20 January 2006
Standing up for NHS managers is a tough assignment, but a new union leader is tackling the challenge in a determined yet relaxed way. Seamus Ward reports
Forget being prime minister, the coach of the England football team or trying to revive an ailing multinational – the toughest job in Britain is probably that held by Jon Restell. For it falls to him to defend NHS managers, whether it is during employment disputes or against attacks from politicians and media, who blame the easy stereotypes of bean counters and grey-suited bureaucrats for the health service's ills.
Only last month, the pressure on NHS administrators was ramped up again. As ministers announced a forecast NHS deficit of around £600m, they were quick to point the finger at 'incompetent' managers and promised to send in private sector hit squads to sort them out.
In this climate, it is easy to see why Managers in Partnership (MiP), the union where Restell is chief executive, was set up. After a four-year gestation, it was launched last June to support senior NHS managers, a product of a partnership between Unison and the top civil servants' union, the FDA.
'Managers are not liked and I think the main job we can do is to make them respected,' he says.
Restell, 34, insists NHS managers have the public's best interests at heart. 'Managers are people balancing all the difficult issues within complex organisations, improving standards, addressing waiting lists. These things don't happen just because there's some money around. The tension is that there is a lot of bureaucracy in the health service but that is often confused with management.
'We need to free up managers' time so they can start to deliver better services. I think it's analogous to freeing up police officers' time so they can be out on the streets rather than filling in forms.'
He believes the professional bodies have a role to play in helping the public understand the important job done by their members, but adds that politicians must also help by avoiding turning to an easy target when a scapegoat is needed.
'Managers should be held accountable for the things they can reasonably foresee and plan for. But in the government it seems there is a feeling that managers should shoulder the responsibility for the financial implications of its policies – things like the new contracts for GPs and consultants and shifting the working patterns of junior doctors, over which local managers had no control. There is a point where the government needs to take responsibility for the financial implications of its policy.'
The announcement that the government was to send in turnaround teams to the trusts with the biggest deficits was a further slight on NHS managers. 'There is an assumption that the private sector will come in and tell the public sector how to do their jobs. This is missing the point that a lot of the main financial decisions were taken elsewhere.'
Restell's analysis of NHS managers' plight is passionate and thoughtful – and it's clear that he faces an uphill battle to change hearts and minds. But he is not one to get all hot and bothered. In fact, he comes across as positively relaxed.
After all, this is not the first time he has been in this situation. He began his working life at the FDA, as a national officer from 1993 to 2000. During this time he represented hundreds of senior NHS managers in disputes with their employers. In 2000 he joined the Association of Teachers and Lecturers as national officer for its 20,000 members in independent schools before becoming MiP chief executive in March. 'You can see I go for popular groups of workers,' he jokes.
He certainly left a good impression at the ATL. Gerald Imison, the union's deputy general secretary, says: 'You shouldn't be fooled by the highly sociable, relaxed image that Jon cultivates. He tends to get what he wants. At ATL, he significantly boosted our membership and our influence within the independent schools sector with a subtle combination of charm and steely determination. I am sure he will be really successful in this new role, developing a strong and effective organisation.'
The origins of MiP date back to the early 1990s, when some NHS general managers looked for a trade union to represent them. As the trust movement developed, around 150 managers joined the FDA. Over the next decade, this group grew to around 1,300. However, the FDA did not have the resources to expand further.
Unison had the resources but had not been successful in recruiting NHS managers. For both unions, image was a problem – senior managers wondered how they could be part of a union to which their staff also belonged. On the other hand, their managers in Whitehall were likely to be FDA members, creating other potential conflicts of interest.
The answer was a new union, a partnership that would be independent of both. The unions discussed the idea for four years before coming to an agreement. Unison transferred 2,800 members and the FDA 1,300 into the new union. Since June, MiP has recruited a further 400, a 10% rise in the first six months. The new recruits include 45 chief executives and 35 finance directors.
Membership is open to managers in the four UK health services, the health-related voluntary and private sectors, and related areas such as health think-tanks – as long as they are at least in Agenda for Change salary band 8, which starts at £34,372. Where Agenda for Change does not apply, the basic salary must be at least £35,000.
'We are looking at potentially a large number of members,' says Restell. 'We have a challenging objective around growth. Over a five-year period we want to have 10,000 members; that's something like a third to a half of the management community five years after launch.'
He admits the union has recruited a disproportionately high number of members from the primary care sector of late. But he says that is to be expected with so many jobs in PCTs under threat following the publication of Commissioning a patient-led NHS last summer. By October, the 300-odd PCTs could be halved.
'Commissioning a patient-led NHS happened after we launched and at the moment we have very few cases attached to it. For individuals, that will be an issue next year, once the consultation is over and the changes are implemented. We have about 400 cases at all levels, which is the normal pattern of work, but once the changes are implemented there will be a lot more. There is a lot of concern out there about this.'
At the moment, the union is building up its capacity to deal with more employment disputes. It has six national officers for case work but Restell admits there is more to be done on a regional and local basis, particularly as the human resources framework for a patient-led NHS allows for negotiations to take place on those levels.
Restell is also keen to promote the union's positive agenda, such as encouraging better management of staff and leadership. One avenue for this is the Knowledge Exchange, which he describes as an 'on-line community that allows individual managers to interact with a community of other professional health managers and seek solutions to problems'.
While such initiatives are laudable, many of MiP's members and potential members will be concerned that they are being made health service pariahs. Others will be worried about whether they will even have a job this time next year. Over the next 12 months, this new union could come into its own.
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