'Clinical leadership is key' - the chief executive’s viewpoint

How does the Working Time Directive fit amongst all of the priorities that a typical NHS trust has and where is it on the agenda right now for a chief executive? Calling Time spoke to Dr Chris Burke, chief executive at Stockport NHS Foundation Trust to find out.

As chief executive of a foundation trust/district general hospital, the agenda of managing complexity is an underpinning theme.

“The challenge is to deliver the present whilst attempting to guarantee the future and the Working Time Directive is one element of that complexity which requires sustained intervention.” explains Dr Burke. “The directive is only one aspect of a fast changing clinical world for the foundation trusts as a healthcare business and as we look at how our clinical services need to change to meet patient need, we must also ensure continued financial profitability. We are looking at where we go as an organisation and business over the next two to four years and how the directive, coupled with the changes from Modernising Medical Careers (MMC) will impact on our ability to deliver healthcare for our local community. These could be highly disruptive to our future service plan and greatly affect our ability to deliver in a complex health market.”

The approach needs careful analysis and planning as Dr Burke states: “My responsibility as a chief executive is to ensure that we have the capability to deliver services for our community and take advantage of opportunities that the market may present whilst analysing the changing profile of our clinical workforce that will make those plans more difficult. WTD, MMC and other factors such as age profile are part of a whole range of factors that come into play when reviewing continuity and service plans both in terms of the hours that staff will work and the future changes in their skill and competencies within that contribution.”

Early planning is essential and that means bringing together workforce analysis expertise, financial and service planning skills.

“As a foundation trust we need to look at the future contribution to care that medical staff will be making. The WTD is a tip of a large workforce and service delivery change iceberg that needs to be fully understood and carefully navigated around. We have a number of clinical specialties that are already hard pressed in this delivery environment. We have plans which include a variety of solutions including networking with other hospitals and providers.”

“I feel that clinical leadership is the key to overcoming this challenge. Trusts can work with their medical staff to find solutions to these service delivery challenges by reviewing their rotas, hours worked and the care pathways. Some of the changes are not always welcome, particularly with junior doctors and need careful implementation in order to prevent disruption to services and that’s why it has got to be led by clinicians themselves. Clinical directors must lead in their respective areas in order that these changes are acted upon.”

Other key initiatives involve enhancing nursing roles and introducing new practitioner posts. This is a key opportunity that has emerged frothe Working Time Directive challenge and one that Stockport is closely examining, looking at the developing contribution that nurses can make to care by advanced competency development. In addition the way that the hospital provides services via initiatives like Hospital at Night will be expanded to ensure a more holistic teamwork approach to emergency care throughout the day. The foundation trust responsibilities are an added dimension for Stockport. “For a foundation trust the bottom line is that you have to look at business continuity and profitability and workforce is a major component” says Dr Burke.

Overall, the board at Stockport is maintaining a close review on the implementation of the directive and its challenges to services. The key message is that this must be owned at clinical director level in the short term and the chief executive and board role is to empower those lead clinicians to ensure that progress is maintained in the short and long term.

“As a board, Working Time Directive is carefully reviewed. We know that it will become more central in the years to come and will affect our ability to deliver clinical care. The steps that we need to take this year are a means of guaranteeing that comprehensive change solutions are available as the more challenging implementation reaches full impact in 2009. There will be a service gap for us and many other organisations unless solutions are carefully planned and implemented now. I see the role of a chief executive as providing the steer to empower clinical colleagues to make sure that those solutions are being addressed now so that challenges to business continuity and clinical care are not allowed to materialise. That’s a prime responsibility I have to the foundation trust and our community.”