NHS procurement frictions are slowing infection control innovation from small firms
Healthcare-associated infections remain one of the most stubborn problems in hospital medicine, and the commercial pathway for products meant to prevent them is often as difficult as the clinical problem itself. In the Liverpool City Region, a qualitative study examined why small and medium enterprises developing infection prevention and control products struggle to secure adoption inside the NHS. The message from the interviews and survey responses was consistent: promising innovations do not fail only on technical merit. They are frequently stopped by procurement complexity, regulatory burden, and weak access to the people who actually make purchasing decisions.
The study, published in PLOS One in 2025, drew on an online survey of 114 SMEs and five semi-structured interviews with management teams involved in IPC innovation. The work focused on the practical barriers that arise after a product is developed and before it reaches routine use in the health service. In real terms, this is the stage where many prevention tools disappear from the pipeline, even when they are designed to reduce hospital-acquired infections and help blunt the spread of antimicrobial-resistant organisms.
A short sentence captures the central problem. Good ideas were not enough.
High entry costs and procurement complexity shape the route to adoption
The analysis identified several recurring barriers. High market-entry costs created an early hurdle for smaller companies that lack the capital reserves of larger suppliers. Complex regulatory and procurement frameworks added another layer of friction, and the burden was not simply administrative. For SMEs, every additional requirement can mean slower product development, delayed market access, and more time spent navigating systems rather than improving the device or service itself.
Procurement in the NHS is not a single gate but a sequence of decisions, reviews, and local processes. For companies with limited resources, that sequence can become a choke point. The study also found that access to key NHS stakeholders was limited, leaving many firms without a clear route to clinical champions, procurement leads, or decision-makers who could evaluate a product’s value in real-world practice. Fragmented decision-making inside NHS Trusts compounded the problem, creating an environment where a product may be considered in one setting and effectively invisible in another.
This fragmentation matters because infection prevention products often depend on local uptake rather than central mandate alone. A hand hygiene technology, surface decontamination tool, or screening aid must persuade clinicians, managers, procurement teams, and budget holders at the same time. When those audiences are disconnected, adoption stalls even if the underlying public health case is strong.
SMEs remain committed despite a difficult path into the NHS
The interviews did not describe a sector ready to retreat. Instead, they showed persistence. SMEs continued to invest in IPC innovation because the clinical need is unmistakable: healthcare-associated infections extend length of stay, raise costs, and expose patients to pathogens that are increasingly difficult to treat. The same pressure that makes these products important also makes their development commercially risky. Firms are being asked to solve a high-value NHS problem while absorbing uncertainty at nearly every stage of the route to market.
That tension is especially sharp in infection control, where benefits may be diffuse across an entire institution rather than tied to a single revenue-generating service line. If a product prevents infection, the gains may appear in fewer bed days, fewer complications, and lower antibiotic pressure rather than in a neat purchasing metric. Those gains are clinically meaningful, but they can be hard to translate into procurement language unless stakeholders share the same priorities and data.
The study’s findings point to a basic but often overlooked reality: innovation in this area is not blocked only by science, but by institutional architecture. A company can develop a product with a plausible mechanism, a clear safety profile, and strong relevance to antimicrobial resistance, yet still struggle to find a buyer if the pathway to evaluation is opaque.
Streamlined support could speed adoption of useful products
The report recommends more structured support for SMEs, better access to NHS decision-makers, and policy reforms aimed at simplifying procurement. Each of those steps addresses a different bottleneck. Support mechanisms can help companies interpret regulatory expectations earlier, reducing wasted effort and duplicate work. Better access to stakeholders can shorten the distance between product development and clinical assessment. Procurement reform could reduce the number of points where promising products are delayed or rejected for procedural reasons rather than clinical merit.
For NHS leaders, the implications are direct. If the service wants faster uptake of tools that reduce healthcare-associated infections, it has to make the purchase pathway legible to smaller firms. Otherwise, the system will continue to favor organizations with the staff and capital to absorb complexity. The result is not only commercial inefficiency. It is slower diffusion of interventions that might reduce infection-related admissions, antibiotic use, and avoidable harm.
The study does not claim that every IPC product should be adopted quickly or uncritically. Some products will fail on effectiveness, usability, or cost. But the work shows that worthy innovations can be slowed by a procurement system that asks small firms to clear too many hurdles at once. In a sector where antimicrobial resistance is already tightening treatment options, delays in adoption carry their own clinical cost.
One of the clearest findings was the gap between need and access.
Why the findings matter for infection prevention and antimicrobial resistance
The broader public health relevance extends beyond one region. Hospitals everywhere are under pressure to reduce infections that lengthen stays and fuel antibiotic exposure. If SMEs are a major source of new IPC products, then barriers to their NHS adoption become a patient-safety issue, not just a business problem. A procurement structure that is difficult to navigate can indirectly slow the arrival of tools designed to protect patients from resistant organisms and prevent ward-level transmission.
For clinicians and commissioners, the study is a reminder that innovation policy and infection control are linked. The performance of an IPC product does not end at the bench or pilot phase; it depends on whether the service can actually buy and deploy it. The Liverpool findings suggest that smoother decision-making, clearer points of contact, and less fragmented local procurement could help convert more promising products into routine care. The remaining question is not whether these barriers exist, but how quickly health systems can remove them without weakening standards for safety, value, and oversight.