Improving NHS efficiency through internal management consultancy
Translating research into practice following findings of inefficient use of external management consultants.
Strengthening NHS improvement capability from within
The NHS is under pressure to deliver better services, improve productivity and use public money wisely.
Many organisations buy support from external management consultants. Yet University of Bristol research highlights some of the NHS' most valuable improvement expertise is already available within the health service itself.
NHS expertise hidden in plain sight
Professor Andrew Sturdy and his colleagues have spent several years studying how the NHS uses management skills and expertise.
Their research shows that the NHS already has a wider variety of internal consultancy teams. Many people are unaware these teams exist, but they operate across a variety of priority areas including strategy, improvement, complex system level transformation, analytics, leadership development and clinical service and pathway review.
In 2026, the team produced the first national study of internal consultancy services across NHS England. The study identified an ecosystem of NHS teams operating at trust, regional and national levels.
The findings suggest the NHS could make better use of this expertise. Making these teams easier to find and better connected could help the NHS:
- Improve services and efficiency
- Reduce spending on external consultants (and make better use of them)
- Keep valuable skills and knowledge within the NHS
- Identify expertise that already exists
Why internal consulting matters
Every pound spent on management support is a pound not spent elsewhere.
External consultants can provide value in specific circumstances. However, the research found that external consultancy is mostly inefficient and should only be used in limited contexts, while internal consultancy is key. These findings provide evidence for the first time to support UK government guidelines on consultancy use and are consistent with the recent rise in the development of internal consultancy in the public sector internationally.
[1] Average spend per year from a sample of 120 NHS trusts studied between 2008 and 2013 - ‘The impact of management consultants on public service efficiency’| 2019 study.
Internal management consultants are not line managers, but specialist improvement professionals. They work within NHS organisations and NHS-related bodies, even if they do not always use the label 'consultants'. The latest findings reveal that internal management consultancies can provide:
- Expertise across strategy, transformation, improvement and organisational change
- Deep knowledge of NHS systems, culture and operational realities
- Trusted support for clinicians, managers and system leaders
- Better value for money than many external providers
- Capability building that develops skills within the NHS
- Support for national priorities, including productivity, digital transformation and service integration
- Opportunities for collaboration, shared learning and spreading best practice across organisations, including through working with externals
Unlike many external providers, internal consultants combine consultancy expertise with a deep understanding of NHS organisations, culture, systems and priorities. This can be particularly valuable when organisations are tackling complex change programmes that require trust, credibility and local knowledge.
The challenge: limited visibility and co-ordination
The issue is not always a lack of expertise. The issue is that expertise is often difficult to find.
The research found no clear national picture of internal consultancy provision across the NHS. Many teams operate independently with limited opportunities to:
- Share learning and best practice
- Collaborate on projects
- Develop common standards
- Build professional networks
- Demonstrate their collective value
As a result, managers and NHS organisations may purchase support externally when similar expertise already exists elsewhere in the NHS. This can increase costs while missing opportunities to strengthen capability within the health service itself.
Research suggests that greater coordination between internal consultancy teams could help address this challenge. Better visibility would make it easier for NHS leaders to identify relevant expertise. Stronger networks could increase capacity by enabling teams to collaborate across organisational boundaries, respond to larger change programmes and share successful approaches more consistently across the health service.
What this means for policy-makers
This research has helped shape national discussion about consultancy use in the NHS through PolicyBristol, the Health Service Journal and engagement with NHS leaders and policymakers.
The findings show that significant improvement capability already exists within the NHS. With greater visibility, coordination and support, internal management consultants could play a larger role in delivering transformation, building organisational capability and reducing reliance on external providers, but also working more effectively with them.
The research also supports the development of a new network of NHS internal consultancies. By improving visibility, sharing expertise and creating opportunities for collaboration, a networked approach could help strengthen management capability, support workforce development and spread best practice more consistently across the NHS. Research suggests this would allow organisations to make better use of existing capability before seeking external support.
This creates opportunities to:
- Reduce unnecessary spending on external consultancy
- Strengthen NHS management and leadership capability
- Retain knowledge and expertise within the health service
- Support workforce development and specialist career pathways
- Share expertise and best practice across organisations
- Improve productivity, efficiency and value for money
What this means for NHS leaders
For NHS executives, board members and system leaders, the research highlights a significant opportunity: specialist management expertise already operates within the NHS. With greater visibility and investment, they could form a genuine alternative to external advisers in tackling NHS reform as well as working with them. Support for an emerging network of internal management consultants will serve to co-ordinate this existing expertise whilst facilitating knowledge sharing across regional boundaries as a national resource.
Before commissioning external consultancy, organisations may benefit from asking:
- What expertise already exists within our organisation or elsewhere in the NHS?
- Can we build internal capability alongside delivering this work?
- Are there opportunities to collaborate with other NHS organisations or internal consultancy teams?
- How can we ensure knowledge and skills remain within the NHS after a project ends?
- Could a blended approach, using primarily internal expertise with target external support, deliver better value?
Building collaboration across NHS consultancy teams
The University of Bristol is continuing to work with NHS partners, policy-makers and improvement leaders to understand how specialist management expertise can be used more effectively.
By supporting collaboration, knowledge exchange and evidence-informed policy, this work aims to help the NHS build stronger internal capability and make better use of public resources for the benefit of patients and communities. In response to the research, internal consultancy providers are beginning to work together through an emerging network led by NHS Elect and the Advancing Quality Alliance (AQuA). The network aims to strengthen connections, improve visibility of expertise, share best practice and maximise the contribution internal consultancy can make to healthcare improvement across the NHS.
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