Friday, 13 May 2016

March of the lawyers

In a previous blogpost for #JusticeforLB, using Freedom of Information requests I went through how much Southern Health NHS Foundation Trust spent on external consultancy and legal/professional services in 2013/14 and 2014/15 (see ). I’ve now got this information for 2015/16 (in two batches because I was impatient, see ) via the good offices of What Do They Know? and the genuinely efficient FoI office at Southern Health.

The previous blogpost goes through a lot of the issues in too much detail, and I don’t want to repeat all of that detail here. Instead, I want to talk about some general trends in Southern Health spending over these three years.

The graph below shows the total amount that Southern Health spent on consultancy and legal/professional services (although these categories seem to be somewhat arbitrary to me) from 2013/14 to 2015/16.

Overall, in 2015/16 Southern Health spent £2.23 million on consultancy/legal/profs - 0.7% of their total income of £331 million in 2015/16. Overall this is down from 2014/15, when Southern Health spent £3.28 million (0.9% of their total income of £346 million). But still not a trivial amount when your income has dropped by 6% in two years.

Looking at the two main categories of spending, the big drop came in spending on consultancy (from £2.17 million in 2014/15 to £1.06 million in 2015/16). However, spending on legal/professional services stayed pretty steady (from £1.12 million in 2014/15 to £1.17 million in 2015/16) and is now outstripping spending on consultancy.

So who are the lawyers and what are they getting paid for? We know from the excellent My Life My Choice (see ) that Southern Health apparently spent £318,121 (including VAT) just on the costs of lawyers at LB’s inquest. The FoI tables don’t typically give that level of detail, but there are some clues.

First, there seem to be some law firms that do the kinds of tasks you would expect, for example relating to property (Paris Smith LLP; Savills LLP) or a whole range of legal stuff (Capsticks LLP; DAC Beachcroft). The amount that Southern Health pays to these law firms fluctuates over the three years and adds up to a tidy sum (£236,003 across these four law firms).

However, it’s not nearly as much as the amount paid to three other law firms, whose services go under the strategically vague ‘clinical governance and audit’ category. By far the biggest is Bevan Brittan LLP – from £47,802 in 2013/14 and £44,932 in 2014/15, their income from Southern Health leapt to £265,522 in 2015/16. Their stance on inquests involving the deaths of people in public services can be gained from articles on their website such as “Avoiding a  Coroner’s Rule 43 report at an inquest” ( ) and “Under the microscope: a note on inquests and NHS Trusts” (  ), which has the following gem of wisdom:

“There is a view that if something goes wrong, it is usually somebody’s fault and unless the mistake is paid for by the person responsible it is more likely to be repeated. At the same time, post-incident investigations undertaken within the NHS are usually expected to adopt a no-blame approach. The inquest process still seems to pay lip-service to both ends of the spectrum. A stock phrase at the outset of an inquest is that ‘no-one is on trial, least of all the deceased’. At the same time it is becoming common for inquests involving healthcare staff to be a trial by ordeal in all but verdict and sentence. And yet there is little that can be done to protect such staff or the Trust from gratuitous intimidation, particularly given the cost of a challenge to an inquest and the likelihood that, even if successfully challenged, it will only mean the inquest will be repeated.

Other new entries for 2015/16 were Hempsons (‘Leading lawyers for health and social care’ ) – paid £52,147 in 2015/16 by Southern Health, and Weightmans LLP (‘A top 45 law firm’ ) – paid £45,669 by Southern Health in 2015/16.

On the consultancy side (although boundaries are blurred, to say the least), the reduction in Southern Health spending is largely accounted for by the demise of Going Viral, designed by occupational psychology firm Talent Works ( ) - spending went from £908,832 in 2013/14 to £642,272 in 2014/15 to a big fat zero in 2015/16.

Other consultancy firms are still being paid large amounts by Southern Health – by far the biggest is Deloitte, which was paid £65,455 in 2013/14; £285,128 in 2014/15; and a stratospheric £611,721 in 2015/16.

Local management consultancy buddies Consilium Partners continue to get regular bungs from Southern Health - £158,250 in 2013/14; £114,261 in 2014/15; and £103,920 in 2015/16. IRG Advisors (another ‘management consulting firm’ ) got £64,893 in 2015/16 (although way down on their £265,599 in 2014/15). Newcomers PA Consulting (their website seems to suggest they will do absolutely anything ) pocketed £56,056 in 2015/16.

In what strikes me as an even more sinister turn, we have MBI Health Consulting – they were paid £25,000 in 2013/14, £296,431 in 2014/15 and £39,600 in 2015/16. What particularly perturbed me was that the 2015/16 amount was, according to the spreadsheet, for ‘LD management’. And even worse, in 2015/16 Southern Health paid £4,536 to St Andrews Healthcare (yes, that St Andrews), also for ‘LD management’.

If I had any sort of role in the governance of Southern Health, I’d be very concerned about what all these shadowy management consultancies are doing (quite apart from demanding my money back…). What is their role in the management of an NHS service? Where’s the scrutiny (they very rarely appear in Board papers, and don’t seem to ever be called to Board meetings)? Where’s the accountability? (I know such a question seems naïve to the point of, I don’t know, something, but how could a person in one of those consultancies be disciplined for bullying members of staff, for instance, or for taking a management decision that directly led to a person’s death in the service?).

Just to finish off, a couple of snippets that caught my eye. In 2015/16, Southern Health paid Hampshire County Council £59,459 relating to Southern Health’s Chief Operating Officer, Chris Gordon. A thickening of the local web of connections, and a disincentive for Hampshire County Council to push Southern Health too hard?

And finally, Southern Health paid £47,280 to Aston Organisation Development, but £42,552 was paid back.  Aston Organisation Development (see ) is a consultancy company based on team-based working, and its director is Mike West, guru of promoting health service cultures to promote high quality care. Southern Health is not listed as one of Aston’s recent clients on its website. An accounting error, or one of the parties deciding very quickly that an intervention from Aston wasn’t going to work out?


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