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Lies, damn lies and management consultants

When the Jobbing Doctor started his career, the NHS spent precisely nothing on management consultants. The service was then the envy of the world. Whereas now...

When the Jobbing Doctor started his career, the NHS spent precisely nothing on management consultants. The service was then the envy of the world. Whereas now...

It's already here.

Recently, the Government received a report from the management consultants McKinsey, who recommended up to 10% cuts in areas of the NHS. There was quite a storm in various circles about this and ministers at the time said that they were receiving the report and it would be considered as part of the overall debate in potential funding cuts in the NHS. No decisions had been made, they said.

There were some aspects of this issue that bothered the Jobbing Doctor. Firstly, it had been on the desks of civil servants and ministers for several months before this information was released. Secondly, it was released at the end of August, a time when politicians are on a 82-day holiday, and when its release was likely to generate less political heat. I believe this is called news management.

Estimates of the costs of employing management consultants in the NHS range from £350 million through to £600 million per year. When the Jobbing Doctor started his career, the NHS spent precisely nothing on management consultants. The service was then the envy of the world. Now we are spending increasingly vast amounts of money of management consultants, and the service is getting progressively worse. More management tied in with worse service: it might not be causation, but it is correlation.

McKinsey are an important and influential group of management consultants. They are an international firm who have employed politicians in the past, including William Hague (the current shadow Foreign Secretary). The problem with management consultants to the Jobbing Doctor is that the people they tend to talk to are the senior managers, and they see issues through the prism of the managerial view.

I would like to think that they had made efforts to talk to the workforce who are actually delivering the service. The jobbing nurses, porters, cleaners, ambulance people and doctors in the system. After all, the general public don't go to hospitals to see managers, they come to hospitals to see doctors and nurses.

From what I have read of their report (until I slipped into the arms of Morpheus), much of their recommendations are likely to impact directly on front-line staff. There is a focus in the report and the subsequent comments and commentaries about the most effective strategies around making cuts in the NHS so that the electorate won't notice. The response of management consultants is to recommend further management changes. This is a one-track strategy that does not recognise where the waste is in the system.

There are huge savings to be made in the system without any effect on front-line services. One simple change would sort the problem out in a trice.

Abolish the market-driven reforms of the NHS that have cost so much and achieved so little. That will manage the change in a jiffy. They have not gone down this route in Scotland and Wales, and I don't perceive these areas as delivering an inferior service to that in England. There would be no huge finance departments, no billing, no ‘Payment by Results', no HRG codings. That should do it. Service preserved, cuts achieved. Nirvana.

That won't happen, because New Labour are wedded to the market. My own PCT are already well down the road to considering all the McKinsey changes. So, although Government are saying that they are only considering the report, managers are already starting to plan to implement it.

There is a lack of transparency here. Government ministers say one thing, but another thing is happening.

Some might call it lying.

Jobbing Doctor Jobbing Doctor

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