2018 in some ways, was a year of change – the world sat up and took notice as the #MeToo agenda took flight. Diversity and equality were embraced across many industries, with companies required to publish their gender pay gap, and many firsts – we have our first female Doctor Who and the first national NHS female Chief Financial Officer in Elizabeth O’Mahony of NHS Improvement. As a specialist recruiter for the NHS, I am reflecting on what this means for the NHS and where it stands on diversity (and isn’t it nice to think about something rather than Brexit…..).
Gender equality, inclusion and diversity were key issues discussed at last month’s HFMA Annual Conference – As the industry continues to push for gender equality for example, there remains much more work that needs to be done within the NHS. Despite women making up 77% of the healthcare workforce, in London only 5 Provider Trusts have a female CFO. In the 20 years that I’ve been recruiting into the NHS there feels to me that there hasn’t been that much progress on these figures yet most if not all of the clients I talk to recognise the need to embrace diversity and are unequivocally positive about the impact more female CFOs would have.
Moves are already afoot to address the balance in both gender and ethnicity in senior leadership roles including the creation of sponsors to further develop belief and confidence in applicants from underrepresented minorities, as well as courses and sessions run by Future Focused Finance and the HFMA on diversity in leadership. Recruitment consultancies can also play their part in ensuring shortlists reflect a truly diverse field by more proactive approaches and by focusing on skillset and ability, moving away from a “like for like” match to their client.
I don’t want this to be just one more article which discusses the problem and not the solution, but I am interested in your views on what else it will take to get real change in diversity in 2019? We are working on initiatives to bring female leaders together for networking and roundtable events, and working on a 1 to 1 basis to bring about positive solutions. But we would welcome your thoughts and ideas if this is a subject you are equally passionate about.
With an ageing population, a crumbling estate and a tight budget, 2019 represents what must be the most challenging period that the NHS has faced to date. It is crucial that we value diversity as a key ingredient for success.
The NHS Long Term Plan that was released last week threw few surprises and continues the journey upon the path we are already on. Yet that takes nothing away from the fact that this is an ambitious plan. Essentially the key tenant of the plan is a renewed focus on expanding services outside of main site hospitals, in the direction of a more co-ordinated, preventative and individualised way for patients.
Making the plan a reality is now the biggest challenge facing the NHS. This is something we will be exploring over the coming months, and we are keen to hear your views.
Whilst there are a number of key issues, the focus for what we can positively help with include:
• Roll-out of ICS’s across the country
• Continued expansion of Urgent Care and Out-of-Hospital Care services
• Increase in Mental Health budget and performance metrics for Adult Mental Health
• Accelerated Turnaround Process for 30 worst financially performing Trusts
• Achieving Financial Balance by 2020/21
• Creating a more flexible workforce
• Improvements across Cancer and Stroke particularly
The NHS workforce plan due to be published later in the year, will be a fundamental moment in assessing whether the Long Term Plan can be effectively delivered. Together with the difficulty of delivering such a scale of transformation within the financial constraints. These two factors seem to be key in determining the eventual effectiveness of the plan.
Specifically looking at finance, the Long Term Plan states that the provider sector will return to balance in 2020/21. A new financial recovery fund will phase in a restoration of financial balance but what will this look like in reality is still uncertain. For example, will it create financial sustainability as opposed to just a bail-out fund which could be considered unfair to other Trusts not worthy of this funding. In addition, a faster financial turnaround process will be implemented for the worst performing trusts, currently standing at 30. Whilst great to read and sound in theory, it makes me question why this hasn’t been in place previously if the answers to these significant problems have been known all along. Having worked with countless Trusts in turnaround to provide solutions to their problems I will be most interested to hear the detail of this new approach.
There will also be a move to integrated care systems across the whole country by April 2021. This could create some activity on the interim market as second and third wave systems look to utilise the experience of senior managers who have led early adopters.
We believe that the NHS Long Term Plan will collapse or prosper depending on whether the outcomes are achievable both now and in the longer term. It is vital that performance and financial recovery trajectories, alongside productivity expectations are sensible but also the leadership are given the right, and moreover, effective levers with which to make meaningful change.
In short, whilst the Long Term Plan is a significant step forward, and we should be optimistic, several questions remain unanswered. Foremost is, to what extent will NHS Organisations and its leadership teams be given the right backing and authority to make significant changes. There should be no illusions about the scale of the challenge ahead. So what do you think these are?
We are interested in hearing now about the biggest challenge you will have to overcome in making this a reality.
I am currently looking to add one or two individuals to our team. As a small and newish business, we don’t yet have a recognisable brand name, so I am often asked what our culture is like.
We don’t enter the office down a slide like Google or encourage employees to sing a company song like IBM, but we do have a unique and non-cheesy culture which I hope some readers will identify with.
Even though the 3 consultants here have been in NHS recruitment for a ridiculous amount of years, we approach our work with an urgency and fervour which may surprise you. Each of us has chosen to specialise in NHS as we enjoy the sector, and we are passionate about doing our job well.
It’s in our name and it’s in our nature – every single consultant here has worked for at least 3 other recruitment companies, some more professional than others…… This experience has shaped how WE want to work and ensures we apply consistently high standards. Relationships with our clients and candidates are open and honest and based on respect. We are fiercely protective of our professional reputation and this comes across in how hard we work and with the integrity which drives our business.
I wouldn’t work here if it wasn’t fun. Don’t get me wrong, we ARE under pressure and face considerable challenges in recruiting into the NHS in the wake of rate caps, restricted budgets and the IR35 revolution, but working with people I genuinely like, whose recommendations I value and who make me laugh makes it worth getting up at 6am for. A normal day consists of banter about Giles’s hair, discussions about what to have for lunch and a healthy amount of NHS geeky chat, you don’t know what you are missing!
One of the main reasons I joined IP was to have more autonomy, responsibility and control over my career. We are mature in how we manage our businesses, each of us accountable for our own success and defining the direction we travel in. There is a culture of individual responsibility but the feeling of being â€œin it togetherâ€. We work flexibly to allow for gym sessions, school parents’ meetings and ridiculously long cycle rides. Some things are more important than work – not many things, but some things.
All of us have left great jobs in leading recruitment companies to be part of Interim Professionals and we are all determined to make it work. This is not all fun and games, the flip side of a small, specialised business is that everything you do is exposed – if you have a bad day, everyone around you is aware of it but equally when things are going well you know it’s because of how you have handled the situation and it makes you feel proud. Besides, it’s inspiring to be the underdog, working hard for every little win, in your own way.
As a small and young business, we are flexible in the way we grow. If you currently work for a staid and static business or an organisation in decline, we could present a fresh and enticing challenge. We are here for the long haul and want to hear from self-motivated, unique, talented, ambitious and hardworking consultants – if you like the sound of our company and our culture, give me a call to discuss further, just don’t expect to turn up to work via a slide, as that’s just weird.
A lot has been said about the forthcoming changes to IR35 and the full technicalities can be found here.
So not to dwell on the mechanics I’d rather give a view of what we believe will happen and how the market for the NHS will be impacted.
Firstly, we cannot take this in isolation as it coincides with the agency cap pressures we are experiencing, which together with the new tax rules compound the issue for LTD Co interims in the NHS. When taken together, and importantly followed to the letter, I cannot see why the vast majority of people would work as an interim in the NHS. It makes no sense financially and the other rewards for variety and political detachment would be lost with greater job insecurity and lack of continuity of work (upsides of jobs are only relevant when you actually have a job that meets your minimum, fundamental requirements).
Any organisation should worry when there pool of available talent is being so drastically eroded but even more so when demand already outstrips supply. With Trusts’ having such performance challenges as they face today and being so resource-light with many having significant transformation, integration and/or merger plans then I believe market forces will eventually prevail and there will be opportunities for interims to work as exception to the new norm. But with a caveat.
Thus I believe that interims who offer real change, who have a strong track record of success and a strong reputation will continue whilst the “Temp” market covering permanent roles and those who struggle to set themselves significantly apart from their substantive colleagues will see a deterioration of opportunities.
However, to get to this point where market forces determine the landscape we are (almost) all going to experience turmoil and it is yet to be seen if there will be any winners at all at the end of it.
Interim Professionals derived from providing quality in the market. Where other agencies were happy to deal in volume we wanted to stand out with the quality of contractor we provided and if this above scenario plays out then, in time, it would work to our advantage. Many competitors would retreat from this sector and clients would value our knowledge and ability to source the interims who make a difference.
It is going to be a bumpy ride but rest assured we are working hard to being able to offer our clients and candidates the best advice and opportunities.