The people map

Module 07 named the cast. This section says what each is measured on, what they can sign, and how you earn thirty minutes of their time — because in the NHS, time is scarcer than money.

Clinical roles

Clinical director / clinical lead. A consultant accountable for a specialty. Cares about outcomes, waiting times, service safety, colleagues' workload, professional reputation. Can give you clinical buy-in and participation in an evaluation, occasionally small discretionary spend; cannot commit trust money at scale. Earn their time with a clinical problem in their vocabulary and an ask under thirty minutes, citing their own service's published data — audit results, GIRFT benchmarking, national audit position.

CCIO and CNIO. Practising clinicians with a digital remit; the translation layer between clinical reality and IT. Care about workflow fit, clicks added per patient, alert fatigue and digital safety, and hold the clinical opinion that unblocks or kills you. Never pitch: ask where your product would sit in the existing workflow, and be honest about what it adds to a clinician's day.

Clinical Safety Officer. A qualified clinician owning the deployer's clinical risk management under DCB0160. Send your hazard log and clinical safety case before they ask.

Operational and technical roles

Service / operational manager. Runs the clinic, the ward rota, the diagnostic pathway; cares about throughput, capacity, vacancies and this month's numbers. The most underrated stakeholder in the building, and usually your best route to a hard operational metric finance will believe.

CIO / Director of Digital. Owns the estate; cares about integration burden, cyber exposure, support load, licence sprawl and whether you duplicate something already bought. Can approve within a delegated limit and veto absolutely. Lead with interoperability and support model, not features — the fastest way to lose a CIO is to be the eleventh point solution proposed this quarter.

IG lead and Data Protection Officer. Care about lawful basis, data minimisation, data flows, sub-processors, hosting location, retention, and whether your answers survive an ICO question. They authorise nothing and stop everything. Arrive with a completed data flow diagram and draft DPIA content, not an offer to "answer any questions".

Caldicott Guardian. A senior clinician or director responsible for protecting patient confidentiality and enabling appropriate sharing, working to the eight Caldicott Principles — NHS organisations have been expected to have one since 1998. The seventh principle is the one vendors forget: the duty to share can be as important as the duty to protect. A well-argued sharing case is not an imposition; it is their job.

Commercial roles, and the board

Procurement lead. Cares about legal defensibility, route selection, competition, contract terms, savings against target; authorises the route and the timetable. Ask early which framework the trust prefers, offer your listings unprompted, and never try to route around them. Procurement remembers.

Finance business partner. Cares about affordability within an envelope, whether a claimed saving is in the CIP, recurrent versus non-recurrent cost, capital versus revenue classification. Send a one-page summary in their format: recurrent cost, one-off cost, year-one and full-year effect, cash-releasing benefit separated from capacity.

Transformation / programme manager and the PMO. Care about delivery capacity, benefits realisation and whether your deployment consumes staff time they do not have. Often hold the transformation budget and the project managers you will need.

The board. Anything material is finally approved by the trust board — chief executive, COO, CFO, medical director, chief nurse, CIO — usually after a finance and performance or investment/digital committee, against delegated approval limits that scale with the trust's oversight position; centrally funded schemes need central approval regardless of size. NHS England's new advanced foundation trusts carry extra freedoms from 2026/27 (check the current cohort), and a more autonomous trust is a faster trust to sell to. At ICB level the equivalents are the chief medical officer, director of commissioning, chief digital or transformation officer, and the ICB's own committees.

The political dynamics

• Clinical versus operational. Clinicians want quality; operational managers want flow. A product that improves quality but adds five minutes per patient will be championed by one and quietly resisted by the other. Find out which your product taxes.
• Digital versus finance. Digital teams are convinced technology is under-invested in; finance is holding a deficit. Digital directors often have ambition without recurrent budget — do not mistake enthusiasm for money.
• Trust versus ICB. Trusts are protective of their autonomy and data; ICBs are planning across a system. Tell a trust the ICB will standardise on you and you have made an enemy; tell an ICB the trust prefers a local solution and you have made two.
• Procurement versus the requester. Clinical teams often see procurement as an obstacle; procurement often sees them as people who pick a supplier first and ask for a compliant process afterwards. Your value is making both look competent.
• Incumbent gravity. "Our EPR supplier says they'll have this next year" is one of the most common late-stage objections in NHS software. Prepare a factual, unsmug comparison of today versus roadmap, and let the CCIO draw the conclusion.
• Who owns the benefit. When savings are claimed, someone's budget is expected to shrink. Identify whose, early, and get them into the room — they will find out eventually and object at the worst moment.

Keep all of this on one page and ask two questions of it. How many of these people have you actually met — fewer than three is not a deal. And who would object last, at the investment committee? Usually finance or IG — and the whole craft of NHS selling is bringing that objection forward by six months so you have time to answer it.

3. Getting in

You cannot sell into an organisation you cannot reach. The routes, roughly in order of conversion rate:

Clinical champions — how you actually find one

The champion is not somebody you appoint; they are somebody who already has the problem and lacks a solution. They are findable:

• Published work. Quality improvement projects, service evaluations, audits and posters in your problem area. The author of a QI poster about your exact pathway problem is, by definition, a clinician who has already invested unpaid time in it.
• Clinical networks and specialty societies. Most specialties have a national society, a regional operational delivery network and a national audit; the people who present there are the engaged minority.
• Conference speakers. A clinician who spoke about your topic at Rewired or NHS ConfedExpo has publicly staked a position. Watch the talk, reference it specifically, ask one substantive question.
• Digital leadership communities — CCIO and CNIO networks and their published commentary — identify who in a trust actually cares about clinical software. And existing customers: a champion at one trust knows counterparts at three others, so ask "who else is wrestling with this?"

Then qualify honestly, using module 07's test: can they broker an introduction to somebody with budget? A champion who cannot or will not is a friend, not a route.

Innovation bodies and structured support

• Health Innovation Networks. The fifteen regional bodies formerly called Academic Health Science Networks were relicensed under the new name from 1 October 2023, initially to 2028 (check current status and naming). They spread proven innovation and are the closest thing to a legitimate warm-introduction service in the English NHS — convening clinicians, supporting evaluation, validating. They will not sell for you, but a network that believes in your evidence changes your conversations.
• The NHS Innovation Service (innovation.nhs.uk): a national front door where innovators submit one structured record and are routed to expert support rather than repeating themselves to twelve organisations.
• SBRI Healthcare runs themed competitions with staged development funding; accelerator programmes run by regional networks and academic partners provide cohorts, mentoring and — crucially — introductions. The AI and Digital Regulations Service, curated by NICE, the MHRA, the CQC and the HRA, is the free official guide to what developers and adopters each need to do.

National programmes, and pre-market engagement

Selection into a national programme is a genuine accelerant: funding, evaluation, credibility and a list of sites. It also has costs — slow selection, prescriptive deployment, and money that stops, leaving adopting sites with no recurrent budget the following April. If you win a place, start the local recurrent-funding conversation on day one.

Preliminary market engagement is the most underused route in health tech. Under the Procurement Act 2023 a contracting authority can consult the market before writing its requirement and publish a preliminary market engagement notice describing it — lawful, published, and designed exactly for suppliers to inform a buyer's thinking before a specification exists. Suppliers who engage here write bids that fit; those who first learn of a deal at ITT publication are usually making up the numbers. Monitor Find a Tender and respond to every relevant one.

Conferences — Rewired and NHS ConfedExpo concentrate NHS digital and management leadership, alongside the sector's other trade shows and regional network events. The mistake is treating them as lead generation: attend clinical sessions rather than staffing a stand, note what leaders say they are struggling with, and follow up in writing with something useful rather than a meeting request.

The honest truth about cold outreach into trusts

It works far less well than in commercial B2B, for structural reasons. There is no central buying inbox and generic addresses go nowhere. Clinicians' NHS email is a firehose many barely use for anything but rotas and results. Procurement teams are cautious about unsolicited approaches and during a live procurement must not talk to you outside the published process — approaching a named evaluator can get your bid excluded. Many trusts publish a no-cold-calling policy and route suppliers to a portal.

What works, in descending order: a referral from a known clinician; a named, specific email referencing that person's own published problem and asking for twenty minutes; a genuinely useful artefact offered with no ask attached. What does not: sequences, generic value propositions, "just checking in".

Expect low conversion — but note the compensating advantage: because these buyers are public bodies, their problems, budgets, board papers and purchase history are published. Personalisation that would take an hour of guesswork in commercial B2B takes fifteen minutes of reading here.

Voice from the field

"Running twenty-first-century public services on analogue systems is not a neutral choice; it is an active decision to waste time, money, and human potential." … "If we opt for timidity or incrementalism, we will fail."
— Wes Streeting, Secretary of State for Health and Social Care, keynote at the Institute for Government annual conference, January 2026 (reported by HTN)

Field note

There is a specific moment when a trust becomes reachable: when something has gone wrong publicly. A poor CQC report, a missed target, a coroner's Prevention of Future Deaths report, an ICB improvement plan — all published, all creating a named executive with a deadline and a duty to show action, which is the closest thing the NHS has to a compelling event. Done respectfully this is not ambulance-chasing: you are offering to help with a problem the organisation has already told the public it has.