Dr Johnny Marshall
NAPC Senior Leadership Team
Health and care systems across the UK are under intense pressure — rising demand, workforce shortages, and financial constraints dominate headlines and daily reality. Yet, as Dr Johnny Marshall set out in our latest NAPC Thought Leadership webinar, the answers may not lie in another structural overhaul or a new flagship programme.
Instead, the evidence suggests the most powerful levers for improving health, wellbeing and sustainability are human ones: activation, agency, and connection.
During the session, Johnny unpacked a simple but evidence-rich logic model showing how better outcomes, reduced pressure, and stronger team performance all flow from the same place — enabled people, effective teams, and connected communities.
Below are the key themes from the webinar.
Rethinking Health and Wellbeing
Around 10–20% of our health and wellbeing is attributable to access to healthcare. The remaining majority is shaped by the conditions in which we live, work, learn and age.
This isn’t to diminish the NHS — it’s a reminder that without addressing these broader influences, the system becomes trapped in a cycle of treating people and returning them to the circumstances that made them unwell in the first place.
Johnny highlighted that population health management often focuses on cohorts, but a more powerful approach starts at the level of the individual — what matters to them, not just what’s the matter with them.
Activation as a Core Lever for Better Health
Activation, as defined in the webinar, includes:
- How enabled staff feel
- How well teams work together
- The level of agency people have over their own health
- How connected and supported communities are
These concepts aren’t named directly in national policy — but policy assumes they’re already happening. The gap between assumption and reality is exactly where systems break down.
Activation turns passive expectations into designed, measured, and intentional practice.
Activated Teams Deliver Better Outcomes and Reduce Pressure
NHS performance correlates more strongly with staff activation than with staffing levels or pay.
Activated teams share several characteristics:
- Genuine autonomy
- Clear objectives
- A shared purpose
- Psychological safety
- Regular reflection and continuous improvement
When these elements are in place, the gains are significant:
- Better CQC ratings
- Higher productivity
- Improved quality of care
- Lower burnout and turnover
NAPC’s CARE Programme data shows a return of £3.60 in productivity for every £1 invested in staff activation.
In short: activation isn’t a soft issue — it’s a productivity strategy.
Integrated Care Works — But Only When Teams Are Activated
Integrated care has extensive national and international evidence behind it. But the real impact comes when integration is combined with activation:
- Reduced friction and duplication
- Fewer unnecessary hand-offs
- Better experience for clinicians and patients
- Greater efficiency
- Better outcomes, especially for rising-risk cohorts
Evidence shows that when integrated care programmes are sustained over time — particularly beyond 12 months — their cost and quality benefits increase substantially.
Citizen Agency: A Critical Driver of Demand Reduction
Nearly half the population could take more action to improve their health — but only when supported with the right skills, confidence and resources.
Higher activation is associated with:
- Fewer GP visits
- Fewer A&E attendances
- Shorter and fewer hospital admissions
- Lower costs per person
Targeted prevention and public health interventions deliver a median return of around £14 for every £1 invested, making them among the highest-value interventions in the system.
As Johnny stressed, this isn’t about denying care — it’s about reducing avoidable care by increasing people’s ability to manage their wellbeing.
Activated Communities Change Health at Scale
Around 80% of health outcomes are shaped outside clinical settings, meaning community connection is not a “nice to have” — it’s a core determinant of demand.
Community-based interventions such as social prescribing, men’s sheds, knitting groups, or local singing groups show:
- Reduced emergency admissions
- Improved wellbeing
- Higher social connectedness
- Better outcomes at a much lower cost
Again, the theme is clear: health is created with people, not delivered to them.
All Improvements Come From the Same Place
Better outcomes.
Reduced demand.
Improved sustainability.
These are not competing goals.
They are the natural result of designing systems around activation and agency.
When:
- Staff feel enabled
- Teams work as “real” teams
- People have agency
- Communities are connected
…the system works better for everyone.
“The NHS doesn’t need to wait for new structures.
It needs to enable the people already within it.”
— Dr Johnny Marshall
And NAPC will continue lobbying nationally for bottom-up workforce enablement to be recognised as a priority.
To watch the full webinar, become an NAPC member for free here
