The full scale of controversial plans drawn up by management consultants to raise the productivity of consultants across England has been revealed.
A report produced for the previous government by McKinsey has finally been published, revealing plans to slash workforce numbers by 137,000 in order to achieve up to £20bn of savings by 2014.
In February 2009, McKinsey was instructed by the Department of Health to provide advice on how commissioners might achieve greater productivity in the NHS.
The information was presented in March 2009 though not made public. It was partially leaked in September 2009, but released in full last month in response to freedom of information requests.
There are three key themes to the presentation - driving through cost efficiencies in provider organisations; optimising spending and ensuring compliance with standards; and, shifting care into more cost effective settings.
Driving acute provider productivity is a major focus, with a stated aim to provide more care with the same level - or less - of staff and resources.
McKinsey claims that up to £2.4bn could be saved through higher productivity.
It suggests improvements in diagnostic referrals, lowering re-admission rates and improving the cost effectiveness of interventions.
On staffing, the management consultancy urges the NHS to tackle sickness absence and maximise the amount of time clinicians spend with patients.
It calls for a review of patient contact time and processes in ward rounds and clinics, and the recalculation of staffing rotas.
In nursing, it suggests that only 41% of their time is spent with patients and must be increased. And, in primary care, proposes that variations in productivity between GP practices could be reduced drastically by increasing their working hours.
McKinsey criticises most surgical specialties for their lack of progress on day surgery rates. It highlights big gaps in breast surgery, gynaecology, urology, vascular, general surgery, head and neck surgery, ENT and orthopaedics recommended levels of day cases as a proportion of total activity and reality.
McKinsey also urges the NHS to stop procedures with limited clinical benefit.
Cuts are also important to the McKinsey strategy. And the presentation suggests that they would be felt as much among clinical staff as administrators.
Based on its analysis of different staff group efficiencies, it says the reductions required to full time equivalents for an NHS hospital with a clinical staff of 300 would be: two consultants, one registrar, 10 nurses, 10 healthcare assistants, three allied health professionals and eight non-clinical staff.
In preparation for reducing the head count, the presentation recommends aligning training with reviewed funding. It urges cuts in medical training positions at the next academic year to avoid oversupply. An early retirement programme should be introduced within two years to deal with recessions.
Also, it calls for the introduction of mandatory staffing levels to be limited. “Some royal colleges are recommending introduction of mandatory staffing ratios on safety grounds that will lead to increases in staff required above the activity growth e.g. the ratio of 1:28 per midwife,” it explains. “Review current plans to introduce mandatory staffing costs or investments in quality of care requiring an increase of the staffing levels.”
The presentation also calls for a recruitment freeze, based on stats showing that the average leaving rate is 10.5% for medical staff.
Barriers to progress also need to be removed, it claims, citing the immobility of the workforce, the lack of a failure regime for poor providers and the inability for trusts to embark on mergers and acquisitions.
Other large scale efficiencies that need to be made across the NHS include reducing drug spend, optimising the supply chain and procurement of supplies, and better estate management by trusts.
Shifting care into more cost effective settings is also a major theme, and the presentation calls for greater self-care, significant local health reconfigurations and the shift of acute care to primary, community and home settings.
The leaked presentation was met with great dismay last year and the former government was quick to say it represented advice rather than policy.
Its publication on the Department of Health website follows the release last month of an equally contentious report by McKinsey submitted to NHS London, which formed the basis of proposals to shift work en masse from hospitals to GP polysystems.
And the latest report to emerge makes clear that the London plans, now vetoed by Lansley, were recommended for implementation across the UK.
Read the full presentation into the fiscal future of the NHS.
Tags: Cuts, Management consultants, Productivity, Workforce
