The NHS interim market: a client perspective

A couple of months ago we published blogs written by two candidates who gave their honest and personal perspectives on the challenged market for NHS interims. I did ask whether there might be client wiling to contribute their view and last week I went to see a senior leader at one of the country’s largest ICBs. We had agreed in advance to have a general discussion, which would cover certain key topics and then I could write a summary of our conversation into a blog for publication. I met my contact Dave* a week or so after the publication of the Darzi review, so inevitably that was a topic of conversation that quickly came up, and I should mention that our next blog will offer more reflections on the Darzi review and how that might impact the market in future, so please look out for that later in October or early November.

 

I am grateful to Dave for his time and for providing some frank views on the state of the NHS, the weight of financial pressures and the impact on the market for NHS interims.

 

You can read more by clicking on this link. If you have any thoughts or feedback please feel free to email me, or comment on Linkedin. If you want to go one step further and be a direct contributor to a future Melber Flinn blog, then I would be especially keen to hear from you!

 

Melber Flinn has not seen much business coming through from ICBs over the last 1-2 years and that was where we kicked off our discussion, Dave commented that the ICB headcount today is broadly comparable to the combined headcount of the constituent CCGs that formed this particular ICB, not great on the face of it, but he made the point that any shedding of posts by the ICB has been offset by the transfer of key functions from NHS England to ICBs. NHSE might claim to be 20% smaller in terms of headcount, but that does not represent a reduction in workforce costs to the overall NHS, as the cost of many salaries has simply passed over to the ICBs. Workforce growth through  Covid has been well publicised, but activity levels have not grown in tandem with that workforce growth, leading a drop in productivity nationally for the service. Many organisations are under pressure to reduce workforce and the ICBs have been broadly targeted with reducing their workforce costs on average by 30%. This particular ICB has seen its workforce across the ICB region grow by 5% since  2022, resulting in a policy today of strong vacancy control to try and stall and hopefully reverse that growth. Trusts are now not allowed to sign off recruitment to a role without the wider systems permission, which brings a number of practical challenges. Dave commented that the ICB recognises the importance of being gatekeeper to recruitment plans, but can find it difficult from their vantage point to make a fair assessment on the value and importance of some clinical roles. There are also challenges around consistency, with certain organisations applying their own VCP processes and sending less up the chain for ICB approval, and other organisations trying their luck with every vacancy. But it has its advantages too, as the ICB is often well sighted on future strategic re organisation plans in the patch, which means it can check and challenge a senior appointment, and propose a job share arrangement, or a wait and see approach if a merger might be looming. But there are firm instructions embedded with the VCP processes – no agency and no interims, which we have very much felt out in the interim market. I asked whether there is any scenario where a spend to save business case is being pitched by organisations to support some planned recruitment, but Dave said its extremely rare, it might only happen for example if a GP surgery needs a pharmacist. He commented that anything interim “and the shutters come down”.

Given this approach it is galling that the large consulting firms have been awarded large contracts with 9 ICBs (as reported here: Consultants sent in to tackle overspending at nine ICSs | News | Health Service Journal (hsj.co.uk) to support them with financial recovery planning. Could a similar job be done by an interim Turnaround Director plus team? We would argue yes, and at a much more competitive price, but as the old adage goes, “nobody gets fired for hiring IBM” and I do recognise that NHS England will get something of a standardised diagnostic and approach from the consulting firms to help them compare apples with apples. This would be arguably harder collating information from a network of disparate interims unknown to one another and using varying styles and approaches.

So when might this financial freeze finally thaw? No time soon seems to be the message. Dave explained he and colleagues have regular dialogue with regional teams at NHSE. The stern message is that there is no money this winter and NHS leaders will have to do the best with the resources they have, with no abatement in performance expectation either. But of course labour are still in the luxurious position of being able to blame their predecessors for all the woes of the health service, although that license to blame will probably expire next spring, when the 10 year plan will be published and labour have to start taking ownership of the problems. So will we see some investment in 25/26? We can’t count on it, some ring fenced allocations may come back but the indications are that funding will be flat for 25/26, meaning an actual reduction in real terms. Labour continue to publicise the 22B black hole they have inherited, and we have all been told to expect some pain in the looming budget statement, which is a depressing indictment of current public finances. But how does this reconcile with a 10 year plan? So many findings of the Darzi report are surely going to require major investment? Well as West Streeting said, there will be no funding without reform, so Dave suggested the main priorities will be efficiency and lean thinking, the NHS will have to get preconditioned and match fit, which will help ensure that further funding (when it arrives) will be spent wisely and carefully. As I speak to NHS leaders on a regular basis, I regularly hear stories of stress, burn out and rising sickness absence rates, which will surely mean there is very little current match fitness to embark on major reform.

Where we are headed I do not know, but it was a sobering discussion and one that I am afraid has not given me much optimism for major improvement in demand in the interim market.

*not his real name