This piece forms part of Praxis, a regular reflective series from The Christie Institute of Cancer Education exploring equity, inclusion, wellbeing and the lived experiences that shape healthcare education and practice.
Across the NHS, discussions about accessibility, inclusion, co-production and health inequity are much more fluent and occur in ways that perhaps would not have been possible even a decade ago. That matters. It reflects genuine work, genuine care and, in many places, genuine commitment.
But when we spend time in communities, listening to people speak honestly about healthcare, it’s clear that this isn’t always translating into better experiences. People talk about feeling overwhelmed by information, frightened to ask questions, and exhausted before they even enter the building. Feeling as though systems are something to navigate or survive rather than something designed to hold them. There is a disconnect between organisational language and the reality of people’s lives.
Systems have become good at identifying inequity, mapping deprivation, stratifying populations, and identifying variation in outcomes, for example we know that cancer outcomes are often worse in communities experiencing structural and socioeconomic exclusion, but so much nuance about health and well-being is lost; data alone can’t explain what exclusion feels like in the body, what chronic stress does across generations, what happens when institutions repeatedly feel inaccessible, unsafe or impossible to navigate. Or why some communities with relatively few material resources often have forms of connection, collective care and meaning that protect and sustain health in really profound ways.
Healthcare still centres on a very individualistic understanding of health; the way we talk about wellbeing is rooted in the idea that self-actualisation only becomes possible once material needs are fully met. But many collective and Indigenous understandings of health have always held something different: health and wellbeing emerge through belonging, reciprocity and connection to the group.
We think collectivism/community is so important for healthcare to understand. Systems can (and should) create policies, pathways and frameworks, but they don’t automatically create trust with communities, patients and colleagues. That happens slowly, relationally and alongside people, but often the healthcare system sees this vital work as something external, delivered by charities, engagement projects or organisations invited in to bridge the gap between the people and the institution. Education, too, is often understood as a product to be delivered rather than as something capable of changing relationships, culture and power.
In fact, this work sits in the intersection between education, health inequalities, cancer strategy delivery, and workforce development. And this is why the Institute is so central to this work: we understand how education creates the environment in which lived experience is recognised as expertise, and in which people who are often least present in institutional spaces have the clearest understanding of where systems struggle. It starts with listening…
Over the past few months, we have been spending time in community spaces and hearing people speak about what it actually feels like to move through healthcare. Not only clinically but also emotionally, psychologically, and relationally. Everyone we listened to said they wanted healthcare to feel more human, more understandable, more relational. So, we’re co-creating something new together: a community space for anyone affected by cancer to explore what support, connection, and community could look like beyond the hospital. A place for conversation, peer support, connection, reflection, and belonging.
This is slow, foundational work, underpinned by our ethos and vision to transform cancer care locally and globally, which happens not simply through education, but through relationships, communities, lived experience, creativity and reflection.
This is slow, foundational work. But this is what transformation really looks like. It doesn’t begin with strategy; it begins with relationship and listening. It’s the work that makes meaningful change possible. By creating spaces where people can share their experiences, learn and influence the future of care, we are beginning to reshape not only services but the relationships that sustain them. That is where education, lived experience and community come together, and where a more equitable, compassionate future for cancer care begins.