NHS innovation isn’t failing... it’s getting stuck

With a new ten-year NHS strategy on the horizon, innovation has never been higher on the agenda.

But as a recent panel featuring clinician-entrepreneur Dr Krishan Ramdoo and Neuronostics co-founder Professor John Terry highlighted, the real challenge isn’t generating ideas; it’s making them work at scale.

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The shift is happening… slowly

There’s no doubt the NHS is becoming more receptive to innovation. The rise of AI, growing clinician interest in entrepreneurship, and programmes like the NHS Clinical Entrepreneur scheme are all contributing to a cultural shift. But that progress comes with a caveat:

Adoption remains slow, fragmented, and inconsistent.

As our panellist Dr Krishan Ramdoo put it, innovation in the NHS is “long and hard”, particularly when it comes to proving impact and gaining system-wide traction.

Evidence is the currency of change

If there was one consistent message, it was that ideas don’t move the system; evidence does.

And not just internal data. Independent validation plays a pivotal role in unlocking adoption, particularly in a system that is necessarily risk-averse. Alongside clinical proof, health economic data is essential. Even the most effective and impactful innovation will struggle to gain traction if it can’t clearly demonstrate cost-effectiveness.

In this context, innovation becomes less about invention and more about building a compelling, evidence-based case for change.

A system built for complexity

One of the biggest barriers to innovation is structural. Because the NHS is not a single entity, it’s a network of organisations, each with its own procurement processes, priorities, and decision-making structures.

Naturally, this creates challenges around procurement fragmentation, lack of clear accountability, and uncertainty around funding ownership. In practical terms, this means innovators often find themselves having the same conversation multiple times across different organisations; each with different requirements.

This systemic complexity points to one thing: more friction, more frustration and slower adoption.

The case for collaboration

Given these challenges, collaboration between the public and private sectors is not just beneficial; it’s absolutely essential.

While the NHS offers unparalleled access to clinical expertise and patient data, the private sector brings agility, capital and the ability to scale innovation quickly. But perceptions still pose barriers. Historical scepticism towards commercial involvement in healthcare continues to influence decision-making.

Overcoming this requires a shift in mindset towards a model where both sectors are aligned around a shared goal: better patient outcomes.

The move to community care

Another clear direction of travel is the shift towards community-based healthcare.

Patients increasingly expect to be treated closer to home and innovations that support this model- from diagnostics to digital tools are likely to play a significant role in the NHS’s future. Technologies and practices like this will be even more vital in rural and underserved areas – where technology is enabling care to move out of hospitals and into communities.

The challenge now is ensuring systems support that transition effectively.

The founder reality

Behind every innovation is a team navigating a complex, resource-constrained journey.

From securing funding and navigating regulatory requirements to building the right team and generating credible evidence, the path from idea to impact is far from straightforward.

That difficulty isn’t just about the product. It’s structural. Healthcare innovation demands time, evidence and capital but rarely in so predictable a sequence. Funding comes in stages, often before outcomes are proven, leaving founders to carry risk while trying to demonstrate value in parallel.

There is also not an infinite amount of capital, a reality that forces constant trade-offs between progress and sustainability. This pressure is compounded by the system itself. Pilots, validation and adoption all take time, meaning founders must often “play the long game”, investing ahead of certainty, with no guarantee of scale.

What ultimately determines whether that journey holds is the team. The founder’s ability to recognise gaps and build around them is what turns a clinical insight into something commercially viable.

For many, that shift is profound. You’re an academic or a clinician, then all of a sudden you’re running a company.

It’s a transition that exposes another challenge: knowing who to trust.

In an ecosystem crowded with advice, not all of it is useful, and as Dr John Terry puts it, “there are lots of people who claim to be able to help,” so discernment becomes part of the founder’s role.

The result is a version of innovation that looks very different from the outside. Less about breakthrough moments, more about endurance. Because in this space, success isn’t just building something valuable; it’s staying in the game long enough for the system to recognise it.