PSYCHIATRISTS AS LEADERS

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PSYCHIATRISTS AS LEADERS

• Dr Nigel Fisher FRCPsych
• Senior NHS Advisor
• Department of Health
• nigel.fisher_at_dh.gsi.gov.uk
• 16 May 2008

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OUTLINE

• What are the key elements of central policy?
• Does the Department of Health want clinical
  leadership?
• What does this mean for future psychiatrists?

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POLICY FROM 1997

• Detailed, centrally driven targets
• Emphasis on access
• Greater investment
• National Service Framework (1999)?
• Prescribed NSF teams
• NHS Plan (2000)?

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FOR MENTAL HEALTH

• More money
• More staff
• More services
• Better outcomes

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SPEND ON SERVICES FOR ADULTS WITH MENTAL ILLNESS
(millions)?
Source Mental Health Strategies
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Psychiatry consultants (wte)?
Source Information Centre
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PEOPLE SERVED BY CRISIS RESOLUTION TEAMS
Source Local Delivery Plan return
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SO WHAT NEXT?

• Continued investment, but not as much
• Greater financial rigour
• Fewer national targets
• More local targets
• System reform
• World class commissioning
• Next stage review (Darzi)?

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WHAT NEXTFor mental health (1)?

• IAPT
• Social inclusion
• Race equality
• Legislation Mental health bill, Mental Capacity
  Bill
• But what of older people, children
• System reform Foundation Trusts, payment by
  results, contracts, competition
• But what of choice, eighteen weeks

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The public will expect far more from public
services, with services tailored to their
individual needs
Public Expectations
Consumer expectations now apply to public services
This will require a sophisticated understanding
of needs
People will look for soft factors - a more
personal and sensitive approach to care

• The aspects of private sector services that
  consumers value speed, availability choice, and
  up to date information are now being demanded
  from public sector services

rank
40
5th
2nd
Areas of public services that need improvement
4th
Around 50 of patient satisfactions with
hospital treatment is related to non-medical fact
ors
1st
3rd
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There are now 17 million baby boomers marching
towards retirement with a high set of demands and
a clear expectation of what they want in
retirement (Age Concern 2004)?
Source Marion Nestle, NYU, Nutrition Action
Healthletter, 2002 PMSU policy review of public
services Motivations, mindsets and the NHS-SHM
research 2007 Understanding drivers of patient
satisfaction DH 2005 What the citizen wants -
HenleyCentre 2007
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Information is likely to continue to become less
dependent on expert input or the traditional mass
media
Information
People increasingly access health information
from the internet
Moreover, user-generated content is challenging
traditional sources of information

• For most patients the first and most trusted
  source of information is their doctor, however
  faith in doctors expertise if beginning to erode
  especially the younger patients ( MORI 2001)?

Number of weblogs, cumulative March 2003 to March
2007
Source Usage and Attitude survey DH Mori
Technorati, April 2007
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Wireless connectivity is forecast to become
ubiquitous - everything and everyone will be
connected
Information
Growth in wireless devices will make
communication pervasive
This will allow an increase in remote monitoring
of conditions

• Now that mobile phone penetration has reached
  saturation point (85) and 50 of homes have a
  broadband connection, the next stage in
  communications technology is to use wireless
  technology to connect an increasing number of
  devices to the internet
• This is already starting in businesses and homes
  (e.g. ordering new stock or food as supplies
  decline), but is forecast to spread to health

Forecast shipments of wireless machine-to-machine
devices and sensors (m)?
Smart Shirt monitors heart rate, EKG,
temperature etc and uses wireless technology to
relay results to an operator
Vital Monitoring System intended for hospital
use. Using the device, medical staff can track a
patients vitals. Data can be sent wirelessly,
reducing the need for paper and ensuring that
patients can be closely monitored without the
need for intrusive testing
Source Economist April 2007 Trendhunter.com
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WHAT NEXTFor mental health

• New technology
• Discontinuous change
• Changing professional roles
• Breaking down boundaries
• Competition
• An even greater need for leadership

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LEADERSHIPDEFINITIONS (from NWW)?

• Leadership
• Delivery through complex systems by engaging
  partners in the pursuit of major,
  transformational change. Coping with change
  (Kotter, 1988).
• Management
• Transactional, operational processes, controls
  and problem solving. Ensuring that the
  performance of the team and the individuals
  within it matches objectives or requirements.
  Coping with complexity (Kotter, 1988).
• Clinical leadership
• No agreed definition. About strategic vision and
  driving service improvement and effective team
  working to provide excellence in patient/client
  care. Further work needs to be done on this.
• Professional leadership
• No agreed definition. Includes the development of
  professional identity and standards in a
  professional group dispersed throughout many
  different types of team, representing the
  profession and developing its contribution to the
  overall objectives of the organisation. Further
  work needs to be done on this.

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THE STATUS OF MEDICINE

• View of the public
• Other professions
• Politicians
• Span of experience and expertise

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WHAT IS THE LEADERSHIP CHALLENGE?

• Darzi review leading local change
• Change always for the benefit of patients
• Change will be clinically driven
• All change will be locally led
• You (the public) will be involved
• You will see the difference first

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CLINICAL LEADERSHIP

• Vision
• Self sacrifice
• Role modelling
• Spokesperson
• Expectations of high performance
• Recognising the contribution of others
• Clinical expertise
• Accountability
• Rational argument

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THE FUTURE PSYCHIATRIST

• A positive future
• Confidence in their role
• Breadth of clinical expertise
• Uniquely placed to take on the leadership role
• A strong track record of leading change
• Must engage with the management