DOCTORS PERSPECTIVES OF ORGANISATIONAL MERGERS

Size: px
Start display at page:

Download "DOCTORS PERSPECTIVES OF ORGANISATIONAL MERGERS"

Transcription

1 DOCTORS PERSPECTIVES OF ORGANISATIONAL MERGERS JUNE 2012 MADELEINE KNIGHT

2 Contents 1. Overview Introduction Method Survey results Interviews...9 Clinical leadership and staff engagement...10 Organisational culture...11 Merger into larger organisations...11 Achievement of objectives Conclusion...13 Doctors perspectives of organisational mergers 1

3 1. Overview The concept of integration in healthcare has gathered pace in policy discussions in the UK in recent years. With the aim of gathering doctors views on integration, a BMA study began to investigate this topic with a survey of members in July and October Following the survey, organisational merger was chosen as an area for further investigation as it can be viewed as a mechanism to bring about greater integration of healthcare services. Building on the results of the survey this project (one of three new reports on integration) examines the option of merging organisations for integrated care in more detail. Semi-structured interviews were carried out with a small number of respondents who had experience of organisational merger and a summary of our findings is reported. 1 BMA. Doctors perspectives of integration in the NHS: BMA interim report Doctors perspectives of organisational mergers

4 2. Introduction Definitions of integration in healthcare are broad and describe any activities intended to improve coordination of services around patients and address fragmentation in the healthcare system 2. Integrated care is often referred to as a principle which encompasses patient experience, efficiency, better coordinated care for multiple and long term conditions to reflect the elderly population and rising incidence of chronic disease 3. A strong case has been made for integration as a positive step to improve healthcare 4 5. However, the major question remains how this can be achieved 6. Healthcare services are fragmented for a number of reasons. Commonly due to separation between: Health and social care Primary and secondary healthcare Purchasing and provision of healthcare Integration to address this fragmentation can take a number of forms including 7 : Vertical integration, which brings together organisations providing services at different levels, for example primary and secondary care organisations Horizontal integration bringing together organisations providing services of care at the same level, for example merger of two acute hospitals Virtual integration involving partnerships and networks between organisations to encourage more coordinated working Real integration involving structural merger of organisations Organisational merger may be considered one option to facilitate integrated care 8. This project set out to understand whether real integration or structural merger of organisations, horizontal or vertical, can be an effective mechanism for integrating services in the NHS and whether this is a mechanism that doctors would welcome or find advantageous in integrating services. This is of particular relevance given the current policy context in the NHS points to a greater likelihood of organisational mergers with a variety of aims. 2 Nuffield Trust. What is Integrated Care? Nuffield Trust. Towards integrated care in Trafford G Bevan. K Janus. Why hasn t integrated health care developed widely in the US and not at all in England? J Health politics, policy law The Kings Fund. Clinical and service integration the route to improved outcomes Nuffield Trust. Where next for integrated care organisations in the English NHS? Op cit. Clinical and service integration the route to improved outcomes Ham, Chris J and De Silva, Debra. Integrating Care and Transforming Community services: What works? Where next? Health Services Management Centre Doctors perspectives of organisational mergers 3

5 Current policy context In England, the current NHS reforms enshrined in the Health and Social Care Act 2012, promote the Government s desire for all trusts to achieve Foundation Trust status within the next three years. It is likely that some trusts will merge in order to meet the requirements for Foundation Trust status. In addition, the current financial situation within the NHS, in particular the Nicholson challenge to recoup 20 billion in efficiency savings by 2015, is a further factor likely to drive mergers in an attempt to reduce costs by consolidating services. The Transforming Community Services (TCS) initiative introduced in 2009, required PCTs to divest themselves of their provider arms, and some of the reconfigurations resulted in mergers. In Northern Ireland, Health and Social Care are integrated. A new Review of Health and Social Care Services 9 was announced in June The review is examining the future provision of services including acute hospital configuration, the development of primary health care services and social care, and the interfaces between the sectors. Mergers of organisations might be considered in this context. In Scotland, NHS Boards both commission and provide health care. This does not apply to social care. However, projected future demand for elderly care services has added to the desire to achieve greater integration between health and social care and Community Health Partnerships (CHPs), were introduced in 2004 as the means to improve delivery of health and social care in the community. In addition, a pilot is being introduced for NHS Highland in The NHS board and local authority will both be accountable for deciding the resources to be committed and the outcomes to be achieved for specific services. In Wales, NHS Boards both commission and provide health care, but social care is organised separately. The Welsh Government has committed to reshaping social care services in light of the challenges of rising demand, increasing expectations of quality and a poor financial outlook. NHS Wales and local government bodies will be expected to work together to form coherent, whole-system plans to deliver integrated services in their localities, and deal with the budgetary pressures they face. A key aspect of this exercise will be reducing the number of social services authorities to seven, to match the number of local health boards. 9 HSSPS. Review of Health and Social Care: Transforming your care. June Doctors perspectives of organisational mergers

6 Existing literature on integration in healthcare suggests that organisational merger is not necessary or sufficient to bring about integration of services and improve care for patients In addition, it has been recognised that structural change can have disadvantages 13 suggesting that other approaches should be taken to bring clinical staff together 14 and coordination of care should be the focus, rather than organisational merger 15. These arguments call into question the case for organisational mergers for integration. We decided to investigate doctors views of organisational mergers and the potential for mergers to deliver integration to see if they shared this view. The main research questions were: Do organisational mergers bring about integration of services in the eyes of doctors? What have doctors experienced to be barriers and enablers to organisational merger? What have doctors experienced to be barriers and enablers to integration of services in merging organisations? 10 Op cit. Integrating Care and Transforming Community services: What works? Where next? Health Services Management Centre Ramsay A and Fulop N. Integrated Care Pilot Programme: The Evidence Base for Integrated Care. Department of Health Burns, L.R. and M.V. Pauly. Integrated Delivery Networks: A Detour on the Road to Integrated Health Care? Health Affairs 21: Op cit. Where next for integrated care organisations in the English NHS? Op cit. Integrating Care and Transforming Community services: What works? Where next? Health Services Management Centre Op cit. Integrated Care Pilot Programme: The Evidence Base for Integrated Care. Department of Health Doctors perspectives of organisational mergers 5

7 3. Method An initial set of survey questions were trialled in a general survey of members in July Following these initial findings a longer survey, specifically looking at different aspects of integration was conducted in October , which included a section specifically on organisational mergers. Building on the results of the surveys a small number (n=7) of semistructured telephone interviews were carried out with respondents who indicated that they had experienced an organisational merger for integration. 16 Op cit. Doctors perspectives of integration in the NHS: BMA interim report Doctors perspectives of organisational mergers

8 4. Survey results The initial survey questions asked in July (n=303) showed that doctors do not find organisational mergers to be a high priority for integrating care. When asked how important they considered various factors to the integration of healthcare services, the most popular options were: 1. Creating joined-up care pathways (53.4 per cent) 2. Shared information technology systems (51 per cent) 3. Shared guidelines and protocols across organisations (48.7 per cent) Merger of organisations was the lowest ranked (13.4 per cent) in the list of factors. However, the factors which came at the top, including shared IT and shared protocols could arguably be more easily implemented through organisational mergers. Analysis of the responses to the October survey (n=369) showed that those who had experienced organisational merger had a negative view of the disruption caused and the relative benefit derived from mergers. Respondents from across the UK indicated that the most important barriers to achieving joined up care pathways were: 1. Conflicting organisational priorities (47.8 per cent) 2. Separation of purchasing and provision (England only) (20 per cent) 3. Lack of coherent information technology systems (19.2 per cent) This suggests that doctors recognise organisational factors to be the most important barriers to integrating healthcare. Such organisational barriers may be seen to be potentially overcome by organisational mergers. Respondents to the same survey found the most important enablers to achieving joined up care pathways to be: 1. Collaborative culture e.g. ethos of shared values (29.9 per cent) 2. Good professional relationships (28.2 per cent) 3. Effective clinical leadership (26.8 per cent) In contrast to the barriers, doctors saw the soft factors including ethos and relationships, which are factors amenable to medical practise as potential enablers of integration. The focus for enablers relates less to the organisational structure. When asked, what their reaction would be if services in their area were merged with another organisation in order to be able to deliver more integrated services, respondents across most sectors (social, secondary/tertiary, community, commissioning) were neutral, and respondents in primary care were mostly welcoming. This does not suggest a particular enthusiasm for merger, but nor does it suggest strong opposition. Doctors perspectives of organisational mergers 7

9 When asked what their main concerns would be if such a merger were to take place the responses were as follows: 1. Whether the merger would achieve objectives (46 per cent) 2. Competing priorities between the merging organisations (33.5 per cent) 3. Disruption to patient care caused by the merger (19.9 per cent) When asked more specifically about organisational mergers. Respondents were overall neutral to this option. Responses suggested they were open to the possibility of mergers if the intention was to improve patient care, but there was also a degree of scepticism that it may not achieve this. Many of the survey respondents questioned whether there is a genuine need for organisational mergers given that the desired outcome of joined up care for patients can be achieved without the costly and difficult merger of organisations. Instead, many felt that efforts should be focussed on establishing more joined up ways of working, and promoting a common ethos of shared values to include cooperation and pragmatic problem solving. The cost of mergers was queried as an unnecessary expense by survey respondents, especially if it resulted in additional layers of management structure. A number of respondents cited poor previous experiences of merging organisations, resulting in poorer patient care due to the distraction of efforts and time required by the merger. Detracting time and resources from patient care with a potential decline in standards was a commonly cited concern. However, some respondents felt that if a merger occurred for the right reasons with efficient planning and insight, some benefits could ensue. This was particularly noted in light of pooling budgets for health and social care. When asked if they had been involved or are currently involved in a merger of organisations for the purpose of integrating services, the majority (78.5 per cent) had not. There have been relatively few mergers to integrate services in the UK. There is little evidence, and little experience of this among doctors. As few doctors appear to have experienced organisational mergers for integration we were interested to find out more about the experiences of those who had been through mergers in light of its future relevance. 8 Doctors perspectives of organisational mergers

10 5. Interviews In order to investigate the themes arising from the surveys, the interviews aimed to find out what mattered to doctors about their experiences of mergers. The questions aimed to discover what had been especially helpful or problematic in their experience of the merger, and whether they viewed the mergers to have resulted in greater integration of patient care. Themes investigated in the interviews included communication and leadership, staff engagement and input, relationship building and evaluation. Those interviewed had experienced a variety of different organisational mergers including: mergers of acute trusts, PCT clustering, and mergers of community and acute trusts. In the majority of cases the aim of the merger had, in the view of the interviewee, been to make financial savings and not primarily for the purposes of integrating services. A number of the interviewees questioned the financial argument for mergers and were unconvinced that mergers would reduce costs. However, the lessons from these experiences of merger can equally be applied when considering mergers that aim to integrate services. The interviews indicated concerns around organisational merger in light of continual organisational change in the NHS. A number of the interviewees described a feeling of uncertainty during the process of organisational mergers, which was worrying for staff. Some interviewees saw this to be a result of the constant change of organisational restructures following successive rounds of NHS reforms. The clustering of PCTs only to be followed by a new system of smaller Clinical Commissioning Groups, therefore greater in number, was given as an example. It was felt that a constant churning of organisations is not helpful to the aim of improving quality and efficiency and that allowing time for structures to settle and mature would provide an opportunity for this development. The rate of change is demoralising and you haven t really settled into one job before somebody tells you you have to apply for a job with another organisation Following the experience of a merger, a number of interviewees felt that it takes time for things to settle down. The change to working life was described as particularly difficult for those staff that are moved to a different site. One interviewee described an example where staff were made to feel unwelcome. It is also difficult for all staff to grow accustomed to changes to their working pattern and protocols that may be the case when services are closed or merged. The issue of staff morale was also raised as an issue in situations where the argument for merger is organisational failure. This is felt keenly by staff working in the failed organisation and this description may not be reflective of the trusts clinical activities. Doctors perspectives of organisational mergers 9

11 Clinical leadership and staff engagement As described in the literature on integration, genuine consultation with all stakeholders including staff, patients and the public is essential to a successful organisational change in order to bring about more integrated services There was a breadth of experience across interviewees in terms of the attempts made by their organisations to communicate with and involve staff in the changes occurring during the merger. While most interviewees described some attempt to communicate and explain changes to staff, few had experienced a genuine two-way staff consultation exercise. Some consultation exercises were perceived as tokenistic. Interviewees said: They clearly had a blue print that had to be met and suggestions that didn t fit it were ignored There were a couple of meetings where people came and told us what was happening In most examples discussed, clinical leaders, such as medical directors were involved in the implementation of the merger. Those in formal leadership roles that were interviewed felt more comfortable with the degree of input from clinical staff. This may indicate a difference between the experience of those in direct communication with trust management and in an influential role and doctors on the ground that may feel relatively disempowered. However, in some examples it was felt that although doctors were involved in decisions, they were under pressure to work within a narrow framework. For example, one interviewee described how due to time pressures and top down directives they felt the care pathways they were involved in designing were not ideal. This suggests that consultation with staff should take place from the beginning of the process to allow meaningful input and genuine two-way communication should invite and consider the views of staff before decisions are made. The need for clear career paths to lead to clinical leadership roles was mentioned by a number of interviewees corroborating findings from other BMA research 19. The requirement for doctors to 17 Ernst & Young, RAND Europe and the University of Cambridge. National evaluation of the Department of Health s integrated care pilots Op cit. Towards integrated care in Trafford BMA. Doctors perspectives on Clinical Leadership Doctors perspectives of organisational mergers

12 maintain a certain amount of clinical practise in order to retain GMC registration was mentioned by two interviewees as a restriction on the amount of time doctors can commit to medical leadership roles raising concerns that this may be a limiting factor in clinical influence. Organisational culture Some interviewees described clear differences of values, and expectations, between organisations that merged. Interviewees mentioned that responsibilities varied across the same roles in different organisations, and that cultures differed with regard to access to services. It was felt that doctors that were moved into new organisations took a while to get used to how things are done in the new system. However, it was felt that these cultural differences settle over time, both differences among staff and between management styles. There was an impression that staff that are moved into a trust were expected to take on board the host trust s way of working, some described this as the dominant trust taking over. Despite none of the interviewees having received any training or formal activities to integrate staff from different organisations, more than one interviewee mentioned a feeling that doctors pull together to make things work and that this informal relationship building ultimately ensures services run effectively. This indicates the need for organisational stability to allow the values and relationships that are so important to joined-up working to develop. Merger into larger organisations A number of interviewees mentioned the larger size of the new/resultant organisation pointing out that communication is less effective in large organisations. This can affect both the communication between hospital management and others where clinical staff are communicating with colleagues on different sites. Logically, it was felt that communication is particularly difficult where sites are far apart. Merging trusts can also produce a feeling of disenfranchisement and reduced professional autonomy among staff. This is particularly true where services are reduced to simplified arrangements, it was felt that already underfunded or undervalued services are particularly at risk of being sidelined. One interviewee who worked in a service that was merged into a larger organisation said: I think it s a de-professionalisation and de-personalisation of the job. I now feel like someone who turns up, does the job and leaves again, I don t feel any loyalty to the trust to do anything extra for them when previously I would have done when I felt we owned the services and wished to develop it Doctors perspectives of organisational mergers 11

13 Some positive aspects of larger organisations were noted, however. Larger departments mean that a broader range of specialities are represented and reduces the need to refer patients outside of the department. In addition, better rotas, and less time on call were mentioned. Achievement of objectives Those that experienced mergers that were not aimed to improve integration of services did not feel that any improvement had been made in the integration of services. They were also not convinced that the objective to improve the organisations finances was achieved by the mergers. Those describing experiences of integration that had occurred in order to integrate services, between acute and community care, for example, found that this had been successful in improving the service for both patients and the doctors working in those services. 12 Doctors perspectives of organisational mergers

14 6. Conclusion This project set out to examine doctors views of organisational mergers in light of the potential for this to help integrate healthcare services. The current policy context across the UK suggests that organisational mergers are more likely to happen in the future. However, the literature on integration suggests that mergers are not necessary or sufficient to bring about integration of services. In order to investigate doctors views we conducted surveys and interviews to gain a greater understanding of their experiences of mergers and the potential of mergers for integration. The findings of both the surveys and interviews indicate that doctors are sceptical about the potential for mergers to bring about integration. The main concerns raised identified the disruption caused during mergers, and that this may not bring the hoped for benefits to patients. The anecdotal evidence shows this was the predominant view of those that had experienced mergers which were not implemented for the primary purpose of integration and situations in which integrating care was the main aim. The two interviewees working in integrated organisations that combined care across the acute and community sector and health and social care were more convinced of the benefits. This suggests that if integration is a purposeful aim there is more potential to achieve improvements in integrating care. Where future organisational mergers are considered, whether the primary objective is integration or not, consideration should be given as to how services can be better integrated by the merger. These findings suggest that doctors largely agree with the literature that suggests that mergers in themselves are not sufficient to cause integration. However, there may be benefits from integration if this is built in as an objective for the merger. Doctors descriptions of negative experiences reported in both the surveys and interviews are a clear sign that there is work to be done in ensuring that merging of organisations does not alienate the medical workforce. In doing so, this could damage services, and possibly act as a barrier to integration. A number of the experiences mentioned in the interviews could give this impression, such as lack of ownership, lack of consultation and input to changes in services, and difficult relationships between staff moved onto new sites. It is important that lessons are learned from previous experiences of organisational mergers and attempts to integrate services. None of the interviewees had been aware of an evaluation of the merger activity in their organisation. Even after accounting for our small number of interviews this is a worrying finding. If organisational mergers are to become more common, to meet with the aim of integration or in order to implement other policy measures, proper evaluation is essential in order to learn from previous experiences. Doctors perspectives of organisational mergers 13

15

Collaboration in general practice: surveys of GPs and CCGs

Collaboration in general practice: surveys of GPs and CCGs Collaboration in general practice: surveys of GPs and CCGs Stephanie Kumpunen, Nuffield Trust Natasha Curry, Nuffield Trust Nigel Edwards, Nuffield Trust Dr Mike Holmes, Royal College of General Practitioners

More information

Test your talent How does your approach to talent strategy measure up?

Test your talent How does your approach to talent strategy measure up? 1 Test your talent How does your approach to talent strategy measure up? Talent strategy or struggle? Each year at Head Heart + Brain we carry out research projects to help understand best practice in

More information

Board report for 31 May 06 Item 8

Board report for 31 May 06 Item 8 Board report for 31 May 06 Item 8 DRAFT Internal communications strategy Contents 1. Executive Summary 2. Introduction 3. Background 4. The vision for communications 5. Strategic objectives 6. Early priorities

More information

SECTION 1: Example Exercise Outcomes. Instructions and Questions Booklet. AssessmentDay. Practice Assessments

SECTION 1: Example Exercise Outcomes. Instructions and Questions Booklet. AssessmentDay. Practice Assessments SECTION 1: Example Exercise Outcomes SECTION 2: Competencies Competency and Behavioural Indicators Based Interview Instructions and Questions Booklet Practice Assessments Instructions These competency

More information

Student Bursaries, Funding and Finance in England

Student Bursaries, Funding and Finance in England RCN Policy and International Department Policy briefing 11/15 December 2015 Student Bursaries, Funding and Finance in England An update on the proposed changes to student nurse bursaries and the RCN position

More information

Investors in People Assessment Report. Presented by Alli Gibbons Investors in People Specialist On behalf of Inspiring Business Performance Limited

Investors in People Assessment Report. Presented by Alli Gibbons Investors in People Specialist On behalf of Inspiring Business Performance Limited Investors in People Assessment Report for Bradstow School Presented by Alli Gibbons Investors in People Specialist On behalf of Inspiring Business Performance Limited 30 August 2013 Project Reference Number

More information

Why communication is key to successful change management. Case study

Why communication is key to successful change management. Case study Case study Why communication is key to successful change management Whether to gain a competitive advantage, survive the global economic downturn or improve operational efficiencies, most companies have

More information

Measuring the Impact of Volunteering

Measuring the Impact of Volunteering Measuring the Impact of Volunteering Why is measuring the impact of volunteering important? It is increasingly important for organisations or groups to describe the difference that volunteering makes to,

More information

Evaluation of the first year of the Inner North West London Integrated Care Pilot. Summary May 2013. In partnership with

Evaluation of the first year of the Inner North West London Integrated Care Pilot. Summary May 2013. In partnership with Evaluation of the first year of the Inner North West London Integrated Care Pilot Summary May 2013 In partnership with 2 The North West London Integrated Care Pilot is a large-scale programme incorporating

More information

NHS Staff Management and Health Service Quality

NHS Staff Management and Health Service Quality NHS Staff Management and Health Service Quality Michael West 1 and Jeremy Dawson 2 1 Lancaster University Management School and The Work Foundation 2 Aston Business School Foreword This report draws on

More information

BriefingPaper. The access/relationship trade off: how important is continuity of primary care to patients and their carers?

BriefingPaper. The access/relationship trade off: how important is continuity of primary care to patients and their carers? CONTINUITY OF CARE SEPTEMBER 2006 BriefingPaper The access/relationship trade off: how important is continuity of primary care to patients and their carers? Key messages Patients want both quick access

More information

Zainab Zahran The University of Sheffield School of Nursing and Midwifery

Zainab Zahran The University of Sheffield School of Nursing and Midwifery Understanding advanced nursing practice: perspectives from Jordan RCN-The 2010 International Nursing Research Conference Zainab Zahran The University of Sheffield School of Nursing and Midwifery Aims and

More information

Care service inspection report

Care service inspection report Care service inspection report Full inspection Richmondhill House Care Home Service 18 Richmondhill Place Aberdeen Inspection completed on 25 May 2016 Service provided by: Aberdeen Association of Social

More information

Public Health Wales NHS Trust Job Description Professional Lead Consultant for Health Protection

Public Health Wales NHS Trust Job Description Professional Lead Consultant for Health Protection Public Health Wales NHS Trust Job Description Professional Lead Consultant for Health Protection Accountable to Director of Health Protection (managerially) and the Executive Director of Public Health

More information

CONSULTANT OCCUPATIONAL THERAPIST

CONSULTANT OCCUPATIONAL THERAPIST 21 College of COT/ BAOT Briefings CONSULTANT OCCUPATIONAL THERAPIST Publication Date: August 2007 Lead Group: Professional Practice Review Date: August 2009 Country Relevance: UK Introduction The purpose

More information

Making Foreign Languages compulsory at Key Stage 2 Consultation Report: Overview

Making Foreign Languages compulsory at Key Stage 2 Consultation Report: Overview Making Foreign Languages compulsory at Key Stage 2 Consultation Report: Overview Introduction This report summarises the responses to the consultation on the Government s proposal to introduce foreign

More information

Guideline scope Workplace health: support for employees with disabilities and long-term conditions

Guideline scope Workplace health: support for employees with disabilities and long-term conditions NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Workplace health: support for employees with disabilities and long-term conditions Short title Workplace health: employees with disabilities

More information

Section 4: Key Informant Interviews

Section 4: Key Informant Interviews UCLA CENTER FOR HEALTH POLICY RESEARCH Section 4: Key Informant Interviews Purpose Key informant interviews are qualitative in-depth interviews with people who know what is going on in the community. The

More information

360 feedback. Manager. Development Report. Sample Example. name: email: date: sample@example.com

360 feedback. Manager. Development Report. Sample Example. name: email: date: sample@example.com 60 feedback Manager Development Report name: email: date: Sample Example sample@example.com 9 January 200 Introduction 60 feedback enables you to get a clear view of how others perceive the way you work.

More information

Objective Oriented Planning Module 1. Stakeholder Analysis

Objective Oriented Planning Module 1. Stakeholder Analysis III. Stakeholder Analysis Stakeholders are people, groups, or institutions, which are likely to be affected by a proposed project (either negatively or positively), or those which can affect the outcome

More information

The publication of fitness to practise data by secondary care location in the UK: guide to the data

The publication of fitness to practise data by secondary care location in the UK: guide to the data Appendix B The publication of fitness to practise data by secondary care location in the UK: guide to the data For terminology used in the data and in the memo please see Annex A. Our Role 1. As the regulator

More information

GP attitudes and practices relating to the provision of medical evidence as part of the Employment and Support Allowance (ESA) claim process

GP attitudes and practices relating to the provision of medical evidence as part of the Employment and Support Allowance (ESA) claim process GP attitudes and practices relating to the provision of medical evidence as part of the Employment and Support Allowance (ESA) claim process Background CAB advisers know it s more likely the Department

More information

Perspectives. Employee voice. Releasing voice for sustainable business success

Perspectives. Employee voice. Releasing voice for sustainable business success Perspectives Employee voice Releasing voice for sustainable business success Empower, listen to, and act on employee voice through meaningful surveys to help kick start the UK economy. 2 Releasing voice

More information

BMJcareers. Informing Choices

BMJcareers. Informing Choices : The Need for Career Advice in Medical Training How should the support provided to doctors and medical students to help them make career decisions during their training be improved? Experience elsewhere

More information

When being a good lawyer is not enough: Understanding how In-house lawyers really create value

When being a good lawyer is not enough: Understanding how In-house lawyers really create value When being a good lawyer is not enough: Understanding how In-house lawyers really create value Contents Foreword... 3 Do you really understand how In-house lawyers create value?... 4 Why creating value

More information

Carr Gomm - Edinburgh Housing Support Service 16-18 London Road Edinburgh EH7 5AT Telephone: 0131 228 6623

Carr Gomm - Edinburgh Housing Support Service 16-18 London Road Edinburgh EH7 5AT Telephone: 0131 228 6623 Carr Gomm - Edinburgh Housing Support Service 16-18 London Road Edinburgh EH7 5AT Telephone: 0131 228 6623 Inspected by: David Todd Type of inspection: Announced (Short Notice) Inspection completed on:

More information

Consultation Questionnaire. The case for change

Consultation Questionnaire. The case for change Annex G Consultation Questionnaire The case for change Question 1: Is the proposal to focus initially, after legislation is enacted, on improving outcomes for older people, and then to extend our focus

More information

Policy Statement 16/2006. Acute and Multidisciplinary Working

Policy Statement 16/2006. Acute and Multidisciplinary Working RCN Policy Unit Policy Statement 16/2006 Acute and Multidisciplinary Working The Royal College of Nursing of the United Kingdom and the Royal College of Physicians (London) September 2006 Royal College

More information

Tracing the impacts of public dialogue projects supported by Sciencewise

Tracing the impacts of public dialogue projects supported by Sciencewise Tracing the impacts of public dialogue projects supported by Sciencewise: Recruiting participants for health research March 2016 Page 1 of 6 Recruiting participants for health research Key facts Date August

More information

Developing a database to support patient and public engagement (PPE) A DH PPI pathfinder project with Leeds South and East CCG

Developing a database to support patient and public engagement (PPE) A DH PPI pathfinder project with Leeds South and East CCG Developing a database to support patient and public engagement (PPE) A DH PPI pathfinder project with Leeds South and East CCG MSDi Overview History Established in 2000 by MSD to leverage emerging informatics

More information

The Royal College of Pathologists response to Lord Carter s report on operational productivity, February 2016

The Royal College of Pathologists response to Lord Carter s report on operational productivity, February 2016 The Royal College of Pathologists response to Lord Carter s report on operational productivity, February 2016 Executive summary Background Lord Carter s independent report, Operational productivity and

More information

Augmented reality enhances learning at Manchester School of Medicine

Augmented reality enhances learning at Manchester School of Medicine Augmented reality enhances learning at Manchester School of Medicine Welcome to the Jisc podcast. The University of Manchester is taking a unique approach to prescription training for its medical students

More information

YOUR SERVICES YOUR SAY

YOUR SERVICES YOUR SAY YOUR SERVICES YOUR SAY LGBT PEOPLE S EXPERIENCES OF PUBLIC SERVICES IN SCOTLAND PUBLIC SECTOR CONSULTATION REPORT AND RECOMMENDATIONS FOREWORD In 2014 for the first time in Scotland, we published a detailed

More information

Making a positive difference for energy consumers. Competency Framework Band C

Making a positive difference for energy consumers. Competency Framework Band C Making a positive difference for energy consumers Competency Framework 2 Competency framework Indicators of behaviours Strategic Cluster Setting Direction 1. Seeing the Big Picture Seeing the big picture

More information

Understanding sport and physical activity as a therapy choice for young disabled people. Views and opinions of paediatric physiotherapists

Understanding sport and physical activity as a therapy choice for young disabled people. Views and opinions of paediatric physiotherapists Understanding sport and physical activity as a therapy choice for young disabled people Views and opinions of paediatric physiotherapists 2 Contents Acknowledgements... 4 Executive Summary... 6 Section

More information

Statement on the core values and attributes needed to study medicine

Statement on the core values and attributes needed to study medicine Statement on the core values and attributes needed to study medicine Introduction This statement sets out the core values and attributes needed to study medicine in the UK. This is not an exhaustive list

More information

NON CONSULTANT CAREER GRADE DOCTORS AN IMPORTANT PART OF THE PAEDIATRIC WORKFORCE

NON CONSULTANT CAREER GRADE DOCTORS AN IMPORTANT PART OF THE PAEDIATRIC WORKFORCE NON CONSULTANT CAREER GRADE DOCTORS AN IMPORTANT PART OF THE PAEDIATRIC WORKFORCE Background Non consultant career grade doctors (NCCGs) have traditionally formed a large part of the paediatric workforce.

More information

A SCOPING REVIEW OF HEALTH VISITING AND SCHOOL NURSING

A SCOPING REVIEW OF HEALTH VISITING AND SCHOOL NURSING ANEURIN BEVAN HEALTH BOARD A SCOPING REVIEW OF HEALTH VISITING AND SCHOOL NURSING EXECUTIVE SUMMARY 1. Health visiting and school nursing services differ from other health services in that they are concerned

More information

THE HEALTH & SOCIAL CARE

THE HEALTH & SOCIAL CARE THE HEALTH & SOCIAL CARE SECTOR in greater manchester overview of skills ISSUES 1. INTRODUCTION This briefing summarises the findings of primary and secondary research in respect of the skills and training

More information

The Audit of Best Value and Community Planning The City of Edinburgh Council. Best Value audit 2016

The Audit of Best Value and Community Planning The City of Edinburgh Council. Best Value audit 2016 The Audit of Best Value and Community Planning The City of Edinburgh Council Best Value audit 2016 Report from the Controller of Audit February 2016 The Accounts Commission The Accounts Commission is the

More information

SPRING 2013 SENIOR MANAGEMENT SURVEY RESULTS

SPRING 2013 SENIOR MANAGEMENT SURVEY RESULTS SPRING SENIOR MANAGEMENT SURVEY RESULTS WELCOME RESULTS OF OUR CORNERSTONE SPRING SURVEY As a world-ranked recruiting and leadership development organisation, we seek to inform and advise businesses on

More information

Case Study: A collaborative approach to Strategic Estates Planning The Urgent Care Centre at Widnes Health and Resource Centre

Case Study: A collaborative approach to Strategic Estates Planning The Urgent Care Centre at Widnes Health and Resource Centre Case Study: A collaborative approach to Strategic Estates Planning The Urgent Care Centre at Widnes Health and Resource Centre Case study: The Urgent Care Centre at Widnes Health Care Resource Centre To

More information

Witness information. Investigations

Witness information. Investigations Witness information Investigations We are the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. We exist to safeguard the health and wellbeing of the public.

More information

A guide for prospective registrants and admissions staff. A disabled person s guide to becoming a health professional

A guide for prospective registrants and admissions staff. A disabled person s guide to becoming a health professional A guide for prospective registrants and admissions staff A disabled person s guide to becoming a health professional Contents Who is this document for? 1 About the structure of this document 1 Section

More information

Information for Parents and Students

Information for Parents and Students Information for Parents and Students CONTENTS Welcome... 3 Obtaining entry into medicine... 4 What should I do now? Three years from completing high school... 8 Two years from completing high school...

More information

Liberating the NHS regulating healthcare providers consultation on proposals

Liberating the NHS regulating healthcare providers consultation on proposals Liberating the NHS regulating healthcare providers consultation on proposals This document is the response from Association of British Healthcare Industries (ABHI) to the consultation above. ABHI has responded

More information

Scoping Study on Service Design

Scoping Study on Service Design Scoping Study on Service Design Submitted by the Madano Partnership to: FINAL REPORT December 2012 1 Executive Summary This short executive summary pulls together our reflections on the main areas of enquiry:

More information

MINUTE TAKING. All material copyright of Lindsay Wright This pack is for sample purposes only, and not for re-use

MINUTE TAKING. All material copyright of Lindsay Wright This pack is for sample purposes only, and not for re-use MINUTE TAKING All material copyright of Lindsay Wright This pack is for sample purposes only, and not for re-use 1 Minute Taking Sample Programme OBJECTIVES As a result of the programme participants should

More information

Big Lottery Fund Research Issue 24. Out of School Hours Childcare: lessons learnt and themes for the future

Big Lottery Fund Research Issue 24. Out of School Hours Childcare: lessons learnt and themes for the future Big Lottery Fund Research Issue 24 Out of School Hours Childcare: lessons learnt and themes for the future 1 Out of School Hours Childcare: lessons learnt and themes for the future Stock code BIG-OSHCHILD

More information

An overview of Modernising Scientific Careers (Gateway Ref: 14943)

An overview of Modernising Scientific Careers (Gateway Ref: 14943) An overview of Modernising Scientific Careers (Gateway Ref: 14943) Why does healthcare science need to evolve? A combination of factors is driving the need for change in the education and training arrangements

More information

Care service inspection report

Care service inspection report Care service inspection report Full inspection Stirling Home Care Service Support Service Wallace House 17-21 Maxwell Place Stirling Inspection completed on 13 May 2016 Service provided by: Sue Ryder Service

More information

Participants Manual Video Seven The OSCAR Coaching Model

Participants Manual Video Seven The OSCAR Coaching Model Coaching Skills for Managers Online Training Programme Part One Fundamentals of Coaching Participants Manual Video Seven The OSCAR Coaching Model Developed by Phone: 01600 715517 Email: info@worthconsulting.co.uk

More information

Integrating Health and Social Care in England: Lessons from Early Adopters and Implications for Policy

Integrating Health and Social Care in England: Lessons from Early Adopters and Implications for Policy Knowledge base Integrating Health and Social Care in England: Lessons from Early Adopters and Implications for Policy Chris Ham Professor of Health Policy and Management John Oldham Honorary Senior Fellow

More information

Improving Our Services for Older People in Cardiff and the Vale of Glamorgan. The Development of Clinical Gerontology Services

Improving Our Services for Older People in Cardiff and the Vale of Glamorgan. The Development of Clinical Gerontology Services Improving Our Services for Older People in Cardiff and the Vale of Glamorgan The Development of Clinical Gerontology Services What s this document about? Cardiff and Vale University Health Board (UHB)

More information

EU-WISE: Enhancing self-care support for people with long term conditions across Europe

EU-WISE: Enhancing self-care support for people with long term conditions across Europe EU-WISE: Enhancing self-care support for people with long term conditions across Europe Summary framework and study protocol for the EU-WISE intervention EUGENIE Project partners: SOTON UNWE UNAV UniO

More information

Communications strategy refresh. January 2012. 1 c:\documents and settings\mhln.snh\objcache\objects\a654473.doc

Communications strategy refresh. January 2012. 1 c:\documents and settings\mhln.snh\objcache\objects\a654473.doc Communications strategy refresh January 2012 1 c:\documents and settings\mhln.snh\objcache\objects\a654473.doc Contents 1. Introduction p 3 a. SNH: corporate aims and objectives b. SNH and communications

More information

Principles and standards in Independent Advocacy organisations and groups

Principles and standards in Independent Advocacy organisations and groups advocacy 2 0 0 0 Principles and standards in Independent Advocacy organisations and groups Advocacy 2000 January 2002 We would like to acknowledge that the Scottish Executive partly funded the editing

More information

A Review of the Integration of Brokerage Services in the South West

A Review of the Integration of Brokerage Services in the South West A Review of the Integration of Brokerage Services in the South West EXECUTIVE SUMMARY This report presents the findings of the research study, A Review of the Integration of Brokerage Services in the South

More information

2. What type of job are you seeking? It can help to have a specific objective or use the position to craft a targeted resume.

2. What type of job are you seeking? It can help to have a specific objective or use the position to craft a targeted resume. The Purpose of a Resume A Marketing Tool: Designed to capture attention and get you to the next stage in the recruitment process. It presents the skills, accomplishments and qualifications that you bring

More information

Board of Member States ERN implementation strategies

Board of Member States ERN implementation strategies Board of Member States ERN implementation strategies January 2016 As a result of discussions at the Board of Member States (BoMS) meeting in Lisbon on 7 October 2015, the BoMS set up a Strategy Working

More information

Introductory Level Management Training Programme

Introductory Level Management Training Programme Introductory Level Management Training 2016 Foreword January 2016 Managers and supervisors across the career development sector, be this in the context of career education, career guidance/development,

More information

Careers and the world of work: roles and responsibilities

Careers and the world of work: roles and responsibilities Careers and the world of work: roles and responsibilities Careers and the world of work: roles and responsibilities Audience Headteachers, principals, governing bodies, management committees, careers and

More information

Social Return on Investment

Social Return on Investment Social Return on Investment Valuing what you do Guidance on understanding and completing the Social Return on Investment toolkit for your organisation 60838 SROI v2.indd 1 07/03/2013 16:50 60838 SROI v2.indd

More information

A Guide to Cover Letter Writing

A Guide to Cover Letter Writing A Guide to Cover Letter Writing Contents What is a Cover Letter?... 2 Before you get started - Do your Research... 3 Formatting the letter... 4 Cover letter content... 5 Section 1 - Opening... 5 Section

More information

UNSOCIAL HOURS ARRANGEMENTS IN THE PUBLIC AND PRIVATE SECTORS

UNSOCIAL HOURS ARRANGEMENTS IN THE PUBLIC AND PRIVATE SECTORS UNSOCIAL HOURS ARRANGEMENS IN HE PUBLIC AND PRIVAE SECORS Introduction his factsheet provides a comparison of the main features of unsocial hours schemes across public sector bargaining groups as well

More information

Shell Mentoring Toolkit

Shell Mentoring Toolkit Shell Mentoring Toolkit A reference document for mentors and mentees Human Resources LEARNING 25/07/2007 Copyright: Shell International Ltd 2006 CONTENTS What is Mentoring? 4 The Mentor s Role The Role

More information

Why Disruptive Innovations Matter in Laboratory Diagnostics

Why Disruptive Innovations Matter in Laboratory Diagnostics Article: S. Nam.. Clin Chem 2015;61:935-937. http://www.clinchem.org/content/61/7/935.extract Guest: Spencer Nam is a Research Fellow specializing in healthcare at the Clayton Christensen Institute for

More information

Care service inspection report

Care service inspection report Care service inspection report Full inspection Inspire Huntly Housing Support Service 18 Milton Wynd Huntly Inspection completed on 11 May 2016 Service provided by: Inspire (Partnership Through Life) Ltd

More information

BMA SURVEY OF CONSULTANT WORKING PATTERNS AND ON CALL SERVICES

BMA SURVEY OF CONSULTANT WORKING PATTERNS AND ON CALL SERVICES BMA SURVEY OF CONSULTANT WORKING PATTERNS AND ON CALL SERVICES Health Policy and Economic Research Unit Report author: Duncan Bland Ocber 2014 bma.org.uk British Medical Association, 2014 Index Executive

More information

Personal Branding. Our survey reveals the performance drivers for Brand YOU. June 2012

Personal Branding. Our survey reveals the performance drivers for Brand YOU. June 2012 Personal Branding Our survey reveals the performance drivers for Brand YOU. June 2012 Views of all management levels, professional and technical employees and team members. Methodology Branding can be

More information

Quality with Compassion: the future of nursing education

Quality with Compassion: the future of nursing education Quality with Compassion: the future of nursing education Report of the Willis Commission 2012 Executive summary Introduction Nursing is a demanding yet rewarding profession that asks a lot of its workers.

More information

Case study: Improving performance in HR London Camden

Case study: Improving performance in HR London Camden Case study: Improving performance in HR London Camden The London Borough of Camden is in the heart of London and employs over 5,000 people. The borough s HR directorate has a major influence on the core

More information

Supporting best practice in community development. Reaping the Legacy of the Commonwealth Games

Supporting best practice in community development. Reaping the Legacy of the Commonwealth Games scottish community development centre Supporting best practice in community development VOiCE Case Studies Reaping the Legacy of the Commonwealth Games Suite 305, Baltic Chambers, 50 Wellington Street,

More information

What are the key current issues shaping equity release by older home owners?

What are the key current issues shaping equity release by older home owners? What are the key current issues shaping equity release by older home owners? Round table discussion November 7th 2012 About this project Focus today on equity release but a bigger picture. Initial proposal

More information

At the beginning of a presentation I like to make sure that we are all on the same page when I say value-based purchasing so here is the definition

At the beginning of a presentation I like to make sure that we are all on the same page when I say value-based purchasing so here is the definition 1 Idea of Value-Based Purchasing is scary to some. During today s session I hope to give you the tools to understand basic terms, ideas, and options for working with health plans and in developing value-based

More information

4 Year Primary Degree QTS Student Survey Summer 2007

4 Year Primary Degree QTS Student Survey Summer 2007 4 Year Primary Degree QTS Student Survey Summer 2007 The 4 year Primary QTS degree team conducted a survey of student teachers in their final year of the 4 year Primary degree QTS. Institutions represented

More information

Employee Engagement FY15. 1. Introduction. 2. Employee Engagement. 3. Management Approach

Employee Engagement FY15. 1. Introduction. 2. Employee Engagement. 3. Management Approach 1. Introduction This document forms part of our Disclosures on Management Approach (DMA) series, prepared in accordance with the Global Reporting Initiative s G4 Guidelines. The DMA series is designed

More information

Staff engagement in the NHS: some local experience

Staff engagement in the NHS: some local experience November 2010 Briefing 79 Staff engagement can help the NHS meet the challenges of reducing costs, raising productivity and implementing the organisational changes arising from the NHS White Paper. High

More information

Revalidating Doctors Ensuring standards, securing the future: Response to the General Medical Council consultation document

Revalidating Doctors Ensuring standards, securing the future: Response to the General Medical Council consultation document Revalidating Doctors Ensuring standards, securing the future: Response to the General Medical Council consultation document Introduction The Academy supports the principles of revalidation and welcomes

More information

Survey of DC pension scheme members

Survey of DC pension scheme members Survey of DC pension scheme members A research report on understanding, engagement and perception among members of defined contribution (DC) occupational and work-based personal pension schemes Contents

More information

WHAT WORKS IN INNOVATION AND EDUCATION IMPROVING TEACHING AND LEARNING FOR ADULTS WITH BASIC SKILL NEEDS THROUGH FORMATIVE ASSESSMENT STUDY OUTLINE

WHAT WORKS IN INNOVATION AND EDUCATION IMPROVING TEACHING AND LEARNING FOR ADULTS WITH BASIC SKILL NEEDS THROUGH FORMATIVE ASSESSMENT STUDY OUTLINE WHAT WORKS IN INNOVATION AND EDUCATION IMPROVING TEACHING AND LEARNING FOR ADULTS WITH BASIC SKILL NEEDS THROUGH FORMATIVE ASSESSMENT STUDY OUTLINE The OECD s Centre for Educational Research and Innovation

More information

Pharmacovigilance and the Internet: A Call for Change

Pharmacovigilance and the Internet: A Call for Change Pharmacovigilance and the Internet: A Call for Change A white paper from the ABPI Pharmacovigilance Expert Network 13 June 2011 Page 2 of 6 Pharmacovigilance and the Internet: A Call for Change (ABPI)

More information

Case manager. Person specification and competencies. Version 2 November 2013 www.revalidationsupport.nhs.uk

Case manager. Person specification and competencies. Version 2 November 2013 www.revalidationsupport.nhs.uk Case manager Person specification and competencies www.revalidationsupport.nhs.uk Contents Introduction Purpose and context Primary audience What is a case manager? Person specification Competency framework

More information

TECHNICALS LEVEL 2016 3 BUSINESS

TECHNICALS LEVEL 2016 3 BUSINESS 2016 Suite Cambridge TECHNICALS LEVEL 3 BUSINESS Unit 16 Principles of project management M/507/8163 Guided learning hours: 60 Version 2 - Revised content - March 2016 ocr.org.uk/business LEVEL 3 UNIT

More information

PACIFIC ISLANDS FORUM SECRETARIAT FEMM BIENNIAL STOCKTAKE 2012

PACIFIC ISLANDS FORUM SECRETARIAT FEMM BIENNIAL STOCKTAKE 2012 PACIFIC ISLANDS FORUM SECRETARIAT PIFS(12)FEMK.05 FORUM ECONOMIC MINISTERS MEETING Tarawa, Kiribati 2-4 July 2012 SESSION 2 FEMM BIENNIAL STOCKTAKE 2012 The attached paper, prepared by the Forum Secretariat,

More information

DEVELOPING COLLECTIVE LEADERSHIP IN HIGHER EDUCATION

DEVELOPING COLLECTIVE LEADERSHIP IN HIGHER EDUCATION Supported by DEVELOPING COLLECTIVE LEADERSHIP IN HIGHER EDUCATION Executive Summary to the Interim Report Georgy Petrov, Richard Bolden and Jonathan Gosling Centre for Leadership Studies University of

More information

Business Benefits of Volunteering

Business Benefits of Volunteering Business Benefits of Volunteering An introduction to skills based volunteering Mari Frengstad TABLE OF CONTENT: Executive Summary... 3 Introduction... 5 What skills are key to Hammerson s success?... 5

More information

Achieve. Performance objectives

Achieve. Performance objectives Achieve Performance objectives Performance objectives are benchmarks of effective performance that describe the types of work activities students and affiliates will be involved in as trainee accountants.

More information

Update on NHSCB Key features of (proposed) NHSCB operating model for primary care

Update on NHSCB Key features of (proposed) NHSCB operating model for primary care Aim to cover Update on NHSCB Key features of (proposed) NHSCB operating model for primary care NHSCB dental commissioning strategy all dental services Concept and context of local professional networks

More information

Response of the Royal College of Nursing to the Nursing and Midwifery Council consultation on revalidation

Response of the Royal College of Nursing to the Nursing and Midwifery Council consultation on revalidation Response of the Royal College of Nursing to the Nursing and Midwifery Council consultation on revalidation With a membership of over 410,000 registered nurses, midwives, health visitors, nursing students,

More information

Supporting information for appraisal and revalidation

Supporting information for appraisal and revalidation Supporting information for appraisal and revalidation During their annual appraisals, doctors will use supporting information to demonstrate that they are continuing to meet the principles and values

More information

EXECUTIVE SUMMARY: 2013 ICF Organizational Coaching Study

EXECUTIVE SUMMARY: 2013 ICF Organizational Coaching Study EXECUTIVE SUMMARY: 2013 ICF Organizational Coaching Study coachfederation.org Formed in 1995, today the International Coach Federation (ICF) is the leading global organization, with more than 20,000* members,

More information

Childcare for adult learners in further education

Childcare for adult learners in further education Childcare for adult learners in further education Access to further education (FE) and training is crucial if parents are to gain stable and well-paid employment. It is also vital for reducing child poverty.

More information

UK Commission s Employer Perspectives Survey 2012. Executive Summary 64 December 2012

UK Commission s Employer Perspectives Survey 2012. Executive Summary 64 December 2012 UK Commission s Employer Perspectives Survey 2012 Executive Summary 64 December 2012 UK Commission s Employer Perspectives Survey 2012 Jan Shury, David Vivian, Katie Gore, Camilla Huckle, IFF Research

More information

Who can do an SVQ? How they work

Who can do an SVQ? How they work A guide to SVQs What are SVQs? Scottish Vocational Qualifications (SVQs) are based on national standards which are drawn up by people from industry, commerce and education. SVQs are badges or benchmarks

More information

Citizenship education in Northern Ireland, Wales, Scotland and England

Citizenship education in Northern Ireland, Wales, Scotland and England Citizenship education in Northern Ireland, Wales, Scotland and England Northern Ireland The Northern Ireland curriculum is described as six Areas of Learning at key stages 1 and 2: Language and Literacy

More information

Medical Appraisal Guide

Medical Appraisal Guide A guide to medical appraisal for revalidation in England March 2013 (reissued with updated hyperlinks September 2014) www.england.nhs.uk/revalidation/ Contents Introduction 3 Purpose and context 4 Primary

More information

The Child at the Centre. Overview

The Child at the Centre. Overview The Child at the Centre Overview Giving our children the best start in life Twin aims of early education and childcare: Free part-time quality pre-school education place for all three and four year olds;

More information

Care service inspection report

Care service inspection report Care service inspection report Full inspection 1st Homecare Ltd Housing Support Service Banchory Business Centre Burn O Bennie Road Banchory Inspection completed on 10 June 2016 Service provided by: 1st

More information

Announcement. Interreg Project Management Camp. 28 June 1July 2016 Gothenburg, Sweden. Dear Colleague,

Announcement. Interreg Project Management Camp. 28 June 1July 2016 Gothenburg, Sweden. Dear Colleague, Interreg Project Management Camp 28 June 1July 2016 Gothenburg, Sweden Announcement Dear Colleague, Following the success of the Project Management Camps held in 2015, two more Camps are being planned

More information