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Exporting NHS restructuring experience to the Middle East

Denise Raw, Principal of Health at Interim Partners, talks to Pelham Allen, a very experienced turnaround director, about his successful career within Healthcare and why he has taken on the challenge of helping Saudi Arabia to build first class hospital services.


Having initially trained as an accountant, I have spent the last 35 years working in corporate turnaround. This involves looking at businesses or organisations that are very close to collapse, deciding whether or not they have a future, and if so putting together a management team and a plan to secure the organisational and financial future of the business.

In 2006 I was given the opportunity of becoming turnaround director of a London teaching hospital that had made an unexpected in-year loss. It was clear to me that the fundamental challenge was not financial (it rarely is), but reflected a corporate management structure that failed to empower clinicians and managers close to the patient, centralising decision-making without good information about operational and financial performance.

I was able to use the burning platform of the financial crisis at that hospital to restructure the management team, with clearly defined lines of responsibility from ward to Board. The impact was significant, and played a major role in enabling that hospital to become the most stable and successful teaching hospital in London over the last ten years.

This initial success resulted in a number of assignments on behalf of the Regulator or the relevant Strategic Health Authority in some 20 NHS hospitals. The scale of assignments ranged from short assessments of capability and effectiveness of the Chief Executive and management team, to complete organisational restructure. I completed the most satisfying of these assignments two years ago, at the hospital where I was originally treated for cancer myself, and which prompted my interest in the organisational effectiveness of hospitals.

For 15 years, I have lectured at London Business School on turnaround. Last summer I was approached by an MBA student who had heard me speak. He invited me to have a look at a large specialist hospital in the Middle East where he was working. An initial visit last September resulted in a major consultancy assignment this year to help the Chief Executive of that hospital build a team that can provide first class tertiary medical services to an entire Country.

Whilst this assignment does of course have its own challenges, it is exciting to work in an environment where plans are being made for the medium and long-term, rather than just coping day-to-day. There is both the willingness and the resources to do the job properly, which does not need to lead to wasteful or extravagant behaviours, but will - I hope and believe - build a financially and sustainably run centre of excellence in medical care.

There is considerable demand for expertise in effective management and organisational development that has been developed within the NHS in recent years to be deployed in other countries. This gives rise to interesting opportunities, which should be considered seriously by anyone who does not feel that they can fully utilise their skills in the UK. We are also of course contributing to the export of professional services - a contribution that is particularly important post Brexit.

Everything moves in cycles. At some stage, sadly only after standards and patient experience have suffered badly, there will be recognition that the NHS has to change, and in particular that centralised decision-making, imposing targets, and preventing discretion and judgement being exercised close to the patient simply doesn’t work in a large and complex health system. Unfortunately, the problems I have seen in the NHS are, I believe, replicated in other areas of public service. The challenge is therefore systemic to government as a whole, not just the health service. When the Brexit process has run its course, politicians and the public will have time to look at what they want from their public services, and there will be a lot of work to do. In the meantime, those of us is working in this area must develop and sustain our skills elsewhere.


Denise Raw is Principal - Public Sector 

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