NHS managers are grappling with the challenges of having to maintain capacity and quality of services in the face of buoyant demand, but under the incessant and unremitting downward pressure on budgets.  Private care managers are also seeing the future in terms of tougher demands from commissioners of services not to mention patients demanding greater value for money.  Our work with health care providers in the public and private sectors has equipped us with the experience and confidence to undertake change projects in some of the toughest and most demanding environments.  The organizations we have worked with are listed below.  The case studies listed on the left provide some examples of our work.