A management consultant is someone who turns problems into gold. They turn your problems into their gold. There are many old jokes like that. For there are few professions that attract as much ridicule, mixed in with a little fear, as management consultants. Save perhaps for those who work for McKinsey & Company.
Many already believe that the problem with the NHS is that it has too many management consultants and not enough hospital consultants. So the reaction to the news that emerged yesterday that McKinsey staff have been at work on the health service and are proposing a cut in frontline NHS staff was predictable. Predictable, but depressing. And wrong.
Among its many proposals for saving money and reorganising services, the McKinsey report recommends that the NHS stop carrying out procedures of limited benefit, reduce the length of hospital stays for many patients and put pressure on the least well-performing hospitals to come up to the average level. The consultants hope that such changes will allow a large reduction in the number of staff the service requires.
The Government, despite having purchased this advice, has made it clear that it rejects it. This has not stopped Andrew Lansley, the Shadow Health Secretary, from ridiculously accusing the Government of “drawing up secret plans for swingeing cuts”. He describes it as “extraordinary that Labour plans to take an axe to the hospital budget rather than to the bloated health bureaucracy”. This is a juvenile attack that Mr Lansley may live to regret.
There are three reasons why the McKinsey report did not deserve the response it got. First, it is perfectly sensible to bring in outsiders to make suggestions for reorganisation. Those in the service have vested interests and favoured solutions they wheel out endlessly. It is a good idea to pay for advice from outside, from time to time. The Government spends too much on such advice, but this one is not a good example of waste. It is silly to pretend that proposals for change made by an outside group constitute a “secret plan”. This attack is an assault on creative thinking.
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The second reason why the response of the parties is depressing is that there is much to think about in what the McKinsey team suggests. The sale of hospital estate, the reorganistaion of outpatient treatment and the review of the effectiveness of medical procedures are all worthwhile. And although there may be questions about whether the staff reductions go too far — or, some may say, not far enough — current numbers should not be regarded as sacrosanct.
Indeed they cannot be. McKinsey was hired because the NHS cannot keep growing as it has been. The fiscal position dictates that. And the pressure of increasing demand means that the service has to be reformed to provide more for less. The idea that only reductions in administrative costs will be required, an idea that Mr Lansley appears to be advancing, is incredible.
Nor is this just a question of money: the underfunding of mental health, the new developments in reproductive medicine, the possibilities opened up by genomics and the issues surrounding assisted dying raise moral and emotional questions about the shape and functions of the NHS. The time for creative thought about the costs of the NHS is not nigh. It is here.