Strategy, business change and transformation
TPHC’s Strategy, Business Change and Transformation (SBCT) directorate works at the strategic and system level, supporting NHS commissioners, integrated care boards and national bodies to tackle some of the most complex challenges in London’s health and care system.
Where other parts of the business have a defined primary focus in digital automation, data and analytics capability or workforce development, SBCT works across several concurrent transformation areas simultaneously. In 2025-26, that included mental health transformation, weight management, maternity, ADHD, children and young people’s mental health services, Health and Justice, and helping NHS organisations scale shared services to release capacity and reduce costs.
What connects them is less the clinical topic than the nature of the work: multi-stakeholder, often politically complex, and requiring both the strategic thinking to set direction and the practical delivery capability to see it through.
NCL Weight Management Programme
Around 64% of adults in the UK are overweight or living with obesity. Integrated care boards are required to make new treatments for weight loss, including tirzepatide (Mounjaro), available for a defined group of their population. However, rollout has been slow, and the medication is unavailable in many areas. More than nine in ten people currently on these treatments are paying privately. This two-tier system risks making health inequalities worse.
What we did
TPHC supported North Central London (NCL) Integrated Care Board to design and commission new equitable weight management pathways.
Access to weight management medication
NCL patients with the greatest clinical need for tirzepatide now have access to the medication for the first time. Pathways have been deliberately designed to reach people with learning disabilities, people from diverse communities, those with lower levels of health literacy and others facing health inequalities, in order to address inequities in access to care and improve outcomes across the population.
This has also brought NCL ICB into compliance with its statutory responsibilities, including local commissioning pathways, phased rollout, access to lifestyle and behavioural support programmes and clinical eligibility guidelines.
Potential future impact
Three-year results from the SURMOUNT-1 study showed that continued use of tirzepatide in pre-diabetic patients with obesity resulted in a sustained weight loss of up to 19.7% and a markedly lower risk of progressing to Type 2 diabetes.
Client feedback
‘I would strongly recommend TPHC to any colleagues across the NHS. They have been invaluable in supporting our programme of work and we would use them again for any additional support that is needed.’
Hannah Logan, Public Health Consultant, NCL ICB
London Adult ADHD Transformation Programme
NICE estimates that approximately 3.5% of UK adults have ADHD, around 1.6 million people in England. In London, just 16% of that population currently receive treatment, rising to 23% for those with moderate or severe ADHD. Insufficient service capacity, and differences in how services are organised locally mean that adults with suspected or diagnosed ADHD are facing delays and unequal access to diagnosis and treatment.
What we did
TPHC partnered with NHS England London to develop a clear, evidence-based approach to transforming the adult ADHD pathway across the capital. By engaging a wide range of clinical, commissioning, and operational leaders, and drawing on expert oversight, we built a more consistent and effective model of care for London. We also coordinated a once-for-London response to national policy developments, establishing a robust baseline and practical mechanisms to support implementation.
Reducing waiting times and addressing health inequalities
Implementation will focus on strengthening primary care capability, improving consistency in service standards, tariffs and market management, and improving transitions of care. The aim is to reduce waiting times, address health inequalities—including for under-recognised groups such as girls and women—and bring ADHD mental health care closer to parity with the treatment of physical health conditions.
Wider benefits
This work gave NHS England London, ICBs and providers a shared understanding of adult ADHD services across the capital. It will lay the foundation for a once-for-London service specification with more seamless pathways and reduced health inequalities.
Client feedback
“TPHC’s expertise in strategic transformation and service improvement will enable meaningful, sustained improvements across the adult ADHD pathway in London, ensuring people receive the right interventions and care to help them thrive in every aspect of life.”
Maria O’Brien, Chief Executive of West London NHS Trust and Senior Responsible Officer for the NHSE London ADHD Programme.
Curious to see how we can make a difference?
Interested in hearing more about how we have helped tackle health inequalities? Contact us for an informal chat.
email us at:rf-tr.tphc-communication@nhs.net
