I read with interest an article in The Independent (Wednesday 10th December, 2014), regarding the costs that the NHS is spending on management consultants. As one of those management consultants, and the MD of a consultancy practice, I personally contribute to that spend. I am also shocked at the price the NHS is prepared to pay some consultants – the £3,000 – £4,000 per day quoted in the article is all too readily paid to the large consultancy groups that are found frequently on NHS premises. Furthermore, smaller consultancies like Halland Institute are often called on to complete the work that the larger consultancies have not done well or have started – at vast expense – but not got the relevant skills to deliver. So, why are FDs and CEOs prepared to pay these fees?
I believe that one reason this happens is because, when things go awry or continue as they were before the consultants were engaged, they feel justified in saying that they have tried to resolve whatever the issue was and, furthermore, they paid for the “best advice” or intervention. Therefore, they feel vindicated in that they were prepared not to stint on the cost for a ‘solution’. Despite the evidence that large consultancies frequently don’t deliver what the NHS needs, they are still engaged at vast expense because there is an assumption that you must be getting quality if you are paying such vast fees. The smaller consultancies do deliver for the NHS and, paradoxically, are finding their day rates getting squeezed. Indeed, my day rate is less than the King’s Fund used to charge me out at, 20 years ago. This is a literal figure, so imagine what it is really reduced by in cost of living terms today, compared to 20 years ago.
Another issue raised in the article was why ‘well-paid and experienced clinical and organisational leaders’ lacked the the skills to solve their problems in-house. In my experience it is because people in senior and middle leadership and management positions are promoted without the appropriate development going alongside their promotion. If any element of management development is offered to managers, it is likely to be the technical aspects of the role, such as managing budgets and writing business cases. Whilst these skills are of course important, the things that are neglected are the so called ‘soft skills’ of leadership and management: how to manage people. The essentials of people management are neglected:- how to hold difficult conversations; manage performance; build a high-performing team; lead followers who follow willingly and go the extra mile; build trust in a team; develop team and department culture; manage change effectively; have open and honest conversations; build support and challenge in departments; develop personal insight; lead with emotional intelligence. I could go on. Poor communication skills are, unfortunately, normal. Leadership and managerial skills are not inherent in people. They may have excellent clinical skills but this does not translate to excellence in leadership and management.
Another issue that appears to be increasingly common is that career managers, as opposed to clinicians in managerial positions, are being promoted rapidly, without having the basics of people management skills. Graduate trainees can become Band 8s within 2 years of completing their training programme. They are very bright, and often stand head and shoulders above the competition at interview. However, they are often quite young and have little experience of leading people and it is not surprising, therefore, that they perpetuate poor leadership skills.
There is a huge lack of leadership and management ‘soft skills’ ability in the NHS. This is the development that management consultants like myself and colleagues of Halland Institute are frequently called in to help deliver. Our aim is to raise the standards of leadership and management, building leadership communities in organisations so that they can lead by example and be independent in up-skilling their workforce. We do not provide a crutch or promote dependence on us.
If the National Health Service really wants to get value for money, it needs to seek external resources from people with expertise of the sector and, furthermore, the passion for delivering high quality patient care. The people who can really deliver for the NHS do not have a value system that charges a fee of many £1000s per day. They are passionate about patient care, respectful of the NHS budget and really do want to make a difference to health and social care.
The reason that I and my colleagues do what we do is because we care about the NHS and want it to be led by highly competent, professional leaders. We know that if the quality of leadership and management is improved, then so is the patient and service-user experience. If we can do our bit to help Health and Social Care organisations grow that expertise in-house, be independent after we have contributed our expertise to their organisation, and really make a difference, then that is money well spent. It is an investment, not a sticking plaster.