More about Andrew Vincent


Andrew is a Partner at Academyst LLP and Head of Leadership & Transformation, specialising in assisting both individuals and groups with highly complex transformations in response to a deeply troubled and rapidly evolving healthcare landscape. Moreover, he is a passionate advocate for sensible, informed decision-making and timely action in things that have consequences if ignored. Renowned for his deep insight into the macrolevel drivers for healthcare system change and the policies that have emerged as a result, his true passion and even deeper understanding is in the realm of behaviour, both individual and leadership, along with how that comes into play in adverse circumstances or situations of complex change.

Andrew’s career has always been healthcare but it started in pharmaceuticals, culminating in an International senior management responsibility for a division with a turnover of some $200+ million and a huge international workforce of immense cultural diversity. His international focus has resulted in a deep understanding of different healthcare systems and how individual organisations (and indeed individuals) have developed successful strategies within these. However, for 15 years his focus has been decodifying behaviour and transformation understanding, synthesising it into useful learning and tools and then supporting individuals in the UK system to tackle both personal change and service transformation in the right way. It’s an ongoing journey… never more needed than right now.

A vigorous writer, he is an Oxford University Press author and has an MBA (with Distinction – very proud…) from Manchester. However, it is combination of healthcare insight, deep behavioural understanding and a passion for helping individuals that make his support so unique and valuable.


Hi, Hello & Welcome

Not-so-brief insight into my thoughts, mindset and the challenges we all face.

However, despite what I have passionately pursued for 15 years, you need to read the rather more stark thoughts about where we are at this moment. It’s uncomfortable reading but it goes to the heart of this coaching support and helps explain my own change in focus.

A warm welcome to anyone with the interest or desire to discover more about me, why I feel so strongly about what we are doing and other thoughts that I think need sharing.

I am absolutely passionate about really making healthcare work because it has to, for all our sakes. Health is our most precious condition, and it is reliant on the combination of our own stewardship of ourselves coupled to a well-functioning, sustainable health system.

Our health system is breaking (arguably collapsing) under the pressure of a multitude of converging ‘bigger picture’ issues, most of which are not of its own making. However, our healthcare system must be restored to sustainable health and this is something that is not happening. Most would agree, on the whole, that it is declining fast, especially recently, and many services are finding themselves in either acute distress or delivering healthcare they are increasingly worried about. I believe this doesn’t have to be so and that positive transformation is possible. It is not only possible but everything we need to know is available but not understood, used or applied.

Although I have been passionate about changing that by bringing better insight into Trusts and services for the last 15 years, I am of the belief today that we have tipped over a cliff and the combination of circumstances, especially internal and system leadership ones coupled to dire underlying stability in most organisations, is such that we will not recover in our current form. Whereas the adult leadership approach would be to acknowledge the reality, protect what’s most important and seek swift and safe passage to whatever emerging healthcare system lies on the other side, we are in fact perpetuating a level of denial that will lead to clinical, service and individual collapse. It’s a stark conclusion but one made from watching the whole picture for 15 years, from the macro-level perspective right down to individuals on the ground. The majority will not believe or accept it until it is unignorable and affecting them personally. That’s too late.

A Sense of Responsibility

I have always believed strongly that healthcare is a responsibility requiring stewardship from all who act in it, preside over it or rely on it. Consequently, I also feel that career, business or political success should be a function of successful stewardship, never at the selfish, career- or profit-motivated expense of it. However, we do see this all around us:

  • Managerial decisions motivated by short term outcome that careers rely on, instead of longer term stewardship that the system would benefit from
  • Individuals undermining progress because it doesn’t suit them personally
  • Literally hundreds of thousands engaged in things they don’t believe in, almost ‘ordered’ to by others that probably don’t either (a system-wide failure in authenticity)
  • Denial and defensive reasoning allowing the real problems to persist, unaddressed, whilst wasteful, white elephant solutions consume valuable and scarce resources

These examples are not stewardship over something so vitally important to us all. But neither is an uninformed rejection of change, new ways of doing things or attempts to address the problems we face, in the absence of suggesting an informed alternative. Good stewardship is being maximally informed on the complexity of the issues and holding everyone to account in finding better solutions. But what happens when we find ourselves in situations today whereby those that uphold those principles are also suffering the most from the policies and decisions of those that do not?

Increasingly today, the committed many find themselves increasingly without voice or influence, as leaders seek to manage the calamatous under-resourcing of the system we have currently have on the backs of a struggling clinical workforce. It’s unsustainable. The most committed are watching their services decline, their terms & conditions eroded and their work-life balance destroyed, many suffering a significant decline in their own personal well-being too. That’s not ‘striving for the greater good’ and certainly not stewardship over the health system. My personal belief is that it isn’t a set of decisions made in ignorance either.

The Need for a Difficult but Adult Conversation

Healthcare faces the most immense set of emerging challenges, the facts and figures of which only a tiny fraction are genuinely informed about. I believe this is not helpful to an adult debate about how we face our future in healthcare.

I spend a great deal of my time speaking on the complexity of the emerging challenges but the more I understand, the more I realise how few grasp the magnitude, the breadth or the implications of these complex, interrelated challenges. I strongly suspect that Government does but then does not act with stewardship. So healthcare policy is driven by these challenges but does not address these challenges. That has implications for everyone. I believe:

  • Population changes (which we have very little influence over) will transform society as we know it and we must be ready for it and contribute to ensuring it isn’t a catastrophic transformation (which it has the potential to be)
  • We are unlikely to ‘solve’ all of the issues we face (if you know the figures, I doubt you disagree) over the timescale in which we face them but we must learn to cope and survive regardless, doing the right thing i.e. act with stewardship
  • Services really have very little idea how to operate in their new environment but must learn to, fast & positively, to act with stewardship for their patients, their service and the system as a whole
  • Individuals will literally kill themselves and their careers trying to save a deeply valued system that the Government itself is not trying to save (and arguably might be trying to design into failure)

Four years ago, I suggested that Government does understand the reality but doesn’t know what to do in the face of the real complex problem and does not have the financial capability to rescue the system in its current form. I suggested that the DH and Government would behave increasingly erratically, unintelligently or with political motivation (shocker…), whilst selling their policies otherwise, and yet devolve responsbility left, right and centre out of political protection. EVERY aspect of this set of predictions has come sadly true and in many respects STP is the ultimate expression of it.

I am an advocate for an adult, selfless, intelligent debate about the problems we face, underpinned by ensuring those contributing to it are armed with the true facts in all their complexity. It is only in this way that we can move from moaning about something we don’t like to designing, collectively, something that we believe in that genuinely addresses the future reality of the NHS and UK society as a whole. However, when I started advocating this 10 years ago, we had time and financial resources. Today we do not and yet we have not really budged the system in any meaningful way. It is for this reason that I believe we have stepped over that cliff. The point being, once over the edge, if you can’t fly already you are going to crash.

A Responsibility Shared – Distributed Leadership

Our approach to leading is wrong. The people feel it, the evidence says so and you only have to look around and ask yourself a question you may have heard me ask “how well is this turning out for you?” I have spent 10+ years, alongside others who know far more than me, calling for and advocating a different approach.

If healthcare is a collective responsibility requiring collective stewardship, then leadership is a collective activity or set of behaviours too. We are organised so that the people at the top (of anything) carry disproportionate authority but not accountability. Leaders rule, others comply or passively resist and it doesn’t work. I believe this must change to a more distributed model, where all who act in healthcare, preside over it or rely on it genuinely share the responsibility for how it turns out. Consequently the answers to our deepest problems must be built as:

“An agreed solution to a commonly understood problem”

I believe passionately that collectively we have the intellect and mindset sufficient to come up with the answers but our approach to leadership undermines this. Good leadership values an alternative view, recognises the people best placed to devise solutions and selflessly defers to those that act with good judgement, demonstrate unwavering stewardship and produce ideas or innovations that can change healthcare for the better. I still believe predominantly that clinical professionals are best placed to do this. In healthcare, we have the planet’s highest collection of top tier intellects, highly motivated to do what is right and rigorously trained to overcome complex problems, collaboratively, whilst never forgetting you must act with good judgement even before you have all of answers you would like. This is what medicine is and why medicine has been so successful and this combination of mindset and intellect is where the answers will lie, enabled by those that can help them realise those answers. They just need an environment or conditions and leadership that helps this flourish productively, rather than viewing clinical behaviours as part of the problem.

I remain dumbfounded that despite the above capability, all too often clinical professionals are suppressed and controlled, not encouraged, enabled and released. Our most successful Acute Trusts are ones that are genuinely clinically-led. Furthermore, they are pretty much the only ones that concurrently manage to attain financial balance, enduring safety and successful transformation. They are a beacon of hope. However, whilst they have been ‘left alone’ by regulators, providing the space needed in which they could thrive, the one-size fits all policies now emerging, coupled to a set of rules that everybody must follow, means that even the most successful are at risk of being dragged back down into the mire.

And Finally…

I hope this has given you a small insight into the mind, beliefs and inner drivers that have made me passionate about really making healthcare work and provided the drive for 15 years of passionate pursuit of the right thing attained the right way. However, that same 15 years of system and behaviour observation, coupled to a depth of insight into the combination of the system, its policies and human behaviour that I suspect exists in very few (and certainly not where it is most needed), also leads me to believe we are on the cusp of times that few could possibly comprehend but many will be adversely affected by. Much as I would love to believe that it is a direction that can be reversed, the conditions necessary for reversal are just not present and the rate of decline is accelerating. Armed with the breadth of data, understanding and observations, it would take denial on a gargantuan scale to believe we stand any chance of avoiding HealthCRASH. Far from making mine and others efforts redundant or futile, I’d suggest it makes them critical but with a different and more realistic focus.

I continue my unabated pursuit of insight and understanding and my passion for really making healthcare work where it can. However, my focus has changed. Today, I am deeply worried about the fate of individuals and services. We are in danger of witnessing the mass drowning of individuals as they try to save a boat that the Government has already abandoned in the face of a storm so large they know they cannot save it. It’s an immensely strong statement and many will argue otherwise. Whereas I know it will feel safer to believe otherwise, the belief does not make you safer if the reality is different. I would politely ask if those pursuing that argument are doing so on the basis of a thorough examination of the data or whether out of denial or fear. If it’s the former then I will undoubtedly be proven wrong. If it’s the latter, you will unfortunately discover it the hard way. That is not my wish.

I will help services learn how to weather the crisis they are in and to emerge in reasonable shape for the system that will emerge on the other side. I am deeply committed to helping individuals through extremely difficult and personally very risk-filled circumstances. Whether that’s through life-change, approaches to personal protection or in identifying courses of action to mitigate some of the adverse effects of today’s system perversions, I’ll continue to use everything I have learned about behaviour and our system to help you understand, be confident in your conclusions and take decisions that will enable a brighter future.

My best wishes and continued efforts.


Andrew Vincent
Director, Progressence Ltd
Partner, Academyst LLP & Grow Medical LLP
Director, eMedicus Ltd