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In July, NHSE and NHSI co-authored a financial reset document, outlining instructions to all NHS organisations on the actions they must take to help stave off the worsening financial positon of the system. Within the document were specific new rules targeted at CCGs and CSUs which require organisations to seek ever increasing levels of permission from NHSE to appoint interim managers above certain day rates.

The new rules are the latest in a series of messages emanating from the centre about avoiding or curtailing the use of off payroll contractors. In a climate that is increasingly financially sensitive, the use of premium interim resource is starting to get a bad name, however much we might argue of the value for money offered by most interims. The reset document specifically mentions the need for commissioning organisations to submit a business case to justify the retention or appointment of interim managers at certain levels, and the template makes for interesting reading. I would encourage all interims to consider the questions asked of NHS organisations in that business case template, and to think about how they might help a client write the business case to justify their appointment.

Firstly, the business case template asks the requestor to outline the outputs or specific deliverables that are expected of the interim, and states that “the deliverables should be capable of objective evaluation”. This is sensible, and reflects an intention to appropriately utilise interim resource. Clients should be mindful of this when articulating a brief, to state the clearly expected deliverables and appropriate timescales, and if the candidates are sighted on those deliverables before an interview stage they will have the opportunity to think about how they can meet those deliverables, and what skills and experience they possess that prove they are capable of doing so.

The business case also asks “what skills can or will be transferred to permanent CCG staff”. So candidates need to be able to talk about sustainability and legacy – ensuring that when the stabilisers are taken off the bike, it doesn’t fall over.

Additionally, the business case template refers to “robust contract management” and instructs organisations to “explain the steps you will take to manage the supplier to deliver value for money”. This should be an active part of any client strategy to properly manage their interim resource. Expect clients here to respond by shortening notice periods, breaking contracts into smaller chunks, creating checkpoints based on ongoing delivery, and potentially considering the linkage of performance to payments. Candidates who can respond in kind, and can accept slightly higher levels of risk in contracts, are likely to prosper.

Finally, the business case template asks the requestor to “provide details of the proposed procurement / resourcing method” and “to provide details of how you have calculated the cost of the resource and justification for the number of days required”. Negotiating on price can be a tricky skill, I’ve rarely talked to clients who have given background analysis on a stated budget figure to hire an interim, more often than not it’s me advising them what it will cost. But with NHSE oversight on all planned interim use, I’d expect clients to be driving a harder bargain on price, or at least asking for justification on why a price is what it is.

For a copy of the full document, feel free to drop me a line directly. As with the price cap guidance policy which became mandated in April 2016, I would expect compliance to be patchy, the business case document does not outline specific penalties for non compliance, but instead states that “a failure to (comply) may be taken to indicate, for assurance purposes, that a CCG does not have adequate expenditure controls in place”. No CCG CFO would want that.

There is also the small matter of NHSE processing the business case submissions, I spoke to one organisation who submitted business cases in July to retain their interims, but has still not heard back. But we have to imagine NHSE have expected a deluge and will have a plan for clearing it. Either way, if the recruitment of most interims will soon be funnelled through the business case approval process, we can expect more robust hiring processes and a gradual shift towards proper, appropriate and justified use of interims, and probably a reduction in “casual” interim use, where organisations pull interims in on poorly defined briefs, or to cover gaps here and there. For all of us, as tax payers, that’s probably no bad thing.