The must-read stories and debate in health policy and leadership.

Little sympathy

Management consultants don’t get a lot of sympathy from NHS staff.

The general sentiment is that they’re hugely overpriced and “borrow your watch to tell you the time” – which is a little unfair.

It is easy to decry any spend on consultants as a waste, when surely the NHS could do this itself? But often, after cuts in staff budgets, it can’t.

Since the rules on consultancy spend were tightened in 2016, the types of projects that NHS improvement signs off on are an interesting reflection of what the centre deems important.

It can’t be a coincidence that the recent spate of invitations to tender for finance and efficiency projects – after a mini drought – comes as the quarter three results saw more than one in 10 acute trusts declare a worsening of their deficit position by £15m or more.

And this is just for the end of 2018-19. Speaking to system leaders working on plans for the next financial year and beyond, there is a sense that 2019-20 will be a “car-crash” year.


Far from proving a panacea, sticking two struggling acute trusts together has often intensified the problems.

There are major concerns over the planned coming together of Aintree University Hospital and Royal Liverpool and Broadgreen Hospitals later this year.

The trusts have a combined deficit of £80m – the biggest of any major city’s acute sector outside London – and are struggling with multiple performance issues.

A near full sweep of director changes at the Royal, with lots of interims now in place, only adds to the apparent fragility, while the trust is still trying to pick up the pieces from Carillion’s collapse.

Leaders in the region will hope the appointment of the well-regarded Michael Wright as a “turnaround director” at the Royal can help steady the ship.

He has been finance director at Barnsley Hospital Foundation Trust since 2015 (where the finances have been relatively stable) and has been appointed on a permanent basis at board level.

It’s not yet clear how this role will fit into the joint board if the merger goes ahead in October as planned, but it’s positive that the trust is viewing turnaround as a long-term concept.