None of my best friends are management consultants.

But even in the aftermath of the revelation that the DH funded such people to the tune of nearly half a billion pounds in 2009-10, I can see five main reasons why you might use such people.

Some of the reasons are better; some simply dispiriting.

The first is pragmatic: there are certain skills that you might not need forever. These might be the skills of very senior NHS managers with decades of experience and knowledge of where the bodies are buried (in truth, such people were often gravediggers themselves).

Or they might be very specific analytical skills – most intelligently, such people would be hired as trainers and manual writers. Give a man a fish and he eats for a day; teach a man to fish …

Whichever might be the case, you could quite reasonably not need to employ such people full time, forever. Equally, such people might simply have decided that their skills are in sufficient demand that they would prefer not to be employees.

The second reason is blame hound politics. The blame hound dates back to the banqueting halls of the medieval period: the host would keep dogs under the table, which were known as ‘blame hounds’ - the intention being that any social indiscretions resulting from the feasting and wassailing could be blamed upon the houds.

As in medieval feasting, so in the NHS.

The third reason is romantic - the concept that an independent outsider can speak truth to power with perspective.

While the fundamental organising principle of the NHS – equity – is undoubtedly romantic, developing policy and organisational strategy on a romantic basis may be unwise.

The fourth is brand snobbery - the faith that a report from a certain management consultancy provider gives it higher intrinsic value. To borrow the marketing phrase of Stella Artois (a non-prestige brand in its native Belgium, but rebranded as such for UK sales), these adherents regard ‘big name brands’ as “reassuringly expensive”.

This attitude links ecumenically to the fifth reason: religious faith. Only such an impulse can be associated with healthcare policymakers’ consistent lack of using evidence or consistent methods. The new National Cancer Drugs Fund is a beautiful example of this.

Which of these five do you think has been influencing DH decision-making?

And do you think they have been auditing the value for money of their spending?