Public: Wellbeing + Comment | Public

The road to recovery

Fri, 07 May 2010 09:15:00 GMT

While celebrities may check themselves into an expensive rehab clinic for a 'miracle cure', recovery for most people struggling from an addiction is long and hard - which is why they need all the support they can get

Ask any member of the public how to beat a drug or drink problem and, chances are, they'll say; you first check into an expensive rehab, you learn to abstain, you exercise, you eat healthily, and a few months later you emerge all fixed and ready to go and take your place in the world again.

This is the media story of the 'recovered' celebrity. Strong disapproval is dealt out to those in the limelight who are deemed to have 'failed' to get better. No recognition is given to the possibility that they may be struggling with an addiction.

And this is the reality for the many, the road to recovery is long and hard. People need a lot of support. It can take years for them to turn their lives around.

Treatment is inevitably a complex process

For it to work treatment is inevitably a complex process that is tailored to the individual. Each person needs committed and caring support as they move forward step by step. And they can at any point relapse and disappear but the hope is they will come back. There really is no simple, short sharp shock solution and there are no absolutes. Far too much talk about recovery focuses on the media celebrity model.

Until an open discussion about what recovery really means takes place - putting people with drug and alcohol problems in the driving seat - the media' s mythical one way route to salvation will remain.

The people we see and work with at Addaction have complex lives and their problems are not just with drugs and alcohol. They often have difficulties with relationships, family, education, employment, mental health or housing.

Some of these may be the cause of their drug use, others may have been caused by it – but for someone to truly recover, each of these needs to be addressed.

One of the first steps along the way is, without a doubt, to reduce the harm that someone's drinking or drug use is causing to their health, the way they live, and the distress to those around them. Some people can stop immediately, the majority can't; but that doesn't mean they can't still be helped.

In my discussions with services, users trust is a critical factor in this journey. People need to feel safe and supported in order to begin the journey to recovery. For many this first step is engaging with a service such as one of our 'needle exchanges' - all of which are part of community projects.

Like methadone and substitute prescribing this is not the goal it just a start. We run the risk of failing to truly support people if we do not have as our ultimate aim of getting people free of their addiction.

We owe it to everyone person who seeks our help, in what ever service, for whatever addiction the belief that they can recover completely and, on the way, rediscover the family, friends and relationships they once had.

Simon Antrobus is chief executive of Addaction

Weblink

National Treatment Agency for Substance Misuse microsite - explaining the benefits of supporting recovery and reintegration from drug addiction: guardian.co.uk/drug-treatment

Culture, champions and politics

Thu, 18 Mar 2010 12:16:36 GMT

There's no point dancing around the issue - arts and culture are hugely important to the nation's health and wealth and should be supported accordingly, says Gail Brown

Last month's Dance Summit fell at a curious time as there is much debate in the cultural sector at large, whether it is about funding the future of dance, supporting new talent or succession planning for creative leaders.

The Dance Champions have a target of getting 100,000 more people dancing by 2012 and they were enthusiastic, open to discussion and curious as to how they can a) achieve this and b) support the dance sector up to and beyond 2012.

The current picture of dance highlights national and regional dance agencies and Youth Dance England are firmly embedding infrastructure for dancers across the generations.

A collective approach to national dance delivery

Arts Council England is utilising the recent dance mapping research and leading a national arts debate, Big Dance has embraced a collective approach to national dance delivery working with key organisations such as Foundation for Community Dance, Central Council for Physical Recreation, Dance Champions, Youth Dance England and the National Association of Local Government Arts Officers.

Meanwhile, Allan Davey, chief executive of Arts Council England (ACE) continues to lobby for sustained investment in the arts.

Dance UK is leading us by example both in terms of joined up approaches to political lobbying across the world and by embracing new approaches to supporting dance, such as working with the Dance Champions.

This organisation provides evidence to the ever growing arguments for dance and culture to make the case that it deserves ongoing investment. Almost five million people participate in community dance each year, a total of 10,000 students are in training a year and the dance workforce is 40,000 people.

Furthermore dance is the second most popular physical activity for young people after football and the most popular physical activity for girls and there are 50 professional dance companies in the UK producing over 500 productions every year which are enjoyed by over one million people.

Last week, at the National Campaign for the Art's London Art Hustings, Lib Dem MP Don Foster said that of every "£100 that the government spends in and on this Country 7p of it goes to art and culture". Foster also stated that it would be "economic madness and cultural vandalism to even think about cutting this".

Art and culture are integral to place making

All political parties agree that culture addresses a variety of key local and national priorities such as health, education, reduction in crime and repeat youth offending. Art and culture are integral to place making, regeneration and the growth of capital infrastructure as well as creative industries.

There is a wealth of evidence to illustrate where we are spending large amounts of money on continued problem areas. For example within the last year alone Birmingham Total Place findings highlighted that a high contact family costs up to £250,000 per year. Nationally we recognise that the average cost of a young person being held in a youth offending institute is £100,000 per year and the obesity epidemic is costing the country millions of pounds.

An average youth arts project for young people, in the first instance aimed at addressing one of the many social issues such as social exclusion, high truancy rates, bullying, low academic achievement, isolation and crime as well as encouraging growth in confidence, communication skills, self esteem and empowerment could cost as little as £150 a day (working with between 10-30 participants).

It is time to invest in the front line, the engine room, the artists, producers, spaces, consistent education across all key stages and succession planning for cultural leaders of the future. We must maintain investment in local authorities arts development and arts development teams.

Culture and art make an extraordinary contribution to this country and we must continue to create a climate for improvement, including all elements of culture. This is the arena that requires champions. If all cultural champions, including dance truly want to help the sector then they will assist by utilising the afore mentioned facts and evidence to support culture at both a local and national level.

Together cultural champions and the arts/creative sector can lead the UK to a healthy, successful, creative and dynamic future by recognising that culture must be held firmly in your palm and the palm of the political party that will next lead this country up to and beyond 2012.

Gail Brown is arts manager of the Kent Arts Development Unit

Executive stress in the NHS

Fri, 05 Mar 2010 09:19:00 GMT

Keeping a cool head when others around you are in panic-mode takes a certain type of personality. NHS chief executives, by their nature are resilient creatures - and the best are also good at creating a 'pressure positive' in their organisations

NHS chief executives will be facing many challenges over the next year. Leadership agendas will need to shift to ensure the delivery of more with less; and at the same time, employees will need to be motivated in this context of scarce resources.

Now is a good time for chief executives to reflect on their own capacity to meet these challenges and to plan how they will lead their staff in a way that enables their organisations to deliver the most testing objectives they have faced for years.

To achieve these goals, it is essential for a chief executive's own wellbeing and personal resilience to be in a positive state. Not surprising and no mean feat given the many pressures faced at the top of NHS Trusts, where there is always a risk of them resorting to a reactive style of management and leadership.

Behaviour will be mirrored by other staff

The first step is for NHS chief executives to realise their behaviour is likely to be modelled by their immediate executive team and then by employees in the organisation. So if they panic in response to a new demand from the Department of Health, the foundation trust watchdog, Monitor or the strategic health authority or make decisions without appropriate consideration, their behaviour may well be mirrored by their executive team and then ripple outwards to other staff.

If sustained, this kind of behaviour can threaten the wellbeing and engagement of senior colleagues, which in turn cascades down through the organisation.

However, the key is not just for them to avoid stress and burn out - although that is obviously important - it is about creating an environment where positive wellbeing and engagement is generated throughout the workforce.

The work of positive psychologists such as Martin Seligman and Barbara Fredrickson demonstrates that people who experience positive emotions regularly at work (eg feel inspired or determined) tend to broaden their capacity to meet difficult challenges and cope with them effectively.

The creation (or not) of this kind of wellbeing climate in NHS Trusts usually starts with the chief executive.

Keeping pressure positive is one of the most important aspects of creating a well-being climate in NHS organisations. There are two types of pressure that can be applied by leaders – this means that they need to understand how to create challenge pressures and minimise hindrance pressures.

While challenge pressures drive people on towards higher performance and well-being levels, hindrance pressures create barriers and potentially develop into stress. Critically, it is the response of leaders that determines whether new pressures or requirements become challenges or hindrances.

For example, a chief executive may respond to the Quality, Innovation, Productivity and Prevention agenda by challenging senior managers and clinicians to find innovative ways of improving patient services in a climate of increasing resource constraint.

However, if this is done without clear goals or without considering the workload involved, it may be interpreted as a hindrance. If this is the case, the management team is likely to be apathetic in response, rather than motivated by the challenge.

The chief executive needs to understand how to harness work pressures positively, while minimising the likelihood burn out - both for themselves, their senior teams and the workforce in general.

Generally, chief executives are very resilient – it comes with the territory. However, there is a risk that they take this resilience for granted because different people deal with pressure in different ways at different times in their lives.

While many at this level recognise that the pressures they face require them to raise their own game in response, they may not be able to easily draw on their existing experience to meet these demands.

Until now, very little investment has been made by chief executives to look after their own health and wellbeing. However, given the acute challenges ahead, now is the time for chief executives to examine their own resilience and learn new techniques that will enable them to develop their resilience to ensure they can lead and motivate their workforce in the face of new and unique challenges.

Gordon Tinline is a director of business psychology company Robertson Cooper

Striking out in a world of shifting labour markets

Thu, 11 Feb 2010 10:35:19 GMT

Back to work policies need more gender awareness, says a new report that claims initiatives for working age men are available - but in a sector dominated by women

The paper, Striking out: Shifting labour markets, welfare to work policy and the renegotiation of gender performances, [Critical Social Policy] details stay-at-home dads gaining skills and negotiating gender constructs to find work in the childcare sector, only to find their communities reluctant to offer childcare work to men.

Meanwhile, teenage dads are under-supported both in their new role as parents and in their position of responsibility as wage earners.

Since 1997, the government has been committed to the inter-related policy aims of reducing health inequalities and tackling social exclusion.

Initiatives have largely been focused on the supply side, aimed at potential employees, and have been 'gender blind'. The underlying assumption is that unemployed men and women can get back to work when they receive the right combination of training and support.

We used data from qualitative case studies of two interventions in the North-East of England. One study offered unemployed parents childcare training, and the other provided vocational and advisory support to young parents.

The first case study investigates a 'gender blind' intervention aiming to get the unemployed back to work, which encouraged unemployed fathers to carry out childcare training to pursuing careers in childcare.

The policy behind the intervention did not intend to challenge traditional gender roles. The participants found positive ways to deal with gender identities, so that they were able to envisage themselves gaining work in childcare.

Negative community attitudes

Unfortunately the intervention did not support the men in this, or in dealing with negative community attitudes to men working in childcare. The study highlights the oversight that in this labour market, working age men would be a target group for the intervention, yet the jobs available were in a sector dominated by women.

Teenage mothers often hit the headlines, but surprisingly little is known about their babies' fathers. Despite the common stereotype of an invisible or absent teen father, recent research suggests that large numbers of teenage fathers do play a positive role in their children's wellbeing.

The second intervention provided vocational and advisory support to young parents. Legislation's main focus has been on facilitating women's dual roles as both mothers and employees, despite recent policy moves to acknowledge the importance of fathers' involvement in re-conceptualising relations between parents and children.

The short-sightedness of 'gender blind' policies has been noted before, but a common assumption is that gender blind means 'male-centred'.

Our findings from the second case study suggest that interventions aiming to support young parents should consider the benefits of targeted support for young fathers in addition to that offered to young mothers. The first highlights the ineffectiveness of training the unemployed using a gender blind approach, such that their new skills may not be utilised.

It is important not to assume that policy biases which favour some men in some situations will necessarily favour all men in all situations.

Not only should policies take socially excluded men into greater consideration, but policymakers also need to "consciously and consistently reflect on the potential impact of all social policies on gender relations."

Although this may benefit more women than men, men cannot be ignored – not only because tackling inequality in gender needs their participation, but also because men's lives are often closely intertwined with those of their families.

The UK government is aware of the importance of gender to employment and social policy. A publication by the Social Exclusion Unit (1999) directly suggest that policy responses to some social problems need to be more sensitive to gender issues and the recent Equality Bill (2008) demonstrates a continuing awareness of the need for gender parity. This paper and other recent research suggest that this remains at best aspirational. Gender must be re-introduced and re-emphasised in social policy debate, and policies should be audited for their impact on gender.

'Striking out': Shifting labour markets, welfare to work policy and the renegotiation of gender performances by Katherine E. Smith, University of Bath; Clare Bambra and Kerry Joyce, University of Durham, is published in the February issue of Critical Social Policy, published by Sage

Sizing up the workplace

Fri, 30 Oct 2009 10:00:00 GMT

Outlawing workplace discrimination against aspects of personal appearance would mean employment tribunals
establishing the attractiveness of claimants

On 19 October 2009, the Size Acceptance Movement staged a demonstration in front of the mayor of London's office, calling for the introduction of legislation outlawing workplace discrimination against the overweight.

The mayor's office and the government are yet to comment on the demonstration but it raises some intriguing questions that are worthy of consideration.

Current legislation prohibits discrimination against employees or prospective employees on grounds of sex (including marital status, civil partnership and gender re-assignment), race (including colour, nationality and ethnic origin), disability, sexual orientation, religion or belief, and age.

However, it does not cover less favourable treatment or victimisation on grounds of weight (so-called 'size-ism') or other aspects of personal appearance (commonly known as 'look-ism').

In some circumstances, it may be possible for individuals to bring claims relating to issues of size-ism or look-ism using existing employment laws. For instance, there has recently been a well-publicised case involving a one-armed employee whose trendy retail employer took her off customer-facing duties, on the basis that her appearance might be off-putting to customers.

Equally, a female employee who considered herself to have been less favourably treated than a slimmer comparator might also be able to show that an overweight male employee would not have been treated in the same way, in which case she could bring a sex discrimination claim on this basis.

Alternatively, an employer who (consciously or subconsciously) treats a younger employee who falls short of its employee image expectations less favourably than it treats fuller-figured or aesthetically-challenged older employees could face an age discrimination claim. Nevertheless, an employer engaging in size-ist or look-ist practices is generally unlikely to be found guilty of unlawful discrimination under the current statutory regime.

Despite SAM's efforts to highlight the issue, it is probable that this will remain the case for the foreseeable future, for a number of reasons.

Firstly, the government has recently proposed major new anti-discrimination legislation in the form of the equality bill, which is likely to come into law during the course of 2010. This will replace current legislation with a single Act dealing with all types of unlawful discrimination, as well as introducing measures to address the gender pay gap.

If there had been any appetite to extend the remit of discrimination legislation to cover size-ism and look-ism, this would presumably have been done during the preparatory stages of this bill, before it was introduced to parliament.

Secondly, even if the government did have a desire to introduce legislation to prevent less favourable treatment on grounds of weight or appearance (or, perhaps more probably, was required to do so by the European Union), drafting such legislation would be problematic.

Defining the point at which an overweight person becomes entitled to employment protection would be extremely subjective and, even if an objective measure (such as Body Mass Index) was used, this could produce some fairly arbitrary results. For example, BMI does not take body type into account and the scores of short and/or muscular individuals tend to be disproportionately high.

Defining the remit of the legislation would be even more of a minefield if it was extended to cover look-ism. It is difficult to see any objective standards that might be used to assess personal appearance and, in the absence of such guidelines, employment tribunals would be required to make a finding as to whether a claimant was sufficiently unattractive to benefit from statutory protection. It is not a prospect one would expect them to relish.

Finally, public policy considerations would also neeed to be taken into account and there would clearly be some conflict between the introduction of such measures and the National Health Service's 'fight against obesity'. Current disability legislation specifically excludes alcoholism and drug addiction from the definition of a disability to ensure that those who might be seen as contributing to their condition are not provided with greater protection than others.

It is not impossible to see similar approach being taken so that the overweight are not 'rewarded' to the detriment of their thinner and (it would be argued) healthier colleagues.

Although SAM's protests are unlikely to result in any change in the law or widen the potential liabilities faced by employers, they nevertheless raise some thought-provoking issues. Unlawful or not, there is no doubt that size-ism and look-ism go on in workplaces across the country, with the result that many decisions relating to the recruitment and promotion of staff are being taken on grounds other than merit.

Although research has suggested links between employees' weight and productivity/absenteeism levels, these only become statistically significant in the case of clinical obesity. It therefore appears that many employers are losing out on talented and hard-working individuals as a result of lazy sterotyping, which, in today's competitive marketplace, seems unfortunate and surprising.

James Williams is a partner at Archon Solicitors LLP

Putting its Trust in staff

Tue, 01 Sep 2009 13:53:11 GMT

Staff wellbeing and engagement underpins major change at Mersey Care NHS Trust

Mersey Care NHS Trust is currently going through a major change process. We are bidding to attain Foundation Trust Equivalent Status (FTe), a new standard of excellence for NHS organisations, particularly
trusts that provide secure mental health services.

If successful, we will receive the green light to work in a similar way to Foundation Hospital Trusts, but will remain under the control of central government. Also, we will be empowered to deliver high quality services to local people who will have greater influence over the health services we provide.

We have had to restructure the organisation; we have appointed a new chair and made significant changes to the way we operate. A tough new financial plan has been created to deliver greater efficiencies and increase productivity.

We recognise these targets will have a major impact on staff and want to ensure that their wellbeing and health are important. To achieve sustainable change, it was crucial to engage all employees so they would respond more positively to the planned changes.

The new leadership roles require people with sophisticated leadership skills

Part of the restructure was the establishment of new clinical business units which are jointly run by a new team of clinicians and managerial staff from within the trust. These units have their own financial and productivity targets and are tasked with reducing absence rates and ensuring employee engagement and well-being are high. The new leadership roles require people with sophisticated leadership skills, commercial know-how and the ability to engage their teams to deliver the new targets.

We appointed Robertson Cooper Limited, a leading business psychology company to help us implement the change process because they offered us a unique way of integrating employee engagement and wellbeing with leadership development.

The company used ASSET, its employee engagement and wellbeing survey with all our staff to assess the impact of the changes. In the past, we used an annual employee survey to assess a sample of our workforce. However, ASSET was given to all staff at every level in Mersey Care and it incorporated a focused set of questions to assess the impact of the changes on employee engagement, wellbeing, motivation and commitment. ASSET helped us get a grip on what matters to employees in terms of feeling good about coming to work.

After the ASSET results had been evaluated, Robertson Cooper devised a development centre programme based on an adapted version of the NHS Leadership Qualities Framework (LQF) that made it easier for leaders to apply to wider organisational development.

At the development centres, 51 managers and senior clinicians who were considering applying for the new leadership positions in the clinical business units were put through rigorous assessments to assess their leadership potential and skills required for the new roles.

The tests included psychometric assessments and realistic scenario-based exercises involving professional actors, where candidates role-played the challenges that would typically confront a leader of a clinical business unit. The development centres played an important role in creating the right climate in which to select the best people for the new roles, improve wellbeing and engagement and to educate new leaders on how to address staff priorities and become more effective leaders.

The board saw great value in this approach and 83% of the senior managers and clinicians who completed the evaluation agreed that the content of the development centres met their expectations. We have now appointed new leaders in all of the business units. In addition, the results from the ASSET survey are being used to build action plans with leaders as they settle into new roles over the next 12 months. We have already reduced employee absence rates across the trust and continue to develop our approach to staff wellbeing and engagement.

Our goal is to achieve sustainable change at Mersey Care. In turn, this will enable us to deliver excellent health services to patients in Merseyside – and that, ultimately, is our mission.

Kim Crowe is executive director, Mersey Care Trust

Birmingham's home comforts

Thu, 27 Aug 2009 11:28:00 GMT

A concerted effort by the city council to deliver a 'three-star improvement plan' for better housing services has won it accolades from the Audit Commission, customer satisfaction and a proud workforce

At a time when local government faces an uncertain financial future and mounting public debt, there is enormous pressure on councils to cut budgets and yet deliver improved levels of public service.

In the area of housing, Birmingham city council has had to face an enormous challenge given the huge size of our customer base and the size of the organisation - the credit crunch means we have more people needing social housing while there is a national shortage of housing stock and less available resource to deliver the services our customers desperately need.

Sales of council land are finite and yielding less revenue, so we need to be inventive to find ways to improve service delivery at the same time as cutting costs.

As part of the council's overall determination to transform our services through the business transformation programme, our aim since 2006 has been to deliver a more efficient and customer focused housing service that meets the three-star criteria set out by the Audit Commission and delivers real improvements for our customers where it really affects them – in their homes.

Whatever the size of an organisation, there is one crucial element that any change and improvement programme needs to consider – how to involve your staff and enthuse them from the very start to share the journey and have a personal investment in the success of the transformation.

Key lines of enquiry

We chose to empower every division in the housing service through our housing transformation programme to draw up and take ownership of a 'three-star improvement plan' to show what changes were needed and how they would make them, benchmarked against both the Audit Commission's key lines of enquiry document and other best practice three-star organisations.

These individual plans were then overseen by a senior management team which would both mentor and challenge, with monthly updates for each plan presented by the relevant manager.

So instead of imposing a corporate vision from above, the individual divisions, who of course had the most direct experience of their specialist areas, were encouraged to think for themselves moderated and guided by senior management.

Some of the key innovations that have come out of this work include:

• The value for money matrix tool, which that helps to calculate whether a service is providing value for money. The process involves asking customers for feedback, investigating costs and comparing them with the costs and customer satisfaction from other local authorities and housing providers. This has proved very successful and has been cited as a good example of current best practice by the Audit Commission in its strategic housing inspection in January

• The roadmap tool monitors the progress of our housing transformation projects to provide clarity across the breadth of our transformation work. We knew that having a number of projects running concurrently needed an understanding of the interdependence between them. At any one time we can see the progress that has been made and the effect each project will have on another project. We continue to monitor the cashable and non-cashable benefits through our existing performance management framework

Partnerships are another key tool. The city housing partnership, set up with housing associations, private sector and the Homes and Communities Agency, has been very valuable and a landlords' forum has been set up to work in partnership with private landlords to help them provide good quality homes and services to some of Birmingham most vulnerable residents.

By working in partnership we have been able to license many of the city's houses in multiple occupation with approved private landlords working to best practice. Our award-winning home options service, run in partnership with neighbourhood offices and specialist agencies such as St Basils, has enabled us to take a more proactive approach to tackling homelessness in the city.

'Ending Rough Sleeping Champion'

By making the best use of support that is available through other third sector agencies, this has culminated in our national recognition as an 'Ending Rough Sleeping Champion'. Since 1998 our pioneering work to tackle rough sleeping has reduced rough sleepers from 56 to four. Our success has been the result of strong partnerships with a range of statutory and voluntary organisations.

Customer interaction is also important. The tenants' performance monitoring group is a group of tenants who review our performance each month against our key performance indicators. They have the ability to issue 'improvement notices' if they are not satisfied with our performance.

There is also a task and finish group that monitors our progress against our action plan to deliver the promise in our housing agenda of better housing services for residents and tenants. This group is informed by an advisory panel of residents and tenants.

We promised our customers back in 2006 that we would work to deliver them a three-star service. By 2010 our decent homes programme to bring all council homes up to the decent homes standard will be complete; we have already reached over 90 per cent in 2009. And it's not just our customers who are happy: the Audit Commission inspectors commented on how proud the staff are of the service they provide and the organisation for which they work.

There has been a real culture change in the directorate. The business transformation programme has reinforced our feeling of self-belief. It's a complete change to how staff felt five years ago when we were a 'no star' directorate. There's a definite can-do attitude and the achievements staff have made over the last four years has given them a thirst for improvements that deliver better services for our customers.

Councillor John Lines is cabinet member for housing and Elaine Elkington, is acting strategic director for housing and constituencies at Birmingham city council

Interview: Roy Clare

Tue, 28 Jul 2009 13:23:48 GMT

Roy Clare is chair of Living Places and chief executive of the Museums, Libraries and Archives Council

Roy Clare is a brisk man. Not, one imagines, someone who tolerates fools gladly. He has a naval background and it shows. He has, he says, a "mission focus".

Clare is chief executive of the Museums, Libraries and Archives Council (MLA) and also chair of Living Places, the coalition of five national cultural and sports bodies that aims to build leisure, arts and heritage into the thinking of local and regional planners and to persuade them that culture and sport can be used as catalysts for renewal.

To that end, earlier this year, Living Places launched a toolkit, which it is taking around England in October, through a series of workshops that will bring together culture and sports policy professionals in England with local and regional planners, for the first time, to encourage professional planners to squirt more leisure, arts and heritage into their regeneration and development plans.

Clare says his two jobs complement one another. "When I became chief
executive of the MLA, two years ago, the reason I also became chair of
Living Places is because they are both about building bridges between
people," he says. "Living Places is a coalition of five leading national
culture and sports agencies and we are trying to build the idea among
planners that you can do roads and houses, but if you haven't put culture in, you will have a soulless place to live."

It's the same with the other part of Clare's job, at the MLA, to which he
brings experience of running a specialised collection: "When I was running the National Maritime Museum, one thing I learned was that our collection might seem like a lot of boys' toys, but if you took those toys into a new context, you could engage with new users," he says. "If you take culture out to people, you get a response: people told us their stories. I have taken that philosophy to the MLA. We have got the scholarship and the connoisseurship, but keepers and curators also need to be sharers and the public need to be co-producers."

Imagination is free

Asked about his challenges, Clare does not go down the route of bemoaning the economic hard times. "Every age is a challenge and there are never enough resources," he reflects. "But one thing that is completely free is imagination."

In fact, he puts leadership at the top of his list of challenges: leadership not in a narrow sense, but in a larger vision for public services. "We need a more strategic sense of what we, the country, can do," he says. "The opportunity is there to join up." The Living Places toolkit is one such example. It's aimed at planning and regeneration officers, but cultural, leisure, sports, education and health professionals will also find it useful, says Clare. He also points to regeneration work in many different parts of the country, including work on housing in Lancashire, and getting culture to be thought about as part of the schools building programme.

Libraries are a case in point. Everyone expects the MLA to defend
libraries, but Clare makes a careful distinction - the organisation defends
library services, he says. The two are not synonymous. The MLA has been closely involved with one local authority that has invested in a central library - but had overlooked the impact of closing some of its smaller existing libraries on local people. They had failed to consult local people, says Clare, or to take in local needs. A walk of just over half a mile to a new library may seem insignificant if you are fit, but becomes a real problem for some. "We're not there to keep the library open. We're there to say you need a library service," he comments.

And library services don't necessarily have to be located in libraries. What about a local GPs' surgery? Or a post office? More innovative thinking is needed, maintains Clare. "We may not be able to afford to have a library in a school and a public library in a building next door, for instance; we need new schools that don't close at 5pm," he points out.

Strategic planning at local level

Another challenge is to get more strategic planning at a local level. "I
spend a lot of my time meeting chief executives and elected local authority members." This aspect of his role sometimes takes others aback - but Clare is clear. "Some of my MLA colleagues perhaps think I should be a kind of trade unionist, but our offer needs to be understood," he comments. "I think leadership is about change.

There's no point working in an organisation if you want the status quo. I do tell people to fasten their seatbelts and let's make it interesting. You do need management discipline and process, but you don't want those processes to clog everything up. I think ideas and leadership might come from anywhere. They aren't locked in at senior level."

And does this clearly well-organised leader have a good work/life balance? "You'd have to ask my wife," he says. "I do lead from the front on this; I think it's important to have thinking time and I encourage my senior team to come with me on this. But I do make a distinction - if you accept a chief executive's salary, you can't abandon ship, so I unashamedly take my Blackberry on holiday with me. I only read it once a day and I don't write any emails, but it does mean I can be called if there is an emergency. Knowing that enables me to relax. Some people disagree, but I think if you are drawing the full rations, you have to take on that responsibility."

Roy Clare is featured in SocietyGuardian's Leading Questions, 29 July 2009

Single equality bill: consultation begins

Thu, 11 Jun 2009 13:34:46 GMT

As the Government Equalities Office sets out its proposals for a new single equality bill, Richard Kenyon says there will be new challenges for public bodies

The much-anticipated equality bill represents a unique opportunity to provide a coherent and consistent legislative framework to tackle inequality in society. It consolidates and harmonises more than 30 years of inconsistent developments in anti-discrimination law and contains some new and more radical measures.

Many of these developments will create new challenges for public bodies.

Tackling socio-economic disadvantage
One such measure is the new duty relating to socio-economic disadvantage. Certain public authorities will have a duty, when making strategic decisions about how to implement decisions in a way "designed to reduce the inequalities of outcome which result from socio-economic disadvantage." If this is a return to "class war" the rhetoric is more convoluted and unlikely to fit on, let alone sell, many T-shirts.
The first problem for those public bodies affected is to identify when the duty applies – when are they making "decisions of a strategic nature"? The second problem is to identify what constitutes compliance. There is no absolute obligation to eradicate socio-economic disadvantage. Rather, there is a duty to have "due regard" to the "desirability" of using strategic decisions as an opportunity to try to reduce inequalities that result from socio-economic disadvantage.
Although there are no enforcement provisions in the bill, public authorities will be vulnerable to a new angle of judicial review for non-compliance with the duty. Given the absence of any reporting obligations in the bill, it will be down to public authorities themselves to share information with each other as to how they have interpreted and applied the legislation.

New equality duty
A new streamlined public sector equality duty is due to replace existing race, disability and gender equality duties and will be extended to cover all strands of discrimination, including gender reassignment. The new duty will require public authorities, when exercising their functions, to have due regard to:
• eliminating discrimination, harassment, victimisation and any other conduct prohibited by the bill
• advancing equality of opportunity between people who share a protected characteristic and people who do not share it
• fostering good relations between people who share a protected characteristic and people who do not share it

Although some public bodies may have already tried to address all strands of discrimination, a single harmonised duty is long overdue. But there will be inevitable costs in moving from compliance with the existing regime to the new. There will also be new challenges in the areas where the different "strands" may come into conflict - most recently seen in respect of sexual orientation and certain religious beliefs.

Gender pay gap
The bill outlaws pay secrecy clauses, which stop employers trying to prevent employees discussing their pay. It is also anticipated that public bodies with more than 150 employees will be required to provide annual details of their gender pay gap (as well as their ethnic minority and disability employment rate). The exact scope and extent of the public sector reporting duties remains to be seen and consultation will take place on the details of this proposal during the summer.

No sensible person would suggest that men and women employed in like work should not be paid the same. However, equal pay legislation extends into more subjective areas where men and women are employed not on like work but on work of equal value or work rated as equivalent. Such claims are not without merit but they are much harder to identify and therefore avoid. The sheer cost of resolving equal pay issues acts as a major disincentive to searching out and correcting equal pay issues for even the most fair minded employer.

The Employment Tribunal system is already at breaking point – latest figures available from the Tribunal Service show a 65% increase in claims over two years largely due to a 263% increase in equal pay claims. Placing more pressure on public authorities to disclose pay information without any form of equal pay amnesty can only lead to more Tribunal claims with the crippling cost of funding claims for back pay.

Positive action
The provisions on positive action have attracted negative publicity, but have often been misunderstood or exaggerated. Under the bill, employers, where they feel it is appropriate, will be allowed to take under-representation into account when selecting for appointment or promotion between two equally qualified candidates. This does not permit employers to make decisions irrespective of merit or to have an automatic policy of favouring those from under-represented groups. It remains to be seen how many public authorities will use this opportunity given the obvious conflict between positive discrimination and the "fostering good relations" limb of the new equality duty.

Age discrimination
The bill extends the prohibition against age discrimination to the provision of goods, facilities, services and the exercise of public functions where people are aged 18 or over.

Timing
Most proposals are expected to come into force this autumn. Certain sections of the bill, such as the socio-economic duty and public sector equality duty, are likely to come into force in 2011. Public sector bodies should monitor how this potentially far-reaching legislation develops over the coming months.

Richard Kenyon is head of employment and pensions at Field Fisher Waterhouse LLP

Gender gap: BBC programme to look at pay inequality between men and women

Mon, 18 May 2009 13:17:47 GMT

Forty years after the Equal Pay Act, it is estimated that a man will earn £369,000 more than a woman across their careers. Last week 'institutional sexism' was highlighted in the justice system

Last week, the Fawcett Society highlighted "institutional sexism" in the criminal justice system, pointing out that most senior management positions in organisations such as police forces, the prison service and the judiciary are still held by men.

The gender gap is still very real: a new BBC two-part television series starts tonight. Exploring attitudes to working women 40 years after the Equal Pay Act, it points out that on average a man will earn £369,000 more than a woman across their careers.

Skills for Justice, the sector skills council for the UK justice system, is working to redress this imbalance through a new initiative aimed at helping women in a variety of jobs in the justice system, to improve their career prospects and earning potential through the development of new skills.

The Women & Work: Sector Pathways Initiative project is a response to recommendations by the 2006 Women & Work Commission's report, Shaping a Fairer Future. The project's aim is to raise the skills and unlock the potential of women who want to move into supervisory, management and senior management positions - areas where women are under-represented, particularly in the justice system.

Funding of £0.5m is being made available for training in team leading, coaching and mentoring, which will be available to about 600 women. For women already in senior management roles, the project offers support on how to effect a change in HR systems and structures through an executive coaching programme.

Alan Woods, the chief executive of Skills for Justice, says that although women make up approximately 44% of the entire justice sector workforce, they make up a significantly smaller percentage at management and senior management level and the new project will provide a great opportunity for women to learn skills that can help them to move ahead in their careers.

"The project also includes help for organisations to explore the role of company culture and structure on women's progression, supporting organisations to consider how their company policies could be a barrier to women's success," he says. "The aim is to help organisations remove the glass ceiling that can prevent women from getting to the top."

Speaking at the Skills for Justice skills summit conference last month, Annette Shepherd, an area manager with security firm G4S, told delegates that a change in management culture and implementation of HR policies in G4S has led to an increase in the number of women at all levels, including middle and senior management.

The two-part BBC series will be shown on 18 and 19 May and will explore men and women's attitudes to working women, asking why men still dominate the top jobs. It will feature interviews with a range of women, including an armed female officer at the Metropolitan Police's firing range.

Felicity Winter is director of policy & communications at Skills for Justice

Social housing

Thu, 07 May 2009 13:04:55 GMT

Although billions of private investment has been pumped into the property market, has it really made a difference to publicly-supported housing?

We need a new vision for social housing in the UK: one that both meets the aspirations of the majority tenants and shared-ownership residents and takes account of the seismic changes in public expenditure that are likely after 2010.

For too long public housing policy has been driven by the broad-brush issues of government, rather than the delivery of popular outcomes really needed by residents, such as repairs and maintenance.

We have been very successful in getting billions of private investment into housing association homes and government has injected substantial sums via one-off schemes such as housing market renewal and the decent homes programme, but have these schemes really delivered what the country and tenants/residents in publicly-supported housing want and need?

This is a pressing question as the proportion of people on benefits grows. The number of people on waiting lists is increasing, as is the number of families experiencing overcrowded conditions. Successive governments may have ameliorated the worst effects of a series of crises, but the underlying direction is clear: the housing system for our poorer citizens is simply not fit for purpose.

Public support through property

At the heart of this is the disempowering policy contradiction that channels public support through property (land and bricks and mortar) and landlords (individually-assessed housing and council tax benefits) while simultaneously encouraging, at least verbally, those on low incomes to take more responsibility themselves.

Add to this the remoteness of housing strategy and management from the other factors with a crical impact on the health and wellbeing of a place and the result is a divisive cocktail that has led to complacent, inefficient providers on one side, and disillusioned tenants and residents on the other.

The answer lies with separating out the property or landlord function and then thoroughly integrating the management of existing and new social homes with the management of benefits, worklessness and community wellbeing within a geographical area and within a system that delivers the outcomes we need.

We need to encourage the Tenant Services Authority to create a new kind of provider; one that accepts the risks associated with the broader management role and can deliver widely agreed community outcomes. The latter may include increasing the proportion of residents who are economically active, reducing the overall cost of benefits and, over an extended period of say 25 years, delivering a substantial increase in housing, public and economic value within a defined geographical area.

The practicality of delivering these outcomes would result from a bidding process that puts residents' and potential residents' interests first in the context of what the country can afford: essentially finding the best innovative management solution.

This scheme differs from others that attempt to create new types of providers as it does not rely upon one method to deliver an outcome but rather puts in place a set of controls that can be used at different times; takes a long-term approach; and puts real incentives in place giving providers a stake in their own success.

It will be a more locally-responsive, accountable and efficient system that puts the tired old debates over tenure and ownership firmly where they belong: as secondary matters to the general health and wellbeing of an area, the views of present and potential tenants and residents, and national and local government realities.

Ian Keys is managing partner of Gradus Consulting. He is also an advisor to the communities and local government department on local government commissioning

Memory tests and a fitness prescription

Thu, 05 Mar 2009 15:51:00 GMT

More health visitors, improved antenatal classes and a £27m campaign to boost young people's knowledge of contraception all figured in a new children's health strategy.

The five-year plan, launched jointly by the health department and the Department for Children, Schools and Families (DCSF), also promised an extra £340m to support children with disabilities and their families. It brings together many existing individual programmes to improve child health but does not include in-depth plans to tackle issues such as obesity, pregnancy among young people and smoking, which have their own separate strategies.
Under the strategy, pilots will be established to examine the impact of extending free school meals to a greater number of pupils. In some areas this will mean free school meals for all primary pupils. There will be a strengthened role for Sure Start children's centres, the government's flagship delivery mechanism for early years initiatives. Separate research published by the DCSF found a high level of satisfaction among parents using children's centres but many were unaware of the health services they provide. The children's health strategy said each centre would have access to a named health visitor.

The NHS Confederation said the biggest challenge would be ensuring different agencies worked together at a local level to improve child health. "We know that the health of children requires more than just the intervention of a single organisation such as a school, hospital or GP surgery," said deputy director of policy Jo Webber. The strategy calls for high-level commitment among service commissioners. Directors of children's services will be expected to consult with primary care trusts to secure GPs as members of children's trust boards. A guide on the joint commissioning of children's health services by local authorities and health bodies was published alongside the strategy.

Another major policy document launched last month was a five-year dementia strategy, promising more specialist memory services, better training for GPs and "dementia advisers" to help navigate the system.

Under the plan each hospital and care home will be expected to appoint a senior member of staff to lead improvements in the quality of care for dementia patients. The long-delayed strategy, which is backed by £150m for the first two years, was described as a "momentous opportunity to avert a dementia crisis that could overwhelm the NHS and social care" by the Alzheimer's Society.

But organisations such as the Alzheimer's Research Trust felt it had failed to deliver on two key areas - research into the causes and potential treatments of dementia and the drugging of elderly people in care homes. A review of anti-psychotic drugs used to sedate people whose dementia makes them angry or depressed has been postponed until spring.

There was talk of a crisis in social work recruitment after new figures revealed one in seven posts across the country remained unfilled. The statistics, obtained by the Conservatives under the freedom of information act, revealed a 30% rise in vacancy rates since 2005. Excessive bureaucracy and low morale have been blamed for recruiting problems.

Tory children's spokesman Tim Loughton said there could be more cases like the death of Baby P in Haringey if the situation was not improved. Meanwhile, the first interviews with Sharon Shoesmith, former head of children's services at Haringey council, raised questions about accountability. Children's services directors across the country will be wondering if they are next as the debate rages over how much personal responsibility they should take for tragedies that occur while they're at the helm. Shoesmith, who refused to resign from her post but was eventually dismissed, told the Guardian it was impossible to guarantee there would not be another Baby P. "You can't stop people who are determined to kill their children. You can work as much as you can to prevent it, but that is the case," she said. Was there an "emotional and symbolic requirement" for someone in her position to go? "If you are going to sack every director of children's services where there is a child death, you're going to turn them over at the rate of a third a year," she said.

The health department published guidelines for NHS organisations on a new way of measuring the quality and effectiveness of treatment. Patient-reported outcome measures (first announced last year) are designed to find out about genuine patient experiences and have the potential provide a more valuable picture of NHS care than simply enumerating "successful" procedures. Patients complete questionnaires about their quality of life before and after treatment. From April 2009, providers, including independent organisations supplying NHS care, must routinely gather this data in four areas - hip and knee replacement operations and surgery for hernias and varicose veins.

Last month saw a conclusion to a year-long row about GP surgery opening hours. The British Medical Association, which represents two-thirds of GPs, agreed to back a contract that will mean more appointments at evenings and weekends. Meanwhile, a new government campaign urged GPs to prescribe exercise to patients in the same way they prescribe medicine. The Be Active, Be Healthy drive was launched alongside new figures showing PCTs spend an average of £5m a year on costs linked to lack of physical activity.

US healthcare reform urgently needed

Thu, 08 Jan 2009 16:18:00 GMT

A new report from the Engelberg Center for Health Care Reform has identified other problems the US will face besides the economy

Despite other urgent national priorities, healthcare reform will receive major attention next year. While the economic downturn has replaced healthcare reform as the top domestic priority, it has also raised public concerns about the affordability and security of healthcare and healthcare coverage. Of those US citizens surveyed before the election, 46% felt major changes to the health system were needed, while 24% believed a complete overhaul was necessary. The president-elect has promised major reforms, and healthcare is also a top issue for many congressional leaders.

But there is little additional federal funding available to expand coverage and reduce costs in the US healthcare delivery system. This is not the result of the recent crisis in financial markets and the expanding resources required from the federal government to address it. The economy will recover. In contrast, as a result of existing healthcare financing commitments, the nation's fiscal outlook - and consequently its ability to sustain new healthcare spending - will continue to deteriorate.

Incremental reform

The current fiscal outlook, and the role of existing federal health care programmes in it, will also shape the timing and direction of reform. The government already plays a huge role in financing health care. Local, state, and federal government spending together were responsible for nearly half of the estimated $2.4tn spent on healthcare in 2008, including Medicare ($461bn) and Medicaid ($361bn).

The government's financial commitment has expanded along with healthcare spending, which has risen about 2.7% faster than the overall economy for the past half century. Total healthcare costs are projected to increase from 16 to nearly 20% of US GDP in the next decade. Combined spending on Medicare and Medicaid alone is projected to account for as much as 13% of GDP by 2040, if these programs continue on their current trajectory.

Given competing policy priorities, budget deficits, long-term fiscal projections for Medicare and Medicaid, and the recession - all of which will further strain state and federal budget revenues - it will be very hard to find significant new funding to support comprehensive expansions in health insurance. Consequently, healthcare reform efforts will be both technically and politically difficult. They must also gain broad support in a political environment where most Americans are satisfied with many aspects of the care they receive, and are understandably wary of big changes that could impact on how and where they get their care.

Against this backdrop, most experts believe that major reform efforts will fail and that Congress will enact, at most, minor reforms next year. Instead, they expect to see the typical "incremental reform" approach - expand healthcare programmes a little by squeezing healthcare payments or access elsewhere. But this approach is becoming more difficult to finance, and does not improve the way that care is delivered. On the contrary, it is contributing to a vicious cycle of rising avoidable costs, reductions in prices, and gaps in quality.

A common policy response to address rising costs is an incremental squeeze on Medicare and Medicaid prices paid to physicians and other healthcare providers, or an incremental increase in taxes or fees. US prices for the physicians, hospitals, brandname drugs, and other products and services that account for a large share of overall healthcare spending are indeed higher than those in most other countries. However, it is not clear how much further prices can be squeezed. In any case, price increases are not the main driver of rising healthcare spending around the globe. Quantity is the main reason that healthcare spending is going up - more people are being treated more intensively for more health problems.

If debates over containing healthcare costs focus on reducing prices or finding additional sources of funding, and if coverage reforms are based on providing additional subsidies to make healthcare marginally more affordable, healthcare reform will neither address the underlying problems in the US healthcare system nor be sustainable.

Focusing primarily on squeezing prices across the board could also threaten valuable innovations in healthcare and in how medical treatments are used. While spending growth has achieved real gains in health, much of it is not clearly linked to such improvements. Wide variations exist in how similar health problems are treated in different regions of the country, which in turn leads to variations in the volume of care used to treat similar patients. Residents of regions in the highest-spending quintile receive about 60% more care than those of regions in the lowest-spending quintile. Some estimates indicate that as much as 30% of Medicare spending does not contribute meaningfully to patient outcomes.

Hope for progress A very large proportion of health spending is on chronic diseases whose progression could be slowed or eliminated with more effective care, and with more prevention. Treatment and management of chronic disease account for about 75% of healthcare spending in the US.

There is some hope of progress. Options on the table include introducing e-prescribing and some sort of payment by results system. But despite much enthusiasm about the potential for broader adoption of health IT to improve quality and lower costs, a recent review by the Congressional Budget Office (CBO) highlighted the complexity of estimating the likely savings to accrue from broader health IT adoption.

The healthcare delivery system does not assure that the right care is delivered to the right patient at the right time. This leaves physicians, pharmacists, hospitals, and other providers in our fragmented healthcare system understandably frustrated that problems with healthcare quality at the person level are not within their control.

This is an extract from a report by the Engelberg Center for Health Care Reform at the Brookings Institute. (brookings.edu)