The Edge of Possible: Health & Social Innovation Consultancy
Change What's Possible.
Shift Power to Where it Can Do the Most Good.
I help organisations working in and with the NHS see the hidden forces shaping decisions, funding and partnerships, and build the power to make change happen together.
What I Do
Charities, Community Services, Primary Care
Grow.
I help you grow your power and influence, in healthcare so that decision makers see and value your work.
Unlock the power of support....
Commissioners, ICBs, Councils, Neighbourhood Health
Balance.
I help healthcare leaders balance competing interests, pressures and demands, so that services work together in harmony, rather than pull apart.
Combine people's powers....
Innovators, Digital, New Models of Care
Flow.
I help you read the flows of power and influence in the NHS, so that you can surf the waves rather than battle the storm.
Navigate the rivers of power....
Understanding Patterns Of Power and Influence.
The hidden rules that decides what happens in healthcare.
Every organisation has its formal rules: the strategy, the governance, the budget. Underneath sit the patterns that really decide things: who gets heard, what counts as evidence, which decisions get made and which never reach the agenda. They’re rarely written down, but everyone working in healthcare feels them.
You’ll probably recongnise some of these….
Deciding the problem at the start
Who decides what the problem is shapes what can and will be done.
The power of no
Saying no reinforces the power of the existing system and those that say it.
The pilot in place of change
The pilot that allows the system to carry on unchanged.
Polite failure
Everyone agrees in the meeting. Nothing happens after it.
Off loading risks
Using partnerships and collaboration to export the difficult problems onto someone else.
Why ChaNGe In Healthcare Feels Like An Uphill Battle
Almost everything in healthcare flows towards existing sources of power
Change means working against gravity.
Money, accountability, data and decisions all run downhill to established services, through tools like the business case, the assurance return and the KPI that were built for them. Our institutions were designed to manage risk and account carefully for public money, and they do that well. But it means every new way of working risks being rooted in their power.
And it’s not only a slope. Big institutions have their own gravity, like a planet. New ideas get pulled into orbit. They’re renamed, absorbed into existing processes and slowly reshaped until they look like what was there before. Whatever the intention, the old patterns pull things back, and the people who brought the idea end up feeling ignored.
Good work rarely stalls for lack of effort or ability. More often, it’s the gravity.
How Patterns of Power And Influence Shape Our Health
The forces determing our health extend far beyond healthcare.
Most people meet the NHS in crisis. Their health was shaped long before.
Health is made on the high street, at home and online, long before anyone sees a GP.
In our most deprived neighbourhoods, a fast food outlet, a bookmaker or vape shop is twice as common as in the most affluent areas.
Whilst our attention, our environment, our working lives and our communities and mental health are all influenced by social media and other powerful interests.
These are not simply individual lifestyle choices. They reflect commercial decisions, investment patterns and wider economic incentives that shape our environments and the choices available to us.
The profits go elsewhere, and the cost rolls downhill into people’s health and onto services that are already stretched.
We cannot build a healthier society simply by treating the damage more efficiently. We must also change the conditions that produce it. That means are public services and wider health system has to work together, if we want a healthy thriving society.
And that requires a different relationship between institutions, communities and the people they serve. That is why power has to shift in healthcare away from our traditional institutional patterns, to ones that engage and nurture good health in our communities.
When we only catch people at the lowest point of their health. It is so much harder to raise them back again.
Those of us working in healthcare need to stop fighting over responsibility. Instead we need to work together to shift these patterns of power and influence, so fewer people fall into crisis.
The NHS 3 Big Shifts Will Only Work IF We Can ChanGE The Patterns of Power.
Everyone knows the three shifts. What holds each one back is where the existing systems fails to respond to our new reality.
Hospital → Community
The money, the beds and the NHS’s attention focus on hospitals. Community work has to compete from the edge.
Analogue → Digital
Tools that could give people more independence risks either risks becoming a chaotic tangle of competing systems or an extension of centralised control.
Sickness → Prevention
Nobody owns the illness that didn’t happen. They only see the cost of preventing it.
To be successful all three shifts need to change something much deeper than some new buildings and a collection of targeted initiatives ever can.
We are changing people’s relationship to their health.
Someone living with diabetes spends a few hours a year with a clinician and manages every other hour themselves. Carers hold families together. Communities look after their own.
Technology is already moving information and power out of our institutions. People look things up, track their own health and find each other online. That shift will happen with or without the NHS.
What the NHS can do is shape it, whilst endorsing, supporting and spreading the best interventions. It can make sure people, patients and carers are informed and supported to make the best decisions for themselves. Whilst people communities facing the greatest inequalities have the support they need to create health for themselves.
Our institutions are still vital, especially when people are in crisis. Their bigger job now is to support the people and communities and work with each other, instead of barricading the front door and expecting people to fit around them, their targets and limitations.
The intention has shifted. The patterns of power in healthcare have not.
We need foster new patterns of power that empower people and communities to manage their own health.
“The righter we do the wrong thing, the wronger we become.”
(Russell Ackoff)
What Works?
Power isn’t just something others hold over us. It’s something we can build together.
Nobody changes a slope on their own. But when we work together create a deliberate focus on each others unique value, and partners pull together their different strengths, whether that’s clinical credibility, community trust, a council’s mandate or funding, they can do things none of them could do alone.
That’s how good work starts to spread. Building momentum, constant learning and improvement and nurturing strong trusting relationships, can amplify everything we do.
How you build it depends on the situation and your unique qualities. Some people need to grow their power, some need to balance it, and some need to find the flow.
Getting that balance of power influence and keeping partners in relations one another right is most of the work.
Grow Your Power and Influence
Charities, Community Services, Primary Care
Your work makes a real difference, but it isn’t being seen or valued where decisions are made. You’re trusted by communities the NHS finds hard to reach, then commissioned on short-term contracts with the risk passed down. Or you’re a GP practice that feels decisions about your patients are made in rooms you’re never invited into.
What growing your power looks like
- You can name where your power comes from, such as community trust, local knowledge and relationships, and you know how much each one counts with the people who decide
- You can see where decisions about your work are really made, including the ones that never reach an agenda
- You make your case in the terms decision-makers use, without trading away what makes your work different
- You take the next step that’s within reach, with partners alongside you, instead of waiting to be invited
Balance Competing demands and interests
Commissioners, ICBs, Councils, Neighbourhood Health
You’ve built something new, and everyone agrees it’s needed. Then the conversation goes quiet. The NHS has its own rhythm, its own gravity and its own way of deciding.
What balancing power looks like
- Decisions sit at the level where they work best, and everyone knows who decides what
- Partners find out where they really differ, whether that’s purpose, approach or what they can actually do, and stop arguing about the wrong thing
- You build a shared way of working, so you can steer by exception instead of controlling every detail
- Risk and cost stop rolling downhill to the smallest partner, and change goes both ways
Work With the flow, not against it
Innovators, Digital, New Models of Care
You’re accountable for outcomes no single organisation can deliver alone. Whilst staff and resources are tight and organisations are struggling to keep their head above water. Partners agree shared goals, then pick the bits that suit them, and one person’s no can hold everything up.
What working with the flow looks like
- You can tell whether you’re in a queue, facing a real disagreement or being pulled back to the old way of working, and you know what to do about each
- You work to the NHS’s rhythm: its budget cycles, its boards and its appetite for risk
- Your idea spreads through trusted relationships and partners inside the system, who help it escape the pull
- You have a business case the NHS can say yes to, shaped by someone who has written, approved and assessed them
How I Can Help
Charities, Community Services, Primary Care
GROW your power and influence
Your work makes a real difference, but it isn’t being seen or valued where decisions are made. You’re trusted by communities the NHS finds hard to reach, then commissioned on short-term contracts with the risk passed down.
What changes
- You know where decisions about your work are really made, and by whom
- You make your case in terms commissioners recognise
- You’re in the room earlier, with partners alongside you
Commissioners, ICBs, Councils, Neighbourhood Health
BALANCE competing interests and demands
You’re accountable for outcomes no single organisation can deliver alone. Partners agree shared goals, then pick the bits that suit them, and one person’s no can hold everything up.
What changes
- Partners agree who decides what, and when
- Competing demands are out in the open and traded off honestly
- The work moves, and the smallest partner isn’t the only one expected to change
Innovators, Digital, New Models of Care
Work with the FLOW, not against it.
You’ve built something new, and everyone agrees it’s needed. Then the conversation goes quiet. The NHS has its own rhythm, its own gravity and its own way of deciding.
What changes
- You know who holds the budget, who carries the risk and how decisions are really made
- Your proposition fits the NHS’s timing and language
- You have partners inside the system pulling with you
Get Started With A Consultation
Your Free Consulation
Agree How We Can Best Work Together.
Start building the conditions where your people can thrive.
Speaking, Workshops and Facilitation
- Thought provoking keynotes on patterns of power and influence in healthcare and neighbourhood health.
- Workshops that help teams explore complex challenges from new perspectives.
- Facilitated conversations that build shared understanding and unlock new possibilities.
- Leadership sessions focused on learning, collaboration and adaptive change.
Available for conferences, leadership events, away days, panel discussions and podcast appearances.
Recongise any of these? Let’s talk about yours.
About Me
Cross-sector Partnerships & Pathways Developed
Across NHS trusts, GPs, local authorities, charities, community groups pharmac and technology companies.
Managed 12 Different NHS Clinical Networks
Across multiple clinical specialties and care pathways including major trauma, cancer, respiratory, Hep C, Diabeties.
Led NHS Programmes in..
Health inequalities, quality improvement, personalised care, patient and public engagement, care homes, prevention, rehabilitation and early diagnosis.
For much of my career I believed the answer to better performance was better processes.
I started out in the head offices of major retailers and manufacturers, helping organisations improve performance, efficiency and operations. Later I joined the NHS, expecting many of the same principles to apply.
What I discovered surprised me.
The organisations that achieved the most were rarely the ones with the best plans, the most targets or the most detailed processes. They were the ones where people trusted each other. The ones where information flowed with and through people working together. The ones where people believed in what they were trying to achieve.
Working across clinical networks, mental health services, cancer programmes, care homes and system wide improvement initiatives, I saw the same pattern again and again. Change became possible when people learned together, collaborated effectively and felt able to contribute their best thinking.
That observation eventually led me to apply my background in psychology with systems thinking, complexity science and the development of emotionally intelligent health systems.
Today I help NHS leaders, neighbourhood health teams, VCSE organisations and healthcare innovators understand why change becomes stuck, strengthen collaboration and create the conditions where improvement can thrive.
Because after twenty years of trying to improve systems I have come to believe something quite simple:
The biggest opportunities for change are often hidden in the things our systems struggle to see.
I have spent more than 10 years working across NHS clinical networks, improvement programmes, Cancer Alliances, mental health services and care homes , alongside after a decade in FTSE 100 retail and manufacturing. I bring systems thinking, complexity science and a practical approach grounded in real delivery rather than theory alone.
If that resonates, let’s talk. and build something that genuinely lasts.
Who I Help?
I work with NHS leaders, neighbourhood health teams, VCSE organisations and healthcare innovators.
Does any of this sounds familiar?
Trying to build neighbourhood health without the conditions for it to work
The framework is published. The expectations are set. But the relationships, trust and cross organisational working that neighbourhood health actually requires cannot be mandated into existence.
Holding impossible tensions
National targets. Financial constraints. Relational, long term work that would actually make a difference. You are absorbing pressure from above while trying to protect what matters below.
Trying to engage communities that have learned not to trust
The people who most need neighbourhood health to work have seen too many initiatives come and go. Building genuine trust takes time the system rarely protects.
Leading across boundaries nobody designed for collaboration
NHS, local authority, VCSE, primary care, community services. Different financial regimes, different accountabilities, different cultures, different pressures. You are trying to create coherence across a landscape that was never designed to work together.
Fighting to get a good idea to spread
You have built something that works. The evidence is there. The people who have experienced it believe in it. But trying to get funding and support is an uphill battle.
You are trying to improve the system whilst working inside it.
Demand rises. Staff leave. Projects stall. The same problems keep returning in slightly different forms. The harder you push for change, the harder the system pulls back.
It does not have to stay that way.
Let’s see how we can work together.
This Probably Is Not For You If….
You want people to do what they are told.
You are looking for a quick fix, or a copy and paste solution.
Your main goal is hitting this year's targets and moving on.
You are not willing to have honest conversations about what is not working.
You want to make all the decisions yourself.
Working On Neighbourhood Health?
Join Us At the Neighbourhood Health Academy
Neighbourhood health is the right direction. Most people working in it already know that.
What is harder is the reality of getting there.
The organisational boundaries that resist crossing. The relationships that take months to build and disappear when funding ends. The gap between what the plan says and what the work actually requires. The sense of trying to build something genuinely different inside a system that keeps pulling back toward the familiar.
If that sounds recognisable, this community was built for you.
The Neighbourhood Health Academy is a space for the people in the middle of this work. Not the showcases and the success stories. The honest conversations about what is actually happening, what is working, what is not, and what might help.
What members get:
- Honest peer conversations with people facing the same challenges.
- Shared learning from across the country, what is working and why, what is stalling and why.
- Tools and frameworks grounded in emotionally intelligent systems thinking.
- Support navigating the organisational and system challenges that slow progress.
- A community that understands the reality of neighbourhood health, not just the aspiration.
Who it is for?
Anyone starting or involved with neighbourhood health work:
NHS leaders, VCSE organisations, local authority colleagues, GPs and practice teams, community health workers, commissioners and innovators who are figuring it out as they go.
You do not need to have the answers. You just need to be working on the questions.
Recent Thinking
How Can We Unleash the Power of Measuring Neighbourhood Health?
Measurement may be the key to the success or failure of neighbourhood health. In healthcare, measurement is often an afterthought. It comes at the end of policy documents, contracts and project plans. Capturing data is something we typically do after the 'real work'...
Why Does NHS Reform Keep Disappearing Into A Bermuda Triangle?
Are neighbourhood health, digital and prevention starting to disappear into the familiar Bermuda Triangle of NHS reform, along with the promises to improve performance? Key Takeaways NHS reforms rarely get cancelled. They slowly disappear, squeezed between three...
Neighbourhood Health Has Changed The NHS Landscape. So Don’t Write Business Cases That Assume The World Is Flat
We are running our next Neighbourhood Health Academy Live meeting on: How Can Your Business Case Fit the New NHS Landscape of Neighbourhood Health? And here's why: Table of ContentsFrom "is this service affordable?" to "what does this population need?"You are now...