NHS tech pilots and adoption with Rishi Das-Gupta and Paul Jones (live from HLTH Europe 2025)

Hello and welcome to Talking digital health, a podcast by law firm Mills & Reeve, hosted by health and tech lawyers Sophie Burton-Jones and Charlotte Lewis.

Our aim on this podcast is to discuss key topics of interest to those procuring tech in the NHS and also those selling tech to the NHS.

I'm Sophie Burton-Jones. And I'm Charlotte Lewis, and we're your hosts for this episode, coming to you live from HLTH Europe, the largest health innovation event in Europe.

And we're delighted to be joined for this episode of Talking digital health by Paul Jones and Rishi Das-Gupta, who'll be talking to us about whether or not technology pilots are right for the NHS and how innovations can be adopted at scale.

So, Paul, Rishi, lovely to have you both here today at HLTH. Would you like to give us, first of all, some brief intros for each of you?

Hi, I'm Rishi Das-Gupta. I'm chief executive of the Health Innovation Network in South London.

We focus a lot on digital transformation and technology-enabled transformation, and that sort of speaks to my background because I trained as a doctor, I worked as a consultant for a number of years, and then have worked as an operational manager and a technology manager within the NHS, and now do transformation on a region scale.

Hi, I'm Paul Jones. I'm the chief digital information officer at Leeds Teaching Hospital.

So Leeds is one of the largest teaching hospitals in the country. I'm responsible for 450 staff there. I'm also the senior responsible officer in The Leeds Place for the digital programme that goes on at The Leeds Place level.

Thank you very much.

So we've invited you to come and talk to us today a little bit about pilots and adoption in the NHS, mainly because you've both spoken about those topics with us before. So we're really keen for you to share those views with our audience. The first thing I'm going to ask you both is, what is a pilot?

So I get very, very upset when we talk about pilots in the NHS. And I have said we've got more pilots than British Airways. And I think the challenge for me is, what is a pilot trying to do? So I actually have a rule which is I don't do pilots because really you don't mean you're a pilot. What you mean is you want to try and deploy your system in my hospital without going through finance and governance and approvals and understanding where the money's coming from. And that's just not very helpful for anybody.

If we're doing a pilot, I guess we need to be really clear what it is we're trying to prove. And in nearly every case that comes across my desk, what we're trying to prove is that a system that's already working in a number of other hospitals will work in our hospital. Well, surely it will. That's not a pilot thing. That's a phase one.

Now, we're here at HLTH, and actually, I sat down this morning with a team who are working on AI in our hospital, and they are doing pilots because we don't know whether those things are actually going to work. There are some really clear metrics at the start of those projects about whether we're going to be happy to take this forward.

We're going to be writing research papers. And for that kind of work, I'm absolutely fine, and it's almost nothing to do with me. I push it all over to our research and innovation team, and they manage those processes. When we decide it might become mainstream, then again, I'll start getting involved at that point.

But this idea of what is a pilot. Do we mean a pilot? Do we mean research? I think that's why we get into a bit of a tangle in the NHS.

I thought I was going to violently disagree with you at the beginning, but actually I find myself, I think that second-half is really important. And I too, when I was a CIO, people would come to me and say, we'll run a pilot and we'll make it under 25,000 and then you can sort of have different procurement rules applied. And that is not what I see as a pilot.

So if I think about one that I think is running effectively, when we were approached about ambient voice technologies a couple of years ago in 2023, where there weren't any products on the market, we didn't know whether it was a good idea in practice.

We didn't know which specialties, what kind of hospitals, whether it would work with background noise and a whole load of unknowns within there.

And also, we didn't know if the business case would stack up because we have no data on UK productivity and how it works. And we could have done what I think the NHS would traditionally do of saying, we'll run a little pilot in one hospital before adoption in that hospital and see how that works, and actually 20 hospitals are all going to run different pilots, but they're all going to be trying to answer the same question. But the opportunity was there to say, actually, let's do this across London, let's do it across eight different sites, let's do some A&Es, let's do some general practice, let's do some mental health, and try and learn which specialties it's working on, so where the benefits are being accrued, to your point.

And also, to frame that around what the business case is for this product at the end of the day, so that we fill those gaps, that then leads to the fact that the research that's in there is not around primary efficacy or those things, it's around implementation.

It's checking on safety and those concerns that are out there. And all those questions, I think, should be asked at the beginning. They should be on paper before you start your pilot. And then the last bit of the pilot, when it works well for me, is that the evaluation point is sufficiently ahead of your procurement point.

So if you decide at the evaluation point it's a good idea, you've still got time to run a procurement afterwards and put in either that or another system.

So in London, we picked one company to do this with, to do that pilot with, because we thought we don't need variability in the product. What we need is all the other business case information.

And the test, I think, will be still to come, actually, which is that as these read out, which is over the next few months, and I think it's going to be broadly positive for most specialties. Do we have time to actually go out to the market and procure a solution? Because it won't necessarily be the company that we did the pilot with, that isn't a given. There are opportunities to do that.

So I think there is the opportunity to run really good pilots, but to your point, Paul, I mean, not all the pilots are being run that way, and coordinating it at that scale is a challenge.

And I think that's why people think pilots don't work, because hardly any pilots are running that way, and the pilots are nearly always pilot in name only. Really they’re a deployment of a product without engaging with the right stakeholders, with the right governance processes.

And then surprise, surprise, if it does get deployed at some point down the line, it isn't funded, you might find there's already one of those in the hospital.

You know, I mentioned we're a large teaching hospital. We have 350 clinical applications in use every day. The last thing I want is 351 and 352, when the chances are the functionality that the staff want that we need for our patients might be there already. I'd like to reduce that number. But recognising there are new things coming along.

I mean, one of the interesting areas at the moment about doing pilots is the whole space of AI. And you can't move in health for AI being the new answer.

One area I'm being challenged on is how much governance do we put on these pilots and my current answer is almost none at all, which might seem slightly counterintuitive from where I'm normally coming this space.

For me, there's the AI world is still in a case of 1000 flowers blooming. We're never going to be quite sure which one of these is the VHS or the Betamax of the future. Sorry for those who are younger than me. But out of two formats, one succeeds and one doesn't. And we don't really know. And I don't know how you would pick at the moment. So I have lots of consultants, lots of staff, lots of doctors playing, piloting different bits of AI and I'm fine with that for now. And again, tend to push a lot of it into our research and innovation team. They've got the processes; they can check the ethics.

When we start seeing which of these are going to be mainstream, which are going to become part of a core care pathway, then we need to put all of the IT stuff around it that me and my team care about, making sure it's robust, it's resilient, it's supported, people know who to phone if it goes wrong.

And within all of that testing and piloting and to some extent playing in a good way, there are some really big questions that are coming up in that whole AI space, particularly about, well, it works today, but the algorithm changes as it learns. How am I confident that thing is still going to deliver the right service next week or the week after? Do I have to hold the AI algorithm and then at some point in the future switch to the next one? And that's not something that the AI muscles do at the moment.

So we have lots of challenges in that space, but I think trying to put too much governance around it at the moment will be counterproductive. And so I'm fine to let 1000 flowers bloom, and we'll see what comes of that, but just have to be careful to put the rigour in when it's needed.

And also, I think, to recognise that that's part of research and innovation within the trust and not something that necessarily infiltrates into the wider system just yet, so that you can allow, like the sandbox concept, you can allow that to do its thing.

How clear do you think industry is on understanding that? Because I think that a lot of people think that that pilot is part of the journey and that pilot is more what you've described, Paul, rather than what it should be. And so there's this, we need to get pilots in, we need to get pilots in. Clearly that's not going to be very effective. So how do you think the communication is, or the understanding is, in industry around pilots and what they are and what they aren't.

I think that the question that I would love companies to ask at the beginning of a pilot is if we're successful, will we be procured? And I think too often it's seen as a, as we were saying earlier, it's seen as an alternative to a traditional procurement route rather than as a test for a procurement route. And I don't think that understanding is as well developed in the marketplace in the UK. And I think it probably reflects the fact that we are a publicly funded health system. And I think you would find the same if you were to go to Denmark or Singapore or other publicly funded health systems, but it's very different if you're dealing with a privately funded health system in the US. And so many of the large tech companies that we deal with are used to the US environment that I think that distinction isn't always made as obvious as it could be.

And I think that that's where you already have a defined product. I think, Paul, when you were speaking about AI governance, I took away, similarly to you, Charlotte, I think the reason that you sound fairly sanguine about it is that there is a good research and innovation infrastructure that you're able to rely on and that companies can engage with. And I would be very keen to surface that to companies earlier so that they can be very clear that they're engaging on a research and innovation infrastructure, not on a live infrastructure that's for general use, and then we can put a really clear stage gate in about when it becomes into that live environment. Would you agree with that, Paul?

I would, and I think coming back to Charlotte's question, I don't think it is well understood by suppliers. And it was somewhat of a leading question. I get the sense that some of the sales teams in some of the health tech companies are targeting getting a pilot as a success and as a sale and I think that's why we get this unhappiness in the supply market, because they chalk it up as a sale, they start thinking about the revenue that's going to come in the future.

But actually, by not going through the, and I accept, very painful process of working out how is it going to be funded to be rolled out across the whole hospital to, in my case, 20,000 staff, if you haven't worked that out, before you start, then the money's not going to magic itself.

And I think Rishi's right, when people come to us, particularly some of the… actually it's not just people from other health markets inside the UK, we have tech startups where the people have seen what they consider to be a problem, it may well be a problem, they recognise that their product will help save some time and therefore we should buy it because it will make the NHS more efficient.

But saving a bit of time doesn't generate any cash releasing benefits to pay for the product. And I have a fixed amount of money in my budget, the trust has a fixed amount of money in its budget, and so just adding on to what we spend isn't reasonable. there has to be cash releasing to make it work in our health system.

And as challenging as that is, that is what we have to deal with. And so, you get lots of examples of people saying, this is silly, we save two minutes of every consultant's time every day. You've got 3,000 consultants, therefore you could save 100,000. Not really. It's not real.

I remember you saying, because in reality, and that formula playing out, and you said in reality what happens isn't, say it's nursing staff five minutes a day or whatever, in reality what happens is that they actually get to make themselves a cup of tea or they use the loo.

You know, if you're talking about that sort of margin, which isn't going to, it's great that they can actually have a tea break, but not going to save money. But I think it's actually worth investing in some of that stuff.

So I might take account of you to say, well, actually, if you were in other industries, you'd say, well, what's the cost of retaining staff? And what's the cost of recruiting staff? And does this reduce our staff turnover as we work through? Are people happier?

And the reality is, if you gave me back 30 minutes a day, I would probably use 10 minutes for patient care, 10 minutes for making my cup of tea, and I'd probably leave work 10 minutes earlier. And there'll always be some of that trade-off going on.

But if you've got happier staff and people are going to be working for 40 years, then this does add up. I think that the trade-off question, the allocative question, about where the money is going is a live one. And I might go back to a little bit of what you said earlier about, I think, Paul, you mentioned that you make the tech companies unhappy. I think that's certainly true.

When I was a CIO, I certainly made some of the consultants in the hospital unhappy because they would see something at a conference, they would think it's a good idea, they'd talk to the company and get very excited, and they'd come back and we'd go, well, the core functionality you're after is provided in one of the systems already, or I can tweak it, and we don't need you to, you know, we don't need to deploy a whole other system to do that.

And I wonder the extent to which we also need to support our clinical workforce in how they select. companies.

Paul, have you done any of that up in Leeds?

Well, I mean, that's an interesting area. We at Leeds have started over the last three or four years having each year a set of seven commitments across the trust, rather than having 101 things that everybody's being asked to do. Last year's commitment we had making best use of our digital resources as one of our commitments across the whole trust. We've expanded it this year, so they're still digital, but we've also included estates and medical devices, basically our capital programmes.

And what was really interesting when we did that bit of a focus was it is interesting how many staff don't actually know what's It's already there. It's interesting how many staff ask for things because they don't, and when they're told, actually, that's in the electronic patient record. Actually, you can do that with the prescribing system. Actually, that's in the document management system. Go, oh, oh, that's great. I didn't know. I'll go and use that then.

And so we get quite a lot of requests for functionality where maybe not the exact functionality already exists, but something like it. Or you could do 80% for free today and so there is a real challenge around education.

And I can't remember the stats, but people talk about Microsoft Word and the average user uses 10% of what's in there. Well, it's not quite as to that extent, I think, with the clinical systems we've got.

But as electronic patient records have become more advanced, as we integrate more systems together, I do think there is a a learning gap with our staff around what we've already got. And so, I mean, yes, we still get the chief executive read something in a magazine, the consultant's been to a conference like this and thinks the answer to all their problems. And often the pushback to that, you know, unfortunately does have to be the funding and the resourcing. And the question can be, well, what would you like us not to do?

So at Leeds we have a really clear process of prioritisation of the projects and I don't sit on that. So that isn't a CIO decision. It sits with our clinical teams, our medical directors, our heads of nursing. They come together and they decide on the priorities of the projects that we're doing, recognising that we have a set of limited resources. So if you can make your case and you can get onto the list, then sure, we'll do your project.

That's really interesting. I'd always thought of that as a CCIO function in the trust that I've worked in to try and do that prioritisation. CCIOs are involved, but we have representation of medical directorate, the corporate nursing directorate. We have a general manager representing all the general managers. We have representatives from the corporate ops team, and I'm probably missing some as well. But it's chaired by one of the CCIOs.

I think that number of systems questions are really interesting one because I ran a trust society, which was focused on a best of breed approach. And the model that we had applied was, I used to talk to teams about, this is effectively another member of your team. And you're going to think through, how do I recruit them? So, you're going to select who's available at that point. There's a cost to getting them on board and onboarding them and bringing them through the process. And they're going to work with your team for a while. And at some point, they're going to be out of date.

So you're either going to be constantly refreshing what's in there or you're going to be retiring them at some point and bringing someone else on the team. And that comes with it, all of that comes with a cost. There's an ongoing cost to running this that I think the teams need to think about and that suppliers don't usually think about. So they don't think, how do I make this easy to onboard your teams? They don't think about, well, I'm coming up to a procurement point.

Often they try and make themselves as sticky as possible just before the procurement point, rather than us, and we aren't necessarily at a distributed team level at the point where we can manage them through that process so that we could exit if we wanted to.

That's been my experience of it.

No, I think that's fair. I think the post implementation, supplier management, understanding when contracts finish. I mean, thankfully we don't get surprised by contracts finishing at the moment, but I know that that's not an unusual model in the NHS where all suddenly I have to sign something or that they're turning it off next week because there's just so much else going on. But those are just good management practices and they need to be put in place and you need to plan and think forward.

I mean I do think there is a, I mean you're right, things do get sticky. And sometimes because of a lack of resources, it's easier to do the upgrade, it's easier just to keep the same supplier in place than it is to do a wholesale procurement. But by doing that, you then miss out on innovation, potentially you miss out on lots of new things coming along. But also, the health market perhaps isn't as mature as people think it is, so there are some areas where there isn't an awful lot of competition. And the reason for that is there's not that many people who buy that particular service, that particular clinical specialty is quite narrow.

And in that case, I do think we get a little bit tied up with all the other governance when you know, I don't want to use a particular example, but there are some areas where I was really hoping you wouldn't use that. You're going to have to buy that product because they're the only ones who do that thing in that way. And you're kind of hoping actually that they just keep investing and building the functionality that they need and that your teams need to use that.

I think if I were choosing how to allocate adoption funding at the moment, some of it might be around, well, how do I manage the processes for when something's coming to an end? And that might be a very legitimate use of adoption funding. I think when we talk about implementation funding, I mean, this is where I do throw the IT card forward really, because we have so much legacy across the NHS. We've done some maths at Leeds Teaching Hospital and we think we need somewhere between 17 and 20 million pounds to fix the legacy that we've got across the trust. We're about 1% of the NHS budget, so you can extrapolate that up to how many billion pounds we might need across the NHS to fix the legacy and the technical debt. And it's not a one-off cost.

So that technical debt today, in three, four, five years' time, you build up more technical debt unless you have that consistent funding coming through. And I think that's where I get very worried when we talk about, let's put some more money into implementation for nice shiny things, when what we've got at the moment is some quite creaking infrastructure and quite a lot of hospitals, some basics that need fixing. And in my head, you know, we've heard about the 10 billion pounds that might be coming in. My share of that should be about 100 million quid. Fantastic, if I got it. But actually, what would I really want to do with that?

And my first 20 million would be, let's fix the basics. Then I'd want to get more staff onto my service desk, get more staff into my end user computer engineering team, so I can provide a service to the trust where they get used to, my laptop broke, my keyboard's broken, and it gets fixed that day. That's the service we should provide.

If clinical staff had that service and that underpinning, they're going to start innovating themselves and we can then build on that. But at the moment, and I know because I go around the hospital, and they say, that printer's broken, Paul.

I say, well, when did you report it?

Oh, we haven't bothered.

And they haven't bothered because they've kind of been trained into the fact that it's going to take ages for it.

So there's a whole culture change that needs to go on.

And I think investing in a service that gets out there and fixes things quickly would add a huge amount of value to our staff and therefore to our patients and support future patient pathways rather than focusing a bit too much on the next silver bullet.

There's a couple of things that you've said that I think that really resonate. So I think investing in the foundations, you've both said that, that's hugely important. I think that for some there's a bit of a misconception that that's either been done or isn't it, you know, so a lot of people I think see the shift to digital and EPR.

We've got an EPR now, so surely, but we know that doesn't necessarily deal with the legacy.

But so I think there's clearly an investment that needs to happen across the NHS. And then I think an investment in, you mentioned it, optimisation of EPR or existing systems. And neither of those two things, sounds particularly sexy, is not going to get, you know, by streeting it, terribly excited and something that he can talk about.

But you made exactly that point. It's about culture. It's about a culture shift and it's about the staff.

And actually, if you do those things, that's going to improve, as you said, the lives of those people on the ground, which means you're going to have happier staff, you're going to have the retention as well.

So it is an investment. It's not just an investment in tech, it's an investment in the service, it's an investment in people, but it's going to swallow up, even if you do get your 100 million, hopefully you will, and it's going to swallow up a huge chunk of that just to get the basics right.

But then actually, then you can be much more clever about how you spend the rest and what shiny stuff you spend it on, because everything that it's sitting on is as efficient and effective as it can be.

But is that me being far too kind of, I don't know, a bit optimistic, a bit naive?

I think you're right, and Rishi touched on earlier about investing in these systems and services will have a positive impact on staff and staff retention and staff productivity. The challenge we've got from a finance point of view is drawing a straight line from we've made these digital investments to we've made these savings in recruitment or staff wellness or attendance or reduced sickness or any of those kind of things. It's very hard to draw that line and actually know that there's a real direct cause and effect.

We can look at it and say intuitively, we know it's helping, but there's so many other things going on across the NHS all the time to just do that one thing. I think I would come in with a slightly different angle on it. So I think everything you've said is important and we've got to do it. But I think there's a risk that we end up putting all the additional funding to solving that technical debt early on.

And I think that if we did that, the opportunity we'd miss is to do tech-enabled service change in a really concerted way. So the reason I frame it that way is because I think there's quite a lot to having totally different services to the ones we have now.

And Ian Abbs was speaking at this conference yesterday, and we were describing, if you're at top of one mountain at the moment and you want to go to another, you've got a choice of either you go down, you start at the bottom and you go up the other one, or you jump from one to the other. And I'm not sure the extent to which we can make that jump happen without a lot of support and building the bridge that goes across. And for me that's around having infrastructure and networks of people. who are willing to work together and reimagine what these services look like, involving patients in that and really co-designing it.

And then rolling out and doing that problem solving and evaluation as it's going to achieve the benefits and measuring those benefits that are being achieved. And I agree, I don't think we can have 1000 flowers blooming. I don't think there's enough money to do that. But I'm also quite reticent to say, well, we're only going to pick one model up front based on the evidence that we've got today, and that's the one we're going to roll out everywhere.

And I think I've probably been the recipient of too many national programmes that are designed in that very single way of doing it approach. And I would much rather us move to a model whereby there are three or four alternatives for how you do it. It's not a million ways to do it, or 1000 ways to do it.

But in parallel with rolling them out, we choose to evaluate it as we're going and work through. And I still haven't worked out what the best improvement methodology around that is. I know we've invested a lot in sort of quality improvement methodology along the way, which gives us incremental change, but that genuine rethinking what it is that our healthcare services do, what it is individuals do in a supported way, and what should we as an NHS be supporting as part of that.

I think that now's the right time to do that and the 10-year plan might give us the platform to do that.

So how do we make that leap happen?

Yeah, I was talking about that this morning and I do wonder if some of the move of some of the ICB functions into, I'm not quite sure what the current phrase is, kind of local provider collaborative.

So when I look at where I live, we've got Leeds Place and the idea that the providers will work more closely together. So often in the NHS, those pathways, or the funding of those pathways, falls apart because we have primary care making investments that save hospital admissions and none of it quite works out in the funding. If we start looking at that much more holistically, there might then be opportunities where we can look at those care pathways across whole systems and make the investments in the right places.

I think so.

And I would say that the systems are going to get more, our jobs are going to get harder because the systems are going to get more complicated. So again, the NHS has always traditionally thought about places and geographically contiguous zones to do this in. But if I think about what's returning money to the Treasury and the impact that health can have on that, actually, there's a lot more that we could do in workplaces, for instance, around supporting people who are working age people. I don't know if Mills & Reeve have a programme in that space?

Yeah, that's pretty good to be fair.

But I mean, you benefit from that.

And we think as health innovation networks, we've done a piece of work to look at what the benefit of improving employee health would be. And for the NHS alone, looking at our employees, we'd probably get about a 5.6% improvement in productivity as a result of fixing the health of all our own staff who are already working in the healthcare facilities at which they're looking to be treated.

So I think that we might see the NHS as an employer doing more in that space, but also other large employers doing more in that space. And then the challenge is on us to say, well, how do we interact with the services that are doing that, some of which will be NHS, and I suspect some of which won't be.

Do you think how you've described it with the clusters or local neighbourhoods and the systems kind of more widely being collaborative, that actually potentially reduces the ability for new and up-and-coming companies to get in and scale up, because if they miss their opportunity with a bigger area rather than, say, an individual trust or other provider that they're not going to have enough funding to kind of continue, they're not going to get any revenue. So you actually might reduce down the competition and market for certain innovations.

I mean, I'm not sure that it's as simple as that. So if I look at my current ICB, which is West Yorkshire, that's a huge ICB. If you're a small company, that's too big to sell to, and actually becoming Leeds, Bradford, Calderdale would open opportunities in some cases.

I was talking this morning, there is a company in Leeds who do a triage with general practice. I didn't get into details, I think it was around a particular type of cancer, but the idea again being to operate between primary care and acute and reduce the number of referrals. As we're sat today, I don't know where they would sell to. Because the ICB is looking at West Yorkshire and bigger regions looking even more widely. And yet that fits much more sensibly in the neighbourhood model.

So that's a small startup company in Leeds. That to me feels like they might actually be in the right place at the right time. If they'd have been two or three years ago staring at the West Yorkshire ICB, I'm not sure that would look very helpful to them.

Yeah.

And then, I guess, to go back to what we've been talking about in terms of pilots, would you say a pilot is the right option for both you and them in terms of working out if they can deliver something that would be good for you? Or is there another kind of alternative option that you could have?

They have already been piloted.

Oh, they have.

Yeah, so they've been very formal pilots. And it is very much more in the research space, they're publishing their data in peer-reviewed journals, so there's no kind of argument about whether this is marketing or not.

So my understanding is they've been doing that work. They've been going for about seven years and it's still kind of through that working. So I'm assuming they're quite well funded. But that's clearly a challenge.

A lot of start-ups do need to start getting some revenue in quickly and kind of recognise that and that is a challenge of the market that we're in.

I think the market dynamics thing that you just mentioned is a really, really interesting one. And if we looked at other industries and thought through how they work, I'm always surprised that the UK doesn't have an integrator that is supporting small companies and bringing them on board. And to an extent, you might expect the EHR companies to do some of that work. The reality is whenever we've looked to do a large scale procurement, such as virtual wards in London, there has been a very small number of companies that could deploy at scale, at pace, across ten million people.

And so the idea that we're automatically going to take an innovation and scale it at that rate with a small company is challenging. They need a lot of support. So one option is to support them. Another is to have a marketplace for integration and scaling. And I think that the risk that you are outlined can also be addressed by market consolidation at a later stage, you know, with some fair guardrails around it.

And I suspect that that's where a lot of companies might seek advice about how they structure themselves and how that would play out in the future in different strategic scenarios. Or who they partner with now in terms of, I mean, going back to health, there's a lot of the standards there today where it's groups of teams from different companies who are trying to partner together to allow them to kind of make the most of those opportunities and work together for the bigger at scale opportunities.

And some of those big companies are deliberately going to the small companies and saying, we are your scaling partner, and they're all the big names that we would be used to.

So like Paul, I'm not going to mention names.

Insert your own chosen company.

Absolutely.

I mean, I think that's a really good point.

So the purpose of this conversation was really to talk about sort of pilots and what they are, what they aren't, thinking more about sort of innovation research and that being sort of early stage stuff that happens. And then actually about adoption and scaling, both from your perspective within the NHS, but actually from an industry perspective, how do they go about doing that? And I think that that's really important to recognise that certain businesses are on it, they're at a certain point in that journey.

And they may well be at the innovation research point, and a pilot might be quite right for them, or a small kind of test contract or whatever.

Let's not call it a pilot, but it's actually is a deployment, but it's a small-scale deployment versus... adoption and scale, which is actually much further down the track. And it might be that in order to achieve that as an innovative business or let's say a more early stage business, your way to achieve that is that you're going to have to grow through other means, which maybe involves, you know, partnering with a larger business, which obviously does happen, but I think it's thinking about, you know, you won't be able to go for everything as a small business, but there are still routes available.

There are, but I think As with many of these things, the answer to that or part of the caveat around that is it depends.

If you're a small company delivering a service into a particular specialism within the hospital that by its nature is going to be relatively small numbers of staff and patients, then it's fine to do a small scale thing.

If you're deploying something where it only really makes sense if it's used across the hospital, then there's no point starting unless you can explain how you're going to roll that out across 20,000 staff, 7 sites, 114 wards, 1.6 million patients. Because if all you can do is deploy it into a small specialty and you haven't got the capabilities to do that big rollout in a teaching hospital, then we shouldn't start.

Yeah.

So I think it's recognising what's the market that's being done, that you're targeting as a supplier. And if it is niche and it is, maybe it's the cystic fibrosis team who at Leeds teach using a system that isn't used anywhere else in the hospitals, very specialist. It's just them using it. Works really well with primary care. That's fine. That just, you know, it's a small, it's self-contained, it makes sense.

But if what you're doing is something about, I don't know, document management or prescribing, it has to work everywhere.

Yeah. We're going to wrap up with a final question on funding. We've mentioned it at various points, but there's this concept of 10 billion pounds for NHS Tech.

I don't think we know yet the details around what that might be allocated for, but what would you like to see the money spent on, ideally, from your own personal perspectives or a wider NHS perspective?

Yeah, I mean, I've touched on this earlier and I think it'd be interesting to get a little more detail on sort of the time scales, on how the allocation might work.

I think one thing that we perhaps haven't touched on that we discussed separately is how much of this may be dealt with nationally. and how much may be allocated on the basis that doing it once for the NHS makes sense. And there are some situations where that works, but I think they're relatively few.

And to do something once for the whole NHS actually implies that all hospitals, GPs, mental health foundation trusts, community trusts are all the same. and therefore, the same thing will fit across them all. And that clearly isn't true. And so, I do hope that national policy recognises that there are local differences, that hospitals, just at the level that I work, but hospitals are different.

And we locally have really good ideas about what will make a really good impact for our patients and for our staff, and that we're given a little autonomy to spend at least a portion of that money locally on our priorities.

So I think ten billion pounds sounds like a lot of money. And we were working out, I think if there's a million staff, that's roughly 10,000 pounds per person. So it sounds like it's a lot, but I think that it can very quickly be absorbed into addressing the technical debt. So I think it's quite important early on to say, do we want that money to do that alone? Do we also want it to enable technology, enable service change or new models of care in supporting those? And if it's the latter, then I would be very keen that we use some of it to invest in the implementation part.

And my colleagues at Manchester are always very keen, Health Innovation Manchester, are always very keen to say, you should be spending four to six times as much on implementation as you should on a kit. Obviously that depends what the project is and how it works, but the bits of that spend would be on how do I build the network of people who are going to adopt and change things? How am I running the processes to design new services? How am I supporting the rollout and actually the technical implementation?

But I think the bit that often gets missed off is how am I supporting the evaluation infrastructure to do those rapid service evaluations that haven't been traditionally the wheelhouse of big universities and we haven't necessarily had teams in the NHS to do in order to make sure that the benefits really are being realised.

And then if we were able to do that really well, then I think we'd be in a position to work with suppliers to say, actually, now we can evaluate it, let's do a bit of risk sharing around the rollout. And if you claim benefits that haven't been proven, let's test them as they go live and maybe we do a gainshare around it. but we've never traditionally been in a position to do that in the NHS, which would allow us to use the scale of the NHS to give real value, I think, to the payers for the NHS, which is all of us, right?

Yeah. we'd all love a great health service.

Well, I think that, unless you've got anything you'd like to add, that really nicely wraps up the conversation. Thank you for your time.

Thank you for coming into our rather warm apartment here in Amsterdam, next to the HLTH Europe Conference. And yeah, that's it.

Thanks very much.

Thank you.

Very nice to come to your professional recording studio.

Thank you.

That's it from us at HLTH Europe.

We're always happy to discuss any legal queries you might have about technology adoption in the NHS. Our individual contact details are available on our website at mills-reeve.com. Thanks for joining us for this episode of Talking digital health by law firm Mills & Reeve.

Looking for information and advice on key legal points for you to consider when selling your health tech product to the NHS?

Listen to our Selling to the NHS episodes on Mills & Reeve's Talking digital health podcast where we discuss key legal and regulatory issues to consider when developing and launching your product.

Just search Talking digital health on your preferred podcast platform.