Profiting from confusion: a management consultant's view of the NHS

A management consultant working in healthcare speaks out on what can be a cynical profession, thriving on the fear and uncertainty of clients. He forecasts a worrying future in which consultants play a central role as the NHS prepares itself for radical reforms.

A management consultant working in healthcare speaks out on what can be a cynical profession, thriving on the fear and uncertainty of clients. He forecasts a worrying future in which consultants play a central role as the NHS prepares itself for radical reforms.

Rapid policy change often leads to pressure, confusion and uncertainty.  And wherever you find management under pressure and uncertain about how to implement policy, you can bet there will be a management consultant knocking at the door, ready to speak with confidence about a suggested ‘way forward’ that will solve all of their problems.  Many such consultants are experts in their field, and can save public money at an order of magnitude higher than any fees they charge.  However, there are others who take advantage of uncertainty, regardless of their ability to improve the situation.

The NHS is proving fertile ground for such consultants as the health service prepares for the radical reforms set out in the Health and Social Care Bill, now passing through the Lords. Changes are already well underway ahead of the Bill’s passing, particularly in the creation of the new Clinical Commissioning Groups of GPs. On top of this, many hospitals are being forced to seek support in fighting against chronic underinvestment to make further ‘efficiencies’ and to obtain Foundation Trust status by 2013.

I write as a graduate management consultant working in healthcare.  I have no deeper knowledge of the NHS than what I have learned first-hand over the last six months of working in a ‘failing’ hospital and through actively following the policy debate.  But I was shocked to find that many of my more senior colleagues were in a similar position. Many did not have any understanding of the nature or depth of the reforms being implemented, let alone their ideological underpinning.  Most trumped up any previous knowledge they had of the workings of a hospital, and few seemed to have any deeper concerns about the nature of the work we were undertaking.

I was in a hospital full of hard-working people, passionate about improving the service they deliver. But they live in a world of uncertainty, scared for their jobs and worn down by endless rounds of restructuring and laborious temporary fixes for aging, inefficient systems. On the whole, I found that they knew what their problems were and they were working to solve them. We consultants did little to help. We worked for the management, to whom the opinions of staff are often a revelation. And our objective, let’s not forget, was to encourage the hospital to continue to spend money on us.

There are management consultants who add great value to the NHS.  It is unfair to view all consultants as being jargon-touting suits intent on ‘headcount reduction’ (otherwise known as culling staff). The NHS does need to update some of its working practice, and many consultants, in a stable environment, would be well placed to offer advice on changes based on their extensive experience. But in an unstable environment the NHS will get exactly the sort of consultants it doesn’t need.  By forcing through changes that the NHS does not have the time or capacity to implement, the government is forcing up spending on consultants. 

So what’s the alternative? Empowering leading experts from within the health service to make change happen. The government should have worked with these leaders from the outset to devise any large policy changes, and should now give them the mandate, support and freedom to help their peers bring about reform in a sustainable, cost effective manner.

But it is clear that the government has already alienated many of the professionals who will have to play out its reforms on the ground. Forcing through changes without the support and leadership of those in the Health Service is clearly a mistake. The government must broker deals that empower and give a voice to the disenfranchised body of the Health Service. Leaving a power vacuum around the NHS will mean it is management consultants, not doctors, whose “mouths are stuffed with gold” to bring about these reforms. 

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