NHS Wales Betsi Cadwaladr University Health Board JOB DESCRIPTION

NHS Wales Betsi Cadwaladr University Health Board JOB DESCRIPTION Post Title: Accountable to: Secondary Care Medical Director Professionally accountable through Executive Medical Director to LHB Chief Executive and Board for professional and regulatory issues for doctors in Secondary Care. Operational accountability through Secondary Care Director to Chief Operating Officer. Key Relationships: Secondary Care Director Secondary Care Nurse Director Area Directors Area Medical Directors Director of Quality Assurance Finance Director for Secondary Care Services Hospital Medical Directors Hospital Directors Hospital Nurse Directors The Therapy Professions and Professional Groups BCUHB Board Senior clinicians and clinicians across all sectors, directors and management team Unified Public Health Service Other NHS organisations Local Authorities Local and national voluntary organisations Members of the Stakeholder Reference group Staff representatives and trade unions Professional bodies and associations Patients I service users and their relatives/carers The public CHCs Local partnerships Independent Contractors Professional and regulatory bodies Educational institutions (higher and further) Postgraduate Dean Advisory Committees AMs. MPs, Ministers and WAG Officials Members of the National Advisory Board and National Delivery Group

Remuneration and Terms and Conditions: Location: As determined by the BCUHB Remuneration and Terms of Service Committee within the Policy Framework set by the Welsh Assembly Government Co location with Secondary Care Director, Secondary Care Nurse Director

JOB PURPOSE The Secondary Care Medical Director will be responsible for medical leadership, building, motivating and developing a team of clinicians, to drive forward service transformation across the three acute hospital sites (Ysbyty Gwynedd, Ysbyty Gian Clwyd and Ysbyty Maelor) as well as Abergele and Llandudno Hospitals. As a member of the Secondary Care Leadership and Management Team the Secondary Care Medical Director will hold responsibility jointly with other members of the secondary care team for the strategic direction, and operational delivery of services. The Secondary Care Medical Director will provide Medical Leadership on behalf of the Office of the Medical Director for Implementing the Quality Improvement Strategy and promoting a culture of Prudent and Compassionate Health Care. The Secondary Care Medical Director will promote the five key objectives of the Office of the Medical Director. The strategic planning of clinical services and meeting healthcare standards. Improving communication and collaboration between secondary and primary care. Developing a culture of quality improvement and compassionate care Leading and developing the Medical and Dental Profession in North Wales Building relationships and a positive reputation with our people, our patients, the media and other organisations within and external to Wales They will also: Ensure that the LHB makes a significant contribution to health improvement and the reduction of health inequalities. Work with the Hospital Medical Directors and be the principal source of medical advice to the Executive Medical Director. They will act as the professional lead for all secondary care doctors and clinical networks within the healthcare community employed by the LHB. Support the Responsible Officer by overseeing the appraisal process for all secondary care doctors within the LHB to allow revalidation decisions to be made. Provide Medical Leadership for clinical governance and assurance, in conjunction with the Secondary Care Nurse Director and the Director of Quality Assurance, for the overall discharge of clinical governance in the LHB. Provide leadership on the medical implications of service reconfiguration, clinical performance and conduct, medical education, research and development, senior doctor appraisal and validation across the health community.

Create an environment in which excellence, research and development, public protection and patient safety can flourish to meet the challenges of the 21st Century. KEY ACCOUNTABILITIES Improving Population Health and Patient Services Championing the change in emphasis from in-hospital care to effective prevention, early intervention and long-term community based support. Drive the redesign and modernisation agenda across the healthcare community. Lead and foster effective clinical leadership and promote clinical engagement so that the LHB provides safe, high quality, acceptable care for patients I service users in accordance with the prudent health care approach and NHS standards for services in Wales. Initiate and facilitate effective partnerships and alliances between the LHB and other agencies, and NHS providers in Wales and the rest of the United Kingdom (and in the North West in particular) so as to influence the agendas of these bodies and to draw on their experiences and perspectives in creating local NHS and community strategies, policies and actions, to deliver long-term health improvements. Delivery of an integrated healthcare system across primary, secondary and community sectors by working with the Area Directors, Area Nursing Directors and Area Medical Directors, the Director of Mental Health & Learning Disabilities and the Director of Public Health; providing leadership and management of the integration of the various components of the LHB, to develop a unified organisation which delivers a service that: delivers improved population health and wellbeing; 1000 Lives Campaign reduces inequalities and improves patient safety.

Motivate all clinical staff to benchmark services continuously against best practice evidence, research and audit, to ensure high quality standards of patient care. Foster a culture which embraces and recognises the opportunities for the utilisation of new clinical and service technologies. Quality, Safety and Patient Experience I Quality Improvement F u l l y s u p p o r t the Implementation of the Health Board's Quality Improvement Strategy and ensure effective organisational arrangements and capacity in secondary care that enables the Health Board to meet its strategic aims within a framework of strong, effective governance. This should be consistent with the standards of good governance set for the NHS in Wales, which are based on the Assembly Government's Citizen Centred Governance Principles. Accountability for all medical clinical governance issues in secondary care and shared responsibility with the Secondary Care Nurse Director for the overall discharge of clinical governance and provision of assurance in Secondary Care. To ensure active participation by all medical staff. Establish clear lines of accountability and ensure that all relevant clinical staff in secondary care are managed, supervised and trained appropriately with regard to clinical services, managing through a strong governance framework and in accordance with the regulatory requirements. Ensure a robust and clearly understood approach is taken to the management of clinical risk including the major risks held in secondary care are properly reported on the risk register. Supporting the Hospital Medical Director to deliver key areas of the Quality Strategy (the quality priorities) to include Mortality, Sepsis, Hospital Acquired Thrombosis and RRAILS, on each site. To ensure a robust system of monitoring of clinical outcomes and effective clinical audit. To ensure a direct link between national & local audit priorities and the audit programme. Monitor the quality of patient care against national and local indicators. Ensure the safer patient groups across major hospital sites are well coordinated and focus on major patient safety issues (e.g. Hospital Acquired Infection and Thrombosis, response to the deteriorating patient, and safer prescribing) Through coordination of safer patient groups ensure there is sufficient "spread" of lessons learnt from concerns, complaints, Safety Incident reporting (DATIX), Serious Incident Reviews, Root Cause Analysis and Coroners cases. Improving the quality of prescribing by giving expert medical support to the Prescribing Advisory Team and others as required.

Within secondary care to co-ordinate inspections by external bodies including the Royal Colleges, the Deanery and response to National Confidential Enquiries. The Secondary Care Medical Director will advise the Executive Medical Director of the outcome and implications of external inspections and will ensure that recommended actions are implemented. Performance As a member of the Secondary Care Leadership and Management team, to ensure effective clinical and managerial structures are in place in Secondary Care to achieve the financial and corporate objectives set for the LHB. To ensure the effective, efficient and economical use of resources in achieving planned activity and delivery of all required performance targets, with a drive for optimum productivity. Ensure the development of clinical information strategies, to assess health needs and to support evidence based decision making. Responsibility for effective local systems, which will enable individual doctors and clinical professionals to discharge their professional obligation to report clinical colleagues if there is cause for concern, or reason to believe that their conduct, performance or health might present a threat to patients I service users as outlined in 'Duties of a Doctor' and to raise these concerns in confidence. Strategic Development and Partnership Working Take strategic responsibility for service and policy development, particularly relating to national or regional initiatives and directives from the National Institute of Clinical Excellence (NICE), Health Inspectorate Wales, the Annual Operating Framework and the Local Delivery Plan. Engage with and promote co-operation and collaboration with other organisations, to develop strategic partnerships and alliances to improve the health of local communities and ensure effective partnership working. Actively support the development of effective strategic links between health service planning and delivery and the public health function. Support the development of a culture of public involvement that is open and transparent, ensuring that users, carers and the general public's views are effectively represented and appropriately incorporated into decision making across the LHB. Develop effective relationships with the Community Health Councils, Professional Fora and Stakeholder Reference Groups, to ensure strategic plans are developed with full cognisance of their views.

Leadership of the Medical Profession To provide visible leadership for medical staff on both professional and managerial issues. Establish and head up a strong team across secondary care which will provide clinical leadership for acute services. Develop processes, which ensure the optimisation of clinical leadership, full engagement and commitment of all clinicians, to deliver improvements to patient accessibility and clinical outcomes. To ensure regular communication with medical staff, ensuring that they are engaged with the development of service plans and policies. Develop an organisational culture that supports clinical engagement in decision making, a drive for continuous service change and improvement, and a learning environment to deliver high quality, safe services in the new environment. Working with the Executive and Deputy Medical Director ensure effective medical workforce planning in order to provide the appropriate level and mix of skilled clinical staff to address the health needs of the LHB, both now and in the future. To take a proactive approach in the management and governance of locum and agency medical staff. Advise the Executive Medical Director and the Board on the impact of legislation, and national policy on the LHB's ability to deliver secondary care services e.g. European Working Time Directive, Modernising Medical Careers, the implementation of the amended Consultant Contract, SAS Contract, and the introduction of reduced working hours. Provide advice on medical staffing issues, having regard to statutory requirements and national and local policy and guidance. This includes the implementation of national policy, directives and the use of clinical indicators, appropriate standards in medical practice. to ensure safe and Take a lead role in the resolution of any employment matters for the LHB Secondary Care medical staff, working closely with the Executive Medical Director and the Director of Workforce and Organisational Development. This relates to conduct, capability, competence or performance and to manage the exclusion and disciplinary procedure for medical and dental staff, on behalf of the LHB, ensuring that there are appropriate processes in place to embrace all medical and dental staff across the LHB area Support the site Medical Directors to ensure that appraisal and job planning for doctors and dentists occurs and is carried out to a high standard with clear objectives being given.

Support the site Medical Directors to manage regulatory and performance issues within the secondary care medical staff groups. Education, Research and Development Maintain and develop links with Higher Education Institutions, ensuring robust communication takes place with the Postgraduate Dean and Royal College Advisors on postgraduate training issues and the Medical School. Ensure that all recommendations from external visits have an action plan and that these are implemented. Ensure that standards of postgraduate medical education and training for secondary care meet national requirements and contribute to the successful recruitment and retention of doctors in training, across all areas of healthcare. Oversee processes for the delivery of undergraduate education in secondary care in conjunction with Undergraduate Organisers Ensure that appropriate medical education is in place for doctors in training and for all career grade doctors within the LHB. Contribute to the LHB's research and development (R and D) agenda in collaboration with the associate Medical Director for (R and D) to ensure that outcomes of relevant research are assessed within the LHB. This will include fostering an evidence based culture by working with clinical colleagues to ensure appropriate use of research evidence in order to improve practice and service delivery. Take a key role in the Research and Development strategy for secondary care, working closely with the R&D Director Building Positive Relationships To attend the Local Negotiating Committee and develop the relationship between the Health Board and the British Medical Association. To contribute to NHS Wales strategy development and delivery and to actively engage in work at a national level. As one of the cadre of senior leaders within Wales, to contribute to the wider health and organisational agenda of NHS Wales and WAG. The Secondary Care Medical Director will act as one of the ambassadors of the LHB and NHS Wales. To meet community groups and other partners who have an interest in our services OTHER RESPONSIBILITIES

The post holder may be required to undertake other relevant duties, including the operational lead for specific services and localities, as required by the Chief Executive. PERFORMANCE APPRAISAL Performance will be appraised and objectives agreed on an annual basis with the Secondary Care Director, with corporate and professional input from the Executive Medical Director and the Chief Operating Officer.

PERSON SPECIFICATION Qualifications Qualified Medical professional with an unblemished registration with the GMC Evidence of continued professional development. Further evidence of management training and a commitment to ongoing professional development. Experience and Knowledge Must have significant experience working as a practicing GP or specialist hospital doctor Clinical Governance. Medical Management Significant organisational change experience I managing difficult and complex change. A track record of achievement in: o Effective performance management; o Introducing robust systems and processes; and o Facilitation of groups. Undertaking sensitive negotiations. Successful initiation and facilitation of strategic partnership working and alliances. A good understanding of the health and social care management environment in Wales and of roles and responsibilities within it. A good understanding of national targets. A good understanding of performance management methodology. Developing an organisational culture that promotes clinical engagement in decision making and leading continuous change and improvement in services, encouraging the use of new clinical and service technologies. The Safety and standards agenda. An understanding of the principles of Public Health Medicine that are relevant to, and underpin the work of the LHB. Abilities and Personal Qualities Innovative, with strong service focused approach, exceptional communication, interpersonal, negotiating and influencing skills. Ability to think and act strategically and to articulate a clear sense of direction and vision to a wide audience. Ability to build effective relationships with a range of internal and external stakeholders. Demonstrable leadership and ambassadorial skills with an ability to demonstrate a flexible leadership style. Commitment and passion for citizen focused service with the ability to embed such an ethos at all levels of the organisation. High level of; o Negotiating skills; o Interpersonal skills; and o Communication skills. Ability to contribute to policy development. Decisive leader, capable and committed to translating policy and analysis into practical actions.

Strong prioritization, skills with the ability to manage competing demands. High degree of analytic skills. High degree of report writing skills. T earn player with experience of managing teams. Ability to deal with the media.

NHS Wales S econdary Care Medical Director - Behavioural Competence Structure Drawn from NHS Wales Leadership Qualities Framework, NHS Wales Executives Behavioural Competency Structure and other strategic documents. Seizing the future Thinks and acts for the future. Intellectual flexibilit~ Handles information and clarifies comolexitv. Broad scanning Gathers information from a wide range of sources. Political Astuteness Understands the politics I power bases. Drive for results Sustains a focus on improving performance to meet challenging goals. Financial Leadership Ensures sustainable financial viability and most effective use of resources to achieve stratecic aims. Leading change through people Makes change inclusive mobilising people's energy and commitment Setting Direction Acts now to articulate, shape and implement a compelling, shared vision that takes current s ervice developments into a coherent future strategy. Acts quickly and decisively in a crisis and builds new programmes and capabilities rapidly. Introduces flexible, innovative approaches to achieve service improvements and promotes organisational ability to cope with change and shape the future. Leads continuous service improvement, encouraging the use of new clinical & service technologies Synthesises, reframes and prioritises complex demands, consequences and critical points from a mass of disparate and conflicting data Demonstrates ability to move between significant detail on the ground and the strategic big picture, modifying plans and actions to take account of new/diverse views, information and standpoints. Interprets complex medical workforce strategic agenda into action on the ground. Checks what is happening on the ground, asking patients I service users, their carers and staff about their experience of services and is visible and accessible at all levels - "walking the talk". Actively seeks out diverse viewpoints, promoting inclusivity. Purposely uses wider networks to keep up with developments in medicine, health, social care, housing, and education, building relationships with partners, clinical and academic colleagues. Builds consensus alliances through purposeful engagement with key networks of interest groups and influencers to shape and deliver change. Demonstrates understanding of complex stakeholder networks and ensures actions take account of political sensitivities in building agreements. Balances political, professional, technical, financial and cultural considerations to achieve change Focuses and clarifies objectives and boundaries and is goal focused, resisting any pressure to be deflected f r o m achieving quantifiable service improvements. Takes calculated risks within integrated governance, to achieve longer-term service improvements creating enduring benefits of improved healthcare for patients I service users and carers. Wants to make a real difference to people's health and well-being by delivering a high quality service and by developing improvements to service. Uses a range of strategies to shift the organisational emphasis from in-hospital care to effective prevention, early intervention & long term community based care Ensures high standards of medical care, using audit and clinical information strategies to demonstrate quality outcomes for oatients and their carers. Contributes to the management of financial flows in the LHB to deliver short & long term objectives. Focuses use of resources on achieving the future vision of the organisation, advising on the impact of diverting resources from current programmes to invest in development and change. Demonstrates financial literacy/quantitative problem-solving skills. Contributes to the delivery of agreed recovery plan and contributes to resolving deficits Ensures a high standard of financial management and control, with financial systems I procedures promoting the efficient and economical conduct of business, safeguarding financial proprietary, governance and regularity throughout within the organisation. Delivering the Service Engages others as partners in developing a shared vision within the organisation and across the local health and social care and academic community to achieve buy-in and commitment. Aligns efforts and shares leadership and power to achieve integrated service improvements, winning and retaining the respect of other clinicians. Builds organisational frameworks for continuously improving quality and safeguarding high standards of care supporting others who lead implementation. Builds effective clinical leaders and teams, removing obstacles to effective working. members to account through stretching performance and rewards systems. Holds team

Holding to account Promotes a high performance culture. Empowering others Fosters independence. Effective and strategic influencing Uses range of influencing strategies. Collaborative working Engages constructively with internal and external stakeholders. Self belief Inner confidence to succeed. Self awareness Understands own emotions, strengths and limitations. Self management Manages own emotions and demonstrates resilience. Personal integrity Commitment to openness, honesty, inclusiveness and high standards. Professional Accepts personal responsibility for the medical workforce, holding others directly accountable for delivering what has been agreed, both within and outside of the organisation Intervenes swiftly and consistently to address poor performance or inappropriate behaviour where this is impacting on patient safety and effective service delivery. Challenges and confronts conflict affecting service standards or safety, brokering agreement. Embeds the duty of providing high quality patient I service user care throughout the organisation, ensuring that the Board receives reports on quality and safety and that appropriate action is taken. Provides high quality advice to the Board on all matters relating to medicine. Ensures statutory and regulatory aspects of medicine are delivered, including validation requirements for all doctors. (cont.) Delegates effectively, securing resources as required and providing space for others to be creative. Takes risks with others, coaching their development using failure as an opportunity to learn. Explains clearly and concisely the reasons for plans and actions to affected people, stakeholders and partners and listens and acts on responses. Leads the investment in talent management, ensuring that appropriate development processes are in place for the medical workforce (including succession management). Coaches and mentors others to help them maximise their contribution. Nurtures doctor's ability to lead and encourages the development of clinical leaders Uses a range of effective influencing strategies that will bring about desired outcomes and long term change in health services, building and using extended networks of influence. Gains commitment and credibility from the local community through responsive involvement of local people, staff and other agencies in shaping local health priorities and strategy. Champions the organisation in external forums e.g. local authorities, Government bodies and national organisations and represents both the organisation and the medical profession at local, national and international level. Creates the conditions to promote sustainable partnerships and works closely with health, social care and academic partners on all important investment decisions to ensure joined up action which creates enduring benefits for stakeholders. Leads the shared duty to engage the public and other bodies in planning and monitoring services and is informed on the current and changing priorities of partners, modifying own plans in order to seek "win-win" outcomes. Demonstrates effective management of relationship with Chief Executive, Chair and Board members, jointly creating cohesive strategies for delivering a world class health care. Personal Qualities Takes on stretching challenges that some peers may back way from. Constructively challenges others, regardless of position or status. Willing to take tough decisions and is openly optimistic about achievement of goals. Stand up for what they believe in, speaking up and have a can do sense of confidence. Makes the care of people first concern, treating them as individuals respecting their dignity. Understands the nature and cause of own emotional reactions to particular situations and takes account of the likely implications and impact of own behaviour. Role models effective behaviours and shows understanding of own strengths and limitations in providing leadership that makes a difference to patientsiservice users, carers and staff. Manages responses and reactions consistently when under pressure remaining calm in a crisis and without transferring unnecessary stress on others. Takes conscious steps to manage own emotions and absorbs and deals constructively with criticism and performance feedback. Models a healthy approach to work I life balance, having a range of interests outside of work. Stands up for that which is consistent with stated NHS values and delivers on own commitments even when this is difficult and there may be personal cost. Acts as a consistent role model for engaging staff, patients I service users and other stakeholders at all times, taking a fair and inclusive approach to decision making within a framework of integrated NHS governance. Open, and honest, acts with integrity and uphold the reputation of the medical profession. Requires and expects others to be open and honest in their communication. Works with others to protect and promote the health and wellbeing of patients I service users, their families and carers, and the wider community. Provides a high standard of practice and care at all times, respecting people s confidentiality Models a professional approach to medicine and maintains practical competency and credibility

.. Integrity Commitment to the medical profession and to standards of conduct and ethics Accountable for actions and omissions in personal clinical practice and is always able to justify own decisions. Always acts lawfully, whether those laws relate to own professional practice or personal life. Maintains clear professional boundaries with those in their care or anyone close to them. References: NHS Wales - Leadership Qualities Framework ("LQF") - ; NHS Wales Chief Executive Development Center - Competence Framework Welsh Assembly Government - Accountable Officer Memorandum for Chief Executives of NHS Trusts Welsh Assembly Government - Accountability, Performance and Development Handbook for NHS Wales Chief Executives Welsh Assembly Government - "One Wales" Welsh Assembly Government - Consultation Document on Reorganisation NHS Institute for Innovation and Improvement - Leadership Indicators NHS England - Competence and Experience Framework for Chief Executives NHS Wales & IHM - Leadership Framework; Audit Commission Report - Financial Failures in NHS Trusts, Department of Health UK - Kennedy Bristol Inquiry Report on Care of Children; Leadership Roles in Meeting the Challenge of Change - University of Leeds Review of Leadership Theory and Competence Frameworks - Exeter University Centre for Leadership Studies Seven Leadership Leverage Points - Institute for Healthcare Improvement (MDcomp framework v2 0309)