Our love/ hate relationship with private management consultants – An issue for all political colours from time immemorial
Dear Editor
We read with interest your news item on the findings of the House of Commons Public Accounts Committee on Test & Trace (1). When NHS Test and Trace (NHST&T) was founded on the 28th of May 2020 in the initial stages of the COVID-19 pandemic, with the UK plunged into National Lockdown, this system was hailed as one of the initial tools in the UK arsenal for saving lives and limiting case numbers, with the existence of a vaccine far on the horizon (2). However, as with many aspects of managing a pandemic, this system had to learn constantly and change and adapt quickly. Since its inception, Test and Trace and the authorities involved have been criticised for failing to deliver ambitious targets. In March 2021, one criticism (3) levelled against the service has been the overreliance on expensive management consultants, resulting in a lower degree of value being added to the system than would be expected in return for cost incurred. In a time where the budget is already pulled in a multitude of competing and important directions, assessment of these outgoings in relation to the balance of cost versus value must be carefully considered. We do acknowledge that some of the consultants possess unique and specialised skills.
From the onset, NHST&T has employed external consultants to scale up the programme. In November 2020, labour member of Parliament Andy Slaughter asked (4) the government for clarification on costs incurred on employing consultants. The response from the government in January 2021 was that the total cost of employing consultants was approximately £375 million, with 2,300 consultants employed working for 73 different suppliers (4). Reasoning included benefits of short-term contracts and providing expertise in a multitude of fields including digital design, testing workflows and tracing systems. These are defended as integral features of the T&T apparatus, and without which, the system could not perform effectively. T&T have stated that the consultancy teams have successfully built the T&T digital platform which has been visited 1.6 billion times (5), and research (6) has suggested that using the T&T Covid App has prevented an estimated 200-900,000 further infections between October and December 2020. These results are comforting but many say the system has not gone far enough to support the fight against COVID.
Members of Parliament have questioned (5) the cost and utility of employing these consultants and whether this choice is really providing value for money. In response to criticism regarding consultant payment, NHST&T stated that the ‘average is 1.1 thousand per day’ (5), and that when envisaging the pay when this work is transferred to an equivalent civil servant, a like for like comparison is not appropriate. As these costs come into public domain, with resources stretched, perhaps some clarification may be required on why the payment appears so high. The Government has defended T&T saying it has allowed people to ‘restart their lives (7)’, however clearly there are questions being asked (3) around the systems effectiveness.
The UK Parliament Accounts Committee issued a report (3) on the 10th of March stating that NHST&T must ‘wean itself off its persistent reliance on consultants and temporary staff’, as well as criticising the ‘unimaginable’ costs of NHST&T, and that “there is no clear evidence of T&T overall effectiveness”, with failures to meet the target of turning around tests with 24 hours and below 50% utilisation rates (3). These are damning assessment of a service that will cost £37 billion over a period of two years (8). This report has also been picked up by mainstream media (9), with the BBC reporting that some consultants are paid over £6,600 a day and highlighting the Committees plea that ‘the taxpayer should not be treated like an "ATM machine"’. Therefore, it appears that if objectives are clearly defined and ultimately achieved, then T&T will be accepted more readily as a necessary expense to release the UK from restrictions. It is worth adding that the cost of consultant employment has certainly shocked the MPs and been highlighted by the media.
The issues of reliance on and the cost of private consultants is by no means a problem only seen in times of the current government or in COVID times. In 2009, The House of Commons divulged (10) that under the Labour Government, between 2005-06, £0.6 billion was spent on consultancy services, and payment per consultant mirroring that of today, £1000 for senior partners and £500 a day for junior consultants. To provide further support to the view that this is an integral issue for parties of all colours and ideology, the coalition government was also criticised for spending £640 million in 2014 (11). A report in 2019 (12) covering a period of four years made this shocking conclusion “the findings show a significantly positive relationship between consulting expenditure and organisational inefficiency. These results lend support to critical accounts of management consulting, highlighting the need for organisations to be circumspect in deciding whether and how to use these services”.
It is interesting to revisit the role of management consultants in the 1974 NHS reforms. According to a case study (13) assessing this “…. their involvement in the 1974 reforms speaks directly to ongoing questions about the ways in which consultants come to be hired by health policymakers (often through reputation or established relationships), the quality of their work, the perceived lack of expertise inside the civil service and the NHS, and the ways in which they appear to legitimise decision-making processes”. This appears to continue even today decades later. The senior author of this communication had the opportunity to work with management consultant during a previous NHS reorganisation and still has mixed feelings. This debate is especially crucial when the State cannot afford more than a 1% pay rise due to financial constraints (14) for NHS staff who put their lives on the line and many making the ultimate sacrifice in our battle against COVID.
Elizabeth Cubitt, Public Health Specialist Fellow, Suffolk County Council
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine, Director, Public Health Specialist COVID19 Centre.
Suffolk County Council & Associate Clinical Lecturer, University of Cambridge. Directorate of Public Health, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX. p.badrinath@suffolk.gov.uk
Disclaimer: The views expressed here are the personal views of the authors and in no way represent the views of Suffolk County Council. PB leads the local Specialist COVID response team.
References
1. Covid-19: NHS Test and Trace made no difference to the pandemic, says report BMJ 10th March 2021 [Accessed on 11/03/21] Available from https://www.bmj.com/content/372/bmj.n663
5. Select Committee on Science and Technology, Oral evidence: UK science, research and technology capability and influence in global disease outbreaks, Wednesday 3 February 2021, [Accessed 10/03/21] Available from https://committees.parliament.uk/oralevidence/1647/pdf/
9. Covid-19: NHS Test and Trace 'no clear impact' despite £37bn budget. BBC News. 10th March 2021. [Accessed 10/03/21] Available from https://www.bbc.co.uk/news/health-56340831
13. Begley P, Sheard S. McKinsey and the 'Tripartite Monster': The Role of Management Consultants in the 1974 NHS Reorganisation. Med Hist. 2019 Oct;63(4):390-410. doi: 10.1017/mdh.2019.41. PMID: 31571693; PMCID: PMC6733764.
14. Covid-19: Nurses prepare for strikes over 1% NHS pay rise in England. BBC News. 6th March 2021. [Accessed on 11/03/21] Available from : Covid-19: Nurses prepare for strikes over 1% NHS pay rise in England - BBC News
Competing interests:
The views expressed here are the personal views of the authors and in no way represent the views of Suffolk County Council. PB leads the local Specialist COVID response team.
12 March 2021
Padmanabhan Badrinath
Consultant in Public Health Medicine & Associate Clinical Lecturer
Elizabeth Cubitt
Suffolk County Council & University of Cambridge
Endeavour House, Suffolk County Council, Ipswich IP1 2BX
Rapid Response:
Our love/ hate relationship with private management consultants – An issue for all political colours from time immemorial
Dear Editor
We read with interest your news item on the findings of the House of Commons Public Accounts Committee on Test & Trace (1). When NHS Test and Trace (NHST&T) was founded on the 28th of May 2020 in the initial stages of the COVID-19 pandemic, with the UK plunged into National Lockdown, this system was hailed as one of the initial tools in the UK arsenal for saving lives and limiting case numbers, with the existence of a vaccine far on the horizon (2). However, as with many aspects of managing a pandemic, this system had to learn constantly and change and adapt quickly. Since its inception, Test and Trace and the authorities involved have been criticised for failing to deliver ambitious targets. In March 2021, one criticism (3) levelled against the service has been the overreliance on expensive management consultants, resulting in a lower degree of value being added to the system than would be expected in return for cost incurred. In a time where the budget is already pulled in a multitude of competing and important directions, assessment of these outgoings in relation to the balance of cost versus value must be carefully considered. We do acknowledge that some of the consultants possess unique and specialised skills.
From the onset, NHST&T has employed external consultants to scale up the programme. In November 2020, labour member of Parliament Andy Slaughter asked (4) the government for clarification on costs incurred on employing consultants. The response from the government in January 2021 was that the total cost of employing consultants was approximately £375 million, with 2,300 consultants employed working for 73 different suppliers (4). Reasoning included benefits of short-term contracts and providing expertise in a multitude of fields including digital design, testing workflows and tracing systems. These are defended as integral features of the T&T apparatus, and without which, the system could not perform effectively. T&T have stated that the consultancy teams have successfully built the T&T digital platform which has been visited 1.6 billion times (5), and research (6) has suggested that using the T&T Covid App has prevented an estimated 200-900,000 further infections between October and December 2020. These results are comforting but many say the system has not gone far enough to support the fight against COVID.
Members of Parliament have questioned (5) the cost and utility of employing these consultants and whether this choice is really providing value for money. In response to criticism regarding consultant payment, NHST&T stated that the ‘average is 1.1 thousand per day’ (5), and that when envisaging the pay when this work is transferred to an equivalent civil servant, a like for like comparison is not appropriate. As these costs come into public domain, with resources stretched, perhaps some clarification may be required on why the payment appears so high. The Government has defended T&T saying it has allowed people to ‘restart their lives (7)’, however clearly there are questions being asked (3) around the systems effectiveness.
The UK Parliament Accounts Committee issued a report (3) on the 10th of March stating that NHST&T must ‘wean itself off its persistent reliance on consultants and temporary staff’, as well as criticising the ‘unimaginable’ costs of NHST&T, and that “there is no clear evidence of T&T overall effectiveness”, with failures to meet the target of turning around tests with 24 hours and below 50% utilisation rates (3). These are damning assessment of a service that will cost £37 billion over a period of two years (8). This report has also been picked up by mainstream media (9), with the BBC reporting that some consultants are paid over £6,600 a day and highlighting the Committees plea that ‘the taxpayer should not be treated like an "ATM machine"’. Therefore, it appears that if objectives are clearly defined and ultimately achieved, then T&T will be accepted more readily as a necessary expense to release the UK from restrictions. It is worth adding that the cost of consultant employment has certainly shocked the MPs and been highlighted by the media.
The issues of reliance on and the cost of private consultants is by no means a problem only seen in times of the current government or in COVID times. In 2009, The House of Commons divulged (10) that under the Labour Government, between 2005-06, £0.6 billion was spent on consultancy services, and payment per consultant mirroring that of today, £1000 for senior partners and £500 a day for junior consultants. To provide further support to the view that this is an integral issue for parties of all colours and ideology, the coalition government was also criticised for spending £640 million in 2014 (11). A report in 2019 (12) covering a period of four years made this shocking conclusion “the findings show a significantly positive relationship between consulting expenditure and organisational inefficiency. These results lend support to critical accounts of management consulting, highlighting the need for organisations to be circumspect in deciding whether and how to use these services”.
It is interesting to revisit the role of management consultants in the 1974 NHS reforms. According to a case study (13) assessing this “…. their involvement in the 1974 reforms speaks directly to ongoing questions about the ways in which consultants come to be hired by health policymakers (often through reputation or established relationships), the quality of their work, the perceived lack of expertise inside the civil service and the NHS, and the ways in which they appear to legitimise decision-making processes”. This appears to continue even today decades later. The senior author of this communication had the opportunity to work with management consultant during a previous NHS reorganisation and still has mixed feelings. This debate is especially crucial when the State cannot afford more than a 1% pay rise due to financial constraints (14) for NHS staff who put their lives on the line and many making the ultimate sacrifice in our battle against COVID.
Elizabeth Cubitt, Public Health Specialist Fellow, Suffolk County Council
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine, Director, Public Health Specialist COVID19 Centre.
Suffolk County Council & Associate Clinical Lecturer, University of Cambridge. Directorate of Public Health, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX. p.badrinath@suffolk.gov.uk
Disclaimer: The views expressed here are the personal views of the authors and in no way represent the views of Suffolk County Council. PB leads the local Specialist COVID response team.
References
1. Covid-19: NHS Test and Trace made no difference to the pandemic, says report BMJ 10th March 2021 [Accessed on 11/03/21] Available from https://www.bmj.com/content/372/bmj.n663
2. Government launches NHS Test and Trace service. Gov.uk 28th May 2020 [Accessed 10/03/21] Available from: https://www.gov.uk/government/news/government-launches-nhs-test-and-trac...
3. Test Track and Trace. Public Accounts Committee. 10th March 2021. [Accessed on 11/03/2] Available from: https://publications.parliament.uk/pa/cm5801/cmselect/cmpubacc/932/93203...
4. Contact Tracing: Consultants. UK Parliament 14th October 2020. [Accessed 10/03/21] Available from: https://questions-statements.parliament.uk/written-questions/detail/2020...
5. Select Committee on Science and Technology, Oral evidence: UK science, research and technology capability and influence in global disease outbreaks, Wednesday 3 February 2021, [Accessed 10/03/21] Available from https://committees.parliament.uk/oralevidence/1647/pdf/
6. COVID-19: NHS Test and Trace app has prevented 600,000 cases, study suggests 9th February 2021 [Accessed on 11/03/21] Available from https://news.sky.com/story/covid-19-nhs-test-and-trace-app-has-prevented...
7. PM: NHS Test and Trace helping 'restart our lives. BBC News. 10th March 2021. [Accessed on 11/03/21] Available from: https://www.bbc.co.uk/news/live/uk-56343912
8. Unimaginable” cost of Test & Trace failed to deliver central promise of averting another lockdown. UK Parliament Committees. 10th March 2021 [Accessed 10/03/21] Available from: https://committees.parliament.uk/committee/127/public-accounts-committee...
9. Covid-19: NHS Test and Trace 'no clear impact' despite £37bn budget. BBC News. 10th March 2021. [Accessed 10/03/21] Available from https://www.bbc.co.uk/news/health-56340831
10. The use of management consultants by the NHS and the Department of Health. House of Commons Health Committee. 4th June 2009 [Accessed 11/-03/21] Available from: https://publications.parliament.uk/pa/cm200809/cmselect/cmhealth/28/28.pdf
11. NHS spends 640 million on management consultants NHS spends 640 million on management consultants. Consultancy.uk) 23rd December 2014. [Accessed on 11/03/21] Available from: https://www.consultancy.uk/news/1240/nhs-spends-640-million-on-managemen...
12. The impact of management consultants on public service efficiency. Kirkpatrick, I et al January 1st 2019. Available from: The impact of management consultants on public service efficiency: Ingenta Connect https://www.ingentaconnect.com/content/tpp/pap/2019/00000047/00000001/ar...
13. Begley P, Sheard S. McKinsey and the 'Tripartite Monster': The Role of Management Consultants in the 1974 NHS Reorganisation. Med Hist. 2019 Oct;63(4):390-410. doi: 10.1017/mdh.2019.41. PMID: 31571693; PMCID: PMC6733764.
14. Covid-19: Nurses prepare for strikes over 1% NHS pay rise in England. BBC News. 6th March 2021. [Accessed on 11/03/21] Available from : Covid-19: Nurses prepare for strikes over 1% NHS pay rise in England - BBC News
Competing interests: The views expressed here are the personal views of the authors and in no way represent the views of Suffolk County Council. PB leads the local Specialist COVID response team.