McKinsey report was no fiendish plot, just an attempt to grasp the reality

10 September 2009 | By Richard Vize

Last week’s revelation by HSJ of the pain the NHS might have to endure to achieve savings in the order of £20bn by 2014 dominated the national media.

But the ensuing debate over the report by consultancy McKinsey on what a saving of this size might mean for the health service did little to enlighten the public about the choices facing ministers, let alone managers.

Do not be distracted by political fog about rejecting the report or finding the savings in the NHS bureaucracy

The atavistic reaction to anything involving management consultants allowed many commentators and virtually every politician to miss the point. This was not a fiendish private sector plot to decimate the NHS workforce; this was a report revealing the brutal reality of the true cost to the NHS of the collapse of the banking system.

It is not, as health minister Mike O’Brien implied, a question of accepting or rejecting the McKinsey report. It is a question of facing up to the issues it raises.

There are pointless operations being carried out. There are wild variations in the numbers of patients seen by comparable doctors and nurses. Estate management is often poor. Bed blocking is still wasting large chunks of hospital capacity. Administration systems, not least around basics such as bookings, are too slow. These are just some of the issues managers are tackling as the public sector recession looms.

What starts to emerge from the debate in this week’s HSJ about the future for the NHS is a service of a markedly different shape from today. For example, scenarios for sharp reductions in hospital income in London are revealed. Although circumstances for the capital’s providers are particularly tough, this nonetheless gives a taste of what each region must address.

Fewer, larger providers integrated with community healthcare may be part of the new landscape. But there is a risk that consolidation of the hospital sector is driven by financial failure - trusts being too slow to restructure while trying to grow their way out of recession at the same time as primary care trusts are clamping down on demand.

Do not be distracted by political fog about rejecting the report or finding the savings in the NHS bureaucracy. Politicians can afford to obfuscate until after polling day. Managers cannot.

Readers' comments (1)

Anonymous | 14-Sep-2009 2:00 pm
Has any one commenting on the Mckinsey suggested cost cutting looked at the health service in a detached manner? Probably not. Have they spoken to a wide variety of frontline and back office staff? Probably not. Have they looked at the quick wins and the low hanging fruit? Probably not.
Has any one looked at the most expensive resource within the NHS that could be made to work more efficiently and effectively? Have you not guessed yet? It is the medical workforce. 30,000 consultants at an average cost of £100k per person. And ofcourse what about the GPs? Are they really good value for money? If all they are going to do is prevent referrals, why not appoint a senior nurse? A nurse will cost at least 50% less and will probably examine the patient, talk to her and even draw blood for tests! Is a 10% reduction possible? I am not suggesting a reduction in the workforce, however, have we examined if those who get paid the money actually put in the effort comensurate with the remuneration? If one looks at the diaries of some of the doctors one will be amazed! Many of them claim to work 60 hour weeks, week on week since the times of Adam & Eve (ok I admit I have exaggerated the timescale). On top of that they find time for private practice and other commitments. Has any one tried working those hours continuously? What is the effect on the brain? It turns into mush after a few weeks. Do we want our doctors to be zombies? Certainly not! So what is the solution? If something appears to be too good to be true, it is probably not. All the doctors claiming to be working 60 hrs a week in the interest of patient care is a myth!
What some one in the DH, and in the Trusts needs to take the bull by the horn. It is time we called a spade a spade. Re examine the consultant and GP contracts (nothing should be sacrosanct in an age of austerity). If found necessary, take away the extra payments. If need be hire qualified doctors at non-consultant grades (after all they will provide all the service and cost atleast 30% less on an average). Certainly it is worth cutting the excessive wages of the non performers. And do not believe in the propaganda that there will be a huge exodus of doctors to the USA or down under or to the middle east! Just do it!
Dont shy away or else the one single most exemplary institution in the country will die an ignominous death
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