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A world-class waste of NHS money

The NHS has been ordered by the Government to find £10.5bn in savings over the next couple of years as its contribution to easing the economic crisis. PCTs will be expected to contribute a big chunk of that.

The NHS has been ordered by the Government to find £10.5bn in savings over the next couple of years as its contribution to easing the economic crisis. PCTs will be expected to contribute a big chunk of that.


As well as plans for trusts to make cuts of £500m a year by pushing people out of hospital sooner, PCTs are also under orders to drive down spending on apparent luxuries such as GP referrals and specialist follow-up appointments.

And yet, at the same time as these core NHS activities are being branded unnecessary and pinpointed for spending cuts, we now learn PCTs are spending not only bloated but rapidly expanding sums on external consultants.

GPs are entitled to wonder whether there might be a more obvious place for trusts to seek savings than by ushering old ladies out of hospital before they are ready and questioning GPs' judgement over which patients need specialist input.

The findings of Pulse's investigation into PCT spending on consultancy fees are startling for the sheer pace at which the sums have grown.

Just two years ago, PCT expenditure on external consultants averaged £360,000. Many GPs might argue even that was £360,000 too much – but trust managers have spent the past two years splurging out ballooning sums of NHS money on external advice. In 2008/9, each PCT spent an average of a whopping £1.2m on external consultants – and often much more than that when you also factor in professional services and legal fees.

The drive to use external consultants has come right from the core of the Government, which itself seems addicted to the allure of big consultancy firms.

Just a few weeks ago, leading GPs left a meeting with the Department of Health deeply disenchanted after learning that their advisory role had been effectively supplanted by a commission to a big consultancy firm. Their anger was not only prompted by wounded pride but also by what they saw as sheer waste. They felt they could have provided equally useful advice, sitting around a meeting table, for the cost of a cup of coffee and a packet of HobNobs.

The DH's devotion to private consultancies came through loud and clear in its World Class Commissioning guidance, which was circulated to PCTs in January and has since been sending chills down the spines of many LMCs. That document sets out a template for yet greater use of the private sector and of external commissioning advice. The costs involved have already tripled in two years, and we can expect that pace of increase to continue in the years to come.

In a year of heavy recession and with plans for deep efficiency cuts in NHS services, GPs will be entitled to ask what exactly is so world-class about that.

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