From pressure to progress: why strained health and care systems need a different model of delivery support

Michael Wyatt recently returned to IMPOWER after a spell as Associate Director of Clinical Pathways and Deputy Divisional Director of Operations (Medicine) at Surrey and Sussex Healthcare NHS Trust.

Closing the gap between knowing and doing

Most systems already know what needs to change. What they lack is the time, capacity, and delivery support to make it happen. IMPOWER works inside the operating reality of health and care systems, helping leaders convert intent into action, and action into measurable improvement.

Public services are not short of clarity about what needs to change. In urgent and emergency care, and the shift towards neighbourhood health, the picture is largely well understood. We know the pressures: sustained demand in emergency departments, high bed occupancy, delayed discharge, and growing complexity in need. We also know the solutions: stronger out-of-hospital care, earlier intervention, optimised acute clinical models, better integration, and a more proactive neighbourhood offer.

The challenge is not in diagnosis. It is in delivery.

Why transformation stalls, even when the answer is known

Having recently returned to IMPOWER from a senior NHS leadership role in acute care what stands out is not a lack of intent, but operating conditions that make sustained improvement difficult to land.

At the frontline, teams are under continuous pressure. Emergency departments are full before the day begins, wards are over capacity, patients wait for beds in corridors. From there, leadership becomes a cycle of operational management: flow escalation, bed coordination, and real-time risk balancing. These are not occasional demands. They define the working week.

Alongside this sits responsibility for workforce, budgets, and transformation, all of which need space and sustained focus. In reality, that space is scarce. Strategic work is not absent. It is pushed into the margins of already pressured days. The result is a predictable pattern: we know what needs to change, but we struggle to create the conditions to make it happen.

What needs to change: from insight to execution

Overcoming this requires a shift in how transformation is supported. These reflections speak to consultancy, but apply to health and care teams alike, with three key principles:

1. Start quickly

Move away from extended diagnostic cycles where the problems are already well understood. The issue is rarely a lack of analysis. It is the absence of capacity to act on what is known. A strong case for change still matters, but it must be built at pace to keep momentum.

2. Shift from outputs to outcomes

Reports, frameworks, and slide decks only add value if they change behaviour, decisions, and delivery. If it is not clear who is doing what differently tomorrow, the intervention will not create impact.

3. Embed change in operating reality

Transformation cannot be designed in isolation and handed over. It must be developed, tested, and adapted in real time alongside the teams delivering care, so they own the future ways of working rather than receive them.

Underpinning all three is a focus on building system capability, not dependency on any individual or external partner. The goal is not to deliver change for systems, but to strengthen their ability to deliver change themselves.

This also requires something more human: the deliberate growth of a coalition of the willing. Under sustained pressure, it is hard for teams to keep believing things can improve. Part of effective support is therefore strengthening the group of people who still believe change is possible, and turning that belief into visible progress others can join.

Why IMPOWER is different

IMPOWER teams are embedded within systems, not positioned outside them. That means working with operational leaders and frontline teams in the real conditions of delivery, at the pace the system demands. The language of “us” and “them” gives way to a genuine sense of “we”.

Our focus is turning intent into action, and action into measurable improvement. That requires a different discipline from traditional consulting: less time on abstract design, more on supporting implementation and behavioural change in practice. In urgent and emergency care, that means improving flow, reducing avoidable admissions, and helping patients progress through the system. In neighbourhoods, it means shifting from reactive service delivery to proactive, coordinated care.

A true outcome of successful support is not only improved performance, but a workforce that feels more able, more confident, and more hopeful that change is possible.

Closing reflections

Public services do not need more clarity about what is wrong. They need partners who can help create the conditions for change to happen, and stay happening, in the real world.

If I did not believe this, I could not have left my NHS colleagues. This move is about growing the coalition of those who still believe things can be better, by proving it.