The NHS generates world-class ideas, technologies and clinical advances. Yet too often, promising innovations remain confined to local pilots rather than becoming routine practice. If innovation is to improve patient outcomes, increase productivity and support economic growth, we must, collectively, become better at implementation, adoption and spread.

Devolution offers an opportunity to change that.

The principle is straightforward: clear national priorities and accountability should be matched by empowered local systems with the capability to implement change and mechanisms that allow what works locally to spread nationally.

Greater Manchester's experience as a combined mayoral authority offers useful lessons. Bringing together health services, local government, academia, industry and communities around shared priorities has demonstrated what can be achieved when organisations align around common outcomes. The model is not unique to Greater Manchester, nor should it be copied wholesale. But it illustrates an important principle: lasting change happens when local systems have both the authority and capability to deliver. The biggest impact has been on the much quoted economic growth statistics. The same is potentially true for health innovation.

In recent evidence to the House of Lords Science and Technology Committee, I argued that while much attention focuses on technologies such as AI, genomics and personalised medicine, the barriers to adoption are remarkably consistent across most innovations. Whether a solution is digital, diagnostic, therapeutic or AI-enabled, success depends less on the technology and more on how effectively it is implemented.

We need to move beyond proving that an innovation works and focus instead on proving its value. A successful pilot may demonstrate clinical effectiveness, but adoption at scale requires much more. Solutions need robust real-world evidence, a clear economic case, integration into redesigned care pathways and confidence they can work across different settings and populations.

This is where place matters. Pathways, workforce models, infrastructure and population needs differ between systems. Real-world evaluation, pathway redesign, workforce engagement and change management cannot simply be directed nationally. They require strong local relationships, clinical leadership and implementation capability.

The opportunity from getting this right is substantial. Research undertaken by Frontier Economics for the Health Innovation Network estimated that greater adoption of proven health innovations could unlock up to £278bn in annual economic value.

That makes implementation not simply an operational NHS challenge, but a national health and economic priority. Yet investment remains heavily concentrated on discovering and developing innovation, while the resources required to embed it into everyday practice can be overlooked.

Technology rarely drives transformation on its own. Realising its value requires leadership, relationships, workforce capability, pathway redesign and sustained change.

Implementation is a collective leadership opportunity. National bodies have a role in setting priorities, standards, incentives and accountability. Local systems bring the relationships and understanding needed to translate those priorities into changes in care. Industry, innovators, clinicians and patients all have a role. And we need mechanisms for connecting places, sharing evidence and spreading proven approaches across the country.

The opportunity is not simply to devolve responsibility for innovation, but to create a connected national adoption model: aligning national leadership and accountability with the implementation capability of places, and using networks such as ours to connect the two.

Without that connection, greater local autonomy risks simply creating more isolated pilots. Devolution should instead enable local systems to implement around their own needs and context, while contributing to a national approach that identifies, learns from and scales what works.

We know this approach is possible. National programmes such as PReCePT and lipid optimisation have demonstrated what can be achieved when national priorities, evidence and coordinated implementation support are aligned with strong local delivery. Similar approaches are now being applied in areas including chronic kidney disease and respiratory transformation.

The Government's commitment to devolution creates an opportunity to build on this. Across England, local health systems already have strong partnerships, clinical leadership and implementation expertise. Further empowering places could reduce the distance between national ambition and frontline delivery, while creating stronger routes for successful approaches to spread.

If we are serious about moving from pilots to adoption at scale, three changes are needed.

First, we need greater alignment around priorities. Innovation is most successful when national policymakers, local health systems, clinicians and industry work towards shared outcomes. National priorities need to focus collective effort while allowing places flexibility in how they deliver them.

Second, we need to rebalance investment towards implementation. The benefits of innovation are only realised when solutions become part of routine care. That means investing not just in technology, but in the people, processes and change required to implement and sustain it.

Third, we need a more disciplined pathway from innovation to adoption. Too many initiatives become trapped in cycles of disconnected pilots. We need a consistent approach that starts with clearly defined problems, generates robust proof of value and gives decision-makers confidence to adopt and spread proven solutions.

The UK begins from a position of considerable strength. We have a National Health Service, world-leading science, rich data assets and increasingly mature regional innovation ecosystems. The opportunity is to connect those strengths more effectively. Success should not be measured by the number of pilots launched, but by the number of proven innovations that become routine practice and deliver measurable improvements for patients, staff, the NHS and the wider economy.

The next phase of NHS innovation should not be a choice between national direction and local autonomy. We need both: clear national priorities and accountability, matched by empowered local systems with the capability to implement change, prove value and spread what works.

Done well, devolution can help us move beyond isolated pilots and create a more effective route from innovation to impact, locally delivered, nationally connected and capable of scaling what works.