The BMJ Today: Management consultants are like Marmite

rich_hurley“It must be comforting to live in a Manichaean world where management consultants are devils and doctors are angels,” posted Stephen Black, a confessed management consultant for a “major management consulting firm that often works for the NHS,” on yesterday. “It makes solving the many problems of the NHS so easy.”

He was responding to a recent Personal View by David Oliver, a visiting professor, at London’s City University, which was his call to “Stop wasting taxpayers’ money on management consultancy for the NHS.”

Oliver had argued, “Those with relevant experience of the sector rarely have a better track record of delivery than those they are advising. Consultants often sell back the solutions offered to them by the staff they speak to. Or, in glossy reports, they tell service leaders what they want to hear when they haven’t the courage to take ownership of their own decisions.”

And he continued his criticism, “Consultancy firms are unaccountable and can walk away from bad or damaging advice with no consequences. I have lost count of the number of reports that model drastic reductions in urgent activity or cost, based on no credible peer reviewed evidence. Recommendations are often not implemented before the panic button is pressed, and another consultant’s report requested.”

But Black accused Oliver’s condemnation as “knee-jerk,” “naive,” and “childish.”

“I don’t want to be a naive apologist for the consulting profession,” Black wrote. “Some work done by my fellow consultants is rotten and naive, but no self-respecting consulting firm would shy away from a proper evaluation of whether its work was any good.”

“Moreover, no firm would get any repeat business if the people paying for the work were not at least a little satisfied with it. The industry can’t force the NHS to buy its wares,” he assured.

“I’d certainly vote for more accountability and transparency for the outcomes of the work done by management consultants. Perhaps adopting the same levels of transparency as that for medical consultants, where the outcome of their interventions are widely published for all to see. Oh, wait. Sorry: I’m guilty of living in a dream world. Many medics . . . have bitterly opposed transparency around measures of outcomes. Their lobbying bodies have argued that simple measures of, for example, surgical mortality would be too complicated to be interpreted fairly by outsiders.”

And, elsewhere in the journal, Max Pemberton, mental health doctor, author, and Daily Telegraph columnist has also had a recent dig at the consultants.

If I Ruled the NHS is a new series that invites guest contributors to offer their remedy for problems in the health service. And were Pemberton in charge, he said, “I’d also ban management consultants from working in the NHS. We have managers already, and if they are unable to evaluate and restructure their services then they have no business being employed in a managerial role.”

“Spot on, Max!” concurred David Levine, retired consultant physician, in a rapid response.

“No one will be surprised if management consultants dislike your suggestions; if they did, it might even cause concern.”

Where do you stand on the issue of a doubling in annual NHS spending on management consultancy from £313m to £640m between 2010 and 2014 despite politicians’ promises to reduce such spend? Let us know by sending a rapid response to either article. We republish the most interesting and useful as formal letters to the editor. If you are interested in submitting an If I Ruled the NHS column, please email Gareth Iacobucci or call +44 (20) 7874 0738.

Richard Hurley, deputy magazine editor, The BMJ. You can follow him on Twitter @rich_hurley. Email