Is NHS Spending on Consultancy Wasted?

As the official spends from NHS organisations are made public there are plenty of stories about how much is being spent on ‘Consultancy Services. After reviewing the figures myself I found that it wasn’t the actual spend in 09/10 which was the most alarming figure, it was seeing how the sums have increased over the last few years.

From just 2008-2010 the average percentage increase in spend in this area is nearly 150% for PCTs and Hospital Trusts.

Some organisations show dramatic increases such as the University Hospital of North Staffordshire who spent just £18K in 07/08 and £1.8m in 09/10.

So is this a terrible waste of money?

Well that does depend on how the money is spent. From my experience in the NHS, many organisations rely heavily on consultancy services. This is not necessarily a criticism. Most NHS organisations are required to implement very complex information and IT projects and the development of these services are generally short term projects which need specialised support and resourcing. It can often prove much more cost effective to bring in short term consultancy to develop these tools than it would be to employ full time staff and the added overheads these staff would incur.

Over the last few years there have been a myriad of government initiatives requiring organisations to collect, interrogate and report back information on a previously unprecedented level. This has lead to a requirement of specialist services in this area.

There is also the ‘performance review’ aspect. Most organisations now realise that to improve services and be more cost effective they need some kind of measure. The work involved in analysing the huge volumes of information to define these measures and then monitor them is a specialised world.

So is it a waste of money bringing in consultancy services for these specialised and short term projects? Well I guess it depends on what you get for your money. Spending £50K on a snapshot view of performance is not really value for money as the information is soon out of date. Spending on implementing systems which allow information to be monitored on an ongoing basis would seem to be a better prospect.

Can We Really Cut Benefits Spending?

After reading this and many similar articles about the shake up of the welfare system I started to examine how much is spent in this area and what the trends are. The key point I noted is that spending is increasing in these areas. If you look at Job Seekers Allowance for example, the spending per head of population has increased for all but 3 councils from 2003 to 2010. Only Tower Hamlets, Camden and Newcastle have shown a decrease in spending in this area.

For the remaining councils the spending increases are averaging at 81% over this period of time.

Even if you just look at the last 12 months (Mar 2009-Mar 2010) only 1 council shows a decrease in spend (Newcastle)and the average increase is 64%.

Although the recession has already been felt in terms of job losses in the private sector the public sector job losses haven't really started to take effect. Many public sector organisations are just starting major redundancy programmes which will take some time to make their impact felt but when they do, and you add this to the shake up of health organisations, I think we can expect to see huge numbers of people on the move and looking for new positions.

Marry this with to the recruitment freeze in place in most organisations and it is not difficult to come to the conclusion that more people will shortly be joining the welfare system from the public sector resulting in these costs continuing to rise!

Falling and the Elderly

I read this story on the BBC website and as I started pulling together statistics on falls I remembered what an impact falling really does have. My gran fell badly on some wet mossy paving slabs outside her house. Prior to the fall she was very active. As an 85 year old she lived alone and she looked after herself probably better than I do. She travelled to America each year to visit her son and walked everywhere. She never learnt to drive and since grandad died over 20 years ago she is totally reliant on public transport. The nearest bus stop is about a quarter of a mile away up a steep rocky path and she had no problems negotiating this is in all weathers and coming back carrying her weekly shopping.

Then she fell.

Not only was it sad to see her feel her age for the first time in her life, she lost a huge amount of confidence. The fall didn't injure her badly in terms of needing hospital care. However it left her in a lot of pain for a good few weeks and the sheer shock of it meant she was frightened to step outside for a long time. This is coming from a very very independent and sometimes quite eccentric lady!

I remember taking bleach and a scrubbing brush to those paving slabs to wipe them clean so they weren't slippery any more but she never recovered from it and has never got her confidence back.

Since that day I don't remember her ever walking to the bus. She takes a taxi when she has to go out and relies on friends and family for lifts to the shops and hairdressers. She has also taken to walking with a stick which she vowed she would never do as it makes her look old (she is now 90!). Falls - once it happens you can never go back.