hsj event HSJ 's Management Challenge offers a chance to prepare for the demands of a patient-focused NHS, explains Lyn Whitfield

Published: 02/05/2002, Volume II2, No. 5803 Page 18

Permanent revolution has become the normal state for the NHS. Almost any year in the last decade could be described as one of unprecedented change.

Yet this year still feels different.

On 1 April, there were structural upheavals at every level of the service - something never tried, even during the internal market reforms. And the Wanless report and the Budget have laid out the challenge to provide a userfocused service in starker terms than ever before.

So it is not surprising that managers are using the HSJ Management Challenge as a crash course in team building and a 'safe'way to explore the new agenda.

When the challenge was created four years ago, the aim was to provide training for a neglected group - managers at just below board level. This remains its primary focus, but talking to last year's winners suggests it is as much valued for its wider impact.

David Balderston, who took the challenge last year as part of a South East Birmingham primary care group team, says: 'We were a new PCG.We had only been together for four months, and we had all had our jobs to do, so a day out getting to know each other was very useful.'

The PCG has now merged with another PCG and a community trust to form the South Birmingham primary care trust.

Mr Balderston says: 'This year it would be useful for the new PCTs to take part.A lot of these things are very artificial, but [the challenge] was realistic and I think they would get a lot out of it.'

The challenge lasts a day, with teams playing out a role within a local health economy. The scenario is written by Birmingham University's health services management centre and senior NHS managers act as assessors.

This year, participants will find themselves in Middlechester, an urban area with an established acute trust, a new strategic health authority, two new PCTs and a major social services department.

HSMC fellow Jeanne Hardacre says the five organisations will have to work together to modernise services, tackle access problems and make best use of national initiatives. 'The teams will also be jointly accountable to the director of social services, ' she adds. 'They will all need to sing from the same hymn sheet, as well as deal with their own service issues.' Team members do not necessarily play the role they have in 'real life'. Indeed, many get more out of seeing their working lives from another angle.

Mr Balderston says: 'We were playing a hospital trust.Halfway through, there was a Commission for Health Improvement investigation - it was interesting to see their pressures.'

Andrew Singfield entered last year as part of a district audit team. 'For us as an organisation it was good to get in there and do the job instead of being auditors of it, ' he says. 'It gave us a chance to put into practice our theory of how organisations should run - it must have worked because we won the teamwork prize.'

This year's challenge puts a new emphasis on service users. 'The NHS plan in its totality is supposed to have the user at its centre, but there has perhaps been a preoccupation with the restructuring and modernising bits of it, ' says Ms Hardacre.

'We felt organisations could benefit from focusing on that centre: and the Wanless report has confirmed the importance of that. It is also a different kind of challenge for managers to be accountable to patients in a way that has never been explicit before.'

Ros Boddington, who was an observer last year for a team from University Hospital Birmingham trust, says: 'If it was staged the same each year, it would just be something for managers to do, but it changes each year to reflect the challenges they face.'

The trust is entering two teams this year because of the emphasis on developing partnerships and the user focus.

Teams will be expected to draw up a proper communications strategy and deal with breaking news that could be presented as a 'scandal' in their local paper.

Although HSJ staff play the local paper reporters, it is the importance of internal and partner communications that winners remember.Mr Springfield says: 'You could tell so much visually, just from the way people were spread around the room.You got people working out their lovely strategies and then going out to launch them on the world, only to find that the world had moved on and was not interested, or thought they were trying to launch a take-over bid.'

But as Mr Springfield points out, the challenge is a safe environment in which to learn such lessons. 'If you balls it up, you can think, 'well, I would do it differently in my real job'.'

The event is also meant to be enjoyable.Ms Hardacre says teams 'get a real adrenaline rush' when things go right. l