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Medical directors bulletin July 2001 Issue 2

Hard copy versions of these publications can be ordered from the NHS Responseline 08701 555 455.

Contents

1. Shifting the balance of power

2. Leadership development for doctors

3. 'Action On' programmes

4. Paediatric & Congenital Cardiac Services Review

Shifting the balance of power

The past few months have seen some major developments in the NHS. At the heart of these is the commitment to devolve power to frontline NHS staff.

Some of the key messages for clinicians were strongly put in Alan Milburn's speech this month to the British Association of Medical Managers:

• the main priority is to increase the number of NHS professionals — for example, providing 10,000 more qualified doctors and a 57% increase in medical student numbers over the next five years
• meanwhile, the priority for reform is to free the NHS frontline to shape local services, within the clear national framework of standards now in place
• reform will aim to reorganise services from the patient's viewpoint. Key areas for progress will be the clinical priority areas (cancer, heart disease, elderly services and mental illness); plus improvements in primary care, emergency care and cutting waiting times
• the 'collaborative' principle will be spread to all parts of the NHS — following the example of the Cancer Collaboratives, which have already reduced outpatient waiting times by 50%
• hospitals will be expected to devolve responsibility to the frontline as far as possible; for example, consultants and other senior clinicians will decide on how the new £100 million a year equipment budgets are spent
• devolution within organisations will be matched by devolution in the upper tiers of the service:
• by 2004, two-thirds of existing health authorities will have been abolished
• the NHS regional offices will also have been abolished to devolve power to frontline NHS services
• a reformed Department of Health will provide the resources, setting the standards and holding the system to account
• every member of NHS staff will have the opportunity to contribute to the programme of NHS reform through local modernisation reviews this summer, culminating in local three-year action plans that set out the changes and investment required to deliver the NHS Plan.

Leadership development for doctors

The Leadership Centre, part of the Modernisation Agency, has a remit to develop leadership across the NHS to support delivery of improved, patient-centred services. The agency aims to cover all levels of the profession, but giving early priority in secondary care to medical and clinical directors.

A national leadership programme offering support and development for all medical directors will be in place by the end of spring 2002. Similar work for clinical directors will be piloted nationally during this financial year for local implementation. Recognising that leaders need support from the start of their careers, future work will involve all grades, from undergraduate upwards.

To inform this programme, the Leadership Centre will shortly be circulating a questionnaire to 10,000 doctors in leadership roles. The aim is to establish their current roles and support, their exposure to leadership development, and their perceived development needs. Medical directors are asked to cascade this questionnaire throughout their organisations, and to ensure that all medical leaders appreciate the key role the results will play in defining future support.

'Action On' programmes

Three new 'Action On…' programmes have been set up, to try out new ways of working in dermatology, ENT and orthopaedics.

Forty-nine pilot sites have been chosen to pilot new ideas and spread them to the rest of the NHS. Every pilot site has a lead clinician — usually a consultant, but sometimes the role is shared with a GP.

The pilot sites will look at how the patient's journey can be redesigned and streamlined, with shorter waits and fewer visits to health services. Some of the pilots are considering technological innovations — endosuite technology in theatres, telemedicine, and e-education for GPs. Others are looking at extending the role of non-medical professionals such as physiotherapists, audiological technicians and specialist nurses, so as to free doctors to do the tasks that only they can do.

Many of the pilots are looking at how assessment, diagnosis and treatment can be better coordinated across primary and secondary care. For example, how should GPs be developed, trained and rewarded as part of a specialist service?

These new ways of working should be better for patients, and also reduce the hassle in the working lives of doctors and other NHS staff. Patient and staff satisfaction will be important measures of success for the pilots.

Paediatric & Congenital Cardiac Services Review

A new group met for the first time in March to review paediatric and congenital cardiac services. It has been established to undertake initial scoping work in anticipation of the publication of the Bristol Royal Infirmary inquiry. Its final report will also take account of reports from Alder Hey and Brompton and Harefield Hospitals.

The group has a multi-disciplinary membership, including paediatric cardiac surgeons and cardiologists, specialist nurses, patient representatives and chief executives from an NHS trust, a health authority and a primary care trust.

The group aims to complete its work by January 2002. The main elements of the work programme are:

• Systematic review of the evidence for best practice
• Survey of information on service configuration, activity and outcomes
• Involvement of patients, parents and carers
• Visits to all units providing paediatric and congenital cardiac services
• Consultation on emerging findings with key professional stakeholders
• Report with recommendations

For further details contact Dr Naomi Brecker, group secretary, on 020 7972 5609.

The documents in this bulletin are Crown copyright but may be reproduced by NHS and Local Authority staff without formal permission or charge for personal or in-house use - ©2001

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copyright: © | published: Mar. 24, 2002