Getting NHS innovation from pilot to national adoption is one of the biggest challenges facing life sciences companies today — and the NHS itself.
Understanding why pilots stall, and what the NHS now needs from industry to move beyond them, is essential for any company seeking scaled NHS adoption in 2026.
The NHS has never been short of innovation pilots. What it has consistently struggled with is what comes next. Technologies that demonstrate clear clinical value in a single Trust, a primary care network or an ICB programme routinely fail to spread beyond the original site. Others get repeated in a new location by a team that is unaware the same evaluation has already been conducted elsewhere. The result is a landscape of promising innovations that spend years in a cycle of local pilots without ever reaching the patients who need them at scale.
This is the problem that NHS leaders, life sciences companies and policymakers describe with growing frustration as “pilotitis”. At NHS Confed Expo 2026, the NHS England National Clinical Lead for AI said “We need to stop doing pilots. The time has come to move together.” The King's Fund roundtable on innovation, economic growth, medtech and the NHS reached the same conclusion, describing a system that needs to move “from a culture of pilots to a culture of delivery.”
The problem applies as much to pharmaceutical patient programmes as to technology: medicines with strong evidence of benefit routinely fail to reach the patients who need them because the pilot that demonstrated their value in one setting was never designed to scale.
Several structural changes are now underway that begin to address the problem. None of them, individually, solves it, but together, they represent the most significant shift in NHS innovation infrastructure in a decade and understanding what they do and do not change is essential for any company bringing a technology to the NHS.
The reasons an innovation stalls after a successful pilot are rarely about the technology itself. A pilot typically operates with dedicated project management, grant funding, motivated clinical champions and an evaluation team. It runs in conditions that do not reflect routine NHS operation. When those conditions are removed, the barriers that the pilot masked become visible: IT integration requirements, procurement framework inclusion, staff training at scale, pathway redesign across multiple departments and the fundamental question of who pays for it from which budget once the pilot funding ends.
A lack of funding certainty is consistently identified as the biggest single barrier. For many companies, the challenge is not demonstrating that a technology works but establishing whether that value will ever translate into sustainable commissioning. Decision-making structures vary across organisations, evaluation processes are not standardised, and the route from a successful pilot to a business-as-usual contract is often unclear to both the company and the NHS team involved. As the NHS Accelerator noted in its March 2026 analysis of the healthtech adoption challenge, innovators are frequently left guessing what level of evidence will be sufficient to progress, and who ultimately decides.
Variation across the NHS compounds this. With more than 1,400 procurement frameworks managed across Trusts and ICBs, a technology that has been adopted by one organisation cannot simply be transferred to another. Each new site requires its own approval process, its own procurement decision and its own integration work. Companies that reach one site face the prospect of repeating that entire process dozens of times before achieving anything resembling national reach. The Kings Fund roundtable on medtech and innovation, cited above, captured this dynamic: national incentives, including league tables, discourage collaboration and sustain the silos that make scaling solutions so difficult.
The most substantive structural change is the shift to value-based procurement for medtech, which is now being rolled out across the NHS following pilots at 13 NHS Trusts. The new DHSC value-based procurement guidance, launched in October 2025 and entering wider rollout in 2026, introduces a standardised framework for assessing value at the quality stage of procurement across five domains: social value, efficiency, patient and staff outcomes, supply chain resilience and purpose, alongside a whole-life cost assessment. The NHS currently spends around £10 billion a year on medical technology, and the shift away from lowest-cost purchasing toward outcome and pathway value is, for companies that can demonstrate that value, a notable change in the commercial conversation.
The guidance is being adopted by NHS Supply Chain for three forthcoming framework tenders covering cardiology and vascular, negative pressure wound care and infusion pumps, and by the London Procurement Partnership for its clinical AI framework. For companies competing in those categories, the ability to evidence whole-pathway value, including productivity gains, reduced length of stay, avoided admissions and patient-reported outcomes, is highly valuable.
Fifteen Health Innovation Networks (HINs) operate across England, established by NHS England to accelerate the spread and adoption of innovation at local and national level. Each HIN is embedded in its regional health and care ecosystem, working with NHS organisations, academia, industry and the voluntary sector. Nationally, the network maintains a searchable pipeline of more than 1,600 ready-to-implement technologies and pathway transformations across all clinical themes.
For industry, HINs offer a practical route into the NHS that sits between the regulatory and assessment pathway and the full commercial rollout. They support companies in generating the real-world evidence that commissioners need, in navigating local adoption decisions and in spreading what works across multiple sites without each requiring a separate commercial negotiation. Their work covers medicines and patient programmes as well as technology: a HIN can support a pharmaceutical company in spreading an evidence-based patient programme that has demonstrated value in one ICB but has not been picked up nationally, the same structural problem that faces digital products. Companies looking to move beyond a single successful pilot should consider HIN partnerships as part of their scaling strategy, alongside the procurement and policy routes described above.
The launch of the National HealthTech Access Programme (NHAP) in February 2026 addresses the adoption problem for a small number of high-impact technologies by extending the legal funding mandate previously reserved for NICE-approved medicines to health technologies. As we set out in our earlier post on NHS medtech market access, the NHAP is deliberately narrow in scope. It is not a general solution to the adoption gap. But it establishes an important precedent: that a diagnostic or digital health technology can carry the same commissioning obligation as a medicine when the evidence and system-level impact justify it. The NHAP’s first topics, AI tools for cancer histopathology and capsule sponge testing for oesophageal cancer detection, are both technologies that have spent years in exactly the kind of pilot cycle the programme is designed to break.
NHS England, DHSC and NHS Supply Chain are jointly developing a MedTech Commercial and Growth Strategy designed to bring cohesion to a procurement environment that is currently fragmented across more than a thousand separate frameworks. The strategy’s stated aims include reducing duplication, creating consistent category approaches, simplifying market access and positioning medtech as a strategic driver for UK economic growth. The engagement phase concluded in March 2026; the strategy itself is expected later this year. Its significance lies less in any individual measure than in the direction of travel it represents: a national-level commitment to treating the NHS as a unified commercial partner rather than a collection of independent purchasing decisions.
The structural changes above address real problems, and companies should take them seriously. They do not, however, remove the need for companies to understand the NHS as a commercial environment and to approach it accordingly. The NHS Accelerator’s analysis identified three things that NHS organisations consistently say they need from industry partners, and that industry consistently under-delivers:
The NHS is the world’s largest single-payer health system, with a diverse patient population, strong real-world evaluation capability and institutions, including NICE and MHRA, that carry international credibility. A technology that achieves scaled adoption in the NHS has demonstratedsomething that few other health systems can replicate, and that carries weight in global markets.
It is also a system where the distance between a successful pilot and routine use can be years, where procurement decisions are made by hundreds of organisations with different priorities, and where the clinical and commercial conversations that drive adoption are often happening in different rooms. The structural reforms underway are narrowing that distance for a specific class of technologies. For the majority, the route to scale still runs through the kind of sustained, relationship-based NHS engagement that cannot be shortcut by regulatory approval or NICE guidance alone.
The 10-year plan’s ambition is for the NHS to be among the fastest health systems in the world at adopting proven innovations. Reaching that ambition requires both a more coherent NHS and an industry that engages with the system as it is, not as it might be. The reforms of 2025 and 2026 have moved the NHS closer to being a system that industry can work with at scale. The question is whether industry is ready to meet it.
CHASE works with pharmaceutical, medtech and digital health companies on NHS commercial strategy, market access and NHS–Industry Partnerships. Our teams support companies at every stage of NHS engagement, from early market access planning through to scaled adoption programmes. Get in touch to find out more.
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