Here are the thoughts and reflections on leadership and management of the Chair of the Leadership and Management Committee, Dr Helen Crimlisk.
Working with carers and users on the LMC
I am writing this having just come out of a restorative and fruitful meeting with the new Carer and Patient Representatives of the RCPsych Leadership and Management Committee, along with Committee Administrator, Stephanie Whitehead and LMC Co-Chair, Suhana Ahmed. Sarah and Hayley will introduce themselves in a future post, but the purpose of the meeting was to get to know one another a bit better and think about their strengths and passions and how we will work together on the Committee. It was also an opportunity to think about the focus of the Committee’s work over the next year, building on the Strategy review which we are undertaking.
Protecting patients and learning from tragedy
I thought it would be helpful to reflect on the value of our conversation. We touched on the importance of organisational culture and compassion, given renewed relevance in these last few days as we reflect on the failings and damage caused to patients and families as a result of the Letby case. Individuals and organisations are still in the process of absorbing the horrifying details and over the course of time will no doubt come up with a series of responses to ensure that nothing like this can happen again. A key change being widely proposed at this point is a regulatory process for healthcare managers.
Of course. senior medical and nursing leaders are already regulated through professional routes and some other professionals have other bodies that have a similar function. We discussed the fact that the abhorrent actions of previous health professionals such as Harold Shipman, brought about significant changes in the way in which doctors were regulated, with a formalised process of appraisal and revalidation (Learning from tragedy, keeping patients safe - Overview of the Government's action programme in response to the recommendations of the Shipman Inquiry). Has this been effective in reducing the likelihood of such events we wondered? Looking into this I can find some evidence supporting the value of the approach put in place but with cautions about its value in smaller organisations or private practice and caveats regarding its value in improving the performance of the majority of doctors whose performance is good. The report also highlighted the negative impact of the administrative burden of appraisal in maintaining doctors in the workforce.
Reclaiming the language
As we discussed these issues Sarah and Hayley talked about the importance of understanding the language being used which struck me as really important. I did not know that the Greek origins of the term appraisal refer to “estimating the value of something” or saying “how much something is worth”. Likewise, the word revalidation has clear etymological roots in the Latin “Validus” linking it to the concepts of “strength and effectiveness”. The meaning behind these terms is positive, but do we really find ways of conveying this when talking about appraisal and revalidation? What can we do to ensure that for the majority of well-performing psychiatrists, this process really feels positive? Can it generally be a moment to reflect and for most, be a positive statement affirming competence which should be celebrated as a vote of confidence rather than feared? Recent reports by the GMC have encouraged the need for appraisals to be supportive and developmental whilst ensuring that the focus on patient safety, and colleague and patient feedback provide data which can be acted on where there are concerns. We hoped that any changes proposed would bear in mind the need to be proportionate in putting processes in place which are likely to be costly in time and money.
Holding conversations like this with people such as Sarah and Hayley coming from different perspectives provide me with a great opportunity for me to reflect and I look forward to their ongoing contributions to the LMC over the next few years.
Working with Faculty of Medical Leadership and Management to become the first FMLM-endorsed Mental Health Trust
As Associate Registrar for Leadership and Management at the Royal College of Psychiatrists (RCPsych), I was familiar with the work of the Faculty of Medical Leadership and Management (FMLM). The National RCPsych Leadership and Management Fellow Scheme is a one-year in-training programme for Higher Trainees in psychiatry and has recently been accredited by the FMLM.
I have also been involved in supporting leadership development at a national level of Specialist and Specialty Psychiatrists and early and mid-career Consultant Psychiatrists, particularly those working in Transformation and System Leadership. But leadership development needs to be supported at all levels: national, system and organisation and when I was offered the opportunity to work with FMLM locally in Sheffield Health and Social Care NHS Foundation Trust (SHSC), I jumped at the opportunity.
Following meetings with colleagues from FMLM, a programme was mapped out to work towards Endorsement with FMLM which SHSC achieved at the beginning of this year. Engagement with all Doctors was essential and work was undertaken with the Directors of Medical Education, the Medical Management Team, the SAS Tutor and the Medical Education & Staffing Team to ensure that they understood the FMLM standards and were supported to encourage them to think about their leadership skills and development needs.
Leadership sessions were built in to CPD and training programmes and Medical Director of FMLM, Dr Paul Evans and colleagues visited and ran a session jointly at a Medical Staff Committee attended by over 50 Consultants, SAS Doctors and Trainees.
There was agreement that the FMLM Standards, focussing on Self, Team, Organisation and System, provided a framework which Doctors found easy to understand in the context of a progressive approach to development. With the support of the Responsible Officer, FMLM standards were incorporated into the online appraisal documentation and Appraisers undertook training to ensure that all Consultant and SAS Psychiatrists were able to have a good quality conversation about leadership at appraisal. Work was also undertaken with the Medical Management team and with the support of the Medical Director, job planned time for leadership roles at team, organisation or system level was agreed for all Consultant Psychiatrists.
An important group who often miss out on development in this area were SAS psychiatrists. SHSC already has a successful CESR programme with job planned development time for those SAS Psychiatrists wishing to pursue this route to Specialist Registration. However, some want to remain in SAS roles but would nevertheless like to develop their leadership and management competencies. In conjunction with the SAS Tutor, bespoke sessions were designed and delivered on leadership and management to the SAS group and policy change was made that all medical leadership roles would be routinely offered out to SAS doctors as well as Consultants (unless there was a clear reason for not doing so).
During the course of the year, the new contract came out for Specialty and Specialist doctors, and after reviewing the roles SAS Psychiatrists in SHSC were undertaking, seven experienced SAS Psychiatrists were put through a process to promote them to the new Specialist grade and an SAS Advocate was appointed. Since then we have also appointed two further Specialist Psychiatrists through recruitment processes and developed a formal contract for the GPs with extended roles (GPwER) who are employed in some specialist services in SHSC, which is mapped to SAS pay scales.
There are now a range of Leadership and Education Fellowship opportunities and a range of other opportunities for Trainees to undertake during higher training to ensure they are aware of the organisational and system context in which they will be expected to work as Consultants.
Anecdotally, new Consultants often find the non-clinical aspects of their Consultant role more challenging than the clinical ones and introducing Higher Trainees to concepts such as change management, transformation, quality improvement, coproduction, assurance, professional standards and project management at an earlier stage in training has been generally welcomed.
In addition, Psychiatrists were included in a range of other multidisciplinary leadership development opportunities, including an Agile Mindsets approach for those in senior management roles, Medical Directorate development sessions with senior corporate staff supported by the Medical Director, externally-delivered Leadership Development courses through FMLM or NHS Leadership Academy and Restorative Just and Learning courses for new and early career Consultants.
Psychiatrists at all levels were also given the opportunity to participate in the SHSC Developing as Leaders offer. This provided an opportunity for Trainees, SAS Psychiatrists, GPwER and Consultant Psychiatrists to both develop their own leadership as well as support the delivery of the programme to help develop others.
These events have contributed to a change in culture in SHSC, with a focus on leadership at all levels. Regular online Leaders Meetings are chaired by the CEO and are open to all. A weekly half-hour on-line Doctors Chat chaired by the Medical and Deputy Medical Director, helps to ensure that safety or other relevant issues are identified and addressed promptly.
Leadership is talked about by many staff at different levels across the organisation and there is a much better understanding of the need to provide a menu of opportunities for development for everyone. Times may be tough across the NHS, but the work we have done on leadership and the affiliation with FMLM has been of great value contributed to a change in culture to enable SHSC to face the uncertainties of the future with a sense of optimism.
To find out more about FMLM accreditation and submit your own application get in touch with email@example.com.
It is “hard” to keep up with the news in both meanings of the word. As I write, it looks like we are rapidly moving away from the immediate concerns of COVID. Mask wearing and social distancing are waning generally and are now also being reviewed in clinical settings. Whilst people (especially the vulnerable) are still becoming unwell, for many of us, anxiety about the pandemic is receding. Its legacy, however, continues to be felt. The impact on waiting lists for many services has been disastrous and the delayed impact on the mental and physical health of our communities are only just becoming apparent and need us to think differently. At the same time new or renewed concerns are taking the place of the direct impact of the pandemic, which we as psychiatrists need to play our part in addressing:
The war in Ukraine, although in retrospect perhaps more predicable than we had acknowledged, has been shocking to witness. Millions of displaced, traumatised people are now seeking sanctuary across Europe. There are likely to be generational impacts on mental health as a result of this new conflict. As psychiatrists, we understand what is important to help people caught up in war and flight and need to use our influence wisely, both internationally and at home, to ensure that people are helped with finding suitable homes, supportive communities and psychological support where this is needed. College resources for Ukraine conflict
The economic downturn in the UK has been sudden and dramatic. The cost of living crisis and the projected increase in absolute poverty are likely to impact particularly hard on those who are disadvantaged or disenfranchised, especially through mental ill health. We need to continue to advocate for people who are vulnerable and help others to understand the importance of public health (and public mental health) interventions which will mitigate the impact of this. The launch of the Public Mental Health Implementation Centre will help us to develop a language and evidence base to persuade others of the value of interventions. It will also be important to listen to those impacted, helping them as partners to design supportive services to help. It may be that the voluntary sector is more agile in this space and we need to work with and learn how to integrate and innovate with them?
Our organisations continue to struggle with a workforce crisis and this has a direct impact on the quality of services we can provide and an indirect impact on the wellbeing and retention of our own staff, many of whom are struggling with issues of workload and vacancies. The transformation of our health and social care workforces has never been more important. The emphasis on wellbeing and supportive processes such as those outlined by the work on Restorative Justice, offer us an opportunity to do things differently, but to make this work we have to accept that we may need to change how we work too?
Finally, the environmental crisis looming as a result of global warning, continues. Trusts and ICSs have been mandated to write Green Plans but the real key is going to be how we are held to account and how we can continue to build on our ambitions to meet the targets being set. This will only happen if we all see that the part we play by our words and actions are crucial. Do you know what your Trust’s Green Plan says? What can you do to support it?
The Leadership and Management Committee is a group of psychiatrists trying to understand and develop their own leadership roles to address these complex issues. If you are interested in joining the Committee or have things you would like to share with us, please do get in contact with the chair Helen.Crimlisk@shsc.nhs.uk or deputy chair Suhana.Ahmed@swlstg.nhs.uk.
The Leadership and Management Committee (LMC) met in September 2021 with 22 attendees. There has been a focus recently on ensuring that Faculties and Divisions are represented at LMC as there is no direct process for open recruitment. There have been several co-options to address particular aims of linking with our three year strategic plan. We agreed a plan to invite Patient and Carer leads to help us review this at a meeting soon.
A particular focus recently has been on the development of the RCPsych Leadership and Management Fellows Scheme which has recruited 30 higher trainees funded by Trusts for the one year programme. The Director Dr Alex Till has redesigned the scheme to align it with the Faculty of Medical Leadership and Management standards with the aim of achieving accreditation of the scheme. Fellows will be able to apply for associate membership for the year at no cost.
The newly appointed Tutors, Dr Suhana Ahmed and Dr Ross Runciman will be working with senior leaders from a number of Trusts who will co-run modules. Many thanks to all those who are contributing.
Members of the LMC have continued to support the expanding College Engagement Network which will be expanding across England with a focus on Community Mental Health Transformation. As part of this work, a small subgroup is working on guidelines for job descriptions for community consultants, paying attention to the system leadership aspects of working with the expanding primary mental health services.
The LMC also discussed the opportunities afforded by the new contracts for SAS Doctors with the Chair of the Specialty Doctors Committee, Dr Lily Read, particularly the explicit need for leadership development in the new Specialist roles. Mohan Bhat presented an HEE funded Local leadership development for SAS Doctors which could be held up as an example for other trusts to follow.
A presentation by RCPsych Sustainability Scholar, Dasal Abayaratne reviewed the opportunities for addressing the pressing issue of sustainability as a result of the need for all trusts to develop a green plan by January 2022. There are a couple of good examples by Trusts which can be used as models and this was an opportunity to think about how clinical leadership can support the ambition of these. This paves the way for a further focus on sustainability by LMC next year.
Equality, inclusivity, working together & leadership development
I'm writing this blog at the end of a week which began celebrating International Women's week. The hashtag this year was #ChooseToChallenge. As part of this, there was a launch of the College’s 25 Women project which introduced us to 25 women, wonderfully diverse in terms of their roles, their seniority and their backgrounds, all of whom are achieving great things as women psychiatrists in their localities. It was a week since I had heard Kate Lovett demonstrating fantastic leadership with her talk "Where were all the Women" and I really felt it showed how far we as a profession have come regarding gender equality. The end of this week, however, was rather more depressing, with abominable behaviour shown towards women respectfully remembering Sarah Everard, which demonstrated how far we, as a society still have to go to ensure that women's voices are heard and that the misogyny, discrimination and violence faced by women in the UK and internationally is challenged and changed.
I was privileged to be invited to speak to the first RCPsych Patient and Carer Conference this week, (talking about the co-production of the Leadership and Management Committee (LMC) Strategy with Simon Rose and Rachel Bannister which I mentioned in my last blog). The conference launched the College's new approach to working with patient and carers "Working Together", which aims to ensure support, pay and fairness with regard to their input into College work. Diversity and inclusion were high on the agenda there as well, as were the principles of co-production. The LMC strategy includes ensuring opportunity and support for diversity of all kinds in leadership and despite the aims to work towards equality, diversity and inclusion it remains the case that there is much work still to be done in and outside the College.
The LMC is very proud of the work that has been undertaken over the last 2 years of the RCPsych Leadership and Management Fellows Scheme and in particular, of the 32 graduates from last year, many of whom are now moving into their first consultant roles. There is an active L&MFS Alumni group who are supporting our current cohort and we will be recruiting next year’s cohort very soon. Following a review, there will be some changes next year which we hope will contribute to an improved and more sustainable programme as well as the potential to offer out some of elements of the course to SAS and consultants as well as working towards accreditation by the Faculty of Medical Leadership and Management. Adverts will be going out soon for Honorary College positions of educational and operational leads and we will also be looking to recruit senior leaders and managers to co-run individual modules.
Please get in contact with me if you would like to support the scheme or have other ideas about what the LMC should be doing!Helen Crimlisk Associate Registrar Leadership and Management
As I write this we are hunkering down for another period of national lockdown which I know will be occupying you and your teams. I know that balancing the urgent work of today with the important work which will help us more long term is a challenge all of us face.
I would like to thank the Leadership and Management Committee and also Simon Rose and Rachel Bannister (Patient and Carer representatives at RCPsych) for the work that you all put into coproducing our Strategy for 2021 to 2024. It was extremely helpful to have your contributions both at our meeting and afterwards and to have jointly come up with a strategy which is hopefully relevant for the times, challenging but also achievable.
I am particularly excited by a number of the areas we are proposing to focus on and will highlight my thoughts on a couple of areas.
1. Co-production in action
Many of us talk about it, but how many of us remember to routinely seek patient and carer views about the work we are doing? Especially during the recent COVID-19 crisis, this has been less evident, and yet, never more important. We shouldn’t need to be reminded of the value of keeping patients and carers involved in decisions whether that relates to delivering care individually, delivering services or developing to new ways of delivering care, but too often it feels too difficult or challenging. I am pleased that the LMC have demonstrated a commitment to working together with patients and carers and look forward to developing these relationships.
2. Leadership and Management Fellows Scheme
It has been a pleasure to see the first cohort of 32 College Leadership and Management Fellows graduate after a challenging year. I would like to extend my thanks to Michael Hobkirk, Alex Till and Michelle Braithwaite, who have kept the scheme running smoothly and are now supporting the 21/22 cohort, with a programme improved by feedback and relevant to the issues which this year has highlighted, including a focus on inclusivity and diversity and of digital leadership!
Some of the cohort, Ross Runciman, Emma Brandish and Sophie Behrman, have developed a Fellows Alumni group which will provide ongoing development and support for their and future cohorts.
3. Specialty Doctors’ and Associate Specialist Committee
I am delighted to have been able to work with the LMC SAS representative, Renato Merolli, to support the initiatives to encourage the development of this sometimes overlooked part of our workforce. An increasing number of Trusts are offering SAS posts with a focus on CESR support but adherence to the SAS Charter and supporting SAS psychiatrists who want to remain in his role is equally important and leadership development is something which should be on offer to all SAS doctors as part of their SPA time.
4. New Roles in Mental Health
Meeting the increasing demands on mental health services and manning or womaning the new services being developed by the Long Term Plan means embracing people entering the workforce through new roles. New competency frameworks for Peer workers and Advanced Practitioners and a Toolkit for employing Physician Associates working in mental health provide an opportunity to support more people, but at the same time, we need to ensure appropriate training and support.
5. College Engagement Network
The College is keen to develop a stronger link with the innovative work which is going on at ICS level and we have been working with the College and Billy Boland, chair of the General Adult Faculty to develop a network of psychiatrists linked in at Trust level to the developments occurring around the Community Mental Health Framework as a starting point. The LMC looks forward to supporting these psychiatrists as they try to tease out the learning from the change processes involved in these innovative models, influencing how they adapt and are adopted elsewhere.
Of course, none of this could happen without your input and help between and at LMC meetings, and I welcome offers to lead/ co-lead items in our strategy and/or am willing to consider co-opting people onto the Committee who are keen to work in this area. Please contact me at firstname.lastname@example.org with offers of help, comments or suggestions!