As more evidence accumulates of Integrated Care Boards (ICBs) veering increasingly off course financially, it seems like there could be another bonanza year for management consultants and so-called “turnaround” specialists.

Greater Manchester ICB, facing a massive £606m target for “savings” to balance the books is already £100 million off course at month 4, faces the unwelcome attentions of a PwC consultant installed as a “turnaround director”, funded by NHS England.

Stephen Hay came from KPMG to work as an NHS gamekeeper, helping to establish the NHS regulator Monitor, and later became director of regulation at NHS Improvement – until he reverted to a role as poacher for PwC.

As the person reportedly responsible for the design and operation of the health sector’s “failure regime” while at Monitor, and reputed to “robustly challenge” poor performance by providers, Mr Hay will no doubt play the role of NHS England’s axe man, driving forward the cuts that GM ICB’s bosses might pull back from.

The HSJ’s North by North West column reports a senior medic saying the focus in Greater Manchester has already shifted dramatically “away from operational issues and patient safety, to balancing the books.”

Another ‘system financial improvement director’, known to have picked up fees of around £2,000 per day, has been installed in North East London ICB, which has fallen £74m into the red in the first five months of the year.

Freelance cost-cutter Phil Orwin describes himself as an “experienced consultant, director and chief executive with a history of working in the management consulting industry,” having worked for Buckinghamshire, Oxfordshire and West Berkshire ICS, North Bristol Trust and Betsi Cadwaladr Health Board in Wales over recent years.

The HSJ reports that in 2018 the Isle of Wight Clinical Commissioning Group and Trust employed Mr Orwin as an interim director providing “turnaround support” at a cost of £1,920 a day. Inflation since then must mean his current fees are £2k or more per day.

As Lowdown has reported the NE London plan for 2023-4 assumes a total of £487m in efficiency savings (£278m, with a risk of delivery slippage) and unmitigated risk (£209m). (p14)

As of month 3, just £103m out of the total system risk had been mitigated (p167) and the ICS was working on a financial recovery plan including:

“Identify unpalatable measures to achieve the financial plan.” (p168)

Enter Mr Orwin as the hired gun from out of town to force the pace.

Meanwhile West Yorkshire ICB, which as Lowdown has reported hung its hopes of break-even this year on achieving a massive 7% (£350m) cost saving programme, is also off course financially, with its CEO Rob Webster reporting to the September Board:

“We are currently forecasting an end year position of c.£25m deficit against a requirement to break even. Achieving this position has become less likely due to a number of factors, including the costs of Microsoft Licences as we switch from local to national arrangements; drug costs; pay costs higher than the sums allocated; higher drug and continuing healthcare costs; and the costs of industrial action. We have also lost ground on delivering some cost improvements.”

According to an HSJ report, “NHSE enacted formal intervention powers in light of the [West Yorkshire] system’s financial performance in May, implementing “additional grip and control measures” across providers.”

In South West England, Cornwall’s ICB has opted for a “partnership with Deloitte” (the firm that made so much money from delivering so little expertise to test and trace services during the peak of the Covid pandemic), hoping to improve performance and “shape the future of healthcare delivery in our region”.

The ICB has red rated its financial performance, its delivery of one-off and recurrent efficiencies and its “gross system risk”.

Whether Deloitte manages to deliver genuine savings to match their own hefty fees remains to be seen.

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