What do external consultants from private and not-for-profit companies offer healthcare commissioners? A qualitative study of knowledge exchange

Abstract

ObjectivesThe use of external consultants from private and not-for-profit providers in the National Health Service (NHS) is intended to improve the quality of commissioning. The aim of this study was to learn about the support offered to healthcare commissioners, how external consultants and their clients work together and the perceived impact on the quality of commissioning.SettingNHS commissioning organisations and private and not-for-profit providers.DesignMixed methods case study of eight cases.Data collection92 interviews with external consultants (n=36), their clients (n=47) and others (n=9). Observation of 25 training events and meetings. Documentation, for example, meeting minutes and reports.AnalysisConstant comparison. Data were coded, summarised and analysed by the research team with a coding framework to facilitate cross-case comparison.ResultsIn the four contracts presented here, external providers offered technical solutions (eg, software tools), outsourcing and expertise including project management, data interpretation and brokering relationships with experts. In assessing perceived impact on quality of commissioning, two contracts had limited value, one had short-term benefits and one provided short and longer term benefits. Contracts with commissioners actively learning, embedding and applying new skills were more valued. Other elements of success were: (1) addressing clearly agreed problems of relevance to managerial and operational staff (2) solutions co-produced at all organisational levels (3) external consultants working directly with clients to interpret data outputs to inform locally contextualised commissioning strategies. Without explicit knowledge exchange strategies, outsourcing commissioning to external providers resulted in the NHS clients becoming dependent.ConclusionsNHS commissioning will be disadvantaged if commissioners both fail to learn in the short term from the knowledge of external providers and in the longer term lose local skills. Knowledge exchange mechanisms are a vital component of commissioning and should be embedded in external provider contracts.

The impact of management consultants on public service efficiency

“…This deep involvement of management consultants has been especially marked in healthcare. In the English NHS, McKinsey and Co. again have been significant 'partners' in the development of reforms, leading to the creation of the internal market (O'Mahoney and Sturdy, 2016;Saint-Martin, 2012) and the establishment of Clinical Commissioning Groups (Wye, Brangan, Cameron, Gabbay, Klein, Anthwal and Pope, 2015). Other firms have provided advice on Foundation Trust (FT) applications and support for outsourcing, including the negotiation of Private Finance Initiative (PFI) contracts (Craig and Brooks, 2006;Lonsdale and Watson, 2007).…”

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Commissioning care for people with dementia at the end of life: a mixed-methods study

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External scrutiny, faculty research culture and the changing university

“…External consultancy expert reviews and evaluations are now commonplace across health and higher education sectors and for good reason (Milam , Naylor & Goodwin , Wye et al . ). As a recent US report into university research noted:…”