As NHS management expenditure tightens, management consultancy costs are in the spotlight. The NHS is big business for the consultancy industry. We spend hundreds of millions of pounds a year on consultancy services.


My motivation in writing a blog about management consultancy comes from two recent experiences. The first was helping to judge the national “Management Consultant of the Year” awards, run by the Management Consultancy Association. I got to judge some outstanding consultants, at the top of their game, who were delivering a massive return for the consultancy investment that their client organisations were making. My second experience was reading a publication copy of a new book, No More Consultants by Geoff Parcell and Chris Collinson. The authors contend that a lot of investment in management consultancy services is a waste of time and money because we don’t think through the issues properly before we bring management consultants in and we might get better, less expensive outcomes by using our own internal capability and existing networks first.


Over the next period, we need to ensure that as section 3.55 of the NHS Operating Framework 2010/11 states, external consultancy is “used only when there are no other options” and that every pound invested in consultancy support delivers a significant return. However, this doesn’t mean the demise of the consultancy industry in the NHS. In fact I believe that management consultants can play an even more effective role and help us get better, faster results. Key to this is how we, as NHS leaders, become better users of management consultant services.


If we look back over the past five years, we can see what a significant contribution external consultants have made to the transformation of the NHS. They have:


  • brought skills and perspectives that we just don’t have in our organisations
  • given us confidence to think the unthinkable and take decisive action
  • helped speed up the change process
  • brought an external, neutral perspective that senior leaders take more notice of and therefore given more credibility to our change plans
  • created additional, much needed, capacity for change
  • helped us to get better outcomes for our populations and patients

 However, there have been many situations where NHS investment in consultancy has just not led to the outcomes we seek. I think that the “blame” for this lies as much with us in terms of how we set up and manage the consultancy relationship as it does with consulting firms who fail to deliver the goods.


Too often, we unthinkingly seek quick fixes, reaching out for an external cavalry to rescue us from our most vexing problems. We bring consultancy support in to help us answer the wrong questions or solve the wrong problems. We need to spend more time reflecting ourselves on what the real issues are. We can be more purposeful in our use of consultants if we understand the problem that we are trying to solve, what resources we already have in the organisation and what help and support is already available in the wider NHS system. In many cases, most of what we need is already there for us.


One of the most significant unintended consequences of working with consultants is that because we purchase their services as experts to help us solve our problems, we subconsciously “let the experts take over”, giving consultants the lead role in diagnosing and making recommendations, in facilitating change events and in initiating action. We move into a subordinate role, even when we are NHS change experts in our own right. Management consultants tend to come to NHS organisations with their own change tools and methods. Often they are quick to disregard other methods or approaches. But if they solve the problem their way, we don’t own their solution because we haven’t played a big enough role in creating it. There is an awful lot of talk of “skills transfer” and “co-production” in NHS consultancy specifications but in my experience, too few consultancy assignments are set up with a delivery model that allows for wholesale knowledge transfer and rapid development of our own people.


The evidence suggests that the receptivity of the local culture for change is more important as a predictive factor of success than the strength of the consultancy intervention. By consistently looking inside the organisation first, and by truly engaging the workforce in the change process, we have the best chance of unleashing the latent energy and potential of the organisation and achieving and sustaining the change we seek.


I want to tell you about a situation that occurred a few months ago. There was an important project which needed a large amount of information to be collected and summarised for use across the NHS. For reasons that are not important to my story, the contract couldn’t be let to external consultants as intended and the work had to be done in house. It meant that all kinds of people from across the NHS were marshaled to help with the initiative. Could one of the consultancy firms have done the work more quickly and have come up with solutions that were more perceptive and more strategically aligned? Probably. However, the fact that the NHS had to do it for itself meant that people got involved from the start, got enthusiastic about the process, surfaced great ideas from within the service and created an energy to fuel the change that would not have been there if they had been asked to implement a pre-packaged solution.


We will need the expertise and brainpower of external consultants to help us reach our quality and productivity goals over the next three years. If we look at other examples of system transformation, we see that bringing in radical ideas, approaches and inspiration from outside the system is a key aspect of change. However, we need to be more resolute as to why we bring consultants into our organisations, the timing and focus of assignments and the process of selecting which consultants we work with. Here are some of the things we should consider:


·        give our leaders and staff problem assessment/solving and consultancy skills so that they can create and implement their own solutions

·        create and develop internal facilitators to support the free flow of knowledge and skills. Give the facilitators the time and space to do the job properly. The recent research report on The Productive Ward commissioned by NHS London identified that this investment in trained facilitators was one of the key factors that made organisation-wide change fly. Investing in these kind of leadership roles can save overall management costs, not add to them

·        involve a wide range of people (staff, patients, public) in identifying the underlying issues and framing the true nature of the problem

·        even if we haven’t got the knowledge or capability in house, we need to consider who can help us externally. Find out who else in the NHS has already tackled this problem.  Network and benchmark with the best

·        be powerful and proactive in our roles as customers of management consultancy services; be clear about the outcomes we seek, and the nature of the relationship; set explicit outcomes for skill and knowledge transfer as well as service or strategic outcomes; define the criteria and manage the process for evaluating the effectiveness of the intervention from the beginning - don’t wait for the consultancy firm to determine it; intervene as soon as questions are raised about the capability of individual consultants; insist on a formal post-assignment review of both outcomes and learning for the organisation

·        be role model leaders. Make visible demonstration of continuous learning a part of our everyday leadership job. Change our perspective from seeking out and solving problems to appreciating and building on the strengths of the team and the organisation. Don’t delegate to others the thinking that we should be doing for ourselves


At the end of the day, this discussion is not really about management consultants at all but about our own resourcefulness and power to challenge and change things. Key to meeting our quality and productivity goals is unlocking the talent that already exists in our organisations. We need to start by looking inside our organisations for the answers. By starting inside, we are in the best place to understand what we need externally and we are most likely to get a strong return on our consultancy investment.


One thing that all the award winners from the Management Consultant of the Year understood was that their role was to enable and coach their clients rather than to solve their problems for them. Perhaps they and the authors of No More Consultants aren’t so far apart after all.


Helen Bevan


PS: No More Consultants has some great practical approaches for tapping into the strengths and assets of our own people. The book reference is:


Parcell G and Collinson C, (2009) No more consultants: we know more than we think  Wiley   ISBN 978-0-470-74603-5