Rethinking Consultancy in the NHS: The Case for Internal Expertise

“Consultancy is draining the NHS of money.”

It’s a line we've heard often. Media headlines and watchdog reports often point the finger at consultancy firms redirecting resources from front line services in an NHS system already under enormous financial pressure. It’s a valid concern, external consultancy spending can run into millions; in some cases, the return on investment is unclear. But this narrative, whilst not unfounded, overlooks a powerful alternative that often goes under the radar: internal NHS consultancy.

At a time when NHS organisations are being asked to do more with less; reduce deficits, cut waiting lists, improve productivity, embed digital transformation, and meet ever-shifting central expectations - in-house capacity and capability are increasingly stretched. This creates a vacuum.

Last week I attended an event organised by the Universities of Bristol and York on the value of internal NHS consultancy, which stated that 2% of NHS budget spent is on management vs 10% in most other sectors.

In addition, many commentators have highlighted that the lack of investment over the past 10-20 years in training and developing a strong cohort of senior managers and potential future executives, has compounded the challenges that most NHS organisations currently face.

The Case for Internal Consultancy

Studies such as Kirkpatrick et al. (2019) suggest that higher spend on external consultants correlates with poorer performance outcomes across NHS trusts. However, when internal consultancy capacity is developed and utilised effectively, organisations see a measurable improvement in performance; financial and otherwise.

Published data from the University of Bristol supports what many in the system already suspect. Exclusive use of commercial or non-NHS consultancy support could be sub-optimal, particularly when consultancy becomes a default solution rather than a targeted, strategic tool. Most internal NHS Consultancy services are led by people with significant experience of working in NHS organisations and have essential skills and knowledge that can blend with the ideas, skills and knowledge that private teams can bring.

The most effective approach

A blended model is likely to work best and to optimise outcomes for the commissioning organisation. The internal consultancy takes the lead and external expertise and partners are brought in selectively to create capacity and capability that can make it the ‘go to’ model. Therefore, resulting in lower cost, better organisational learning, and stronger, more sustainable outcomes.

Most people in the NHS would agree that we can’t be sustainable without change, but how we do this is crucial. A blended approach accepts we don’t have all the ideas and answers, but the internal experience, knowledge, relationships, and skills will help in managing and delivering the changes that will be inevitable and to ensure they are effective and sustainable.

What Do We Mean by Internal Consultancy?

Internal consultancy isn’t just project management or QI teams in a new wrapper. It includes highly skilled professionals working across change management, business intelligence, digital transformation, financial management, workforce planning, clinical redesign, and more, with a clear focus on solving problems, implementing change, and delivering results.

Think of it as a trusted internal partner; familiar with the culture, close to the context, and motivated by public good and laser focus on delivering Return on Investment.

MIAA’s Internal Consultancy Offer

At MIAA, we’ve built a model of internal consultancy that works. Our MIAA Solutions team is a trusted NHS-hosted, not-for-profit partner with deep public sector roots (MIAA has existed for 35 years), with a track record of delivering meaningful transformation, with numbers to prove it.

We bring:

• Experienced, multi-disciplinary teams with specialisms across clinical, operational, financial, and digital transformation.
• Solutions grounded in the insight of internal audit; practical, evidence-based, and uniquely informed.
• A strong culture of partnership, transparency, and public value.
• Cost-effective support, aligned to NHS values.

Our work is designed to complement NHS teams, not to replace or override them. We work with you where capacity is limited, capability is still developing, or an independent view is needed to catalyse action. We don’t parachute in, deliver a report, and walk away; we work alongside, build trust, and deliver real outcomes.

From Cost Centre to Value Generator

Too often, consultancy in the NHS is seen as a sunk cost. But when used wisely and strategically, particularly when built from within, it becomes a driver of value, capability, and resilience.

Internal consultancy gives organisations:

• Greater control over cost and delivery.
• Better organisational learning and continuity.
• Stronger alignment with NHS culture and priorities.
• The ability to scale support in response to demand, without losing focus or agility.

Looking Ahead: A Smarter Approach to Consultancy

As the NHS continues to face unprecedented financial and operational challenges, the need for innovation, transformation and value has never been greater. Internal consultancy isn’t a silver bullet—but it’s an underused asset that, when properly supported, can deliver huge returns and with more cuts to come, surely, we should nurture and strengthen our internal consultancy and advisory services?

At MIAA, we’re proud to be part of that approach.

If you’d like to find out how our internal consultancy offer could support your organisation, get in touch with the MIAA Solutions team. We’re here to help, and we’re here for the long haul.

References

Kirkpatrick, I., Sturdy, A. J., Alvarado, N. R., Blanco-Oliver, A., & Veronesi, G. (2019). The impact of management consultants on public service efficiency. Policy & Politics, 47(1), 77-95.