Leaders of aspiring FTs receive confidential help to improve
More than 20 hospital trust boards have signed up to a leadership training programme which they hope will help them make efficiency savings and achieve foundation status, HSJ has learned.
The NHS Leadership Academy is also providing support to 10 foundation trusts which have admitted their board members need help.
The programme offers development and support to boards on a confidential basis, so their names are not being made public.
So far six trusts have successfully completed the process, 15 are having their problems assessed and tackled while another 12 are in talks about receiving help in future.
The trusts are first visited by three senior staff from the Leadership Academy: Its foundation trust support programme project director Chris Gordon, former NHS Top Leaders Programme quality, innovation productivity and prevention lead David Thomas and former King’s Fund head of leadership Liz Thiebe.
They draw up detailed statements about each trusts’ problems then associates are sent to help resolve them. The NHS trusts receive a “significant discount” on a contract with one of four private consultant firms who have been procured by the academy to offer support. They are KPMG, PricewaterhouseCoopers, The Hay Group and GE Healthcare.
Dr Gordon said trusts using the programme ranged from very troubled to those that had nearly achieved foundation status.
He said: “Some are pretty recognisably in trouble. There are a cohort who are close to the finishing line, there are a few trusts who are having an enormous amount of attention addressed to them. Then there is a big chunk in the middle where our main focus is.”
Dr Gordon said it was important the programme was not seen as a “diagnostic tool” to assess trusts.
He told HSJ: “Trusts will tell you that they are diagnosed to within an inch of their lives. The vast majority recognise the nature of the challenge and are looking for something different, which they need to do to get to where they need to be [to be authorised].”
Dr Gordon said the most common major problems for trusts were securing clinical leadership, achieving strategic goals, and board development.
He said many senior leaders did not find time to address leadership issues. He said: “It is very difficult for people who are in a tight situation in trusts where money is tight and they are under a lot of pressure.”
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Readers' comments (15)
Anonymous | 7-Aug-2012 7:36 am
Does this say that the leaders of the FTs are working above their grades and should be replaced ? VSM pay and they can't perform ! In other worlds this would be P45 time, but not the NHS
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Anonymous | 7-Aug-2012 9:18 am
Anonymous | 7-Aug-2012 7:36 am
I am no fan of VSM and high pay but get real. In other worlds they would be payed a lot more for running organisations that big and that complex.
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Kenneth Lownds | 7-Aug-2012 1:30 pm
If they can't lead by now they never will. More easy money for the usual suspects. As quoted Dr Gordon simply has no idea - "many senior leaders did not find time to address leadership issues"; so they are not leaders. In the real world they would not have risen above their level of competence but would have been given the distance test long before! Paid a lot more ANONYMOUS 9:18 AM, just how much are you prepared to squander for poor performance?
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Anonymous | 7-Aug-2012 1:34 pm
I find the ton of some of the previous comments difficult to understand.
Surely a recognition that some help is required is a good thing as opposed to going on and on without this. Having moved from the priovate sector to the NHS there are slso things that are easier to resolve in the Private sector that are less so in the NHS without a system change.
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Anonymous | 7-Aug-2012 2:38 pm
anumber of trusts in difficulty have already been "helped" by big consultancy firms !!!
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Kenneth Lownds | 7-Aug-2012 5:20 pm
Come on 1:34 - you understand. How long have these people been going "on and on"? What have the NEDs been doing at these places? No doubt executive coaches in abundance as well. Interesting comment from 2:38. System change ? You betcha, but who should be driving that? If you're in a leadership role isn't all of it leadership? When are you doing other things? CYB?
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Anonymous | 7-Aug-2012 8:54 pm
One of the main issues, in my experience, is that everyone wants a quick fix for things, but don't always want the right fix.
The problems faced are not new and not rocket science. The current economic climate increases pressure and many organisations are taking the easy route by eradicating posts or downgrading them, then wondering why there is no cohesion within their organisations to work together to solve problems. They also then wonder why there is a divide between the senior managers and the rest of the workforce.
Leadership in the NHS happens every day, but mostly under immense pressure leading to mostly knee-jerk decisions that don't use well proven leadership techniques because these require true engagement and that takes time and may not produce the answers those pulling our strings want to hear.
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David Hooper | 8-Aug-2012 7:41 am
I find it hard to believe the crass stupidity of the "management basher" contributors. I imagine some are medics who should know about whole systems and the utter simplicity of failing to understand that struggling trusts (e.g. Several in London) are not about poor management but the drive to maintain too many hospitals and hospital beds open thus leading to an inefficient allocation of resources. Try and rise above your second class intellectual analyses before you vent your spleens on more management bashing.
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Glen Burley | 8-Aug-2012 8:01 am
It is a shame to see the views expressed here that all leaders should be the finished article. Such a stance shows little understanding of leadership or of the need to adapt to the ever changing environment that we operate in. Watching the Olmpics should emphasise the fact that even the greatest athletes need coaches.
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Anonymous | 8-Aug-2012 1:04 pm
I would be interested to know who Kenneth Lowndes thinks should be doing this job. I presume he has applied for some of these post given their extreme simplicity and huge salaries.
Our local Trust, which is in the middle of the pack described above, appointed a new Chief Exec a couple of years ago. They already taken a smaller trust to foundation status but this Trust has proved more of a challange with more entrenched financial, demographic and cultural issues. I have no idea if they have taken up the offer of support. From what I know of the person they will use it if it helps.
So Mr Lowndes, Who would you appoint as their replacement and what salary would you offer to attract them?
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Anonymous | 8-Aug-2012 3:03 pm
'confidential help to improve' - methinks this means 20 mins in the broom cupboard and a [padded] baseball bat.............
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Anonymous | 8-Aug-2012 4:10 pm
Some sympathy for David Hooper's irritation: as a medic and former clinical director, I know medics can be a difficult bunch. Just answer me this David [and all the other 'bashed' managers]: why do acute Trust boards consist almost exclusively of managers and non-execs? And have done for years and years and years. Please do not tell me the medical director and his/her deputy are enough. Why the near total exclusion of the most important clinical leadership class? No large healthcare institution in the US would be run [at board level] with so little senior clinical, experienced input [maybe no longer clinically active, but with the background nonetheless]. Why do Trust websites assiduously list the members of the Board and their biographies, but many, many do not even tell you the NAMES, let alone the briefest of bios of their top clinicians. They might as well not exist. Sorry David, but this long, deep historical, petty and deliberate snub reaps what it sows. It was deliberate to keep pesky, uppity clinicians from rocking the boat. Because NHS 'leadership' has for years and years and years consisted of one management class bullying the one below it form the DH all the way down. Dissent is not permitted. Nothing and I mean nothing, will change until a Trust's most senior clinicians are welcomed in greater numbers at Board level. And they must be elected by their peers to serve limited terms without ANY interference or they will be seen as, therefore be as effective as, stooges. Mid- Staffs could never have happened if enough senior clinicians sat on the Board. Or at least it would have been stopped a lot earlier.
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Anonymous | 8-Aug-2012 4:41 pm
BTW, I do partly agree with David Hooper's assessment of the situation in London i.e. too many hospitals, inefficient allocation of resources etc. Not sure about the total number of beds, but I digress........
What I do KNOW, not just think, is that any re-organisation that is not driven, to the finest devil in the detail, by senior clinical input will fail. The senior clinical input must be sought on the basis that it is genuinely valued, and treated accordingly. Naturally, not everyone [including groups of patients] can have their way, and there will be controversy or dissent. It will be difficult. But if it is done like so many 'consultations' in the past, it will be a mess. The message, once again, is that we have to wean the NHS off it's diet of systematic, top-down, dictation and bullying. So far with the HSC Bills 'reforms', it is not looking good. The NHS is sooo good at taking outwardly noble intentions or ideas [like 'Patient Choice' or CARE -w.r.t pensions - or clinical involvement] and thoroughly perverting them.
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Anonymous | 9-Aug-2012 2:48 pm
My own background is in PCT governance rather than acute trust governance, but I'm sure some parallels can be drawn, even if there are also some different tensions between professional groups.
If you go back to the original PCT establishment orders, which are statutory instruments, you will see these very specifically set out the number and role of executive and clinical Board members: generally this breaks down to chief executive, director of finance, director of public health, PEC [professional executive committee] chair, PEC nurse, plus one other PEC member to be nominated by the PEC and confirmed by the Board. The number of non-executive Board members is expected to at least equal if not surpass the combined number of executive and clinical members in order to prevent employed staff from forming a majority on the Board.
I would assume acutes have a similar structure imposed on them (if anyone out there is an expert in acute trust governance structures please do correct me), in which case it's not within an individual trust's gift to change this but dependent on the DH and possibly even requiring new secondary legislation. Not to mention that if the same philosophy as for the old (pre clustering) PCT structures holds true, any increase in clinician numbers at Board level would presumably have to be at least matched by an increase in non-executive director numbers too?
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Mark Newbold | 13-Aug-2012 6:17 pm
If Boards/CEOs find this initiative helpful then it is to be welcomed.
It isn't possible to sort the problems in most chronically struggling acute Trusts by only looking inwards. Entrenched failure on 4 hrs, 18 weeks, or finance is likely to be related in large part to health economy-wide issues. After all, there is no shortage of help and advice and any 'quick fix' solutions for hospitals will have been tried, often tried many times.
Both the causes, and the solutions, are systemwide, and needs leadership that recognises and addresses this. That is a challenge for some leaders, but also one for the regulatory system, because pressure to achieve targets 'today' will drive CEOs to look for quick-fix solutions. And these, as we can clearly see, simply perpetuate the problems.
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