This edition of Overture is the first in a series in which Fidelio explores the opportunities and challenges facing senior executives transferring from the private to the public sector. Here, Fiona Buxton considers the contribution that private sector expertise can make in the context of health care reform.
Fiona Buxton, Director, Fidelio Partners
In the UK, public to private sector career moves have fallen into a number of stereotypes over time – from the retiring cabinet minister picking up an enviable portfolio of non-executive directorships, to the captain of industry who becomes chairman of a charity. But what is the picture at the sharp end of operations? As successive secretaries of state push for more commercial practices in the health service, what might NHS leaders gain from recruiting from the private sector? And what makes a successful transfer?
We were going to be working in a new way and I wanted someone with innovation and creativity whose perspective stretched beyond the NHS. I got a shortlist of appointable candidates, with blue-chip experience. Our FD was a great success and is still working in the NHS.
– Sarah Whiting, Chief Executive, Inner North West London PCTs
Sarah Whiting, a London-based health trust chief executive, recruited a Finance Director with a strong private sector background when she was managing the integration of Hammersmith and Fulham’s Primary Care Trust with the local borough council. “We were going to be working in a new way – and I wanted someone with innovation and creativity whose perspective stretched beyond the NHS. I used a search firm and got a shortlist of appointable candidates, with blue-chip experience. Our FD was a great success and is still working in the NHS. Obviously there are issues when someone is used to a private sector salary – you can’t compete in London, though outside London, senior public sector salaries are very competitive. Holidays are a plus and a public sector pension is still extremely attractive.”
Sheila Childerhouse, the Chair of NHS Norfolk, has recruited a number of people from the private sector. Her current deputy chief executive, Ian Ayres, trained at BP has a career spanning senior NHS roles and private sector consultancy. She recently recruited an MD from the private sector to take forward the development of a Commissioning Support Unit for local GPs. She is keen on balanced teams, bringing together the public sector values of transparency and good governance, with private sector focus on the end point, rather than the process of getting there. “For our CSU, I wanted someone who could work with the GPs to create this new service: developing commissioning support is a hard task – because the client hasn’t had to buy it before – so helping them work out their needs is crucial – and I needed that type of customer focus from the MD.” She also feels that private sector experience can bring improvements to commissioning: “Ian has really improved our commissioning relationship with providers – rather than developing lengthy, prescriptive and punitive clauses in our contracts, he focusses on the outcomes, which has improved our working relationships and the quality of health services provided for local people.”
Executives making the switch are motivated by a number of factors: often they are looking beyond commerce for more social or ethical value in their work. If they are at a time of life when flexibility is important, then the public sector can often be more accommodating than private business. The complexity of public sector organisations can also make roles particularly interesting if people are looking for intellectual challenge. High quality, seasoned executives are often prepared to make a mid-career change, which is an opportunity for public sector directors looking to refresh their senior management teams.
Those who make the move successfully respect the fact that while the overwhelming need for transparency and public accountability can make decision making slower than the private sector, public sector employees are generally highly motivated by a commitment to delivering good quality services and want to do their best for people who use these services.
Work/ life balance is often an attraction – hours tend to be more regular and holidays longer than in the private sector although at director level there is still a substantial amount of out-of-hours work.
Other opportunities exist in the new organisations arising from the Health and Social Care Bill – Clinical Commissioning Groups are currently recruiting non-clinical executive directors. At present many of these are former Primary Care Trust (PCT) or Strategic Health Authority (SHA) executives. Some of these already come from clinical backgrounds – but may have moved into administration early in their careers. Judy Oliver, an organisational design consultant in the health sector, points to the current over-supply of young doctors. “Unemployed young medics might choose to move abroad – or join a healthcare practice in one of the big management consultancies. I can see these people moving back into the public sector to take on commissioning or other roles later in their careers.” Independent provider organisations operating as social enterprises will need marketing and business development skills which recruits from traditional NHS backgrounds won’t have.
If NHS leaders can think of their roles in the context of a whole healthcare economy, rather than a fragmented group of providers and commissioners, we can deliver much better health outcomes for patients.
– Patricia Wright, Chief Executive, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust
However, what NHS chairs and chief executives are looking for increasingly, are executives who are flexible, commercial and dedicated to providing good services with excellent outcomes and a strong focus on quality and safety. Patricia Wright, Chief Executive of Queen Elizabeth Hospital, King’s Lynn, comments “what I will be looking for in my staff team are people who understand a number of areas: from primary care commissioning to local government services and the management of acute care. If NHS leaders can think of their roles in the context of a whole healthcare economy, rather than a fragmented group of providers and commissioners, we can deliver much better health outcomes for patients.”
About the Author…
Fiona Buxton, Director, Fidelio Partners, was an NHS non-executive director for 4 years. She is currently Chair of the Health and Wellbeing Board for the Royal Borough of Kensington and Chelsea.
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