Two years after its birth, the association representing NHS managers has made admirable strides but it still has a long way to go as it tries to boost their poor public image. By Helen Mooney

When politicians and pundits grumble that there are more managers than beds in the NHS, managers may be tempted to shrug their shoulders and get on with the job of providing the best health service they can. But in a world where the average tenure of an NHS chief executive is 24 months, managers need someone to challenge ill-informed public comments and put their side of the story.

So it seems fortunate that for the past two years NHS managers have had a representative united voice in Managers in Partnership. MiP is the product of an unlikely pact between Unison, the biggest public services union with 1.3 million members, and the FDA (formerly the First Division Association), the union for senior public services professionals, which is approximately 100 times smaller. Both had been unsuccessfully trying to recruit NHS managers for years. The FDA lacked the resources to service up to 50,000 NHS managers across the UK, especially as NHS managers need high levels of help from union officials. There were also problems with managers being in the same union as their bosses in Whitehall. Meanwhile, Unison found managers reluctant to join a union to which many of their staff already belonged. But both also shared a conviction that tens of thousands of NHS managers did want a union.

Negotiations between the FDA and Unison took five years before MiP finally came into being. Technically members are part of Unison and the FDA, with voting rights and access to union services. However, because MiP is treated as a separate section, its members are not bound by the policies of their 'parent' unions.

Unison's assistant general secretary Bob Abberley was to all intents and purposes MiP's founder. He says that this kind of union joint venture had not been tried before - and was inspired by a flight he took on British Airways. 'I realised lots of airlines were linking up with British Airways in different kinds of ways and I thought this was a model that would work for unions,' he explains.

Playing catch-up

For many, the organisation could not come soon enough. Just a month after its launch in June 2005 the government published its by now notorious document, Commissioning a Patient-led NHS, which left managers reeling. Primary care trusts once again had to face the upheaval of yet another reconfiguration - with many managers' jobs on the line.

Indeed, some felt that MiP had arrived too late. But MiP chief executive Jon Restell worked hard to defend both managers and MiP. 'We may be playing catch-up and trying to lessen the pain,' he admitted at the time on the back of the proposals for reconfiguration, but he saw an important opportunity to tie up with Unison on the HR framework following the changes and in turn helped to lessen the impact and give management the reassurance they needed.

MiP started with 4,000 members, three-quarters inherited from Unison, the rest from the FDA's health section. The organisation works on the assumption that about a quarter of all members will call on MiP for help in any one year - a very high proportion for a union, at least partly because need has not been met before. MiP now has about 5,500 members and is growing rapidly. Earlier this year it also changed its membership rules to allow NHS graduate management trainees. Until last summer managers could only join MiP if they were paid above£35,200 (Agenda for Change pay band 8 or above) or a basic salary of£35,000 upwards if Agenda for Change did not apply.

MiP's aim is to have, as Mr Restell says, not just every NHS manager as a member but every healthcare manager. 'There is no reason we should not try to secure membership in all sectors. We are looking at potentially a large number of members.'

Ultimately over a five-year period the organisation hopes to gain 10,000 members - or a third to a half of the healthcare management community.

The impact of financial deficits and drive to achieve financial balance, coupled with renewed emphasis on local control and community politics in the NHS, has helped to drive the surge in numbers joining MiP. Although Mr Restell admits that the latest NHS reorganisation did 'apply the brakes' to recruitment, he feels that MiP now has the critical mass to have a mandate to represent the voice of NHS managers. He also confirms that MiP has the capacity to represent its members individually if needed.

When it launched, MiP had six national offices representing members in regions across the UK; this has now risen to seven following the recent appointment of a new national officer to cover Yorkshire, the Humber and the North East. It claims to be the fastest-growing trade union-style organisation in England, if not in Europe.

It is a separate entity with its own staff and independent TUC affiliation. It has a national committee but no traditional branch or committee structure.

Mr Restell himself, however, has a long trade union pedigree, having worked for the four years before MiP as a national organiser for the Association of Teachers and Lecturers and before that as national officer for the NHS managers' section of the FDA.

In future the MiP does not foresee collective bargaining along the lines of Unison and it is not aiming to set up local branches. What it wants to set up is a forum for members and local networks where members can share advice, best practice and, importantly, meet one another.

Unfair blame

Members can already access the MiP Knowledge Exchange, an online network where they can meet and discuss issues. This, it is hoped, will become an online community that allows members to interact with a community of other managers to solve problems.

As Mr Restell points out, NHS managers cannot be recruited in traditional union ways, as there are no branches. 'We have to reach members via surveys, online, in the virtual arena, as well as phoning them up and going to meet them at conferences.'

He hopes that forming local networks and having MiP national officers to provide professional advice will sift out some cases before they develop into serious issues. 'A lot of our case work is about mopping up things that could have been avoided,' says Mr Restell.

He says that the need for MiP has grown as NHS boards increasingly seek to blame someone when things go wrong. 'When things go wrong it is expedient to say it was a management failure and there is very little between you and the door. Due process evaporates the further up the NHS you go. It has become normal [for managers] to accept that pressure and concentrate on getting as good [leaving] terms as possible rather than saying: "I'm not responsible for this and I'm going to stand my ground."

'A lot of our members get into trouble because non-execs panic in the face of press stories and indeed pressure from the wider community,' he admits.

He points out that managers can unfairly take the blame for problems caused by central government. 'In the government it seems there is a feeling that managers should shoulder the responsibility for the financial implications of its policies - things such as the new contracts for GPs and consultants and shifting the working patterns of junior doctors, over which local managers have no control.'

MiP is also keen to be seen for its positive approach to issues such as encouraging better management and leadership. And, although MiP is unlikely to come out and openly oppose government policy, the organisation can and does raise concerns.

Mr Restell admits that one of MiP's main jobs is to improve the image of managers. The traditional tactic of emphasising the low numbers of managers in the health service is, he says, a defensive position that shows a lack of confidence in good management.

The association aims to provide real-life examples of managers and clinicians working together positively to show that managers and good relationships are an integral part of good health service provision.

There is no that doubt robust talking up of healthcare management is long overdue. According to a survey commissioned for MiP's launch, 85 per cent of NHS managers felt that politicians, the media and the public lack a reasonable grasp of what their jobs involve.

The NHS Confederation and NHS Employers, which represent managers at an organisational level, are complimentary about what MiP has managed to achieve since its conception. Deputy director of NHS Employers Siän Thomas says managers are 'very lucky' to have a representative body like MiP which has a good profile.

'It has its foot in the door with most organisations, the DoH and representative bodies, and I think it has been networking and partnering in a mature way.'

She says there was a definite need for MiP as managers needed a 'unique' voice to speak up for them. MiP must be sure to stick to its core focus of representing individual managers and suggests that it develop 'link' managers in every healthcare organisation.

NHS Confederation policy director Nigel Edwards agrees. 'MiP have gained an important position, they are an important stakeholder and a partner with us on key issues,' he says.

MiP has also done well to attract its fair share of high-profile managers to help boost its reputation. Former acting NHS chief executive and current NHS South West chief executive Sir Ian Carruthers is a member and University College London Hospitals foundation trust workforce director and former Department of Health deputy director of human resources David Amos chairs the organisation. It is also known to have the ear of NHS chief executive David Nicholson.

The future

Mr Amos says that the existence of MiP is 'massively useful' in that it provides support and protection for individual managers.

He adds that, although MiP is not a traditional-style trade union, it is insofar as it represents and advises members, although he admits that the organisation does need to become 'more democratic'.

'Although we have a national committee at present, those sitting on it have not been elected.That needs to change; we need to have an elected national committee,' says Mr Amos.

He echoes Mr Restell's vision for the organisation, saying that it does not want to set up lots of local committees but rather harness the membership in new ways which centre on networking.

So what does the future hold for the organisation? It wants to expand and ensure that, as Mr Amos says, the 'thousands of potential members become actual members'. It also wants to build up a positive image and reputation for managers, while representing them on a case-by-case basis. As Mr Restell concludes: 'NHS managers are not liked. We have got to restore the reputation of a manager and the positive role they have to play.'

Managers in Partnership: who are the members?

  • 61 per cent of members earn less than£60,000.

  • The Midlands has the biggest concentration of members with 17 per cent of members based there. The second largest membership by region are London and the North West, which have 15 per cent of members each.

  • 35 per cent of members work in hospital trusts and 30 per cent in PCTs.

  • Men and women are almost equally represented, with 52 per cent male.

  • 46 per cent of MiP members are aged between 40 and 50, with 39 per cent falling into the 50-60 age bracket.

  • Almost half of the members are at board level; 53 per cent are senior managers, 40 per cent are directors and 7 per cent are chief executives.

MiP chief executive Jon Restell joins HSJ as a columnist from November.