NHS efficiency does not automatically equal value

Up to that point I had been focused on the earlier row about Andrew Lansley’s decision to publicise his discovery that assorted NHS organisations - from strategic health authorities down - spent £300m a year on management consultants. It was a “staggering” and wasteful amount when public borrowing was running out of control, the health secretary protested.

The figure turned out to include spending on lawyers, architects and surveyors, and the BBC amended its bulletins. But management consultants make a better headline as they arouse public suspicion.

Either way it is a lot of money to spend on what are often underpaid, inexperienced young graduates who don’t see much of the £1,000 a day their cult firms charge for their services. Some of it is bound to have been wasted or duplicated.

But coalition ministers poised to axe public spending - services as well as jobs - need to ram home the narrative message that it is “waste” they are cutting, although there is increasing independent evidence that looming cuts will be “unfair” by hitting the poor hardest. We are not all in this together.

That is less of a problem for Tory ministers than Lib Dem ones because their voters tend towards a “realist” world view that life is tough.

What repeatedly strikes me is what I called half-baked populism from politicians who are not as media/voter savvy as they think.

Hence the bagel problem. On Radio 4 Bob Neill was justifying his boss Eric Pickles’ decision to abolish the Audit Commission, which monitors the financial performance of some NHS trusts, among others. Its overheads are too high, it staged training conferences at Newmarket (though not on race days, it now emerges) and spends £40,000 on pot plants (in 37 offices) and £4,000 on bagels.

Competitive private sector audit will do all this cheaper, said Neill, who wants the Audit Commission team to join the fray via a management buy-out. But such people will still charge more than £6.50 a day for bagel type grub, countered the economically literate Evan Davis. That is their business, said Neill. They are more efficient.

Sort of fair enough. Private companies are often more efficient, though not always better value, let alone more suitable to provide universal public services. And the global “big four” accountancy firms constitute a very dubious oligarchy, which governments are scared to tackle.

But Lansley’s populist attacks on the use of management consultancies surely contradicts the wholesome Neill-Pickles view of private sector wisdom. Yet outsourcing is what his vision of the NHS is about too, isn’t it?

Indeed, he is about to turn England’s network of primary care trusts into GP consortia or privately run commissioners in one impressively scary experiment. As the Tory Bow group, as well as the ubiquitous NHS Confederation leader Nigel Edwards, were quick to point out, this will probably involve hiring, er, um, hiring outside experts.

By chance I crossed paths with Candidate Burnham, dashing around the country in his battle bus, determined to “do a Harriet Harman” and win the Labour leadership on second preferences. The US Commonwealth Fund says the NHS is very efficient and I had already trimmed the management consultancy budget, he said.

But his telling point is that his successor is engaged in a contradictory strategy: asking NHS managers to seek unprecedented efficiency at the same time as he is demoralising them with another reorganisation.