Ask Hardian: Navigating the stakeholder landscape in the NHS
For digital health innovators, the NHS can seem like a maze. It’s vast, decentralised, and full of confusing acronyms. But behind that complexity is a set of real people, teams, and incentives that, once understood, can help shape the routes to market access. If you want your digital technology to reach patients and scale within the NHS, it’s key to understand who matters, what drives their decisions, and when and how to engage them.
1. The NHS isn’t one customer – it’s many
The first and most important mindset shift is that the NHS isn’t a single buyer. It’s an ecosystem of interlocking organisations with distinct priorities and budgets. Broadly speaking, in England you’ll encounter:
Integrated Care Systems (ICSs): 42 regional partnerships responsible for planning and funding services across health and social care.
Integrated Care Boards (ICBs): responsible for commissioning services locally. The current 42 ICBs are being reduced to around 27 regional clusters.
NHS Trusts and Foundation Trusts: acute, community, and mental health providers that deliver care.
Primary Care Networks (PCNs): groups of GP practices that can adopt smaller-scale digital tools, often with an emphasis on prevention, population health, and early intervention.
NHS England (NHSE): the national body setting strategy, allocating funding, and running innovation programmes. However, the 10 Year Plan announced that NHSE would be dissolved, with many of its functions likely moving to the Department of Health and Social Care (DHSC).
Understanding how these organisations interact – who has the authority to say yes, and who can quietly block progress – is the foundation of a viable NHS market access plan.
2. Understanding the individual stakeholders
While organisations like ICSs and trusts are important, your success often depends on connecting with the right individuals — the people who make decisions, influence adoption, or champion innovation internally. Here’s a breakdown of key stakeholder types you’re likely to encounter:
Clinical Leads / Consultants – Often the first and most influential advocates. They know the patient pathways, understand the day-to-day clinical challenges, and can make or break the adoption of a new digital tool. Robust evidence that addresses their clinical priorities can win their support quickly.
Transformation / Change Leads – These are the people tasked with delivering innovation and efficiency within a Trust or ICS. They care about workflow improvements, service redesign, and measurable outcomes. Building a relationship with them can help you align your solution to broader strategic initiatives.
IT and Digital Teams – Adoption hinges on integration. IT directors, digital architects, and informatics teams will evaluate how your solution fits with existing electronic health records, cybersecurity policies, and interoperability standards. Early engagement avoids technical roadblocks later.
National Clinical Directors & Specialty Leads – Within NHS England, these directors oversee specialty areas like cardiology, mental health, or diabetes. Their endorsement signals clinical credibility and can accelerate adoption across multiple ICSs.
Commissioners / Programme Leads – Especially within ICSs, commissioning teams decide which services and technologies receive funding. They evaluate cost-effectiveness, scalability, and alignment with population health priorities.
Procurement and Finance Teams – Ultimately, someone has to approve the budget. These teams scrutinise business cases, total cost of ownership, and contractual terms. Understanding their criteria is critical to turning interest into adoption.
The key is recognising that each stakeholder has a different lens: clinicians focus on patient outcomes and implications for day-to-day practice; transformation leads on efficiency; IT teams on integration; and commissioners on cost-effectiveness. Mapping your engagement strategy across these roles – and tailoring your messaging to each perspective – dramatically increases the chances of success.
3. Start with the problem, not the product
Every NHS organisation is under pressure with long waiting lists, workforce shortages, and constrained budgets. The fastest way to lose credibility is to pitch your app or platform as “innovative” without linking it directly to a measurable NHS priority.
Before you even think about procurement, define how your product meets a current NHS priority. Are you reducing outpatient appointments? Supporting community care? Improving patient flow? Aligning your technology with national strategies such as the Long-Term Workforce Plan, Core20PLUS5, or the Digital Clinical Safety Strategy makes your offer far more compelling.
When you can show that your innovation solves a real pain point or helps meet a national strategic objective or target, not just that it’s clever or novel, you are likely to start getting the attention of the people you will need on your side.
4. Know your allies (and potential champions)
In the NHS, change doesn’t happen just because you’ve built something great. It happens because someone inside the system believes in it. Finding your clinical or operational champion – a consultant, digital nurse, or service manager who advocates for your product – is important
Health Innovation Networks (HINs, formerly AHSNs) exist to help innovators navigate the NHS landscape. Their role is to connect promising technologies with the right clinical teams, provide guidance on evidence generation and evaluation, and support early pilots that can demonstrate value. The NHS Innovation Service is intended as a single point of access for innovators seeking to engage with the NHS innovation ecosystem. But just as often, your initial point of entry might be via an individual trust where a clinician or team sees the value in your product and champions its adoption.
5. Evidence is your passport
In a world where every organisation is cautious about risk, robust evidence isn’t a ‘nice to have’ - it’s your passport to adoption and scaling up. Start small, generate data, and build a story.
For digital tools, that means demonstrating three things:
Clinical effectiveness – Does it improve outcomes or support clinicians safely?
Economic value – Does it save time or money?
User acceptability – Do clinicians and patients actually use it?
The NICE evidence standards framework for digital health technologies and the Digital Technology Assessment Criteria (DTAC) checklists are your go-to tools. Meeting these standards early saves you painful rework later.
6. Be patient, but strategic
Selling into the NHS is rarely fast. Procurement cycles can take months, and pilots even longer. However, there are routes that can help accelerate things. For example, participating in an ICS-led innovation pilot, being selected for the NHS Innovation Accelerator programme, or successfully applying for SBRI Healthcare or NIHR funding. These can help you build evidence, gain NHS credibility and move more quickly toward adoption.
Build relationships with multiple stakeholders in parallel with clinicians, procurement leads, digital transformation teams, and commissioners. Each holds a different piece of the puzzle, and alignment among them accelerates decisions.
7. Think ecosystem, not endpoints
Finally, the NHS is moving toward integrated, data-driven care. That means your product won’t live in isolation – it needs to interoperate with electronic patient records, fit into clinical workflows, and comply with data governance (GDPR, UK GDPR, and NHS DSPT). Position your innovation as part of the digital ecosystem, not as a standalone tool.
The bottom line
Breaking into the NHS is challenging, but it’s also one of the most rewarding markets in the world for digital health. If you approach it with curiosity, patience, and empathy – understanding what NHS leaders need, not just what you’ve built – you’ll find allies who want you to succeed.
Navigating the NHS isn’t about selling harder. It’s about co-creating value with a system under immense pressure to modernise, and showing, with evidence and empathy, how your innovation helps it get there.
Hardian Health is a clinical digital consultancy focused on leveraging technology into healthcare markets through clinical strategy, scientific validation, regulation, health economics and intellectual property.
