“We shouldn’t be buying software, we should be buying outcomes”

What is standing in the way of other parts of the NHS emulating this success? “We need to look at why innovative ideas don’t get in there in the first place,” says Kevin Monk, the managing director of SARD, a start-up that provides workforce management software to different NHS organisations. He places the blame squarely on the procurement process, which he believes is loaded with perverse incentives.

Stuart Mackintosh, the founder of OpusVL, which builds open-source software for the NHS, says: “There’s a lot of emotion in procurement, which is why people buy based on comfort or based on what other people buy rather than on pure logic of what is the right thing.”

Monk agrees that there is a culture problem with procurement, which leads to risk-averse decision-making – a case of ‘nobody ever got fired for buying IBM’.

“It’s not a case of making the best decision. It’s about making the decision that’s the easiest to defend,” Monk says.

In his view, NHS tenders are too driven by specification rather than outcome. They specify how a task must be carried out, instead of simply outlining the ultimate goal, and leaving it for bidders to innovate and discover new and better ways of working. This means that start-ups that take new approaches could be frozen out of the bidding process from the beginning.

“It never takes into account the things that make you different,” says Monk, “If you presuppose a solution to your problem, you’re not going to get any innovators in.”

Mackintosh adds: “We shouldn’t be buying software, we should be buying outcomes”.

Shah thinks the challenges run even deeper. “Most of the NHS gets its funding for seeing people. Whether you see them in person, or speak to them on the phone, or do some surgery, most of the funding is based on seeing people. There isn’t any special ring-fenced funding that is just for digital transformation,” he says.

“Unfortunately the combination of the culture, the policy, the procurement process, and the resources available create an environment which means that not much change happens,“ he laments.

Great review of the NHS in the UK’s attempts at digital transformation since the pandemic.