NHS spent a ‘staggering’ £313million on management consultants in Labour’s last year
The NHS in England spent more than £300million on management consultants in the last year, new figures showed today. The cost is almost the same as the amount spent on skin and lung cancer services combined and is the equivalent of the salary of 10,000 nurses, the data for 2009/10 showed.
The Government released the figures to show how much was spent on management consultants – as well as advice from architects, lawyers and surveyors – in the last year of the Labour government.
Overall, primary care trusts (PCTs) and strategic health authorities (SHAs) spent £313.9million on consultancy services. In the West Midlands, £29.38million was spent on the services, while in the east of England the figure was £27.2million. London spent £114million, the South East spent £22.5million and the south central part of the country spent £23.3million.
Health Secretary Andrew Lansley, said: ‘I am staggered by the scale of the expenditure on management consultants in the NHS. ‘Even at a time when it became clear that the nation’s borrowing was out of control, Labour allowed wasteful spending to blossom. ‘In contrast, I have asked PCTs and SHAs to reduce their management costs by 46 per cent over the next four years. This will root out unnecessary bureaucracy and any expensive duplication of functions. ‘Every penny saved will be reinvested in improving patient care, meeting demand and driving up quality.’
Dr Peter Carter, chief executive of the Royal College of Nursing (RCN), said: ‘These figures are shocking and nothing short of a scandal. ‘It is extremely difficult to see how spending more than £313million on consultancy services in one year can be justified. ‘There are currently more managers within the NHS than at any point in its history, so why are SHAs and PCTs buying in additional expertise?
‘At a time when nurses and other staff are seeing frontline services cut and being asked to accept a pay freeze, these organisations need to clearly demonstrate they are getting good value for money from the taxpayer’s health pounds. ‘Spending this amount of money at the same time we have identified NHS trusts cutting thousands of NHS jobs is outrageous.’
Nigel Edwards, acting chief executive of the NHS Confederation, which represents NHS organisations, said: ‘Any spending of taxpayers’ money has to be justified, and the NHS has been asked by successive governments to perform tasks for which internal expertise was not present or needed to be developed.
‘Dismissing all this spending as wasteful is unfounded. ‘External advice will be necessary if NHS organisations are to deliver change and, with the financial challenges and the size of the current reform programme, it is probable that NHS organisations, especially new GP consortia, will require external help to deliver what the Government wants.’
Shadow health secretary Andy Burnham said: ‘The Commonwealth Fund, an international organisation, recently judged Labour’s NHS as the most efficient healthcare system in the world. ‘This is something of which I am extremely proud.
‘We were already acting to bring consultancy spend down by one-third, but Mr Lansley’s reforms will give consultancy firms a field day. “What he seems not to understand is that the NHS needs good managers. ‘By wiping away the expertise currently in primary care trusts, he is opening the door to consultancy firms who know that hundreds of new, untested GP groups won’t have the experience to go it alone.
‘Mr Lansley says he will root out unnecessary bureaucracy and duplication – but he is diverting billions from patient care for his unnecessary structural upheaval.’
Alan Leaman, chief executive of the Management Consultancies Association, said: ‘The NHS spends 0.3 per cent of its budget on management consultancy and the vast majority of this goes on projects that save the NHS money and improve patient care.
‘Research by the association has shown that on average, for every £1 spent on management consultancy, benefits worth the equivalent of £6 are returned to the client. And the amount spent per employee on management consultancy by the NHS is roughly one-tenth that spent by private sector organisations.
‘An organisation as complex and fast-changing as the NHS is entitled to benefit from the high quality advice and delivery that is offered by MCA member companies.’
The tragic genetic consequences of Muslim cousin marriage in Britain
A huge health problem but nobody campaigns against it. They campaign against “junk food” instead — which is NOT a demonstrated health problem
Sitting in the family living room, I watched tensely as my mother and her older brother signed furiously at each other. Although almost completely without sound, their row was high-octane, even vicious.
Three of my uncles were born deaf but they knew how to make themselves heard. Eventually, my uncle caved in and fondly put his arm around his sister.
My mum has always had a special place in her family because she was the first girl to live beyond childhood. Five of her sisters died as babies or toddlers. It was not until many years later that anyone worked out why so many children died and three boys were born deaf. Today there is no doubt among us that this tragedy occurred because my grandparents were first cousins.
My grandmother’s heart was broken from losing so many daughters at such a young age. As a parent, I can’t imagine what she went through.
My family is not unique. In the UK more than 50 per cent of British Pakistanis marry their cousins – in Bradford that figure is 75 per cent – and across the country the practice is on the rise and also common among East African, Middle-Eastern and Bangladeshi communities.
Back when my grandparents were having children, the medical facts were not established. But today in Britain alone there are more than 70 scientific studies on the subject. We know the children of first cousins are ten times more likely to be born with recessive genetic disorders which can include infant mortality, deafness and blindness.
We know British Pakistanis constitute 1.5 per cent of the population, yet a third of all children born in this country with rare recessive genetic diseases come from this community.
Despite overwhelming evidence, in the time I spent filming Dispatches: When Cousins Marry, I felt as if I was breaking a taboo rather than addressing a reality. Pakistanis have been marrying cousins for generations.
In South Asia the custom keeps family networks close and ensures assets remain in the family. In Britain, the aim can be to strengthen bonds with the subcontinent as cousins from abroad marry British partners.
Some told us they face extreme pressure to marry in this way. One young woman, ‘Zara’, said when she was 16 she was emotionally blackmailed by her husband’s family in Pakistan who threatened suicide over loss of honour should she refuse to marry her cousin.
She relented and lives in a deeply unhappy marriage. But others told me of the great benefits of first cousin marriage – love, support and understanding. To them, questioning it is an attack on the community or, worse, Islam.
At a Pakistani centre in Sheffield, one man said: ‘The community feels targeted, whether that be forced marriages or first-cousin marriages. The community is battening down its hatches, not wanting to engage.’
As a British Pakistani, I am aware of the religious, cultural and racial sensitivities around this issue and understand why people would be on the defensive when questioned about it. At times I was torn between explaining the health risks while privately understanding the community’s sense of being demonised.
But I have also grown up in a family that has suffered the medical implications and strongly believe that people should have the choice to make an informed decision.
Throughout I had to remind myself that this is a health story – nothing more. It is not about religion or cultural identity. It is about avoidable suffering such at that experienced by Saeeda and Jalil Akhtar, whom I met in Bradford.
They are first cousins and have six children, three with the genetic disease mucolipidosis type IV. This stops the body getting rid of waste properly and affects brain functions controlling vision and movement.
Mohsin, their second eldest, is 17 and blind. He wanders aimless and helpless, often crying in frustration. His sisters Hina, 13, and Zainab, 11, have the same condition. They live in almost complete darkness.
Saeeda is worn down from years of round-the-clock care. She spoon-feeds them, dresses them and fears for them. Neither she nor her husband can quite accept that their familial link is the cause of this pain.
This is a major public health issue that has huge implications for other services. The cost to the NHS is many millions of pounds. On average, a children’s hospital will see 20 to 30 recessive gene disorders a decade, but one hospital in Bradford has seen 165, while British Pakistani children are three times more likely to have learning difficulties, with care costing about £75,000 a year per child.
However during this investigation we found no efforts to introduce any national awareness-raising campaign. Why? We approached 16 MPs with a significant number of British Pakistani constituents for interview – every one declined. We asked 30 MPs with a high population of British Pakistanis in their seats to give their views in a short survey. Only one, who wanted to remain anonymous, responded, saying anyone who tried to talk about it risked being attacked politically.
A lone voice was Ann Cryer, former Labour MP for Keighley, near Bradford, who said ‘fear of being accused of racism or demonisation’ prevented politicians speaking up.
It is not just British Pakistani families who suffer. Wayne and Sonia Gibbs are white and first cousins once removed. They had no idea this could lead to problems. Their daughter Nicole had juvenile osteopetrosis, a genetic disease that causes the bones to thicken and crush the body’s organs. Nicole died aged two. The couple now know both carry the recessive genes that caused Nicole’s illness. They wanted more children – but had genetic counselling first. They have two healthy boys today.
I have travelled nationwide, meeting doctors and families whose lives are full of pain. To me the solution is simple: Ring the alarm bells loud and clear.
In Birmingham, one GP practice has taken radical action. The doctors have campaigned heavily to stop cousin marriages. They have introduced genetic screening and testing for patients, starting at 16, and now claim that very few cousin marriages take place there.
My mother tells me that, long before I was born, her siblings and their cousins decided their tragedy would never recur.
The conclusion some will draw is that cousin marriages should be banned. I disagree. But people must be able to make informed choices about the risks involved and options available, be they genetic screening, counselling or carrier-testing. At least there should be leaflets in doctors’ surgeries and school campaigns.
Meeting the families in the programme upset me greatly. Every day for them was an uphill struggle, mostly because their children needed so much help and this put enormous stress on their family lives.
Yet this was avoidable. If this were any other health issue, politicians would have been out in force. But they are silent and as a result children continue to be born with terrible, preventable disabilities that are devastating their lives and those of their loved ones.
Beware of the cobbles: British parishoners told path at 1,300 year-old medieval abbey is too dangerous to walk on
For 1,300 years worshippers and visitors have trodden the cobbled path to the medieval abbey. Few, it appears will now be following them after the route fell foul of the modern obsession with health and safety.
Councillors fear that someone could trip on the uneven surface at Sherborne Abbey, Dorset, and sue them for compensation. So they are applying for permission to spend £30,000 building a modern path on grass alongside it.
But their plans for the abbey dating back to 705AD have provoked anger and warnings that the character of the building will be damaged. Town councillor Katherine Pike said: ‘If we go on being so risk-averse, we will not have a cobble, hill or step left. ‘Those are the kinds of things people come to places like Sherborne to see.’
The cobbled path leads from the Sherborne Museum past the entrance of the abbey. But Mike Keatinge, head of the abbey’s fabric committee, insisted that a new smooth path was needed to prevent trips and falls. ‘We have had a steady trickle of accidents, people tripping on the cobbles,’ he said. ‘We know of one lady who had a particularly bad fall.’
He admitted there could be objections on historical grounds but claimed that the pathway was not as old as many believed. ‘We conducted archaeological surveys and I’m convinced it is not medieval,’ Mr Keatinge told councillors at a meeting last week.
A modern path, costing £30,000 is proposed to run alongside the cobbles to reduce the chance of anyone falling and injuring themselves
A modern path, costing £30,000 is proposed to run alongside the cobbles to reduce the chance of anyone falling and injuring themselves
Sherborne Mayor Jane Smith added: ‘It is uncomfortable to use even if you’re an able-bodied person. These things don’t get better – only worse. ‘There is a public liability factor to take into account if someone has an accident.’ Councillors voted six to four to press on with the measure.
High School exams are a mess, says top British headmaster
Britain’s examinations system is a “complete mess” and A-levels need major reform to allow the brightest students to flourish, a leading educationalist has warned. Dr Martin Stephen, the head of St Paul’s School, London, said the new A* grade was nothing more than “statistical trickery” which will only serve to stifle “creativity, imagination and the willingness to take a risk”.
He spoke out after last week’s A level results produced the 28th successive increase in the overall pass rate, with 8.1 per cent of results being graded at A* – more than had been expected.
Writing for The Telegraph, Dr Stephen said: “The frightening truth is that if we are to rescue our ailing examination system, all we have to do is put the clock back.
“We need to recognise that the top 15 per cent of the ability band are both a priceless asset to the nation and a special-needs category who require specialist teaching. For all their faults, the old grammar schools did recognise this. “We need an extra tier at A-level, with material that can stretch and yet set free the most able, and is marked by those who understand what it is all about.”
Dr Stephen continued: “Our examination system is a complete mess, and the new A* A-level grade – awarded for the first time this year – has done nothing to clear it up. The A* is the right idea, but dreadfully executed.”
Figures published by the Joint Council for Qualifications showed that the overall pass rate rose to 97.6 per cent, with 27 per cent of papers graded at least an A, compared with 26.7 per cent a year earlier. The number of A grades awarded is more than triple that of the early 1980s.
Dr Stephen, high master at the 500-year-old school in south-west London where basic fees are £5,800 a term, said the A* had been misconceived and insisted that standards should be set by universities and not by civil servants.
“It’s madness to invent a new grade without basing it on testing new material, and the A* is simply statistical trickery, giving the new top grade to those who score over 90 per cent in their three modules,” he said. “It means that a candidate could get 100 per cent in one module, 89 per cent in another, and be denied the A*. This means candidates and teachers will suffer.
“The huge pressure not to drop a mark will mean we demote creativity, imagination and the willingness to take a risk. It does not reward those capable of brilliance, but simply rewards those who make the least mistakes.”
He proposed that candidates with A* potential should sit an additional advanced paper, or write a 2,000 word essay on an original topic with a viva to guard against plagiarism.
“One of the greatest ironies of the A-level is that our universities exercise virtually no influence over the exam that is meant to decide their entry,” he said. “We must reinsert universities back in to the management structure of the A-level. If nothing else, this would address the problem of exam boards that have moved from an academic to a commercial agenda.”
Exam boards told schools they had made their papers more “accessible” – which Dr Stephen said was a euphemism for “easier” – because they were under pressure to increase their market share of candidates sitting each subject.
A-level marking schemes restrict the most able students because they leave no scope to express original thought, he said. “I well remember a very bright student who got an E grade on his Shakespeare paper. “He had answered the question ‘Is Hamlet mad?’ by arguing that far from being mad, he was the only sane person in the play. It was the rest of us who were mad. “Brilliant idea, but not one the examiner was allowed to give credit for because it stepped outside the narrow boundaries of the mark scheme.”
Dr Stephen went on: “We have turned the word ‘elite’ into a swear word, denying the fact that all the world’s leading universities are an elite. “In the past, that elite discovered the double helix and invented the internet. In the future, it is only that elite that will find the answer to global warming and a cure for cancer.
“We will not get an effective A-level until we tell those responsible for it that it is okay to give the exam a fast lane, and for it to be used as a means of identifying the most able.”
Last week, John Schmitt, head of English at Charterhouse, criticised the A-level as an “increasingly meaningless” exam which “no longer discriminate between the able and the outstanding”. He advocated the use of alternative systems such as the International Baccalaureate Diploma Programme.
Isabel Nisbet, chief executive of qualifications regulator Ofqual, said: “You can be confident that those who have been awarded an A* have achieved it consistently and have been marked fairly. “Other ideas for the A* are a legitimate and important debate. “We would welcome high-level public and academic input into A-levels.”
On the allegation that marking regimes stifle the brightest students, she said: “This year the criteria for marking the A2 papers were particularly aimed at allowing creativity and originality.”
Miss Nisbet urged Dr Stephen to come forward with any evidence he had that exam boards had made papers easier for commercial reasons.
Spinach and cabbage ‘may reduce risk of type 2 diabetes’
A minuscule correlation that proves nothing
Eating extra cabbage, broccoli and spinach may reduce the risk of developing type two diabetes, researchers have found. A diet rich in leafy green vegetables was associated with a 14 per cent reduced risk of developing the condition, a study by a team at University of Leicester has found.
There are around two million people in Britain with type two diabetes and some do not know they have it.
A diet high in fruit and vegetables generally has been found to reduce the risk of cancer and heart disease but it had not been known whether there was a beneficial effect in diabetes.
Patrice Carter, a research nutritionist at the University and lead author, wrote in the British Medical Journal online that a lack of fruit and vegetables is thought to account for 2.6m deaths worldwide in 2000.
The team analysed six research studies involving more than 220,000 people. It was concluded that eating 1.15 servings of leafy green vegetables a day resulted in a 14 per cent reduced risk of type two diabetes when compared with people who ate less than half a serving per day. This was the equivalent of eating 122 grams of leafy green vegetables per day.
However there was no significant link between overall consumption of fruit and vegetables and the condition although the trend suggested eating more portions was beneficial.
Mr Carter wrote: “there are several possible mechanisms that could explain the benefit of consuming green leafy vegetables in the diet.
“Our results support the evidence that “foods” rather than isolated components such as antioxidants are beneficial for health.
“Results from several supplement trials have produced disappointing results for prevention of disease, in contrast with epidemiological evidence.
“Results from our meta-analysis support recommendations to promote the consumption of green leafy vegetables in the diet for reducing the risk of type 2 diabetes. The results support the growing body of evidence that lifestyle modification is an important factor in the prevention of type 2 diabetes.
“The potential for tailored advice on increasing intake of green leafy vegetables to reduce the risk of type 2 diabetes should be investigated further.”
However in an accompanying editorial, Professor Jim Mann from the University of Otago in New Zealand, and Research Assistant Dagfinn Aune from Imperial College London, were cautious about the results.
They said that the overall message of increasing fruit and vegetable consumption must not be lost“in a plethora of magic bullets’, even though leafy green vegetables are included in that.
It was too early to reach a conclusion about leafy green vegetables on their own, they said.
Dr Iain Frame, Director of Research at the charity Diabetes UK said: “We already know that the health benefits of eating vegetables are far-reaching but this is the first time that there has been a suggested link specifically between green, leafy vegetables and a reduced risk of developing type 2 diabetes.
“However, because of the relatively limited number of studies collated in this analysis it is too early to isolate green leafy vegetables and present them alone as a method to reduce the risk of developing type 2 diabetes.
“Diabetes UK would be concerned if focusing on certain foods detracted from the advice to eat five portions of fruits and vegetables a day, which has benefits in terms of reducing heart disease, stroke, some cancers and obesity as well as type 2 diabetes.”