I see McKinsey have been doing work on the NHS

... and getting pretty bashed for it in the UK press today.Only doing their job I suppose but not sure the recommendation demonstrates much in the way of understanding of the challenges faced in the NHS.Could however all just be a clever piece of politics?

Well given that the country is bust there need to be savings. Big savings. It is all government will be talking about. Some hard decision to be made so really no surprise that a consultancy, that does strategy work, has been paid to recommend how to cut costs.A non-story really in my view, but hey, consultants are often the whipping boy for bad news.

Who specifically commissioned the report?

The report, I believe, was some pro bono work that all of the big4's and McK did on the DH request. It was all part of some sensible rational debate we should allow our public services to have in today's economic state. Look in this week HSJ - there is another report on London reconfiguration and its a pretty rational approach.

A non-event really. McKinsey did not demonstrate a understanding of the NHS and the healthcare sector. A foundation issue really is to do with the need for development and adoption of new medical and life science technologies to enable effective transformation. For example adoption of accurate and reliable point of care diagnostics devices that can help to transform workflow, improve care and reduce costs. Such devices are only just emerging.In most sectors similar types of transformations have been implemented such as just in time processes in manufacturing which also demanded the development and adoption of new production technologies.The healthcare sector is facing the same type of challenge today - only it is much larger.

Paul, you either haven't read or haven't undertood McKinsey's report. The report has nothing do with the:"development and adoption of new medical and life science technologies to enable effective transformation." or "just in time manufacturing"and everything to do with taking the least productive providers / poorest quality services and raising them to the level of the average, thus realising large savings of clinical time and operating cost.

<B>I FOR ONE WOULD RATHER HAVE THE GOVERNMENT GIVE ME BACK THAT PART OF MY TAX MONEY WHICH IS USED TO FINANCE ONE PERSON&apos;S USAGE OF THE NHS AND THEN LET ME PURCHASE THE SERVICES I REQUIRE DIRECTLY FROM A HEALTHCARE PROVIDER OR INSURANCE COMPANY OF MY CHOICE.

OK, as long as you need below average health care costs for the rest of your life, and don&apos;t need some expensive drug.So tell me, do you feel lucky?

Pro bono? No knowledge? Hmm, at least according to a quick search of NHS:http://www.google.com/search?hl=en&safe=off&num=100&q=mckinsey+filetype%3Axls+site%3Anhs.uk&aq=f&oq=&aqi=and the result:http://www.london.nhs.uk/webfiles/FOI/July%202009%20disclog/L305%20attachment%2003.xlsshows that the consultancy spend has been almost 3.5 million pounds on five projects in 08-09. One might assume that they at least have some teams that are aware of the challenges and internal workings of NHS.Some of the other files:http://www.derbyshirecountypct.nhs.uk/content/FOI%20Responses/FOI%20responses%2009/March%2009/MckinseyPresentation%20-%20final.pdfShow at least a passing appreciation for some of the challenges that currently affect NHS...

<B>BELOW AVERAGE HEALTH CARE COSTS WOULD BE GREATLY WELCOMED.REGARDING THE THING ABOUT THE EXPENSIVE DRUG, MY LOGIC HERE IS THAT I AND OTHERS SHOULD HAVE TO PAY OUR OWN WAY THROUGH LIFE SO LONG AS WE HAVE £1 TO OUR NAMES. THEN, AND ONLY THEN, MAY THE STATE STEP IN TO START PAYING FOR THINGS. IT ALL HAS TO BE PAID FOR ONE WAY OR THE OTHER, AND MAY WAY HAS THE ADVANTAGE OF GIVING PEOPLE CHOICE AND CONTROL OVER WHAT THEY BUY, PLUS IT CUTS OUT THE UNNECESSARY STAGE WHEREBY GOVERNMENT GETS INVOLVED AND TAKES ITS SHARE OF THE MONEY.

The capitalist, could you please stop shouting? Besides the content the fact that everything is in CAPS and in bold is annoying (usually done by males in the age category of 18-24, too much testosterone and definitely not a MC).

ok i will keep the noise down a bit from now on

@ the capitalist - how would your plan work if I had an illness that needed £20K of treament and I only had £5k in my entire savings?I could spend that on the treatment, the govt could then pick up the 15k remainder (not sure where this would come from if no one is paying tax towards NHS anymore?) and then I&apos;d be left with no money to pay for food or rent....Presumably I&apos;d then be healthy but hungry and homeless?

well firstly your insurance company would pick up the tab, if you had wisely purchased a good quality policy with your nhs savings.secondly, provision of low-interest financing options could be means tested for exceptional circumstances like yours. when/if you ever have the money, you could then pay it back (like they do with student loans).

The capitalist - at best a GCSE level understanding of the NHS"provision of low-interest financing options could be means tested for exceptional circumstances like yours"what is exceptional about these circumstances? I think you will find that this is the rule rather than the exception

the capitalist - I&apos;m afraid I&apos;d go so far as to say you are exhibiting a GCSE level knowledge of life!Sadly there is a directly converse relationship between the ability to afford insurance and the need for it. This extends not just to health insurance but to all "voluntary" protection. One of the strengths of a mandatory contibution system, such as NI, is that it "forces" lower income individuals to continue to contribute. Where this is made voluntary, insurance commitments quickly become luxuries that are second to more basic needs of housing, food, heating, etc. You also find that parents forego their own cover in order to bolster the insurance cover of their children - thus making themselves vulnerable. Economic systems where revenue (income and taxation) generators are unable to contribute quickly creates downward spirals of decreasing contribution and increasing reliance.Also who exactly would pay for the subsidised finance deals? I too believe in capitalism over any other economic system, but I&apos;m afraid you&apos;re being incredibly niave about the impact of the removal of social support on the overall efficiency of the machine. You do not have to be a communist to understand the importance of a healthy (not just medical health) community in ensuring economic efficiency.

ok guys, point taken but it all sounds a bit commie to me.you seem to be advocating the nhs as the &apos;fairest&apos; way of delivering healthcare to the uk populace. well firstly, government control is inefficient. free markets are better at achieving efficiency in delivering services. the nhs is basically just one big insurance scheme so there&apos;s no reason why this can&apos;t be delivered privately at lower cost. under my scheme we would either keep our tax money or be given &apos;vouchers&apos; that we could choose to spend as we wish.secondly, it sounds brutal, but why not let others choose who they want to help. you wanna pay for other people&apos;s healthcare? fine... contribute to a charity or something. as for the rest of us, we might rather keep the money we earn, or contribute a different amount. oh but we "have" to care for the needy do we? well firstly that&apos;s a matter of opinion, secondly making the nhs a private scheme need not affect it (an insurance scheme could do the same job more efficiently), and thirdly just because you want an efficient delivery mechanism that actually responds to issues of consumer choice because otherwise the individual players go out of business rather than being propped up forever by tax money, it doesn&apos;t mean you want to stop helping others.basically i just think the nhs is one big commie concept that&apos;s inefficient and doesn&apos;t work simply because there&apos;s no imperative to change. in the private sector, you respond to market demand or you go out of business. the nhs is immune to this, and will continue to be inefficient for as long it is insulated from market forces and paid for by tax money regardless of its performance.

1. The great thing about democracy and freedom, is that if you don&apos;t like it you can vote for the party that supports your views, form a party that has your views and see if anyone votes for you, or go to somewhere in the world that aligns with your views.2. Much as it pains me to say, most of the consultants I meet from McK in healthcare ARE clinicians who want to make a better service. In fact the big four have some pretty good folk who work much longer hours than the NHS folk do to make sure its good.3. The NHS is some 500+ organisations, many as big as FTSE250 companies. Of course they employ consultants. That what big organisations tend to do as they see value in their input as it compliments the in house skills in areas they need support. If firms (not just NHS) didn&apos;t, all the consulting firms would go out of business.It simple really. The market does balance out, democracy is a good thing, and some inefficiency will exist in any system. Even for capitalists. Good luck friend, and finding caps lock is step 1 on the road to enlightenment.

so i suppose your idea of freedom is having to give 60% or so of what you earn (once VAT etc are also taken into account) to an organisation (government) who thinks they know how to spend it better than you do?

Capitalist, I recon you are at the beginning of your career and complain about the taxes you pay. It is quite easy to complain about the NHS (or anything in this world) but at least show some indepth knowledge about the other (potential) better alternatives. In the Netherlands they are making the transition from public to private. And for 3 years in a row the healthcare costs are rising... (on top of that the taxes are equal or higher than in the UK). But guess what, it&apos;s still one of the happiest and healthiest countries in the world. Let&apos;s be honest; does it really matter if you pay 3% less tax? I&apos;d rather have money thrown at healthcare than the expenses of politicians...

basically i would prefer to be able to keep all of the money i earn and decide how i want to spend it, rather than having some nanny state tell me what&apos;s best for me

If I may say so, that&apos;s a pretty uneducated POV.If you don&apos;t pay taxes, why should anybody else? - how would you afford to fund central services like medical (who&apos;d paid for it if you don&apos;t and I don&apos;t), how would you get there (since there&apos;d be no transport infrastructure - no roads) etc etc.

well i&apos;ve got a better idea, why don&apos;t we all give 100% of everything we earn and own to the government and then they can spend it in the very best way possible!i agree that there is a place for government, but providing services where a centralised approach is not necessary is not one of them.

OK.Now let&apos;s return this discussion to the original topic so as not to disappoint other readers - ie Management Consulting, and I will try to find you another forum for GCSE economics and politics.

Nice to see a debate where passions run high, but consider the following (figures are for illustration only - I appreciate simply adding them up is not entirely valid)1) No one who has ever worked for an insurance company would ever argue they are a model of efficiency – lets be generous and say they only waste 10% of their resources.2) Insurance companies are corporate bodies – in the UK that means paying 20% of profit in corporate tax. 3) Insurance companies are owned by shareholders (or similar) and need to make a return on investment – lets say a lowly 5%.4) Insurance companies have loss making years and therefore have to retain earnings from profitable years to cover financial liabilities – lets say a paltry 3%.5) Insurance companies are FSA regulated and need to spend a huge amount every year on FSA compliance relating to sales of regulated products and investment disclosure – lets assume 1%Total leakage away from medical expenditure if private insurance companies were to replace the NHS as a source of funding, could easily be 20% to 40%.Hmmm. Not quite so clear cut is it……All this ignores the fact that even if insurers replaced the NHS as funders, there would still need to be an organisation to manage the central infrastructure, just like the railways. You can deregulate the carriers, but you still need Railtrack, because you can’t have competing tracks. All this achieves is a transfer of inefficiency away from the privatised elements, consolidating it in the owner of the non-profit making infrastructure elements. It moves the problems, it doesn’t alleviate them.I&apos;m pretty supportive of capitalism as an economic and democratic philosophy, but for those who eschew it to the degree of zero taxes, there is an easy way to practice what you preach - simply move to any one of the countries where there are no income taxes - Nevis, Andorra, Nauru, Sark, Monaco, etc.Of course you may find either NO infrastructure Nevis, Nauru), or one that is paid for by incredibly high property values and beer at £12 a pint (Sark, Monaco), so you might find life no less expensive. Thats the world free market for you...