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In this episode of Unprescribed, hosted by Accurx CEO Jacob Haddad, we’re joined by Lord James O’Shaughnessy, former Health Minister and a leading voice on UK health policy and life sciences. James shares how he found himself in healthcare almost by accident, what it was really like stepping into a ministerial role, and the reality of leading and learning inside a system as complex as the NHS.
They discuss why innovation so often struggles to reach patients, what recent patient safety scandals have exposed, and why the near-elimination of hepatitis C shows what’s possible when focus and imagination come together. James also shares his perspective on the NHS’s productivity and data challenges - and the UK’s opportunity to stay world-leading in life sciences if public trust is protected. Finally, he reflects on COVID-19, the day-to-day barriers to change, and why clearer goals, better communication and genuinely empowering patients matter more than ever.
James didn’t plan a career in health. After years working on national school reform, he found himself appointed Health Minister almost overnight, just as the NHS was heading into one of its toughest winters. Thrown “straight into the deep end”, he had to learn quickly how a system this vast really works, and where ministers can genuinely make a difference. One of the first lessons was the importance of listening - not only to officials, but to clinicians, patients and campaigners - to truly understand how policy translates into practice.
James reflects on why reform in healthcare is so much harder than in education. There aren’t many universally-accepted “exemplar” organisations to point to, and there’s almost a quiet instinct not to let any one part of the system get too far ahead. Constant operational pressure, limited downtime and multiple layers of governance mean change is often an “evening hobby” for clinicians. So even when the case for change is obvious, spreading it consistently across the NHS is incredibly difficult.
The conversation looks at major patient safety failures, particularly those affecting women, and why letters from patients and families are often the earliest warning signs of systemic problems. James talks about the importance of meeting people face-to-face, listening carefully to their lived experiences, and staying emotionally available, even when it’s uncomfortable. That empathy, he says, is often what prompts action and helps rebuild trust when the system has fallen short.
James uses hepatitis C as an example of what happens when science, policy and delivery finally line up. Once the disease became curable, the real challenge wasn’t the medicine - it was redesigning the system so people could actually get treated. With focus, imagination and a ruthless emphasis on patient benefit, the NHS was able to drive cases down at scale. He argues that too often the barrier is not the science, but the structure of the system - advocating for Integrated Health Organisations (IHOs) to overcome the provider–commissioner split and unlock productivity.
Drawing on his experience across government and industry, James sets out specific prescriptions for the future: creating dedicated research time for clinicians, investing in enabling technology, and rebuilding public trust in the use of health data. He highlights the UK’s unique advantage in genetic diversity and its potential to lead global clinical research - if data can be used safely, transparently and at scale.