We have bedbugs. Annoying, blood sucking, pointless little insects. They’re like bankers but less smug.
They only bite me. My wife is untouched by bedbugs. This amuses her. I wake up after a night of combat, covered in bites and poorly applied antihistamine and she lies there all serene, saying things like “I slept right through” and “are you sure you’re not imagining them?”
In the end, we got someone in. Bedbug experts. Not only do these people get rid of the bugs but they also kidnap some of them and keep them in jars so they can study their bedbug ways. I don’t know why and I expect an angry email from some animal rights activist but I rather admired that. These experts did not take their expertise for granted - they want to stay one step ahead of bedbugs, and apparently they feed them by letting them sit on their arms. They understand the enemy and, as a consequence, we are now free of bedbugs.
‘One trust spent £12m on consultants. Maybe senior managers were unable to decide if they should draw the curtains without hiring some external advisers’
Sometimes that’s what we all have to do isn’t it? Hire some experts to do something we can’t. Even the NHS has to do it on occasion, although you would expect to be able to find most skills lurking somewhere in that organisation. Or you would if it was a national organisation rather than the regionalised corporations it has become.
However, do we really expect to find that the NHS spent £300m on buying in consultancy “experts” last year? One small primary care trust (Camden) managed to spend £12m on its own - £50 per head of the local population. One imagines that its senior managers were unable to decide if they should draw the curtains or not without first hiring some external advisers.
Obviously, this is ridiculous. It not only means a waste of resources but also creates a new and in my view quite sinister “consultancy class”, a group of people who never have to take responsibility for what they do nor actually produce anything, but get paid lots of money nonetheless. This is a small part of the wonderful private sector we keep being told to try to be more like.
Goodness knows, sometimes we all need help from experts. But when calling for expertise becomes an excuse not to engage in or take responsibility for decision making or even think through a problem, something unhelpful is happening. Managers do themselves no favours when they divert costs out of the public purse in that way. It needs to be managed, either by capping consultancy costs or by docking the pay of senior executives who are unable to do their jobs without recurrent external help.
Alternatively, could we find a way of cooperating across trusts and PCTs; sharing skills and expertise, maybe even employing a centralised pool of problem solvers who would be available to all NHS organisations? Try to think creatively about how we could help fellow trusts or organisations to solve problems? Act like the NHS is a national organisation and work in partnership with colleagues across the country? Could work, would save money. What are the odds?