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In this episode of the Unprescribed podcast, hosted by Jacob Haddad, Mike Bell, Chair of North West London and North Central London ICBs, reflects on more than 25 years in NHS board-level roles. He talks about his journey into healthcare through HIV activism, the lessons he’s learned from both success and failure, and shares candid views on neighbourhood health, why delivery matters more than ambition and the foundations needed for change to last.
Mike speaks candidly about failures in his leadership roles. During his time as a non-executive director at NHS London, he reflects on Healthcare for London - a landmark report he believes could have accelerated the shift to neighbourhood health by many years, but where they failed was in bringing general practice with them.With hindsight, he acknowledges that this contributed to later system fragmentation, including the Lansley reforms, turning potential partners into opponents.
In Mike’s words, neighbourhood health isn’t new, it’s another way of talking about integration. Patients already assume services are joined up and are often surprised to find they’re not. He points out that, despite repeated commitments, primary care funding has actually moved in the opposite direction, including in London. For Mike, the issue now isn’t vision or ambition, but delivery, consistently shifting funding, focus and accountability towards primary care and community services.
Mike argues that neighbourhood health isn’t about endless local reinvention. In his view, 80–90% of what neighbourhood teams do should look the same everywhere, with limited and justified local variation. He reflects on how many successful neighbourhood models depend on inspirational local leaders, and why that creates fragility when change depends on individuals rather than structures. For Mike, central direction isn’t the enemy of innovation, it’s often what allows effective models to scale and last while still leaving room for local judgement.
Drawing on his experience as a chair, Mike argues that trust boards should focus more on the levers they have - particularly patient flow, triage, same-day emergency care and discharge. He points to a practical example from his time at Lewisham and Greenwich NHS Trust, where working differently with local authorities helped reduce delayed discharges, getting patients home sooner and more safely while lowering overall cost. Mike also reflects on how siloed commissioning makes that work harder, with services too often designed around organisations and budgets, rather than around patients and pathways.
Mike ends on a hopeful note, pointing to the creativity, commitment and professionalism he sees across NHS staff, even under intense pressure. In his view, the problem is rarely a lack of talent or effort, but the structures and processes that get in the way. If the NHS can remove those barriers and give people the right support, he believes it has everything it needs to deliver lasting change.