Case study 3

The chapter discusses management consultants and consulting knowledge in health care, highlighting significant expenditure on consultancy and how consultants have shaped thinking in public services, which some critics suggest has served consultants’ own (financial) interests. The chapter then discusses the way consultants mobilize management knowledge and frame clients’ problems and solutions. It discusses an empirical case study of a consultancy project to redesign NHS organizations to make substantial ‘efficiency savings’. Here, consultants framed the NHS’s problem and solution, and then imposed an organizational redesign. Local NHS managers and clinicians framed the NHS’s problem differently, doubting the consultants’ framing and proposing redesign, but feeling unable to engage in dialogue about these concerns. Consequently, they engaged with the project in a calculated and defensive way, superficially accepting the redesign while waiting for its implementation to fail. Thus, the...