Internal consultants as entrepreneurial subjects: enabling hybrid public value through entrepreneurship within the English NHS

Public sector entrepreneurship (PSE) is often perceived as an effective means of mitigating endemic instability initiated by a 2008 economic crisis and exacerbated by the 2020 Covid-19 pandemic. The key to mitigation is PSE’s capacity to exploit opportunities while still being bound by a moral imperative to deliver public value, centred around patient care in the English National Health Service (NHS). However, lingering impacts of austerity have led to an incongruent discursive blending, in which the pursuit of effective patient care needs to be balanced against financial viability and enhanced income streams. This hybrid notion of public value, in which care provision is counterbalanced by economic considerations, had a profound influence on the conduct of internal consultants working on a data project within the NHS. Exposure to the hybrid public value model prompted the internal consultants to shape themselves into entrepreneurial subjects: that is, products of power/knowledge who were motivated by the altruistic desire to improve outcomes for patients and the capacity for navigating the economic realities of their context. Utilising Foucauldian theory, this chapter explores how these “entrepreneurs of the self” (Foucault, 2010, p. 226) were able to utilise change management interventions such as consensus management and facilitating change governance to establish an entrepreneurial rhythm within their organisation, driving progress towards achieving the overall opportunity. These findings have an impact on both theory and practice, as they outline how the marketisation of the NHS has mutated the concept of public value, which in turn influences how NHS employees pursue entrepreneurial opportunities.