What matters most to NHS managers: Healthcare leaders are exhausted and overworked – but they want to do the best for their staff and patients
The annual conference of Managers in Partnership last month included a debate between members about what it means to be a good manager of health and social care and what the role of our union should be in supporting managers.
Speakers and delegates were positive and in a mood to tell it how it is. In short: NHS managers are exhausted and suffering from too many staff cuts – but they see no option but to make the best of it, for patients and the staff who care for them.
These areas are uppermost in managers' minds:
The Lansley restructure will be delivered technically on time, but the fallout will last years beyond April. Managers talk bitterly of a "lost year", when the NHS was distracted from patients and services. Jeremy Hunt may be speeding away from his predecessor, and Labour promises no reorganisation. But redisorganisation is a hard habit for politicians to kick. Managers in Partnership will keep punching home the message that change that stops managers focusing on patients and staff is not worth having.
At Mid Staffordshire, managers stopped listening to patients, carers and staff. The shockwave of the Francis inquiry will galvanise managers throughout the UK, and we back the review of how managers are held to account. Responsibility for care standards, however, is shared – with the professionals who deliver the care, and with the politicians who set the policy framework and the money. A tough framework must be fair and hold people to account for matters within their control. Managers in Partnership will resist a scapegoating charter, because false attribution – good for politicians and vested interests – is bad for patients.
Management skills are changing. Where once the ability to eyeball orthopaedic surgeons was key, we now need more participative, supportive and engaging styles. Decent leadership and management development is not a perk, but good for patients and staff. Forget the bogus claptrap about the frontline: the healthcare team needs managers and support staff to integrate, organise and support care standards. The new Leadership Academy has money to spend on directors, clinicians and graduates, but it can't plug the gap for middle managers who must make things work. We will bang the drum for non-clinical training, from healthcare assistants to managers.
Keeping a job may be on the minds of many managers, but the financial squeeze also affects those who stay. Some managers have unsustainable jobs after restructure. Are employers looking after their welfare? Not always. Stress, as HR managers told us from the floor, grips the workforce, from board to ward. The pay freeze bites at all levels, compounded by increases in pension contributions, and, some hospitals may pull managers out of agenda for change pay system. Disciplinaries and grievances, redundancies and contractual disputes (especially over transfer rights in a massively re-organised system) will rise next year, leaving our union plenty to do.
Management culture needs change. A recent survey found managers work in a "culture of fear". And the merry-go-round is turning faster. Many NHS teams succumb to "the pathology of working harder and harder", rather than reflecting more. But leaders have answers. Vision, clear roles, concern for wellbeing, communication, and engagement will see us through.
It is good to know that in all this mess and harshness, managers are still inspired by good leadership values. The talk at our conference was of wisdom, courage, humanity, kindness, justice, prudence and wonder.
The public are fortunate to have managers on their side, people who can manage the NHS with their heads and with their hearts. Like everyone, managers must be cared for.
Jon Restell is chief executive of Managers in Partnership, a union representing 6,500 UK healthcare managers in the NHS, private and third sector. Guardian Professional.
The annual conference of Managers in Partnership last month included a debate between members about what it means to be a good manager of health and social care and what the role of our union should be in supporting managers.
Speakers and delegates were positive and in a mood to tell it how it is. In short: NHS managers are exhausted and suffering from too many staff cuts – but they see no option but to make the best of it, for patients and the staff who care for them.
These areas are uppermost in managers' minds:
The Lansley restructure will be delivered technically on time, but the fallout will last years beyond April. Managers talk bitterly of a "lost year", when the NHS was distracted from patients and services. Jeremy Hunt may be speeding away from his predecessor, and Labour promises no reorganisation. But redisorganisation is a hard habit for politicians to kick. Managers in Partnership will keep punching home the message that change that stops managers focusing on patients and staff is not worth having.
At Mid Staffordshire, managers stopped listening to patients, carers and staff. The shockwave of the Francis inquiry will galvanise managers throughout the UK, and we back the review of how managers are held to account. Responsibility for care standards, however, is shared – with the professionals who deliver the care, and with the politicians who set the policy framework and the money. A tough framework must be fair and hold people to account for matters within their control. Managers in Partnership will resist a scapegoating charter, because false attribution – good for politicians and vested interests – is bad for patients.
Management skills are changing. Where once the ability to eyeball orthopaedic surgeons was key, we now need more participative, supportive and engaging styles. Decent leadership and management development is not a perk, but good for patients and staff. Forget the bogus claptrap about the frontline: the healthcare team needs managers and support staff to integrate, organise and support care standards. The new Leadership Academy has money to spend on directors, clinicians and graduates, but it can't plug the gap for middle managers who must make things work. We will bang the drum for non-clinical training, from healthcare assistants to managers.
Keeping a job may be on the minds of many managers, but the financial squeeze also affects those who stay. Some managers have unsustainable jobs after restructure. Are employers looking after their welfare? Not always. Stress, as HR managers told us from the floor, grips the workforce, from board to ward. The pay freeze bites at all levels, compounded by increases in pension contributions, and, some hospitals may pull managers out of agenda for change pay system. Disciplinaries and grievances, redundancies and contractual disputes (especially over transfer rights in a massively re-organised system) will rise next year, leaving our union plenty to do.
Management culture needs change. A recent survey found managers work in a "culture of fear". And the merry-go-round is turning faster. Many NHS teams succumb to "the pathology of working harder and harder", rather than reflecting more. But leaders have answers. Vision, clear roles, concern for wellbeing, communication, and engagement will see us through.
It is good to know that in all this mess and harshness, managers are still inspired by good leadership values. The talk at our conference was of wisdom, courage, humanity, kindness, justice, prudence and wonder.
The public are fortunate to have managers on their side, people who can manage the NHS with their heads and with their hearts. Like everyone, managers must be cared for.
Jon Restell is chief executive of Managers in Partnership, a union representing 6,500 UK healthcare managers in the NHS, private and third sector. Guardian Professional.
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