Managing for Health

Source: Exec Digital UK

Date :07/05/2008 16:10:38

Interim managers are filling an increasingly important structural role in the UK’s National Health Service. The profile of the jobs and of the people who do them is changing, and other complex organisations should take note

Written by John O’Hanlon

There’s a rocket under the health service as trusts merge and hustle for the foundation status that gives them control over their own budgets. Foundation hospitals are given greater freedoms to manage their own affairs and improve services.

The government says the objective is to ‘evolve more power and responsibility to the local level ‘by incentivising innovation and entrepreneurialism’ (sic). So far so good, but remember that the NHS is a big tanker with a budget of more than £100 billion and approaching 100,000 employees. To get foundation status, hospital trusts have to reach consistent standards of patient care and good governance. Highly bureaucratic, riddled with waste and notoriously low in morale with high staff turnover and low pay, innovation and ‘entrepreneurialism’ are not thick on the ground in the NHS.

Interim managers have a big part to play in changing entrenched attitudes and cultures. The merging of Primary Care Trusts (PCTs) two years ago displaced some senior people onto the job market – many of whom decided not to return to full time employment and offer themselves instead as interim managers moving from assignment to assignment.

In post for an average of nine months, these men and women don’t come cheap, earning from £300 to £800 a day. And according to Adam Green, co-founder of Finegreen Associates, one of the UKs leading providers of senior and middle management interim and permanent staff, the typical interim manager is no longer someone with many years of NHS experience who wants to work after early retirement. Now they are just as likely to be young energetic managers who are coming into the market by choice. “They like the flexibility and variety offered by the interim market-place not to mention the financial rewards,” he says.

Interims have played a large part in the turnaround of Brent TPCT, which nosedived into a £25 million deficit in 2006/7, its new CEO Mark Easton told me. “The recovery at Brent was largely led by interim managers. The failings ran very deep, and it was important for the Financial Director and CEO, both interims, to focus on short term turnaround measures.” They turned the deficit into a modest surplus: now Easton has the challenge of establishing long-term sustainability at Brent, and to do this he will be making full use of interim managers.

“We have gone a long way towards financial balance, now we have to sustain and build on that. I have interim directors of Public Health and Provider Services, for example. Our immediate goal is to become a high performing organisation, then a high morale organisation. As you can imagine morale was hit hard when the extent of Brent TPCT’s debt exposure came out.”

My prejudices and some experience told me that the life of an interim is bleak. The job has to be done to a deadline so forget social working hours, family or down time. You have to hit the ground running when you are parachuted into a disaffected team; motivate them, get results and be ready to move onto the next project in six months.

The interims I spoke to agree that the job is unforgiving and demanding. But there are always fresh challenges, and if you are smart – and they are – you can build the job round your life.

Andrew Clarke

Andrew is on his fourth interim assignment as a commercial director with a Foundation Trust. “New Foundation Trusts producing an integrated business plan should think hard about the range of commercial opportunities open to them. Effectively they are part of ‘NHS plc’ – it’s a different mindset from the old hospital service model, with a whole lot of services that can be developed on a hub-and-spoke basis.”

Andrew has more than 20 years of biosciences and healthcare experience, but you can see how his job, which has much in common with brand development or project management in industry, could be done by someone from outside the health service. Somehow he manages to run his own consulting business, Athene Medical Solutions, helping private medical institutions to optimise their commercial potential. The trusts are driving the interim market, he says. “Now they can run their own budgets they need people who can come in and generate income, identify opportunity and make the business case to ensure the Trust grasps those opportunities.”

Stephen Simmons

Steve is a Finance Director. “At present I am 15 months into a three month contact!” he says. He’s happy to allow the present situation to take its course because though he is working full time at present, and is far from his Cornwall home, his wife Sue, an interim information director at a mental health trust is on an assignment that allows them to share a flat in the East Midlands. They get home about once a fortnight – it’s not ideal, but Steve says he won’t take on a full time job again. He’s not ready to retire, in fact he never will.

Steve and Sue are a bit different in that they have both done senior jobs in the world of football – Steve was for a time FD of Watford, and Sue, though a career health service manager, implemented Plymouth Argyle’s new ticketing system. “I am a rescuer, and I enjoy solving problems,” says Steve. “Once a functioning finance department has been created and things are on an even keel, that’s when I start to get restless and look for new challenges.”

And he confirms that life as an interim is always a matter of choice. He has been offered his present job on a permanent basis, and when his local PCT tried to head-hunt him as its FD he was tempted for all of thirty seconds. From now he will take on only part time assignments, leaving space to pursue his interest in wildlife and with Sue to run Parker Woodhouse, a management consultancy.

John Halsted

John’s a project director. One of the things Trusts have to do, along with knocking MRSA on the head and keeping nursing recruitment on target, is to deliver the government’s 18 weeks waiting limit. It’s one of the key performance targets for hospitals aiming at Foundation status and that’s what John is doing right now.

Originally from South Africa, where he worked in the automotive industry John came to the UK via New Zealand, where he was delivering IT, banking and finance projects. He has been an interim for nine years now, and has taken on about 15 different roles, including turnaround jobs. There’s no way he would spend extended periods away from his family – he has four children – and his present assignment is the first that requires him to live elsewhere, if only for three days a week.

“Interims bring great value to the NHS,” he says. “We don’t have to toe the political line and we are not part of the health service mafia!” When he arrives his first objective is to get the people working alongside him, identifying the early adopters, the followers and the tailenders. “They are the ones we have to spend the time with – the others get behind change pretty soon.”

As well as bringing in business and manufacturing experience (he’s a Bath University MBA), John Halsted is an author and historian having researched and written The Legend of the Last Vikings (www.vikinglegend.com). When not at his desk, he’s likely to be found at the British Museum.

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For more information on Fine Green Associates please visit www.finegreen.co.uk