Healthcare consulting-where does all the money go and what can doctors do?
A Health Select Committee report on the use of Management Consultants in the NHS and Department of Health estimated that the NHS spends upto £600 million per year on consultancy services, representing one fifth of total annual public sector consultancy spending, and the amount has increased in recent years. All areas of the health service: Strategic Health Authorities, Primary Care Trusts and NHS Trusts seem to like spending their money on external consultants, who often charge in excess of £1,000. Based on the committee’s recommendations, the government’s response last year was to call for centralized and local collection of data about what is being spent on management consultancy in the different sectors of the health service.
Last night, I was at the Royal Society of Medicine in London for a Salon, hosted by Diagnosis. Set up by junior doctors, Emma Stanton and Claire Lemer a few months ago, Diagnosis is a "healthcare consultancy for organisations such as the NHS, Department of Health and arms length bodies such as the Health Foundation”.
Management consulting can be traced back to a firm, Arthur D Little, set up by an MIT professor of the same name in 1886. Particularly after the Second World War, there was a huge demand for consultants who could offer a new perspective and strategic expertise within organisations. If you speak to management consultants, and I spoke to a few at last night’s networking event, they all mention “quality” and “performance improvement” as the key skills which they bring to an organisation. Interestingly, the same words appear repeatedly throughout Lord Darzi’s NHS Next Stage Review. Perhaps he wants doctors to be more management consultants and less medical consultants.
The fundamental tenet of Diagnosis is that there is a vast untapped resource among health professionals which can be as useful as any existing management consultancy, and importantly has a clinical perspective which the large consultancies such as McKinsey are lacking. "Diagnosis invites high potential junior doctors, medical students and allied health professionals into a virtual talent pool as Associates. Individuals are contracted at a daily rate to contribute towards a portfolio of projects that can be carried out alongside clinical and other professional commitments." Traditionally, doctors have felt that management and performance improvement roles are the remit of other people within the healthcare arena, and so have missed out on a great opportunity to influence and change healthcare, but also to use their expertise and experience in an unconventional way. One recent project involves producing an innovative 'Induction to the NHS' DVD for 7,000 newly qualified junior doctors. Stanton and Lemer are both passionate about the role of doctors as future healthcare leaders to change the culture of the NHS and you cannot help but be inspired by the massive combined potential that must be lurking throughout the organisation.
Another word that was bandied about a lot was “trust”. The trust that a client should have in their friendly management consultant. The trust that a patient should have in their doctor. In the 2002 Radio 4 Reith Lectures, Onora O’Neill, Cambridge philosopher, spoke of the “crisis of trust” in public organisations. There is surprisingly little consensus on what trust means in the healthcare setting and little evidence that any particular intervention can change a patient’s trust in their doctor. However, doctors do have a unique position of trust with patients and society which may also put them in a unique position to change healthcare practices.