Open letter to the Rt Hon Jeremy Hunt MP, Secretary of State for Health and Social Care
2nd July, 2018
Dear Mr Hunt,
Re Calling for a moratorium on the use of external management consultants in the NHS until effective governance is established
We recently conducted independent research on the use of external management consultants in the NHS in England. This was subjected to peer review to establish the rigour of its analysis and published in an academic journal (Policy & Politics). Since then, it was mentioned in a parliamentary debate (23rd April, 2018, Hansard Volume 639) and widely reported in the media (21st February, 2018), including in The Times, which has also seen this letter. Continue reading →
Ian Kirkpatrick, Andrew Sturdy, and Gianluca Veronesi
Few topics have provoked as much debate and controversy in many western societies as the growth in public spending on management consultants. In the UK’s public healthcare sector: the National Health Service (NHS), this spending more than doubled from £313 million in 2010 to £640 million in 2014. Understandably, it is under constant scrutiny and there are considerable pressures to cut the use of management consultants, but spending remains high. Management consultants provide advice on strategy, organisation, financial planning and assist with the implementation of new information technology. Frequently, they promise significant improvements in efficiency. According to the main industry body in the UK, the Management Consultancies Association (MCA), for every £1 spent on consulting fees, clients can expect £6 in return. However, as shown in a study we conducted recently, published in Policy & Politics, the use of management consultancy in English NHS hospital trusts is more likely to result in inefficiency.
Every year, the NHS experiences more than 2 million unplanned hospital admissions for people over 65 (accounting for 68 per cent of hospital emergency bed days and the use of more than 51,000 acute beds at any one time). With an ageing population and a challenging financial context, such pressures show no sign of abating – and the NHS is having to find ways of reducing emergency hospital admissions (in situations where care can be provided as effectively elsewhere). Often, the assumption in policy and media debates seems to be that potentially large numbers of older people are admitted to hospital without really needing the services provided there, but because there is nowhere else for them to go or because other services are not operating effectively. Continue reading →
George Osborne always plays the role of the smiling conjurer who pulls the rabbit out of the hat and steals the scene with aplomb. In his 2015 spending review and autumn statement, the surprise announcement was that cuts to tax credit will not be as stringent as expected – although housing benefit claimers are the losers. Concealed within the chancellor’s hat are cuts of more than 50% in grants to local government and tense optimism about the growth, employment and pay forecasts on which everything depends.
The chart below gives the main winners and losers in the spending review over the period up to 2019-20. Cuts are legion. The winners are the big players – the NHS and pensions – both accounting for about a fifth of total spending – which receive real increases of 3 to 4%.
In the last twelve months’ heated debates about the SNP’s evolving role in UK politics, there has been far too little focus on their record North of the border, where they have now been in Government for almost two full terms (first as a minority government from 2007-2011, and then, beating the odds of the electoral system, with an unexpected majority since 2011). The UK media has only occasionally engaged with this record in government, and these efforts have often been haphazard potted histories, shifting between judging Scotland’s policies or its outcomes, and between comparing them to the other countries of the UK, or to the pre-recession past.
The difficulty of discussing devolved policy in a measured fashion is not new, although it is certainly heightened in the current political climate. In 2011, when I sat down to write what was eventually published in Policy & Politics as ‘A mutual NHS: the emergence of distinctive public involvement policy in a devolved Scotland’, I was trying to pin down some substance behind the pervasive rhetoric of ‘mutuality’ in the Scottish NHS. Much academic analysis of the ‘distinctiveness’ of Scottish health policy has relied on data from interviews with politicians, civil servants Continue reading →