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Flory: 'Loss of experience is greater than I’ve seen'

David Flory has said the current NHS reforms have prompted the greatest loss of management experience of any health service reorganisation he has seen in his career.

In an exclusive interview with HSJ, the NHS Trust Development Authority chief executive and former deputy chief executive of the NHS said the service was now struggling to find enough people with the “requisite capability” to run its most challenged hospitals.

The old system of primary care trusts and strategic health authorities was abolished on 1 April prompting many senior leaders to leave the NHS. The hospital sector has also seen a significant number of experienced chief executives and senior directors retire.

Mr Flory was talking about the leadership challenge faced by the service in the wake of the changes set in train by former health secretary Andrew Lansley.

He said: “I sat in my kitchen on Sunday reflecting on my last day as deputy chief exec at the Department of Health and looked through my contact book of the people who I regularly connect with.

“Forty-two per cent of them left last week, so the scale of the change and loss of experience is greater than I’ve seen in any reorganisation before.”

His view was backed by another very senior manager from the previous system.

Sir Neil McKay, who was senior responsible officer for human resources transition during the reforms and chief executive of NHS Midlands and East, told HSJ: “I think David is right. It’s not been easy to provide the depth of NHS talent in recent years and that has been exacerbated by the reforms. I think there are significant risks in terms of keeping the show on the road in the short term.”

He supported Mr Flory’s view that the loss of management experience extended to the hospital sector.

“We managed to make good appointments, but whereas in the past there would have been a deep pool of talent, that’s not always the case these days,” he said. “There might be some people who in the past might have aspired to these roles and are now thinking twice.”

Mr Flory said encouraging people to take up posts within struggling trusts would be key for his organisation.

“In the provider sector those jobs at a challenged provider are the toughest in the NHS by some way, and [there is] an increasing number of them, and they’re increasingly hard to fill,” he said. “And in that sector the evidence shows us we have not got enough people with all the requisite capability.

“We need to redefine what success in those jobs looks like,” he added. That would mean making it as rewarding to get an organisation “which has been in trouble for five years” out of trouble as it was to run “an internationally recognised world-class centre of excellence”, he suggested.

Jon Restell, of trade union Managers in Partnership, also lamented the leaking of talent from NHS during the reforms.

He wrote in a blog entry: “Talented and experienced leaders and managers have left the service over the last three years, forced out through redundancy, the dismal rhetoric of ministers and the endless uncertainty.

“Staff who have secured new jobs have done so in conditions that have been far from ideal. The HR transition programme did well in the circumstances, but there was too much to be done in the closing few months for everyone to feel they were treated properly.”

However, NHS England said the reorganisation had been a success. A spokeswoman said: “NHS England spends around 50 per cent less on running costs and has around 60 per cent fewer highly paid executives in comparison to the old system.”

Readers' comments (50)

  • what a crass statement from NHS England - as long as the numbers add up, then all is well.... clearly a statement from a cheap and inexperienced member of staff which is all the NHS E can afford. By all accounts NHS E is full of very young and inexperienced individuals. I don't even work in the NHS and find this comment offensive.

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  • That is a very strange comment from NHS England, and a most unusual definition of success. I'm sure Mid Staffs could demonstrate that they were spending less money.

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  • How interesting that NHS England defines success as spending 50% less on running costs with around 60% fewer highly paid executives in comparison to the old system?
    I thought it was about improving the quality of care and keeping patients safe whilst the service is starved of resources. If only someone had told me this before…...

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  • “NHS England spends around 50 per cent less on running costs and has around 60 per cent fewer highly paid executives in comparison to the old system.”
    Great finances resolved!
    Sorry.. What was that about Quality... Great Leaders... Strategic Thinkers...?

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  • I tendered my resignation last week - my current post being untenable in the new structures. Feeling sad, because I have so much to offer in my field - and will be taking my expertise outwith the NHS - which I have been proud to have been associated with for nearly four decades.

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  • I was made redundant some time ago as part of the measures leading to this reorganisation and was told I was no longer needed. I now work as a project manager with both NHS and Private companies earning more than the NHS paid me and receiving far more gratitude for the service I provide. After 24 years loyal and committed service to the NHS I felt short changed. I am sure part of the move to get rid of people was to remove history from the organisation.

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  • Unless that was NHS England agreeing that they have lost lots of senior experience and don't have enough money to run the system; "I'm afraid we only have half the budget we used to have and one third of the numbers of people we need to manage things properly."

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  • I'm nothing to do with NHSE but I do know that there were a large number if redundancies in the Comms teams at the DH and in the SHAs, with many people leaving the NHS entirely. So yes, it probably is staffed by junior people with little experience in how to put together a proper press release.

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  • 12:19 - what a 'glass half full' person you are! :-)

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  • Wonder what the running costs look like when you add in the thousands paid to "contracted" GPs who are now..er....managing?

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  • The real shame is Lansleys' NHS vision could have been achieved by evolution rather than revolution. GP's could have taken over PCT Boards and Commissioning Support Units created by merging PCT commissioning staff, in order to enjoy economies of scale. Valued staff would have been retained whilst employees who were 'surplus to requirements' or'less able' would have been made redundant in order to meet the Nicholson challenge. SHA's would have merged into NHS England regional offices without needing to be closed. It's looks like we've wasted £2-£3 billion in order for the Coalition to demonstrate to a disinterested electorate that there was a 'new sheriff in town' when it came to NHS strategy.

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  • All this knowledge and experience lost to the nhs. What a shame

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  • The closer to the centre (Jeremy Hunt/La La Lansley, David Nicholson and the top layers of NHS England) you get the greater the chaos and stupidity. And these are supposed to be our most highly paid, 'experienced' strategic thinkers. Instead, they demonstrate how shambolic and out of touch they are every time they issue a quote. When will they learn that saying something is a success does not make it so, particularly when there is universal consensus and overwhelming evidence to the contrary. Living through this chaos and watching what it is doing to patient care is bad enough, but being told it's a success is one step too far. Someone please give these people some proper comms professionals to teach them how to fake compassion and understanding or have them replaced with proper leaders who know what they're doing.

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  • The DH "spokespeople" havent yet learnt the new language!!!When they have learnt it they then have to believe in it Francis was about changing culture and concentrating on quality The DH press releases demonstrate that this change will not be led from the top !

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  • David Flory is right although I am surprised that the figure is in the forties I would have thought that the figure of senior people leaving was even higher Just at the time we need the experience and corporate memory so that the mistakes of the past are not repeated

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  • I agree with David, having spent far too much time over the last few months saying goodbye to some people with huge values, great experience and real expertise. We need to find some short term solutions for people with us now, which I think is about providing genuine support and investment. We still do have lots of really good experienced leaders who are always happy to give of their time to provide mentorship and support, and we really need their help now. The solution though surely is a much longer term one - digging deeper into our organisations and making sure that we provide leaders from all professional backgrounds with the skills, behaviours and motivations to reach senior leadership levels in the NHS. In the meantime we also need to work harder on making these jobs attractive, doable and rewarding.

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  • 12:19 - what a 'glass half full' person you are! :-)

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  • NHS England said the reorganisation had been a success. A spokeswoman said: “NHS England spends around 50 per cent less on running costs and has around 60 per cent fewer highly paid executives in comparison to the old system.”
    The person who gave this quote either needs training or is in the wrong job - I expect her bosses will already be onto that.
    The role of the NHS Engalnd is to ensure that all health care services are commissioned are focused on Patient Safety and High Quality - perhaps authors of the Francis report would be very interested in this is NHS England inane quote and the carers and patients involved at Mid Staff horrified.

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  • Its ionly a week in and the Area teams are in a state of disarray - understaff, poor or no IT and many staff not knowing what their role is or how to carry it out. This is a result of "around 50 per cent less on running costs and has around 60 per cent fewer highly paid executives in comparison to the old system.”
    They are relying on freeby's from CSU organisation to maintain many services such a distirubtion of alerts, Serious Incident handling and Complaints.

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  • Anonymous 12:40 PM. There was a system in place which could have done all you say in an evolutionary, rather than a revolutionary manner. If much of the huge increase in expenditure since 2000 had been channelled through that system, where would we be now? It was called GP Fundholding and it was triumphantly abolished as soon as NuLabour came to power in 1997. Roll forward to 2013 and we now have CCG's /CSUs etc. etc. Yet another attempt to create an internal market overnight. We have spent billions, nay trillions of pounds educating a handful of ministers and they still do not get it.

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