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If you’re a founder looking at the UK health market, start here: the NHS was not built to innovate. It was built to deliver care, free at the point of use, at population scale. That’s an operational mission, and it shapes how the system thinks about risk, speed and change.
Compare it to other industries. Your bank lets you open an account with a selfie. You find inspiration for your summer holiday travel through an AI agent. Those sectors absorb new technology because the cost of getting it wrong, while it can cause setbacks, is not as high stakes. Healthcare doesn’t have that margin. When things go wrong in healthcare, people are harmed. The NHS is built on that reality, and rightly so.
It’s tempting to look at the Microsoft Copilot rollout, deployed across 90 NHS organisations with more than 50,000 staff using it, and assume the door is wide open. It isn’t. NHS England has confirmed Copilot must not be used in any way that affects clinical decision making or patient care. Appetite for AI in the back office does not translate into clinical settings. And the big headline contracts, like IBM’s recent £160 million deal to become NHS England’s strategic delivery partner for the NHS App, tend to go to firms with the scale, track record, and resources to navigate procurement at that level.
That makes sense, and many of those companies are doing genuinely valuable work. But it does mean smaller companies, often the ones building the most specific solutions to the most specific problems, have a harder road. Being the best-placed company and being the best fit for a particular problem aren’t always the same thing. So, innovation isn’t the problem. The UK is full of companies building genuinely transformative tools, and programs exist to support them: the NHS Innovation Accelerator, the AI Lab, regional frameworks. The barrier is adoption. And adoption is, fundamentally, a communications problem.
Why most founders get this wrong
The NHS is not one organisation. It’s a complex web of entities, each with their own pressures and priorities. One ICB might be focused on health inequalities in a deprived urban population. Another might be wrestling with an aging rural population and stretched community services. A third might be tackling a growing elective backlog. The “problem” your product solves looks different in each of those places, and the language you use to describe it has to change accordingly.
This is where most founders stumble. They build a single pitch, a single case study, a single set of evidence, and try to scale it across a system that doesn’t work that way. The NHS is risk averse for legitimate reasons, but those reasons are local. The risk a rural trust is trying to avoid is not the same risk an inner-city one is managing. If your communications can’t speak to that, you’ll be politely shown the door, repeatedly, and you won’t always know why.
What works is the opposite: deeply specific, locally grounded, evidence-led communication that takes each part of the NHS on a journey. That means understanding what keeps a particular trust CEO awake at night. It means showing your evidence in a form their governance committee can actually use. It means making the case for why the perceived risk of adopting your technology is smaller than the very real risk of doing nothing. Most founders underestimate how much of this work is communication, not product. The companies that scale in the NHS are the ones that have learned to make the risk of saying yes feel smaller than the risk of saying no.
Is the NHS for you?
It probably is, if you’re willing to fall in love with the problem, knowing that it isn’t one problem but many, and that they present differently depending on where you are in the country. If you’re prepared to develop genuine local knowledge in every system you enter, build evidence that speaks to local priorities, and communicate in a way that takes risk-averse stakeholders with you rather than around them. If you’re in this because you want to relieve pressure on exhausted clinical teams and change how care is actually delivered, not because of how it looks.
Look at DrDoctor. In 2012 Tom Whicher set out to fix NHS outpatient appointments backlog, one of the most costly and widespread issues facing the NHS. He understood the scale of the problem, fell in love with solving it, and built the deepest operational knowledge of NHS booking systems in the country. Today DrDoctor works with more than 70 NHS trusts and health boards, supports 35 million patients, and powers nearly 40% of all UK outpatient activity. That happened because he understood the terrain, learned how to communicate with each part of it, and stayed to see it through.
The founders who genuinely change this system understand their problem deeply, develop evidence that stands up to scrutiny, know exactly what makes them different, and stay to see the work through. Above all, they help the people around them understand that saying yes isn’t the risk. Staying still is.
