Why the NHS and Industry Can’t Solve This Alone – and Why Independent Brokers Matter
There is a growing consensus that collaboration between the NHS and industry is essential. Rising demand, constrained capacity and the pace of innovation mean that neither side can meet future challenges alone. And yet, despite goodwill on both sides, many collaborations struggle to get off the ground or fail to move beyond pilot stage. The question is often framed as one of intent or trust. In my experience, that framing misses the point. The real issue is not whether the NHS and industry want to work together. It is whether either is structurally able to do the work required to make collaboration safe, credible, and sustainable.
Different pressures, different rules: Why the NHS and industry struggle to align
The NHS and industry operate under fundamentally different conditions. NHS teams are accountable for patient safety, public money, workforce wellbeing, and organisational reputation, often simultaneously and under intense scrutiny. Capacity is limited, risk tolerance is low and change must compete with delivery. Industry teams meanwhile are under pressure to demonstrate value, secure access and build partnerships that show real-world impact. Innovation moves quickly but success depends on navigating a system that was not designed with industry in mind. Both realities are valid. But they are rarely aligned by default.
Good ideas, stalled progress – Why collaboration so often loses momentum
Many collaborative initiatives fail not because the idea is wrong but because the system cannot absorb it. From the NHS perspective, collaboration often raises immediate questions around ownership, accountability, risk, workload and fit with system priorities. From the industry perspective, the same project can feel slow or opaque, with unclear decision making. Without someone explicitly responsible for bridging those perspectives, momentum is easily lost.
The invisible work behind NHS/industry collaboration
What is often missing from discussions about collaboration is recognition of the invisible work required to make it function. This includes navigating governance and information assurance, translating clinical, operational, and commercial priorities, engaging frontline teams, designing evaluation that matters to NHS decision makers, and managing risk in a way that builds confidence rather than resistance. This work rarely sits neatly within an NHS job description, nor does it align cleanly with industry functions. As a result, it is often nobody’s core responsibility.
Read my blog – The workforce challenge: The NHS cannot transform without addressing its people problem – by clicking here.
Why the NHS cannot carry the weight of collaboration alone
NHS teams are already operating at, and often beyond, capacity. Asking them to redesign pathways, manage external partnerships and hold additional clinical, operational and reputational risk alongside day to day delivery is rarely realistic.
This is not a failure of leadership; it is a reflection of sustained system pressure.
Even where there is enthusiasm for collaboration, NHS teams are constrained by time, governance requirements and competing priorities. Change work must compete with delivery and delivery will always win. As a result, collaboration activity often becomes fragmented, dependent on individual champions or postponed indefinitely.
There is also a structural challenge. NHS organisations are designed to deliver care safely and consistently, not to absorb and adapt external innovation at pace. Introducing something new requires governance, engagement, evaluation and assurance, all of which take time and expertise that are often in short supply.
In this context, asking the NHS to independently design, manage and sustain collaboration with industry is unrealistic. Without additional support, even well-aligned initiatives can stall before they reach patients.
Why industry cannot bridge the gap on its own
Industry teams bring innovation, expertise and resources the NHS genuinely needs. However, they are not embedded within the NHS system and do not carry NHS accountability. This fundamentally shapes how they are perceived, regardless of intent.
From an NHS perspective, industry led initiatives can feel risky. Questions arise around commercial motivation, long term commitment and alignment with system priorities. Even when trust exists, industry teams are rarely positioned to hold risk on the NHS’s behalf or to act as a neutral convener across organisations.
Industry teams also face structural limitations of their own. Internal pressures around timelines, deliverables and return on investment can conflict with the slower, more cautious pace required to build NHS confidence. This tension is not about values; it is about operating context.
As a result, industry alone often struggles to bridge the gap between innovation and implementation. Without support, good ideas can become trapped between ambition and reality.
The role of the independent broker in making collaboration work
This is where independent brokers matter.
An effective broker operates in the space between systems, translating priorities, de-risking proposals, and aligning expectations until collaboration becomes viable. They are not there to sell solutions or manage projects in isolation but to create the conditions in which partnership can function safely.
In practice, this involves identifying genuine system need rather than forcing solutions, building trust across organisational boundaries and designing governance that clinicians and leaders are comfortable standing behind. It often means slowing things down early, asking difficult questions, surfacing concerns and resisting premature delivery.
Crucially, the broker must be trusted by both sides. This independence allows them to challenge assumptions, manage pace and hold risk in a way that neither the NHS nor industry can easily do alone.
What successful NHS/industry collaboration actually looks like
Where collaboration succeeds, it rarely feels dramatic. Instead, it feels calm.
Roles are clear, expectations are aligned and risk is visible rather than hidden. Frontline teams understand why the work matters, how it fits into existing pathways and what support is available if challenges arise. Industry partners understand the pace and constraints of the system and work within them rather than against them.
Importantly, good collaboration feels supportive rather than extractive. It reduces uncertainty for the NHS, and it builds confidence rather than dependency.
Most importantly, collaboration leaves behind something tangible, e.g., a pathway, a framework or a blueprint that others can use. The value is not just in what is delivered, but in the capability that remains.
From fragile projects to resilient pathways
Across different clinical areas and systems, the same pattern repeats.
Where collaboration relies on individual enthusiasm alone, it is fragile. Progress depends on specific people, informal relationships and short term momentum. When those individuals move on or priorities shift, the work often stalls.
Where collaboration is designed deliberately, with governance, engagement and ownership built in, it becomes resilient. It survives changes in personnel, pressure and context because it is held collectively rather than personally.
The difference is rarely the idea itself. It is whether someone has taken responsibility for designing collaboration as a system function rather than an optional add-on.
When partnership moves from theory to practice
I was recently involved in a piece of work that was shortlisted for Best Consultancy Partnership with the NHS at the 2026 HSJ Partnership Awards. The project centred on integrating a regulated digital therapeutic into NHS primary care in a way that went beyond a time limited pilot and became something clinicians could use within everyday pathways.
The core challenge wasn’t innovation or appetite for change. It was the familiar disconnect between promising solutions and the realities of adoption. Primary Care teams needed a way to support patients more quickly without adding to already stretched workloads, while industry partners needed a route to integrate that was safe, credible and aligned with NHS governance and operational norms.
My role was to support that translation process, working alongside clinicians and partners to turn ambition into something workable on the ground. That meant putting governance, co-design and workflow integration front and centre from the very beginning, rather than attempting to retrofit them later.
A six-month pilot across three GP practices showed that this approach could deliver measurable patient benefit without increasing pressure on practices. The recognition the project received was less about the technology itself, and more about what it demonstrated, that innovation can embed successfully in the NHS when it’s designed to fit how the system actually operates.
You can read more about the project here.
Why poorly designed collaboration makes things worse, not better
As the NHS continues to face unprecedented pressure, collaboration with industry will only increase. Innovation is accelerating and the gap between what is possible and what can be safely implemented is widening.
In this environment, poorly designed collaboration is not neutral, it is actively unhelpful. Initiatives that add risk, workload or confusion can undermine trust and make future collaboration harder.
If collaboration is to genuinely help patients and staff, it must be treated as a discipline in its own right. That requires judgement, translation and a willingness to engage with complexity rather than bypass it.
Someone has to hold the risk – The missing responsibility in collaboration
The most successful collaborations I have been involved in share one common feature – someone took responsibility for making them work.
Not for owning the solution and not for driving the agenda but for holding the risk, translating priorities and staying with the work long enough for trust to form.
These reflections draw on my work supporting NHS organisations and industry partners to move from pilots to embedded pathways, focusing on governance, trust and long-term system value.
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.