Waiting times and deficits: pressure to transform continues to mount

The need for high quality integrated health and care services increases as pressures on the system grow, including the rising number of patients with complex conditions and our ever-increasing expectations of the NHS in the digital age. Achieving this integration amidst rising financial pressures – dealing with more people, with more complex needs, within tighter budgets – across a fragmented system is challenging to say the least.  The growing concern is how can the health sector perform today and transform for tomorrow?



How can you ensure you deliver great care today that serves the long-term interests of the populations you serve, whilst also supporting major changes to service models?


How can you encourage organisations to work across organisational boundaries, whilst also ensuring here and now pressures are met?


How can you assure yourselves that individual organisations are adequately focused on consistently delivering the highest quality of care now, whilst also incentivising and encouraging long-term change?


Gate One brings our experienced, trusted teams to work shoulder-to-shoulder with our clients to deliver:

• strategic reviews and business case development
• governance and leadership
• organisational design and digital transformation
• quality improvement and cultural change
• operational improvement
• cost improvement planning and delivery.


Our health team has worked directly with:

  • 18 health and care providers
  • 14 local health systems, working across Clinical Commissioning Groups, Sustainability and Transformation Plan footprints, and local authorities
  • 4 regional and national commissioners
  • 4 health and care regulators (including regulators now part of NHSI).

We are proud to be a Crown Commercial Service Framework supplier, which enables us to support some of the most significant areas of transformation in the health sector. 


Our health and care team are all experienced, passionate deliverers in the sector. We bring lived experience, resilience and insight in small teams to get results at pace. We understand the sensitivities and nuances in working in this sector and will not ‘learn as we do’.
We understand how to add true value. We bring an evidence-led approach focussed on sustainable change. We believe we have failed if we ‘land and expand’ – our focus is on transferring capability from day one.


The impact we have is lasting. We work with our clients to ensure change initiatives and interventions are designed with you, and owned by you. This includes engagement with all levels of the organisation, across executives, clinicians and front-line staff to upskill and empower your teams in leading change.

We seek to truly understand you and your needs, to address the challenges and opportunities that are most meaningful for you.

If you would like to speak to Gate One about how we can help you deliver quality and sustainable health care, please contact Nick Kennell, Client Director, on


Our team of experts regularly shares their insights about the things that matter in the health sector. You can read some of them here.

HealthcareInsightsPublic Sector
10th September 2018

We are all empowered to shape our NHS

Grace Blundell attended this year's TEDxNHS event, based on 'Shaping our Legacy'.
Company NewsHealthcareLatest News
23rd July 2018

Shaping our legacy in health

Gate One is proud to support TEDxNHS 2018
HealthcareInsightsLatest News
24th May 2018

The health sector financial improvement myth

Switch attention from the catch to the throw
HealthcareInsightsLatest News
26th January 2018

Winter: the accidental emergency

Shifting from fire fighting to sustainable solutions: supporting the move to Accountable Care Systems


Strategic roadmap development and governance review:

Gate One supported a regulator in developing a strategic roadmap to transform in response to the changing needs of the health sector. Our support was focussed on successful strategy articulation, operating model design, and delivery blueprint design, including co-working around true benefits realisation.

Working closely with our client, we planned the transformation, including prioritising service changes, implementing new governance alongside their operational commitments, and developing an integrated roadmap of changed over the next three years.

By truly understanding the complexities of the changing environment and building the flexibility to adapt to these, our client is now able to evolve and adapt in a way that prioritises overall system impact on service users and patients.

Quality strategy development:

In an acute NHS Trust that serves over half a million people with 4,500 staff and volunteers, on a journey out of special measures, Gate One led the development of a quality strategy to help the Trust drive the highest quality of patient care through cultural change.

We developed the operating model for leading and developing quality across the organisation by establishing cross-organisational engagement forums with front-line staff. This involved an extensive engagement exercise to co-design a vision and strategy for quality.

Our support has helped the Trust to establish a new culture and the supporting capabilities that will help them on the next step of their journey towards excellence.

Pathway design and delivery (in partnership with an Acute NHS Trust):

Our client had been awarded a place on the National Diabetes Prevention Programme Framework, and asked Gate One to support them to design, integrate and mobilise a new Tier 0 pathway for diabetes prevention across three STP areas.

Following the award of the local health economy contracts, our client was required to take their first referral within 14 weeks. Gate One developed a mobilisation and transition Project Initiation Document (PID), which was enacted on day 1 of us starting. Over the 70-operational day deployment window, we mobilised corporate departments around a central vision, recruited a full-time team of 20 FTE, and rolled out to plan for a population area of over 7 million people. The service met all regulatory and compliance requirements by the commissioners.



Nick leads our health team at Gate One. He is passionate about working on the things that matter most in delivering improved, sustainable care to patients. He has worked across the health sector to help rebalance programmes in favour of empowering teams to deliver lasting benefit and improved quality.

How have you supported the health care system recently?

I have worked across the health sector for several years and have been on the journey that regulators, providers, commissioners and patients have been on since the 2012 reforms. My most recent work has been across two clients at opposite ends of delivery – a regulator and a provider – in both cases working with their senior leaders to support more collaborative working, both internally and with partners. Whilst there are many structural changes the sector needs to implement, these will only work if the cultures and ways of working support them. It is privilege to be part of helping drive that cultural change across the sector.

If you could change one thing about the health sector what would it be?

If you would have asked me a few months ago, I would have said the best change would be to stop considering the health sector as a separate sector from social care, but fortunately the new Health and Care remit of the Secretary of State has addressed that! The challenge now is to really consider things from the end to end perspective of the patient and abandon our financial and organisational allegiance to location and stage of care.


James leads our Government and Public Services team at Gate One. He has experience across advisory and delivery – working across providers and commissioners – with a focus on strategy, policy and service development.

How have you supported the health care system recently?

Most recently I’ve supported a range of NHS organisations understand future growth options, and reviewed special education needs pathways to best position health and social care support. Prior to this, I spent the last decade working across health and social care, from supporting whole system reconfiguration and provider turnaround, to new service and product development built around the needs of patients. Moving strategy into action is my focus – if a vision and plan isn’t owned, even the best business case will give only marginal returns to those on the frontline.

Over the next 10 years, what will be the biggest challenges to the health and care sector?

People, people, people. More specifically, workforce, public expectations and leadership. Even the most robust workforce planning won’t counteract the seismic reduction in supply. The challenge of how to develop and retain a high performing workforce is top of the list. Followed by a need to re-establish the contract between patients and the health service to disease-burden together, as an expectation bias exacerbated by digital change is unsustainable. Lastly, avoid reform and policy change again. Trust the system and give it the right time horizons to manage properly.


Grace is a Manager in our health team. She has experience working across a broad range of the health systems, with clients including NHS England, STPs, CCGs and NHS trusts.

How have you supported a health care organisation recently?

I recently worked with a specialist trust who wanted to refocus their approach to quality. They were seeking to drive a culture change of putting patient experience at the heart of their health care delivery, as well as delivering excellent clinical outcomes. I worked with them to write a five year quality strategy, interviewing the Executive team, front line clinicians, patients and Trust Governors to draw out their vision and objectives for the future.

What excites you about working with organisations in the health sector?

The support that we give makes a lasting impact, long after we’ve left the building. We build strong relationships with our clients, and effectively join them at the coal face to help them deliver their transformation, and do it in a sustainable, cost effective way.


Lucy is a Senior Consultant in our health team. She is committed to improving service user experience in health care, combining a practical knowledge of the NHS with transformational programme experience in multiple sectors.

How have you supported the health care system recently?

I have been working with a large NHS Trust just outside London that serves over half a million people with 4,500 staff and volunteers. I’ve led the development of a quality strategy which will support the hospital Trust in driving the highest quality of patient care through cultural change. This work has included extensive staff engagement at all levels of seniority, establishing new ways of working, and enabling governance, systems and processes.

You’ve been a practicing assistant psychologist and you’ve also worked across multiple sectors. Do you think the health sector really has such different problems to other sectors?

I’m not sure there’s a straightforward answer! The well-known challenges are not unique to health: for example, empowering staff, making cost savings and improving process efficiencies are areas all organisations seek to improve. We absolutely should apply what we’ve learnt in other sectors to our health clients to help bring innovation. However, our NHS is a truly unique establishment. As such, you cannot over-generalise the problems or minimalise the challenges staff – clinical and non-clinical – face within it.

If you would like to speak to Gate One about how we can help you deliver quality and sustainable health care, please contact Nick Kennell, Client Director, on