To gain insights and perspectives from across the industry, HTN asked a variety of NHS and health tech professionals: what is holding the NHS back from innovation, and what is needed to break these barriers?
From NHS Norfolk and Waveney ICB and ICS, head of innovation Dr Tim Clarke said that a lack of ring-fenced funding for innovation culture, implementation capacity and deployment is a key factor in holding the NHS back from innovation, along with lack of clarity on expectations and knowledge on how innovation can be funded from existing budgets. Additionally, he listed barriers including centralised innovation clinical discipline approval that can be shared; delays in innovation testing in NHS to guidance; implementation to support; and innovation not being prioritised as part of transformation or wider improvement agenda.
What is needed to break these barriers? “More joined up innovation functions across the NHS innovation ecosystem,” reflected Tim. “Dedicated innovation funding that is recurrent and consistent; specialist and wider articulated support from enabling organisations/teams for innovation support; and a better way to share innovation efforts and lessons across the NHS.”
Bex Cottey, business manager, Conisbrough Group Practice shared her views, stating that a key barrier for the NHS is “simply its size – there is little autonomy over funding spend in smaller innovative groups or sectors of the organisation. When funding is provided it comes with so many strings attached and reporting guidelines that is becomes prohibitive in how it can be used.”
“I would say that the culture of procurement needs to change,” reflected Ruby Bhatti, chair of the Wolfson Centre for Applied Research and chair for the Quality and Safety Patient’s Panel and Improvement Academy at Bradford Institute for Health and Research. “Chief officers are fire fighting everyday issues in the NHS and really don’t have time, investment and sometimes the understanding of how innovation can change and support patient care. They only commit to innovations that have that immediate positive result but not the time to invest in innovations that may need time to develop.” As for how these barriers can be overcome: “Providers need training and, more understanding about commercial decisions,” Ruby states. “They need motivation and a reason to engage from all areas. It needs a culture change from the entire workforce.”
From University Hospitals Birmingham NHS Foundation Trust, chief strategy and digital officer Mohammed Hussain shares a number of key factors holding the NHS back from innovation in his view.
Listing short-term financial planning as the first barrier, Mohammed says: “Funding for innovations have historically been short-term or calls for exploring or deploying innovations often have a requirement to spend money quickly and demonstrate a return on investment. Innovations by their very nature may be untested and an element of risk should be accepted. Central funding for innovation is often not ring-fenced and has been historically raided/frozen as seen recently with re-provisioning capital and digital funding to compensate for national pay awards. More attention is therefore required on how to build longer term planning when it comes to resourcing innovations in the NHS and shifting the culture to fail fast but also learn fast.”
The next barrier raised by Mohammed is that “research and evaluation aren’t often done well”. Here, he elaborates: “Organisations should start to generate detailed data on what is really working. Proper evidence is sometimes missing and there can be a culture to “over-call success” leading to hype and opinion disguised as fact. Learning from clinical/drug and therapeutic trials, a research based approach to examine the benefits (intended and unintended) and ‘side effects’ should be developed and virtual simulations/labs could be created (given advancements in technology) to apply and map out variables.”
Next, he draws attention to the barrier of inflexible culture and capacity. “There is limited capacity by those who do the work to think about how to improve it as they are busy running/delivering services. Creating capacity to innovate is therefore key, especially from a user perspective as they are closest to the ‘problem’. Similarly, for true disruptive innovation to take a hold, there needs to be encouragement to break away from traditional models of care, translational learning may be a useful starting point to consider.”
Finally, Mohammed highlights translation and scalability as a barrier. “Translating learning/innovations from one industry to another is sometimes done but often as a complete package rather than distinct aspects. Similarly, innovation spread is often limited by not thinking about how the application could be scaled up/ mass marketed whilst still maintain a focus on problem led, rather than solution led. Unlike the private sector, there is therefore a lack of time/capacity in taking the product/innovation to market causing poor and differential adoption.”
Radar Healthcare’s CEO and co-founder Paul Johnson raises barriers such as “the overwhelming number of data sources within the healthcare sector”, elaborating that whilst integration and analysis of this data is “crucial”, it places a heavy demand on resources.
To overcome this, Paul hopes to see a system “capable of integrating third-party software and devices”, saying that this “would allow for the automated analysis of data, facilitating actions from a combination of devices and systems”. This tech, he adds, would enable “informed and insight-driven decision-making by integrating data, preventing duplication and allowing quicker intervention”.
Hanley Consulting’s managing director Sharon Hanley shares the view that “the real-world application of technology in the NHS is far behind the technologies available. There are many efficiencies and process improvements that can be gleaned from various available technologies, but the implementation of these is very often met with digital fatigue, aversion to risk, and a lack of protected time to implement them. The technological solutions have already been developed and continue to appear at a rapid rate.”
To break barriers, she said, “they need to be applied correctly to build confidence in the message that digital transformation is of real benefit to the population, as people have yet to really see it in action.”
To address this, Chris suggested that “rather than add more and more security and safety requirements for innovators and NHS teams, the system needs to provide innovators and NHS teams with the funding, support and automation tools to ensure compliance is streamlined, maintained and visible to all”.
From Clinitouch, chief medical officer and co-founder Dr Noel O’Kelly highlights barriers from “increasing bureaucracy in decision-making, to constant changes in leadership structures that only add to the confusion, innovation becomes a tedious, drawn out process when quick and impactful solutions are needed. We can’t ignore frontline clinical engagement either; a top down approach and general low morale amongst the workforce does nothing to encourage staff to contemplate new ways of working. We must support the local innovation ideas from frontline services that will have a genuine impact on the local delivery of health care, and help to get them aligned to the overall strategic vision and objectives of the wider NHS.”
Noel acknowledged the need for balance between “accountability at a larger scale and devolving decision making and budgets to more locally based health communities, but I’m not sure we’ve got this right.We also can’t ignore organic growth and building from the bottom. There’s nowhere near enough reward or investment for innovation projects that show outcomes and learnings, enabling them to expand their rollout. When we keep reinventing the wheel, is there any wonder innovation is lacking?”
“Difficulty in seeing past the current financial/staffing pressures and invest for the future, with most procurement decisions made by management who are most interested in the next financial year,” states Mr Edward St John, co-founder & chief medical officer, Concentric Health, with regards to the main barriers facing the NHS when it comes to innovation. To tackle this, he said, strategic decisions should be made by clinicians and policy makers with an attitude of looking forwards, for a 10-year perspective.
Another barrier is that the “clinical environment can make a ‘fail fast’ attitude towards innovation very risky from a patient safety point of view, and there is limited ability to sandbox and test in a safe environment”. To counter this, Edward suggests the development of more ring-fenced sandbox environments to allow new innovations to test in.
Other challenges include variation in the introduction of new innovations and the fact that some processes remain reliant on paper; solutions here could be standardising the requirements of committees and processes, and supporting digitisation of niche areas to allow a 100 percent focus on electronic means.
Edward also shares his view that digital infrastructure is in itself a challenge, with a “continued desire to have one main provider” despite “bespoke specialist applications providing better services and features. Interoperability has been a buzz word for a while, but can be hard to action.” The NHS has the ability to “force interoperability, and it should”, he states.
From Evergreen Life, founder Stephen Critchlow comments: “A ‘first do no harm’ environment does not set up an organisation for innovation.“The challenge is always to stop errors occurring with changes to process each time one occurs. There is not a similar regular trigger to mean that innovation is required, and this means all managers and staff are praised for continuity and predictability over delivering outcomes. Waiting lists are seen as an inevitability rather than a risk. If a doctor has not seen a patient, they are not at risk of providing the wrong treatment. If the waiting list is too long they are not held to account.
“We then let doctors work for both the NHS and do private work where there is an obvious incentive to have long waiting lists that drive demand for private options. Why don’t we decide to reward loyalty with well paid NHS permanent contracts that don’t allow private work as well and then reward regularly those who innovate holding them to account if they don’t?”
Ruby Kuzemko, healthcare lead at Cloud Gateway, reflects that a key feature driving digital transformation is that of the unified patient record. “The benefits of unifying previously fragmented data, improving care continuity and easing administration are clear to see. But achieving this vision requires facing some big hurdles, particularly in security and infrastructure.”
“Creating a single, secure record requires resilient networking infrastructure that can support secure data access. As well as robust cybersecurity measures, like zero-trust architecture, DDoS protection and data encryption, to protect sensitive data from cyber threats, safeguard sensitive patient information and maintain public trust. Without these protections, the risk of breaches could deter progress, especially given the high-profile NHS cybersecurity incidents that have happened in recent years.”Ruby also notes that health tech companies can encounter challenges when working with NHS systems, point out that whilst they “bring advanced tools like AI diagnostics and personalised care, they must navigate strict data regulations, which can slow integration and innovation. In the end, a secure, seamless digital infrastructure is critical. By tackling the security and integration barriers, the NHS and its partners can pave the way for a more efficient, responsive healthcare system that supports meaningful, lasting innovation.”
“Frontline staff are incredibly innovative. We’ve seen this time and time again over the past eight years. It’s the lack of headspace, particularly for leadership, which is where it can fall down,” considers Jacob Haddad, CEO and co-founder of Accurx. “The operational pressures, often involving emergency care, will always take priority, and this is entirely understandable.”
However, Jacob continued, innovation is “essential to addressing those pressures long-term, so headspace simply must be created for healthcare to continue working. There are two things we’ve seen address this. Firstly, empowering frontline staff to change things for the better, so they don’t have to wait for big initiatives or permission. Secondly, making a senior leader responsible for a big long-term problem, like outpatient transformation, and removing their other responsibilities. That way their headspace is protected.”
It’s about funding, according to Grace Gimson, CEO Holly Health. “The major bottleneck is in the scaling of proven technologies from local deployments to regional and beyond. What prevents scaling is lack of investment in these technologies. What is needed is for regional ICB leaders and central NHS England leaders to commit small amounts of capital up front for scaling proven health technologies, to prevent 10x greater costs which will come later as a result of not being more proactive now.”
Dr Marcus Baw, GP, clinical informatician and software developer, focuses on the issue of procurement. “The traditional procurement mechanisms prevalent in the NHS’s organisations result in an incapability to experiment, innovate, develop and learn,” he says. “It perpetuates long contracts with bad software from in cases unresponsive software suppliers. It wastes months of people’s time, preparing the endless procurement documentation. It empowers risk-averse leadership and frustrates innovators.
“Procurement cannot cope with agile development, research, learning and iteration, preferring immutable contracts, lengthy specifications and clunky systems which don’t update with user needs because the specifications are set once at the start and they can’t be changed without a new procurement. Procurement can only ever procure a system that is owned by an external company, meaning the intellectual property of the solution is never retained by the NHS even though many millions of hours of NHS staff time have been ‘donated’ into helping build other companies’ solutions.”
Despite this, Marcus continues, procurement “slowness and bluntness” and “catastrophic project failure”. He cites “total market stagnation (as we see in the current GP system market)” as factors.
There are solutions, he concludes, but there is a “closed-minded culture in NHS organisations that refuses to learn from the wider tech world and side-step procurement entirely, by building in-house technical capability within the NHS; creating shared NHS-wide open source products; and lowering both the time to build and the total cost of ownership of such solutions”.
From System C, CEO Nick Wilson comments that “innovation can be hard – but one of the techniques which I’ve seen deployed well by the NHS, especially in a crisis situation, is to take small steps, try them, and when they work, reinforce that success. If it doesn’t work, then try something else. Sometimes we get hoodwinked by the allure of an all singing all dancing solution that sounds great, but often takes so long and gets so complex that it misses the target. Try bite sized, pragmatic, innovations, do them quickly, build on what is effective today and fail fast when they don’t work. In short – don’t let excellent be the enemy of good!”
Scaling digital innovation is a key challenge, according to Chris Davies, CEO, The Institute of Clinical Science and Technology. “While local pilot projects frequently show promise, translating these successes into system-wide initiatives requires a cohesive framework that supports large-scale implementation. To fully realise digital innovation’s potential, it’s essential to prioritise tools that integrate effectively across care pathways, addressing issues such as chronic disease management, waiting list backlogs, and patient empowerment.”
Chris adds: “A shift towards patient-centred digital solutions is equally crucial. Empowering patients to manage their health through accessible digital tools can reduce demand on frontline services and aligns well with the prevention and early detection goals outlined in the NHS Long Term Plan and the Darzi Report. By adopting a responsible, scalable approach to digitalisation, informed by lessons from other industries, the NHS can foster a more engaged, empowered patient population while creating a more sustainable healthcare system.”
Dr Anas Nader, co-founder and CEO Patchwork Health, notes that whilst data is a “huge obstacle to digital transition”, it is “also our biggest opportunity. Our health service collects vast amounts of operational, workforce and patient data every day, but it’s rarely joined up or truly capitalised upon as a result of siloed systems. This fragmented information represents a major missed opportunity for service improvement and financial grip and control, as well as a chance to ease the burden on clinicians and remove frustrations for patients.
“If we can’t surface, connect, and learn from data, we’ll never truly unleash the full power of digital tools – they too will remain in silos. Nor will we ensure systems across the health service operate smartly and in harmony with each other. In order to break this barrier and unlock the impact on offer, we must first understand where valuable data is held across the system. We then need to use software and machine learning tools to bring it together and surface insights. Only then will staffing teams be properly equipped to action those insights and capitalise on this knowledge to make informed, data-driven decisions.”
Last but not last, babblevoice co-founder and product and innovations director Nick Knight reflects that innovation in the NHS is “hampered by a highly fragmented institution with a cultural resistance to change. But I do believe there is hope for the future! A renewed focus on integrated strategies that unify approaches to change across business units and regions would enable innovations to take hold and bring about sustainable improvements.
“Our work with primary care has shown us that prioritising workforce engagement is critical. An emphasis on collaboration with consideration for the right training and support for clinicians, managers and their teams empowers people to have the confidence to embrace the use of innovative tools.”
Thanks to all contributors for taking part.
