If you would like to receive Perspective - our monthly newsletter – which brings you all of our latest news and views as well as interviews and opinion pieces then please follow the link below...
The Leadership Gap
Agenda for change
In a report by the King’s Fund it was revealed that one-third of trusts have at least one board level vacancy or an interim executive board member in place. Most of the vacancies were for finance director roles, with nine per cent of all trusts having no substantive finance director. In addition, over 12 per cent had no substantive chief operating officer.
With the average life tenure of an NHS chief executive currently averaging 20 months, this significant number of vacancies doesn’t come as a surprise. In fact, these figures arguably reflect the deep seated problems within the culture and environment in which NHS leaders operate. In an industry concerned with protecting lives, this lack of leadership is, in my view, becoming an additional and unnecessary hurdle organisations need not face.
Interim managers have and continue to play an integral role in helping the health service plug specific skills gaps. These experts can be used as part of the solution in tackling budget deficits and frequently deliver considerable savings, which can be reinvested into developing services that will ultimately improve quality of patient care.
Worryingly, after the Government’s review of senior interim staff in the NHS and their daily rates, a salary cap has been introduced (from 23 November 2015) where trusts are now not able to pay agency staff 55 per cent more than an equivalent permanent member of staff. The question is, can the NHS afford these changes to take place and what is the potential impact on patient safety and quality of care?
The importance of leadership
Moving into 2016, the key challenge for the NHS continues to be plugging the £22bn funding shortfall and responding to overall budget challenges, through severe cuts, improvements in productivity and a sharpened focus on efficiency. In order to achieve this, without compromising the quality of patient care, the organisation’s staff and its ability to build strong senior leadership must be at the heart of its response.
There is no single right answer on how to balance the pressure to deliver a higher quality service with the severe squeeze on NHS finances. However, it is undeniable that new paradigms of thought will be required by senior leaders to make it happen. NHS boards have a major role to play and skilled leadership members with sector insight and commercial expertise are critical in order to formulate and implement the necessary strategic approach.
Filling the commercial expertise skill gap
The NHS Confederation recently published its member survey whereby “71 per cent of senior NHS leaders described the current financial pressures as the worst they have ever experienced”. With this financial pressure being felt so keenly, the sector requires commercial acumen now more than ever.
In recent years we have seen many NHS organisations benefit from commercially focussed interim managers, some from a private sector background, with a track record of achieving ‘more for less’ and identifying areas of revenue. Indeed, interim managers can provide an injection of specific expertise and introduce best practice processes within a fixed time period in order steer an organisation in the right direction for the future.
Although demand remains robust for interims in the sector, the 55 per cent salary cap could have a significant downward impact on market rates. This might continue to create a negative perception of a career in the sector, meaning there may be a significant shortage of both interim and permanent staff willing to fill the roles so desperately needed.
Value over cost
Focusing on the immediate cost of an interim rather than the long-term value can be a mistake when seeking to address the problems of the NHS. Interims are experienced professionals who, prior to becoming interims, have worked within specific sectors for a long period of time. As such, many can offer a granular understanding of the NHS and the complexities of the system, have a good network and are familiar with new and old policies.
When employed via a compliant provider who operates within a recognised framework, interims can be part of the solution in helping to help manage change and reduce costs, while ensuring a continued standard of patient safety and quality of care.
Protecting existing expertise and bringing in the right skills in senior positions will be fundamental to the development of healthcare services over the next five years, particularly at such an important and uncertain time in the NHS’s history.
Sarah Lovell, Partner at Odgers Interim