Guest interview with David McNeil, Interim Chief of Staff at Aintree University Hospital

David, could you please tell the readers of Perspective about your career to date?

I have worked at the Department of Health in the policy teams, in private office as Private Secretary to the Under Secretary of State for Health and as Principle Private Secretary to the Permanent Secretary and NHS CEO. I have also worked in two strategic authorities and I spent five years on the Board of an acute trust as Director of Communications and Corporate Affairs. For the last three years, I have been working as an interim in various Trusts, both FT and non-FT, normally around governance/ board secretary roles.

From your perspective as a career interim what is your perception of how the new inspection programme feels like on the ground?

When you are aware that an inspection team is about to descend, especially in a Trust that has a CQC warning notice and a breach of licence letter from Monitor, there is a general sharp intake of breath: is this the opportunity to redeem ourselves or will they find more and leave us firmly routed to the naughty step? So, panic or plan? Of course, you have to go through both before you get to the mature position of preparing to answer all the exam questions. Once the smell of new paint is fading, the action plans are populated (and evidenced) and members of staff are fully briefed, the day can’t come soon enough. And when they arrive, you find they are similar colleagues from other Trust’s who know what they are doing but can empathise with the degree of challenge we all face.

The domains of Safety, Caring, Responsive, Effective and Well–Led (they don’t put them in that order as it spells SCREW!), become the mantra you end up using to describe – and categorise - most of your organisational plans: Do they fit with your Executive Portfolios?... If not, make them. Debrief after every interview, cascade the learning and wait six more weeks for the (hopefully) positive report to land which proves you can come off the naughty step.

What dimension do you think external insight provides NHS organisations in the context of the challenges around quality and governance?

Delivering safe effective services (Quality) is supported by good structures and processes (Governance). What an external perspective does is bring in best practice models from other areas. It also means that there is a fresh pair of eyes, not weighed down with organisational history, that feels able to challenge aspects that have remained as they are because “that’s the way we do it”. It works at the divisional/delivery level, but it also works very well when challenging the way the Board and Committees work. A common trait is that overtime organisations mix the operational with the assurance functions, so external insight can bring clarity to this important area.

How can an experienced interim such as yourself support organisations at the current time?

I would say this wouldn’t I, but interims provide support - not just by bringing to the party experience (and expertise) from elsewhere, but also by hitting the ground running and delivering from day one. This is often what organisations need more than anything. You tend to find that the more experienced interims provide more than what they have been brought in to do. For example, someone might be employed on a project to develop a CIP programme, but they do it through leading clinical engagement/reorganisation. If you keep doing what you do, you keep getting what you get – interims perhaps offer a different perspective.

Do you think the new inspection regime has impacted on the need for experienced interim capability in respect to your skill set?

The new inspection regime needs to be understood and owned by the Trust. Where interims can add value is when they have seen it work before and by adding ‘pace’ to the planning stage. However, just passing the ‘exam’ isn’t the answer. The answer is to not just reach ‘adequate’ at the end of the inspection, but to continue to deliver a consistent service in each of the five domains which means that you’ll be ready when they descend again! Interims can assist with this, of course, but to use that awful phrase.... the response to CQC needs to be embedded in the organisational DNA.

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