Everyone is aware that the NHS is screwed for funding for the foreseeable future.
Debate has raged over just how much the NHS is going to have to cut sorry, save through ‘efficiencies’ - but it’s going to be many billions.
We know this because we keep being told it. David Nicholson (you know the one, your boss, head honcho of the NHS) has been particularly active in the media warning that we’re all going to have to tighten our belts.
Fair enough. Though it does make his recent appearances in front of the health select committee (HSC) over the use of management consultants appear paradoxical.
It’s estimated that the NHS spends at least £600m a year on management consultants - and that’s a conservative guess. The truth is we don’t know hence the HSC’s interest.
In his first appearance in front of the HSC, in December 2008, Nicholson said all the right things. The HSC suggested that NHS should know centrally how much it is spending, and Nicholson agreed.
Nicholson also said that expenditure was set to fall in the first half of this year as they’d set up an internal consultancy that would perform the same role but using existing employees. Considering that some management consultants charge the NHS more than a £1,000 a day for their services, it makes a lot of sense.
However, Nicholson then changed his tune when he appeared in front of the HSC again a few months later. This time he was adamant that the Department of Health shouldn’t be monitoring the spend centrally - it amounted to micro-management. “We do not think it is the right thing to do,” he said.
Why did he change his mind? Presumably he decided there are enough checks and balances locally to ensure transparency and accountability around the use of management consultants. I don’t think there are.
Fortunately, the HSC urged the government to centrally record overall spend, and day rates, and coordinate the assessment of value.
The big management consultancy firms are very powerful, with their leading figures often advising - and sometimes sitting within - government. One could imagine that they wouldn’t want too much scrutiny around all their public sector contracts.
The common experience from the front-line is that management consultants come in and, with great fanfare, tell managers and senior doctors what they already know. It recently prompted Dr Jonathan Fielden, chair of the BMA’s consultants’ committee, to call for the NHS to stop using them altogether.
I don’t agree. Maybe they can be useful. Nicholson claimed they were instrumental in taking the NHS from deficit into surplus. But, we need more evidence on the value of their work.
I’d also like the HSC to throw a little light on the role of senior civil servants and their advisors within the Department of Health. There have been a steady stream of them - with some big name new additions - who have tub thumped for the introduction of the private sector into the NHS only to then move into that sector and benefit from the reforms.
I’m sure they’ve made their decisions for the right reasons - but we should have procedures in place to prove it.