How leaders work across systems to deliver better outcomes for people and communities
Great care is delivered by great organisations. Lasting impact is created when those organisations work together.
The pressures facing health and care systems continue to grow. Demand is rising, resources remain constrained, patient needs are becoming increasingly complex and communities often find themselves navigating services that can feel fragmented and difficult to access.
At the same time, expectations are changing. There is growing recognition that lasting improvements in health and wellbeing will not come from individual organisations working in isolation, but from better collaboration across systems, stronger partnerships and a greater focus on prevention, early intervention and community-based support. The challenge is no longer simply how services respond to need, but how they work together to improve outcomes before needs escalate.
In this edition of Changing Systems, Liz Dean, Principal Consultant in our Not for Profit practice, speaks to Philip Clayson, C- Suite Leader, Technology Trustee at the Royal Hospital for Neurodisability, and an experienced non-executive working across healthcare and community pharmacy. Drawing on a career spanning commercial organisations, healthcare providers, charities and innovative start-ups, Philip reflects on what it takes to create meaningful change across complex systems. From specialist neurological care to community pharmacy, he shares insights on leadership, innovation, prevention and the importance of designing services around the people and communities they serve.
Together, we explore why fragmentation remains one of the greatest barriers to progress, how organisations can become catalysts for wider system change, why prevention must become as important as treatment, and what leaders can do to create more connected, responsive and sustainable services for the future.
Liz: What do you believe is the biggest challenge facing health and care today?
“The challenge isn’t a shortage of expertise. It’s connecting all the moving parts around the patient.”
Philip: When people talk about the challenges facing health and care, they often focus on funding, workforce pressures and demand. Those issues are clearly significant, but one of the biggest barriers to better outcomes is fragmentation. Across the system there are highly skilled professionals delivering outstanding work every day. The challenge is ensuring all those different components work together effectively around the individual. Patients move between commissioners, healthcare providers, community services, families and support networks, yet information and decision-making often remain fragmented. Within specialist healthcare where many patients have highly complex neurological needs, success depends on joining those different elements together. The better connected the system becomes, the better the outcome for the patient.
Liz: How do organisations turn that complexity into better outcomes?
“The best systems don’t start with process. They start with people.”
Philip: The starting point has to be the individual. One of the things that makes impactful organisations unique is that every patient journey is different. There is no standard pathway that works for everyone. Effective care requires organisations to build their services around the individual rather than expecting individuals to fit predefined systems. That is where expertise becomes so important. Many of our clinicians and care teams have decades of experience. Alongside professional qualifications sits a huge amount of practical knowledge that helps teams understand needs, anticipate challenges and make better decisions. Technology can support that process, but it cannot replace it. The most effective systems combine human expertise with tools that help professionals make better-informed decisions.
Liz: Why is prevention becoming as important as treatment?
“For decades we’ve built systems that are brilliant at responding. The next challenge is building systems that are equally good at preventing.”
Philip: Historically, most healthcare systems have been designed around responding once a problem becomes visible. Increasingly, technology gives us opportunities to identify risks earlier and intervene sooner. That shift from reaction towards prevention has the potential to transform outcomes. If we can spot deterioration before it becomes a crisis, if we can identify patterns before somebody becomes seriously unwell, and if we can provide support earlier in a person’s journey, then we improve outcomes while simultaneously reducing pressure elsewhere in the system. For me, prevention is one of the most exciting opportunities in healthcare today because it allows us to improve people’s experience while also improving overall system effectiveness.
Liz: Where do you see the greatest opportunity for innovation?
“We’ve reached a point where technology can identify problems before people can see them.”
Philip: We’ve already begun to see examples where technology can identify changes in a patient’s condition long before those changes would traditionally have been recognised. For example technologies are being used that can detect signs of deterioration significantly earlier than would otherwise be possible. That additional time can be critical. It creates opportunities to intervene sooner and potentially avoid more serious complications. We’re also seeing wearable technologies and monitoring tools that can provide a much richer understanding of a patient’s condition over time. The exciting part isn’t the technology itself. It’s what becomes possible as a result. The value comes from earlier intervention, improved care and better outcomes for patients and families.
Liz: What role can charities play in accelerating innovation?
“Being outside the NHS doesn’t mean standing apart from the system. Sometimes it means helping the system move faster.”
Philip: Charities often occupy a unique position within the healthcare ecosystem. We must works closely with NHS commissioners and operate within many of the same quality and governance expectations but ensure we are creating flexibility. That flexibility allows us to work with innovators, start-ups, researchers and technology providers who are looking to test ideas and demonstrate impact. We can help bridge the gap between concept and implementation. Increasingly, organisations are seeing these environments where innovation can be evaluated safely and meaningfully. That benefits us, but it also benefits the wider healthcare system because successful innovations can go on to create impact well beyond our own organisation.
Liz: How do you balance what’s best for your organisation with what’s best for the wider system?
“Sometimes the hardest decision isn’t what to do. It’s deciding what not to do.”
Philip: There are always more good ideas than there are resources to deliver them. Every organisation has to make choices about where it focuses its time, energy and investment. The challenge is ensuring those decisions are made with both organisational outcomes and wider system outcomes in mind. One thing I’ve observed in trustee and board roles is the importance of constructive challenge. The best decisions rarely emerge from complete agreement at the outset. They emerge through discussion, questioning and bringing together different perspectives. When organisations create space for diverse expertise around the table, they make better decisions, not only for themselves but also for the communities and systems they serve.
Liz: What can health and care learn from commercial organisations?
“The technology is important. The outcome is what matters.”
Philip: One of the lessons I’ve carried throughout my career is that technology on its own rarely creates value. Early in my career, I was naturally focused on engineering and technology. Over time, I came to appreciate the importance of operations, finance, governance, customer experience and organisational strategy. In healthcare, just as in commercial organisations, successful transformation depends on getting the foundations right. Good data, strong governance, effective processes and clear objectives matter every bit as much as the technology itself. Sometimes organisations become distracted by the newest innovation when the real opportunity lies in strengthening the basics.
Liz: How has your own thinking about leadership evolved?
“Experience taught me that technology is only useful when it solves the right problem.”
Philip: My career began as an engineer and software developer, and naturally my focus was on the technology itself. A mentor encouraged me to broaden my perspective and understand organisations more holistically. That ultimately led me towards leadership roles where success was measured not by the quality of the technology alone but by the outcomes that technology enabled. As a result, I now spend less time asking whether something is technically possible and more time asking whether it is strategically valuable. That shift in perspective has probably been the biggest change in my own leadership journey.
Liz: What can community pharmacy teach us about systems change?
“If people can get help sooner, everybody benefits.”
Philip: Community pharmacy provides a fascinating example of services moving closer to people. These models recognises that highly trained pharmacists can play a much bigger role in supporting communities. By helping people access expertise sooner, pharmacies can reduce pressure elsewhere in the system while improving access to care. Behind the scenes, technology and automation are helping make that possible. By streamlining routine activities, pharmacists can spend more time doing what they do best: working directly with patients. It’s a good example of how systems change can create benefits for multiple stakeholders simultaneously
Liz: What role can community-based services play in tackling inequalities?
“The closer care is to communities, the easier it becomes to access.”
Philip: Access remains one of healthcare’s biggest challenges. For many people, community-based services are the most accessible part of the healthcare system. Local pharmacies in particular can play a critical role because they are embedded within communities and often available without appointments. When services are easier to access, support can be provided earlier. That creates opportunities to improve outcomes, particularly in places where people may otherwise struggle to engage with healthcare services. Community-based provision has the potential to be both a healthcare intervention and an inequality intervention.
Liz: How can data and AI help tackle fragmentation?
“We’ve got more data than we’ve ever had. The question is whether we’re prepared to use it.”
Philip: One of the biggest opportunities over the coming years will be using data more intelligently across the healthcare system. Today, valuable information is often held within individual organisations and systems. As a result, understanding the whole patient journey can be difficult. Advances in analytics and AI create opportunities to understand relationships that previously remained hidden. They allow us to ask better questions about demand, outcomes, investment and prevention. However, technology alone won’t solve the challenge. Organisations also need to be willing to collaborate, share information and think beyond traditional boundaries.
Liz: What needs to be true five years from now?
“The future depends on how effectively we connect services, data and decision-making.”
Philip: I would hope we see a system that is significantly more connected than it is today. We should be sharing information more effectively, making better use of technology and using data to inform decisions around investment and patient care. Most importantly, I would hope we become much better at identifying issues before they become crises. If we can combine earlier intervention, stronger collaboration and smarter use of technology, then I believe we can achieve significantly better outcomes while making more effective use of resources.
Liz: What opportunity would be unforgivable to miss?
“It would be unforgivable to have the tools to improve patient outcomes and choose not to use them.”
Philip: We are living through one of the most significant periods of technological advancement that most of us will see in our careers. Of course, AI and technology require strong governance, clinical oversight and human judgement. They are not a substitute for expertise. But when used responsibly, they create opportunities that simply did not exist before. I’ve seen examples where technology can identify deterioration sooner, help clinicians make decisions more effectively and improve outcomes for patients. If, five years from now, we have failed to use those advances to improve people’s lives, that would represent a huge missed opportunity. I’m optimistic because many of the building blocks already exist. The challenge isn’t finding solutions. The challenge is bringing those solutions together. The prize isn’t better technology. The prize is better outcomes for people and communities.
If you are reviewing your board composition, planning for executive succession, strengthening your leadership pipeline or considering what capability your organisation will need in the years ahead, Liz Dean would be delighted to have a conversation.