Power, patients, and change: Young people can help to reimagine healthcare

How young people reveal weakness in the health system

As an NHS user (RB), I have experienced vast differences in the quality of care I have received. I now get effective, compassionate care for my chronic condition, but previously I felt disrespected and undermined as a young person of colour. My concerns were dismissed because of my age and gender, and I received conflicting, confusing information about my prognosis. This made me feel powerless.

Even when doctors were kind, care pathways were meandering and confusing. I sensed a lack of unity within the healthcare workforce: different roles and disciplines clashed, seemingly forgetting that their frustration at a crumbling NHS was shared. It’s hard to trust a system when you’ve seen clinicians strike for fair pay; the doctors and nurses who safeguard our health should also be treated fairly.

Now that I am at university, accessing treatment has become harder. I commute for hours to appointments because my GP won’t perform tests ordered by another hospital. Meanwhile, public transport is expensive, and appointment letters arrive with little notice. If I, a middle-class young person, struggle to take time off for appointments, we can clearly see the impact such barriers could have on less privileged groups. Inequality—affecting health, education, career progression, and financial stability—is shaping a whole generation.

I am learning that power is key to driving change. Contributing to initiatives like the Wellbeing and Health Action Movement (WHAM) and Powering Up allows me to highlight health inequalities and support doctors in tackling the systemic determinants of ill health. WHAM offers an alternative model of medical professionalism, acting as a “social incubator” to inform, empower, and unite clinicians to tackle child poverty and health inequality. It bridges the gap between clinicians’ concerns about social determinants of ill health and the limited support from conventional medical education. WHAM provides a digital platform with knowledge, tools, and a community for clinicians supporting families affected by health inequalities. Its pilot project, Powering Up, embodies WHAM’s vision of “radically reimagining health”, using creative approaches and patient voices to challenge power imbalances in healthcare.123 For example, as a young person I am given a platform to speak, challenge, and work alongside clinicians to redesign health systems. My input helps expose weaknesses in a system that often assumes its approach works for everyone. Although initially intimidating, stepping into this role has increased my confidence and agency—inside and outside the clinic. It has reframed what it means to be a patient.

Power alone isn’t enough; it’s what you do with it that matters. These initiatives have shown me that healthcare can change. With imagination and a willingness to redraw professional roles, clinicians and patients can become joint creators of better health.

What young people taught this doctor

As a paediatrician (GS), hearing from young people today is heartbreaking and uplifting. For those aged 16-24, the NHS often falls short.4 Mental health services are particularly inadequate, with more than 250 000 young people waiting for support after referrals.5 The situation is equally grim for young people with long term conditions. Adolescent health is overlooked, and clinicians struggle to connect with this age group, citing generational, linguistic, and sociodemographic divides.6 This contributes to high “did not attend” rates for appointments that are strongly correlated with deprivation,78 which further widens existing inequalities. Delayed access to care perpetuates health inequities that follow young people into adulthood.9

Doctors can help this generation by empowering patients—enabling them to gain control over decisions affecting their healthcare. True empowerment requires shared responsibility and decision making, but this is challenging given disparities in knowledge, skills, and expertise within healthcare.

Our pilot, Powering Up,2 is raising interesting ideas about how to do this. In 2023, we received seed funding from the Health Foundation to test the use of creative methodologies and approaches, including music, theatre, and art, to engage service users in redesign of the system. By working alongside young people, we have begun learning how we might redress the power imbalances in healthcare. Conventional co-production initiatives often neglect health equity, risking exclusion and exacerbating inequities. By contrast, Powering Up aims to decolonise knowledge production, challenge power dynamics, foster open dialogue, and increase agency and empowerment—particularly for marginalised populations—to uncover new pathways to reduce inequalities and improve health outcomes for young people.

As healthcare professionals we must think of our actions across different “geographies”: in the clinic, in our services, and in society. Young people are clear: a quality consultation is insufficient if clinical pathways and social conditions continue to perpetuate their health concerns. Services must be genuinely linked so that young people don’t fall through the cracks within healthcare or between health, education, and social care sectors.

We must listen with humility and authenticity. Young people emphasise the importance of the three R’s in consultations: being real (open, honest, and vulnerable), realistic (not overpromising and acknowledging system limitations), and reliable (following through on commitments).

Young people reveal how power works in healthcare, showing clinicians that despite best intentions, services often fail to meet their needs. They expose the system’s weaknesses but also point the way forward. By adapting our practices and pathways to centre patients and those who advocate for a better future, we can fundamentally reimagine healthcare.