BT chief medical officer Dr Paul Litchfield certainly did not pull his punches when addressing NHS Plus’ inaugural Health at Work conference at the University of Warwick in January.
NHS occupational health (OH) services were, he argued, often seen as paternalistic, complacent, self-serving, narrow-minded, lacking in innovation, commercially naïve, bureaucratic and slow.
If they were going to give commercial providers a proper run for their money, they needed to be providing greater leadership, managing people better, providing better customer service and, simply, become more commercially aware, he stressed.
Harsh home truths they may have seemed. But even just a quick glance down the conference agenda highlighted the fact that, despite NHS Plus having been in existence and providing services to businesses large and small since 2001, for many of those running NHS Plus units, the world of business clearly remains a bit of a grey area.
During the course of the two-day conference, for example, there were talks on strategies for promoting and marketing your business, how to increase productivity and efficiency through process re-engineering, and advice on how to do business modelling. While these undoubtedly were all useful to the individual delegates listening, they are nevertheless subjects that most operations or business managers working in a commercial environment would probably already to be up to speed on.
But NHS Plus is different, concedes NHS Plus project manager Keith Johnston.
“It is worth bearing in mind that many OH departments have business managers who have come from a variety of backgrounds,” he says. “Some have already come from a commercial background and for them the learning curve is, most often, the NHS. But most come from a nursing background, and are being asked to take on what is very often a role that is quite challenging,” he adds.
This is why the Strategic Development Programme, specifically designed for NHS OH business managers based in England and funded by NHS Plus, was launched at the conference.
The 15-month programme, run by Durham Business School, kicks off this May and runs until June 2009. It will give 20 lucky NHS OH business managers the chance to take a step back and look at how they are managing and operating their units.
It will encourage participants to examine ways they can grow or change their departments or units and, very simply, improve their business (as opposed to their clinical) performance.
While, for the moment, the course is a one-off and relatively small-scale, if successful, it could be repeated more widely.
“I think it is a reflection of the increasing importance of looking beyond purely the NHS as the host organisation,” points out Durham Business School’s Richard Whitaker, programme manager for the course.
“There is an assumption that people already have these business skills. Within OH units there are some quite skilled business managers, but a lot of them are basically clinicians who have been given the job of running the unit,” he says, echoing Johnston.
“They have certainly got the clinical skills, but it is very unlikely that they have the necessary management skills to run their unit effectively the awareness of what you need to be doing to plan and lead your business unit,” he adds.
And these are skills that are increasingly in demand both within and outside the NHS. NHS Plus chief executive Kit Harling pointed out during his speech to the conference that, just as the barriers between private and public providers have blurred elsewhere within the NHS, so the distinction is likely to become less clear within NHS OH over the coming months and years.
Uniquely within the NHS, NHS Plus services are not solely inward facing, and therefore need to have a strong focus on how they can increase their commercial revenue, agrees Whitaker.
On top of this, NHS Plus units are increasingly having to compete with commercial OH providers. “It is the case that some NHS OH units have been losing contracts to commercial rivals,” he points out.
Andrew Gilbey, associate director for OH, York Hospitals NHS Trust, stresses that what employers wanted to see – and by implication were therefore not getting, much of the time – was a consistent, national range of OH services.
NHS Plus was too often trying to sell something that people did not understand, illustrating that NHS Plus providers too often did not know how to speak to businesses in a way that got the message through.
As Gilbey pointed out: “If you are about trying to raise the profile of OH, to help businesses understand how OH can contribute to their bottom line, you have to get out there among the business community. We need to educate the marketplace. There is not enough awareness about what OH is and can do.”
The course will have a close focus on business planning, plus the development of financial skills, argues Whitaker. In particular, it will have three key objectives:
To give participants the business skills and tools (and the confidence) to “enable them to leverage the business performance” of their NHS OH units, or, in plain speech, to perform better and get better value for money
To “create a vibrant network of participants committed to working collaboratively in taking forward the NHS Plus brand”, or, in other words, to manage their teams more effectively ensure people are pulling in the same direction and make sure everyone has a clear idea of what their goal and strategic vision is and should be
To demonstrate an improvement in their business performance over the period of the programme.
The business managers will look at issues such as building strategic awareness, how to plan their growth better, and the importance of ‘step-change’ management.
The strategic awareness element will examine subjects such as how better to understand and learn from the environment in which an organisation operates, how smaller organisations and their managers perceive and respond to events or external influences, and how it is possible to ‘read’ an external environment more accurately.
On planned growth, it will be looking at things such as how to assess how your unit is performing within its market, in both operational and financial terms. Then it will look at issues surrounding the assessment of growth potential, including accurate assessment of resources, experience, ideas and leadership capabilities within an organisation.
In terms of step-change management, the focus will be on issues such as how to develop innovative responses and solutions to challenges and how to implement them. This element of the course will also involve participants taking a close look at how they operate and manage those around them.
As the course guidance explains: “Activities in this component will focus on helping you to ‘step out’ of your personal perceptions and pre-conceptions. This will be achieved by helping you to champion your own personal development and improve your leadership and management capabilities.”
Finally, there will be five three-day residential group workshops looking at particular aspects of the each participant’s unit. They will also undertake work specifically looking at how what they have learned can then be embedded into their own organisations.
“Everything locks into business planning,” Whitaker explains. “It is about being able to manage the team and understand the market and have the right sort of leadership skills. But a lot of that will revolve around ensuring they have business planning skills.”
Supply and demand
The reason Durham was chosen was, in part, because it has long had a good track record of working with small- to medium-sized enterprises (SMEs) and looking at enterprise-related issues. Crucially, it already had a similar programme in place that could be easily tailored to create a bespoke programme for NHS Plus practitioners.
Demand for such a course very much came from the bottom up, stresses NHS Plus’ Johnston.
The catalyst for tasking Durham with the creation of the course was a survey of NHS OH managers, asking them where they felt their strengths and weaknesses lay, he points out. The majority of respondents identified business support issues as one of their key areas of weakness, including aspects such as organisational and management development.
“The demand came from within the service,” says Johnston. “These are people who are operating in quite a complex environment. They are running, in effect, small businesses, but within the bureaucracy of the NHS. And they are dealing predominantly with SMEs, for whom bureaucracy is something they try to minimise. So it can be quite a balancing act between facing inwards and working within the NHS system, and providing a service for NHS customers while also looking outwards and operating a service for SMEs.”
While areas such as business modelling may seem quite commonplace to those working in a commercial environment, for those coming from an NHS, clinical background, they can be quite new and daunting. “So what this course will hopefully do is to help them rise to the challenges,” Johnston explains.
What’s more, agrees Whitaker, for those who do, the skills they will be learning are likely to become increasingly useful within the NHS context, too. “They are very transferable skills,” he stresses.
Of course, the big question is not so much what the 20 guinea pig delegates take back to their NHS Plus units – although that will be important – but whether this small-scale start evolves into something more substantial.
Whitaker, for one, agrees 20 is probably “scratching the surface” when it comes to demand for such a course. But for the time being, the school does not have the capacity to offer any more places.
If the programme is a success and ends up being over-subscribed, which seems likely, he is hopeful that a further 15-month programme may be commissioned.
“What has struck me is the difference between OH units across the country,” Whitaker says. “Some are run by business managers who seem pretty clued up about business issues, but some are just run by nurses or doctors, and there is a huge difference in terms of scope, facilities and resources.”
The course attracted “a lot of interest” in the wake of the January conference, says Johnston. “The feedback was very positive, and I would not be surprised if it filled very quickly,” he says. However, the deadline for applications was mid February.
Yet whether the programme remains a one-off or becomes a regular fixture for NHS OH practitioners very much remains a moot point.
“As ever, it is going to be an issue of funding,” explains Johnston. “At the moment we are not planning a second programme, but we do not rule out the possibility.”
More widely, if the Durham programme starts to create a different mindset among NHS OH providers, giving them the ability to take a different look at where the NHS site within OH, it could well become something quite important.
As Harling himself made clear at the conference, one of the criticisms of OH in the past has been its propensity for “navel gazing and process analysing”. But with the profession potentially on the cusp of huge change, the role and function of NHS OH services is going to be critical.
NHS Plus, as BT’s Litchfield made clear, still has a long way to go. If NHS Plus wants to be influencing change, rather than simply being influenced, it will need to take a long, hard look at what its primary purpose is, who it should be looking after, and what its role is within the health profession.
“We have to have a sense that the care you get is the same in the North East, South West or wherever,” Harling told conference delegates. “And we will eventually need to be able to demonstrate outcomes.
“Our belief is that organisational delivery is as important as clinical quality. If you do not deliver and are not answerable as a service to the people who need it, then you are wasting your time,” he pointed out.
Durham’s Strategic Development Programme may be a small step in this direction, but it has the potential to be a hugely important step for all that. As Whitaker reiterates: “I expect it to be quite a culture shift for a lot of people. So it is whether they are willing to embrace that.”