly realised

Slow payprogression

Partly realised

Extend patientservices

Partly realised

Secure extrawork at standard

contractual rates

Partly realised

Reduce waitingtimes

Times havereduced but dif cultto attribute tocontract

The DH gave the NHS 715 million (2003-4and 2005-6) to cover additional contractcosts, with recurrent costs of 400 millionpa. Over 80% of Trusts said that they nowpaid for work, which they had not previouslypaid for under the old contract (NAO, 2013).

Given heightened media and policyinterest, public perceptions of doctors payare noteworthy. For example, High PayCentre (2012) asked the public whetherthey thought certain workers earned toomuch, too little or about the right amount ofmoney. Doctors (not just consultants) pay(estimated at 82,962) was deemed aboutright by 73% of respondents, the highestamongst all the categories of workers.Doctors were thought to earn too much by20% and too little by 5%. This compareswith nurses (30,742): 37% about the rightamount, 1% too much and 61% too little (the

second highest, after domestic cleaner,earning 14,144).

ChallengesIn the coming years, the NHS faces fourchallenges in paying its consultants.

a. PayThe 2011 NHS staff survey found thatconsultants were the grade most satis edwith their level of pay. Although pay restraintmay be eased for some NHS staff (Lintern,2014), doctors will not get signi cant payrises (and annual increments of 3% to 8%have been revoked (BBC, 2014)). Majorreforms to CEAs seem unlikely; as 60% get

a CEA, they are becoming a de facto salaryladder. As with similar health systems,doctors pay is nationally-determined.

b. ProductivityThe working time directive, qualityimprovement initiatives, rising workloads,changing skill mixes and technology makeevaluating improved consultant productivityproblematic.

c. PerformanceConsultant pay progression in most Trustsis not linked to performance. Moreover,most Trusts thought that CEAs rewardedexceptional performance although lessthan half of consultants thought so (NAO,2013).

d. PopulationThe UK still has low numbers of physiciansby international standards, despitesigni cant increases during the 2000s: 2.8practising physicians per 1000 populationup from 2.0 doctors per 1,000 populationin 2000 (OECD 2013). However, it is stillbelow the OECD average of 3.2 per 1,000population.

The resolution of these challenges will beindicative of the politics of the double bed(Klein, 1990), the settlement between thestate and the medical profession. Continuingthe metaphor (perhaps unwisely), no-onesuggests that either party is likely to fall outof the `bed but on-going tensions over paywill move the duvet between them!

*Mark Exworthy , Prof. Paula Hyde (DurhamBusiness School) and Pamela McDonald-Kuhne (Kingston Business School) arecurrently conducting an empirical study of

the ways in which clinical performance isde ned, interpreted and implemented in thecommittees allocating Clinical Excellence

Awards (CEAs). It is funded by the British Academy of Managements ResearcherDevelopment Scheme ( www.bam.ac.uk ).

ReferencesBBC (2014) http://www.bbc.co.uk/news/uk-

politics-26556047BMA (2014) http://bma.org.uk/news-views-

analysis/news/2014/february/action-urged-on-consultant-shortage

DDRB (2013) Review Body on Doctors andDentists Remuneration (2013) 41streport 2013. London: DDRB

Donnelly, D. (2014) Doctors paid up to3,000 a shift, of cial gures show. TheTelegraph http://www.telegraph.co.uk/health/healthnews/10641189/Doctors-

paid-up-to-3000-a-shift-of cial- gures-show.html

High Pay Centre (2012) Its a mums world:attitudes to business reform, theeconomy and pay . London: HPC

Klein, R. (1990) The state and theprofession: politics of the double bed,British Medical Journal , 301(6754):700-702.

Le Grand, J. (1997) Knights, knaves orpawns? Human behaviour and socialpolicy, Journal of Social Policy , 26(2):149-169.

Lintern, S. (2014) Employers chief mootsend to pay restraint. HSJ http://www.hsj.co.uk/news/exclusive-employers-chief-moots-end-to-pay-restraint/5068232.article?blocktitle=News&contentID=13251

Public Administration Committee (2013)Department o f Health: managing NHShospital consultants . London: Houseof Commons

National Audit Of ce (2013)Managinghospital consultants . London: NAO.

HSCIC (2014) NHS Staff Earning sEstimates to October 2013 -Provisional statistics www.hscic.gov.

uk/searchcatalogue?productid=14064&topics=1%2fWorkforce%2fStaff+earnings&sort=Relevance&size=10&page=1#top

OECD (2013)OECD Health Data 2013:how does the United Kingdomcompare? http://www.oecd.org/unitedkingdom/Brie ng-Note-UNITED-KINGDOM-2013.pdf



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China crisis?

train) is Tianjin, a city of over 12 million, with304 hospitals and over 2000 village healthrooms. The pace of change is stretchingexisting capacity and capabilities here, aselsewhere.

2. From secondary to primary care: Hospitals dominate the health carelandscape. In China, 90% of health carecontacts are in secondary care, unlike theNHS where 90% of contacts are in primarycare. Although the policy rhetoric is tomove away from existing funding steams

at prospective payment models (similarto PbR), the shift to primary care remainsproblematic. For example, minor surgeryin primary care has largely disappeared.Moreover, the public has expectations ofseeing a specialist in secondary care. Thecontinued dominance of secondary care andthe weak infrastructure in primary care mightaugur higher costs and reduced access inthe long term. This could exacerbate healthinequalities. Current investment in primarycare facilities will remedy this situationsomewhat but the scale of the challengemay hamper such ambitions.

3. Health spendin g: China spends 5.2%of its GDP on health care (compared to9.3% in UK). In the past decade, there hasbeen a growth in social insurance coverage.In some places, it is currently over 90%whereas it was only 15% ten years ago.Packages of essential care are still providedby the state. Despite such social insurance,patients still make signi cant co-paymentsof 40-60% of the costs of their care. In suchcircumstances, it is understandable thatthe public seek to save as much of theirincome as they can, not least for cases of

catastrophic health care costs (Li, 2012).The effect across the country is an economyunbalanced towards investment and notconsumption

Corruption remains a signi cant challengeas, in some sectors, it is endemic. Somestrides are being made to address this.The GSK case of bribery has become anotable illustration of the states commitmentto tackling this issue (Guardian, 2013).Corruption has also, some claim, hadan antagonistic effect on doctor-patientrelations (given the role of the former inprescribing drugs).

4. Social determinants of health: Throughout the week of the visit, smogpollution was ever-present. Although wevisited only cities (where pollution might

David Nicholson famously claimed that therecent NHS reforms could be seen fromspace. If he visits China, he will need torevise his analogy. My participation (onbehalf of HSMC) in a health care `trademission to China (led by Ken Clarke MP)in January 2014 brought home the scaleof change and enormity of the challengesfacing China and its health care system(Healthcare UK).

The rami cations of Chinas economicgrowth are being felt in all aspects of

society, not least public services. Risingambitions and expectations amongst thepublic are presenting enormous challengesto the Chinese government as it moves froma command-and-control to a mixed marketeconomy. With in ation and unemploymentremaining stable and economic growthremaining (moderately) strong (currently7.5% pa), China may be able to meetgrowing demands for the time being.However, rising (income and geographical)inequality may yet threaten this.

Until about 30 years ago, 20% of China

health care costs were out-of-pocketexpenses, with the rest met by thestate. Then, health care reforms madehospitals take care of their own nances,as commercial entities. However, suchincentives led to over 50% of hospitalincome currently being derived from drug

sales andunnecessarymedicalprocedures.

The Chinesegovernment is

now seeking todevolve away

from the centre, to reduce bureaucracy andshift from (direct) provision to regulation. Sofar, the agenda seems remarkably similar toEnglish health care reform. Indeed, manyChinese policy-makers and practitionershave a high admiration for the NHS, seekingto learn from it and even emulate it.

Yet, enormous challenges remain for thehealth-care system. These include:

1. Scale of change: In the past 10 years,

over 100 million people have migrated tocities and even more will move in the next10 years. Meeting the health needs ofsuch a population is becoming increasinglydif cult. For example, just 30 minutes fromBeijing (admittedly by the very fast Harmony

Mark Exworthy

be expected to be at its worst), traintravel between them revealed persistent`grey skies. Combined with on-goingurbanisation, reliance on coal red powerstations, and growing car usage, deleterioushealth effects will be substantial. Risinglife expectancy (2.4 years increase in thelast decade, for example) may not besustainable. Moreover, policy-makers areespecially concerned with models of carefor the growing elderly population andthose with associated conditions such asdementia.

A nal word is merited about the purposeof the trade mission. It was interesting tonote the mix of 50 or so delegates fromthe UK from IT companies, the NHS anduniversities. While IT companies had aparticular focus on digital health, the NHS(mostly specialist Trusts) was exploringthe development of education, researchand commercial links which may ultimatelycreate a new income stream for the NHS.For universities, there was interest inadvancing existing research and educationalprogrammes. The University of Birminghamhas a major collaboration with Guangzhou.HSMC has won British Academy fundingto conduct a learning network on health

care reform in China (see HSMC latestNewsletter). To that end, my visit helpedHSMC pursue yet more international linksand in doing so, revealed familiar challengesof health care reform in a completelydifferent context.

Healthcare UK: https://www.gov.uk/government/organisations/healthcare-uk

Li Y, Wu Q, Xu L, et al. (2012) Factorsaffecting catastrophic health expenditureand impoverishment from medicalexpenses in China: policy implications of

universal health insurance,Bulletin of

the WHO 90(9): 664-71.Guardian, 23 Oct 2013: http://www.

theguardian.com/business/2013/oct/23/gsk-china-corruption-scandal-glaxosmithkline



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Postgraduate programmes

HSMC will welcome a new group of studentsin September. Our three programmes giveopportunities for study at Masters level in:

Health Care Policy and Management Healthcare Commissioning Leadership for Health ServicesImprovement

All of our programmes emphasise theapplication of learning to practice in policy,management and leadership. Our staffgroup has a wide range of expertise and

experience in research and publication andin management and leadership.

Most of our students work in health andsocial care as managers or clinicians andundertake the programme part time over twoacademic years, with a dissertation takingaround six months at the end of the taughtmodules. We also have a group of full-time students, mainly from overseas, whocomplete the programme in one academicyear with a dissertation. The diversity of ourstudent group adds to the learning and theHSMC experience.

In the Health Care Policy and Managementprogramme there is an opportunity tospecialise in:

QualityIntegrated Care

Commissioning

Specialty programmes are based ontwo optional modules, as well as fourcompulsory modules which cover policy,management, patient and user involvement,and organisation development.

The Healthcare Commissioningprogramme includes modules on strategiccommissioning, procurement and marketmanagement, and decision making andpriority setting.

The Leadership for Health ServicesImprovement programme is based aroundan action learning programme. It is onlyavailable for part time students working inleadership roles during the period of study.

All of our programmes offer the opportunity

to study exibly, and to take quali cations ofPostgraduate Certi cate and PostgraduateDiploma. These are substantialquali cations in their own right, and thereare opportunities for progression. Weunderstand the pressures of professional liferequire some exibility in study and makeevery effort to accommodate that.

Assessed work for the modules includesshort assignments to support the workshopactivities and a 3,000 word individualassignment for each of the modules.

Dissertations may be literature based,empirical studies, or based on students ownleadership roles.

Please join us on Friday 11th April fora Masterclass where youll be able tomeet staff and prospective students, andsome current students, and discuss theprogramme in more depth.

For details of this session, and theprogramme, please contact Kate Vos,

[email protected]

Doctoral student achieves international recognitionDr Ching Yuen Luks research, Health Insurance Reform in Shanghai and HongKong: Using the Lens of Historical Institutionalism has been chosen, by theeditorial team of Journal of Health Organization and Management, as a HighlyCommended Award winner of the 2013 Emerald/EFMD Outstandin g Doct oralResearch A wards in the Healthcare Management category.

Dr Yuk was supervised in her research by Professor Martin Powell of the HealthServices Management Centre and by Professor Peter Preston of the Departmentof Political Science and International Studies at the University of Birmingham.

Nye Bevan LeadershipDevelopmentProgrammeBevan is a one year programmeaimed at leaders aspiring to beBoard members (or Nationalequivalent) in the next 1-2 years.The learning is largely self-directed,though guided through a seriesof learning events: on-line, in

residential workshops, throughexperiential sessions (suchas simulations and live pressconferences) and through SelfManaged Learning (SML) sets.Patients are at the heart of thisprogramme and are present at thestart, throughout the journey, andform part of the assessment ofparticipants at the end. A uniqueaspect of this programme is theconcept of SML, which emphasisespeer review and challenge forparticipants. The learning sets

have to agree that each individuallearning contract is suf cientlyambitious and relevant. Theywill also assess the progressof the individual against thesepersonal development goals, aswell as the overall programmelearning outcomes. Participantswill ultimately decide whether theindividual has attained the standardrequired to achieve the programmeaward (NHS Leadership Academy

Award in Executive Leadership -

Leading Care III). Six cohorts arecurrently on the programme witharound 300 participants to date, withmany more to follow.

More information can be found onthe Leadership Academy web site.http://www.leadershipacademy.nhs.uk/grow/professional-leadership-programmes/nye-bevan-programme/

[email protected]



12/16

Projects Update

ESRC-funded proj ectsCatherine Needham is leading two ESRC-funded projects. The rst, evaluating micro-enterprises in social care, now has its rstpublication, which is available as an HSMCPolicy Paper (Social Care for MarginalisedCommunities: Balancing self-organisation,micro-provision and mainstream support,by Sarah Carr). The second, a KnowledgeExchange project on the Twenty-FirstCentury Public Servant, has a project blog athttp://21stcenturypublicservant.wordpress.com/. Do visit the blog and contribute tothe discussion via the blog or the Twitterhashtag #21Cps. Catherine also has a newpublication in Critical Social Policy, entitled'Personalisation: from Day Centres toCommunity Hubs?'[email protected]

Reducing emergency hospitaladmissions: a user and carer perspectivePressures on acute care are currentlyintense, and there has long been a desire torebalance the system away from hospital-based services towards care closer to

home. However, the number of older peopleadmitted to hospital on an emergency basiscontinues to rise. Part of the problem is thatthis is a multi-faceted issue, and only anequally wide-ranging response will suf ce.

As a result, HSMC has been commissionedby the Research for Patient Bene tprogramme to identify ways of reducingemergency admissions by understandingthe perspectives of older people and theirfamilies and of front-line staff. Alongside aformal review of the literature, the study willwork with three case study sites to explorescope for prevention from the perspective

of older people as well as from differentprofessional perspectives. The study isbeing conducted jointly with Prof DavidOliver, the former National Clinical Directorfor Older Peoples Services and will result innational good practice guidance based onthe lived experience of older people.

j.g lasby @bham.ac.uk

As pi ri ng Dir ect ors L eadersh ipProgramme for the West MidlandsHSMC and Manchester Business School,in conjunction with Hay Group have

been awarded the contract to deliver the Aspiring Directors Leadership Programmefor the West Midlands. Health EducationEngland, West Midlands (HEEWM) arethe commissioners and 50 participantsstarted this 10 month programme in

March 2014. The usual mix of experientiallearning, organisational consultancy andimprovement projects will be enhanced thisyear with a more explicit focus on patients/service users. We look forward to welcomingthe new participants to Yarn eld ConferenceCentre, and are delighted to be back runningthis programme once [email protected]

Integrated care and chronic diseaseFrom early 2014, Jon Glasby will beleading a ve-year research project toevaluate interventions to support peoplewith multiple long-term conditions. This isone of four substantive service areas withinthe new West Midlands Collaborations forLeadership in Applied Health Researchand Care (CLAHRC), and a number ofemerging service models in participatinghealth economies will be evaluated and/orsupported to develop the evidence base.The CLAHRC represents a key partnershipbetween HSMC and the Universitys MedicalSchool, as well as between the Universitiesof Birmingham, Warwick and Keele.


Leadership programme for WestMidlands GP mental healthcommissi oning leadsHSMC has been chosen to deliver aleadership programme for the GP mentalhealth commissioning leads in CCGs withinthe West Midlands and East of England.Procured by NHS England, this programmewill support participants to develop theirknowledge and understanding of thecommissioning process and to act as localleaders for mental health services.

[email protected]@bham.ac.uk

Whole system leadership in a liberatedNHSOne of the key concerns expressed duringthe recent health reforms was that wecould create a system lacking systemleadership, and where all the incentivesencouraged silo-based working. Againstthis background, HSMC has been asked towork with the Birmingham and Solihull ChiefExecutives Forum to look at whether current

service models are t for purpose in an eraof long-term conditions, and the potentialrole of the Forum in providing the wholesystem leadership required to make anynecessary changes.


British m edical tourists seekingtreatment overseas without suf cientinformation and adviceThis research was funded by theNational Institute for Health ResearchHealth Services and Delivery Research(NIHR HS&DR) Programme. A team ofresearchers (including Russell Mannion andMark Exworthy from HSMC) has found thatBritish people travelling abroad for medicaltreatment are often unaware of the potentialhealth and nancial consequences theycould face and that this can, in some cases,have catastrophic effects for individualpatients. The researchers recommend thatmore information and advice is provided topotential medical tourists. This, they say,needs to be packaged and disseminated soit will reach those who may not consult theirGP or a specialist website before travelling.

The researchers found that decision-making around outward medical travelinvolves a range of information sources,with the internet and information by informalnetworks of friends and peers playing keyroles. They concluded that medical touristsoften pay more attention to soft informationrather than hard clinical information. Theyalso found that there is little effectiveregulation of information be it hard or soft

online or overseas.

Professor Mark Exworthy, who recently joined the University of Birmingham fromRoyal Holloway, University of London, said:The rise of medical tourism presents newopportunities and challenges in terms oftreatment options for patients and healthpolicymakers in all countries. This studyhelps clarify the scale and nature of thesechallenges for the UK. Whilst there remainsmuch doubt about the extent and impact ofmedical tourism, it is likely that these issueswill become more salient in the [email protected]

Healthtalkonline project: Service usersand carers experiences of ECTThis Research for Patient Bene t fundedproject examined qualitative accountsof having (or refusing) electroconvulsivetherapy. The research was carried out

by Laura Grif th and Bruce Gorrie. It isnow nearing the end of its funding anddrafts of the nal website pages have nowbeen written. The website, hosting video,audio and written accounts of peoplesexperiences should be online July 2014.l.grif [email protected]



13/16

Promoting integrated workingHSMC has been funded by the WestMidlands Academic Health Science Networkto develop an innovative training package topromote better integrated working betweenGP practices and adult social work teams.The project will last 12 months and willproduce free training materials that can beadapted by local [email protected]

Development of a culturally adaptedweight management programme for

children of Pakistani and BangladeshioriginLaura Grif th, Lecturer, HSMC, is co-researcher on this project which is lead byMiranda Pallan and funded by the HTA.During the three years of this project Laurawill be supervising community researchersand advising on the analysis of focus groupand interview data.l.grif [email protected]

SPCR funded pr oject: Meeting thehealthcare needs of recently arrivedmigrants to the UK - the perspectives of

primary care providers As co-researcher on this project LauraGrif th, Lecturer, HSMC, will interview andrun focus groups with GPs, nurses andpractice managers and reception staff,asking what they know about the rulesstating who can access different typesof healthcare (e.g. hospital treatment);whether there are particular barriers tomigrant patients accessing primary care,what they believe the greatest problems arein communicating with patients. Charitiesworking with migrants and NHS staff whoserole it is to make the health service moreequal will also be interviewed.l.grif [email protected]

Building better partnerships betweenacademia and the NHSResearchers at the University ofBirmingham hope the ndings of a newlypublished study will help academics andhealth care professionals work more closelytogether in the future.

The ve-year Birmingham and the BlackCountry CLAHRC Theme 1 project set out tolook at how NHS Trusts redesign services,and how these changes affect patientsexperiences and clinical outcomes. In the

process, researchers also looked at newways of working together with managersand clinicians, in the three NHS Acute Trustsinvolved in the project.

The CLAHRC Programme, which standsfor Collaborations for Leadership in AppliedHealth Research and Care, is funded by theNational Institute for Health Research withmatched funding from participating NHSorganisations. The second phase of theprogramme was launched at the start of theyear with HSMCs Professor Jon Glasby leading the Chronic Disease theme.

Read the full report CLAHRC Theme 1: Health Service Redesign

British Academy funded project: Healthand Wellbeing in the era of superdiversity(health histor ies proj ect)Co-researchers: Laura Grif th, AntjeLindenmeyer and Jenny Phillimore.Based at the Institute of Research intoSuperdiversity (IRiS), the aim of this study isto pilot and develop an approach which canll these gaps in knowledge. The proposed

method involves the collection of narrativehealth history data from 20 recently arrivedmigrants (between 18 months and 5 years ofarrival to the UK) by community researchers.l.grif [email protected]

Set to Care - Enhancing Compassi onateCare in Practice: An Action Learning

Ap proachIn view of the emerging ndings fromthe Time to Care project, and thewider evidence which suggests that anorganisational approach is required ifcompassionate care is to be provided(Dixon-Woods et al 2013, Jacobs et al2013, Kitson et al 2013, Kings Fund2011), a programme of work centred onenabling staff teams to support each otherin placing care back at the heart of practicehas been developed. This research hasbeen funded by Health Education WestMidlands and will focus on nursing staff intwo large organisations - an Acute Trust anda Community Trust - helping them to identifythe best approach for them to implementa system of staff support, in recognitionof the impact emotional labour can haveon nurses. They will be supported toimplement this by Yvonne Sawbridge and

Al is tai r Hewis on as co-researchers, andit will link with the Community of practicebeing established at HSMC to develop

compassionate [email protected]

Commissioning for Better OutcomesThe Care Bill, Better Care Fund (BCF),transfer of Public Health to local governmentand the comprehensive re-organisationof the National Health Service hasrenewed the focus on the importanceof effective commissioning to improvethe experience of social care users andtheir families. HSMC, in partnership withINLOGOV, at the University of Birminghamhave been commissioned by the Local

Government Association (LGA) to developcommissioning standards to supporteffective commissioning practice.

The aim of this work is to provide Local Authorities, and their partners, with a basisfor improving commissioning practice inorder to deliver better outcomes for peoplerequiring social care. The standards areintended to support the implementation ofthe commissioning element of the CareBill once it comes into force in 2015. Thestandards will provide a focus for sector

led improvement developed by the LGAand Towards Excellence in Adult SocialCare (TEASC). They will therefore supporta local dynamic process of improvementin commissioning, and through self-assessment and peer review, challenge


Elderly Care by Mark Adkins on Flickr (CC BY-NC-SA 2.0)
http://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/2014/CLAHRC-BBC-Health-Service-Redesign-Final-Report.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/2014/CLAHRC-BBC-Health-Service-Redesign-Final-Report.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/2014/CLAHRC-BBC-Health-Service-Redesign-Final-Report.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/2014/CLAHRC-BBC-Health-Service-Redesign-Final-Report.pdf


14/16

'Turning the welfare state upside down?'Developing a new approach to adultsocial care07 Apri l 2014 (09:30-16:00)HSMC, University of Birmingham'Turning the welfare state upside down?'Developing a new approach to adult socialcare: A one-day workshop focusing on waysto build on social capital and community

resources.

Developing a compassionateorganisation: An Action Learning Set

Ap proach: Day 302 Ju ne 2014 (09:00-16:30)This is the third day in a series of fourevents. The format is a combination ofexpert input and facilitated learning sets tohelp people to put the evidence into practicein their own organisations.

European Health Management As soci ati on (EHMA) Co nference 2014:24-26 June 2014University of Birmingham

This prestigious event will be hosted by

the Health Services Management Centreand held on the University of Birminghamcampus as well as other venues inBirmingham City Centre.

A provisional programme is availableat: http://www.ehma.org/index.php?q=node/1748 and the socialprogramme at: http://www.ehma.org/index.php?q=node/1834

Bookings can be made on the onlineregistration link at: http://shop.bham.ac.uk/browse/extra_info.asp?compid=1&modid=2

&deptid=34&catid=101&prodid=819

Some recent events:

Developing and supporting the role ofNurse board members i n CCGsYvonne Sawbridge, HSMC SeniorFellow, lead a session on the skills andcompetences and role of Nurses in ClinicalCommissioning Groups at an event entitledDeveloping and supporting the role ofnurse board members, chaired by StaceyMcCann, Commissioning Lead - Nursing,

NHS England. This one day national eventwas held at Austin Court, Birminghamon Thursday 20 March, looked at theimportance of this new role of nurses onthe CCG board and addressed currentchallenges facing them and offered thesolutions and support these nurses need.

HSMC direct or, Jon Glasby, chaired theNational Housing Federations Care BillConference: Simpl e steps to syst emchange?The conference provided the latest learning,expert advice and focused debate on theextent to which the Care Bill will give usthe framework needed to make person-centred integrated care a reality. High pro lespeakers from across government, housing

commissioners, with their partners,to innovate and develop new ways ofcombining resources to support peoplerequiring social care.

The work on the standards started in

February and they are scheduled to belaunched by the end of 2014 at a nationalevent. The development process involves:

1. A literature review to identify goodpractice and the evidence base foreffective commissioning;

2. Interviews with key stakeholders ata national level, to explore the main


dimensions of commissioning tosupport the ASCOF and Making it Realoutcomes.

3. Seminars and webinars to developthe content for the framework throughthe facilitated use of scenarios on key

commissioning challenges for socialcare (e.g. personalisation in the contextof strategic commissioning; integratedcommissioning, market shaping,decommissioning, commissioning totackle inequalities etc.).

4. Testing the draft standards in eight -ten local health and care economies,selected for their diversity in terms oftheir demography and geography.

Oversight of the project is being steeredthrough TLAPs National MarketDevelopment Forum. A Project SteeringGroup has been established, chaired by BillMumford, with a wide range of stakeholders,including people with care and support

needs themselves.

Further informationFurther information on the project isavailable from the project lead Dr KarenNewbigging k.v.newbiggi [email protected]. You can contribute by Twitter#outcomes4people and regular updatesabout the project will be posted on the LGAand ADASS sites.

and the wider voluntary sector shared theirperspectives and insights on where housingassociations as providers and landlordsshould t into the developing vision forintegrated care. Key speakers included:Paul Burstow MP, Former Care Minister andChai of the Care Bill Committee;Shaun Gallagher, Director of Social CarePolicy, Department of Health;

Richard Humphries, Senior Fellow, SocialCare, The Kings Fund.

This conference built on HSMCs previouswork with the National Housing Federation,following which HSMC have published aspecial edition on health, housing andsocial care in the Journal of IntegratedCare.

Integrated Healthc are - Interactiveacademic engagement with policystakeholders: Knowledge ExchangeTrialsThe Health Services Management Centrehosted a knowledge transfer event withpolicy makers from the Department ofHealth in late February. The workshopaimed to raise awareness of the policy-making process, how research can in uencepolicies and how academics can engageand collaborate with the user communityin policy and program development andimplementation, for demonstrable impact.Speakers included: Ed Moses, DeputyDirector, Strategic Partnerships, PublicHealth England, Professor Jon Glasby ,

Director, HSMC, John Garrett, DeputyChief Executive, Sandwell MetropolitanBorough Council, Graham Beaumont, ChiefExecutive, Health Exchange CIC Limited.

Events

E H M A A N N U A L C O N F E R E N C E 2 0 1 4

Leadershipin healthcare:from bedsideto boa rd

S a v e

t h e d a t e !

_


15/16

Commissioning for Mental WellbeingHSMC held a free seminar oncommissioning for mental wellbeing inMarch which explored the current policyemphasis on prevention and improvingthe mental health of the whole population

with input from Gregor Henderson,Director of Wellbeing and Mental Health forPublic Health England. Drawing on workundertaken by Prof Chris Heginbothamand Dr Karen Newbigging , the seminarprovided an opportunity for commissionersand their partners to identify what they cando to translate current aspirations of publicmental health into tangible commissioningstrategies. A book launch of the new titlefrom Sage by Prof Heginbotham and DrNewbigging entitled Commissioning forHealth and Wellbeing followed the seminar.

Selected publications:

HSMC professor raises concerns aboutthe use of payment for performanceschemes in health careProfessor Russell Mannion in a new anarticle published in the International Journalof Health Policy and Management warnsof the dangers of expanding payment forperformance schemes in health care in theabsence of a robust evidence base. Hecomments:

"Many countries are turning their attentionto the use of explicit nancial incentives todrive desired improvements in healthcareperformance. However, we have only aweak evidence-base to inform policy in thisarea. The research challenge is to generaterobust evidence on what nancial incentiveswork, under what circumstances, for whomand with what intended and unintendedconsequences"[email protected]

Mannion, R. (2014) Take the money and

run: the challenges of designing andevaluating nancial incentives in health care,International Journal of Health Policy andManagement, Vol 2, rst published online 5February 2014.

HSMC contributes to Birm ingham PolicyCommission report Health Ageing in the21st Century: the best is yet to come

As the Care Bill 2013/14 reaches its nalstages in the House of Lords, a BirminghamPolicy Commission report makes a series ofrecommendations for future policy, practiceand research. Launched at the Houses ofParliament with the support of BaronessCumberlege, Gisela Stuart MP and formerCare Services Minister Paul Burstow, theCommission focused on ways in whichpeople can thrive in older age and sought

to counter the common perception of anageing society as a problem. Chaired byProf Steve Field, the Commission focused inparticular on the experience of older peoplefrom black and minority ethnic communities,urging policy makers to recognise and

accommodate super-diversity whenplanning services for an ageing population.

The report also found that somecommunities and faith groups draw on thehuge contribution older people make tosociety and that sharing this good practicepresents a real opportunity for communitiesof all kinds. It also stressed the importanceof drawing on relevant equalities andhuman rights legislation, with potential for astatutory Commissioner for Older People.

Download the full report

HSMCs Professor Jon Glasby was one ofthe Policy Commissioners and research forthe report was undertaken by PhD studentsSarah-Jane Fenton and Jennifer Lynch.

j.g lasby @bham.ac.u k

Providing effective preventative s ervicesfor older people

An article by HSMC's Robin Miller entitled'Providing effective preventative services forolder people' was recently published in 'TheGuardian'. Robin writes:

The potential to provide preventativeservices for older people has beenpromoted by the third sector as oneof its unique selling points. This hasbeen re ected in national policy on thebasis that key characteristics commonlyattributed to the sector suggest they havean advantage over public and privateorganisations. These include a connectionwithin local communities, the trust thatolder people often place in their brand, andtheir willingness to work holistically andexibly to achieve better outcomes for theirbene ciaries.

There are many examples of third sectororganisations successfully providinginnovative preventative support that

are valued by older people and also bycommissioners. But as with any suchdiscussion it must be remembered that thisis a diverse sector in terms of size, scopeand organisational missions. Factors beyondthe organisation will affect the impact it can

make, in particular its relationship with thecommissioners who provide an increasingproportion of their funding.

A study funded by the NIHR School forSocial Care Research explored theperspectives of the two sectors in regardsto preventative services for older people.In contrast with the tensions that areoften described, it found that third sectororganisations and their commissionersenjoyed positive relationships andhad shared understandings of theirrespective roles which were largelymet. Commissioners' priorities werepreventing older people needing socialcare services in the future, while for thirdsector organisations the emphasis was onimproved quality of life for individuals. Butthis difference was reconciled in practice Read the full article in the [email protected]

Building Better Health - Why SocietyNeeds Jo int Worki ng Between Health,Housing and Soc ial CareHSMCs Jon Glasby and Robin Miller

explore the relationship between health,housing and social care in this specialedition of Journal of Integrated Care. Witha balanced mix of case studies, researchand expert viewpoints, the issue exploreshow the complex interaction of deprivationfactors can and should be addressedthrough the collaboration of agencies.

This special issue, as well as an introductoryvideo from Jon Glasby, can be accessedby visiting http://www.emeraldinsight.com/tk/housing - See more at: http://www.emeraldgrouppublishing.com/about/news/

story.htm?id=5253#sthash.IsL64EkV.dpuf

http://www.birmingham.ac.uk/research/impact/policy-commissions/healthy-ageing/index.aspxhttp://www.theguardian.com/social-care-network/2014/jan/23/preventative-services-older-people-third-sectorhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.emeraldgrouppublishing.com/about/news/story.htm?id=5253#sthash.IsL64EkV.dpufhttp://www.theguardian.com/social-care-network/2014/jan/23/preventative-services-older-people-third-sectorhttp://www.birmingham.ac.uk/research/impact/policy-commissions/healthy-ageing/index.aspx


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People at HSMC

We are pleased to welcome Hayley Stevenswho has joined HSMC as a member of theNHS Leadership Academy administrativeteam.

Karen Newbigging attendedthe 4th international WHOconference on service user andcarer empowerment in mentalhealth in Lille on January 31st

2014. The focus for the conference was toshare good practice and discuss potentialindicators to promote empowermentexperiences for service users and carers

in Europe. Karen, and fellow researcherLaura Able, presented the ndings from theirresearch into experiences and outcomesfrom statutory mental health advocacy inEngland.

On 1 January HSMC welcomedMark Exworthy who joinedHSMC as Professor of HealthPolicy & Management fromRoyal Holloway, University of

London where he was Course Director ofthe MSc Leadership and Management inHealth'. He has previously held posts at

Southampton University, London Schoolof Economics (LSE), University CollegeLondon (UCL) and Oxford BrookesUniversity. He was a Harkness Fellow inhealth care policy, based at University ofCalifornia-San Francisco (UCSF) (fundedby the Commonwealth Fund of New York)and is currently a Visiting Professor at theUniversity of California-San Francisco.

Prof Exworthys research interests fall into3 themes:

(a) Governance and implementation relatingto policies to tackle health inequalitiesand other social problems',

(b) Professionals and managerialism inhealth care organisations (especiallyrelating to management of clinicalperformance), and

(c) Decentralisation in health careorganisations including a focus onorganisational autonomy and localism.

His research has been funded by the ESRC,NHS (Dept of Health and NIHR), JosephRowntree Foundation, NHS Confederationand the Commonwealth Fund of New York

and he has been involved as PI or co-PI onresearch grants totalling 2.5m.

He has written 3 books and has authored 50articles and advised NHS organisations, theDepartment of Health, NICE and the WorldHealth Organisation among others

New HSMC Policy Papers:Is integration or fragmentation thestarting point to improve prevention?Policy Paper 17This policy paper is based on a discussionpaper which was commissioned bythe Institute for Social Change atManchester University as part of a seriesof Knowledge Exchange Trials workshopswhich brought together academics, policymakers and programme stakeholders tofacilitate exchange of ideas, expertise and

research. The importance of health, social careand other sectors working together hasbeen recognised for many decades bygovernments of all political persuasion.This is true within the current policyenvironment, in which integration hasbeen proposed as the binding force toconnect an increasingly diverse rangeof providers around individual patientsand their families. This integration isbeing encouraged not only in respect ofstatutorily funded clinical, public healthand social care services but also withother policy areas such as housing andleisure and other sectors (in particular thethird sector). Despite this continued belief in policy thatintegration will lead to a more preventativefocus there is not a strong research baseto support this view; however, accepting

the limitations of the evidence base, thisPolicy Paper looks at ve key lessonswhich can still be drawn for national policymakers with responsibility for promotingintegration and prevention.

Read the full Policy Paper 17

Social care for marginalisedcommunities: understanding self-organisation for micro-provision

Policy Paper 18 Although adult social care works withsome of the most disadvantaged andmarginalised people in society, for variousreasons mainstream services dontalways get it right for people. Thats whythere are different forms and sources ofcare and support developing outside themainstream. HSMC is currently doingsome Economic and Social ResearchCouncil-funded research on the differencemicro-providers can make in adult socialcare and the team wanted to know moreabout how very small providers couldmeet the needs of people who canbe marginalised in large, mainstreamservices. So we reviewed some of the UKresearch on how small, local communityorganisations are already working withBME people, LGB people, people fromdifferent faith communities and refugeesand asylum seekers. The review has beenpublished as HSMC Policy Paper 18 .

HSMC is now on Twitter! So, if you want to keep up to datewith all of the latest news from across the Department,including upcoming events and research being undertakenat HSMC, then follow us at @_HSMCentre

QR codes are similar to barcodes in that they store information which can thenbe transferred onto your smart phone/Blackberry quickly and accurately. Bydownloading a free QR scanning App onto your phone you can then read thiscode and view HSMCs homepage

HSMC ViewpointVisit the new HSMC blog at http://hsmcviewpoint.wordpress.com/ for regularcommentary on health and social care issues and research. We are encouragingstaff and friends of HSMC to write contributions. If you would be interested in writinga blog post contact Catherine Needham [email protected] or get in touch

via Twitter @DrCNeedham

http://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-seventeen.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-18-sarah-carr.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-18-sarah-carr.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-18-sarah-carr.pdfhttp://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-seventeen.pdf

Hsmc Newsletter Vol20 No1 April2014

Documents

Transcript of Hsmc Newsletter Vol20 No1 April2014