This week: I have spent a long time inside health equity conversations that look convincing from the outside but feel hollow once you get close to how decisions are actually made.

They live in policy papers, conference panels, strategy decks, and funding applications. They use the right language. They reference the right communities. They signal intent.

And yet, the same patterns repeat.

The people most affected by healthcare decisions remain distant from power. Funding incentives quietly shape behaviour. Lived experience is invited in, but rarely allowed to change anything that matters.

I started Unwritten Dispatches because I needed a place to write more honestly about that gap. Not as critique from the sidelines, but as someone actively building inside it.

This is not a newsletter about best practice. It is where I document how my thinking is changing as the work becomes more real.

This first Dispatch pulls together three threads I have been wrestling with over the last few weeks: how funding shapes behaviour, why lived experience panels so often fail to deliver what they promise, and why accountability is the missing link between the two.

I no longer believe most initiatives drift because founders or teams lose their values. What I see, again and again, is something more structural.

In the UK, less than 1% of venture capital has historically gone to Black founders. All-female founding teams received around 1% of UK VC funding in 2022. Grant funding tells a similar story. Innovate UK data shows that the vast majority of recipients identify as White, with ethnic minority and disabled founders significantly under-represented unless they apply through targeted schemes.

I am writing this as an only child of Indian immigrants, without family wealth, inherited capital, or informal networks to fall back on, in an ecosystem that routinely assumes founders can begin by approaching friends and family for early funding. That assumption shapes who gets to take risk, who can afford to fail quietly, and who never gets to start at all.

Funding frameworks tend to favour certainty, speed, and clean narratives. Health equity work rarely offers any of those things. It is slow. It is relational. It involves uncertainty, disagreement, and trade-offs that do not compress neatly into milestones.

When funding timelines are tight, engagement becomes rushed. When outcomes must be pre-defined, complexity gets smoothed away. When scale is prioritised early, trust is treated as something that can be bolted on later.

I have watched well-intentioned teams start with care and curiosity, only to find themselves optimising for funder expectations rather than community reality. Not because they wanted to, but because the funding structure made it feel necessary.

If we do not interrogate how money shapes behaviour, we end up blaming delivery teams for failures that were structurally baked in from the start.

What’s next: I am now spending time looking at different funding routes and having more honest conversations about what kind of capital this work actually needs, and what it cannot be built around.

Lived experience panels are frequently positioned as the corrective to these problems.

Bring people into the room.

Listen to them.

Learn from them.

And sometimes, this genuinely helps.

I have seen panels influence language, improve design, and surface blind spots that teams had not noticed. When they are brought in early, resourced properly, and treated as experts rather than storytellers, they can add real value.

But I have also seen a consistent failure pattern.

Panels are formed after strategy is set. People are asked to react rather than shape. Stories are collected, but decisions remain unchanged. Participants feel heard in the moment, but see no evidence that anything shifted as a result.

In some cases, people are repeatedly asked to share deeply personal or traumatic experiences without adequate safeguarding, compensation, or clarity about how their input will be used. In others, dissenting voices quietly disappear because they make the room uncomfortable.

The result is not malicious. It is structural.

Lived experience becomes symbolic rather than influential.

It reassures organisations without redistributing power.

I am increasingly uncomfortable with advisory-only models for this reason. Advice without consequence is not partnership. It is consultation.

The distinction I keep returning to is between listening and accountability.

Listening is about collecting insight. Accountability is about what happens next.

Listening asks me what people said. Accountability forces me to ask what I changed because they said it.

Listening can end with a report, a panel, or a quote in a deck. Accountability requires ownership. It requires being explicit about which decisions are open to influence, who is responsible for acting, and what will not change and why.

Most systems are very good at listening. Very few are designed to be answerable.

That gap matters.

As I have sat with this distinction, I have also been thinking more seriously about how lived experience is valued in practice. One patient expert said something to me recently that stayed with me. They said, “You would pay for financial expertise. You would pay for legal expertise. This is no different.” That reframed things for me. If I am asking people to bring judgment, context, risk, and responsibility into the work, then asking them to do that unpaid, or without any structural recognition, starts to feel inconsistent with the standards I apply everywhere else. That is why I am now exploring not just compensation, but whether equity or other funding models for the panel make more sense. Not as a reward, but as a reflection of responsibility. I do not know yet what the right mechanism is, but I am clear that treating lived experience as “input” while everything else is treated as expertise is a distinction I can no longer justify.

Inviting lived experience into a process without being clear about where power sits can quickly become extractive, even when intentions are good. People give time, energy, and trust, but have no visibility over how decisions are made or whether their input had any effect.

This is where trust erodes.

This is the point where my thinking has started to shift more materially.

I am no longer convinced that panels alone can carry the weight we place on them. If lived experience is always advisory, and never structural, power never really moves.

There are models that do this differently.

Across the UK and Europe, cooperative and shared-governance approaches have shown that it is possible for people with lived experience to hold real influence. NHS Foundation Trusts were originally designed as member-led organisations. In Wales, social care cooperatives have embedded service users as members and board participants, shaping how care is delivered and governed.

These models are imperfect and complex. They raise real questions about legal structures, risk, and decision-making. But they do something important.

They make accountability unavoidable.

Ownership changes incentives.

Governance changes behaviour.

Equity changes who benefits when something succeeds.

This is why I am actively exploring whether equity or shared ownership has a role to play in how the lived experience panel at Unwritten Health is structured. Not as a gesture, and not as branding, but as a mechanism that forces responsibility rather than just consultation.

I do not have the final model yet. I am deliberately not rushing this.

If you have experience with cooperative structures, shared governance, or equity-based participation in health, research, or mission-led organisations, I would genuinely welcome learning from what worked and what did not.

As I build Unwritten Health, I am holding myself to a simple test.

If I am not prepared to change what I am building, I am not ready to ask people to contribute their lived experience. That test applies to funding, governance, and data. It is the line I keep coming back to when decisions feel ambiguous or uncomfortable.

This way of working is slower. It introduces friction. It narrows some options while opening others. But it feels honest, and it feels aligned with the kind of organisation I am trying to build.

Alongside Dispatches, I am also committing to sharing a short Still Unwritten reflection each week, the first one is at the bottom of this post. These are not updates or announcements. They are brief moments where I name what I am sitting with as a founder, often before I have resolved it. Dispatches holds the longer thinking. Still Unwritten is where the uncertainty lives. Together, they are my way of building in public without pretending I have it all figured out, and without outsourcing that honesty to polished narratives.

I do not see this Dispatch as a conclusion. It is a record of where my thinking is right now, as the work becomes more real and the trade-offs more visible.

If this way of building resonates with you, and you invest, advise, support innovation funding, or know someone who does, I would welcome a conversation.

More to come.