‘Like poachers and gamekeepers’: The health sector’s own revolving door problem
We are currently experiencing the lingering and unpleasant aftertaste of the Greensill scandal. An ex-Prime Minister lobbying his old colleagues to benefit his new employer is likely to be a high-profile tip of the political iceberg.
The so called ‘revolving door’ between senior public servants and the private sector is an old problem. In essence it is like poachers and gamekeepers. Poachers know the tricks; the gamekeepers know where the traps are. Poachers like to recruit ex-gamekeepers – and gamekeepers like poachers to give them consultancy advice.
For ex-ministers and senior civil servants, there is a ‘two-year rule’ barring working for organisations they used to work with. Although poorly enforced, this is an important rule to avoid decision makers consciously or sub-consciously favouring those they may end up getting jobs with.
In NHS leadership this rule does not apply.
There are many examples of this revolving door, to the extent where it can be considered to be an established career path.
A typical example would be a senior director or officer, often at national level, commissioning commercial partners – management consulting, contractor etc, or adding them to a ‘framework’ for future contracts. Then at some point in the future with the networks and contacts established, the public servant will move across to a position in one of the companies.
The company benefits from the inside knowledge on how to navigate an opaque and complex bureaucracy and gains the most useful resource – receptive ex-colleagues. In some instances, the director may have worked for one of the companies before starting with the NHS.
This issue is likely to be even more important as management consultant spend is being relaxed. As it stands the NHS spends over £300 million per year on management consultancies, but could be a lot more given the notorious opacity of NHS finances.
To openly debate this is not to judge the people involved – given current practice it is a rational decision for an individual. This is a problem with the system.
In addition, there is the argument that this practice could improve the efficiency of these partnerships, and both sides will benefit from understanding the other – a symbiotic relationship.
There is a stronger argument that the NHS benefits from outside ideas, although I suspect the opposite may be more true. For the companies involved it makes sense for those who know the NHS to do that work, and their currency and value is highest shortly after leaving the NHS/DH, when their knowledge and networks are fresh.
The concern the public should have is that decisions about their money and their services may be made for the wrong reasons.
The decision to use these commercial partners to do work for the NHS in the first place, spending large amounts of public money in the process, may therefore benefit individuals not the public if the motivation is murky.
More subtly, the thinking and culture this introduces makes these decisions more likely- if the received wisdom constantly is to outsource expertise and contracts then the people involved will naturally gravitate towards working for these companies. This prophecy then becomes self-fulfilling, reduces the resources available to ‘in-house’ teams, and loses expertise and career opportunities for those remaining.
The upper echelons of the NHS management can be opaque and secretive, decisions are hard to scrutinise and the decision makers often unseen. The work of the NHS is highly valued and respected, so it is especially important to maintain the faith and trust of the country.
To do so the decision making, and the decision makers need to be transparent and open and not influenced by factors other than delivering high quality and high value healthcare.