What Healthcare 4.0 actually means
11 July 2026
The model I have taught for years is being overtaken. Here is what is replacing it, and what that means if you run, build for, or invest in a health system.
Read the essay →Writing
The argument of this site in long form. Start with the definition, then read by theme: how the NHS actually buys, why adoption beats invention, and who does the adopting.
Pinned essay
Reliable by Design
29 September 2026
Why a patient app that worked still failed, what Elaine Bromiley and the Pin Index Safety System teach about reliability, and a five-part test for any new tool, pathway or AI system in healthcare.
The 60/40 Rule: How Value-Based Procurement Changes What Surgical Technology Must Prove
22 June 2026
NHS England has formally rolled out Value-Based Procurement across all trusts. No more than 40% of any procurement score can now be based on cost. Here is what that means for surgical technology.
The Workforce Question NHS Modernisation Keeps Avoiding
18 May 2026
Every plan to modernise the NHS rests on a workforce able to use what it builds. That readiness is currently left to chance, and no serious plan is changing that.
Problem-First Procurement: What Buying a House Taught Me About MedTech Innovation
23 March 2026
Pilotitis is misdiagnosed almost every time it occurs. The problem is not NHS risk aversion or commercial impatience. It is a design failure that happens before the pilot begins.
The Puzzle at the Heart of NHS Transformation
2 March 2026
As ICBs restructure, every Chief Digital Officer has been removed from the top table. The consequences for MedTech companies and digital transformation are already becoming visible.
The Whale That Isn't: Why Selling to the NHS Is Harder Than It Looks
11 February 2026
From a distance, the NHS looks like a whale. A single, enormous customer. But as you get closer, the whale dissolves into a shoal of hundreds of smaller fish, each needing slightly different bait.
Three Assumptions That Kill MedTech Companies in the NHS
4 February 2026
Most MedTech companies don't fail because their product is bad. They fail because they built it on assumptions that don't survive contact with reality.