With the NHS looking to fill a funding black hole of more than £20bn, NHS organisations are turning to management consultants to devise efficiency savings plans. Yet such plans deliver far fewer savings than promised.
An in-depth study of NHS organisations’ use of consultants suggests that one reason for this is a conspiracy of silence between senior NHS managers and management consultants, devising plans unlikely to be fully implemented to alleviate short-term pressure from the Department of Health.
In the paper The Silent Politics of Temporal Work: A Case Study of a Management Consultancy Project to Redesign Public Health Care published in Organisation Studies, researchers discuss a consultancy project to find 20 per cent efficiency savings in a group of NHS organisations.
Local NHS managers were developing a bottom-up consultative process that they believed would deliver sustainable change but with a Department of Health deadline looming, senior NHS managers hired a global management consultancy to help them produce an efficiency savings plan.
Gerry McGivern, of Warwick Business School, said: “The consultants offered a plan that NHS managers ultimately agreed but both realised would be difficult to implement without sufficient time for dialogue with local clinicians. But having a plan kept the Department of Health off their backs in the short term.”
Describing the ‘silent politics of time’, Professor McGivern added: “The time-frame you view issues through affects what you see. The consultants viewed the NHS’s problems through a short-term lens and drew on standardised global ‘best practice’ to develop an efficiency savings plan within 12 weeks. But they didn’t take the time to talk to NHS managers and clinicians about how it might be implemented in the local NHS, or to get everybody on board.
“NHS managers and clinicians view change through a longer time frame. Many have decades of experience of the complex, political and often difficult process of making changes in the NHS, and are more interested in the sustainability and impact of efficiency savings for local NHS patients in the long-term.”
Professor Sue Dopson, of Oxford University’s Said Business School, said: “We found that, faced with what they perceived as simplistic top-down change imposition, an unrealistic deadline and limited opportunities for dialogue, local NHS managers used these temporal differences politically. They superficially agreed changes they knew would fall apart to deflect immediate performance pressure.
“These differences in time-frames were never discussed, but our research shows that if you use consultants as a quick fix you are just storing up problems for the future.”
The Silent Politics of Temporal Work: A Case Study of a Management Consultancy Project to Redesign Public Health Care was written by Professor McGivern, Professor Dopson, Professor Ewan Ferlie, of King’s College London, Professor Michael Fischer, of the Australian Catholic University, Professor Louise Fitzgerald, of Said Business School, Dr Jean Ledger, of University College London, and Chris Bennett, of King’s College London.