The NHS is dangerously close to being knackered.

Ask anyone in or around it what’s happening just now and where it’s all going to end up, and you’ll get a sigh and a shrug. Some brave people might offer a theory about which earlier iteration of the service we’re about to reinvent (are we going back to Strategic Health Authorities? Are IHOs the new ICOs?). The level of conviction behind that response often depends on whether the person offering it is hoping for, or bracing themselves against, redundancy. And with some 18,000 posts being lost in the NHS this year, there are a lot of people in that position.

That chaos, and the lack of a coherent vision, is actively undermining the system’s ability to do the things that actually matter. In a world where the NHS is more political than ever, and in the context of ministers wanting to take back direct control of the service, that is deeply problematic. In that kind of environment, capable people working in the service don’t stop caring, but they do burn energy on the wrong things, lose faith that effort makes a difference, or switch themselves off.

Photo by Peter Conrad on Unsplash

I see this happening a lot at the moment. People who are trying to do good work, but are spending more and more time reacting to noise, and creating more of it. People working alongside the NHS, or trying to support it, who feel that the ground keeps shifting under their feet. They’re trying to work out how best to add value, and nobody can really tell them.

The real cost of this is misdirected effort is that it often ends in apathy. If people don’t feel effective, they lose motivation. And once apathy creeps in it’s very hard to reverse.

I think I’ve ended up in a slightly unusual position in all of this. Partly because of where I sit in the system, partly because of the kind of work I do, and partly because I seem to have a low tolerance for things that don’t make sense. I’m a very simple and pragmatic person, so I look for the underlying, and often unspoken, factors that shape how people behave. Their unspoken motivations. I think I’d make a decent Faithful, should anyone ever put me in a Scottish castle.

I spend a lot of time around strategy, change, and decision-making, but also a lot of time watching how those things land on real people. And believe it or not, everyone working in the NHS, no matter how senior or how fancy the job title, is a real person.

That’s where The Prescription comes in.

It’s an idea that’s grown in my head from a kernel a couple of years ago. I’ve thought about what it should be, and what value it can add to an overcrowded world. And I think I’ve finally landed what it is, and isn’t. It isn’t a set of hacks, templates, or magic phrases designed to help you “win” at the NHS. It isn’t another podcast. It’s an attempt to help people interpret what they’re seeing, form their own views, and develop the judgement, narrative, and influence needed to operate effectively in complex systems.

Some of this work will be very practical. One of the first things I’ll be launching, in the next fortnight, is a course called Being Interviewed in a Changing NHS. It’s designed for people navigating interviews, restructures, and organisational change, and focuses less on perfect answers and more on helping people make their thinking visible under pressure. It aims to give insight into how panels are thinking, how they interpret performance, and how you can be honestly and unapologetically yourself while still showcasing your judgement, thinking, and potential.

With the biggest reorganisation the NHS has ever seen happening in 2026, a lot of people will be interviewing to stay in jobs, navigate redeployment, or find a way out. I hope this course helps people find their place in whatever system emerges next.

Alongside that I’ll be offering a limited number of 1:1 practical slots with me, where I’ll use my experience of being on both sides of the interview table to undertake a mock interview with someone undergoing organisational change from within the NHS, and then provide detailed, constructive and personalised feedback.

But that is just the first offering from The Prescription. The broader aim is to support people to improve their effectiveness. Because being effective, in a way that aligns with your values, is one of the few reliable routes to doing a satisfying job in a system like this. There’s more coming, including courses, conversations, and writing. These will explore areas such as decision-making behaviour, leading in complex systems, and navigating change without losing your sense of self.

This won’t be generic ‘leadership’ fluff. Any motivational quotes over pictures of mountains will be shared with tongue firmly in cheek. If you’re looking for shortcuts or textbook ‘increase your earning potential’ nonsense, this won’t help. If you’re trying to become someone else in order to get the job, it definitely won’t. If you want to be more confident in showcasing the best version of yourself and increasing your effectiveness, then hopefully it will.

We are heading into a period where organisational change, restructuring, and uncertainty are no longer isolated events with seven to ten years of stability between them. For the first time in the life of the NHS, every part of the system is being reorganised at the same time. The level of complexity and volatility people are being asked to absorb is unprecedented. 2026 is likely to be the most destabilising year the NHS has ever experienced, not just structurally, but psychologically.

So I’m trying to do what I can to help.

If you spend time with The Prescription, you can expect me to try to provide clarity in complexity, without pretending certainty exists. I’ll help you navigate choppy waters without asking you to compromise your values. I’ll hold myself to high standards, but in a way that is unmistakably and unapologetically me. My aim is that the work feels accessible and grounded, but also insightful and, I hope, energising and maybe even entertaining.

More soon.