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Thanks once again to all of those who responded to our recent survey on interim management in the NHS. I wrote an article summarising the findings in the most recent Interim Partners newsletter, we also issued the article to our PR company, and the survey was picked up by the Times on 10th December and the Guardian on 14th December - click here to view the Guardian article. But I also wanted to post the same article in a blog, so that our interims would have a chance to comment.
Were you surprised by any of the findings? Are you optimistic about 2011? I look forward to hearing your views.
There is certainly scepticism amongst our NHS interims that Lansley’s proposed changes will improve service delivery or cut costs. 76% of respondents think government plans to empower GPs to commission services will not reduce costs, when one of drivers of this initiative is to abolish PCTs and strip out layers of NHS management. However 78% think opening up the NHS to any willing provider will improve service delivery, this suggests our interims feel there is plenty of room for improvement in NHS service delivery and with the introduction of competition into the market place, standards of care should improve as NHS hospitals start competing with private providers for patient activity.
Our interims also feel that the interim management market in NHS will fare relatively well compared to other areas of the public sector. 39% felt that central Government and 36% felt local government would see the biggest falls in demand for interims and this is certainly reflected in the number of new candidate registration enquires we are receiving. There has been a marked increase in the number of local government, BSF and central government interims enquiring about opportunities, even though Interim Partners has historically not had much presence in these areas. Interims in those sectors are clearly trying to broaden the number of providers they work with in an effort to try and increase access to the fewer opportunities that are coming through, this is a trend which is not necessarily in evidence for NHS interims, 38% are working with a greater number of providers than one year ago, but 40% are working with the same number and 22% are actually working with a smaller number.
Anecdotally I have certainly been aware there is pressure on rates, 45% reported that roles they are being approached about are at rates lower than their usual expectations, this is driven by a general lack of opportunities in the marketplace but also increasing commercial awareness with clients that it is a buyer’s market. We receive quarterly updates from the Interim Manager’s Association which has management information across the interim management marketplace which comes from the 30 IMA members. The latest analysis of Q3 2010 shows an 12% drop in average day rate for interims compared to Q4 2008, this figure applies to the wider market not just public sector or NHS interims but I expect the drop would be more marked in the NHS, given the 12% decline will be dragged upwards by strongly performing areas such as financial services.
Certainly I have had three client enquiries in the last three months where a conversation about a potential requirement has turned to budget and the client has offered a budget well below market rate, or stated a strong preference to appoint on a fixed term contract.
Unsurprisingly, a significant number of interims would now consider taking a fixed term contract or permanent opportunity, suggesting that declining rates and utilisation over any given 12 month period means the income differential between interim and more substantive employment is narrowing, plus the uncertainty and anxiety of looking for interim work means the security of fixed term or permanent employment looks more attractive.
94% of interims felt confident they could transition into the private sector if they had the core skill set required, but our experience across interim partners is that it is often difficult to transition candidates from one sector to another. This is a feature of a maturing market and a growing understanding amongst clients that they can generally ask for a certain skill set and experience AND the right sector expertise, and the market is able to offer it to them.
Interestingly, 54% of our interims think 15-20B in savings can be found without affecting service delivery, suggesting NHS interims feel there is alot of fat to trim. The HSJ reported that as such as 1Bn could be saved by merging back office functions, something many feel the NHS should have looked at years ago. Respondents also recognise that system wide transformational change will be key to making savings; nearly half (49%) think organisational change will be the biggest area of demand for interims in the NHS. Interestingly, David Nicholson told delegates at the NHS Employers conference a couple of weeks ago that the proposed reforms in the NHS are the “biggest management of change exercise in the world” and those who are not ready to embrace and drive the change should go. At Interim Partners, our business is largely driven by change. There will be pockets of talent in the NHS leading the reforms, but change management capability is not in abundance, and has been and will continue to be depleted as we go through MARS and voluntary redundancy schemes as PCTs re base their management costs and acute trusts need to find year on year savings just to stand still. External support will be needed, it’s just of question of when it starts to happen and it what kind of volume.
Steve Melber is Senior Consultant, Health at Interim Partners.
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December 24th, 2010 at 11:11 am
It’s the biggest paradox of our age: the organisation most in need of stability and time to absorb the blows of the past 15 years is also the organisation with which politicians of all flavours most love to meddle, for reasons good and bad. It’s an organisation at once used to a process of continual change, yet totally punch drunk and ill-equipped for delivering change, let alone feeling the benefits of any change.
Change can be a cumulative process or a revolutionary one, though when changes big and small pull in conflicting directions, it’s hardly surprising that the humble trust, whose first duty is to the patients, stumbles around reconciling the irreconcilable: hit 18 week targets while reducing capacity to meet financial targets for example.
When David Nicholson says this is the “biggest management of change exercise in the world” he is probably right, but if “those who are not ready to embrace and drive the change should go” then who does he believe will conduct the implementation? Inevitably the people who are already doing the day jobs to keep the service operating will bear the brunt, but while GP surgeries form consortia, PCT commissioning teams tout their services, and Acute trusts ponder system and process changes, pity the poor patient.
This change, whatever the end result, will be costly and heavily disruptive for the service. It will be confusing and will inevitably result in patients getting a bad service because people haven’t been trained, or computer systems were not written for these circumstances, or workarounds resulted in their details going astray.
So if it will cost £3 billion to achieve, the question is really what management expertise is required to plan and implement the scheme and will it be employed from consultancy companies, interims, a combination of both, or in some cases, neither? More to the point, will it be done dogmatically or pragmatically? Consistently or randomly?
Saving money is evidently a very costly and complicated business. Merry Christmas!
January 2nd, 2011 at 5:28 pm
I would like to express some surprise that there is a majority view that the GP Commissioning reorganisation wont lead to cost reduction. This implies that keeping PCT’s and trying to make changes within the existing structures is the way to set about achieving the £20Bn reduction.
The problem is that the PCTs have not really shown the way; What would have catalysed the existing PCTs to manage differently?
Having given a support though to the GP Commissioning strategy, I have to agree it is a risky strategy. It seems to me that the biggest risk is the Govenment’s plan to limit consortia “management costs” to a fixed and relatively small per capita figure. The risk is that the figure will be barely enough to fulfill statuatory obligations and basic provider contract and performance management. It wont be enough to invest in thinking through and implementing the care pathway changes that are so needed. What’s the point of empowering GPs, who are supposedly better qualified to work out better pathways, but then removing their means to achieve the reforms by limiting their budget. The Govt’s attitude to “protecting front line services” seems to be a paradox; is this all money well spent on patient care, or is some of it wasteful, and in urgent need of reform?
January 24th, 2011 at 11:56 am
I have to agree with Charles in being surprised at the majority view that the move to decision making at the GP Consortia will not lead to cost saving, I believe that it will, of course it will take time, probably at least 5 years. The organisations that best meet their customers requirements are those that adopt a Lean Philosophy. This is well accepted in the private sector, but is no less true of the Public Sector.
The proposed organisational structure is leaner, it puts the decision closer to the customer(the patient) which is a very good thing.
The PCT’s and to some extent the SHA’s both of which contain many excellent managers have nevertheless grown monolithic, and there is a strong argument that says that they are layers of back office administration that are not necessary, that is to say that the necessary and essential commissioning and financial functions can be carried out at much less cost under the new structure.
Of course this is a massive change management programme, perhaps the biggest in the world as has been said, but that should not detract us from proceeding, the most important element in change programme is communication with and across all stakeholders and there a serious risk that that this will not be sufficiently extensive robust.
Andrew quite rightly points to our politicians love of meddling with the NHS, for sure there has been much too much of that, far too many ill thought out performance measures that lead to behaviour that is not consistant with the voice of the customer, on the other hand is it not the job of politicians to meddle?.
I have concerns about the EC competition laws will work alongside the “any willing provider” and patient choice, there is conflict here, but these are apparent now.