Why I’m no longer embarrassed to call us a consultancy

Kaleidoscope came into the world nine years ago. At first I was a bit embarrassed.

We were a healthcare consultancy, but I couldn’t quite say the c-word without a slight wince. We were (and still firmly are) a social enterprise with a mission to build a future that’s more kind, connected and joyful. We self-funded mission projects about health in 2100 and kindness in healthcare. The consultancy bit? That was just how we paid the bills.

I was wrong.

The awkward truth is that consultancies get constant stick, and yet sometimes bringing in external help is exactly what’s needed. Not always, but sometimes. And pretending otherwise doesn’t help anyone.

The question isn’t whether consultancies should exist. It’s whether they make change that actually works – with people, for people.

Why should the NHS use external consultants?

We spent last year with East Kent Hospitals developing their strategy through to 2035. We could have swept in, written something polished, and left. Instead, we worked with their people to create something they actually owned, driving cultural change alongside the plan.

When we worked with more than 3,700 NHS staff as part of Change NHS for the 10 Year Health Plan, that wasn’t about producing another strategy document. It was about creating something people believed in because they’d helped shape it.

When we helped South East London develop their system leadership academy, we were building the capability for leaders to drive change long after we’d left.

The NHS is full of utterly brilliant people. What it often doesn’t have is the capacity for those people to step back, design something new, and see it through while keeping everything else running. Consultancies work when they add capability that genuinely isn’t there – not because NHS staff aren’t clever enough, but because they’re already doing three jobs.

Over our nine years we’ve never sought to make ourselves indispensable. We’re there to make ourselves unnecessary.

Why shouldn’t the NHS use external consultants?

Consultancies become a problem when they’re a substitute for difficult decisions. When they’re hunting for validation rather than challenge. When the real issue is political courage, not technical expertise.

They’re also pointless when they deliver reports that sit on shelves. We’ve all seen them: 150 slides of impeccable analysis that nobody implements because the people who’ll have to do the work weren’t involved in creating it.

When budgets are this tight, spending money on external support had better deliver more of value than was actually spent

And yes, sometimes consultancies can appear an expensive luxury.

When budgets are this tight, spending money on external support had better deliver more of value than was actually spent – through efficiency, through preventing expensive mistakes, or through building capability that lasts.

Paradox of NHS consultancies

The paradox of consultancies in the NHS is real. Money’s never been harder to come by. Staff are burnt out. And here we are suggesting that sometimes it’s worth spending money on people from outside.

But why I’m no longer embarrassed is that I’ve seen time and again how we can help people achieve greater impact by improving how they work together; helping people turn ambition into impact – defining where they’re heading, shaping how they’ll get there, and understanding the difference they’re making.

That’s not a luxury when the system’s under pressure. It’s more important than ever.

What makes the difference

Recent research from Bristol University found that while blanket use of external consultancy tends not to work, small and targeted external support can improve performance, particularly for organisations under pressure.

So what does ‘good’ consultancy in the NHS look like? Three characteristics: first, it leaves capability in place – people should be able to do more themselves afterwards, not less. Second, it’s done with people, not to them. And third, it’s honest about what it can and can’t achieve.

The NHS needs to innovate, save costs and improve outcomes. Sometimes that requires bringing in external expertise, fresh perspectives, or simply the capacity to do work that internal teams can’t. The alternative – pretending the NHS can do everything internally when staff are already drowning – isn’t principled, but rather a way of setting people up to fail.

Building something better

The future we’re working towards isn’t just about fixing problems. It’s about building something better – a health and care system that’s genuinely kind to the people who work in it and use it, that’s properly connected across all its moving parts, and that creates moments of joy rather than just grinding through.

So yes, we’re a consultancy. One that believes change works when it’s done with people, for people. One that’s measured by whether we’ve actually helped, not whether we’ve produced something that looks impressive.

We’re a social enterprise, and an employee-owned consultancy. Everything we earn goes back into our mission work or into making us better at what we do. We combine relational insights with rational rigour to create lasting change.

I’m no longer embarrassed by the consultancy bit. I’m proud of it. And if any of this sounds useful to you and your organisation, let’s talk.