What are the GIANT discussions happening right now? My 2025 outlook

I've been struggling to get my articles out recently, not because I lack something to say, but new babies, snotty season, ergo snotty babies and the fact we're still in a bloody holding pattern on what comes next has had us all playing NHS guessing games, has left my newsletter rather quiet. I've also been annoyed that LinkedIn's algo really doesn't recognise and proliferate longform content (I may shift to Substack in 2025).

But after two days at GIANT Health Event , and a lot of people stopping me to chat about my writing (blush! 😳), to ask how I managed to put my face in 503 places at the conference (helpers), and more importantly to ask for my candid read on what 2025 holds for us all.

Which brings me to the meta.

If I'm going to leave the comfort of my safe little room, get on the choo choo from Bristol to the big city, and put on my social face, then I want to read the room and find out what people are talking about.

After GIANT and Hassan's LIHE over the last few weeks I'm ready to share, and also to give my view on what 2025 has in store.

How long do we have to wait for the roadmap?

It's unsurprising that the main topic of debate and discussion is whether things are going to be any better next year and more generally under Labour, along with an air of frustration that we're getting meagre breadcrumbs from the government, blanket silence from DHSC & NHS England (who are largely blocked from saying anything meaningful at the moment), and a lot of political grandstanding about the last administration.

In good news everyone's stopped saying Darzi every three words.

From chit chat with NHS leaders and those in the know, I've read cynicism, with a dash of hope on certain topical areas, and across industry I've read a mix of hope (because the government keeps saying the word technology), and frustration about how little detail there is to make strategic or even tactical decisions on.

If you're in the latter camp, then somewhat I join the frustration based on the reasons above, particularly given the aim is for the 10 year plan (AKA the empire strikes back) to be out in May, which means that we're already in the start of the 2025/26 NHS financial year. But presumably if the NHS Operational Guidance (usually out 23rd December) is on time this year then we should get some valuable indicative detail in a few weeks. I doubt that the main contractual frameworks will tell us a lot to be honest.

Starting all over again

Secondly, and perhaps to add to the confusion, is the amount of policy, strategy, and other such national documentation that is now detritus 💥: the NHS workforce plan, the NHS long term plan, the Sinker review: all down the pooper to be reinvented anew.

What felt like a bitter additional pill is that the great people's debate about change is being seen as disingenuous and political, although some told me that the local discussions have been surprisingly good given (to quote) they "went in with very low expectations, and was pleasantly surprised". So maybe there is a new hope.

But it does beg the question: was every idea and plan created between 2010 and 2024 genuinely trash or are we throwing it all out just because it smells of the ex.

Good job they didn't make half the national team redundant... oh wait.

So will the new squeeze be better?

I'm not going to answer this one here, although I've got concerns around the tone of language which I'm struggling to connect to the word 'service' that Keir Starmer kept saying on the day after the election, but suffice to say, this was right up there as a big hanging question.

But will it? Really?

In summary, everyone's reading the tea leaves, playing guessing games and hoping that there will be some good news next year.

Like the famous Guinness advert... waiting is what we do here...

Part 2 (ish) outlook for 2025

Now to the meaty business, what have I been saying in response to the regular question people have being asking me about what 2025 has in store (other than war with Russia and the US formally becoming a dynasty)?

So...

I think we need to reflect on: what is comparatively enough to warrant positivity?

The last few years of the Tory reign over the NHS (and other government depts) was a flaming shit show of flagrant ineptitude or outright sabotage.

It will be better than that. Of this I'm positively certain.

But will it be the land of milk and honey, where all those founders saying the word 'revolutionising' finally attain factual accuracy?

Absolutely no chance.

Let's be really clear, the NHS is in a financial hole, and whilst the government made a lot of noise about the "massivist investment in the NHS" (sic), the money will barely touch the sides.

Ahead, financially speaking, lies pain. Sorry.

Bullish the Liam is not.

Similarly, short term bungs do not maketh a market, and short term outlook is what we're getting for now.

Local systems are not going to be investing in big digital multi year projects when they have no idea what their revenue spend is going to be in the following year.

If we're to take the recent NHS England board minutes, and comments from Streeting and Milburn, et al, the NHS is going to be skint (again), and as the current standoff between local CFOs and Julian Kelly (up top CFO) illustrates, we've got a big financial fantasy vs reality disconnect ahead.

On the other hand, don't worry, apparently we'll make it back by sending all the admins off to the job centre.

Too exhausted to be energised

Shifting from pounds to people, what I feel will mark 2025 is that we're going to see hugely ambitious plans emerge, presumably on a shoestring, built on the goodwill of the workforce, and of course, where you'll get sacked if not performing...

EVERYONE I know in the NHS, even the most energetic and passionate, is knackered, jaded and hardly feeling in the right mindset to BE THE CHANGE.

Maybe they could if properly supported, but the feeling I get is that the hope of a new government is a fragile thing; easily shattered, and just asking for harder, better, faster, stronger is going to lose the goodwill of those holding on.

Again if you're looking for champions and advocates for your brand of the digital revolution, dejected people really isn't the ideal audience.

So is 2025 a write off then?

No. Well I think a lot of companies are going to get written off, but for the market I think I'm seeing good signs.

Across the board I'm seeing greater realism, where the hype and the short termism held us back.

The NHS was never about founders coming in, scorching the earth and then exiting in their Lambos.

Ask the most established new breed of healthtech companies in the NHS now. They're thinking long term, they're thinking of iterative strategy and their treating the NHS like the sea: wild, dangerous, sometimes unpredictable, and frequently fatal, but something to be respected as a market.

That's good for us all, because the bigger companies role model the behaviours to the new breed.

The investors that aren't immediately sticking new UK companies on the British Airways direct to California, are becoming more patient and realistic.

That's good for us all.

The ecosystem of players (companies themselves, advisors, supporters, facilitators, standard setters) are starting to talk about collaboration, about compromise and doing some of the things I advocated for last year in my article on super grouping, including getting over some of the constant blockers that can kill collaboration quickly.

That's good for us all.

Many people are talking openly and strongly about the challenges and what isn't working, partly out of frustration, perhaps partly out of hope, definitely as a form of Darzi inspired collective grief, and HOPEFULLY in the ambition to drive a new status quo.

All to often the way the UK system was described was a fantasy in recent years, with too many parties either not seeing it, or just serving their own feudal agendas. Collaboration was paper thin (as can be the case when everyone is defending their existence and budget lines), especially within the NHS, and that got in the way of... truth.

It also got in the way of critique (highly necessary), debate (critical) and progress.

My hope is that we can bottle, and maintain, this period of honest candour and discussion, after labour settles in in 2025 as...

That's good for us all.

In a video a while back I talked about the 'Tragedy of the commons' in systems thinking, where common objectives are eroded by individual objectives, ultimately leaving nobody winning.

All too often the NHS has felt like this: from local providers passing on patients and poaching staff, to national departments infighting for influence and power, to a long history of awful tangible collaboration (aka competition) by the AHSNs, every NHS organisation wanting someone else to do the first pilot work and then follow on once proven, to individuals at many levels being more highly incentivised to avoid risk rather than do the right thing, and so on.

The story of the failed NHS, and perhaps those markets who serve that system, could easily be the tragedy of our commons.

This problem has been eating away at me over the last few years, and particularly this last year it has made me sad and angry in equal measure, which in turn, has affected what I talk about and how.

I really don't want to be sad and angry any more in 2025!

I want to have hope, and I believe that 2025 hold the potential for hope in spite of all the potentially continued bullshit and politics.

So if anyone is still reading here's my heartfelt pitch, and the choice that could actually, genuinely make 2025 a new hope.

Red pill <> blue pill: A call to action for 2025

Let's get the shitty, hopeless 2025 scenario out of the way.

We, inside the system, outside the system, and so on continue to play the game, preserving our own interests for short term gain. We don't speak up and speak out, and that brief period of Darzi collective emotion and truth becomes a similar memory to that brief period of agency, innovation and getting shit done in 2020. We go back to the status quo, compete, and watch our collective prospects wither.

Is that the pill for you?

No?

Let's flip it then.

We get sophisticated, and focus more on the common ground above the individual interest. Companies actually work together to collectivise approaches and offerings, so the NHS can see cohesion and don't have to do the work to make things joined up (they don't have the time or energy), accepting that nobody wins in this industry as an island.

National and regional actors recognise that self preservation is a zero sum game, and nobody wins if everyone is jostling for self preservation. They sit down and say "what would the best work of our lives be if we acted more as a community, even if we're disincentivised to do this?"

On this one, I have hope, and big kudos to the NHS Innovation Accelerator team who I know are really pushing to facilitate this approach, and I hope that this gets to fruition in the rapidly shifting NHS. I won't say more but I'm watching this space closely.

What if we try and drive the #healthtech and #medtech industry to be more sophisticated, and talk about what sophistication actually means. I'm seeing it in the established operators, but there's still too much bullshit, not enough real work to actually meet the NHS where they are and genuinely understand their explicit and implicit needs.

"Hey NHS look at my fancy revolutionary AI gizmo" just doesn't cut it in 2024 and we as a community need to define what the required standard is, driven by honesty and candour from those who have learned the hard way, from the system being really candid around what companies will face in this financially, culturally and more or less operationally broken system.

Next we need the community and our narratives and requests focusing less on top down capitally allocated 'bungs', and more around doing the hard work to integrate technology in a way that accessibly helps the NHS imagine how their revenue funded BAU (business as usual) can shift and be shifted.

The real transformation is a revenue revolution, and not the continued cobbling of capital commissioning (including year end underspend madness), and we need to work towards that, otherwise the progression of the industry is both fragile and reactive.

Total transparency - the real work I describe above is what I built my NHS ready course to do, and what my energy and focus is now on for this industry. Yes I want to be compensated for it and to keep paying my mortgage, but it's there because it's the right and necessary thing for the healthtech industry, and the most valuable work I can dedicate my energy to. My career has always been about building the thing I think we need the most, not the obvious commercial thing. More below.        

I have hope.

It doesn't exist in one place, but is a collective effort to shift from dependency dynamics to genuine collaboration and progress.

Our industry is immature, there is too much expectation (even now), statistically too many companies creating noise, and too few owning the problem, instead pointing to the failure of someone else or some other group.

My hope lies in the sparks of discussion, and of candour, and perhaps of some form of recognition that the status quo is a tragedy (of the commons) in the making. I think this is what Hassan Chaudhury HonFAPM has been strongly advocating in his advocacy for collisions.

That hope lies in US preserving and protecting the emergent bits that are really positive, and trying to achieve more sophistication. Not waiting for some national director to make it all better for us, or some 'Hail-Mary' opportunity to float down from The Rt. Hon. Wes Streeting MP .

Having spent many years observing pharma, the good and the ill, what has always struck me is that we are very very immature as a sector, and we need to fix that (whilst not doing all the stupid, immoral, underhand shit that big pharma does all too frequently).

So 2025.

There is hope, there is opportunity, and things should become more clear and consistent.

No land of milk and honey.

But an opportunity for us (which I use looking at all sides here), for us to make it a really good one.

Perhaps not for all companies - creative disruption needs to reign and failure rates will likely be 90%+ of companies - but for the building of a better environment for us to dig ourselves out of this hole, applying technology when and where valuable, and focusing on the common ground.

I'm committed to this, and committed to being less righteously indignant and critical all the time, and constructively helping to bring about what I'd like to see happen.

2025 isn't a foregone conclusion, it's going to be hard, but whether it's successful in spite of this...

... that my dear readers, I believe, is in our hands.

Until then may your days be merry and bright..... 😉🎄

OK here's how I can help you in 2025

I'm shifting my energy in 2025 away from quietly helping the few who can afford my daily rate, and instead to help as many as I can.

Here are three things I'm doing in January to help you build your sophistication and genuine readiness.

1. My next batch of 𝟮 𝗵𝗼𝘂𝗿 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝘆 𝘀𝗲𝘀𝘀𝗶𝗼𝗻𝘀 to help you improve your NHS strategy. I'm releasing only six of these throughout January. First come first serve, then only available for NHS Ready course subscribers.

2. I'm running my first tactical masterclass - Jan 15th 12-1:30pm on 𝗛𝗼𝘄 𝘁𝗼 𝗴𝗲𝘁 𝘃𝗮𝗹𝘂𝗮𝗯𝗹𝗲 𝗡𝗛𝗦 𝗶𝗻𝘁𝗲𝗹𝗹𝗶𝗴𝗲𝗻𝗰𝗲. £99 + VAT - but FREE for those on my NHS Ready course.

3. 𝗧𝗵𝗲 𝗡𝗛𝗦 𝗥𝗲𝗮𝗱𝘆 𝗰𝗼𝘂𝗿𝘀𝗲 itself - 8 hours of fun and impactful self learning by video, with templates, resources and free access to quarterly masterclasses.

More on all of these here. Drop me a DM if you have questions.