How Covid 19 will impact the interim healthcare market

At least me and my wife aren’t debating what to watch on Netflix anymore. For the last few evenings after the kids have been put to bed we have sat on the sofa watching Sky news in grim silence. I have to confess that a few weeks ago I was one of the many that dismissed this as “just a bit of flu”, as recently as 1st March I found a Facebook message I’d sent to a friend joking about how blown out of all proportion this was. I would never have imagined then what is happening now, and so as we extrapolate further into the future, we have to accept that what we can’t imagine today might be coming true in 3 weeks time.

I was due to head to a trust for meetings on Tuesday 10th March, only to receive a call from the HR Director the afternoon before to advise me the trust had had its first death and all non essential meetings with external visitors were being banned. Mel and I usually plan my diary 4-6 weeks in advance with meetings, but by Friday 13th it was completely cleared, I will be office bound for the foreseeable future. Luckily here at Melber Flinn, we’re all brilliant at self isolation, given we have all been working at home for the last few years. As a lot of companies rapidly have to get to grips with the cultural and technological challenges of remote working, for us it is the norm.

And the market seems okay, for now. Our days are spent speaking to clients and candidates who are getting ready for the curve. We are hearing the anecdotes from the front line which are a mix of alarming and re assuring, but never have we had so much respect for those working in the market that we support. We are yet to register any requirements directly or indirectly related to Covid 19, but it feels like it will only be a matter of time. As the system considers a policy of pulling back in recently retired doctors and nurses, there is every chance the NHS will look to draw upon other sources of capacity resource, including interim managers. But we can also see the composition of demand is changing. We had been handling an interim Service Manager for Surgery with a small trust, only for it to get shelved last Friday. Little point in bringing in a manager to cover a service where non urgent surgery will be cancelled for 3 months from mid April, we currently have a another interim GM for Trauma and Orthopaedics with a different trust but I fear that role might go the same way.

We also expect to see a drop off in requirements for CIP and efficiency interims as Simon Stevens announced in a 17th March letter that financial targets and the tariff payment system will be suspended until further notice. This came after Sarah-Jane Marsh, CEO of the Birmingham Women’s and Children’s Foundation Trust, said on 13th March that removing all cost improvement plan requirements for trusts would be “one of the best things the government could do for the NHS now”. In our experience NHS organisations generally bring in interim support in those areas where they feel the greatest regulatory pressure to improve. There has been a national emphasis on financial performance over the last 10 years ever since David Nicholson highlighted long term NHS financial sustainability in what became dubbed “the Nicholson challenge”. That continued pressure has led to the development of a whole sub market of interims who specialise in hospital CIP work, but I fear requirements for interims with this experience will be short in number in coming months, and they may need to target work in other areas.

One of our recent placements was of a Project Manager to support a trust with CQC preparedness, as they expected a reinspection in June. We confirmed the offer last Tuesday but I nervously called the client two days ago, after the announcement by CQC about suspending all inspections with immediate effect. Did they still want to proceed with the appointment? Fortunately, the answer was a resounding yes, with the client explaining that this will pass and they will be inspected at some point, but at least the appointment of the interim in March gives them more time to prepare for a later inspection. Not all organisations will adopt a similar view of balancing short term pressures with medium to long term priorities, I spoke to a transformation specialist earlier this week who said his client had a golden opportunity to centralise some surgical services, which were currently being delivered from multiple sites. As elective work is set to be cancelled, the trust could seize the opportunity to centralise and revise SOP and access policies, without the usual clinical risk and service interruption headaches that come with trying to physically relocate a service that needs delivering on a 24/7 basis. Whether they grasp that opportunity will depend on just how preoccupied and hard hit they are by Covid 19.

In other areas Covid 19 is almost facilitating change that the NHS has struggled with for years. Virtual outpatient clinics and video appointments with GPs have been an ambition for the system for many years but have been held back because of technological limitations, inflexibility and resistance to change, but now when it is suddenly a matter of life and death implementation of these ideas has been fast tracked. Thought no one would have wished it to happen this way, Covid 19 may in future be remembered as being responsible for the step change in virtual clinic adoption.

It was also suggested to me today that another potential positive impact might be an improved respect for hospital A&E services. I have spoken to three trusts this week who have reported a sharp drop in A&E attendances, the last of which by a third. This doesn’t quite make sense, since the background level of accidents and emergencies happening out in the public domain should stay more or less the same. What it does probably reveal is just how many unnecessary visits the average A&E function sees in normal times, partly caused by a lack primary care capacity no doubt, but also because it is used and abused by those who don’t really need it. Over the last few weeks the public has started to avoid going to A&E unnecessarily partly because they perceive a risk of contracting Coronavirus, but hopefully more because they recognise their local hospital needs to free up all the time, beds and resources it has to deal with patients who are going to be truly sick. Either way if we come out of this pandemic with a recalibrated public view of what truly constitutes an accident or an emergency it will be no bad thing.

One thing I am sure of – post pandemic the NHS will have changed forever. Whilst no one would wish for this to be happening I know that it will also create a strong interim healthcare market for the 2-3 years afterwards. Waiting lists, CQC compliance and financial efficiency have effectively been put on hold, but when the NHS does return to business as usual, waiting lists will have grown, clinical quality may have dipped without CQC hovering overhead and financial efficiency requirements will be backed up, no doubt increasing the ask in years to come. But there may be some semblance of a silver lining, adoption of technology, an agenda strongly pushed by health secretary Matt Hancock will improve pathways and efficiency, and allow quicker access to services vie telemedicine. A&E services might be more appropriately used, allowing trusts to better manage demand. The NHS has always been the pride of UK public services, and I think the UK public’s affection for its health service will only deepen, ensuring all political parties must promise support and investment to help the NHS recover from what might become its greatest ever challenge.