NHS England spends over £20 billion every year on goods and services. A significant part of the remainder of NHS non-salary budget involves the commissioning of health care services. This expenditure and commissioning is controlled by NHS procurement rules, which in part derive from EU law. NHS procurement rules are regularly criticised for imposing excessive red tape and compliance costs, and calls for NHS procurement reform to free it from such strictures are common.
In this context, Brexit could be seen as an opportunity to overhaul NHS procurement and to move away from the perceived excesses of EU law. This post concentrates on two issues. First, does EU law prevent significant reforms of NHS procurement and, if so, can Brexit suppress such constraints? Second, is the way Brexit is unfolding conducive to an improvement of NHS procurement? Continue reading
“I have a problem with gambling. There’s not enough of it.”
Dr Sean Cowlishaw, Research Fellow at the Centre for Academic Primary Care, University of Bristol
That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.
The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling machines, called Fixed-Odds Betting Terminals (FOBTs), which now occupy the high street (within betting shops) and allow punters to wager up to £100 every 20 seconds.
Yet Britain doesn’t have much insight into its problem with gambling. Compared to most other addictive behaviours, involving drugs or alcohol for example, gambling is largely ignored by health services and public health agencies. This is partly because gambling is a hidden concern. It does not manifest with physical warning signs. Indicators are usually visible in extreme cases only, and generally following major life crises such as extreme debt or relationship breakdown. Continue reading
Management consultants are powerful beasts. They can mould businesses and guide governments, both in high-profile projects and behind the scenes. They do this largely free from any specific regulation and, if revenue is anything to go by, continue to thrive in our uncertain world.
But there are constraints and scrutiny at work too – and they are increasing. A recent studyby researchers at the universities of Bristol and Cardiff in the UK shows how one of the most powerful consultancies, McKinsey & Co., is facing up to new and threatening pressures from clients, governments, NGOs and market forces.
Consulting firms like McKinsey, Booz Allen or Boston Consulting exercise power in three main ways: they have vast resources at their disposal; they are able to intervene in decision-making processes; they can influence what their clients think. In terms of resources, McKinsey not only possesses significant economic capital but its CEO-heavy alumni network provides it with an instant sales route into the Fortune 500 list of major companies. Its knowledge resources are the envy of universities the world over. The McKinsey Global Institute, for instance, is one of the largest management research organisations.