This document is a case study that examines the role of Programme and Project Management Offices (PMOs) within the NHS as they support change initiatives. It outlines the increasing importance of PMOs in managing healthcare delivery, particularly in the context of improving patient care while reducing costs. The case study presents three NHS organizations that have successfully established PMOs to facilitate their change programs. It details the challenges faced by the NHS, such as the need for accountability and the delivery of effective services. The document describes specific PMO models implemented in North West London, Hillingdon, and Rotherham, highlighting their governance structures, reporting processes, and the tools used to enhance efficiency and effectiveness. The PMOs are positioned as vital components in ensuring that healthcare services meet evolving demands and improve overall outcomes for patients.