NHS workforce investment: through Rose tinted specs

Medical locum agencies were struck a blow last week as Jeremy Hunt announced plans to invest in training 1500 more doctors a year. This represents a 25% increase in the number of funded medical school places and potentially addresses two issues, firstly it reduces UK reliance on foreign doctors when post Brexit it might become more difficult to import them, and long term a larger complement of permanent NHS doctors reduces the need for high cost locums. More doctors are also going to be needed if the NHS has any hope of developing 7 day services, a leaked DH analysis in August commented that one of the key risks of Jeremy Hunt’s policy was a lack of staff with the skills to do it. But the locum agencies don’t need to panic just yet, students getting one of the extra places in 2018 will not graduate until at least 2023/2024. Still, it’s nice to see some long term thinking by a politician.

In July 2015, a report came out which I thought could kill off the interim NHS market altogether. This was right around the time I had left my last employer of 5 years, and didn’t feel like great timing to be setting up an interim healthcare recruitment business. But it wasn’t about price caps, or agency spend ratios or IR35 changes, it was Stuart Rose’s Better Leadership for Tomorrow report. Stuart Rose, the former Chief Executive of Marks and Spencer, had been commissioned by Jeremy Hunt to carry out a review of the leadership and workforce challenges facing the NHS, and make some recommendations for medium to long term fixes.

In a similar vein to Jeremy Hunt’s announcement this week, the report made 19 recommendations which focused on workforce investment. Key amongst them were: to increase the NHS grad intake by a factor of ten, standardise and centralise management training, require senior managers to attend accredited courses to show consistent levels of experience and attainment have been reached, which then allow for promotion to higher levels, importing more managers from other sectors, and developing nationally standardised balance scorecard appraisals for senior managers and leaders. If all of these measures were successfully implemented, the NHS would be growing a stronger, larger and better trained group of managers for the future, and embedding better resilience in the leadership of the NHS to manage its future challenges. It would also suck a large portion of demand right out of the interim market.

Demand in the current market is driven by two main factors, that are distinct but still intertwined – the first is a lack of leadership and a paucity of next generation leaders coming up through middle and senior management ranks. There simply aren’t enough execs to go around, they aren’t grown quickly enough, and they too often spill out of the system with successive NHS re organisations. This is evident to me on a daily basis, with potential aspirant execs coming out of substantive work at afc 8d and 9, wanting to explore interim and other career route. Only last week I met a COO of a large trust who told me he is starting to get more contact about prospective exec roles for him than he does spam emails from agents offering him candidates. He has been in his current position for 2 years and may well make CEO, but feels it’s a bit early in his career trajectory to be seriously considered for it now. Organisations struggle to recruit to senior roles on a substantive basis, and thus need interims to cover gaps.

The second factor is a need for change resource to support transformation, turnaround, improvement and restructuring activities. Once again the underlying problem is the same, the NHS doesn’t grow and develop these skills in enough numbers, there are pockets in the system, for example service improvement teams, ECIP, and NHS IQ, but it is not a traditional career route off the current NHS graduate programme, and the lack of inherent change expertise creates an interim market for external experts.

As a tax payer and citizen with strong affection for the NHS I would love to see better investment in management and leadership, but I doubt Jeremy Hunt will be making any announcements in investing in this cohort any time soon. Doctors had to be top of the list, as much for clinical reasons as for political ones, and next up should be nurses, a profession which has seen chronic underinvestment for a number of years. But I fear in time honoured fashion, Stuart Rose’s report is yet another one commissioned by the NHS, received well and then popped on a shelf to gather dust.