Comment

Private sector or NHS managers: it’s time for a blend of both

John Flook, a former NHS finance director in the north east who has been a non-executive director of NHS Professionals since 2003, says bringing together managers from different background creates impressive outcomes.

Does the NHS need managers from the private sector? Do they bring much-needed ‘hard’ commercial skills or do they devalue the public service ethos with their excessive focus on the bottom line?

I like to think I have no preconceived notion of the quality of job candidates, whether they’re from the private or voluntary sector, or they’re a career NHS manager. The only criterion for selection must be ‘the best person for the job’.

Too often, trust chief executives who come to the NHS from the private sector are not long lived. And I still see appointment boards which revert to the ‘safe’ option of appointing an NHS candidate when this may not be the right decision. With the NHS Management Graduate Training Scheme still the most popular in the country and phenomenally competitive, there’s relatively little churn within the service. And many argue that sufficient talent exists within the NHS and there’s little need to look beyond the health service for top-quality managers and leaders.

My experience is that neither group holds all the answers. But when a group of talented people – some career NHS managers and others with commercial skills honed in private companies – work together, the outcomes can be truly impressive. The journey we have taken at NHS Professionals (NHSP) demonstrates the benefits of abandoning the either/or approach and instead setting out to achieve a blend of the best of both.

NHSP was born ten years ago out of a national initiative by then health minister John Hutton for the NHS to have its own flexible workforce. It started life as a concept rather than a national organisation with a cohesive business plan. Its work was delivered through workforce confederations.

The challenges in the early days were clear. First, we had to head-off the suspicion in some quarters of the NHS that we were there to take accountability away from individual trusts. But ministers moved quickly to make it clear that NHSP would stand on its own feet – and this was the best thing that could have happened.

Initially we were in the worst of all possible worlds; it would have been far easier to set up a new organisation from scratch. NHSP already existed – but in a very muddled and ill-defined form. There was no central management team; we had 15 payroll systems and several accounting systems; the number of sites we were spread across nearly ran into double figures.

Today NHSP has transformed itself from an organisation that didn’t really exist into the single largest workforce provider in England. Its turnover last year was £370m and we achieved a profit of £6.1m before tax – all of which is retained within the NHS.

So how has our private/public management blend helped to achieve this turnaround? All but one of NHSP’s chief executives has come from the private sector: people who have been vital to the energy and success of the organisation. Crucially, each of them brought different expertise relevant to the stage of development NHSP had reached. They constantly examined the way things were done, and why.

Perhaps where NHS managers have made their most crucial contribution is in the area of clinical governance and compliance. If we’re to provide clients with a top-quality flexible workforce we have to get it right on both these issues. If we don’t provide a quality product, we won’t get clients to take it: it’s as simple as that.

We ensure that everyone is clinically compliant, from head-to-toe. Then we measure performance and feed it back to our clients. It means we have people who speak a common language.

And here’s where the blend works so well. Managers from the private sector have learnt to appreciate the clinical quality that has to lie at the heart of our business while NHS staff have become more open to new ways of looking at and tackling problems – and have developed a more acute sense of the bottom line.

There is no doubt that the learning process has been in both directions and has helped to create a really lively, dynamic working environment.

And the blended environment is demonstrated on our board, too, with our choice of non-executive directors. We have people who come from the IT sector, from media and the recruitment sector. But we also have a nurse director. Here, too, we find private and public sector skills to be a winning combination.

It seems to me that if foundation trusts are going to remain as the preferred model of provider in the NHS, their complexities and freedoms are going to require the highest calibre of mangers we can get.

When it comes to management, we need flexible boundaries. Otherwise we risk chopping off the fresh vision, skills and experience that come from other sectors of the economy.