Medtech market access in the UK is a process that confounds even experienced innovators. The NHS diagnostics market is large and growing. Research funding has never been higher. Yet the pathway from proven product to routine adoption remains narrow, and the framework used to judge whether a technology should be adopted was not designed with diagnostics in mind.
The market is real
NHS England recorded £3.3 billion in direct diagnostic costs in 2023–24, spanning pathology, imaging, physiological measurement, genetics, and genomics. Pathology alone accounts for £1.4 billion across clinical biochemistry, haematology, microbiology, histopathology, and immunology. Imaging costs £728 million. Genomic services, delivered through seven Genomic Laboratory Hubs under block contracts, add a further £500 million.
These are real budgets, attached to real procurement decisions at trust level. For any medical device, AI product, or in-vitro diagnostic that can demonstrably improve outcomes or reduce costs within these segments, the market exists. The question is how to reach it.
Innovation is not the bottleneck
The supply side of health technology has never been stronger. Thousands of publicly funded research projects now target diagnostics, medical devices, and digital health across UKRI’s portfolio. Annual project starts have roughly doubled over the past decade.
NIHR’s Invention for Innovation programme, the most directly relevant funding stream for health technology development, has nearly tripled its annual award value since 2015: from £23 million to over £60 million. The volume of innovation entering the market access pathway is growing year on year.
UKRI’s Gateway to Research records over £350 million in medtech-relevant research funding in 2024 alone. NIHR’s Invention for Innovation programme awarded over £60 million in the same year. The scale of publicly funded health technology research in the UK is unprecedented. The gap between this investment and the number of technologies that reach routine NHS use has never been wider.
The bottleneck is not a shortage of innovation. It is the distance between a funded research project and routine use in an NHS setting.
The narrow gate
NICE’s health technology evaluation programmes have historically assessed a relatively small number of products each year. Across all product-level evaluation routes, around 150 assessments have been completed in 14 years. That is roughly 10 per year, against a backdrop of thousands of technologies in development.
The pace has drawn pointed criticism. Professor Sir John Bell, Regius Professor of Medicine at Oxford, told the Health and Social Care Committee that the UK takes a “slow, incredibly pedestrian approach” to adopting its own innovations, and is “often the last to use them.” Anna Jewell, chief executive of Cancer52, cited a proven cancer detection technology that “has been looked at for 20 years or so and still is not an innovation that we are picking up.”
The recent consolidation of NICE’s work into the MedTech Evaluation Programme is designed to simplify and broaden access. The Early Value Assessment route, introduced in 2023, allows promising technologies to enter the process at an earlier evidence stage. And the National Health Technology Access Programme (NHAP), expected from April 2026, promises something genuinely new: a mechanism for mandating NHS adoption of technologies that complete evaluation successfully.
NHAP would mandate NHS adoption for approved health technologies for the first time. If throughput scales to match the ambition, it could transform the landscape. That remains to be seen.
The commissioner’s question
NICE evaluation is one threshold. But even technologies that pass it face a second: the purchasing decision. NHS commissioners, Integrated Care Boards, trust procurement teams, and clinical leads with budget responsibility all make adoption decisions based on a different set of criteria.
Parliament has heard repeatedly that diagnostic infrastructure across the NHS is under strain. Take dementia as one example: the 2019 National Memory Clinic Audit found “marked variation in almost every aspect of the memory service pathway.” Only 6% of psychiatry services could fully meet NICE guidelines on specialist diagnostic testing. Alzheimer’s Research UK warned the Health and Social Care Committee that the existing diagnostic system was “unlikely to have the capacity to cope” with demand from incoming disease-modifying treatments.
These are not evidence gaps. They are commissioning problems. A diagnostic technology that reduces referral-to-diagnosis time, frees specialist capacity, or moves testing into primary care is solving a problem that commissioners already know they have. The challenge is demonstrating that value in their terms: freed bed days, reduced follow-up appointments, avoided emergency admissions, capacity released for the next patient on the list.
The technologies that reach routine NHS use are rarely the ones with the most impressive clinical evidence alone. They are the ones that can articulate, in specific terms, what changes in a commissioner’s operational reality when their product is adopted.
A framework designed for drugs
Perhaps the most important structural challenge is not speed but measurement.
NICE’s appraisal framework is built around the quality-adjusted life year. The QALY captures changes in mortality and health-related quality of life, and it works well for pharmaceuticals, where clinical outcomes are the primary value proposition.
Health technologies are different. A diagnostic test that reduces laboratory turnaround time creates value in workflow efficiency. A point-of-care device that eliminates a hospital visit creates value in system capacity and patient convenience. An AI tool that triages referrals more accurately creates value in clinical productivity. These are real, measurable benefits. They sit outside the mortality-and-morbidity frame that determines whether a technology gets adopted.
This is not a criticism of NICE. It is a structural observation about a framework designed in an era when the technologies being assessed were overwhelmingly pharmaceutical. As the mix shifts towards devices, diagnostics, and software, the appraisal process is under increasing pressure to accommodate forms of value it was never designed to capture.
The government itself has acknowledged the strain. Health Minister Dr Samir Ahmed told the Science, Innovation and Technology Committee in 2025 that NICE’s “terms of reference and methodology have been largely unchanged” for more than a quarter of a century, “while society around us has changed quite a lot.” The NHS, he said, had been purchasing equipment “at rock-bottom prices almost like a penny-wise, pound-foolish model” rather than based on outcome.
For innovators, the practical consequence is significant. A technology can work, generate evidence, and still struggle to demonstrate its value in the terms the evaluation demands.
The irony is that commissioners often value exactly the things the QALY cannot capture. An ICB managing waiting lists cares deeply about throughput. A trust trying to meet cancer targets cares about time to diagnosis. A primary care network trying to reduce emergency admissions cares about early detection in the community. These are the operational pressures that drive purchasing decisions, and they align naturally with what many health technologies deliver. The disconnect is not between the technology’s value and what the system needs. It is between the technology’s value and how the formal evaluation framework measures it.
What separates adoption from evaluation
As the Medical Technology Group told Parliament in 2025: “Unlike for the pharmaceutical sector, there is largely no guarantee of funding or adoption pathways following a positive NICE recommendation for medical technology.” The gap between a positive evaluation and routine NHS use is wider than most innovators expect.
The pattern is consistent. Technologies that reach widespread NHS use tend to share specific characteristics: a concentrated buyer, where a small number of trusts or services account for most of the relevant clinical activity; a clinical champion with commissioning influence; and a revenue model that is clear before the evidence programme is complete.
Technologies that stall tend to share different characteristics: a fragmented market, where the target activity is spread thinly across hundreds of sites; value that is real but difficult to express in procurement terms; and a development path that prioritised evidence generation without resolving who pays and how.
This is not a counsel of despair. These are patterns that can be identified early and addressed. The innovator who understands their market structure, their buyer concentration, and their route to revenue before designing their evidence strategy is better positioned than one who generates world-class evidence and discovers the commercial question afterwards.
Patient need, clinical need, and system need are not three separate arguments. They are three faces of the same case. The strongest value propositions in UK medtech market access address all three simultaneously: a technology that improves patient outcomes, solves a clinical workflow problem, and releases capacity that commissioners are under pressure to find.
Consider DERM, the AI skin cancer triage system developed by Skin Analytics. The technology could have been positioned on clinical accuracy alone: its sensitivity matches or exceeds consultant dermatologists across multiple peer-reviewed trials. Instead, the company built its case around a specific commissioning problem. Over 600,000 urgent suspected cancer referrals reach dermatology services each year. 94% turn out to be false positives. The specialist workforce is stretched to one consultant dermatologist for every 103,000 patients, and only 74% of urgent referrals are seen within the target timeframe. The value proposition was not “our AI is accurate.” It was “we can safely discharge 60–70% of urgent referrals, free over 115,000 dermatologist hours per year, and help trusts meet the 28-day faster diagnosis standard.”
Even then, NICE initially stopped short of recommending DERM for routine use. It took NHS England to intervene, arguing that with 680,000 urgent referrals per year and 24% of dermatology consultant posts vacant, the technology should be conditionally adopted while further evidence was generated. A resolution panel agreed that NICE’s own evaluation framework had not been properly followed. The recommendation was amended: DERM can be used in NHS teledermatology services during a three-year evidence generation period. Over 230,000 patients have now been assessed across 25 NHS organisations. The company received no NIHR funding. Its £8.4 million in public funding came through Innovate UK, SBRI Healthcare, and the NHS Cancer Programme: alternative routes that many innovators overlook.
The landscape is shifting
The MedTech Evaluation Programme, NHAP, and Early Value Assessment are genuine reforms. Research funding is at record levels. The market is large and the commissioning pressures are real. But the structural challenges remain: limited evaluation throughput, a measurement framework designed for pharmaceuticals, and no guaranteed pathway from a positive recommendation to routine adoption.
For innovators, the question is not whether the NHS needs what you are building. It almost certainly does. The question is whether you can demonstrate that value in the terms the system demands.
How Concordance helps
We help health technology companies navigate medtech market access in the UK: where NHS budgets are allocated, what commissioners are under pressure to deliver, how evaluation routes apply to their specific product, and where the evidence gaps sit. We track the full landscape continuously so our clients do not have to build it themselves.
We do not build your technology or run your trials. We make sure the case you take to the NHS is grounded in the reality of how adoption decisions are actually made.