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Special measures - What does it mean for the NHS interim market?

Hearing the news that yet another NHS Trust has been put into special measures made me think about the impact that this has on the executive interim market.

NHS Special Measures

The latest Trust to be put into special measures is Brighton & Sussex University Hospital. The summary from the CQC says – “inadequate”. Reading the summary report, I’m drawn to the area of ‘well led’.

Headlines under the ‘well led’ section for Brighton include:

  • A culture of bullying and harassment and a lack of equal opportunity was found
  • There was a clear disconnect between the Trust board and staff working in clinical areas
  • There was a lack of engagement in vision and strategy
  • Limited stability of leadership within the Trust and there were several long term vacancies
  • Little support provided from the Trust’s HR department in managing difficult consultants or with staff disciplinary and capability issues

How is an organisation like Brighton supposed to tackle these areas?

Special measures are designed to offer Trusts the support they need to improve. But where does this support come from? It is not usually found within the failing organisation, nor is it found in the form of a newly created substantive post.  One could argue that the most common route to producing results quickly is hiring specialist interim resource. In my experience, when an organisation goes into special measures this usually means there is an increased need for interim resource.

A well thought out assignment, with measurable objectives and milestones, can demonstrate ‘Return on Interim’. ROI is a visible way to show NHS Improvement how you are addressing the inadequate areas. A Trust is usually expected to have made improvements within 12 months, therefore it needs to parachute in expertise to tackle the issues and make an impact PDQ.

Let’s take the first point: ‘A culture of bullying and harassment and a lack of equal opportunity was found’ 

One of my experienced interims, project managed the roll out of cultural change around conflict resolution. This included leading the Quality Improvement Plan to challenge a culture of bullying, identified in their CQC inspection, which placed the organisation into special measures. This work was noted in the re-inspection and highlighted as a positive improvement area. Without this interim resource, this particular Trust may not have achieved improvement in this area. Perhaps Brighton could use the expertise?

Bullying and harassment seems to be a growing problem within the NHS, adversely affecting recruitment and retention issues. The mounting financial costs of increased grievances, employment tribunals and the CQC are hot on the trail of it too. Adding interim expertise to challenge this type of problem can move organisations forward.

So how is this affecting the interim market?

The interim market is buoyant. Despite the pressures on finances and the agency price caps, the demand for experienced NHS interim executives remains strong. With more and more NHS Trusts in difficulty, the need for interim expertise is rising. The interims that are in demand are the ones who can demonstrate a track record of improving organisations and helping to get them out of special measures. 

Clients What are your experiences of hiring interim expertise to solve problems and manage change especially post CQC inspection? How did you measure the return on your interim?  

Interim community
Please share your best cases of ROI - Return on Interim? Particularly when working with organisations who are under the CQC spotlight.


Claire Carter is the principal of the Public Sector at Interim Partners.

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