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My general impression of the NHS market at the moment is that there is a lot of pent up demand, but there are at least two good reasons why that demand is not being released and organisations are not yet coming to market for interim resource. In one sense, the problems just aren’t big enough yet, I spoke to a couple of acute trusts last week who on the face of it should be in the market for interim support: a weakening financial position and a high risk of ending the 10/11 year in deficit, but there tends to be a prevailing culture of addressing issues late in the day, or sending out the search party rather than using a shepherd, to use one of my favourite recent analogies from one of our interims.
But secondly, there is a still a hefty hangover from the recent bad press on NHS spend on management consultancies, any trust or PCT sticking their head above the parapet and bringing in interim support is bound to come under fire. As highlighted in my Aug 2nd blog, tales of “excessive” expenditure in the NHS in times of austerity make for great copy at the moment. Credit then to Andrew Pike at South West Essex in defending NHS South West Essex’s spend on an interim turnaround team in a recent article in the Essex Chronicle. He pointed out that total cost of the support is 585K, but if they successfully deliver 52M of savings, that will represent a brilliant return on investment. Perhaps with the abolition of the quangos, and deeper cuts elsewhere in the public sector to be announced in this week’s spending review, the spotlight will move away from the NHS and trusts and PCTs in need will be more inclined to come out to market for interim support.
I’m always keen to hear how our interims see the market, comments as always are appreciated.
Steve Melber is Senior Consultant, Health at Interim Partners.
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October 22nd, 2010 at 6:41 am
Steve,
This shepherd is currently available and ready to go!
Best regards,
Ian.
October 22nd, 2010 at 6:57 am
Having just left the NHS in disgust at the modus operandi the search party/shepherd analogy really strikes a chord.
Other than that, as the 2011/2012 reality begins to bite, I feel there will be a rush to engage interims/consultants as incumbent staff are all too busy doing what they do to be able to focus on delivering more with less – an eminently achievable prospect given my insight into how money is currently spent.
October 22nd, 2010 at 8:28 am
The Public sector is overdue an insurgency of seasoned Interims cutting through the bureaucracy, setting the agenda for change and delivering robust and sustainable processes and methods of operating…..and of course killing those long and monotonous meetings, reviewing procurement policies and execution processes, taking an axe to non value adding activities and the gentle folk that have lived a life cosseted from the rages of the recession that the private sector companies have had to endure.
However, the PS has to invest before receiving and that is probably the stumbling block (as it has been for some time now)
Interims, unlike Public Sector consultants are born of stronger stuff. They live in a world of tight budgets and pressure to deliver. It is for the IM industry to initiate significant differentiation between such consultancy practices and the Interim team that is focused on achievement and success, not spending someone else’s money in gay abandon to boost their top line!!
October 22nd, 2010 at 9:55 am
I do think that the “press” have a lot to answer for on this one. Great headlines for those not in the know. I also think that PCTs and acute trusts are still trying to cope with very mixed messages, and genuinely haven’t sorted out what direction to take. On the one hand they are being told cut back, and on the other – that the NHS budget is protected. Commissioners are being told to take services out of acute settings into the community, at the same time as being told not to de-stabilise local health economies. GP commissioning isn’t being led robustly, there is little true evaluation of what has worked and it makes the battle field rather messy and un-coordinated. Thus the top bosses are not sure what they want, how to get there and the skills required. Hiring an interim might by a shot in the foot or turn out to be the best thing since… And the NHS has bred a generation of managers adverse to risk taking. My guess is that this situation will remain for some time to come.
October 22nd, 2010 at 10:05 am
Steve,
Your two points make perfect sense and I, like you, love the search party / shepherd analogy!
Added to them, in the private sector there appears to be a strong preference for holding on to cash short-term rather than investing in business development even though we interim managers can deliver mouth-watering ROI (maybe one of the causes of your first factor?).
As someone who’d love to be able to make a contribution to the Public Sector, but who to date has operated in the Private arena though not for want of trying to get in to the former, what do you think is the likelihood that Sir Philip Green’s shocking report might make hiring ‘us lot’ more acceptable to the NHS, for example? I have a vested interest of course, but bringing on board people with strong commercial and team management credentials established whilst working in UK supermarkets seems to be a bit of a ‘no brainer’. I do appreciate that there are cultural differences, but they exist between private sector businesses too, so nothing new there.
Best, Simon
October 22nd, 2010 at 12:40 pm
There are a lot of pent up projects in the NHS that aren’t happening because decision makers have been sitting on their hands and citing the spending review as the reason, even though budgets are supposedly ring-fenced. Steve is absolutely right that all consultants (from millions-guzzling McKinsey to single interims) are unfortunately tarred with the same brush. Even if those doing the hiring know the difference (and I’m sure they do), they’re concerned about being seen to hire ‘expensive’ outside help, even where that’s going to save them money, bring efficiencies or deliver programmes that don’t have the requisite skills internally. Many say that there’ll be a wave of new interim hiring as high calibre manager jump ship, staff facing redundancy get stressed out and go on sick leave, or important, high profile projects that can’t afford to falter simply can’t be held back any longer. The problem is, there little evidence of anyone making the first move. I suppose only time will tell. I agree with Sean that risk taking is not a characteristic of most NHS managers.
October 22nd, 2010 at 2:42 pm
Although I am not interested in politics, as they are usually part of the problem, I do understand why the burning platform does not yet include the NHS. Can you imagine how the coalition would deal with the public criticisms of cut backs if it included the NHS? They are taking adequate flak already for trying to get things sorted in the public sector, but I think there really would be immediate public outcry if the NHS were involved. At the moment the voting public think it only affects councils, police and other such (critical) service providers so it’s not quite “close to my backyard” is probably the majority’s thought.
As I have mentioned before I think there will be a massive demand for private sector interims in 12-18 months time because the quangos/NHS central will stop sending out 10-15 targets per day to every Trust/PCT, the NHS will be required to tow the “cut your costs” line and they simply will not know how to do it without help from outside – interim not consultant help. They have none of them ever been required to work in a commercial environment before, so it’s not their fault, but when they have to do so they will be found failing and that could ignite the crisis. They will for sure be on next year Chancellor’s list as the savings must be many billions p.a.
I think their nemesis is on the horizon and hopefully the more forward thinking CEO’s will act early rather than be acted upon. I mean look at Hammersmith and Fulham, Kensington and Chelsea, and Westminster councils merging. How difficult was that to save two whole management hierachies? Sounds like basic commercial common sense to me and it makes me wonder how much of that sort of easy hanging fruit is available to the NHS……but turkeys and Xmas springs quickly to mind.
So opportunities in the NHS abound – but not imminently, they still want to re-employ their prior employees (who often caused the problems in the first place) on contracts,
and not challenge the status quo.
I agree taking risks in the NHS where lives are involved would not be good, but where business is involved it’s mandatory – it’s our taxes that pay for their service.
October 22nd, 2010 at 4:58 pm
Steve,
This area is my bread and butter. What you’ve said is no surprise. I’ve seen almost 10 year ends at various trusts as their Financial Controller in the last decade. Unfortunately for me the majority of accountants in the NHS are management accountants and these are the people who recruit me but none of them understand my job. As a result of this posts are left vacant until the very last moment.
Complete incapability to plan and also build on previous experiences are common place. Taking responsibility and having drive are in short supply. As Gary Newbury says it’s ‘those meetings’, these gather large numbers of the workforce for such a large amount of time that many staff just attend meetings all of the their so called working day.
The whole thing is a disgrace.
But on top of this there are the 33 days of holiday and, of course, virtually unlimited sick leave.
Is there any hope?
October 25th, 2010 at 8:24 pm
After 1 year as an interim in the public sector you get to know why things can’t change; the people who have to lead the change(cutting costs) are generally the costs that need to be cut. As a resident of Norfolk – I’ve yet to see a turkey vote for christmas!
October 29th, 2010 at 7:09 am
Confidence is key at the moment in the NHS – there are glimmers of new activity. Transformation and efficiency will be key to gaining business – this is not always about cost reduction but also delivering higher quality outcomes (competition agenda)with existing resources. There will be many organisational changes to come and expansion into social care with partnerships formed. The NHS is not particularly imaginative but with greater clinical management on the horizon there will be new ideas coming to the operating table! Manpower management/ new ways of working will also be key – maybe we have to bring better solutions to the market.