The McKinsey NHS story might be an illustration of what a surprisingly tin ear many very smart people have when it comes to basic politics. Or it could just show how very simplistic political debate has become.  Cutting 10% of NHS staff  maybe an intellectually brilliant way of dealing with a funding problem in the health service (personally I don’t think it is, but let’s give McKinsey’s bright young things the benefit of the doubt).  However it would be so politically damaging, so completely devastating to any governing party’s claims to be trustworthy custodians of a public health service, as to be impossible to  enact.  The press coverage I’ve seen is all focused on this element of the report and the condemnation is pretty universal.  However, if you look at the Health Service Journal’s summary of the story, McKinsey recommend much more than just taking an axe to staff numbers.  A lot of what is being floated seems unpalatable but possibly unavoidable if the NHS is to survive – we should at least be talking about the options honestly.  Instead the government have instantly disowned the document ,  the opposition are scoring cheap  political points, and everyone gets to vent some rage about the use of consultants in the public sector.  Thanks chaps.