Why healthcare innovation so often gets stuck, with Neil Spence

Healthcare is full of smart people, breakthrough technologies, and genuine intent to improve lives. Yet progress often feels frustratingly slow.

In the latest episode of Innovation Insider, I sat down with Neil Spence, a healthcare commercial leader whose career spans clinical radiography, medical technology, diagnostics, and market access across Australia, New Zealand, the UK, and beyond.

Neil brings a rare perspective. He has worked inside the system, sold into the system, and helped international innovations enter the system. That combination made for one of the most grounded conversations I’ve had about why healthcare change is so difficult, and where the real opportunities sit.

The fax machine problem

Early in the conversation, Neil shared that his father helped develop international fax standards decades ago. His punchline was that fax machines are still being used in healthcare today.

“The fax machine is still being used in healthcare for sending X-ray requests and ordering medical products.”

Funny on the surface, but it points to something deeper.

Healthcare often runs on layers of old and new technology stitched together over time. Systems rarely get rebuilt from scratch. They get patched, adapted, and prolonged. That creates an environment where innovation competes with legacy infrastructure, tight budgets, workforce pressure, and risk aversion.

As Neil put it:

“Healthcare is typically always been underfunded and it’s make do and mend.”

Innovation fatigue is real

One of the strongest themes from our discussion was that not everyone inside healthcare is waiting for the next shiny thing.

Leaders may talk about transformation. Vendors may talk about disruption. But many clinicians and operational teams are simply trying to get through the day.

Neil described a middle layer of the system that often wants stability more than novelty.

“They’re actually looking to avoid innovation. They’ve had innovation last week and they’d actually like to bed down the technology and just get on with doing their caring professions.”

That matters because great ideas fail when they ignore the human reality of implementation.

Prevention still struggles against politics

We also explored why prevention remains so underdone, despite almost universal agreement that it matters.

The answer often comes back to incentives.

The long-term returns from prevention usually sit beyond budget cycles and election cycles. That makes it easier to fund visible treatment capacity today than invisible avoided demand tomorrow.

Neil’s view was clear:

“There is an opportunity to abstract it from politics.”

He argued that stronger investment in prevention and engagement would reduce pressure downstream and create capacity for better care.

Consumers are gaining more health agency

Where I’m more optimistic is what happens outside traditional institutions.

Consumers now have access to wearables, home diagnostics, AI tools, imaging options, digital coaches, and better health information than ever before. People increasingly want to understand their body, reduce risk, and make smarter decisions earlier.

That shift from passive patient to active participant is one of the biggest healthcare changes of this decade.

Neil captured it well when discussing the need for better support:

“You all need a wellness co-pilot that just sits at the side of the desk.”

He also shared examples of tools helping people better articulate symptoms and accelerate diagnosis pathways such as endometriosis.

What this means for insurers

For private health insurers, this trend is highly relevant.

The future value of insurance may rely less on paying claims efficiently, and more on helping members avoid needing them in the first place.

That means smarter engagement, trust-led data models, prevention pathways, navigation support, and incentives that improve health behaviour within regulatory settings.

As we discussed in the episode, there is strong alignment when both insurer and member want the same thing, fewer avoidable claims and better health outcomes.

Final thought

Healthcare innovation rarely fails because the idea is bad.

It usually fails because incentives are misaligned, workflows are overloaded, systems are outdated, or adoption was treated as an afterthought.

Neil summed up one of the core barriers in a single line:

“If there’s an item number, I’m excited.”

That short quote says a lot about how funding models shape behaviour across the system.

Real progress comes from understanding how change actually happens inside complex systems. Neil gets that.

Listen to the full episode

If you work in healthcare, insurance, digital health, or innovation, this one is worth your time.