The Gravy Train

“You don’t know what you’re doing” they chant from the terraces and it would appear many of those in Government and on the boards of NHS trusts agree. Why else would they make such expensive use of private sector management consultants and why else would the government want to make it easier for those from the private sector to gain employment in the NHS?

Private sector management companies make a lot of money out of the NHS. Between April and January PwC were paid £2.7million, Mckensy £1.9 million, KPM £900K and Deliotts £800k.

It’s not just the NHS that makes use of consultants it has become standard practise across the public sector whether engaging head hunters to recruit to senior management posts, business analysis to advice on outsourcing services, trainers to run management development programmes and facilitators to conduct an independent consultation process. They are used for their specialist expertise, they are used because over stretched management can’t deliver in the time frame, they are used to give credibility to a process which is likely to have a controversial outcome. Local Authorities used them so much that the communities’ minister felt it necessary to instruct them to spend less money on management consultants.

 They are often accused of being expensive, over promising and under delivering, or as one cynic put it borrowing your watch to tell you the time. Their recommendations always seem to involve making more use of them and a greater use of the private sector.

The idea that management consultants could benefit the public sector was based on their use in the private sector and it was those in the private sector who promoted the idea that what the public sector needed was more “business people”. If the salaries in the public sector were too low to attract these business people into management posts then they could be offered positions on the board. NHS Trusts have embraced this model from the private sector with great enthusiasm and have as many non executive paid part time board members as they do Directors.

This preoccupation with all things private has its origins in the public sectors desire to improve the quality of management. Things are changing but initially this involved sending senior managers to business schools where it quickly became apparent that things were done very differently in the private sector. This became the public sector could learn a lot from the private sector and then the public sector needs to become more like the private sector.

Whilst it would be ridicules to say the public sector has nothing to learn from the private sector it would be equally short sighted to claim that just because it works in the private sector its appropriate for the public sector.

May be now is the time to stop trying to be like the private sector and look more to best practise with in other areas of the public sector. In which case we might recognise the expertise we possess and make less use of those expensive management consultancies. 


Blair McPherson is author of Equipping Mangers for an Uncertain Future published by



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