Interims in the NHS – a way to save money and improve NHS patient care in the funding downturn?

New approaches to business planning and financial scrutiny will be essential in the downturn which the NHS is currently facing, saysAlison Cole

Massive government investment in the NHS over the last ten years has brought sweeping changes. But repeated demands for ways to maintain and improve patient services with the added challenge of reducing the cost of healthcare brings an inherent risk that the target-driven culture which still prevails will simply run out of steam and that cutbacks will only add to the pressure on already overworked NHS professionals. Indeed, The Economist, on 12 December 2009, predicted “a jarring slow down after the largesse of recent years”.

Extra cash meant more doctors and nurses, new equipment and bigger drug budgets. But do those who are steering the ship have the skills necessary to weather the storm that’s now upon us? We’re talking here about operational and interpersonal skills – absolutely vital given the disparate roles of healthcare professionals based in such a wide variety of locations.

Resourcing the management of primary care is likely to become a top priority. If streamlining communications in the acute sector, especially where a hospital is split over several sites, is hard, how much more challenging for anyone trying to plug the gaps created by professional boundaries in a largely rural PCT.

Another issue is around practice-based commissioning. GPs are highly trained professionals, but few of them have the time, expertise or indeed the inclination to tackle strategic planning or complex financial analysis.

No one is querying the ultimate goal of getting and keeping people well. But it’s how this is going to be achieved during a funding downturn that will inevitably place additional strain on an already hard pressed system.

Bring on the interim

Financial constraints will concentrate minds and we can predict a greater appetite for action, defined and measurable results and the rooting out of time wasters. This won’t just happen - it needs driving, along with a high degree of objectivity.

Involving an interim is a very credible way forward. But what can they offer?

Challenge the ‘we’ve always done it this way’ attitude & ask the right questions of the right people

The ability to take a step back and see the bigger picture, defining the shape of a project and an achievable end state

Set realisable short, medium and long-term goals for individuals; identify milestones, track progress & accurately assess, monitor and manage risks

Generate greater buy-in from participants who benefit from a clearly defined plan of action; creativity in team building and bring continuity to a constantly changing establishment

Achieve more effective communications, especially running meetings more efficiently.

Often, what is needed most is a firm hand. As one headhunter says: “The value of an interim is in making difficult decisions and not worrying about them having a negative impact on their next career move. What we’re looking for is integrity.”

Another spokesman, commenting on a recent interim appointment says: ““The interim we brought on board played an absolutely key role. Having previously been an assessor, she knew exactly where the main areas of challenge were going to be, and her advice on how to address them was invaluable. As an independent voice, external to the trust team, she was not afraid to challenge the project team robustly where she felt issues were not being addressed, and she pressed her point when necessary.”

Conclusion

The key contribution an expert interim can make is to bring multi-disciplinary teams together and enable them to work smarter, not simply agreeing to a process, but buying into it. Without ‘buy-in’ a project, however well planned, is constantly in danger of being derailed, often unknowingly. Efficiencies are rarely down to cost reduction alone – they are more likely to result from realism, effective monitoring and decisive action.

Alison Cole is a management consultant who directs strategic change across the UK health sector