A need to consult?

If there’s one thing more frustrating than being ignored, it’s seeing someone else coming out with a similar idea and being rewarded for it. But that’s a not uncommon experience for doctors and other frontline NHS staff working for the many trusts that have spent large sums of money on external management consultants.

The trend to “go outside” for a supposedly expert opinion on organisational issues is, according to the Royal College of Nursing, costing NHS trusts in England an estimated £350 million a year. That’s not including the amount spent on consultancies by the Department of Health, which we estimate to be about £150 million per year.

This may be money well spent if it is delivering genuine improvements to the way hospitals operate but my experience is that the good ideas are coming from within the NHS, not from the private sector. What drives through change, what really improves the experience of patients, is the hard work and dedication of NHS teams, especially when led by medical consultants who combine clinical work with service development.

You need to be steeped in the ethos of the NHS, familiar with the issues and personalities to not only understand what changes are needed, but to be able to push them through. Long experience of working with patients is invaluable and irreplaceable. It is the ethos, the “faith” that is at the heart of the health service that drives NHS staff. Many external management consultants come from a completely different environment – one where profits are the bottom line and competition rather than collaboration is the driving force.

So why aren’t we making better use of the talent we already have in the NHS? We have 1.3 million employees including 40,000 NHS hospital consultants. We should be doing more to harness their desire to improve the lives of their patients, listening to their ideas, and not snubbing them by paying an outsider for a less expert opinion.

The explanation, I believe is symptom of deeper underlying problem. Those with power at the Department of Health and in the NHS (especially in England) remain fixated on the private sector, convinced that it can always magically deliver new solutions and value for money. They are blind to its failings, stubbornly refusing to accept that the market is not always the answer.

The way forward for the NHS is for politicians and managers to put greater faith in frontline clinical staff and return to an NHS that works on the basis of co-operation and collaboration, not on competition or the profit motive.