On 18 June, the University of Bristol Business School brought together leaders from across the NHS to explore the evolving landscape of consultancy in health services.
The event, Blending Internal and External Consultancy in the NHS, hosted by Bayes Business School, comprised a unique mix of academics, NHS internal consultancies, and external experts exploring how best to combine specialist management expertise to tackle the NHS’s complex challenges.
Author: Kirsten Armit, Research Fellow, University of Bristol Business School
The event emphasised the persistent mismatch between the leadership and management capabilities available within the NHS and the system’s frequent over-reliance on external consultants. Discussions highlighted the need to fully harness existing internal expertise, developing it into a visible and credible resource capable of addressing strategic and operational challenges.
Past research findings presented at the event indicated that use of external consultancy in the NHS has generally been associated with poor efficiency outcomes at the organisational level[1]. However, new research (yet to be published) shows that small, targeted use of external consultants, particularly in organisations facing significant challenges, can support improved performance. This points to the idea that an optimal blend of (mostly) internal and external expertise is needed, rather than relying predominantly on one or the other. Professor Andrew Sturdy of the University of Bristol introduced what forms this might take and described a project underway with the University Hospitals Bristol and Western NHS Foundation Trust (UHBW) to explore blending in practice.
Three panel discussions
The event’s first panel, chaired by Kirsten Armit, Research Fellow at the University of Bristol, explored the diverse landscape of NHS internal consultancies, which range from small, embedded quality improvement teams to national membership-based organisations, often not using the term consultancy. The panel, sharing insights from their experiences as NHS ‘internal consultancies’, featured:
- Caroline Dove (NHS Elect)
- Fraser Battye (The Strategy Unit)
- Susy Cook (Advancing Quality Alliance)
- Donna Chung (Mid and South Essex NHS Foundation Trust)
- and Cathy Caple (UHBW).
It became clear that these units differ widely in structure, funding, and market reach in responding to the needs of the NHS and other stakeholders they serve. Themes from the discussion included the benefits of internal consultancies’ deep contextual understanding of NHS culture and systems, as well as challenges such as inconsistent recognition of their value, financial constraints, and limited capacity to scale.
The afternoon’s second panel, chaired by Professor Ian Kirkpatrick of the University of York, shifted focus to the national picture of NHS management capacity and capability. Discussions identified gaps in the NHS’s approach to workforce planning for non-clinical staff and management professionals, which has contributed to chronic under-investment in these roles. The panel included:
- Nicola Burgess (University of York)
- Petra Wilton (Chartered Management Institute)
- and Jo Stanford (Healthcare Project and Change Association).
The panel noted that many clinicians lack structured opportunities to develop and apply essential management and change skills, and there is a lack of recognition of the value and contribution of project and change professionals. They also drew attention to how essential leadership and management capacity were for the NHS to improve and innovate. The session emphasised that building professionalised, consistent management capability across the NHS should be treated as a strategic priority.
The final panel of the day, chaired by Andrew Sturdy, delved into the dynamics of blending external consultancy with internal NHS expertise. The panel included:
- Sue Jenkins (Surrey and Sussex Healthcare NHS Trust)
- Antonio Weiss (The PSC), David Hemming (Shared Business Services)
- and Katie Goulding (Kaleidoscope Health and Care).
They highlighted the importance of knowledge transfer and working alongside NHS colleagues to build capacity so that external consultants leave NHS teams better equipped to sustain improvements. The session explored the benefits external consultancies can bring, such as specialised skills NHS organisations may not readily build themselves, fresh perspectives and facilitation that allows staff to speak up about what is not working.
The discussion illuminated a central paradox: while external consultancy can bring many benefits, it can also undermine internal ownership and fail to embed sustainable solutions if not carefully integrated. Both external consultancies and NHS organisations procuring their services had a responsibility to create internal ownership and embed solutions. Effective consultancy was framed as requiring genuine partnership, clear goals, and alignment with organisational values.
Emerging themes from the event
Throughout the event, a recurring theme was the critical need to deliberately blend internal and external expertise. Innovation and improvement in the NHS depend on introducing new knowledge and skills, but this must be balanced with local understanding and buy-in. Delegates agreed that both internal consultancies and external partners can add significant value, but only when their roles are well-defined, complementary, and focused on building sustainable capability rather than quick fixes.
Another key theme was the structural and cultural barriers that drive reliance on external consultants even when internal options exist. Many internal consultancies face restrictions that limit their ability to invest, expand, or carry funds between financial years, putting them at a disadvantage compared to commercial providers. Participants agreed that NHS policy and funding mechanisms need to better enable internal consultancies to thrive.
Closing discussions
The concluding conversations highlighted the need for stronger collaboration among internal consultancies across the NHS. By forming networks, sharing best practices, and coordinating offers, internal consultancies could strengthen their collective profile, create more consistent quality, and better meet NHS-wide needs. There was also recognition that internal consultancies should proactively seek partnerships beyond the NHS, including with universities, technology firms, and aligned external consultancies, to build capacity and access specialist expertise.
Finally, participants discussed the need to make consultancy a recognised career option for NHS leaders. Developing career pathways into internal consultancy roles for clinicians and managers could unlock a wealth of experience, support talent retention, and improve the system’s ability to innovate and adapt.
The event concluded with a shared sense of urgency and optimism. Leaders agreed that by strategically blending internal and external consultancy, and by investing in and coordinating NHS management expertise, the health service can strengthen its capacity for sustainable improvement, reduce unnecessary reliance on expensive external support, and build a more resilient, innovative system for the future. The group will develop these ideas into an action plan and seek to integrate them into the new NHS structures.
Contact the team:
- Andrew Sturdy, Professor of Organisation and Management, Andrew.sturdy@bristol.ac.uk
- Kirsten Armit, Research Fellow, Kirsten.armit@bristol.ac.uk
[1] Kirkpatrick , I., Sturdy, A., Reguera Alvarado, N., Blanco-Oliver, A., & Veronesi, G. (2019). The impact of management consultants on public service efficiency. Policy and Politics, 47(1), 77-95. https://doi.org/10.1332/030557318X15167881150799