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The NHS Leadership Cap
The use of interim senior managers in the NHS has been in many headlines recently and we have seen new controls from regulators around the way in which interims are hired. Most recent is the letter for NHS Improvement (NHSI) last month which indicated that Trusts now need prior approval if they are looking to bring on an executive interim over £750 per day. Trusts are required to submit a business case which includes various assessment criteria.
One section of the assessment criteria introduced by NHSI is to ensure that the scope of the interim assignment is clear and well thought through. This is absolutely paramount and at Odgers Interim we cannot stress enough the importance of having defined objectives and deliverables. For the interim manager this is critical to ensure they are able to provide tangible evidence of achieving the outlined objectives of an assignment in order to build their own track record and for the NHS organisation to ensure that they are getting value for money when investing in interim resource. Rather than looking at how much an interim manager charges per day the focus should be on outcome measures, for example at Odgers Interim we would measure a candidate’s value by the sustainable financial or operational improvements they have achieved for a Trust.
What is important is that Trusts work with reputable agencies that have robust governance processes in place and know their interim network well so that they can provide them with the most cost effective (based on return on investment) option. Unfortunately it seems to be transactional recruitment agencies that are looking for a ‘quick win’ who are benefitting from these restrictions as they are providing under qualified or lower calibre interim managers at capped rates who aren’t able to live up to the brief. We have also seen interims being hired via consultancy firms so they do not count as an ‘interim’ – these firms come with big margins and ironically are costing the NHS more money. Odgers now have a consultancy offering to help clients to define the precise goals for each assignment before introducing independent consultants with the experience, skills and authority to deliver with increased flexibility and at a lower cost than traditional consulting firms.
Another point to make is the approval process wants a justification as to why a substantive appointment hasn’t been made and what steps are being made to make a substantive appointment to the position. All of the interim roles that we recruit to are vacancies which because of their nature would not or cannot be filled with permanent staff. The majority are short term projects with focussed deliverables and a clear end date where the interim manager will move on once the role is complete. We are also known for providing interim senior leaders at short notice when a substantive post holder is moving on which leaves the Trust with a critical gap and potentially at risk if left vacant.
Interim managers provide a valuable purpose and a flexible workforce is essential if the NHS is to deliver significant transformation set out in the STPs or to plug business critical gaps. It was only very recently that Simon Stevens highlighted the lack of capable leadership available to lead on these plans and this has been reiterated by many executive directors of Trusts I have visited in the past few months. Credible interim managers are able to provide skills at short notice and deliver at pace often in settings with challenging capacity and capability gaps. Whilst NHSI have made allowances for some of the benefits that interim managers do not receive including pension contributions, NI and holiday pay, the added risks of interim work are not taken into account. These risks include short notice periods, unremunerated gaps between assignments, costs of insurance as well as expenses incurred through travel and short term relocation. I have spoken to many experienced interim leaders who have advised they would be earning less on the capped rates than they would a permanent post once the agency framework fee and other factors mentioned are taken into account.
Despite these new controls, Odgers Interim continues to be a key supplier of credible executive and senior management resource. We are partnering with various NHS organisations across the health economy and are happy to provide any support or advice for business cases that are required.
Rebecca Brandwood, Consultant