About South Downs Health NHS Trust
South Downs Health NHS Trust employs around 1500 staff and comes into contact with 2500 patients every day. It provides services mainly in Brighton and Hove although specialist services reach a much wider area. They have recently been chosen by West Sussex Primary Care Trust to run their community services from 1 July 2009. This will increase the annual budget of £65m to over £170m.
The trust provides community, specialist and rehabilitation services, ranging from district nursing to rehabilitation for people who have had strokes or caring for people near the end of their lives.
Partnership working
The trust has a history of positive working relationships with trade unions and staff side organisations.
This stemmed from concerns expressed by staff side about the development of primary care groups (PCGs) in the late 1990s and the impact that this would have on staff.
The positive impact of having a dedicated staff side post able to discuss issues amongst all trade unions and present a ‘staff side view’ persuaded the trust of the value of partnership working and led to the creation in June 2001 of one of the first Staff Side Co-ordinator (SSC) roles. The Staff Side Co-ordinator (SSC) is a full time post and has a key role to represent staff and staff side organisations within South Downs Health.
The commitment to partnership working has extended throughout the trust, to the degree that organisational change and changes to the way staff work have been tackled by managers and staff working together; a recent example came with a productivity review
Improving productivity: a review
In October 2007 the trust faced the difficult task of finding cost improvements and savings from within services. It needed to demonstrate that it was the best provider on quality, price and responsiveness, yet continue to balance the books.
The trust decided to appoint some external consultants from a specialist company to help team leaders and front line staff to develop ideas to improve productivity so that:
- the time staff spent with patients could be increased
- team leaders and frontline staff were developed, so that they could manage the productivity of their work more effectively
- systems to manage capacity at an individual level were developed
- how buildings were used to provide health care were improved.
From initial discussions about the improving productivity review, it was accepted that staff were an essential part of the work within services. An Improving Productivity Steering group project group was set up to oversee delivery, the SSC was a key member of this group. Performance Improvement Teams (PIT) were set up for each service, this included front line staff and a staff side representative, the SSC co-ordinated attendance and briefing of these team members.
By examining the patient care processes and the management systems that support them, the consultants used direct observation, statistical analysis of activity systems and diary reviews where appropriate to see how much time was spent on direct patient related activity. This was expressed as a percentage of available time.
The study specifically did not look at the quality of care, but at how much time someone spends providing care. and the time taken on non patient care activities to free up more time for more patient contact.
One of the most important parts of the project was the work that the Performance Improvement Teams (PITs) did within each work stream. These teams include team managers and frontline staff who knew services well and were respected by the rest of the workforce. There also had to be respect between the various staff side organisations, as the staff representative, represented all staff. The Performance Improvement Teams:
- developed, agreed and implemented proposals for their services to increase productivity.
- agreed the desired productivity for each service
- met weekly to review progress and plan the next tasks.
The precise number of PITs for each work stream and the membership reflected the range and complexity of services under review.
Within each work stream there were workshops for team leaders to help them manage their teams in new ways, plan and organise work, set targets and give feedback so that productivity improvements were sustained beyond the end of the project.
The next level was the work stream management group. This included the relevant director, chair(s) of the Performance Improvement Team(s), a staff side representatives and the project manager from the external company. The management group ensured that the work stream plans were on target and that outstanding issues were resolved.
The final level was the Improving Productivity Steering Group which monitored progress on the overall project and provided assurance to the board.
Communication with staff was essential during the process, in order to keep the organisation up to date about progress with the project. This included:
- regular communications with staff within a work stream, following the management group and performance improvement team meetings, highlighting progress, future work, key milestones, risks and issues
- chief executive updates
- the chief executive meeting with staff directly involved in the performance improvement teams
- regular staff meetings arranged throughout the project
- making key information from work streams available on the trust's intranet site
- briefing the Joint Staff Committee at every meeting.
The SSC also spent a large part of their time talking to representatives within the PITs as well as fielding general queries from staff.
An HR group, chaired by the director of HR and with membership from managers of clinical services, staff side and the HR department was established. The group provided information, advice and guidance to work stream management groups and performance improvement teams on:
- information for each team on their starters and leavers, age profile
- process for handling vacancies and recruitment during this time
- identification of criteria for ‘displaced’ staff
- redeployment/talent pool processes
- identification of support needed for staff/managers during process
- capturing learning from the process to ensure sustainability of productivity work/approach.
The HR group proved invaluable in enabling managers, staff side and HR professionals to discuss in an open way the challenges facing the trust and to ‘think outside the box’ in developing solutions. This has been particularly important when the improving productivity review initially gave rise to some concerns amongst staff that reductions in the workforce will be the inevitable result. For example, the suggestion was made to managers to review existing establishments to remove parts of posts (often for very few hours) that were never going to be filled as a first step to releasing money from budgets. This released around 20 full time equivalent posts from across the trusts services with no impact on individual staff jobs. The trust also suspended external advertising of posts and job evaluation processes.
The results
Partnership working was integral to the improving productivity review, without the involvement of staff, suspicion that it was simply a ‘time and motion’ study would have likely undermined the whole exercise. The involvement of front line clinical staff gave them a ‘buy in’ to one of the main aims - releasing time to care (increasing direct clinical time spent with patients). For example, by improving shift handover within district nursing, it was estimated that 84 hours of nursing time could be released to direct nursing care each month.
Improving productivity has become everyone's business, which it makes it more sustainable in the longer term.
“Trust and honesty with all sides engaged came to the forefront, openness enabled frontline staff to understand the workings of management which in turn enabled management to understand staff concerns, and this enabled the productivity process to be a joint project rather than a confrontational one.”
Sean Weston, staff side coordinator
“The work we did in the productivity review was a useful lever to look at individual inputs i.e. how much was being done and challenge some of the traditional ways of doing things. However it was a crude and blunt instrument that didn’t measure how things were being done or the value to patients (outcomes). Having staff engaged from the start and with the support of staff side helped us reach solutions that staff could see working. The work we are now doing as learning partners through Productive Community Services Programme working with the NHS Institute of Improvement and Innovation is more helpful as it looks at these quality measures too.”
Sylvia Russell, Lead Nurse Manager – District Nursing
“The work we did on improving productivity really tested our partnership working, people didn’t always believe we were being honest with them about wanting to hear their views and help with solutions. Our history of involving staff side helped but we (staff side and management) really did have to keep reinforcing our genuine desired to involve them”
Janet Miller, Human Resources Director
Top tips from South Downs Health
for successful partnership working:
- learn to trust each other
- respect each other and sign up to confidentiality
- we all need to be part of the team and not look on from the outside
- remember that it’s not just about the chief executive and staff side talking - managers need to see that involving staff side is beneficial too.
and what to avoid:
- do not prejudge each other's engagement commitments and limitations; agree on your aims and objectives first and you may be surprised at the extent of others' participation
- be clear that partnership working does not negate the need for formal consultation and negotiation processes.
More information and contact details
For more details regarding partnership working at South Downs Health: