McKinsey and the ‘Tripartite Monster’: The Role of Management Consultants in the 1974 NHS Reorganisation

Abstract

The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the ‘mistakes’ that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.

The shadows of waiting and care: on discourses of waiting in the history of the British National Health Service.

“…A new family doctor contract was agreed in 1966, flanked by various state committees to investigate the separate parts of the NHS and its co-ordination ( Rivett, 1998 ), and the NHS itself was restructured in 1974 as part of a drive to rationalize its administration. The restructure devolved more power to local and regional authorities and unified hospital and local government services, ending the previous division of NHS administration into hospital services, family health services and local authority provision ( Begley & Sheard, 2019 ; Ham, 2009 : 23-28; Webster, 1996 ). However, these changes were not simply concerned with efficiency.…”

Back to the future? Lessons from the history of integrated child health services in England

“…5,6 This led to a void of communication between hospital and community services, resulting in pressure to unify the structure catalysed by the belief that community-based care could be cheaper in the face of escalating costs. [7][8][9] In parallel, the 1959 Platt report into children's healthcare advocated for improved communication between paediatricians and GPs and was supportive of services caring for sick children at home. 10 Following this, the 1962 Porritt report recommended unifying services under local 'Area Health Boards'.…”

From “Honeymoon Period” to “Stable Marriage”: The Rise of Management Consultants in British Health Policymaking

“…13 A recent article by the authors also focused on the role of McKinsey & Co. as part of the 1974 NHS reorganization and sought to place it in a more concerted health policy history and NHS history context. 14 However, this agenda can be taken further.…”