Trust Chief Executives Research Articles

Exploring The Impact of Positive Behaviour Support Plans on Adult Acute Mental Health Staff Practice

IntroductionThere is a national movement to reduce restrictive interventions due to the harm and distress they can cause which has been reflected in NHS trust policies and practices. NHS trust policies state that all in-patients who may require restrictive interventions must have a Positive Behaviour Support Plan (PBSP) based on a functional analysis of what drives and triggers their behaviour. A PBSP is intended to facilitate understanding and help manage behaviours that challenge by teaching new skills and ways to communicate a person’s needs. Previous research on the use of PBSPs on adult acute mental health wards is limited but research on PICU wards has shown PBSPs have not been implemented into mental health care as intended.Objectives Trust policies identify that PBSPs should be implemented to reduce the use of restrictive interventions. However, it is unknown whether PBSPs are being used as part of routine practice on the acute mental health ward. The degree to which staff are aware of patients PBSPs and how they use them to guide their practice is unclear. The service evaluation aims to understand the perspectives, attitudes, and experiences of staff who are responsible for using and implementing PBSPs on the ward. The evaluation aims to investigate how PBSP informs practice and to identify the barriers and facilitators to implementing PBSPs on the ward.MethodsA volunteer sample of clinical staff members (including Doctors, Nurses, Psychotherapists, Occupational Therapists, and Clinical Support Workers) who are responsible for implementing PBSPs on an acute mental health ward in the East of England took part in a focus group which lasted up to an hour. There were four focus groups with between two and four participants per group. A total of thirteen staff members participated in the focus groups. The focus groups lasted up to one hour and were guided by a topic guide. Two members of the project team facilitated the group. Focus groups were audio recorded.ResultsThematic synthesis will be the overarching approach used to synthesise the qualitative data from the focus groups. The audio recordings will be transcribed. Analysis will be conducted on a within-case basis prior to cross-case analysis aimed to identify common themes. Two evaluators will work together to code, analyse, and synthesise the extracted data.ConclusionsBased on the results, training may be developed to improve the understanding and implementation of the PBSPs on the ward. The findings may also result in changes to the way PBSPs are used. The results will be presented to the trust chief executives and used to inform how to best support individuals who may be at risk of requiring restrictive interventions.Disclosure of InterestNone Declared

Value-based surgical care: a view from the surgeon's knife.

NHS trusts across the country are facing unprecedented financial pressures, along with rising levels of demand and widespread variation in surgical quality and cost. There is a moral and financial imperative to provide the most efficient use of resources in order to ensure sustainability of a system that is free at the point of use, and provide consistently high-value care for patients across the country. Delivering 'value' does not mean any reduction in the quality of care - it means achieving the same or higher quality at the same or lower cost. Avoidable and costly incidents in surgery occur every day: patients do not receive the right care, procedures or tests are performed without real benefit, complications lead to prolonged hospital stays, to readmissions and re-interventions. Put simply: poor quality surgical care is expensive. The concept of value-based health care is well known in the UK, yet its principles are not yet fully embedded in the health-care system, surgical training or practice. The shift towards better value-based care with a focus on delivery system reform (Getting It Right First Time), outcomes-based commissioning and payment reform (accountable care systems and integrated care systems) provides an opportunity to make significant improvements in surgical care. Radical and immediate change is required, and everyone, from trainees at the frontline, to clinical leaders, trust chief executives, local commissioners and policy-makers, has vital roles to play. The health-care system needs to be designed, organized and paid for differently to deliver better surgical value for patients.

Supporting positive health outcomes through leisure and culture trusts.

A skilled and competent workforce is imperative to tackling health inequalities. The opportunities for health-based conversations and interventions are increasing due to the breadth of services and multi-disciplinary services being delivered in community assets, available through trusts and social enterprises.Sporta member leisure and culture trusts are all charitable social enterprises based within communities, many operating facilities and services on behalf of local authorities. Sporta (The Sports and Recreation Trusts Association) have partnered with Health Education West Midlands and Public Health England West Midlands to scope out the workforce development needs of Sporta members' 55,000 staff through a pilot skills audit. Many of the trust's workforce are frontline and engage with tens of millions of customers per year. Therefore, the opportunities for Making Every Contact Count (MECC)-based conversations, supportive chats, specialist advice on specific conditions or a welcoming cup of tea are apparent and continual.The pilot skills audit evidenced great commitment from trusts investing in the skills of their workforces, identified the skill gaps of the workforces, affirmed actions already being taken and highlighted tangible impacts. As an overview, the evidence collated from the skills audit identified that the greatest needs for development are within1. The trust's wider workforces (e.g. receptionists, library assistants, casual staff, cafe assistants);2. The trust's strategic leaders (e.g. Chief Executives).The Royal Society of Public Health (RSPH), Health Education England and Public Health England regional workforce leads in the designated pilot areas have been instrumental in supporting development opportunities for the wider workforce. There are three core foci:1. Developing a leisure and culture trust- specific 'Making Every Contact Count' course including a train-the-trainer model;2. Trusts accessing the Health Education England and Public Health England regional 'Masterclass' programmes including, for example, learning focused on specific populations and conditions, data and evaluation;3. Trusts are equally exploring opportunities of becoming RSPH Training Centres to deliver in-house and externally with partners, the RSPH level 1 and 2 courses in particular.To build the skills of the trust's strategic leaders, partnerships are being created with regional Public Health Leadership Academy and Masterclass programmes, which can then utilise the trust's ability to cascade the learning throughout their workforce. Driven by Health Education England and Public Health England regional workforce leads opportunities for joint learning events and workshops between Directors of Public Health and trust Chief Executives will importantly build understanding of and confidence in the trust sector. The outcomes to be derived from these opportunities will lead to ensuring trusts are supporting the delivery of the Public Health Outcomes Framework, cross-organisation partnership building to delivering better health outcomes, understanding and complementing each other's role and strengths and supporting collaboration and innovation in service delivery.As alluded to, trusts are already investing in the skills development of their workforces to fully understand and deliver to the wider determinants of health. For example, within Life Leisure's 'Community Partnerships Plan 2010-2015', they highlighted the ambition to create a highly skilled workforce who would feel confident and capable of working with a range of health needs and abilities. The leisure trust, based in Stockport, has high expectations of their workforce, from Apprentices through to Level 4 specialist instructors. This expectation is matched by the trust investing heavily in their workforce with the ultimate outcome leading togreater capacity to see more referrals from deprived areas whilst still maintaining a financially sustainable offer. …

Go to the top for rapid action.

I started writing to trust chief executives after trying to raise concerns about patient safety with a matron… and getting nowhere.

Perspectives on clinical leadership: a qualitative study exploring the views of senior healthcare leaders in the UK.

Clinicians are being asked to play a major role leading the NHS. While much is written on about clinical leadership, little research in the medical literature has examined perceptions of the term or mapped the perceived attributes required for success. To capture the views of senior UK healthcare leaders regarding their perception of the term `clinical leadership' and the cultural backdrop in which it is being espoused. UK Healthcare sector PARTICIPANTS: Senior UK Healthcare leaders METHODS: Twenty senior healthcare leaders including a former Health Minister, NHS Executives, NHS Strategic Health Authority, PCT and Acute Trust chief executives and medical directors, Medical Deans and other key actors in the UK medical leadership arena were interviewed between 2010 and 2011 using a semi-structured interview technique. Using grounded theory, themes were identified and subsequently analysed in an attempt to answer the broad questions posed. Not applicable for a qualitative research project RESULTS: A number of themes emerged from this qualitative study. First, there was evidence of changing attitudes among doctors, particularly trainees, towards becoming involved in clinical leadership. However, there was unease over the ambiguity of the term 'clinical leadership' and the implications for the future. There was, however, broad agreement as to the perceived attributes and skills required for success in healthcare leadership. Clinical leadership is often perceived to be doctor centric and 'Healthcare Leadership' may be a more inclusive term. An understanding of the historical medico-political context of the leadership debate is required by all healthcare leaders to fully understand the challenges of changing healthcare culture. Whilst the broad attributes deemed essential for success as a healthcare leaders are not new, significant effort and investment, including a physical Healthcare Academy, are required to best utilise and harmonise the breadth of leadership talent in the NHS.

Trainee Update September 2014

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

Revalidation fears for those appraised by chief execs.

Directors of nursing are concerned that they may struggle to meet proposed revalidation requirements drawn up by the Nursing and Midwifery Council if they are appraised by their trust chief executive.

Holding up the mirror: how to use quality assurance, peer review to improve sexual health

The Office for Sexual Health was established in the southwest of England in January 2010 as a Department of Health pilot to bring together all elements of sexual health policy...

Pay Cartel will damage nurse morale and local economies.

Unions have written to the chief executives of trusts in south west England urging them to abandon plans to introduce a 'cartel' to drive down nurses' pay (news August 22).

Elective admissions: the journey for the person with diabetes

Elective admissions: the journey for the person with diabetes

Spinal manipulation for the early management of persistent non-specific low back pain - a critique of the recent NICE guidelines

The recent NICE guidelines for the early management of chronic back pain recommend 'offering a course of manual therapy including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks' (1). Even before the document was published, the President of the 'British Chiropractic Association' wrote to all chief executives of English Primary Care Trusts (2). In this letter, he pointed out that NICE had 'assessed the effectiveness, safety and cost-effectiveness of available treatments' and suggested that a 'wider provision of spinal manipulative therapy services by the NHS could be achieved by contracting with chiropractors currently working within the private sector' (2).

Executive pay is rising – guess who’s footing the bill?

With the credit crunch hard upon us and the news full of failing businesses, G20 protests and all-round financial anxiety, you would think that now would be a good time for everyone to tighten their belts, cancel any exotic holiday plans and put thoughts of a pay rise on the back burner. Well, you’d be wrong. Unfortunately, it seems that one group of public sector employees has forgotten to read the newspapers lately and, uncomfortably for any of us connected to the NHS, we are not talking about fatcat hedge fund managers or Russian billionaires, but the very people in charge of our health services – Trust chief executives.

Health care participants’ dualism: are new sub-species evolving?

Humans are distinctive primates behaviourally, yet are also uncannily like chimpanzees. Both evolved for survival in places such as the forbidding African savannah and are thus good at sustaining themselves through activities such as resource foraging and socio-political navigating.1 Amongst humans, this can be observed in both hunter-gatherer and modern technological habitats. Life can be tough in each setting. To get more resources and succeed politically, many humans strive to move from being one of the troops to a place of power—the classic alpha male or socially predominant female. This is especially noticeable amongst that most interesting of cultural groups, the health reformers, who by definition have climbed up the primate hierarchy to a position of authority. These are ministers for health, heads of health departments or private hospital chains, chief executives of trusts, directorate leaders, and others in senior policy and management ranks. They can be contrasted with the staff who occupy posts with little formal influence. We have come variously to call these ‘workers’, ‘clinicians’ and ‘the shop floor’. It is eerily as if there are two emerging, recently evolved, sub-species. Homo commandus controlus and Homo extremus flexibilitus, while often co-inhabitants of the health environment and externally similar to each other, display contrasting cognitions and behaviours. Exposing and understanding these two sub-species, we argue, is important in determining whether and how the health system works. Early identification of the sub-species in situ will allow participants to understand events and reduce fall out damage to themselves. Personal and sub-group survival is, after all, the name of the game in heavily threatening environments.

Letters

I felt compelled to write in response to Debbie's wonderful editorial (BJM 14(10). The comment made by David Nicholson (Carvel 2006) were music to the ears of Trust Chief Executives to endorse them with the authority to slash maternity services down to the bare bones. In consequence removing choice and quality of care for women and their families. Now where could he have got the idea of centralisation from? Ah yes, perhaps from the powerbase of the NHS, as Debbie rightly alluded to.

Delivering high-quality surgical services for the future

In March 2006 the reconfiguration working party published its initial report Delivering High-quality Surgical Services for the Future. This consultation document looked at the key reform dilemmas in the 'new NHS' and set out some potential future areas of work for the College. It was disseminated widely to surgeons, service planners, Trust, strategic health authority and Primary Care Trust chief executives and patient groups. The consultation closed on 30 June 2006 and the responses are being considered by the working party. This article examines the key features of the consultation responses and looks to the future, at how the College will take the reform agenda forward.

Doing Things with Words: The Case of 'Management' and 'Administration'

Over the last two decades, management, rather than administration, has become the dominant category through which both academics and practitioners talk, write and argue the organization of public services. More recently, the discourses of leadership have also been increasingly deployed in this context. Based on interviews with UK National Health Service trust chief executives, the article examines these particular discursive changes, exploring what the distinctions do rather than what the categories might represent. It reminds us of some of the things we do (in reality and to reality) when we deploy such words, especially in the debate about control. It also suggests possibilities for disturbing the dominance of the terms that are generally axiomatic in constructing arguments about the public sector; a dominance that has come to favour the interests of some as it denies the interests of others.

Wessex Professional Programme: general professional development for SpRs

Context and setting The area of general professionaldevelopment, within the specialist registrar (SpR)curriculum, has been encouraged by Wessex Deaneryand highlighted during the Record of In-TrainingAssessment (RITA) process as an important area forthe ‘new consultant’.We have put together a programme of managementand development sessions, open to all SpRs in Wessex.The Wessex Professional Programme starts with a2.5-day residential course (Monday to Wednesdaymorning), aimed at Year 1 and 2 SpRs. Its contentincludes:• legal and ethical obligations to patients;• risk management and clinical governance;• presentation skills;• personality profiling and working with teams(Myers Briggs);• leadership introduction;• making the most of your appraisal, and• self-directed learning and continuing professionaldevelopment.Each course is open to 24 delegates and runs 4times per year.IntheirlastyeartheSpRsattendPart2ofthecourse,which again consists of a 2.5-day residential course(Wednesday evening to Friday). Its content includes:• working with Primary Care Trusts (PCTs) andstructure of the National Health Service (NHS);• writing a funding bid;• leading patient-focused improvement;• outdoor leadership and teambuilding;• preparing your Curriculum Vitae for consultantapplication;• consultant interviews and the practicalities of anew consultant appointment;• educational supervision and appraising juniorstaff;• ‘What trusts want from their consultants’, facili-tated by trust chief executives, and• acting up as a consultant.Why the idea was necessary The SpR curriculum inWessex does not formally integrate the personalprofessional growth and obligations of a new con-sultant into its programme. It was therefore felt that aprogramme dedicated to general professional sub-jects, accessible by all SpRs, was essential, and themanagement course was redeveloped.What was done The course was restructured. For costeffectiveness and ease of administration, the coursewas redesigned to last 1 whole week. This had positivebenefits for those who wanted to attend both partstogether, better rates were negotiated for the resi-dential part of the course and the directors’ timecould be managed more effectively.The content was reviewed and a questionnaire sentto all Year 1 and 2 SpRs in Wessex asking for theirviews. A 60% return rate from a single postingallowed us to adapt the curriculum.Evaluation of results and impact Each course isevaluated by the delegates and feedback is given toevery facilitator within a week of delivery. Evaluationof relevance ranged from a mean of 64% (for asession that has since been changed) to 99% (100%being outstanding). Freehand comments are noted,fed back to the facilitators unedited, and acted upon.The impact of the course is that we have a 1-yearwaiting list and a constant supply of faculty staff whowant to be involved with the programme.In June 2004, 1 delegate commented: ‘I am pleasantlysurprised that this late in my career I have found anear perfect course.’

The Violence in Trusting Trust Chief Executives: Glimpsing Trust in the U.K. National Health Service

This article contributes to the debate about the utility of the work of Jacques Derrida for qualitative interview research. It consists of a case study in which Derridean ideas are exemplified: a set of interviews with people called Trust Chief Executives—top managers of U.K. National Health Service hospitals. In ways that echo Derrida’s approach to the analysis of Platonic texts, the article repeatedly interrogates the word trust in the interview transcripts. Reading interview texts in a Derridean way brings to attention matters that would have been unseen in a conventional reading of the empirical material. Managers’ talk can be read as a form of violence in that it has come to constitute a version of what can be thought and known, in the most part, by the elision of alternatives. Recognizing the violence of language is therefore one of Derrida’s principal contributions to critique, an insight of particular importance in qualitative research.

Maintaining standards through coordinated follow-up of Quality Assurance (QA) Team visit recommendations

The Commission for Health Improvement report into the West London Breast Screening Service recommended that a formal structure for the follow-up of recommendations made at QA Team visits is implemented. In the West Midlands, breast screening services are visited every 3 years as part of a rolling programme. Following a QA Team visit, a service can expect 3-month and longer term recommendations, and on rare occasions immediate recommendations concerning areas that require improvement. Written conformation of immediate and 3-month recommendation is issued to the service within 1 week of the visit. Longer term recommendations are included in the written QA Team visit report, which is issued within 4 weeks of the QA Team visit. A detailed process has been put in place that tracks the receipt of recommendations within the required timescales, highlights nonresponses and distributes the recommendations to the relevant QA Team members for classification and further instruction. One-year post visit, all recommendations must be completed to the satisfaction of the visiting QA Team. At this point a formal document is compiled that details the recommendations and responses from the breast screening service. This document is then sent to the host trust chief executive, director of breast screening and lead primary care trust coordinator to sign, indicating that the resulting actions have been incorporated fully into the service's policies and procedures. In the event of noncompliance, separate reporting mechanisms have been introduced.

The roles and responsibilities of primary care trusts in emergency planning: a report of a major incident in Sunderland, UK

‘Shifting the balance of power: the next steps’ of February 2002 stated that PCTs would become responsible for the majority of previous Health Authority functions, including emergency planning. Chief Executives of primary care trusts (PCTs) were asked to ensure that the PCT had appropriate major incident plans and to ensure that there are mechanisms to mobilise primary care and community resources in response to a major incident. Sunderland had recently reviewed and updated an emergency response plan which it had to implement at short notice when a large WW II bomb was unearthed in the grounds of a health centre. This had a serious impact on the delivery of primary care services and the lessons learned form the basis of this report. Guidance to primary care trusts (PCTs) on emergency planning was updated by the NHS Executive in 2001 as part of the Controls Assurance Programme. The standard was as follows: ‘The organisation has planned and prepared an organised and practised response to all major incidents and emergency situations which affect the provision of normal services’. The standard mirrored the key requirements of previous NHS planning guidance. PCTs were asked to consider a range of scenarios including contingency planning, disaster planning and business continuity issues. Contingency planning involves PCT services being affected by flood or fire which result in the continuity of services being compromised. Disaster planning considers the role of the PCT within major incident planning across all of the local health community. Business continuity examines the organisational response to emergencies or to the activities of individuals or groups which may affect the stability of the PCT.