The NHS Doesn’t Buy Tech, it Buys Trust – Embracing A HealthTech Entrepreneurship Mindset
Written by Coco Newton
There is a curious paradox at the heart of HealthTech. We have never had more entrepreneurial talent, more digital innovation, or more urgency to transform care. And yet, most HealthTech startups fail to meaningfully achieve adoption in the NHS – not because the technology is flawed, but because the assumptions behind how to introduce it are.
I recently welcomed Kevin McDonnell, a leading voice in NHS HealthTech adoption with over 25 years’ experience in building, scaling, and exiting healthcare technology companies, to share his wisdom with the E-Lab.
What emerged was not a familiar lecture on evidence and product-market fit, but something sharper, almost uncomfortable: the NHS doesn’t buy innovation, optimisation, or efficiency like we might expect, but it instead buys trust. Until founders re-design their strategy around that reality, progress will remain painfully slow.
Here I share my three key insights from our discussion that unpack this different entrepreneurial mindset for HealthTech.
One: Solve the want before you solve the need
We like to believe that health systems rationally adopt technology because it solves their biggest problems, just as the traditional entrepreneurial playbook tells us: identify the pressing need, build a clinically and economically savvy solution, collect evidence on service outcomes, iterate a few times, scale.
But as Kevin illustrated, this playbook rarely holds in healthcare. Imagine the NHS is a car permanently driving flat out down the motorway. Most HealthTech founders pull up alongside to offer better tyres. Yet even if the tyres can make the car faster, safer, and cheaper to run, the car won’t stop. It’s not that the NHS doesn’t want better tyres; it just has no bandwidth to stop the car long enough to change them.
So how then to achieve adoption of your tech, if not by solving the most important clinical or economic problem like tyre quality?
It’s by first solving the problem that the NHS already wants to solve, in a way that requires almost no staff behavioural change. It requires forming a keen understanding of the ‘buyer reality’ – having conversations with doctors and nurses which make you realise that the most reliable tool at 2am, when you’re sleep deprived and mid-emergency, is a pen and piece of paper. Until you start living this reality, no-one will trust that you are building something better.
Founders who start by building what the NHS wants – rather than what they believe it needs – earn the credibility and psychological safety required to later introduce more transformational change. It’s not a compromise, but a careful sequencing of small wins that makes change possible.
Two: Procurement is not just an economic decision – it’s a seasonal, emotional and personal decision
NHS procurement (the process by which healthcare organisations strategically acquire goods and services for their daily operations) is often tooted as a centralised bureaucratic workflow to learn and optimise. Yet what Kevin shared was something far more human, and knowing it can make or break your sales pipeline.
Adoption is initially governed by predictable seasonal rhythms: winter pressures block staff bandwidth for change; April funding unlocks opportunities for founders; summer then slows decision-making when people take holidays; and autumn service planning constrains experimentation.
Adoption is then influenced by the emotional risk of decision-makers sponsoring new technologies. Backing an unfamiliar digital solution is to take a career-level gamble. If it works, few notice; if it fails, everyone remembers. Ultimately, you’re not selling a technology, you’re selling a promised outcome that necessarily brings change.
And finally, adoption is personal. Kevin made this point with a story of his team building a diabetic eye screening technology. On paper it sounded perfectly standardised: one national dataset, one mandated reporting structure, one clinical pathway. Scaling across the NHS should have been straightforward.
In reality, however, their screening platform ended up with 728 different configurations. Not because the technology was complex, but because every NHS trust runs the same pathway in its own way. One trust uses community outreach centres. Another routes patients through high-street optometry. Another relies heavily on GP referrals. Another has a cluster of underperforming GP practices that have now been taken over privately.
So you don’t build technology once and then ship it 150 times; you sell it 150 times. Build the 80% that’s universal and expect to customise the final 20% every single time. Each sale means a new conversation, a new compromise, a new piece of tailoring. You need to ask each trust: What matters here? What does “good” look like for you? Where are the bottlenecks? Who touches the workflow?
Selling to the NHS is not about procurement economics. It is about engaging individuals, building a relationship, creating trust, understanding mutual value, and identifying the right opportunity – and then repeating this process over and over again. Empathy and timing are not just “soft skills” but are the heart of HealthTech commercial strategy.
Three: Plan your pilots carefully – or even skip them completely
According to Kevin, many HealthTech start-ups get killed because founders become so wrapped up in their product that they raise money, build something, and only then discover that no one's actually interested when they try to launch a pilot.
Of course, founders need that consuming belief in their mission: without it, they wouldn’t survive the development timelines and tough investment climate. But that conviction can mean they forget to go back to first principles and sense-check themselves.
A pilot needs to start from the most basic question: are you building something that anyone actually wants? A well-designed pilot doesn’t simply get the product “in the hands of somebody”. It tests explicit hypotheses. What do we expect to learn? What evidence will we collect? What does the end user need to experience or confirm for this to count as success?
And crucially, if those success criteria are met, will the organisation procure the product? Without that forward pathway, many pilots become stranded. As Kevin put it, “a pilot is the start of the race, not the end.”
This leads to another first-principles question: is a pilot actually the best route to building early traction and trust with the NHS?
Kevin highlighted that sometimes the smartest first step isn’t an NHS pilot at all. Early deployments with private GP groups, with other private healthcare providers, or even in international markets can give start-ups the credibility they need.
These routes generate exactly what NHS buyers look for when deciding whether to adopt new technology: solid evidence that the product works in clinical settings, trusted reputation signals, and a track record of operational use. They also demonstrate commercial viability and build diversified revenue, both of which matter deeply to investors.
A new mindset for HealthTech founders
These three insights – solve the want before the need; understand the emotional, seasonal and personalised nature of procurement; and think carefully about your pilot – ultimately lead to the same message:
The NHS does not resist innovation. It resists risk, of all kinds – to patient safety, reputation, familiar processes, and reliable tools. And trust is the antidote to risk. The task for HealthTech is not simply to build better products, but to build the conditions and systems for which the NHS is ready to use them.
For founders, this is both sobering and hopeful. It means that success is not reserved only for the loudest innovators or the most radical solutions. It belongs to those who can understand the NHS not as a monolithic “market,” but as a living system with a harsh daily reality: one that fears as much as it hopes, and one that transforms only when it feels safe enough to do so.
Coco Newton is a neuroscientist and translational researcher at UCL and the University of Cambridge, working at the intersection of brain health innovation and NHS implementation. She has worked across academia, industry, and policy to support HealthTech translation, leading multi-site NHS digital research projects and international expert groups on technology for dementia. Currently she is leading on the development of a digital cognitive tool for earlier Alzheimer’s detection in primary care and implementation framework for neurotechnologies in secondary care, funded by NIHR and ARIA respectively.