From Pilot to Pathway: What Real NHS–Industry Collaboration Looks Like

There is no shortage of NHS/industry collaboration. There are pilots everywhere, innovation programmes in every system and no lack of goodwill on either side.    What there is a shortage of is collaboration that genuinely helps frontline teams, survives governance scrutiny, and embeds into pathways rather than quietly fading once initial enthusiasm subsides.    Over the past 20 years, working alongside GP federations, PCNs, hospital and community trusts, and system leaders across a range of clinical areas, I have seen a consistent pattern.

When collaboration fails, it is rarely because of poor intent from industry or resistance from the NHS. It fails because the system underestimates how much work is required to make collaboration safe, credible, and deliverable in practice.

Read my blog – If I Was Health Secretary Wes Streeting – What On Earth Would I Do?

The Hidden Problem That Derails NHS/Industry Collaboration

Most collaborative projects begin with a clearly articulated clinical challenge, set against a backdrop of rising demand, long waits, unmet need and pressure on workforce capacity. These challenges are well understood across the NHS.    What is less often acknowledged is the secondary problem, the one that quietly determines whether any collaboration succeeds or fails:

• Who holds the risk?
• Who does the governance work?
• Who has the time to slow things down enough to do them properly?
• And who remains accountable once the pilot begins?

Without clear answers to these questions, even strong ideas struggle to progress.

The Pilot Trap: Why ‘Trying Something’ Isn’t a Strategy

In primary care in particular, teams are stretched, risk aware and understandably cautious. Introducing something new, especially where industry is involved, immediately raises questions around clinical safety, information governance, workload and reputational exposure.    Too many pilots are launched without a clear route through governance, clarity on roles and responsibilities, an agreed evaluation framework or sufficient engagement with the people expected to make it work day to day.    When this happens, pilots stall, lose momentum and quietly disappear.

Why NHS ‘Resistance’ Is Actually Risk Management

When NHS teams appear cautious, they are protecting patient safety, staff morale, professional credibility, organisational reputation and their own capacity to deliver care tomorrow.

They are also protecting something less visible but just as important, headspace. In environments where teams are already juggling demand, workforce gaps and regulatory scrutiny, every new initiative creates additional cognitive load.

Read my blog – Why NHS Engagement Fails: Talking To The Right Organisations But The Wrong People – here.

Even well intentioned collaboration requires time to understand, explain, govern and manage. And that time has to come from somewhere.

Importantly, NHS teams are acutely aware that once something is introduced, it is very difficult to remove. Caution is often driven by an understanding that pilots have a habit of becoming “the new normal” without the necessary support, funding, or infrastructure in place.

From this perspective, hesitation is not resistance to change, it is a rational response to long term accountability.

What Sustainable NHS Collaboration Looks Like on the Ground

The collaborations that succeed tend to start with system need, involve frontline teams early, take governance seriously and actively manage risk.

They also tend to be unglamorous in their early stages. Good collaboration often involves slowing things down, asking difficult questions and resisting the urge to move straight to delivery.

Time spent aligning objectives, clarifying roles, and agreeing what “success” actually looks like is rarely visible, but it is what allows delivery to happen later without friction.

In practice, this means collaboration feels supportive rather than extractive. Frontline teams understand why the work matters, how it fits into existing pathways and what will happen if something does not go to plan. When those fundamentals are in place, adoption becomes far more likely.

Where NHS/Industry Collaboration Breaks Down: Meaning, Not Intent

Without translation between NHS and industry priorities, misunderstanding builds quickly. Trust is not assumed. It is built deliberately.

NHS and industry teams often use the same language; value, outcomes, innovation, but attach very different meanings to those words. What sounds like opportunity to one side can feel like risk to the other.

Without careful translation, good intentions can quickly be misinterpreted as pressure or lack of understanding.

Read my blog – Building the NHS Business Case: Creating the Case for Change Before Adoption – here.

Trust develops when both sides feel heard and respected, and when concerns are surfaced early rather than minimised. This requires honesty about constraints, realism about pace, and a willingness to sit with uncertainty. In my experience, trust is built less through formal agreements and more through consistent behaviour over time.

What Separates One Off Pilots From System Change

Where collaboration works, it creates a blueprint for governance, engagement and delivery that the system can adapt and scale.

Crucially, this blueprint extends beyond the intervention itself. It captures learning about what it takes to introduce change safely, who needs to be involved, how risk is managed, and how success is measured in a way that matters to the system. This is what allows collaboration to move beyond a single site or individual champion.

When pilots are designed with this in mind, they leave behind capability as well as outcomes. Even if the specific intervention evolves, the system is better equipped to engage with future innovations. That, ultimately, is what sustainable collaboration looks like.

Why NHS Capacity, Not Innovation, Is the Limiting Factor

When NHS teams appear cautious, they are protecting patient safety, staff morale, professional credibility, organisational reputation, and their own capacity to deliver care tomorrow.

They are also protecting something less visible but just as important, headspace. In environments where teams are already juggling demand, workforce gaps, and regulatory scrutiny, every new initiative creates additional cognitive load. Even well intentioned collaboration requires time to understand, explain, govern, and manage, and that time has to come from somewhere.

Importantly, NHS teams are acutely aware that once something is introduced, it is very difficult to remove. Caution is often driven by an understanding that pilots have a habit of becoming “the new normal” without the necessary support, funding, or infrastructure in place. From this perspective, hesitation is not resistance to change; it is a rational response to long term accountability.

Scott McKenzie is an NHS management consultant and advisor to pharma, medtech and device companies working to embed change in complex health systems through industry partnerships.

He’s the author of the book Embedded and host of the Embedded Conversations podcast, where he explores what it really takes to move from insight to impact inside the NHS.

Through the Embedded training and mentoring programme, Scott works with individuals and teams at different levels – from practical guidance and peer learning, through to direct strategic support at board level.

The heart of this work is Embedded Edge – a community for individuals who want to understand how to sell better to the NHS.