Beyond the Pilot: Why Promising NHS Tech Projects Fail to Scale
An insider's analysis of the four systemic barriers, from procurement to incentives, that prevent healthcare innovation from reaching patients.
Welcome to the third installment of Chai With Aditya.
Every year, many amazing health-tech innovations are piloted across the NHS. They arrive with great pomp, promising to save time, reduce errors, and improve patient outcomes. In a controlled environemnt, many do. But then the pilot ends, and/or the funding dries up, and the 'next big thing' quietly disappears.
This happens all too often, but why? After years working in the system, I’ve seen that the reasons have generally little to do with the tech itself. They are systemic. Here are four of the most common barriers that prevent promising innovations from scaling.
Procurement: Winning the Tender Isn't The End
Before a single patient can benefit from a new technology, it must survive the NHS procurement process. The system is designed for purchasing physical goods at scale, and often favours large established vendors over small, agile startups, regardless of who has the better product. The result is that the most innovative solutions could be screened out before they even get a chance.
Workflow: The True Cost of an Extra Click
A piece of technology can have the most advanced AI, but if it adds three extra clicks to a nurse's already too long workflow, it won’t be adopted. The most common reason for a pilot's failure is not technical, but human: a fundamental misunderstanding of the complex reality of frontline clinical work. Technology must feel like a gift, not a burden and actually save time. I’ve personally seen projects where a new tool was designed to save time and it atually resulted in increased adminastrative burden for clinicians. Instead they find workarounds to avoid it (usually by calling it an admin task).
Data Disconnect: Innovation in a Silo
You may have heard the phrase, data is the new oil? Modern healthcare technology is powered by data. However, the NHS often runs on fragmented and disconnected, legacy systems where information is siloed. A new application might be brilliant in isolation, but it can't deliver its full value if it can't speak to the other systems in the hospital, creating what I call "innovation in a silo."Without the right information, the new tool is starved of the right data needed to be effective, and so cannot generate the right insights.
Misaligned Incentives: A System That Buys Sickness Care
Ultimately, organisations do what they are paid to do. In a system where funding rewards activity (treating sick people) more than outcomes (keeping people healthy), the business case for investing in long-term preventative technology is surprisingly difficult to make. This creates a systemic barrier to preventative innovation. I’ve sat in meetings where innovations which generate savings in five years are turned down, as the financial pressures are today and so solutions must be cash saving within the financial year. Perhaps unfair, but this is the truth.
Conclusion
These challenges can be solved but they require a shift in approach from both innovators and policymakers. We need to move beyond just asking 'what can this technology do?' and instead ask 'how does this technology fit into our complex reality?' We must design for our workflows, fix our data infrastructure, and align our incentives towards a healthier future.
What have I missed? What other major barriers to technology adoption have you witnessed in the NHS?
Further reading: Dissecting reality: navigating the implementation gap of AI in the NHS