I invented FAST in 1998. Here’s what it taught me about scaling health innovation

Last month I attended a pre-hospital stroke conference in China. The occasion was celebrating the success of their 10-year programme rolling out the Chinese equivalent of the FAST stroke awareness campaign. The results were remarkable with significant increases in the delivery of thrombolysis and thrombectomy across an entire nation and thousands of patients getting the right care at the right time.

Standing in the room, I found myself thinking about Newcastle in 1998. That was where my stroke team and I developed FAST (Face, Arms, Speech, Time) to help ambulance crews identify suspected stroke patients and divert them to our city hospital which had a stroke service but no emergency department. It was a local solution to a local problem. None of us imagined it would become the national public awareness tool for stroke in the UK, let alone be adapted and adopted in countries across the world.

But it could have happened faster. The international adoption of FAST was driven largely by others, over years, without any formal scaling infrastructure in place. Had the right structures existed in the late 1990s the impact could have been achieved sooner, and more lives saved earlier.

That gap between a great local innovation and its wider adoption is something I think about often in my role at Health Innovation Oxford and Thames Valley (HIOTV). It’s also something every health innovator reading this will recognise. You’ve built something that works and you can see the potential, but the path from “it works here” to “it works everywhere” is far harder than it should be.

The conference in China crystallised five principles I believe are fundamental to achieving adoption of innovation at scale. They’re not new — the implementation science literature has been making similar arguments for years — but seeing them validated in the context of a national stroke programme across one of the world’s most complex health systems made them feel newly urgent.

1. Local innovations frequently have global relevance, but no one is paid to notice

The FAST campaign was created to solve a specific, local logistical problem in Newcastle. The fact that its principles applied everywhere only became apparent gradually, and its scaling happened through advocacy and opportunity rather than design. This is the norm, not the exception.

Health systems are under relentless operational pressure. The team that develops something brilliant rarely has the time, funding or mandate to spend the next five years persuading every other trust to adopt it. This is not a failure of ambition, it’s a structural gap. Filling that gap is precisely what health innovation networks exist to do.

2. Local adaptation is not a compromise — it is the work

One of the most common frustrations I hear from innovators is that NHS organisations want to “modify” their solution before adopting it. It can feel like resistance. Often, it is not. The implementation science literature is consistent on this point: innovations that are adapted to fit local context are more likely to be sustained than those imposed wholesale. The goal is not identical replication. It is faithful adoption of the core mechanism, configured for the environment in which it must function.

Innovators are more likely to scale faster and sustain for longer when they understand this, build flexibility into their implementation model and work with adopting organisations rather than simply selling to them.

3. Policy support is not a nice-to-have

The Chinese stroke programme did not succeed on clinical evidence alone. It succeeded because government and national health authorities got behind it, created structures that enabled adoption and sustained commitment over a decade. FAST became embedded in UK public consciousness in part because the Stroke Association and then NHS England made it a national priority.

For innovators working in the NHS, this means understanding the policy landscape is not optional. NICE recommendations, national commissioning decisions and NHS England programme priorities are not just background noise — they’re the conditions that make adoption possible or impossible. Timing your market entry to align with policy momentum is not cynical; it’s strategic.

4. Evaluation is not the end of the process, it’s how you protect it

Every innovation will eventually face the question: does this actually work at scale, in the real world, with real patients? Robust and timely evaluation of adoption outcomes is how innovators answer that question. It is also how commissioners justify continued investment, and how health systems build the evidence base to spread adoption further.

Building evaluation into your implementation model from the start — not as an afterthought, not as a grant compliance requirement, but as a genuine commitment to understanding impact — is one of the most important things an innovator can do.

5. The solution you need may already exist somewhere else

Martha’s Rule (the right of patients and families to request an urgent review of a deteriorating patient’s care) was adopted across NHS England in 2024. A forerunner called Ryan’s Rule had been running in Queensland, Australia, for a decade. A similar pilot, Call 4 Concern, had been trialled at the Royal Berkshire Hospital in our region in 2010. The ideas were not new, what was needed was the will and the mechanism to implement them nationally.

For innovators, the lesson runs in both directions. Your solution may already be in use somewhere — which is not a threat but an opportunity to learn from real-world evidence. And the problem you are trying to solve may already have a tested answer in another health system. Looking outward is not a sign of weakness; it’s a sign of intelligence.

What this means for your innovation journey

These five principles aren’t an academic framework; they describe the actual conditions under which health innovations succeed or fail in the real world. At HIOTV, they shape how we work — from identifying innovations with genuine national potential, to brokering the partnerships that make adoption commercially viable, to building the evaluation infrastructure that sustains impact over time.

The FAST story had a good outcome, but it took longer than it should have done. The structures that could have accelerated it are now being built and if you are developing an innovation with the potential to change care at scale, those structures are available to you.