Public budgets 1 Daddy or chips?

Or, some observations on the perplexing issue of how sightlines can affect one’s view as to whether the National Health Service in the United Kingdom is being, or should be, constructed or demolished…

Photograph of a hospital building being demolished - JED2_7464_m

View of a partially demolished hospital building. Copyright Janet E Davis, 2010.

NHS spends more than £300m on consultancy services

was the headline that attracted my attention.

My first thought was: ‘that seems seems relatively modest, given the size of the National Health Service.’

My second thought was: ‘ah! I see. I was supposed to think: ‘How much?! How wasteful of them to spend too much on non-essential services whilst I wait at least a year for treatment I need!‘’

My third thought was: ‘what’s the breakdown of that total; what, exactly, do they mean by “consultancy services;” and, who produced the information?’

Looking for facts

It took a while to read through the different articles published around the same time on this topic. It was obvious that they had all been based on the same press release or an executive summary from a report. Eventually, from the various articles, I found some examples of what kinds of services on which the National Health Trusts had spent “more than £300m:”

  • legal
  • human resources (there is no indication of what this covers – headhunting? recruitment for vacancies? training?)
  • “media work” (no indication of what this covers, it might include the leaflets available in hospitals to give patients more information in writing about their conditions or illnesses and how to help themselves improve their health)
  • project management
  • ICT
  • architects
  • surveyors

The more exact figure spent on consultants was £313.9 million which, according to the BBC News report “represents less than half of 1% of the NHS budget.”

‘Less that 0.5% of NHS budget spent on certain types of externally-resourced services’ does not make such a snappy headline, however.

Management consultants versus ministering angels?

Even The Guardian‘s report made the facts look more exciting, beginning:

“Health trusts spent more than £300m on management consultants last year – almost the same amount of money that the NHS puts aside for skin cancer and lung cancer services combined and enough to pay for 10,000 nurses – new figures reveal:

It is an interesting technique, comparing one amount spent with the amount spent on something else. It seems an almost random comparison, but is a masterly piece of compare-and-contrast writing. The key terms are “management consultants,” “cancer,” and “10,000 nurses.”

For “management consultants,” we are all supposed to read ‘cocksure, arrogant bastards who sweep in for a few days, don’t listen, suggest something unworkable and charge a fortune.’ The word “cancer” will be likely to cause an emotional reaction in most readers. Who has not known someone who either has had cancer or has had something that might have been cancer? Then we get offered the magical beings who will make everything better: “nurses.”

Giving us the vision of a vast quantity of ministering angels – “10,000” – almost seems to reduce the quantity of unnumbered management consultants to a few individuals taking large chunks of the millions of pounds. The more specific information on the type of services bought in by the NHS indicates money spent on services not solely or not traditionally associated with management consultancies.

The mention of cancer treatment and a large quantity of nurses in all the reports indicates that this comparison was made in the original press release or executive summary. The Daily Mail, for example, states: “Critics said the sum – revealed in figures released by the Government – would pay for 10,000 nurses…”

In all the reports, there is a tendency to an over-simplification of the issues relating to NHS budgets. Most of us know little about how our health services are organised, and what kind of work is involved to ensure that we get the health services we need.

Doctors or nurses? Nurses or hospitals?

Yes, we need nurses. We also need consultants and other specialist staff. Then there’s the question of where and how we receive treatment. However wonderful our doctors, nurses and other medical staff are, they cannot treat us effectively in rotting buildings or with out-of-date equipment. We therefore need to spend money on repairing or replacing buildings, and on new equipment. Should we have nurses and doctors to spend their time going specifying a building contract, negotiating the contract for supply of toilet rolls?

Early in 2010, on my way to and from medical appointments, I regularly walked past a hospital building being demolished (see picture above), and a new hospital building rising up above the hoardings adjacent to it (see picture below).

Do I think that every NHS Trust should employ a permanent team of excellent, well-qualified construction professionals for the times when they are constructing a new hospital?


New building at the Royal Victoria Infirmary

New building at the Royal Victoria Infirmary

I do expect them to have a fully-qualified team of professionals to manage day-to-day and planned maintenance, and small-scale projects. Demolishing and constructing a substantial new building at a major hospital is a big project, however. It does not happen that frequently so it would be very wasteful to have a permanent team of building professionals large enough to do all that is necessary for major new build projects.

The main parts of the hospital that I watched levelled and rising anew were built in 1906, with extensions added at various times during the 20th century. If they could support sufficient staff permanently to manage such a major capital project in-house, I would wonder if there were savings that could have been made in the past; and how much money would be required for redundancies once the projects are complete.

Shifting sightlines, clearing the view

Yes, there are very difficult decisions to be made when budgets are decreased in order to reduce public borrowing. It all seems so obvious as to where the cuts should be made if one views it from one, very narrow angle. Shift your sightline just a few degrees and it starts to become more difficult.

Daddy or chips? Hospitals or nurses? Do you want a National Health Service in a decade or two’s time, or just for now?

It would be helpful if the press could contribute more to explaining the issues in less simplistic terms, and providing a few more facts. We need facts. We need some intelligent straightforward and honest interpretation, and clear presentation of those facts. It is our National Health Service, and we need to participate in ensuring it is there to look after future generations.


NHS spends more than £300m on consultancy services,’ BBC News < last accessed 23/08/2010>

‘NHS slammed for £300m external consultancy bill‘ on < last accessed 23/08/2010>

‘Health trusts spend £300m on private consultants,’ The Guardian < last accessed 23/08/2010>

‘Consultants cost the NHS £313m,’ The Independent < last accessed 23/08/2010>

‘NHS’s £313m for consultants as thousands faced the axe,’ Daily Mail < last accessed 05/09/2010>


1 thought on “Public budgets 1 Daddy or chips?

  1. Pingback: Tweets that mention Public budgets 1 Daddy or chips? « Janet E Davis – The Blog --

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