Interim managers in the NHS - survey results
By Steve Melber - Senior Consultant, Healthcare Practice.
Interim Partners recently conducted a survey amongst its NHS interim managers to gather opinion on the current state of the NHS interim market, how it compares to other areas of the public sector, and how white paper reforms proposed by the new coalition government will affect both service delivery and demand for interim resource.
Thank you to everyone who responded. The survey went out only to candidates that we recognise as interim managers - who have completed at least assignments in the NHS, using their own personal limited company or similar and who work for daily rates in-excess of £500 per day. We received 114 responses. This strong response rate of nearly 50% gives credibility to the findings.
A more detailed summary of our findings follows below.
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 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 Management Association (IMA) which has management information across the interim management marketplace which comes from the 30 IMA members and is produced by Ipos MORI. 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 a lot 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 was 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 within the Healthcare Practice at Interim Partners.
To view the sample questionnaire please click here