Seven mistakes that healthtech companies make when looking to work with the NHS and what to do differently.

Healthtech isn't usually my go-to article territory, but my friends Rehan and Oli, who are building an initiative for healthtech companies called Boxhealth, asked if I could contribute some thoughts on common mistakes I often see when helping companies try to get a foothold and scale in the NHS. Here's seven that stood out in a rather long list.

👇 p.s. if you'd like to know who I am check the footnotes 👇

Let’s start by not beating about the bush, there’s a huge amount of noise and hype about the promise of the UK health market, along with people who promise they’re one degree of separation away from you winning the NHS.

I don’t want to detract you from seeking to work with the NHS, there are many benefits from working with the NHS, and internationally the NHS reputation means it’s a great global launchpad.

ONE Treating the NHS as one organisation

Often companies ask me how they can work with, or sell into, the NHS. To which I ask - which bit. Often they don’t know the answer because the whole narrative around the narrative is that it’s one thing - whereas it’s quite the opposite. The NHS is a complex system of financial and governance arrangements, independent businesses (e.g. GPs) and stakeholders. Most of these will have very specific remits and financial rules that would dictate who you need to actually engage with.

Do - ask around and with very specific questions about who actually funds the area you’re in, what that funding is for (e.g. some funding is just for roles not tech), and who are the bigger influencers. Think about how you can engage with folks in these two different kinds of roles. 

TWO Expecting there is someone in the NHS national bodies who can deploy or make people deploy your solution widely

The NHS both is and isn’t a top down institution, but all of that time you’ve spent trying to get the attention of national director X will unlikely get you any actual business. When you’re scaling, integrating or facing system challenges down the line then they may be essential, but currently NHS England do not commission tech, and they can’t tell any local organisations to. The best you’ll get is being profiled in a positive light. But, local organisations don’t look to national bodies for inspiration or ideas that much, and so national orgs might provide some guidance, money, operating rules, contracts etc., but it’s very unlikely they’ll get you that much business. 

Do - Focus on where the money and requirements flows down to, specifically the responsibility to deliver specific things. Look for the problem they’re being tasked to solve, and find where you align.

THREE Missing NHS financial year windows

A niche point but many startups miss this crucial point. There are arguably two optimal windows in the year for you to get funding, the rest of the time you might be just wasting a good opportunity to get in the shortlist. Many organisations assume that the new financial year (April) is when the new money lands and it’s game time. Actually the opposite is the case, and you might be trying to get tickets to the festival after it sold out.

Do - Plan your approach times with military precision. I used to do this and all new business and growth often happened in a very short period. Here’s my 101:

• October - November - the time local orgs are starting to think about plans for the next year - relationship development and engagement time.
• December - January - Proposal and business case planning - often tentative but usually they’ll have an idea what they want to do.
• February - March - Game time - national operating plans and ambitions etc. will be out and against this the organisations will be considering  and agreeing business cases for the following year.
• April - September - Delivering the projects with a big quiet holiday period in the middle.

These are your windows for engagement (and limiting engagement), but there’s one final thing: underspend - if you have a clear proposition that’s not super expensive - like a product or trial that they can repurpose from unspent monies then there is usually a last minute dash. There is less oversight and process under a certain amount of money, that could get you a vital early contract, however, underspend is often received at the expense of recurrent monies (ie. it’s a one off), whereas business cased funding is more likely to be recurrent. So be aware of the trade-off. I used to get new orgs through underspend, and then purpose those relationships to transition to recurrent spending around November.

FOUR Trying to sell generic benefits over specific ones.

The NHS is a machine gun for buzzwords - you need to be aware of them, but so many organisations think if they use lots of them to describe their solution then those hits will mean they get to the top of the pile. Nope. In fact the opposite is the case - because most people in the NHS work in specifics - specific topics, challenges and areas. Often there is a joke amongst my peers about the laziness of companies who just use the same general terms, but actually I feel sympathetic - the NHS makes a lot of noise about these terms, and therefore a natural conclusion is that’s what they want.

Do - ignore the noise, and take time to really focus on specifics - specific problems, specific targets, specific needs - as someone will very likely have these exact needs on their to-do list next financial year.

FIVE Selling your product to the NHS

Yes, you may have read that twice - how are you supposed to be paid if you don’t sell to the NHS!? The NHS is culturally very anti-private sector and often the influencers around your clinical product do not deal well with sales pitches. So when you get a Business Development hire and get them pitching your product left-right-and-centre it’s very likely that they might come back with very little. The NHS thinks in needs and projects, and this is their comfortable territory - there are some occasions where you can definitely pitch - such as going for a tender, but getting uptake in the NHS needs a degree of sophistication.

Do - Sell patient stories and experiences, staff needs, issues and errors or wasted time, system challenges, clear ideas for how things can be better, and a genuine vision for change. In other words sell the why not what, but in a way that’s specific and clear. Then once you have some NHS contracts under your belt - sell the best practice of those organisations who you have worked closely with, and what the benefits of them emulating a peer organisation would bring them. The best influencer of an NHS organisation is hands down… another NHS organisation.

SIX Don’t expect them to do loads of running around

Everyone is busy in the NHS, and realistically (rule of thumb) if there are lots of things they have to do to make a case internally for your solution, then they probably won’t. One thing I learned VERY quickly was to write a business case, or some detail that definitely isn’t the text for their tender, but might offer some inspiration.

Do - accept that in some cases you might need to do the work for the person who is your in, for them. It’s not fair, it’s not ideal, but trust me - it’s the difference between you getting contracts and not. So ask what their process would be internally and literally ask if there is anything you can provide to help make that more expedient. Then try to write it in their (NHS) language, not the pitchy hyped language you’ll put to your investors.

SEVEN Believing healthtech echo chambers, VC noise and non-NHS awards will make a difference

When you’re getting a name for yourself: you’re winning 30 under 30, best London healthtech awards, and hundreds of likes about your biggest posts on LinkedIn etc. it may feel like you’re getting momentum to be seen. In reality it’s unlikely the case. Now clearly you need this for investment rounds, but an example I recall is sitting down with a founder who put loads of energy into LinkedIn profiling and industry awards. Looking through the 100+ likes - barely a single person liking the post had any influence on the ultimate customer. Assume that any of this noise will not be seen by many NHS people, that they’re often not on LinkedIn, and they probably don’t go on that much. 

Do - focus your energies on where your commissioner actually is - for example there are loads of Twitter communities of NHS staff focusing on specific topics and hashtags, NHS community webinars, and if you really need to conferences - but not the biggest jazzy ones but possibly the niche specific ones.

Final thoughts / tips

If anyone tells you that getting traction in the NHS is easy, or there are shortcuts, then they’re wrong and you should not heed their advice. Most healthtech successes in the NHS have been - big platforms and the usual incumbents, handy loopholes, major events, or specific funded targets. In honesty my successes were a mix of 3 & 4. But it is getting easier IF you take the time to understand how the NHS actually works, what it needs, and do as much of the work as possible for those who are the key to scaling your solution.

I’m sure your company could really benefit the NHS, staff and patients - otherwise you wouldn’t dedicate the energy you do, and many companies are frustrated at the barrier to entry. But the NHS is well and truly the only brand in town, and genuinely understanding the NHS, and making what you do about them and their success, not yours, is the way forward.

Best of luck with your endeavours.

Liam 🙂

About Liam

Since 2018 I have advised founders and leaders in a range of exciting orgs: big and small, products and services, from AI to Rx to VC, but all bringing the power of digital to health and social care: Abtrace, Alcuris (acq Access), Agilisys, Birdie, Blenheim Chalcot, Coplug, DDM Health, Echo (acq Lloyds), Eva, Feebris, Infinity Health, PCL Health, PUBLIC, Thalamos, TympaHealth, Vinehealth, Zava, Zivver.

Check out my testimonials on my Linkedin for their own words.

I get the NHS. I’ve built within, spun out and scaled up, navigating the funding flows, the power pockets, the rabbit holes, the process pitfalls and the noise vs reality at all levels. My experience from leading and advising national work, to empowering commissioning teams and prescribers, to working with frontline services, allows me to be versatile around the needs of those I work with. I don’t really promote this line of work, and all of the above have come through word of mouth and through the excellent PUBLIC who I'm Health Advisor for.

My work ranges from reframing offerings, spotting and responding to risks and opportunities, aligning with NHS policy, translating to NHS, helping put out fires or to find a way in, supporting your story, message and pitch, and so on. The NHS is hard. I meet you where you are and help find a way to get over the wall and improve care in a system that sometimes acts like you’re not welcome.