The Secret NHS Interim: it’s definitely the worst that the market has ever been

 It was fascinating to read through Steve’s recent “overdue and (fair warning) slightly pessimistic” blog the other week. It gave a very honest and perhaps raw sense of where we are in the interim market at the moment from the agency perspective. As one of those interims out there often dependent on an agency to find me work, I thought it might be worth throwing down a few lines myself to reflect on how things are for the “product” that firms like Steve are trying to sell into the NHS.

To be fair, it’s been grim and I’m a seasoned (gnarly?) interim with 15 years’ experience and a decent perspective on grim or otherwise. In fact, it’s definitely the worst that the market has ever been. I’ve been fortunate enough to have been fully engaged across the whole of my 15-year interim career and indeed, I’ve often finished an assignment on a Friday and been in a new one by Monday! I like to feel that I work hard, build relationships and, most importantly, deliver in terms of the goals of any assignment and in terms of the dreaded value for money. That in turn has helped me build a large network and, hopefully, a good reputation beyond that. “So where has it all gone wrong?” I say to myself as I sit here having not had any work since early March?

This next bit is pretty difficult to write because interims want to be seen as doers, achievers and successful, confident folk. So, what happens when the work suddenly stops dead? Apart from the money (and we’ll come to that) there’s a huge dose of “is it me?” that’s really tough to carry. I’m not looking for any sympathy at all (and let’s face it, if you’re an interim there’s never going to be much of that thrown your way anyway) but the interim role is often pretty lonely. None more so than when the work goes away. I sense that the combination of a huge financial squeeze, a confused financial end of year position for many organisations with delayed financial planning, a general election pushing a lot of “wait and see” before doing anything and, in my view, a kind of general fatalistic apathy around the performance position (I hear an awful lot of “we are just where we are, it’s the same everywhere”) has just ended the interim market in a trice. And so, where does that leave me because I genuinely thought I was pretty good at this stuff and had made it my career.

I’ve accepted for a long time that interims are often not popular and indeed, even the subject of disdain from the NHS substantive hordes. More than anything there is always a big dose of suspicion and disquiet about cost and value. The myth of the interim pulling in huge sums at the taxpayers’ expense is therefore pretty embedded and very strong and often all pervasive. Interestingly “the money” has never been a driver for me in terms of interim roles. I became an interim because it fits my personality type. Having had a long and varied NHS career being mentored by colleagues and senior managers about “broadening your experience” and taking on different roles to help me become more “rounded”, as my career progressed, I finally reached the point in my substantive career where I was actually comfortable with who and what I was. I’d travelled a long way from that jagged, awkward, D-grade staff nurse through several general manager and ops roles to senior VSM roles over the years, becoming more rounded as I went, and whilst I never reached that perfect spherical shape, I was happy with the kind of smooth 50p shape I’d reached. I’m not a maintainer. I like ambiguity, change, surprises and not knowing what’s happening next. I like trying to make sense of mess and chaos but once it’s kind of sorted I find it hard to keep my attention and energy up. Long term roles in the NHS, with weeks of onboarding, months of “settling in” and long notice periods once a role had (in my view) run its course were all exhausting and draining. The interim roles where you on-board in a morning and the COO/CEO would appreciate it all sorted by Friday were far more enticing and continue to be so.

Nevertheless, you still need to get paid. This aspect of the role always seems challenging, especially amongst substantive colleagues. No amount of explaining VAT, corporation tax, no holiday pay, no sick pay, wage insecurity, no paid days off and so forth seems to assuage the belief that we’re somehow coining it in. I’ve found I just don’t bother with that stuff anymore and stay clear of the discussions. The reality is that I do get well paid but I expect to work hard for it and demonstrate my worth. First in, last out every day. Never declining any task. It’s tough though now when the work isn’t there because there are certainly those who simply feel that this is the chickens coming home to roost. The fact that interims are also people with kids and families and loved ones and homes and bills the same as them seems to pass them by. I’ve always been careful and quietly put away a little bit all of the time for that rainy day. Now it’s pouring I’ve fortunately been able to hang in there but it’s shocking how quickly months and years of savings can disappear in days and weeks and even if I got a role tomorrow, I’d likely not see the first income for two months? Working for a month before submitting an invoice and then waiting a further 30 days to be paid.

Mentally all of this takes a toll and as an interim there’re no staff well-being sessions and no occy health drop-in sessions. You’re kind of on your own, mate. I have however been really impressed by agencies like Steve’s that have continued to reach out despite there being no work. As I said earlier, it’s lonely at home on your own struggling with the bills, wondering if you’ve “lost it” and thinking perhaps no-one values your skill set anymore. You spend every morning WhatsApping, calling and emailing everyone you know to see if there’s any work out there. You want to find that opportunity however small but at the same time you don’t want to be that annoying “gi’s a job” guy plaguing everyone such that their eyes roll when your name comes up on their phone. In addition, waking up each morning knowing that no-one wants a scared, desperate interim and therefore squashing all of those natural human feelings down and being bright and positive and confident to sell yourself every day out there is not conducive to a beautiful existence. It’s a strange paradox that a lot of the transformative change I engage in within the challenged providers I usually work in is always about engendering engagement and taking people with us and yet here we are as interims somehow left behind on our own.

The good news (for me anyway I hope) is that I continue to have lots of interest in my skill set and what I can offer. There remain lots of roles out there that do need what I can bring, and I have had lots of positive conversations about possible roles, even though at the moment no-one seems to want to push the button and actually hire anyone. However, at the moment, “the money” seems to be everything and despite the desperate need, COOs and CEOs just cannot get things past the finance guys. In addition, for those of us in urgent and emergency care there needs to be a re-focussing of the patient and clinical need as there is a sense that the UEC agenda is being moved to the backburner somewhat given the unambitious targets and the need for more transactional subjects during an election hungry for quick, easy stats and soundbites. The sense that “waiting lists” (if I hear that phrase one more time…) could be a simpler (and sexier for the electorate) win seems to have really brought the elective agenda very much to the fore so us UEC guys are having to push that little bit harder to be heard. As an interim with a strong, current clinical background that worries me. No-one wants to shroud wave or try and play risk Top Trumps but negotiating our current UEC offerings remains a very scary and flawed prospect for our patients and often a very dissatisfying and draining experience for our staff. There remains a lot to do in UEC. It cannot be left “on the backburner”.

And so here we are. Still putting myself out there every day. Still looking. Still working hard trying to pull something out of the hat. I wrote this anonymously because the paranoia about maybe doing or saying something (anything) that might somehow jeopardise even the smallest chance of a role somewhere is all pervasive but I read Steve’s blog and having some (enforced) time on my hands felt really driven to reach out. Despite feeling like I’m the only one and it’s just me, I suspect there are a lot more interim folk out there just hanging in there at the moment. If you are, you are genuinely not alone. Things will shift. As always, we’ll adapt, improvise and overcome. Just like the NHS itself. I hope in some small way this has been helpful to those waiting (hanging in there!) for the wind to change.