Why Good NHS/Industry Partnerships Fail Before They Ever Reach Patients
Most pharmaceutical, medtech and device companies genuinely want to work in partnership with the NHS. The intent is usually good. The frustration is real. Yet many partnerships fail long before they ever reach patients, often without either side fully understanding why. From the industry perspective, the experience can feel opaque and inconsistent. From the NHS perspective, it can feel risky, disruptive or poorly timed. From working across multiple pathways and systems, I have come to believe failure is rarely about the product. It is almost always about misunderstanding how the NHS operates under pressure.
Read my blog: Strategic Commissioning In The NHS: What The New Framework Means For Pharma, MedTech And Device Companies – by clicking here.
The NHS Isn’t resistant to change, it’s saturated with risk
Industry teams sometimes interpret NHS hesitation as resistance to change. In reality, NHS teams are operating in an environment where risk is constant and capacity is limited. Every new proposal raises immediate questions:
- Who owns this?
- Who is accountable?
- What happens if it goes wrong?
- What workload does this create for frontline teams?
If those questions are not answered clearly and early, the safest option for the NHS is to pause or decline. This is not a lack of ambition. It is a rational response to operating at scale under scrutiny.
Good ideas often stall long before delivery
Many well intentioned projects fail because industry teams approach too late, speak to the wrong stakeholders, underestimate governance requirements or assume enthusiasm equates to readiness. Pilots are often positioned as low risk. From an NHS perspective, pilots frequently represent additional risk, without clarity on benefit, sustainability or ownership. The hidden work industry rarely sees What industry often underestimates is the volume of invisible work required to make collaboration viable:
- Navigating information governance.
- Aligning clinical, operational and financial priorities.
- Engaging frontline teams who are already stretched.
- Designing evaluation that matters to NHS decision makers.
This work is rarely glamorous, but without it even the strongest innovations struggle to gain traction.
Why timing is a strategic decision, not a tactical detail
One of the most common causes of failure in NHS partnerships is timing. NHS teams may fully agree that a solution is valuable, evidence based and aligned with long term priorities but are still unable to act.
This is rarely because of reluctance. More often, it reflects competing pressures, workforce gaps or system level priorities that simply leave no capacity to engage.
From an industry perspective, this can be deeply frustrating. Considerable effort may have gone into preparing a proposal, securing internal support and aligning messaging, only to be met with delay or silence. Without a deep understanding of what else the system is managing at that moment; this can easily be misread as disinterest.
Good partnerships respect timing rather than attempting to override it. They recognise that when pressure is highest, the system’s ability to absorb change is lowest. Pushing pace at the wrong moment can damage relationships and make future engagement more difficult.
The most effective partnerships invest early in understanding the environment, financial cycles, operational pressures, workforce constraints and local priorities, so activity is aligned with moments when the system is able to engage meaningfully. Timing is not a tactical detail; it is a strategic determinant of success.
Why independent support changes the NHS partnership dynamic
Neither the NHS nor industry is structurally set up to do this work alone. NHS teams are focused, rightly, on delivery. Asking them to redesign pathways, manage external relationships and hold additional risk alongside core responsibilities is rarely realistic in the current climate.
Industry teams, meanwhile, bring expertise, innovation and resources but they are not embedded within the NHS system. They do not carry NHS accountability and they are understandably viewed through a commercial lens. This can make it difficult for industry alone to create the psychological safety required for honest discussion about risk, readiness and pace.
Independent support changes this dynamic by holding space between the two systems. Trusted by both sides, it allows difficult questions to be surfaced early, without defensiveness. It enables collaboration to slow down where needed, rather than being rushed prematurely into delivery.
Crucially, independent support is not about accelerating activity at all costs. It is about sequencing work properly, building confidence, aligning expectations and ensuring that when change happens, it happens in a way the system can sustain.
What strong NHS partnerships look like from the industry side
Where partnerships succeed, industry teams tend to engage earlier, long before a formal pilot or proposal is required. They invest time in understanding local context, system pressures and the realities of frontline delivery, rather than assuming a one size fits all approach.
Successful teams also place governance on equal footing with outcomes. They recognise that robust governance is not a barrier to progress but a prerequisite for it. When governance is treated as integral rather than peripheral, NHS confidence increases and decision making becomes easier.
Critically, good industry partners accept pace must follow trust. They resist the temptation to push for rapid implementation before the groundwork has been laid. Instead, they focus on building relationships, aligning incentives and agreeing what success looks like for the system, not just for the project.
Finally, they invest in understanding NHS reality rather than NHS structure. Knowing who sits where on an organisational chart is less important than understanding how decisions are actually made, where pressure points sit and what frontline teams need in order to engage.
A real world example of partnership working
I recently worked on a project that was shortlisted for Best Consultancy Partnership with the NHS at the 2026 HSJ Partnership Awards.
The work focused on embedding a regulated digital therapeutic into NHS primary care, not as a pilot that sat on the sidelines but as a service that clinicians could genuinely use within existing pathways. The challenge wasn’t a lack of clinical need or technological capability; it was the familiar gap between innovation and adoption.
Primary care teams needed a solution that could support patients quickly without creating additional workload and industry needed a way to integrate safely within NHS governance and day to day reality.
My role was to help bridge that gap by working alongside clinicians and partners to translate ambition into something operationally credible. That meant prioritising governance, co-design and workflow fit from the outset, rather than treating them as hurdles to overcome later.
A six-month pilot across three GP practices delivered measurable improvements for patients without increasing pressure on practices. The project was recognised not because of the technology itself, but because it demonstrated what’s possible when innovation is embedded in a way that respects how the NHS actually works.
You can read more about it here.
The NHS partnerships that succeed aren’t the loudest or the fastest
If partnerships repeatedly fail to land, it may not be because the NHS “does not get it”. More often, it is because the system needs support translating good ideas into workable change.
Innovation does not fail in the NHS because of lack of interest. It fails when complexity is underestimated, risk is unmanaged, or responsibility for making things work is unclear. Without someone to hold those elements together, even strong ideas struggle to move forward.
The partnerships that succeed are not the loudest or fastest. They are the ones where time is taken to understand context, build trust and design collaboration that fits the system as it is, not as we wish it to be.
In an increasingly pressured environment, that discipline matters more than ever.
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.