NHS EDUCATION FOR SCOTLAND /SCOTTISH SOCIAL SERVICES COUNCIL
LEADERSHIP AND MANAGEMENT IN HEALTH AND SOCIAL CARE
Purpose
This paper was presented to the NES / SSSC Strategic Group: 13th September 2010. It provides
provides an update to the NES / SSSC Strategic Group on developments in respect to Leadership and Management in Health and Social Care.
The NES / SSSC Strategic Group supported the direction of travel NES / SSSC in relation to Leadership and Management to support managers in CHP’s and CHCP’s
1. Introduction
NES and SSSC strategic partnership involves a number of work streams with one focusing on the leadership and management needs of the workforce in the provision of integrated/joint services in health and social care. The commitment for the public services to sustain high quality, continually improve, to be efficient and responsive to local people’s needs will all require effective leadership in order to achieve these outcomes.
2. NHS Leadership
The NHS National Leadership Unit, NES is taking forward the following development priorities
· Work with partners to drive cultural change in support of the delivery of high quality services
· Build leadership and Organisational Development capacity and capability
· Develop current leaders and teams
· Nurture the supply of future leaders
· Evaluate the impact of leadership development
Delivering Quality through Leadership (2009), the strategy for leadership development in NHS Scotland in summary, it sets out the direction of travel for leadership development in NHS Scotland over the next three years, informed by views gathered during the review and building on what has already been achieved. In addition it sets out in detail the national and local actions that will be required to deliver on the priorities. The guiding principles include
· Effective leadership at all levels is essential to delivering the goals of NHS Scotland. Leadership development is a lifelong activity and should not be confined to specific levels or groups of the workforce.
· Leadership development needs to span clinical leadership, general management, functional management and professional leadership roles.
· Equality and diversity should inform all aspects of leadership development
· The leadership qualities and behaviours expected of our leaders have been impact assessed and updated and are set out in the strategy.
· The strategy recognises the distinct but complementary roles of leadership and management.
· Developing leadership capability and capacity requires us to work collaboratively locally and nationally, across public services and with partners.
· The strategy recognises the extensive local activity that takes place across Scotland. It is not intended to replace this but rather to provide a coherent national approach to leadership development which will guide Boards and complement local activity
· The actions that are set out in the strategy reflect best practice in leadership development
· Review and evaluation are included as an integral part of the implementation plan.
3. SSSC Leadership
‘Changing Lives’ (the report of the 21st century review of social work), ‘Investing in Children’s Futures’ (Scottish Government’s response to the review of the early years and childcare workforce) and the Social Work Inspection Agency’s performance inspections have all identified that effective leadership is essential to good quality outcomes for people who use social services and their carers. Since 2006 there has been considerable leadership activity in the social services sector driven strategically by the Changing Lives Leadership and Management Group. This has included the ‘Leading to Deliver’ leadership development programme, leadership communities, the leadership framework for social services, the Standard for Childhood Practice and the Chief Social Work Officer (CSWO) guidance.
Scottish Government has asked the Scottish Social Services Council to take forward the strategic direction for leadership in social services, working in partnership with the four Scottish Social Services Learning Networks and building on existing activity. Our vision is to build leadership capacity across the whole of the social services sector (public, private and voluntary) including, but not only, those in management positions. Our immediate objectives are to scope existing leadership activity and identify gaps through engagement across the sector. The resulting plan for leadership development in social services will be disseminated in the autumn. Key priorities will include:
· an agreed working definition of leadership and its relationship with management
· a framework for leadership development that is linked to the Continuous Learning Framework for the sector
· a flexible programme for leadership development which meets the diverse needs of the workforce at different levels and in different parts of the sector and includes people who use services and their carers
· supporting succession planning across the sector and in particular for the role of CSWO
· promoting organisational cultures which support leadership development across the workforce
· developing collaborative leadership with other public sector bodies and with the private and voluntary sectors
· evaluating the impact of our approach.
4. Leadership and Management across Health and Social Care
Strong partnership between various organisations, health, social care, education and other public sector bodies as well as voluntary and independent sectors requires strong leadership. A number of educational solutions have been developed to address partnership working and include:-
4.1 Shifting the Balance of Care - Agreeing Priorities and Delivering Outcomes (APDO) project
The Shifting the Balance of Care (SBC) initiative aims to improve the health and wellbeing of the people of Scotland by: Shifting towards prevention. Shifting the delivery of care and Shifting the location of services. The ethos is focussed towards shifting responsibilities towards prevention, the local delivery of care and in the development of community infrastructures, information systems and workforce capacities.
SBC requires partnerships between the NHS, Local Authorities and other partners. Community Health Partnerships (CHPs) play a key role in providing a local forum for agreeing changes between people and health care workers, social workers, independent contractors, housing, transport and third sector organisations.The Agreeing Priorities and Delivering Outcomes (APDO) initiative is a process of developing whole system planning to enable shifts in the balance of care. It aims to support teams who are involved in the planning and delivery of health and social care, aligned with priorities identified for the effective implementation of SBC.
The Agreeing Priorities and Delivering Outcomes (APDO) project aims to refine existing plans for local services (covering health, social care, housing, transport and the voluntary sector) and to develop a single robust five year forward plan for each local system. Four Community Health (and Care) Partnership (CH(C) P) teams and a team from NHS Education for Scotland (NES) were involved in the project. This report evaluates a three day residential event that took place in January 2010. During this time, and in awareness of the political, demographic and economic changes that may be faced, teams had the opportunity to plan ahead and to discuss factors that may impact on local CHP plans. This was facilitated via a simulation exercise that was based on a synthetic, but realistic, Scottish CHP, in which a focus was placed on the immediate future and in the longer term. During the event, a keynote speaker presented an analysis of resource flows on health and social care services which further permitted delegates to refine their local plans during a dedicated team session. Overall, delegates believed that the event was highly informative and helped participants to appreciate the processes involved in shifting the balance of care. In addition, the simulation exercise highlighted the need for organisations to collaborate and engage in meaningful relationships and to have open dialogue at all levels, including that with the public. Key roles of strong leadership and joint integrated, holistic planning were also highlighted.
4.2 Public Sector Leadership Development Collaboration –
Collaborating for Outcomes in the Public Sector
A second Collaborating for Outcomes in the Public Sector programme is due to commence in September 2010 with six modules running until June 2011. This innovative programme for 60 plus participants from the executive cohort across the public sector builds on the format introduced last year by the Public Sector Leadership Development Collaborative. It extends from focusing on the countries five strategic objectives to include a focus on the three social frameworks, “Equally Well” “Achieving our Potential” and “Early Years”, and the economy. A combination of speakers, “inquiry and action” groups and “peer consulting” will enable the participants to grapple with the leadership challenges they face and take collective action to improve outcomes. The intention is to leverage collaborative advantage to continue improving delivery of local and national outcomes in a time of fiscal restraint. The programme was significantly oversubscribed with each of the partnership agencies reporting 50% to 100% more applications than available places. This high demand is in part due to the positive feedback from last years programme and an increased understanding of the public value of working collaboratively.
4.3 Local NHS Boards / Local Authority Initiatives
A number of NHS Boards and Local Authorities are developing leadership programmes with the aim to enable effective partnership working, improving services collaboratively by creating opportunities for partner organisations to think and work together.
5. NES / SSSC Leadership and Management Work to Date
In order to ensure NES and SSSC strategic alignment with the education, training and workforce needs of managers of community based services in NHS Scotland / Social Care a project was commissioned to scope the current leadership and management education and training provision for managers within CHP’s, CHCP’s and Local Authorities. The scope included the current provision of leadership and management training for managers in CHPs, CHCPs and Local Authorities covering health, housing and social care; Identification of how and by whom training and development is provided to people from which background. Analyse responses / issues highlighted by the scoping exercise which may include the following questions: Does the content of the leadership training include shifting the balance of care? Is there a difference between approaches taken by CHCPs ,CHPs? What staff groups are included (eg nurses, managers, AHPs, SWs) Are housing managers or home care managers involved anywhere? Is there a core need that would interest people from a variety of backgrounds and to what extent is the education and training is provided jointly to health and social service workers?
The scope identified that a wide range of credit rated and non credit rated programmes of learning available to Leaders and Managers in Health and Social Care Sectors. Although there is evidence of some joint learning and development between the Community Health Partnerships and Local Authorities there remains a split between health board and social services delivery and outcomes. In a number of instances they identified potential joint programmes of learning that they thought would help develop a more integrated approach to services. They acknowledged that it did not happen for a range of reasons including; different cultures, high turnaround of staff, course costs, communication and “we tend not to think too much about involving others.” Health Board, Head of Learning and Development. In many respects the approaches to learning and development are similar between the two sectors and include; distance learning, self study and reflection, taught programmes, short courses, two hour sound bites, action learning sets, communities of learning and e learning. There are a number of shared learning themes such as; self awareness and self development (from Leading to Deliver and Frontline Leadership) leading change, financial management and emotional intelligence. Although key policy initiatives such as ‘shifting the balance of care’ and ‘21st Century Review’ changes, it was thought that these themes are probably within a range of programmes of learning.
6. NES / SSSC Future Leadership and Management Initiatives
In progressing the leadership and management development for managers in CHP’s and CHCP’s we need to be thoughtful about what we are trying to achieve and what is possible given the financial constraints in all our services. From stage 1 what is apparent is that generally most leadership development is happening separately. In the context of working jointly on often complex issues, this is unlikely to really support managers in CHP and CHCP’s to work skilfully and collaboratively.
Based on this analysis, stage 2 should focus on promoting opportunities for managers to think and work together on a complex / wicked issue related to ‘Reshaping the Care of Older People’. The development initiative should be seen as a pilot with the intention of concentrating on doing a small amount really well, based on best practice in leadership development and providing the opportunity to review what has been done before providing it as a model for wider adoption by other CHP’s and CHCP’s.
The following steps would be required to ensure that this is a high quality intervention which provides maximum return on investment:
· Undertake detailed financial planning
· With colleagues identify ‘fertile ground’ that is to say a CHP/ CHCP where the need to improve how mangers work together is recognised by the strategic leaders who are willing to be ‘sponsors’ to programme participants
· Work with the strategic leaders to identify the target group of managers and the support that will be offered to them while undertaking the programme
· Work with strategic leaders to identify some complex ‘wicked’ issues that they wish to be addressed focussing on ‘Reshaping the Care of Older People’
· Design a leadership development initiative based on Reg Revans action learning model / inquiry groups
· Identify expert facilitation for the groups
· Identify evaluation strategy including the impact / outcome for participants and the organisation
· Run the groups over a 8 to 10 month period
· Complete evaluation
· Present findings and consider further adoption across CHP’s and CHCP’s
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