More broken promises – but this time from me!

Once again I have fallen behind with promises made to myself, colleagues and a few semi-interested connections in the NHS interim marketplace – but here is an overdue and (fair warning) slightly pessimistic blog update!

Some readers may remember we marked the run of the market to a specific date in February 202, and had you asked me back then how long the slump might last, I wouldn’t have said a year, let along 15 months and yet here we are in May 2024, and I think I can say with confidence it had been the longest and deepest slump in market conditions since I came into this market in 2010. 

Over the last 15 months, I have found myself clinging on to specific points in the calendar assuming their arrival might bring about some change. Autumn – could we see rising demand from looming winter pressures? Well apart from an anomalous month in November (read more here) Autumn saw no real change. 

January 2024 and the start of a new year – could we see organisations bringing in resource in a last ditch effort to try and salvage their performance for 23/24? Not really. 

And most recently, April 2024, the start of the new financial year, planning guidance finally published and organisations never feel the same financial pressures in Month 1 as they do in Months 11 and 12, so hopefully they will have the breathing space to consider what gaps need addressing and what programmes of change need resourcing. But as April came to a close last week, we have seen no discernible uptick in demand. 

The key issue remains the money. Financial management was absolutely the focus for 23/24, and unsurprisingly the planning guidance for 24/25 repeats the same message. There is 2.45B of “extra” funding for the NHS, but the reality is that money covers the cost of the pay deal after extended strike action, and so in effect the NHS is receiving no extra funding. 

And this comes in a period of high inflation, where everything costs more – consumables, drugs, utilities and so on. And the largest component of the NHS budget – the pay bill – will also be under further pressure with more industrial action likely. 

Worryingly, under “use of resources” in the planning guidance, there is a specific target to “Reduce agency spending across the NHS, to a maximum of 3.2% of the total pay bill across 2024/25”. In 22/23, the figure was 4.3%.

The figure for 23/24 figures has not yet been published, but I can’t imagine it rose significantly given the decline in the market, which means for this new financial year the NHS is trying to reduce its agency spend from c. 4.3% to 3.2%, which is a figure around 1BN. 

We all know the vast majority of this spend is on agency nurses and locum doctors but the spend on interim managers is also lumped in there. In January I wrote to HSJ and also submitted an FOI request to request an actual breakdown of spend on temp staffing by band and staffing type, but HSJ didn’t have it and NHS England fobbed me off. 

It is likely less than 10% of the total spend on temporary staffing, and yet there will be no special exemptions for our market, and the financial control rules applied to the appointment of an agency nurse will be exactly the same as those applied to the potential use of interim manager. 

So all in all, I predict another tough year for the NHS interim market. Our conversations with clients all follow a similar format – we speak to leaders and managers who are being told they must deliver the same or more, but with less resource, and are frustrated they can’t invest.

I spoke with a COO at the end of last week who said they could easily hit the diagnostics target, and they had quantified what it would cost in terms of extra resource and capacity, but their appeal into region was met with a wall of silence. Which suggests a tacit acknowledgement from NHS England that operational standards will slip, even though the party line will always remain that targets must be hit and standards maintained. 

So what is the next date in my calendar I’m clinging onto, in the optimistic hopes of winds of change? Well not so much as a date, but an event: the general election. That will surely not be in summer 2024 after the drubbing the tories receives in the local elections last week, but its is unlikely to be as late as January 2025. Hopefully it will be held at some point in the Autumn. 

We are likely to see a change of government, and whilst labour would not have any new pot of money to spend they will likely campaign on policies of support to the NHS. In a manifesto document last year Labour stated “we will undertake one of the biggest workforce expansions in history and deliver a long-term workforce plan that addresses retention issues to keep the people we’ve got in the system now”. 

That certainly gets my vote.