There is a particular kind of frustration that runs through the NHS innovation landscape – one so familiar it has acquired its own name. 

"Pilotitis" is the condition in which promising ideas are tested, proven and then left to expire. Their evidence base is often convincing to clinicians but insufficient to unlock the sustained funding, procurement routes and organisational will needed to take them anywhere. 

The result, as one speaker put it, is that something brilliant is happening everywhere – just not consistently, and rarely for the people who need it most.

Two sessions at this year's NHS ConfedExpo examined this problem from different angles. The first, 'From pilotitis to progress', took a system-wide view, asking what needs to change structurally, financially and culturally for proven innovations to reach whole populations rather than select communities. 

The second focused on cancer specifically, exploring how AI and digital tools can help translate the ambitions of the National Cancer Plan into routine clinical practice. Together, they offered both an honest diagnosis of why the NHS struggles to scale innovation and some practical pointers towards what better might look like.

The structural problem

The opening session, chaired by Andy Cowper, Editor of Health Policy Insight, began with a question put to the audience: will the UK realise its ambition to be the third most valuable life sciences economy in the world by 2035? Most said they did not know, a telling answer in itself.

The diagnosis that followed was familiar but no less urgent for that. Financial cycles are annual, innovation horizons are not. NHS trusts, facing various pressures and now undergoing organisational change, often treat research as optional rather than core. Many may benefit from building it into their thinking from the outset. 

Digital innovators trying to sell into the NHS find themselves repeating the same regulatory and procurement process trust by trust, absorbing costs that can run to between £200,000 and £300,000 before a product is even built – and eventually concluding it is simply easier to go to countries such as the United States, where it’s easier to access finance and receive approval by a globally recognised regulator in the FDA.

Professor Sir Stephen Powis, Senior Advisor at Hanover Communications, pointed to the postcode lottery that results. Mechanical thrombectomy – a procedure that prevents serious disability in stroke patients – should be available to between 10% and 15% of eligible patients nationally, yet coverage is deeply uneven. 

Someone having a stroke in London has four specialist centres open overnight within 20 minutes, he claimed. The same person in Newcastle or Middlesbrough may have none available.

Such inequal access to healthcare depending on region is “completely unacceptable”, Powis said. The spread of world-class best practice simply does not happen consistently enough, and the consequences fall hardest on those already least well served.

Rosalind Campion, CEO of the Academy of Medical Sciences, identified a deeper issue that society has not yet made a clear collective decision about the value it places on health innovation. Without that, financial flows can’t follow intent. Short-term thinking dominates, modelling substitutes for measurement, and innovations that could transform outcomes are evaluated against criteria that can’t capture their full value to the system. 

The Academy is working with economists to develop a more sophisticated approach – one legible to both politicians and the public – which starts from different questions about what healthcare innovation is actually worth.

Dr Douglas Clark, Medical Director for the UK and Ireland at Boehringer Ingelheim, pointed to data as a critical enabler that remains underused. England has a genuinely rich data landscape, and the opportunity to build interoperable records linking primary and secondary care is real. 

The use case is threefold: understanding how services are actually being delivered and where resources should go; identifying populations earlier for preventive intervention; and moving from modelling the impact of innovations to actually measuring it. 

Work in Manchester on chronic kidney disease, using data to build neighbourhood-led prevention strategies, illustrated what becomes possible when those threads are connected.

Cancer as a case study

The afternoon session sharpened the focus on cancer – an area where the gap between what is technically possible and what patients routinely receive remains stark. The National Cancer Plan has set out an ambitious programme of earlier diagnosis, faster treatment and more equitable outcomes.

The session's central argument, articulated by Professor Richard Simcock, Chief Medical Officer at Macmillan Cancer Support, was that the NHS does not do enough to measure impact in ways that are persuasive to funders – and that without credible measurement, the cycle of promising pilots and stalled scale-up is almost inevitable. 

The answer lies in more sophisticated partnership models that think carefully about exit strategies from the outset. Outcomes-based contracting, in which capital is advanced on the basis of agreed outcomes and recycled when those outcomes are achieved, offers one route, particularly in areas like end-of-life care where the value to the NHS is quantifiable.

Dr Miles Payling, Chief Scientific Officer at C the Signs, which has developed an AI-based clinical decision support tool to assist GPs in identifying and referring patients at risk of cancer, offered a candid account of what building technology for the NHS involves. 

The early lesson was that optimising for a single metric is rarely sufficient – different stakeholders need to see different kinds of value, and a product that works for the patient but creates friction for the GP or offers no legible return to the commissioning authority will not be adopted. 

The solution his team arrived at was to design around clinical workflow, automating as much of the process as possible so that clinicians could focus on outcomes rather than administration. His company’s AI tool uses electronic health records to identify patients at risk of cancer, but its adoption depended on making it genuinely useful to the people using it day to day, not just to those evaluating it from a distance.

Dr Sarah Byron, Programme Director for HealthTech Strategy and Development at the National Institute for Health and Care Excellence (NICE), described work underway to address one of the most significant structural barriers – the duplication of effort that innovators face every time they engage with a new NHS trust. 

Assessing evidence, checking regulation and navigating information governance are processes repeated from organisation to organisation, absorbing time and money that could be spent on the innovation itself. The HealthTech Access Programme is designed to streamline this, applying to health technology the kind of structured access pathway that already exists for medicines.

What would actually change things?

Across both sessions, a number of common themes emerged. The first is culture. One speaker at ConfedExpo observed that Covid was, for some, “the good old days” – not because conditions were good, but because there was a shared sense of purpose that allowed innovation to move at a speed the NHS rarely achieves in peacetime. The National Cancer Plan potentially offers a comparable galvanising focus by beginning with the clinical problem, building consensus around it and then asking what technology can do to support the solution – rather than starting from the technology and working backwards.

The second theme is honesty about inequalities. Clark was direct: if an innovation is piloted in one locality and it works, by definition those outside that area are being disadvantaged. Acknowledging that openly, and then driving scale at pace, is not just an ethical obligation, but the only credible response to a system that is supposed to serve whole populations.

The third is partnership between NHS organisations, industry, academia, the charitable sector and communities themselves. Building trust with communities is not incidental to innovation, it is a precondition for it.

None of this is simple, and no speaker pretended otherwise. But the cumulative argument from ConfedExpo was that the tools, evidence and policy framework are increasingly in place. What remains is the harder work to align incentives, build sustained partnerships and find the collective will to move from pilots to population-level impact.

That harder work has a legal and structural dimension that deserves more attention than it typically receives in these conversations. 

Our view

Our recent white paper on Advancing Inward Investment into the UK Health Sector, in partnership with Healthcare World, argues that the NHS's fragmented procurement landscape, with frameworks managed across hundreds of trusts and Integrated Care Boards, functions as a structural deterrent to the very innovators the NHS most needs to attract. 

The experience described at ConfedExpo, of companies spending hundreds of thousands of pounds before a product is even built and then repeating the same regulatory and procurement process trust by trust, is exactly the problem. Clearer pathways through which successful pilots can progress to longer-term contractual arrangements would provide the contracting certainty that sustained investment requires.

On data, our white paper's argument is equally pertinent: the NHS's health data assets represent a genuinely distinctive competitive advantage, but realising it requires accelerating the integration of primary, secondary, community and social care datasets, as well as addressing the legal and regulatory barriers to data sharing that prevent the interoperable infrastructure that Clark described as essential. 

More fundamentally, the NHS needs to leverage its global reputation to attract sustained, strategic investment – moving beyond the annual funding conversation towards the kind of long-term commercial and governance frameworks that allow innovation to scale.

The gap between what is technically possible and what patients routinely receive is not primarily a gap in evidence. The evidence exists. It is a gap in the systems, structures and incentives that determine whether evidence translates into routine practice. Closing that gap is as much a legal and commercial challenge as it is a clinical one.