Ensuring that NHS Professional Services Spend Delivers Value

This is another in our series of articles relating to good practice in terms of procurement of consulting and related services, published in conjunction with Bloom, the firm that delivers the NEPO Specialist Professional Services neutral vendor solution.

Today, we’re looking again (after our initial article here) at the recent report, which suggested that consulting spend in the NHS has not provided value for money. Or at least it did not between 2009 and 2013, which was the period relating to the data considered.

As we said previously, there is no doubt that some consulting projects in the health service do deliver valuable results and benefits. Equally, we know that many projects don’t.  So what can the NHS do in order to increase the chances of using consultants well?

Perhaps we should start by sending every trust a copy of “Buying Professional Services – How to get value for money from consultants and other professional services providers”, the book I co-wrote with Fiona Czerniawska a few years back!  I’m joking – but there is a serious point there. How many people in the health service who are involved in engaging consultants really understand the key principles of effective procurement in this spend area?

For any organisation, there are complex challenges inherent in buying consulting services, and clearly we can’t cover every aspect in one article. But here are three points that we suspect relate to NHS failures and reflect points we make in the book.

  1. Understand what you are buying

One of the key insights in our book came primarily from Czerniawska, based on her work as a consultant and in researching the industry. She defined three reasons why organisations use consultants: for specialist skills (technical, solution or market know-how), for intellectual horsepower, and for execution and implementation. But buyers often confuse what it is they are looking for.

And the other key aspect of this is to understand where the skills or knowledge lie – is it at the firm level or the individual level? So are you buying a proven process that a “big 4” firm has applied in many Trusts to reduce bed-blocking (firm-level specialist skill)? Or do you want a team of bright people to look afresh at your problem (individual-level intellectual horsepower, perhaps)?

Not understanding what is needed or not defining this to the market is a common problem. We often see users paying way over the odds to a major firm, for instance, for a skill or knowledge that essentially resides at individual level and could be sourced from a small firm.

  1. Be realistic in setting expectations

Our suspicion is that many consultants in the NHS are basically given impossible tasks. If the configuration of local health facilities is inappropriate, but no-one dares to close a hospital or even a department because of the likely public reaction, a few bright consultants aren’t going to sort that out.

When an independent investigation into Wirral University Teaching Hospital Foundation Trust describes “deep systemic cultural issues” at the organisation, one assumes it would have been difficult for a short consulting project aimed at “team building” to have achieved much.  So many of the failed projects that contributed to the research findings may well have been simply impossible tasks that no consulting assignment could feasibly achieve.

  1. Lack of clarity on deliverables

This links to the last point, in that defining deliverables, outputs and outcomes required from a consulting assignment will help to identify whether the whole exercise is feasible. But too often, the required outputs from the work are not well defined in advice. In the worst cases, there are big mismatches – such as a consultant delivering a report when the client was expecting something tangible to be implemented, not just explained on paper.

Most consultants want to do a good job, but they must be clear what is expected of them. Where this can be combined with some element of payment by results for the consultant (risk sharing), then that can also encourage better outcomes. But that clarity is key.

As Adam Jacobs, Executive Chairman of Bloom Procurement Services says, “One of the basic principles of the NEPRO vendor neutral consulting solution which we operate is that it requires users to define outcomes and milestones to create robust specifications and clearly defined requirements with no confusion”.  That is a real strength of the NEPRO solution; users must define those outcomes. No-one can just say, “I want a consultant for a month to help” – then that month becomes two, or three, or four…

So, measurable outcomes, deliverables and milestones, demonstrable improvement backed up with hard metrics - these are some of the signs of a really successful professional services assignment. We know there are examples in the NHS, but there could be more, if both professional procurement staff and the commissioners of this sort of work ensure they understand the principles and critical success factors.

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First Voice

  1. Sam Unkim:

    No problem sourcing of specialists
    Architects, Legal Experts, Computer Systems, Vat Advoidance or Asbestos advice

    But perhaps as a “trade” website, could anyone suggest a single piece of “procurement related” work that they or another, have carried out to the benefit of the NHS.

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