Concerns have been raised that consultants advising systems on savings plans could be “marking their own homework”, with many of the firms having already done similar exercises for the same organisations, HSJ writes.
HSJ has learned that PA Consulting and PwC were handed most of the contracts after NHS England instructed 10 of the most financially challenged integrated care systems to draft in consultants to help them draw up recovery plans.
But in half of the ICSs in the “investigation and intervention” programme, there is some overlap with previous or ongoing work carried out by the same consultancy firm in the same system, HSJ research has found.
HSJ has also learned PwC director Hannah Cross, who has been seconded into NHSE, has had a key role in running the I&I programme. Her LinkedIn profile describes her as a “senior finance adviser” at NHSE. A spokeswoman said Ms Cross was not involved in appointing any of the consultancies, which were chosen by the ICSs.
PwC, which was one of the shortlisted suppliers recommended by NHSE, has been chosen to work with nearly half the systems.
NHSE said there had been “no direction to use any one supplier, and regulatory safeguards are in place to ensure independence between these firms and their clients”.
But sources familiar with the programme, who work for other consultancies, raised questions about the potential for conflicts of interest.
The programme is split into two phases, with the chosen firms first identifying areas to rapidly deliver savings and then developing plans to deliver them.
One of the sources said: “A number of firms are doing I&I where they are already supporting trusts and systems on financial recovery.
“The scope of the I&I work would potentially look at work that has already been completed by them, which raises concerns around conflicts of interest and whether the scope of the I&I work has already been covered by their support.
“I expect ICSs to tailor work accordingly to adjust for this, but it does raise issues around the phase one work marking their own homework.”
In Nottingham, PA Consulting was awarded work with the ICS, just months after Nottingham University Hospitals NHS Trust, part of the ICS, signed a £7m contract for the firm to be its “financial sustainability partner”.
Elsewhere, PwC is working with Greater Manchester ICS to strengthen its “single improvement plan”, after the city’s NHS was placed in a form of special measures. The ICS was earlier this year criticised by NHSE for not implementing the findings of a previous PwC review, last year.
There is also some overlap with current or previous work in Mid and South Essex ICS, which has engaged PwC; South Yorkshire, where Deloitte is assessing finances; and the Black Country, where PA has been chosen, after carrying out a review last year.
‘Robust’ policies Most ICSs said they were unable to provide costs due to commercial sensitivity, but internal documents seen by HSJ suggest a total bill of around £4m.
NHSE said: “Any costs that systems may incur is significantly outweighed by the substantial financial benefit of systems meeting their collective financial plans this year.”
A spokesman for Nottingham and Nottinghamshire ICS said PA Consulting’s work was “complementary to the pre-existing support” at Nottingham Hospitals and “has a different scope”.
Black Country ICS said PA was selected as it already had insight into the system’s challenges, while Mid and South Essex ICS said external support would help deliver savings.
Greater Manchester ICS said PwC had been chosen from a national list provided by NHSE and argued it was more cost-effective to select a firm with prior knowledge of the system. It said the work had been tailored to ensure it would not repeat previous reviews.
Both PA Consulting and PwC said they could not comment on individual clients but said they had “robust” policies and processes to address conflicts of interest.
Date: 2 September