NHS Dorset clinical commissioning group: leadership award runner-up

Clinical leads from Dorset CCG. The Great Leaders programme has helped family doctors to speak authoritatively about their work and priorities. Photograph: Dorset CCG/Columbia Photography

The Great Leaders programme developed for GPs in Dorset has given them the confidence they need to take on their new role as NHS commissioners, with responsibility for a £900m budget and a 766,000 patient population.

The scheme, which involves 40-50 GPs who have lead roles in the county-wide clinical commissioning group (CCG), has also made family doctors more "media savvy", so that they can speak authoritatively and clearly about the work they are doing and their priorities.

Since the programme was launched in June last year, the GPs involved in it have increased their public profile. They were behind an awareness campaign concerning when the public should use the new 111 out-of-hours telephone advice line and they also launched The Big Ask public consultation exercise seeking patients' views about local services.

GPs also organised two large public meetings to invite comments about the CCG's strategy.

On the commissioning front, the GPs were instrumental in introducing new dementia services following negotiations with their local authority health and wellbeing boards. They have also lad on commissioning services that help avoid emergency hospital admissions, as well as others such as targeting chronic obstructive pulmonary disease services in the over-75s and establishing a community-based pain management service.

The CCG's director of engagement and development, Charles Summers, says the list of achievements illustrates the success of the programme, as the GPs have moved from taking responsibility for the care of their own practice list to having responsibility for a county-wide population.

Having confident GP commissioners has also changed the focus of conversations with providers for the better. "It's now about 'how can your contract support me and my patients?', often in the past those conversations have been financially lead," says Summers.

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Southern health NHS foundation trust: winner, leadership award

Clinical psychologist Claire Corbridge brainstorming examples of how to deliver integration at a Going Viral session. Photograph: Southern health foundation trust

Southern health NHS foundation trust is one of the largest mental health and learning disability trusts in England. It has a staff of 9,000 working across 150 sites, spanning five counties and was created following the merger of Hampshire partnership NHS foundation trust and Hampshire community healthcare NHS trust in 2011.

A key challenge for the new trust was how to ensure that everybody felt part of the same organisation and shared the same values, behaviours and goals. Part of the solution was its Going Viral leadership development programme which, since its launch in June last year, has coached, developed and supported 550 staff. Another 240 will join the programme this autumn.

Richard House, interim head of leadership and management development, says Going Viral has its roots in the trust's organisational and people development strategies which define the attitudes, values and behaviours expected from its workforce in achieving its core aims. He says: "The NHS Constitution goes some way towards doing that but it isn't specific about behavioural expectations."

The Going Viral programme has three modules that tie in with the trust's core objectives – how to redesign services to improve quality and provide better value for money; how to integrate health and social care with partners and how to provide better outcomes and experiences for patients. The course, which takes place over six months, is delivered in nine-and-a-half day sessions. The learning groups are deliberately made up of staff from different departments so they can develop together.

House says the programme is different from others because it does not select employees according to their NHS banding, but by the amount of influence and responsibility they have. He says: "We have tried to include people, not by their pay band or whether they have management responsibility, but by how influential they are in their multi-disciplinary team. For example, a consultant physician who is only responsible for him or herself."

The programme was introduced before the publication this February of the damning Francis report into the Mid Staffordshire NHS foundation trust.

That report identified how an "insidious negative culture" and "disengagement from managerial and leadership responsibilities" contributed to Mid Staffs' failings. Going Viral, says House, is confronting those leadership challenges identified by Francis.

He says: "I think people feel more listened to and empowered and involved in the processes and realise what is expected of them. It's been transformational for people. One medic said to me 'I wanted to hate the programme and went in with that attitude; but I realise now it was one of the best learning opportunities I have ever had.'"

Health Education England and other trusts from around the country have already taken an interest in Going Viral. The trust, which has its headquarters in Southampton, is organising an open event for later this autumn about the leadership programme and how it fits into its organisational development work. House says: "This is too important not to share with others – to enable them to take on this grand scale change."

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Centre for Patient Leadership: leadership award runner-up

David Gilbert (left) and Mark Doughty: 'We are about giving patients the confidence and the skills to engage with other professionals.' Photograph: Centre for Patient Leadership

A unique leadership programme is giving patients, their carers and service users a voice and helping them influence and shape the health services they use. The Centre for Patient Leadership was established three years ago by Mark Doughty, who has severe rheumatoid arthritis, and David Gilbert, who had a nervous breakdown when he was 25.

Both recognised from their own personal experiences the potential power of the patient voice, but both felt no support was available to make sure that voice was heard. Their own health experiences influenced their individual career paths. Between them they have expertise and skills in learning and development, advocacy and patient engagement.

Gilbert says: "We believe current engagement mechanisms are not fit for practice. Life-changing illness, injury or disability is the crucible within which leadership can be developed. Patients can have a vision of, and passion for, change borne out of their lived experiences. Stepping up to want to change things for others, requires learning and support to develop the confidence and capabilities to work with professionals to influence change."

Courses on offer, which are tailored to individual need, range from two months to a maximum of six months. They involve a mix of workshops with mentoring and coaching support, and focus on self-leadership, relationship building and dialogue, and developing influencing and advocacy skills.

Doughty says: "It's about building effective relationships, being able to communicate and having the ability to dialogue ... and talking together about problems that you share. We are about giving patients the confidence and the skills to engage with other professionals in which the patient themselves perceive themselves as being equal."

The company works with individual patients and organisations, which are trying to make patient engagement more meaningful. Between 400 and 500 people from a range of national, regional and local organisations including strategic health authorities and clinical commissioning groups have completed its leadership programme.

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Is there a place for personal values in leadership?

Margaret Hodge MP accused Google of being "devious, calculated and, in my view, unethical”. Photograph: Andrew Winning/REUTERS

In the banking sector, standards have been widely condemned in the wake of the global economic crisis. This year, corporate values were in the spotlight again when Google was accused by Margaret Hodge MP of being "devious, calculated and, in my view, unethical".

To be successful in the cut-throat world of business, you may think there's no place for soft values and morals. But holding on to personal principles as a leader is not just about ethics – it can also boost your career and organisation.

Being true to your values helps performance in the long term, according to Petra Wilton, of the Chartered Management Institute. "Not only does it have consequences for reputation and trust in business, it also has a huge impact through employee engagement, productivity and outcomes."

"Too often people's personal principles go out of the window when they take up leadership positions, when they've got the pressures of targets and bad examples to follow. You can certainly behave unethically and still get good business results in the short term, but it's likely to come back and bite you at the end of the day."

With an increased focus on corporate responsibility since the banking crisis, many companies have made efforts to embrace an ethical culture among employees. But, although company values may provide a useful framework, the ethics of an organisation are ultimately set by the example of its leaders.

"It's what you're doing, not what you're saying, that people will use as an example," says Philippa Foster Back, director of the Institute of Business Ethics. "People recognise that to get on they maybe need to behave like their boss. So the culture of the organisation is set by the top."

If sticking to your principles seems like an obvious objective, why do so many leaders seem to get it wrong?

Petra Wilton suggests: "Most people don't get up and say: 'I'm an unethical individual, I'm going to go and make the wrong decisions'. A lot of the time it happens when people try to meet the corporate and business objectives without having any real measure of the human consequences."

One of the main problems for business leaders is subjectivity – there are no clear cut rules on ethics. "The meaning of ethics changes from person to person," explains Sankalp Chaturvedi, associate professor at the Imperial College Business School.

"What is ethical to me may not be ethical to you. And business processes themselves are very contextual – what is ethical in one country may not be in another."

It's easy to see how principles may not always translate to other people. For instance, Starbucks has been ranked in the world's most ethical companies for six years in a row. Yet its tax avoidance methods have sparked protests and criticism.

Given the ambiguity of ethics, your personal principles may not be shared by everyone. So for leaders, valuing principles must be about honesty and having an open conversation. Chaturvedi says: "Problems happen when people are not authentic – when they say one thing and do something else – so it's about being consistent about what you're saying.

"Being a leader is not just about making decisions, but also making sure people understand what the intention is behind it."

But balancing business and principles is not always easy: challenging decisions can require compromises. "There will always be ethical dilemmas where it's hard to weigh up the consequences of a decision you are making," says Wilton.

"Sometimes there's no clear right or wrong answer. But valuing your principles is about considering the implications of what you're doing and, when in doubt, challenge things where possible."

Back adds: "It comes back to the choices that individuals make, and what they feel comfortable with. What's important is having a mental checklist while you're making decisions and being open about things you're not comfortable with. True leadership is having the courage to say no."

Ethics are not just important for the sake of companies, but also for the leaders themselves. Back says: "If you're not true to your values then you're likely to end up with stress and unease as you have to take on a different persona as you walk in through the door at work. So it is very important for individuals."

And holding on to principles can help guide you through your career. Steve Nicholls, who coaches executives and managers, says that as you climb up the career ladder into more senior roles, there is often less in terms of peers and reality checks.

"It's important to hang on to personal values because, as a leader, there may not be anyone who you see as a peer to put an arm around your shoulder. One of the most difficult things as a leader is the management of ambiguity in business contexts. Yet you need to do this alongside having clear communications."

"At the end of the day, leaders have got to lead and they've got to be strong."

Chaturvedi adds: "Research has shown consistently that culture has an impact on performance in a company. If people share values consistently then there's a strong culture – and that is definitely going to have an impact on the performance of the individual, as well as the company."

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Discussion roundup: what is good leadership in the NHS?

Effective leaders motivate people across the NHS to drive change. Photograph: Christopher Thomond for the Guardian

David Welbourn, deputy director, Centre for Health Enterprise, Cass Business School: "If we look at the role of a board director as a specific category of leader, their duties are laid down in the corporate code of conduct, and good leadership starts from there."

Stephen Brooks, specialist in people, change and leadership at PA Consulting Group: "Leadership is also about establishing the values and ethos of the organisation that provide the framework for decision making by others."

Jane-Claire Judson, national director for Diabetes UK Scotland and a Health Foundation Generation Q fellow: "Leadership is often about being self aware and aware of the mix of skills around you and how to bring out the best in them across a team."

Simon Gilby, chief executive of Wirral Community NHS trust: "I think a key thing for a good leader is to ensure they have people, inside the organisation and external to it, who will tell them the truth – not what they think you want to hear."

Jan Filochowski, chief executive of Great Ormond Street Hospital for Children NHS foundation trust and author of Too Good To Fail?: "The failing organisations I have gone into have typically suffered from this defect. The truth is either ignored or worse concealed. For me the worst fault in a manager is not getting things wrong but not owning up to doing so. We all get things wrong. My favourite adjective for what a good manager will be is 'imperfect'."

Karen Lynas, deputy managing director and head of programmes and practice team, NHS Leadership Academy: "One of the roles of a leader in the NHS, at whatever level they work is to understand the emotional labour required of NHS staff and be hugely invested in providing the right environment for them."

David Welbourn: "Good leadership is independent of organisation, sector and industry."

Jane-Claire Judson: "Working in the third sector we see ourselves as unique too with motivations that differ from the NHS, the wider pubic sector and from the private sector. However, a lot of the discussions around leadership are similar – trust, honesty, dealing with a shifting context and ambiguity, caring for our staff and volunteers whilst also getting through the day to day."

Jan Filochowski: "We often talk of leadership as an inherent quality, and in my view it is dangerous to do so. It needs to be learnt and it must be based on having good management skills. We need more good managers, then we will produce more good leaders."

Karen Lynas: "Good management isn't always the foundation to good leadership but I agree we need to train and develop our leaders. We should not assume that the skills they require are inherent, or can be picked up on the job anymore than we would expect that of a clinical or a finance manager."

Stephen Brooks: "I was shocked that people in senior leadership roles confessed to me that they could not remember when they last had any leadership training."

Paul Taylor, head of engagement and organisational development at NHS Employers: "We should be helping front line staff and all those working to support them in their roles to feel equipped to make decisions and see themselves as leaders in their own right. At the more senior levels, we need to help leaders to lead differently in this new system with much more of a focus on partnerships and collaboration."

Katy Steward, assistant director, leadership development, and Sarah Goodson, senior consultant, leadership development, at the King's Fund: "The issue is really one of developing good relationships between NEDs [non-executive directors] and governors, having the right conversations and knowing when to influence the agenda in the annual cycle of the board business. Governors need to be seen as a positive resource not an unnecessary evil."

David Welbourn: "I cannot think of any failure at this level that wasn't caused either by the hubris of a board that failed to engage with the realities of its context, or alternatively, abdicated its responsibility to others, because it didn't have either the skills or courage to make its own decisions."

Jan Filochowski: "Power is of course distributed between boards, execs, the clinical body, governors and others, but leadership is a bit different. It's about understanding that power distribution and orchestrating it to the most positive effect. Easily said, I know but very hard and skilful to do."

Karen Lynas: "We have thousands of leaders in the NHS, if we want to make a difference we need development support that is significant enough to reach all of them ... We are blessed with some great leaders in the NHS and we would be well served by recognising them more."

David Walker, contributing editor, Public Leaders Network: "Many NHS people shy away from 'politics' but as, for example, NHS bodies have to get closer to elected local government, their engagement with councillors will have to increase. Health and wellbeing boards, whatever they may do, are going to be 'political' and require NHS leaders to add to their repertoire advocacy and representational skills."

Jackie Leigh, a senior lecturer at the University of Salford, programme leader for the MSc Leadership and Management for Healthcare Practice: "We need to learn from the patient and staff stories of where excellent leadership is taking place and what makes the leadership excellent."

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Councils must face difficult decisions on NHS with leadership, not hyperbole

Councils are becoming increasingly aggressive in their opposition to hospital trust moves such as changing an accident and emergency unit. Photograph: Leon Neal/AFP/Getty Images

Councils are becoming increasingly aggressive in their opposition to hospital trust moves, such as changing an accident and emergency unit into a more modest urgent care centre.

In the high court, Lewisham council won a major victory, blocking changes to their local hospital that were part of a plan to save the imploding South London Healthcare Trust.

In west London, Ealing is objecting to changes to A&E services, while down the M4 Windsor and Maidenhead is fighting a plan to move a minor injuries unit to Bracknell and close a birth unit. Trafford council has voted unanimously to fight the closure of the A&E unit at Trafford general hospital, which at peak times see seven patients an hour according to the Department of Health, and expand services nearby.

Councils are taking these actions while they themselves are making similar difficult decisions – closing, downgrading or sharing services, and sometimes handing them over to someone who is doing it better – such as Hampshire county council taking over Isle of Wight's children's services. Is there a whiff of hypocrisy?

Local governments scrutiny of the NHS is often the service's only effective democratic oversight. Foundation trusts have a fig leaf of public accountability through their membership schemes, but there are few trusts who can seriously claim members make much difference.

But councils' local mandate should not be an excuse for hysterical overstatement about what is being proposed. When the high court blocked Ealing's attempt to judicially review the west London accident and emergency reorganisation the council described the GP-led plans as "monstrous", with leader Julian Bell claiming: "The NHS want to treat the people of Ealing as guinea pigs in the largest experiment in its history".

This sort of hyperbole is irresponsible. Spreading the idea that the NHS wants to treat an entire borough's residents in such a way is itself monstrous. It crudely plays on the fears of local people and obliterates the chance of an intelligent discussion about what is being proposed.

Ealing has faced its own tough decisions, such as changes to its services for people with learning disabilities. Surely it must know that everyone loses when debate around reforming – and sometimes simply closing – public services is reduced to invective.

Of course, councils cannot simply abdicate taking a position on something of such profound local interest. On the contrary, if community leadership is to mean anything, it needs to be a vigorous participant in the debate.

But that means actually leading, not unthinkingly following the gut reaction to oppose. It is now clear from Local Government Association analysis that the 2015-16 spending review has left councils facing cuts of up to another 16% – not the 10% that the government stated. If anyone has a vested interest in raising the quality of public debate about how to manage cuts in public services it is local government.

When it comes to their own services, councils are demonstrating a willingness to look at a radical solutions which can offer residents a better service for less money. Trafford is one of them – leading the way in redesigning adult services by championing reablement.

Councils have a duty to scrutinise, question and debate reforms to local health services. Sometimes those proposals will be found wanting – as Lewisham demonstrated. But dogmatic defence of the status quo in defiance of the best long-term interests of patients is a serious error of judgement, even if it may be superficially and tactically appealing.

These difficult discussions between councils and the NHS will be a major feature of local government for the next decade. Attempting to drag proposals through judicial review cannot be the default response. Where that happens it is an indication of failure on both sides. There are numerous examples of where councils and local NHS services have collaborated effectively to make the right, difficult decision.

As the community leaders, councils must be in at the beginning of these debates – helping shape them, questioning them, but also accepting where the evidence leads, and having the courage to support the outcome.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

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Discussion roundup: what is good leadership in the NHS?

Effective leaders motivate people across the NHS to drive change. Photograph: Christopher Thomond for the Guardian

David Welbourn, deputy director, Centre for Health Enterprise, Cass Business School: "If we look at the role of a board director as a specific category of leader, their duties are laid down in the corporate code of conduct, and good leadership starts from there."

Stephen Brooks, specialist in people, change and leadership at PA Consulting Group: "Leadership is also about establishing the values and ethos of the organisation that provide the framework for decision making by others."

Jane-Claire Judson, national director for Diabetes UK Scotland and a Health Foundation Generation Q fellow: "Leadership is often about being self aware and aware of the mix of skills around you and how to bring out the best in them across a team."

Simon Gilby, chief executive of Wirral Community NHS trust: "I think a key thing for a good leader is to ensure they have people, inside the organisation and external to it, who will tell them the truth – not what they think you want to hear."

Jan Filochowski, chief executive of Great Ormond Street Hospital for Children NHS foundation trust and author of Too Good To Fail?: "The failing organisations I have gone into have typically suffered from this defect. The truth is either ignored or worse concealed. For me the worst fault in a manager is not getting things wrong but not owning up to doing so. We all get things wrong. My favourite adjective for what a good manager will be is 'imperfect'."

Karen Lynas, deputy managing director and head of programmes and practice team, NHS Leadership Academy: "One of the roles of a leader in the NHS, at whatever level they work is to understand the emotional labour required of NHS staff and be hugely invested in providing the right environment for them."

David Welbourn: "Good leadership is independent of organisation, sector and industry."

Jane-Claire Judson: "Working in the third sector we see ourselves as unique too with motivations that differ from the NHS, the wider pubic sector and from the private sector. However, a lot of the discussions around leadership are similar – trust, honesty, dealing with a shifting context and ambiguity, caring for our staff and volunteers whilst also getting through the day to day."

Jan Filochowski: "We often talk of leadership as an inherent quality, and in my view it is dangerous to do so. It needs to be learnt and it must be based on having good management skills. We need more good managers, then we will produce more good leaders."

Karen Lynas: "Good management isn't always the foundation to good leadership but I agree we need to train and develop our leaders. We should not assume that the skills they require are inherent, or can be picked up on the job anymore than we would expect that of a clinical or a finance manager."

Stephen Brooks: "I was shocked that people in senior leadership roles confessed to me that they could not remember when they last had any leadership training."

Paul Taylor, head of engagement and organisational development at NHS Employers: "We should be helping front line staff and all those working to support them in their roles to feel equipped to make decisions and see themselves as leaders in their own right. At the more senior levels, we need to help leaders to lead differently in this new system with much more of a focus on partnerships and collaboration."

Katy Steward, assistant director, leadership development, and Sarah Goodson, senior consultant, leadership development, at the King's Fund: "The issue is really one of developing good relationships between NEDs [non-executive directors] and governors, having the right conversations and knowing when to influence the agenda in the annual cycle of the board business. Governors need to be seen as a positive resource not an unnecessary evil."

David Welbourn: "I cannot think of any failure at this level that wasn't caused either by the hubris of a board that failed to engage with the realities of its context, or alternatively, abdicated its responsibility to others, because it didn't have either the skills or courage to make its own decisions."

Jan Filochowski: "Power is of course distributed between boards, execs, the clinical body, governors and others, but leadership is a bit different. It's about understanding that power distribution and orchestrating it to the most positive effect. Easily said, I know but very hard and skilful to do."

Karen Lynas: "We have thousands of leaders in the NHS, if we want to make a difference we need development support that is significant enough to reach all of them ... We are blessed with some great leaders in the NHS and we would be well served by recognising them more."

David Walker, contributing editor, Public Leaders Network: "Many NHS people shy away from 'politics' but as, for example, NHS bodies have to get closer to elected local government, their engagement with councillors will have to increase. Health and wellbeing boards, whatever they may do, are going to be 'political' and require NHS leaders to add to their repertoire advocacy and representational skills."

Jackie Leigh, a senior lecturer at the University of Salford, programme leader for the MSc Leadership and Management for Healthcare Practice: "We need to learn from the patient and staff stories of where excellent leadership is taking place and what makes the leadership excellent."

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Is there a place for personal values in leadership?

Margaret Hodge MP accused Google of being "devious, calculated and, in my view, unethical”. Photograph: Andrew Winning/REUTERS

In the banking sector, standards have been widely condemned in the wake of the global economic crisis. This year, corporate values were in the spotlight again when Google was accused by Margaret Hodge MP of being "devious, calculated and, in my view, unethical".

To be successful in the cut-throat world of business, you may think there's no place for soft values and morals. But holding on to personal principles as a leader is not just about ethics – it can also boost your career and organisation.

Being true to your values helps performance in the long term, according to Petra Wilton, of the Chartered Management Institute. "Not only does it have consequences for reputation and trust in business, it also has a huge impact through employee engagement, productivity and outcomes."

"Too often people's personal principles go out of the window when they take up leadership positions, when they've got the pressures of targets and bad examples to follow. You can certainly behave unethically and still get good business results in the short term, but it's likely to come back and bite you at the end of the day."

With an increased focus on corporate responsibility since the banking crisis, many companies have made efforts to embrace an ethical culture among employees. But, although company values may provide a useful framework, the ethics of an organisation are ultimately set by the example of its leaders.

"It's what you're doing, not what you're saying, that people will use as an example," says Philippa Foster Back, director of the Institute of Business Ethics. "People recognise that to get on they maybe need to behave like their boss. So the culture of the organisation is set by the top."

If sticking to your principles seems like an obvious objective, why do so many leaders seem to get it wrong?

Petra Wilton suggests: "Most people don't get up and say: 'I'm an unethical individual, I'm going to go and make the wrong decisions'. A lot of the time it happens when people try to meet the corporate and business objectives without having any real measure of the human consequences."

One of the main problems for business leaders is subjectivity – there are no clear cut rules on ethics. "The meaning of ethics changes from person to person," explains Sankalp Chaturvedi, associate professor at the Imperial College Business School.

"What is ethical to me may not be ethical to you. And business processes themselves are very contextual – what is ethical in one country may not be in another."

It's easy to see how principles may not always translate to other people. For instance, Starbucks has been ranked in the world's most ethical companies for six years in a row. Yet its tax avoidance methods have sparked protests and criticism.

Given the ambiguity of ethics, your personal principles may not be shared by everyone. So for leaders, valuing principles must be about honesty and having an open conversation. Chaturvedi says: "Problems happen when people are not authentic – when they say one thing and do something else – so it's about being consistent about what you're saying.

"Being a leader is not just about making decisions, but also making sure people understand what the intention is behind it."

But balancing business and principles is not always easy: challenging decisions can require compromises. "There will always be ethical dilemmas where it's hard to weigh up the consequences of a decision you are making," says Wilton.

"Sometimes there's no clear right or wrong answer. But valuing your principles is about considering the implications of what you're doing and, when in doubt, challenge things where possible."

Back adds: "It comes back to the choices that individuals make, and what they feel comfortable with. What's important is having a mental checklist while you're making decisions and being open about things you're not comfortable with. True leadership is having the courage to say no."

Ethics are not just important for the sake of companies, but also for the leaders themselves. Back says: "If you're not true to your values then you're likely to end up with stress and unease as you have to take on a different persona as you walk in through the door at work. So it is very important for individuals."

And holding on to principles can help guide you through your career. Steve Nicholls, who coaches executives and managers, says that as you climb up the career ladder into more senior roles, there is often less in terms of peers and reality checks.

"It's important to hang on to personal values because, as a leader, there may not be anyone who you see as a peer to put an arm around your shoulder. One of the most difficult things as a leader is the management of ambiguity in business contexts. Yet you need to do this alongside having clear communications."

"At the end of the day, leaders have got to lead and they've got to be strong."

Chaturvedi adds: "Research has shown consistently that culture has an impact on performance in a company. If people share values consistently then there's a strong culture – and that is definitely going to have an impact on the performance of the individual, as well as the company."

This content is brought to you by Guardian Professional. To get more content and advice like this direct to your inbox, sign up for our weekly update and careers ebook.

View the original article here