Introduction

We were struck by the stark realism of Amanda Pritchard’s recent statement at the Commons Health and Social Care Committee that training and development of managers is inadequate and patchy. It was also interesting to note her commitment to prioritising the introduction of statutory regulation to generate improvements, and her reference to the recommendation from the Messenger Review for consistent management training delivered through accredited routes.

As the Sectors Skills Council for Health, having a relationship with NHS organisations spanning decades, we see managers grappling with overlapping, unparalleled challenges in many domains every day, challenges that require a reframing of management thinking. We see those challenges in polarity, often mired in a paradox, for example increasing capacity for elective care with inadequate staffing levels.

Let’s talk about management

At any level, regardless of experience and qualifications, management is hard. And it should be. The idea that being a good manager is something anyone can do is a flawed judgement on the skill, practice and character required.

Good management requires comprehensive formal and informal training and a willingness to engage in continuous learning. It requires an openness to change, vulnerability and courage, a good grasp of technical skills and competencies related to service delivery, empathy, compassion, a commitment to understanding what it takes for individuals and teams to thrive, and a purposeful approach to contributing to the management of those conditions.

Good management is, possibly, quite rare, and for equally good reasons. Nobody is infallible, and nor should we expect them to be. The demands placed on managers, the scope of competing ideas that surround the discipline, and the variable expectations of what successful management is and how to measure it, all serve to make a hard job, even harder.

And of course, in the NHS, the context within which we are asking managers to lead their teams is exponentially bounded in an ongoing, era-defining period of turmoil – an environment of ever-increasing complexity, disparate and stretched intra-organisational relationships, multi-cultural teams and a workforce crisis converging with the operational demands of improbable waiting list targets, having to do more with less, and respond to a deep and consistent uncertainty across the health and care system. All under increased regulatory scrutiny.

Management and Leadership –

A Perennial Issue

Flip through any of the many reviews conducted over the last few years and you will note the prominence of management and leadership imbued throughout. From the Kark Review of fit and proper persons, to the Messenger Review, which was clear in its call to action for a more consistent approach to leadership development at all levels within the NHS. And the most recent Hewitt Review that cited the need to ensure the right skills and capabilities are available to ICSs as both systems and national organisations navigate a period of challenge.

There is a clear disparity between support available to managers and leaders from a clinical leadership perspective, and managers needing to acquire broader management and leadership skills.

There are well established paths for clinical development in the form of recognised pathways for medical and dental, nursing and allied health professionals. These pathways provide a body of knowledge and a code of ethics which guide the actions of managers in a clinical setting. But what about those accidental non-clinical managers in Estates, Corporate, Catering roles, who find themselves leading teams with conflicting, complex needs? And just how does a clinical expert make the leap from leading clinically to leading organisationally? There are many critical skills that clinical experts bring to management and leadership, such as their solving complex problems based on tangible evidence. Where we have seen them struggle how to lead organisationally, instituting cultural programmes of change which are more focused on the behavioural aspects of managing and leading teams.

Where to begin?

The Messenger Review called for tangible actions towards recognising the value that needs to be placed on managers and leaders. So, where to begin?

1. A good starting point would be to identify those managers or leaders in your Trust or ICS who are managing well, and whose services are delivering good outcomes for patients. What do you notice that they are doing differently? How might this good practice be replicated more widely?

2. The next step would be to take a short, medium and long-term view of the management development needs within your organisation, avoiding the temptation to initiate quick fixes that do little to creating sustainable learning. What are your managers grappling with? What skills do they need now, tomorrow, and into the future? In our experience, some of the more fundamental and pressing challenges managers are facing now include:

a. How do I have those difficult conversations when conflict and confrontation arises?

b. How do I transition from being a member of the team to being a manager?

c. How do I manage the multi-cultural differences and preferences within my team?

3. Engage the support of an expert who can work alongside you to help bridge some of these immediate skills gaps and facilitate the transition to a more formal, nationally recognised development path for managers and leaders in health and social care.

What’s next?

We propose that management and leadership as a profession needs to be cemented into every aspect of the NHS Long Term Workforce Plan. There is also a longer-term planning and alignment piece to ensure that the way in which NHS organisations are measured is focused not only on operational targets but also on management development.

The NHS People Promise has a clear mandate: We want our culture to be positive, compassionate, and inclusive – and we all have our part to play. Managers and leaders can only really play their part

if they are skilled, competent, and continuously elevating the practice of management and leadership in health and social care. Plant the seeds, nurture them, and watch them grow.

How Skills for Health can help to elevate your management and leadership potential

Our experienced team of coaches and consultants are experts in leadership and organisational consultancy and can work with you to unpick your immediate and long-term management and leadership challenges, and tailor solutions to meet the unique needs of your organisation.

Ready to transform your leadership capabilities?

Find out more today.

But it doesn’t stop there. Karen goes truly above and beyond her role. She runs a bra fitting service for post-operative patients, including prosthesis fitting; offers nipple/areolar tattooing for those who have had reconstruction; runs a monthly support group for patients and survivors; and with the Breast Care Nurses runs Health and Wellbeing seminars for those who have recently finished their treatment. Read on to find out about her motivation and hopes for the future…

First of all – congratulations on winning Clinical Support Worker of the Year at Our Health Heroes Awards 2023!

Thank you. It was a great privilege to be nominated and to have actually won the award was a huge surprise to me. It was an amazing day celebrating some great work that is being done across the country.

We’re excited to be speaking with you, as this month it’s Breast Cancer Awareness Month, and your role is vital in supporting those going through breast cancer treatment. Could you tell us a little bit about the journey that you’ve been on to get to where you are today?

So I started working with breast patients about eight years ago, in a private hospital, where I worked alongside a breast care nurse – supporting patients after having breast surgery. Working alongside this nurse and two amazing consultants really gave an insight in to what patients have to go through after a breast cancer diagnosis and the support that is needed. Then three and a half years ago the job as a Breast Cancer Support Worker came up at Royal United Hospitals Bath NHS Foundation Trust. It was just perfect for me so I applied and was lucky enough to be appointed. Prior to that I worked in childcare and managed children’s day nurseries, which was quite different to what I am doing now. Why did I change, you may ask – well having a close family member who was diagnosed with breast cancer many years ago it has always been something close to my heart. So when I got the opportunity to work in this field I didn’t have to think twice about it.

We’d love to know more about how you broadened your role. It was inspiring to learn about the other services you’ve kick started – what inspired you to do this?

I just wanted to be able to offer patients the best service they could have.

For me, the main thing is that patients feel good about themselves. No-one chooses to have breast cancer and they go on a huge journey from diagnosis through their treatment and if I can do a small thing that helps to make them feel better about themselves and to be able to move on afterwards then that’s what I will do.

I trained to do nipple and areola tattooing a few years ago, and what a difference it can make to patients and how they feel about their breasts if they have had reconstructive surgery. Having the image of a nipple and areola on the breast has a huge impact to self-confidence.

With regards to the bra-fitting service, I have so many patients come to me following surgery to get fitted for a prosthesis and ask me if there are any pretty mastectomy bras they can buy, as so many of them are quite traditional and they wanted something a bit more feminine. I get a lot of patients say to me ‘I just want to feel like me again’ and one of the big things is feeling good about themselves and what they are wearing. So I felt it was really important to start this bra fitting service, selling bras that were suitable for patients who have had surgery, but were also more feminine and made them feel better about themselves.

You’ve been able to build a community through your monthly support groups and Health and Wellbeing events, which must be lovely to see. Have any patients shared how this has made them feel/what feedback have you had from these?

Absolutely, being able to offer a support group where people can meet up once a month to share experiences is so important to them. It is a place where they can talk openly about how they are feeling and ‘not feel judged’ (in their words).

The Health and Wellbeing events have also been a huge success, giving all the patients at the end of their treatment an opportunity to meet with others who have been through a similar journey, share experiences, talk to others and hear from professionals about ways to help them move forward.

Some feedback from Support Group attendees includes:

“This is a wonderful service for which I am very grateful. Talking about issues that I knew were affecting me.”

“Relaxed atmosphere, helpful advice, knowing you are not the only one with these problems.”

“The support you offer at the support group is so important to me. Thank you.”

Feedback from Health and Wellbeing events includes:

“Thank you for organising a most beneficial and informative event.”

“Many thanks for putting on the Heath and Wellbeing event. It makes such a difference.”

“Meeting strangers who have been through the same thing as you, in a relaxed environment was so helpful and made me realise I was not alone.”

There is so much you offer to your team and to your patients. What do you enjoy the most?

The thing I enjoy most is seeing a smile on a patients face. Having a breast cancer diagnosis is not easy and is often life changing for many patients in many different ways, so being able to help them and see them smile after fitting them with a prosthesis and nice bra, or when they look in the mirror after having a tattoo is such a reward. I work with an amazing team and the job that I do is enhanced by working with this great team.

Why do you feel Breast Cancer Awareness Month is important, and how would you like to see this evolve?

It is so important, as an early diagnosis of breast cancer has a much better outcome. We all have breast tissue, both men and women so knowing what to look out for and how to self-examine is so important, as we know our breasts best. Both men and women can get breast cancer and I think that raising awareness of male breast cancer is something that can be developed and improved.

I would like to see more awareness and advertising on changes to our breasts that we should be aware of, for both male and female breast cancer.

I also think that ladies should be better informed about how they can ask to be kept on the screening program even if they are over 71, especially if breast cancer is something that concerns them.

Before we wrap up, what hopes or aspirations do you have for the future?

I would like to be able to work with a company or set up a company designing well-fitting mastectomy bras and non-underwired bras, which are supportive but also feminine, as this is so important to ladies and their wellbeing. This includes offering bras for the larger ladies as they really struggle to find well-fitting bras. There are more companies now that sell mastectomy bras, but they don’t all fit patients well. Breast cancer comes in all shapes and sizes.

I would also like to see a national improvement on holistic support offered to patients after their breast cancer treatment, as this can vary depending on where you have your treatment.

If you need help, support or information about breast cancer, find out more with Macmillan.

Realism and creativity have to be a central part of your workforce planning 

“We make sure that when organisations are thinking about workforce planning that they assess and produce realistic targets, not just ambitious ones. The whole point of effective workforce planning is that it is something achievable and something that will meet the needs of the populations they will serve.  

You must strength test and question your ambitions. If during the process you understand that your needs are not achievable – think about  what other factors are stopping you from being able to meet a staffing level that you need. Those factors are inherent considerations of workforce planning that also need to be worked on and are often not seen to be within the realm of workforce planning.  

You should also think about how else you can solve gaps creatively. To meet ambitious targets, the NHS will have to work differently and not just recruit to the same roles and staffing models. You can look to the future and acknowledge technological advances, and consider how they will shape the roles and the skills required to deliver on service provision.  

The other aspect of this is that what looks realistic to your situation might not match the NHS Long Term Workforce Plan or the IFS findings. If you have, for example, a 15% leaver rate above the average for the NHS-wide workforce, then halving that might not be a realistic target over the course of your workforce planning. You should focus on the direction of travel – a reduction in the leaver rate – at what is a reasonable level for you when you take into consideration all the other dependencies.” 

Theresa Gatfield, Senior Consultant for Workforce Planning, Skills for Health 

If your workforce plan isn’t a strategic consideration for leadership, then it will need to be  

“Part of that realism is understanding that you might not be able to control everything in the system that is affecting your workforce planning.  

This is where collaboration is key. Workforce planning needs to be on the agenda for all levels of leadership – it needs to be informed by them, and they need to be informed by it.  

We see strategic level collaboration really helping when it comes to Integrated Care Systems. We regularly work with ICSs and ICBs to provide training on the Six Steps Methodology to Integrated Workforce Planning®, and for some it’s the first time they’ve gotten into a room and uncovered the system-wide challenges that they need to collectively work on.  

To achieve the ambitious targets in the NHS Long Term Workforce Plan, this will need to become the everyday process for healthcare systems.” 

Theresa Gatfield, Senior Consultant for Workforce Planning, Skills for Health 

You don’t have to be scared by the finances to take them into account 

“Finances are, of course, a central part of workforce planning – but they are only one part of a larger picture. With NHS funding being an incredibly high-profile issue in the UK, it can be easy to worry about it. 

However, we advise people to dig under the skin of the challenges they face based on the workforce they need to create. Funding doesn’t fix everything – there are so often system transformations that achieve more for your workforce plan than more staff funding would. Reducing inefficiencies, being creative and innovative in your patient flows, improving collaboration and staff wellbeing – these things can be game-changers.  

Whilst funding may dictate what you can do to solve the challenges you face, they don’t dictate whether you will be able to face them or not.” 

Theresa Gatfield, Senior Consultant for Workforce Planning, Skills for Health 

Skills for Health are leading workforce development experts. We have worked with most NHS trusts and healthcare organisations in the UK to develop, create and manage workforce plans using our nationally recognised Six Steps Methodology to Integrated Workforce Planning®. Get in touch today to find out more about our services.  

If you or your staff are looking for vaccination refresher courses ahead of the seasonal vaccinations, you can look at Skills for Health’s Immunisation and Vaccination course. Volume discounts are available if booking for multiple employees – make an enquiry with our team to find out more.  

It is a vital tool that NHS organisations of every shape and size can use over the coming years to define and address service level provision and understand the steps they can take to increase both the skills and capacity of the healthcare workforce.

Six Steps Methodology to Integrated Workforce Planning®

Our Six Steps Methodology is the only one cited in the NHS Long Term Workforce Plan as a tool that Integrated Care Boards (ICBs) can use to help develop workforce plans. And that is exactly what Skills for Health have been helping the NHS do for many years – either through delivery of a Six Steps training programme (now CPD certified), or through direct help in researching, creating or auditing workforce plans.

The Six Steps Methodology identifies the elements that are needed in any workforce plan, taking into account the current and future demand for services, the local demographic situation, and the impact on other services – whilst helping you understand and work to a budget you can afford.

What are the actions NHS employers need to take?

The NHS Long Term Workforce Plan is a broad ambition. Skills for Health have been working with NHS providers for over 20 years to enhance and develop their workforce planning capabilities, so we asked our expert team to pull out some of the actions healthcare employers can take to translate ambition into reality.

The below list is by no means exhaustive, as the plan must be considered and adapted to many differing healthcare settings and requirements. We look forward to working with partners across the country to help identify and action the NHS’s staffing ambitions, and illuminating the implementation of the NHS Long Term Plan through our shared learning experiences.

Skills for Health have stood side by side with the NHS since 2002. We have supported the ever-changing landscape of healthcare across the UK, providing expert help where it is needed most. Our ambition is to help the NHS achieve a skilled, sustainable workforce that is ready to meet the challenges of today and the future.

If you need any help in understanding the impact or implementation of the NHS Long Term Workforce Plan 2023, get in touch today.

What causes type 1 diabetes in children?

The cause of type 1 diabetes is still largely unknown, but there are several theories proposed. One popular theory is that the body’s own immune system mistakenly destroys the islet cells in the pancreas, which produce insulin. This destruction of insulin-producing cells appears to be due to a combination of genetic and environmental factors. Once these cells are destroyed, little or no insulin can be produced, leading to an accumulation of sugar in the bloodstream without proper transport to energy-dependent body cells.

There is also a general speculation amongst experts that diabetes may be triggered by genetic characteristics which are inherited, combined with environmental factors like diet or exercise. However, many type 1 diabetes cases in children have no family history of the disease, making its exact cause a mystery.

Symptoms of type 1 diabetes in children

Type 1 diabetes often appears suddenly, and symptoms can occur differently in each child. The most common symptoms of type 1 diabetes in children include:

• Frequent urination. As too much sugar in the urine pulls large amounts of fluids from the body, this can overwhelm the kidneys causing a child to wake up multiple times during the night needing to relieve themselves, or wetting their bed after having been potty-trained for some time.
• Constant thirst. Excessive urination leaves can leave a child highly dehydrated so they will need to drink lots of liquids throughout the day such to replenish these lost fluids.
• Fatigue. Low blood sugars levels, due to lack of insulin production, can make a child feel weak and lethargic, as well as cause increased hunger due to difficulty converting food into energy efficiently.
• Weight loss, despite increased hunger. Because the sugar stays in the blood, the body doesn’t get the fuel it needs. As a result, it begins burning fat and muscle for energy, which can result in unexplained or sudden weight loss.

Warning signs

According to a 2012 survey from Diabetes U.K., only 9% of parents were able to identify the four main symptoms of type 1 diabetes in their children. By 2013, this figure had increased to 14%.

How are children with diabetes treated?

There is currently no cure for type 1 diabetes, so patients must have daily injections of insulin, administered either by injection or insulin pump, coupled with careful management of food intake and regular blood sugar monitoring.

Additionally, dietary habits are key to successfully managing diabetes in children. Parents must help their child make healthy food choices with focus on consuming regular meals full of nutritious foods low in sugar, and counting carbohydrates in each meal served. The combination of balanced meals, timely injections or pump use, doctor-recommended exercise programs, and monitoring will keep the child’s diabetes under control and allow them to lead an active life

What are the possible complications of type 1 diabetes in a child?

The major organs of the body can be affected in the long-term if diabetes isn’t managed properly, including:

• Heart and blood vessels. High blood sugar leads to an increased risk of narrowed arteries, high blood pressure and heart disease which can potentially lead to stroke later in life.
• Nerve damage. Diabetes may also cause nerve damage or neuropathy over time. This can result in reduced sensation in areas such as the feet or hands, causing tingling, numbness, burning or pain.
• Kidney disease. Damage to the waste-filtering blood vessels in the kidneys can result in reduced kidney function.
• Eye damage. Damage to the blood vessels of the eye’s retina can lead to vision problems.
• Osteoporosis. Diabetes can lead to a decrease in bone mineral density, which in turn increases the risk of osteoporosis in adults.

Diabetes increases in children

Researchers have reported an increase in the number of children and teenagers worldwide being diagnosed with type 1 diabetes since the Covid-19 pandemic.

A recent study published in the JAMA Network Open journal has compiled data from various countries, including the UK, on over 38,000 young people who were diagnosed during the pandemic.

Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing – by about 3% a year. But this study found that:

• there was a 14% rise in the rate during the first year of the pandemic, compared to before Covid-19
• in the second year of Covid-19, the rate was up about 27% on pre-pandemic levels

According to experts, the cause of the increase in cases is still uncertain, but there are some theories.

One theory suggests that Covid-19 can potentially induce a reaction in certain children, leading to an increased diabetes risk. However, not all studies investigating this autoimmune response, characterised by the body attacking its own healthy cells, have provided evidence to support this theory.

An alternative hypothesis suggests that childhood exposure to certain germs may offer protection against various conditions, including diabetes. Some scientists propose that the implementation of lockdowns and physical distancing during the Covid pandemic potentially resulted in insufficient germ exposure for many children, potentially limiting this additional protection.

Diabetes education for healthcare professionals

Skills for Health has partnered with HEAL.med to provide access to an eLearning course to aid healthcare professionals to treat and manage under 18-year-olds with type 1 diabetes.

The ‘Type 1 diabetes management in children and young people course’ provides an introductory framework to enable those with no prior knowledge of the disease to treat patients effectively.

By the end of the course, learners will be able to explain the diagnosis of type 1 and type 2 diabetes, how to use insulin safely, the monitoring and assessment of blood glucose control, the role of diet in the management of type 1 diabetes and how carbohydrate counting relates to the correct dose of insulin.

Read more about the partnership with HEAL.med

Leadership and management coaching with Skills for Health

To help develop your or someone in your team’s leadership and management skills, it’s important to ensure you have the right resources and services available to you. Skills for Health offer leadership and management coaching, and have a network of experience coaching professionals that we can match based on best-fit.

Contact us about our coaching services