NHS Left Shift Part 4: What Top Gun Maverick Gets Surprisingly Right About the NHS
Every now and then, life hands you something quite rare, a bit of proper downtime.
Recently, I found myself in exactly that position. No meetings, no calls, no slides to finish, no proposals to review. Just a quiet evening and the luxury of choosing something to watch without simultaneously answering emails.
I decided to escape for a couple of hours and put on Top Gun: Maverick.
Now, I should say at the outset that this is not a film that stands up to forensic analysis of realism. Fighter jets do things that probably defy physics, the timelines are compressed and the mission itself stretches believability more than a little, but that’s not really the point, because somewhere between the dogfights and the training sequences, I realised something I wasn’t expecting, there was a lesson lurking in my film choice.
And not just any lesson, one that felt surprisingly relevant to the work I spend most of my time doing with the NHS, pharmaceutical companies and medical technology organisations.
The right tools will only get you so far
If you work in pharmaceutical or medtech organisations, this may sound familiar. You have strong evidence, supportive clinicians and a clear patient need but progress through the NHS feels slow, decisions are unclear, and adoption often stalls.
This is rarely a product problem. It is usually a pathway, commissioning or system alignment problem.
At its core, Top Gun: Maverick is not really a film about flying. It’s a film about systems, teamwork, training and execution under pressure. It’s about taking highly skilled people, putting them into a complex environment and asking them to deliver consistently in situations where mistakes carry real consequences.
In other words, it’s not a bad metaphor for healthcare.
What struck me most was how often the film returns to a simple truth – success rarely comes from the equipment alone. It comes from the way people work together, the way processes are designed and the way decisions are made under pressure.
And that is exactly where so many innovations in healthcare succeed or fail.
Over the past few years, I’ve increasingly found myself talking to teams about what I call “pathway over product.” The idea that a drug, a device or a diagnostic can be genuinely excellent but still fail to make a difference if the pathway around it isn’t designed to support adoption.
Watching Maverick train his team, simplify the mission and focus relentlessly on execution, I couldn’t help thinking, this is what good pathway design looks like.
Not glamorous. Just practical, disciplined and focused on what actually works in the real world.
So, while Top Gun: Maverick may not be a documentary, it does capture something very real about leadership, teamwork and delivery, and oddly enough, those are exactly the things the NHS needs more of as it moves into its next phase of transformation.
It’s not the plane, it’s the pilot
One of the most memorable lines in the film is simple: “It’s not the plane, it’s the pilot.”
In healthcare, we often see the same dynamic. There is enormous focus on the new drug, the new device or the new diagnostic, but in reality, those things are only part of the story.
What really determines success is the pathway around them.
- Who identifies the patient?
- Who initiates treatment?
- Who follows up?
- What happens if something goes wrong?
- How easy is it for busy clinicians to do the right thing?
If those questions are not answered, even the best innovations struggle to take hold.
I see this time and again. The technology works. The evidence is strong. The clinical case is clear, but the pathway isn’t designed and so adoption stalls.
In aviation the aircraft matters but the training, the procedures and the teamwork matter more. Healthcare is no different.
Most organisations understand the NHS structurally. Far fewer understand how it works operationally. That gap between strategy and implementation is where many promising ideas stall.
Don’t think. Just do.
Another line from the film struck me, particularly in the context of how busy the NHS has become: “Don’t think. Just do.”
Now, at first glance, that might sound reckless, but what the film actually shows is something quite different. It shows the power of training and system design. The pilots are able to act quickly because the processes are clear, the expectations are defined, and the mission has been simplified.
In healthcare, the best pathways work in exactly the same way.
- They reduce friction.
- They remove unnecessary steps.
- They make the right thing the easy thing.
If a pathway requires people to stop, interpret, debate and redesign the process every time, it will fail in the real world. Not because people don’t care but because they are simply too busy.
Good pathway design isn’t about adding complexity. It’s about removing it.
The mission is the only thing that matters
One of the strongest themes in Top Gun: Maverick is that the mission comes first. Personal pride, organisational boundaries and individual preferences all come second.
That, again, feels very familiar.
In the NHS, patients don’t experience care in organisational silos. They don’t think in terms of primary care, secondary care, community services or commissioning structures.
They experience a pathway, and yet the system is still often organised around institutions rather than outcomes.
The shift toward integrated neighbourhood teams, provider collaboratives and more joined-up care is, in many ways, an attempt to realign the system around the mission rather than the structure.
It isn’t easy. It requires trust, collaboration and a willingness to do things differently.
But the direction of travel is clear.
It’s time to let go
Another quiet but powerful theme in the film is the idea of letting go of old assumptions, old ways of working and old identities.
That feels particularly relevant right now.
Many parts of the NHS are still operating in ways that made perfect sense 20 years ago but are increasingly difficult to sustain today.
- Hospital centric models of care.
- Pathways designed around professional convenience rather than patient flow.
- Processes that exist because they have always existed.
Change is uncomfortable, but sometimes letting go is the only way to move forward.
The shift toward prevention, community-based care and earlier intervention isn’t just a policy ambition, it’s a necessity.
There’s no ‘I’ in team – but there’s a Fran in my team
Watching the film also made me reflect on something more personal.
In Top Gun, Maverick may be the one in the cockpit but no pilot ever flies alone. There is always a team, always someone watching your back, always someone making the mission possible.
In my own work, I’m very conscious that while I’m often the one in the room, on the stage, or writing the blogs, I don’t do any of it alone. My long suffering wife, Fran, is very definitely the Maverick in our household, although if I’m honest, in reality I’m probably the wingman.
She’s the power behind the drive in the business. The one who keeps things grounded, keeps things moving, and keeps me going when the days are long and the travel is relentless.
Anyone who runs their own business will understand this, as behind every visible piece of work is a huge amount of unseen support, and I know very well that I couldn’t do what I do without her.
From one kind of pilot to another
So yes, Top Gun: Maverick is a Hollywood film. It stretches realism, compresses timelines and occasionally defies physics.
But the core message, that success depends on teamwork, preparation, clarity and execution, is absolutely real, and those are precisely the things that determine whether innovations in healthcare succeed or fail.
The NHS doesn’t need more ideas in isolation. It needs pathways that work. Teams that collaborate. Systems that make delivery possible in the real world.
In much of my work, I see this challenge repeatedly. Much of what I do involves helping pharma, medtech and device companies design and implement solutions that fit real NHS pathways, so innovations move from conversation to adoption.
The work is rarely about products in isolation; it is about understanding how decisions are actually made, how pathways really function in practice and how to turn pilots and ideas into scalable, sustainable models.
The NHS does not adopt products. It adopts pathways.
That simple truth explains why so many good ideas struggle and why some modest ones succeed. Evidence matters. Innovation matters. But what matters most is whether something fits the reality of how care is delivered, how decisions are made and how busy teams actually work.
Nowhere is this more visible right now than in the growing focus on left shift, moving the right care to the right place, delivered by the right workforce, to release capacity where it matters most.
Over the past year, I’ve been writing and speaking more about this topic, because left shift is no longer a policy aspiration. It is becoming an operational necessity. But as many systems are discovering, left shift only works when it is designed safely, aligned to incentives, and grounded in how the NHS actually functions day to day.
That’s why I started a short blog series exploring:
- Why the NHS doesn’t really have a demand problem, but a placement problem.
- Why many left shift pilots fail to scale, even when the clinical case is strong.
- And what the programmes that succeed tend to have in common.
I’ve also brought these ideas together on a new page on my website, where I’m sharing practical frameworks and lessons from projects that have worked in the real world, because left shift isn’t a slogan. It’s a capacity strategy. And capacity is the NHS problem that really matters.
In the end, whether you are flying a mission or redesigning a healthcare pathway, success rarely comes down to the equipment alone. It comes down to the people, the system around them, and the discipline to make the plan work in the real world.
And oddly enough, one of the clearest illustrations of that isn’t in a policy paper. It’s in a film about fighter pilots.
Why organisations choose to work with me
Many organisations working with the NHS face the same frustration. They have strong evidence, a compelling product and supportive clinicians but progress stalls. Meetings happen, pilots are discussed but adoption never quite materialises.
This is rarely a product problem. It is usually a pathway, commissioning or stakeholder alignment problem.
My work focuses on helping pharmaceutical, medtech and device companies understand how the NHS really works operationally, not just structurally, and how to design solutions that fit within real pathways, budgets and workforce constraints.
Success in the NHS is not about pushing harder. It is about aligning better. That is the work I help organisations do.
At www.scottmckenzieconsultancy.com, I work directly inside the NHS, supporting provider collaboratives, commissioners and system leaders to implement real change. I then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With more than 20 years working within the NHS and Pharma, medtech and devices companies, I bring a unique dual perspective, now captured in my book, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything I’ve learned into a practical playbook.
Tickets now on sale: The inaugural Embedded Seminar – London on September 30. If you’re trying to win work in the NHS, knowing the policy direction isn’t enough. You need to understand how decisions are really made, what creates confidence at Board level and what causes things to stall. This seminar brings that into the open. A small, focused group working through real examples of what gets through, what doesn’t, and how to position your work so it stands up under scrutiny. If you want to move beyond access conversations and into something that actually converts, this is where that shift starts.