Consultants act as ‘band aid’ to NHS

Management consultants have been pulled into the firing line as new ‘hit
squads’ attempt to turn failing NHS finances around.

The NHS has run into financial trouble, despite record levels of government
investment. The hit squads or turnaround teams have examined the finances of 81
health bodies and made baseline assessments before recommending that 18 health
trusts needed ‘urgent turnaround support, and a further 32 required ‘additional

With the overall financial deficit in the NHS set to rise to £1bn by the end
of March, the situation is serious. A tendering process has begun for the
consultants to steer the longer-term turnaround effort.

Consultants are used in the NHS and the public sector more generally on a
regular basis, and, while a figure for the total cost has proved elusive to both
MPs and journalists, it certainly runs into hundreds of millions of pounds each

Whether the external help should have been called in earlier and been in
place to assist the NHS through a period of enormous change is a pressing
question. As a huge organisation set to undergo a further period of upheaval, it
is a question that needs to be answered.

A white paper unveiled last week signalled a major shift from hospital care
to more community based treatments, as the latest in a list of government
initiatives to reform the health service.

Fiona Czerniawska, director of the Management Consultancies Association’s
Think Tank, said using consultants as a ‘band-aid’ was not a productive use of
their expertise.

‘To bring people in to firefight isn’t a good way to proceed,’ she said.
‘There should be an arrangement for external scrutiny and a fresh perspective,
although I don’t think consultants should be there on a permanent basis.’

Steve Freer, CIPFA’s chief executive, said: ‘Opinion is invariably divided
about the value added by consultants.

‘The real challenge is what happens after the consultants leave. Developing
turnaround strategies is the easy bit. It’s delivering them which is tough,’ he

‘The good news is that we do know how to do it. Right across the public
services, including the NHS, there are plenty of examples of seriously
underperforming organisations, which have been turned around. But it does take

Unison, the union which represents most health workers, would like to see a
fundamentally different approach from the government.

Karen Jennings, Unison’s head of health, said: ‘Financial problems are
arising because of instability. The NHS has been in a state of constant
revolution and reform. The systems are not in place to deal with that.’ She said
‘evidence-based’ policy development would help avoid instability and the need to
employ consultants.

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