From pilot to practice: tackling the collaboration challenge in healthtech adoption
If health technology is going to transform care delivery over the next decade, we need to be more honest about where adoption actually breaks down. Promising innovations are constantly piloted across the NHS, yet far fewer make the transition into paid, sustainable services.
This challenge was the focus of a recent workshop with Liam Cahill, bringing together NHS leaders, innovators, academics and national stakeholders to explore a deceptively simple question: why is it still so difficult for health technologies to move from pilot to routine adoption in the NHS?
What emerged was not a list of complaints or demands for sweeping reform. Instead, the discussion revealed something more fundamental. Although the NHS and healthtech suppliers depend on each other to deliver innovation, they often operate as if they sit on opposite sides of a transaction rather than working together to solve a shared problem.
The hidden cost of opacity
One of the clearest insights from the discussion was how difficult it can be for innovators to access basic information about how decisions are made within the NHS.
Suppliers are frequently expected to understand organisational priorities, procurement routes, business case requirements, funding thresholds and governance processes before meaningful conversations can even begin. Yet this information is rarely documented in a consistent or accessible way. Many companies find themselves relying on informal networks, past experience or Freedom of Information requests simply to understand how the system works.
NHS colleagues involved in the conversation acknowledged that these pathways are not always clearly mapped internally either. Decision-making structures, evaluation processes and approval routes can vary across organisations. However, the consequences are significant. Innovators spend valuable time navigating uncertainty, smaller companies struggle to compete with established suppliers who understand the system, and trust can erode before partnerships have even begun. If innovation is truly a priority, greater openness about how decisions are made would remove many avoidable barriers.
When variation slows innovation
Variation across the NHS is often seen as a necessary feature of local autonomy. In some cases it allows organisations to respond to the specific needs of their populations. However, the experience of many innovators suggests that much of the variation they encounter reflects duplication rather than meaningful local decision-making.
Companies regularly face different interpretations of information governance, different business case formats and different commercial expectations as they engage with multiple NHS organisations. Each new conversation can feel as though the process is starting again from the beginning.
This has real consequences. Extended procurement timelines and repeated processes increase costs and slow down adoption. Ultimately, unnecessary variation does not simply create frustration for innovators; it reduces the system’s ability to adopt effective technologies at pace.
The persistent funding question
Funding uncertainty also remains a major barrier to scaling innovation. For many companies, the biggest challenge is not demonstrating value but understanding whether that value will ever translate into sustainable funding.
There is often limited clarity about what level of return on investment is considered acceptable, who ultimately decides whether a solution represents good value, and how successful pilots transition into business-as-usual funding. Without clearer signals, innovators are left guessing what evidence will be sufficient to progress.
Greater transparency around these expectations would not solve the financial pressures facing the NHS, but it would help both suppliers and healthcare organisations focus their efforts on solutions with the strongest potential for impact.
Moving beyond transactional relationships
The workshop also highlighted the cultural dynamics that shape how the NHS and suppliers work together. Relationships often begin with a strong focus on risk management. Procurement frameworks, governance processes and tenders are essential safeguards, but they can also limit opportunities for collaboration at the stage when joint problem-solving would be most valuable.
Participants from both sides recognised that innovation rarely succeeds in a purely transactional environment. Progress tends to happen when organisations work together to define problems, test solutions and share responsibility for managing risk.
A shared responsibility
Perhaps the most important conclusion from the discussion was that these challenges do not belong to one side alone. The NHS does not need to be perfect, and innovators do not need special treatment. What is required is a shared recognition that the system and the supplier community are mutually dependent.
Greater transparency, more consistent processes, clearer signals about funding and better ways of sharing learning across the system would go a long way towards improving the environment for innovation.
If the next phase of NHS reform is going to unlock the full potential of health technology, the real work will begin not with another strategy, but with how we choose to collaborate.
Read the full findings and recommendations from the workshop with Liam Cahill.
