From Intelligent Toilets to NHS Frameworks
Written by James Beattie
For two and a half years, I have workedwork on a project called the “Intelligent Toilet”, a system designed to analyse urine using optical sensing. When people hear this, following perhaps a smile about the name itself, they assume the challenge is purely technical. Can you detect low concentrations? Can you miniaturise the optics? Can you make it affordable?
These are difficult problems. But they are actually not the most problematic issue.
The grander challenge is an institutional one. How do you develop healthcare technology that can survive contact with the NHS?
Through my work developing optical sensing platforms and helping run the Ubiquitous Optical Healthcare Technologies (UbOHT) programme, I have seen repeatedly that breakthrough performance is only the beginning. Across York, Cambridge and Strathclyde, we work closely with clinical colleagues, including GPs Jess and Willie, who are quick to remind us that not every exciting sensing capability translates into a meaningful clinical use case. Translation into public healthcare requires navigating regulatory frameworks, procurement structures, data governance standards, and evidence hierarchies that are necessarily complex.
That complexity is not a bug but an important feature of safeguarding. Public healthcare systems are necessarily conservative; they are the stewards of clinical risk. The NHS operates under extraordinary constraints because it carries responsibility for patient safety, litigation exposure, public accountability, and political scrutiny. Its frameworks are complicated by design.
But complicated systems without clarity creates friction.
The ISO Trap
Early-stage teams entering healthcare often encounter an implicit message: if you want to work with the NHS, you must implement full medical-grade compliance from the outset. This means ISO 13485 quality systems; formal risk management structures; extensive documentation; cybersecurity frameworks; data governance architecture.
All of these are essential… Eventually. The problem is sequencing.
A small team still validating core technical feasibility cannot? easily divert scarce capital or resource into comprehensive regulatory infrastructure before demonstrating clinical value. In doing so, they may commit to device classifications that constrain future flexibility. They may choose inappropriate standards because the pathway is unclear. They may exhaust runway on documentation rather than iteration.
The result is not safer innovation. It is stalled innovation.
The alternative outcome is equally concerning. Faced with opaque pathways and high upfront compliance costs, some teams simply avoid healthcare altogether. They pivot their sensing platforms toward environmental or industrial markets where the regulatory landscape is clearer. Or worse, they abandon translation altogether.
When that happens, the NHS loses optionality and innovations to healthcare are not felt by the broader public.
The Missing Middle Ground
Regulation is not the enemy. Healthcare must be cautious because a diagnostic error is not a minor defect; it carries human consequences.
But regulation is most effective when it is proportionate and staged.
Scientific and engineering disciplines understand progressive constraint. In these areas, prototypes are developed in controlled environments before field deployment, verification processes are formalised as architectures stabilise, and redundancy is introduced as systems scale.
Healthcare innovation would benefit from a similarly explicit progression. You do not build a skyscraper by installing the windows before the foundation is poured.
What is often missing is not rigour, but a clearly articulated pathway between research prototype and fully regulated medical device. These include:
- Structured pilot sandboxes within NHS Trusts.
- Defined early adoption tiers with proportionate evidence requirements.
- Clear sequencing guidance on how/when to implement specific ISO standards.
- Regulatory mentorship embedded within innovation programmes.
Without that middle layer, innovators face a false binary: informal research tool or fully compliant product. For early-stage teams with limited resources, that jump can be destabilising, demoralising and potentially destructive.
Science for Institutions
In the Nanophonics Centre, we think in terms of sensitivity, enhancement, signal-to-noise ratios, and reproducibility. Those metrics matter. But designing for the NHS requires a broader mindset.
It requires understanding risk classification early in development. It requires building data governance architecture into system design rather than retrofitting it. It requires documentation strategies that scale with technical maturity. It requires health economics thinking alongside analytical performance.
It is systems thinking applied not only to hardware, but to institutions.
Through the Ubiquitous Optical Healthcare Technologies (UbOHT), I see both the ambition and the friction. There is genuine appetite within the NHS for sensing technologies that enable earlier detection, decentralised monitoring, and reduced pressure on central laboratories. But appetite does not eliminate structural inertia.
When early-stage innovators mis-sequence compliance, exhaust resources, or disengage from healthcare entirely, the consequence is not individual failure, it is systemic narrowing. The NHS becomes increasingly dependent on a smaller number of established vendors who can absorb regulatory complexity. Smaller, technically ambitious teams often disappear before reaching patients.
Over time, that reduces the diversity of the innovation base the NHS can draw upon when new challenges arise.
There is also a strategic dimension. When early-stage UK innovators disengage because the pathway feels impenetrable, domestic capability erodes. A national health system benefits from a strong local ecosystem of companies that understand its workflows, regulatory culture, and operational realities. If that ecosystem thins, reliance on external vendors increases, and with it, reduced agility in responding to emerging needs.
Clarity as Infrastructure
My perspective on NHS innovation is not abstract. The NHS gave my father seven years beyond a terminal cancer prognosis. It saved my mother’s life after a stroke and brain haemorrhage when I was just fifteen. That experience shapes how I think about healthcare innovation. I am not interested in bypassing safeguards. I am interested in ensuring that responsible innovation can reach patients without being lost in procedural ambiguity.
Public healthcare must be cautious. Rigour is essential. But rigour and opacity are not the same thing.
Engineers and scientists work well within constraints. What we struggle with is ambiguity. When the pathway from prototype to pilot to procurement is unclear, early-stage teams either over-engineer compliance prematurely or disengage entirely. Both outcomes weaken the ecosystem the NHS ultimately depends on.
If safety frameworks are the guardrails of public healthcare, then clear staged adoption pathways are the runway.
Making those pathways explicit would not lower standards. It would widen participation. It would help innovators sequence compliance proportionately. And it would ensure that when the next major healthcare challenge arrives, the NHS has a deeper and more diverse pool of technologies to draw from.
Building an intelligent toilet is a technical challenge. Designing it to survive NHS frameworks is a systems challenge. Both matter.
James Beattie is a Postdoctoral Research Associate in the Nanophotonics Group at the Cavendish Laboratory and a King’s E-Lab Research Associate, University of Cambridge. His research focuses on advancing Surface-Enhanced Raman Spectroscopy (SERS) for diagnostic applications. As the Programme Lead for the £8.6 million EPSRC-funded Ubiquitous Optical Healthcare Technologies initiative, he fosters interdisciplinary collaboration across leading UK universities to translate cutting-edge optical based technologies into practical healthcare solutions.
James holds a PhD from Imperial College London, where he undertook an ICASE collaboration with GlaxoSmithKline (GSK), during which he co-supervised multiple MSc, MEng, and BSc students. With a strong commitment to mentorship and improving accessibility to science, he strives to support the next generation of researchers, particularly those from underrepresented backgrounds.