Recommendations for the National Health Service Chief Executive - Term Paper Example

Report for the NHS Chief Executive Introduction The pattern of social policy-making since 1997, in terms of both the order in which policy areas weretackled and the nature of the policies that were chosen, reflects the core ideas. Many Labour supporters assumed that the new government would begin by pumping money into public services, particularly the NHS. However, most of Labour's first term was dominated by tax-benefit reform. After the introduction of a minimum wage, Labour sought to implement its welfare-to-work strategy via a series of 'New Deals' and its policy to 'make work pay'. The Working Families Tax Credit (WFTC), together with the introduction of a minimum wage, was the centrepiece of Labour's policies to 'make work pay'. In 2003 the system of tax credits for children and for adults was overhauled and extended, such that the meaning of means-testing has been substantially changed. The NHS Plan, published in 2000, finally produced a major cash injection for the service, the results of which did not begin to be felt until the end of 2001. Only after acting to redraw the work-welfare relationship to embody the ideas of opportunity and responsibility via the new instruments of the New Deals and tax credits did New Labour begin to justify vastly increased expenditure on health and education as necessary investments in human capital. It is also crucial to note that Labour Party leaders expressed caution about how much the state could actually do to achieve these ideas at the heart of its policy goals. In a speech on 'modernising central government' in 1998, Tony Blair said: 'Big government is dead. The days of tax and spend are gone. (www.new.bbc.co.uk) Concepts/theoretical frameworks on managing strategic change When people come together in groups, communities, cities or nations, levels of confusion and anxiety rise. Attempts are made to manage this anxiety by creating structure, rules and legislation. Organizations can be viewed as mini societies in which changes are driven or resisted in accordance with the beliefs that are deeply held by the members of that society. The beliefs may not be articulated explicitly. They may be conveyed symbolically, through such things as stories, myths, rituals and ceremonies. (Klein, 2003) Force field analysis was developed by Kurt Lewin. Force field analysis enables managers to identify the forces that are likely to restrain a particular change. Force field analysis is sometimes used with groups in order to structure an open discussion about what is blocking a change. Having identified the potential sources and levels of resistance, Lewin suggested that managers should act so as to reduce the restraining forces, rather than to intensify the forces driving the change. Lewin, like Newton, argued that to every action there was an equal and opposite reaction. Increasing the forces for change increases the forces resisting it. Overcoming resistance was characterized by Russell-Jones as a movement from defiance, through compliance to alliance. Central to the effectiveness of any approach to man-aging resistance is the quality of the relationships that managers develop with people in the organization. We look at conversational approaches to developing closer relationships with people. (Johnson & Scholes, 1999) Practical Force field analysis. Unfreeze current attitudes According to BBC report Mr Nicholson, who has worked in the NHS for 29 years, said some of the changes would be aimed at reducing the NHS deficit, which topped '500 million. But he added it was also about improving services by providing the best care in fewer centres, although he acknowledged this would mean patients travelling further for treatment. Undoubtedly there will be tough decisions to make over the next 12 months to reflect changing services. (www.new.bbc.co.uk) Move to a new level According to BBC report the NHS chief executive further said that there would be up to 60 reviews of hospitals in England. He said the changes could affect every region, and may lead to emergency, maternity and paediatric care being centralised in fewer hospitals. BBC further reports that the PFI scheme was a fast way to get a big hospital built, but a huge distraction for key people. The chief executive, finance director and chairman were always in London. According to BBC report the blame is laid squarely on the shoulders of management, saying "ineffective and inadequate" leadership had caused the problems in the worst cases. (www.new.bbc.co.uk) Refreeze new attitudes The management is interested in changing the system for betterment of people and also for making it efficient financially. But they are unable to convince the people that changes are useful. Common man and politician are working as restrainers, they don't want that service go a little farther from their homes, they don't like to travel for getting medical attention. They want everything at their door step. The leadership of NHS is also playing role of restrainers, they can not make effective changes in their management hierarchy to facilitate the change. Political will of Labour Party leadership is playing the role of driver they want to bring a change for good. The boards of NHS Trusts were advised to include managers from the commercial sector. David Lewis, the Director of Prison Services, was recruited from a media business. As outsiders, managers from the private sector were thought less likely to preserve the status quo. Traditionally, public service progression had been via 'upgrading' or 'enhancement'. This required day release or secondment for training. Decisions about who was given training opportunities, 'upgradings' and 'enhancement' were often based on seniority and 'face-fitting' criteria. This encouraged the advancement of those who identified strongly with the existing culture. (Klein, 2003) Stakeholder analysis Covers hard and soft aspects According to BBC report several trusts in London, Surrey, Sussex, Cornwall and Lancashire which were considering down-scaling or even closing major hospitals. MPs are known to be touchy about the prospect centralizing services even if they support the policy on a national level because of the public's affection for their local hospitals. "Communities facing hospitals closures will be asking why these 'reconfigurations' are being made at a time of severe cost-cutting." BBC reports that NHS staff and opposition parties have been having none of it, pointing the finger of blame at reforms and bumper pay rises respectively. (www.new.bbc.co.uk) According to BBC report Liberal Democrat health spokesman Steve Webb said: "It is vital that any changes to the delivery of health services are driven by clinical priorities, not financial crises." The public is entitled to be sceptical when big changes to local hospitals happen at a time of financial pressure but are presented as being solely about patient care. (www.new.bbc.co.uk) Politicians are playing the role of restrainers as well they can not go against the will of their voters. They want to make their voters happy for future electoral prospects. Although everybody feels that change is inevitable but they are unable sell it successfully to the common people. Cultural web suggestion To think of culture as a web is to think metaphorically. Organizational metaphors help to develop a cultural web of an organization is resilient whichever way the managerial wind blows. That is what makes the cultural web so hard to change. All strands of the web must change. Those strands concerned with authority, control and structure. Trying to change things by reorganizing the structure is as old as the Roman Empire, which rose only to fall again. Forces for change BBC reports that as managers' body the NHS Confederation points out, the Audit Commission was just looking at 25 of the 556 trusts in England. Last year, nearly a third of NHS organisations failed to balance the books and, while it is clear bad managers will be working in the NHS, can they be on the payroll of well over 150' John Appleby, chief economist of the King's Fund health think-tank, believes the Audit Commission has taken an overly simplistic approach. The report further says "This is the conundrum of the NHS deficits problem. Is it bad management that has caused deficits to spiral in certain trusts or have the financial problems been the straw that broke the camel's back' "The answer is both. In some trusts you will find bad management and that is what the Audit Commission has found, but in others no amount of good management may have been able to save the day. (www.new.bbc.co.uk) According to BBC reports, speaking to an audience of NHS managers and doctors, Mr Blair said service improvements in NHS hospitals were being implemented to ensure the very sick have speedy access to specialist care but also to treat people more conveniently closer to home. Mr. Blair further said that no, change was not an option. The key was to shape change to ensure a vibrant future for the NHS. (www.new.bbc.co.uk) Forces against change According to BBC reports Professor Christopher Marks cancer surgeon complains that they set out a pyramid structure whereby super regional hospitals and specialist centres would provide the most complex care, while the second tier includes local hospitals with minor injury units - a scaled down version of A&E - walk-in centres and specialist GP services. According to BBC reports Professor Boyle, the national director for coronary heart disease, told the BBC: "The message is quite a simple one. Modern medicine moves on, the new technologies need to be made available to everybody, they do require more specialised care, and they require more specialised investigation. He said: "The NHS and government should be able to demonstrate how changes will improve care and local people should hold the NHS to account, but they need to understand that preserving the local hospital will not always be in their best interest if something life-threatening happens." (www.new.bbc.co.uk) According to BBC reports, Professor Christopher Marks, cancer surgeon and chairman of the independent campaign to save the Royal Surrey Hospital in Guildford, said: "What local people want is access to excellent care which they can get to easily." He accepted that some complicated cases must go to specialist centres, but warned centralisation of services in Surrey would see a doubling of minimum ambulance times, which could compromise care. He further said "Thanks to the money that the government has put in, particularly to A&E, the service has improved marvellously, and it is a pity to throw the baby out with the bath water when you have spent all this money." (www.new.bbc.co.uk) According to BBC reports the benefits of the '6.8bn upgrade of the NHS IT system risk being overlooked amid the criticisms, experts say. The 10-year IT programmes is aimed at linking more than 30,000 GPs in England to nearly 300 hospitals by 2014 and includes electronic medical records. Report further says that critics have raised concerns over patient confidentiality and delays, which could cause costs to spiral. GPs have raised concerns about patient confidentiality - medical records will be able to be accessed across the country although safeguards restricting access depending on a person's position are being built in. According to a report on Department of Health website, the relationship with the independent sector is changing as the Department of Health looks for new ways of working with private and voluntary organisations to help create more choice and encourage innovation in the NHS. The Department set up the Commercial Directorate in June 2003 to work closely with ministers, other DH officials and the NHS to gain the best value for money in areas of expenditure and to provide a core interface for negotiations with the independent sector. (www.dh.gov.uk) Attempts that had been made to shift the culture of the UK NHS from a role culture to a task culture had failed. The NHS did not know whether it was supposed to be preventative, palliative or holistic. The service, she said, was made up of different 'tribes', including midwives, nurses, doctors and other professional groups. The 'tribes' had different beliefs about what constituted effective healthcare and valued different things in their relationships with their clients. What was needed was clear signalling of the intended direction of the cultural change. Personnel management has great potential for influencing organizational culture. It can legitimately invent new rites and rituals. It controls rites of initiation, such as induction, and rites of degradation, such as disciplinary procedures. Performance appraisal and upgrading schemes can involve rites of passage. The training function can be used to promote the value of learning. (Klein, 2003) It was hoped that importing leaders from the private sector might help to dismantle the resulting alliances. The hoped-for benefits failed to materialize. It can be suggested that any chance of a shared sense of vision between managers and staff was undermined by recruiting leaders from the private sector. Recommendations After undertaking web research one can find the following recommendations for the future of NHS The management should ensure commercial and procurement excellence across the DH and the NHS promote the adoption of best commercial practices where and when they significantly improve the effectiveness and efficiency of the NHS facilitate the adoption and integration of commercial innovations to improve quality of care and exploit commercial opportunities resulting from innovations within the NHS The management should develop and manage links with the independent sector provide sound commercial input to assist departmental strategic reviews and policy decisions. The management should introduce additional capacity and choice through the provision of elective and diagnostic services The management should evolve Supply Chain Excellence Programme (SCEP) - restructure the NHS supply chain to deliver greater efficiencies and improve the effectiveness of supply management to achieve annualised savings The management should encourage NHS staff to produce commercially viable and lucrative innovations for the benefit of the patient, the trust and the inventor. Conclusion It would be fair to acknowledge that many companies now adopt a more open approach to the management of change. Consultation involving surveys or questionnaires of all the staff is more common now than in the days of the previous account, in which the driver for change often appeared to be the CEO alone. In this case, too, the chief executive went round to listen rather than tell and sell. (It is explained here) Perhaps his long experience in the health service made for greater empathy and understanding than newly imposed managers from outside the business. (Klein, 2003) We might comment on a perception from HR that planning and training can improve leadership. Leadership may well be dependent on the perceptions of those who are led as much as it is on trained leadership behaviours. Interestingly, the results of the second survey serve to reinforce a belief in the HR manager that improvement has been achieved. However, how attitudinal surveys can be accurately benchmarked is assumed here rather than explained. An effective change team will be made up of a variety of individuals. First, it is important to ensure that all leaders are either part of the change team or are seen to support the team. Second, individuals who control necessary resources should also be part of the team. Third, it may be necessary to include individuals who represent the organisation's main political groups. Fourth, it is important that the team includes a spokesperson from the departments or staff groups that will primarily be affected by the proposed change. Finally, it is essential that senior management is seen to be supporting the change and should therefore be part of the team. The size of the change team needs to be appropriate for the tasks that are required to be completed and in some cases, members of the team may change depending on the stage that the change is going through. In addition, members may have more than one role; for example, senior managers may also control the resources. It is important, however, that one or two individuals remain part of the team for the duration of the development and implementation of the change. However, with 'partnership' as the new defining characteristic of the mixed economy of welfare, the hope has been to invigorate rather than to attack the public services. Partnership was defined in the New Labour government's first major White Paper on the National Health Service (NHS): In paving the way for the new NHS the Government is committed to building on what has worked but discarding what has failed. There will be no return to the old centralised command and control systems of the 1970s. That approach stifled innovation and put the needs of institutions ahead of the needs of patients. But nor will there be a continuation of the divisive internal market system of the 1990s. That approach which was intended to make the NHS more efficient ended up fragmenting decision making and distorting incentives to such an extent that unfairness and bureaucracy became its defining feature. Instead there will be a 'third way' of running the NHS-a system based on partnership and driven by performance. It will go with the grain of recent efforts by NHS staff to overcome References Cox, R. (2001). 'The Social Construction of an Imperative: Why Welfare Reform Happened in Denmark and The Netherlands but not in Germany', World Politics, 53: 463-98. Deacon, A. (2002). Perspectives on Welfare: Ideas, Ideologies and Policy. Buckingham: Open University Press. Heffernan, R. (2001). New Labour and Thatcherism: Political Change in Britain. Basingstoke: Macmillan. Johnson, G., & Scholes, K. 1999. Exploring corporate strategy. London: Prentice-Hall Europe. Klein, R. (2003). 'Governance for NHS Foundation Trusts', British Medical Journal, 326: 174-5. Leibfried, S. and Pierson, P. (2000). 'Social Policy', in H. Wallace and W. Wallace (eds.), Policy- making in the European Union. Oxford: Oxford University Press. Lewin, K. (1951) Force Field Analysis. Harper & Row. Mohan, J. (2003). Reconciling Equity and Choice' Foundation Hospitals and the Future of the NHS. London: Catalyst. Pollock, A. and Price, D. (2003). 'The BetterCare Judgment-A Challenge to Health Care', British Medical Journal, 326: 236-7. News British Broadcasting Corporation 2003. [internet]. Available from : http://news.bbc.co.uk/1/hi/health/5341242.stm [cited 26 March 2007]. News British Broadcasting Corporation 2003. [internet]. Available from : http://news.bbc.co.uk/1/hi/health/5166028.stm [cited 26 March 2007]. News British Broadcasting Corporation 2007. [internet]. Available from : http://news.bbc.co.uk/1/hi/health/6207278.stm [cited 26 March 2007]. News British Broadcasting Corporation 2003. [internet]. Available from : http://news.bbc.co.uk/1/hi/health/6354219.stm [cited 26 March 2007]. Department of Health UK 2007 [internet]. Available from : http://www.dh.gov.uk/en/Aboutus/HowDHworks/DH_4135425 [cited 26 March 2007] Read More