Health Coaching and Beyond

Summary

In this episode, Ollie is joined by Peak Health's Education Director, Dr Caroline Hart, to explore a question facing the growing health coaching profession: how can we establish consistent standards while keeping health coaching truly person-centred?

Their conversation is prompted by a recently published paper from New Zealand, which reviews 76 health coaching studies conducted between 2013 and 2023. The findings highlight considerable variation in how health coaching is delivered, who provides it and what training practitioners receive. Perhaps more importantly, the research reveals how inconsistently these details are reported, making it difficult to compare approaches and understand what really works.

Ollie and Caroline reflect on what this means for the development of health coaching in the UK. They discuss the importance of recognised qualifications, competency frameworks and external quality assurance, while considering the progress already made through NHS England's Health and Wellbeing Coach Workforce Development Framework.

But standardisation brings its own challenges. If health coaching is fundamentally about responding to individual needs, how do we establish shared principles without becoming overly prescriptive? Caroline explores the importance of maintaining individual agency and ensuring that consistency never comes at the expense of flexibility and personalisation.

The conversation also draws on Ollie's recent experience at an Individual Placement and Support conference, where he was struck by the role that fidelity to a clearly defined model has played in improving outcomes for people experiencing serious mental health difficulties. Could health coaching learn something from this more established approach?

Takeaways

• Health coaching is growing internationally, but approaches to delivery, training and evaluation remain inconsistent.
• A review of 76 studies highlights significant gaps in how health coaching interventions are described and reported.
• Without clear information about training, methods and delivery, it becomes difficult to compare research findings and understand outcomes.
• Consistent standards are important, but health coaching must remain flexible and responsive to individual needs.
• The NHS Health and Wellbeing Coach Workforce Development Framework provides a foundation for developing and assessing practitioner competencies.
• Recognised qualifications, external scrutiny and quality assurance can help strengthen confidence in health coaching practice.
• Person-centred care means protecting individual agency, rather than allowing frameworks to become overly practitioner-led.
• The success of Individual Placement and Support (IPS) offers valuable lessons about the relationship between fidelity to a model and effective outcomes.
• Stronger evaluation, research and shared definitions are needed as health coaching continues to develop.
• International collaboration could help establish common standards while recognising different cultural and healthcare contexts.
• The challenge for the profession is to identify the core principles of effective health coaching without losing the adaptability that makes it valuable.

Further Reading

The research paper discussed by Ollie and Caroline in this episode, can be found in the Journal of Primary Health Care. Implementing Health Coaching for People With Long-Term Conditions, Caroline Stretton, Antonia Rosedale, Angela C. Davenport, Julie Pryor. https://connectsci.au/hc/article/doi/10.1071/HC26082/278819/Implementing-health-coaching-for-people-with-long

Summary

In this episode, Ollie is joined by Nick Downham, an expert in NHS system change, quality improvement and leadership, to explore why meaningful change in healthcare can be so difficult to achieve, and what it might take to create a more proactive, preventative and person-centred system.

Drawing on Nick's extensive experience working across the NHS, the conversation explores his recent research paper, Of Clocks and Clouds: Leading System-Level Change in Health and Care. The research examines different approaches to leading change across complex healthcare systems, questioning whether traditional methods of management and improvement are always suited to the challenges the NHS faces.

A central theme is the distinction between 'clocks' and 'clouds'. While clock-like approaches rely on structure, predictability, targets and control, cloud-like approaches recognise the complexity of human systems, where relationships, trust and adaptability play a crucial role.

The discussion also explores some of the contradictions within healthcare reform. Despite ambitions to shift towards prevention and community-based care, existing incentives, performance measures and financial pressures can continue to reinforce reactive models of healthcare.

They reflect on what effective system leadership looks like, from building relationships and working across organisational boundaries to sharing power and creating the conditions for collaboration. Rather than simply making existing services more efficient, the challenge is to question whether healthcare systems are doing the right things in the first place.

Takeaways

Traditional management approaches based on targets, control and predictability are not always suited to complex human systems.

The 'clocks and clouds' concept highlights the need to balance structured improvement with relationships, adaptability and trust.

Healthcare systems can unintentionally reinforce reactive care, even when their stated ambition is to prioritise prevention.

Poverty, inequality and wider social circumstances have a significant influence on health outcomes and demand for healthcare.

Effective system leadership involves creating the conditions for change rather than simply directing people towards predetermined solutions.

Trust, collaboration and strong relationships are essential when working across organisational and professional boundaries.

Co-production requires professionals and leaders to share power and recognise the expertise of patients and communities.

Focusing on individual organisational targets can sometimes undermine outcomes across the wider healthcare system.

Healthcare interactions can unintentionally create dependency when people are treated as passive recipients rather than active partners.

Building people's confidence, agency and ability to self-manage is an important part of moving towards more proactive and personalised care.

Embedding health coaching effectively requires support and understanding across whole teams and organisations, not just individual practitioners

Links and Resources

Of Clocks and Clouds: Leading System-Level Change in Health and Care (2026). Read Nick Downham's research paper, co-authored with Nicola Burgess and Emily Rowe: https://eprints.whiterose.ac.uk/id/eprint/242007/

Improving Quality in Healthcare: Questioning the Work for Effective Change. Explore Nick's book, co-authored with Murray Anderson-Wallace: https://www.sagepub.com/shop/buy-a-book/improving-quality-in-healthcare-1-274113

Summary
In this episode, Ollie and Tim return to the studio to reflect on their recent AI and Health Coaching Roundtable, exploring what they learned, how their thinking has shifted and what the rapid development of artificial intelligence could mean for the future of health coaching.

Building on the discussion in Episode 36, they revisit insights from the expert panel, including the potential of smaller, more specialised AI models, the importance of trusted information and the distinction between knowing what to do and actually making meaningful behaviour changes. While AI offers exciting opportunities to improve access to information and support, the conversation raises an important question: can technology ever replicate the experience of being truly heard and understood by another person?

The conversation also turns to a major new review of mental health, which highlights the growing pressures facing younger generations and the importance of moving towards more personalised, needs-based support. Ollie and Tim explore the parallels with health coaching, particularly the shift away from focusing solely on diagnoses and symptoms towards understanding people's strengths, circumstances and ability to participate meaningfully in everyday life.

Takeaways

• AI has significant potential to support health coaching, but should complement rather than replace human relationships.
• Information alone is rarely enough to create lasting behaviour change. Coaching helps people bridge the gap between knowing and doing.
• Smaller, more specialised AI models could offer opportunities for safer, more personalised support using trusted information.
• Feeling genuinely listened to, understood and validated by another person can be a powerful intervention in itself.
• AI's constant availability offers benefits, but raises questions about dependency and the boundaries of technology-led support.
• The ability to simulate empathy and conversation does not necessarily mean AI can replicate genuine human connection.
• Health coaches and practitioners need to consider not just what AI can do, but whether it should be used in every situation.
• Concerns around commercial interests, data quality, safety and environmental impact make critical thinking about AI increasingly important.
• Technology that promises to save time does not always create more space for relationships, reflection or wellbeing.
• Supporting autonomy, confidence and independent thinking should remain central to how AI is introduced into health and care.
• A major new mental health review highlights the importance of understanding people's needs and circumstances, rather than focusing solely on diagnostic labels.
• Measuring mental health outcomes through participation and quality of life offers important parallels with person-centred health coaching.
• Growing mental health challenges among younger people need to be understood in the context of increasing social and environmental pressures.
• Human relationships, empathy and shared lived experience remain essential elements of effective health and wellbeing support.
• Health coaches and healthcare professionals have an important role in shaping how AI develops, ensuring technology serves people rather than the other way around.

Further Reading

During this episode, Ollie and Tim discuss the recently published Independent Review into Mental Health Conditions, ADHD and Autism, led by Professor Peter Fonagy.

You can read the review and its recommendations here: https://www.gov.uk/government/collections/independent-review-into-mental-health-conditions-adhd-and-autism

Summary

In this episode, Ollie is joined by Holly Crosby, one of Peak Health Coaching’s most experienced associate trainers, to explore a career spanning counselling, health coaching, workplace wellbeing and training.

Holly begins by sharing her own experience of healthcare following the diagnosis of a rare pituitary tumour in her early twenties. She reflects on how little control she initially felt over decisions about her treatment, and how her relationship with healthcare has changed over time as she has become more confident in asking questions, expressing what matters to her and taking a more active role in her care.

The conversation then turns to Holly’s professional journey, from more than a decade working as a counsellor in bereavement, addiction and mental health, to discovering health coaching and eventually bringing coaching into workplace settings.

Ollie and Holly also tackle a question that comes up regularly in health coaching: where does coaching end and counselling begin? Holly reflects on the considerable overlap between the two, while describing counselling as often creating space to understand and process the past, and coaching as having a greater focus on the present and what someone wants their future to look like.

Throughout the conversation, they return to the power of listening. For people used to helping others, stepping back can feel uncomfortable. But health coaching can sometimes mean doing less rather than more: talking less, telling less and creating the space for another person to recognise their own strengths, choices and capacity for change.

Takeaways

• People are more likely to engage in their health when they feel involved in decisions rather than simply being told what will happen.
• Continuity of care can help create trust and make it easier for people to speak openly about what matters to them.
• Health cannot be separated from the wider realities of someone’s life, relationships and work.
• Workplace wellbeing often involves issues that extend far beyond the workplace itself.
• Counselling and health coaching share many skills, particularly listening, curiosity and creating a safe space for reflection.
• Counselling may spend more time making sense of the past, while coaching often focuses more strongly on the present and future.
• Supporting someone does not always mean giving them more information, advice or solutions.
• Health coaching can challenge professionals to talk less, tell less and trust people more.
• Small changes can have a significant impact and create the foundations for further change.
• Health coaching skills can be valuable beyond patient consultations, including with colleagues, teams, friends and family.
• Sometimes doing less and listening more can help someone else do more for themselves.

Summary

In this special episode of Health Coaching and Beyond, Peak Health Coaching brings together an expert panel to explore one of the biggest questions facing health and care right now: what role should artificial intelligence play in health coaching?

Ollie is joined by Dr Angus Perry, Dr Hussain Al-Zubaidi, Chloe Tetrault and Dr Rob Kemp, who bring very different perspectives on the opportunities, risks and ethical questions surrounding AI. From personalised support and greater access to information, to concerns around trust, dependency, misinformation and the loss of human connection, the discussion explores what AI might genuinely add to health coaching and where its limits may lie.

The panel considers how AI could support people with health information, goal setting and self-management, as well as how smaller, more specialised AI models could potentially offer safer and more tailored support. But they also explore what happens when technology moves into areas traditionally built on human relationships, empathy, trust and the ability to notice what is not being said.

A central question emerges throughout the conversation: if AI can increasingly imitate the language and techniques of a coach, does that make it coaching? The panel explores the difference between appearing to listen and genuinely being in a relationship with another person, and why health coaching may be about much more than simply providing the right information or asking the right questions.

While there are plenty of reasons for caution, the discussion is far from anti-AI. Instead, the panel considers how technology might take care of some of the more repetitive or informational tasks, creating more space for meaningful human conversations.

Takeaways

• AI has significant potential to improve access to health information and personalised support.
• Health coaching is about more than information - it often helps people bridge the gap between knowing what to do and actually doing it.
• AI can imitate aspects of a coaching conversation, but there are important questions about whether imitation is the same as a genuine human relationship.
• Human coaches can notice body language, hesitation, context and what is left unsaid.
• AI may be particularly useful for information, self-management, tracking and other supportive tasks alongside human coaching.
• A human coach remaining "in the loop" could be an important principle as AI becomes more widely used.
• Smaller, specialised language models may offer opportunities for more tailored, secure and energy-efficient AI tools.
• AI systems can produce inaccurate or biased information while sounding highly convincing, making appropriate safeguards essential.
• There are important questions around privacy, data ownership and where information shared with AI systems ultimately goes.
• Greater access to AI does not automatically mean greater equality, particularly where cost, digital confidence and access to technology differ.
• Commercial interests could influence how AI health tools behave, raising questions about trust, transparency and potential conflicts of interest.
• Health coaching organisations and professional bodies have an important role to play in developing standards, governance and ethical guidance.
• The environmental cost of AI should form part of the conversation about how and when these technologies are used.
• Technology should support human connection rather than unintentionally replacing or weakening it.
• AI is developing quickly, but health coaches have an opportunity to help shape how it is used rather than simply responding to what comes next.
• The goal may not be to replace the human elements of coaching, but to automate the mundane and create more space for them.

Summary

In this episode, Ollie is joined by Holly Crosby, one of Peak Health Coaching’s most experienced associate trainers, to explore a career spanning counselling, health coaching, workplace wellbeing and training.

Holly begins by sharing her own experience of healthcare following the diagnosis of a rare pituitary tumour in her early twenties. She reflects on how little control she initially felt over decisions about her treatment, and how her relationship with healthcare has changed over time as she has become more confident in asking questions, expressing what matters to her and taking a more active role in her care.

The conversation then turns to Holly’s professional journey, from more than a decade working as a counsellor in bereavement, addiction and mental health, to discovering health coaching and eventually bringing coaching into workplace settings.

Ollie and Holly also tackle a question that comes up regularly in health coaching: where does coaching end and counselling begin? Holly reflects on the considerable overlap between the two, while describing counselling as often creating space to understand and process the past, and coaching as having a greater focus on the present and what someone wants their future to look like.

Throughout the conversation, they return to the power of listening. For people used to helping others, stepping back can feel uncomfortable. But health coaching can sometimes mean doing less rather than more: talking less, telling less and creating the space for another person to recognise their own strengths, choices and capacity for change.

Takeaways

• People are more likely to engage in their health when they feel involved in decisions rather than simply being told what will happen.
• Continuity of care can help create trust and make it easier for people to speak openly about what matters to them.
• Health cannot be separated from the wider realities of someone’s life, relationships and work.
• Workplace wellbeing often involves issues that extend far beyond the workplace itself.
• Counselling and health coaching share many skills, particularly listening, curiosity and creating a safe space for reflection.
• Counselling may spend more time making sense of the past, while coaching often focuses more strongly on the present and future.
• Supporting someone does not always mean giving them more information, advice or solutions.
• Health coaching can challenge professionals to talk less, tell less and trust people more.
• Small changes can have a significant impact and create the foundations for further change.
• Health coaching skills can be valuable beyond patient consultations, including with colleagues, teams, friends and family.
• Sometimes doing less and listening more can help someone else do more for themselves.

Summary

In this episode, Ollie and Tim come back together to explore what health coaching can offer across two very different but increasingly important areas: workplace wellbeing and the growing use of digital health tools.

Tim reflects on conversations from the NHS Occupational Health & Wellbeing Network annual meeting, where there was strong interest in how health coaching skills could help occupational health teams move further upstream. Rather than waiting until someone is struggling, off sick or preparing to return to work, they discuss the opportunity to involve people earlier and more actively in decisions about their own health and working lives.

The conversation widens into the role of workplace culture, leadership and psychological safety. Ollie and Tim reflect on why trust matters, how vulnerability from leaders can create space for others to speak openly, and why employees feeling able to ask for support or adaptations can be a sign of a healthy organisation rather than a problem to be managed.

They then turn to two recent studies exploring health coaching alongside digital support. Ollie shares findings from the Active Wait study, involving people waiting for hip and knee surgery with lower levels of patient activation.

A second feasibility study, looking at digital support for people living with frailty tells a similar story. While digital tools may offer huge potential, the human relationship can be the thing that helps people engage with them and translate information into meaningful action.

Takeaways

• Occupational health has the potential to move further upstream from reactive support towards prevention.
• Health coaching skills can help people play a more active role in conversations about staying well, returning to work and workplace adjustments.
• Person-centred conversations are not simply about being friendly or supportive, but using deliberate skills that help people think for themselves.
• Workplace culture and leadership have a major influence on whether people feel safe enough to speak honestly about what they need.
• Being able to ask for adaptations or support can be a sign of trust and psychological safety.
• The Active Wait study found high engagement with health coaching among people with lower levels of patient activation.
• Small, personally meaningful goals can sometimes unlock wider changes in confidence, mood and activity.
• Digital tools can provide useful support, but engagement with them varies considerably.
• Health coaching may help people engage more meaningfully with digital health tools.
• Creating the space for someone to think, build confidence and take the lead sits at the heart of health coaching.
• The future of health coaching may increasingly involve finding the right balance between human relationships and digital support.

Active Wait: Feasibility of Health Coaching Targeting Patients With Low Activation Waiting for Total Hip or Total Knee Replacement - https://www.physiotherapyjournal.com/article/S0031-9406(26)00485-2/abstract

DIALOR: A Feasibility and Acceptability Study of a Digital Health Coaching Intervention for Older People With Frailty in Primary Care - https://link.springer.com/article/10.1007/s40520-026-03499-w

Summary

In this episode, Tim is joined by health and wellbeing coach, supervisor and facilitator Laura Williams to explore where a career in health coaching can lead.

Laura shares her journey from veterinary nursing and primary care into social prescribing, NHS health coaching, supervision and staff wellbeing. She reflects on what first drew her to coaching, particularly the realisation that even good advice does not always lead to meaningful change when it doesn’t fit into the realities of someone’s life.

The conversation explores the shift from telling people what to do towards creating the space for them to think, reflect and find their own way forward.

Laura talks about learning to move from being on “transmit and do” to “receive and be”, and why listening well is something coaches continue to practise throughout their careers. Laura also speaks openly about being made redundant from her NHS health coaching role and the uncertainty that followed.

She and Tim discuss changing NHS priorities, the value of building a varied career and the different ways coaching skills can continue to be used beyond a traditional health coaching role.

A key part of the episode focuses on supervision, what it offers, why it is different from line management or clinical supervision, and how it can support coaches with confidence, boundaries, reflection and the emotional demands of the work.

Takeaways

• There is no single career path after training as a health coach.
• Good advice does not always translate into lasting change.
• Health coaching creates space for people to reflect and find their own solutions.
• Moving from advice-giving to coaching takes practice, patience and good listening.
• Coaching skills can be used across a wide range of roles and settings.
• Changing NHS priorities can create uncertainty for health coaches and the wider workforce.
• Supervision can help coaches feel supported, confident and safe in their work.
• Coaching supervision is different from line management and clinical supervision.
• Training as a supervisor can also strengthen your own coaching practice.

Summary

Tim and Ollie are back together this week, chewing over one of the biggest recent developments for health coaching in the NHS - the newly refreshed NHS Health and Wellbeing Coaching Framework.

Three years on from the original framework, the pair explore what has changed, what feels particularly significant and what the update might tell us about where health coaching is heading.

For both Tim and Ollie, the refreshed framework feels like an important step forward. At a time of significant change across the NHS, it offers a welcome reaffirmation of the health and wellbeing coach role, while also recognising the growing potential for health coaching beyond primary care, including in secondary care, community services and the voluntary sector.

A big focus of the episode is supervision. The new framework places much greater emphasis on dedicated health coaching supervision, clearly distinguishing it from line management, clinical and safeguarding support. Tim and Ollie discuss why this matters, particularly for coaches starting out and navigating complex, emotional and sometimes challenging conversations.

They also look at career progression and the four tiers of health coaching practice. More broadly, they reflect on the role health coaching can play in shaping NHS culture - helping people build agency, improving conversations and moving away from the idea that professionals always need to have all the answers.

Takeaways

• The refreshed NHS Health and Wellbeing Coaching Framework is a significant reaffirmation of the health coaching role.
• Health coaching is increasingly being recognised beyond primary care, including in secondary care, community services and the voluntary sector.
• The framework recommends at least one hour of health coaching supervision per month, particularly for those earlier in their practice.
• Becoming a health coaching supervisor can offer an important route for career development.
• The four health coaching tiers provide a structure for progression, but clearer approaches to assessing competence could strengthen the profession further.
• Hours of practice alone do not necessarily demonstrate the quality or maturity of someone's coaching.
• Protecting coaches from excessive caseloads allows time for reflection, supervision, administration and better conversations.
• Health coaching principles have the potential to influence the wider culture of healthcare, not just the work of dedicated health coaches.
• Building people's confidence, agency and ability to contribute to their own care can also reduce the pressure on professionals to provide every solution.
• As digital tools and AI become more prominent in healthcare, questions about the uniquely human elements of support and coaching will become increasingly important.

If you’d like to explore some of the topics discussed in this week’s episode, you can find more information below:

NHS Workforce Development Framework for Health and Wellbeing Coaches https://www.england.nhs.uk/long-read/workforce-development-framework-for-health-and-wellbeing-coaches-2/#7-competency-framework

The King’s Fund - Is the NHS ready for the AI-powered patient?https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-ready-for-ai-powered-patient?utm

Summary

In this episode, Ollie is joined by Frank, a former patient who, over more than a decade, has become a colleague, peer supporter and friend.

Frank was the first person Ollie had met with type 2 diabetes who had managed to come off insulin injections. His experience began a shared journey of learning about metabolic health, self-management, social prescribing and, importantly, the value of lived experience in helping others.

Frank reflects on his diagnosis with type 2 diabetes, his experiences of feeling intimidated by healthcare and the shame and stigma that can surround weight and long-term conditions. After years of trying different approaches, he began making significant changes to his health himself – at first without clinical support – eventually losing weight, reducing his medication and coming off insulin.

The conversation explores what happened next. As Frank became more active, cycling became not only a way of supporting his physical health but a source of friendship, community and purpose. What began with joining an adult cycling group eventually led him to establish his own, creating a supportive community where people look after one another and nobody gets left behind.

Ollie and Frank also reflect on how their relationship evolved from a traditional doctor-patient dynamic into a genuine partnership. Together, they went on to develop diabetes remission groups, roadshows and peer-led support, combining clinical knowledge with Frank’s ability to speak from experience and connect with people in a way that felt relatable, safe and free from judgement.

Throughout the episode, they explore the importance of creating healthcare environments where people feel able to ask questions, build knowledge and take a more active role in their own health. They also consider how peer support can help reach people who may feel excluded or intimidated by traditional healthcare, and why services work better when they are designed with, rather than simply for, the communities they serve.

Takeaways

• Supporting self-management means helping people build the knowledge, skills and confidence to take an active role in their health.
• Lived experience can bring a perspective and credibility that clinical knowledge alone cannot always provide.
• Peer support can help people feel understood, particularly when they are navigating stigma, shame or difficult lifestyle changes.
• Social connection can be just as important as the activity itself when supporting long-term health and wellbeing.
• Social prescribing can help people discover activities, communities and relationships that support sustainable change.
• Health professionals can learn enormously from the people they support when there is space for genuine partnership.
• Co-production means designing support with communities and responding to what works for them, rather than assuming what they need.
• Healthcare becomes more person-centred when people feel safe to ask questions, challenge assumptions and share what life is really like.
• Supporting people to become confident self-managers does not replace medical care – it can make that care more effective.
• Peer supporters can play an important role in helping others see that change is possible without blame or judgement.
• Sometimes the person who first comes through the door as a patient can ultimately become a teacher, colleague and source of support for many others.