Andy Maloney, Interim Executive Director - Solutions, MIAA writes, the publication of Internal Management Consulting in the NHS in England by the University of Bristol should prompt an important conversation across the health service. The report highlights something many NHS leaders already recognise: some of the most effective consultancy capability already exists within the NHS itself, yet too often remains underutilised. The research concludes that internal consultancy can deliver greater efficiency, stronger organisational understanding and more sustainable outcomes than traditional external consultancy models.

At a time when every pound spent must demonstrate clear value, NHS organisations are under increasing pressure to reduce costs, improve productivity, strengthen governance and deliver transformation at pace. The question is no longer whether organisations need consultancy support. The question is where that support should come from.

For years, boards have turned to external consultancy firms to provide specialist expertise, independent challenge and additional capacity. Yet the evidence increasingly points towards a different model. The research from the University of Bristol highlights the opportunity to strengthen internal consultancy capability across the NHS, retaining expertise within the system, reducing reliance on external providers and building sustainable organisational capability.

This is where NHS-led consultancies like MIAA Solutions are becoming increasingly important.

Why NHS organisations are choosing NHS-led consultancy

The challenges facing the NHS are too complex for generic solutions.

Financial recovery. Workforce transformation. Operating model redesign. Continuing Healthcare reform. Digital transformation. Governance and assurance. These are not theoretical exercises. They require people who understand the realities of delivering services within the NHS. Increasingly, clients tell us they are looking for three things:

·       Credibility. Advisors who understand the operational, financial and regulatory pressures they face because they have worked within them.

·       Capacity. Experienced consultants who can provide additional capability without creating long-term dependency.

·       Value. Support that delivers measurable outcomes whilst ensuring investment stays within the public sector wherever possible.

The NHS-to-NHS model provides all three. Unlike many traditional consultancy engagements, our focus is not simply to produce recommendations and leave. Our aim is to work alongside teams, challenge constructively, transfer knowledge and build capability that remains long after the project ends.

What we are seeing across the sector

During 2026, several themes emerged consistently across client demand.

The first is financial sustainability. Organisations continue to face significant pressure to close financial gaps, improve productivity and strengthen governance. Support is increasingly being sought around financial recovery, cost improvement programmes, business case development and value optimisation.

The second is organisational effectiveness. Boards are looking for independent assurance and objective challenge as they navigate complex decisions around service redesign, workforce planning and operational performance.

The third is major programme delivery. As systems progress ambitious transformation agendas, there is growing demand for experienced programme leadership capable of translating strategy into delivery.

Finally, there is an increasing focus on building capability rather than buying dependency. Leaders want support that leaves their organisations stronger, more resilient and better equipped to manage future challenges themselves.

These trends align closely with the findings of the Bristol research, which highlights the importance of developing and strengthening internal consultancy capability as a strategic asset for the NHS.

The impact we deliver

Across the NHS and wider public sector, MIAA Solutions supports organisations to:

• Deliver financial recovery and improve productivity
• Strengthen governance, assurance and decision-making
• Design and implement sustainable workforce solutions
• Lead complex transformation and major programmes
• Improve Continuing Healthcare performance and sustainability
• Build internal capability through knowledge transfer and coaching
• Create lasting improvement rather than short-term fixes

Importantly, our success is not measured by the number of projects we deliver. It is measured by the capability, confidence and resilience we leave behind.

A leadership challenge for the NHS

The Bristol report raises an important strategic question for NHS leaders. If we know that internal consultancy capability exists across the system, if we know it provides deep contextual understanding, and if we know it can offer better long-term value, why would we not invest more deliberately in developing and using it?

The future is unlikely to be a choice between internal and external consultancy. The strongest organisations will be those that make smarter decisions about how and when expertise is deployed.

But one thing is becoming increasingly clear: NHS organisations are looking for partners who understand the NHS from the inside, who deliver measurable outcomes and who strengthen capability rather than create dependency.

That is why demand for NHS-led consultancy continues to grow.

The question for leaders is no longer whether NHS-led consultancy has a role to play. The evidence suggests it does. The question is whether we are making full use of one of the NHS's most valuable and overlooked assets.