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Have you heard the news from Monitor?

With the launch of the HSJ investigation into the causes and consequences of the NHS’s growing reliance on temporary clinical and medical staff, I am interested to discuss the impact and future of non-clinical interim managers within the NHS. 

A large percentage of Interims that I speak to ask me the same questions: have you heard the news from Monitor? How will this affect the demand for interim managers at my level? What’s the market like at the moment? Have Trusts stopped recruiting? 

To clarify, the level I am discussing is board and sub board level, down to band 8b, non – clinical within the provider environment. 

Last week’s data on Q1 trusts and foundation trusts’ financial performance highlighted the need for further action in 2015/16, specifically to address some immediate workforce challenges, including the rapid growth of spending on agencies and the need for a rounded approach to staffing decisions across health economies.  From what I can see the plans for national price caps and the pressure to reduce agency spend are largely focused on clinical agency staff. 

There is still a need for expert interims to parachute in and turn failing organisations round. There is also still a need for expert interim to cover board level roles in times of crisis. 

The BBC article caught my eye last week: 

Even seasoned NHS watchers were shocked by the scale of the £930m in the first three months of the financial year, racked up by health trusts in England.

Casting our minds back to 2013, wasn’t it the Francis Report that suggested new safer staffing levels? Could this be a contributor to the massive dip in financial performance? Look at the dates of the dip below and remember the publication date of the Francis Report, coincidence? 

It is a simple correlation, but do you see where I’m pointing? I am sure the tariff deflator also has a part to play.  


Since its publication in 2013, issues of patient safety, quality of care and culture of collective leadership have been in the public eye more than ever. The demand for staff has changed and reliance on agencies has increased. Getting staffing numbers ‘right’ is a critical part of the overall process of effective workforce planning but it is only one component. Roy Lilley covers this subject well in his recent daily newsletter with some novel ideas about what should be done.

But of course, it is not just the staffing issues with doctors and nurses that the NHS face, it is also suffering from issues in leadership, succession planning and ability to attract and retain substantive senior management. 

As well as highlighting the cost of the Interim workforce in the NHS, perhaps there are some other questions to address; why are NHS Trusts struggling to recruit substantive board members? Currently we have 33 interim Chief Executives and nearly 1 in 10 Trusts has an interim Director of Finance. We saw over 13 movers at board level in the summer months alone. The largest NHS trust in England has a board made up almost entirely of interims. A workforce of 15,000 and a turnover of £1.25 Billion are being run by experienced professional interims. Why is that? 

I believe there is a valuable place for Interim Managers in the NHS. I would like to encourage people to direct their thoughts to the outcomes that these professionals deliver and not their day rate. 

What would the interim management world look like if we focused on managing the outputs of interims? What did they achieve in their 6 months? What have they changed? What has improved? How much money has been saved as a result of their work? Please follow the links below for some examples of where this works well:

Most recruitment providers focus on identifying individuals with particular skills and experience, and they often pay little attention to your goals and desired outcomes. My goal is to focus on measuring assignment outcomes, which allow you to quantify the results and continually improve the performance of your organisation. Click here to find out more about 'Return on your Interim'. 

What would the NHS interim market look like if Return on your Interim principal was applied across the senior management teams in the NHS? 

I’d welcome your views on this approach. As a trust, would it help you quantify the value added by an interim? As an interim would it enable you to deliver real value to organisations and provide you with evidence of what you can do?

Would ROI also help the regulators to have a more considered reaction to the use of interims at board and sub board level within the NHS? 

Perhaps Jeremy Hunt will read this and give me a call…..*ring* *ring*, I can hear my phone already. 

Claire Carter is the Principal of Healthcare at Interim Partners. 

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