The Big NHS PMO Challenges

Blog David Walton 30-08-2023

What are the Big NHS PMO Challenges in 2023 and 2024?

We are all aware of the challenges facing frontline NHS workers, but there are also important challenges facing the Project Management Office (PMO) managers in the NHS.

We have been working with NHS PMOs for a number of years and in this blog we have outlined the key PMO issues that we have encountered during this time, along with some suggestions to overcome them.

Let’s get started.

Why do we even need an NHS PMO ?

In the private sector, the debate of whether we need a PMO has been resolved. If you are running a portfolio of initiatives then a PMO can deliver huge value to an organisation.

They are not a cost centre but a value centre that ensures you have the right portfolio mix and these projects are delivering the right outcomes.

In healthcare there are almost constant cost pressures and sometimes the cost reduction spotlight falls on the PMO. It is perceived as a cost centre so eliminating it will save cost.

However, in reality the reverse is true. Eliminating a PMO will almost certainly increase costs and negatively impact benefits realisation.

How does a PMO deliver benefit?

Ensuring you have the right portfolio mix of projects.

The cost of doing the wrong project can be substantial. A PMO can provide an independent view of what projects should be delivered, i.e which ones provide the best benefit, risk and strategic fit.

Without PMO support, you can get a project initiated because an stakeholder shouts loudest and this may not be the best project to take forwards.

In health and social care across England and Wales, projects cost tens or hundreds of thousands of pounds so delivering the wrong one through bad project planning has a serious cost and also associated opportunity cost

Delivery Standards

Ensuring that these complex projects are delivered to the same organisational delivery and quality standards is critical.

Having projects working to different processes clearly cost an organisation more than projects using the same development processes.

Stopping Projects

Stopping failing projects is probably the biggest benefit of an NHS PMO.

Without the PMO’s independent voice there is a real danger that a project that is failing to deliver the required service improvement, or keeps missing milestones, has valuable resources assigned to it simply because it is a pet project of a senior management stakeholder.

There are many more examples of how an NHS PMO can deliver real value. You can get more information from reading these articles:

What is the Point of a PMO? Best Practice Tips For Your PMO

Unlocking the Value of the PMO

Another important way that the case for an NHS PMO can be made is by using change management methodology to communicate the benefits of a PMO and overcome any misunderstanding and change barriers that may exist.

Setting up a PMO also needs a powerful sponsor.

NHS PMO Team at work

PMO is an Admin Function

This issue is related to the first problem of why we need a PMO and a lack of understanding of what an NHS PMO does.

If an NHS PMO sets standards, prioritises projects, creates the portfolio and stop projects, it cannot and should not be an admin function that is just chasing project leads for status reports.

“Our PMO Tool is a Spreadsheet!”

I will confess my conflict of interest here as Bestoutcome provides PM3, the award winning PMO or PPM tool to the NHS.

Would you use a spreadsheet to run payroll, manage procurement or manage your Human Resources? No. So, why use a spreadsheet to manage the PMO?

There are many reasons why a PMO should use a tool that has been specifically designed to manage a PMO.

A spreadsheet is often seen as having no cost. However, they create confusion when there is no ‘one version of the truth’.

They are not really multiuser and surveys have found that over 80% of spreadsheets contain errors. Delivering meaningful project support via a spreadsheet is not only a poor user experience for the team, but can lead to costly errors that hamper the PMO function.

It also costs a lot of time and energy to build a spreadsheet system to manage multiple projects; much more than purchasing an off-the-shelf system.

More information on this particular spreadsheet issue can be found here:

PMO Staff Churn

There is churn in most organisations and this is true in the NHS. When staff churn happens there is often not the money to train new PMO staff on tools or approaches. In this case the PMO can become unfocused and can lose its way.

PMO tools are also not understood by the incoming PMO team as there is no budget for training.

This is a major problem that we have encountered at Bestoutcome when working with across many NHS foundation trusts.

To combat this we have developed PM3Learn an online learning platform that offers a suite of project management, PMO and PM3 training courses allowing new PMO entrants to be trained at no cost as PM3Learn comes part of the PM3 platform.

PMO Highlight Reports Keep Changing

If your NHS organisation has a PMO tool. E.g PM3, then PM3 contains a large number of out the box report templates including ones for project, programme and portfolio highlight reports.

An example of one of these report templates is shown below. It contains most if not all of the information that a sponsor or stakeholder needs to understand the health of a project.

Sometimes a sponsor or stakeholder will require one, two or even endless changes to these reports.

If these requests are not challenged then time is wasted crafting bespoke highlight reports rather than using one that is out of the box.

If the change to the highlight report is not challenged there will be more changes resulting in more cost. An even better scenario would be to give the stakeholder access to PM3 where any project status or information can be viewed using PM3.


There are many other challenges that PMOs in the NHS face and these are the key ones we have encountered.

However using the right tools, e.g. PM3 and PM3Learn, together with good change management can overcome these challenges and ensure that your PMO delivers real value to your NHS organisation.

Outcome-driven success

Outcome-driven success

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