How an SME–NHS partnership turned a paper safety problem into national award-winning transformation
The public-sector problem was not a lack of technology
For decades, controlled drugs in hospitals have depended heavily on paper registers, handwritten orders and retrospective checks. At University Hospitals Birmingham NHS Foundation Trust (UHB), that meant a safety-critical process spanning hundreds of clinical areas, with limited real-time visibility when something went wrong. Before the programme began, controlled-drug audit compliance had fallen to around 67%, and a discrepancy could potentially remain undiscovered until a quarterly audit.
The challenge was not simply to replace paper with a screen. Controlled drugs sit within a demanding legal, clinical and governance environment. Any digital alternative had to work for nurses and pharmacy teams at the point of care, preserve accountability and traceability, and be safe enough to become everyday infrastructure across one of the UK’s largest NHS trusts.
Where an SME can make a difference
This is where the SME model can be powerful. UHB brought the clinical leadership, controlled-drug governance expertise, frontline workflows and real-world environment. Thula brought a specialist medicines platform, software engineering capability and the ability to turn those clinical requirements into digital controls. The result was not an off-the-shelf implementation. Over three years, UHB and Thula co-designed, tested and refined Alfa Controlled Drugs, making around 40 NHS-specific adaptations to terminology, user experience, formulations and operational workflows.
That closeness matters. Smaller technology companies can put senior product and technical expertise directly alongside clinicians, respond quickly to feedback and keep iterating when the first answer is not quite right. In complex public services, innovation is rarely a single breakthrough moment; it is the accumulation of dozens of practical decisions made with users.
From pilot to measurable transformation
Following pilots and frontline user-acceptance testing, Alfa CD was rolled out across 141 clinical areas at Queen Elizabeth Hospital Birmingham, Heartlands, Good Hope and Solihull. The system creates a continuous electronic record from requisition and pharmacy supply through receipt, stock management, administration and disposal, with barcode verification, advanced electronic signing and real-time discrepancy visibility.
The outcomes show why SME innovation should be judged by public-service impact rather than company size. Average compliance across 25 controlled-drug standards reached 98.3%; out-of-stock controlled-drug missed doses reduced from 6.78% to 5.64% (p<0.001); administration can be up to 80% faster; and modelling anticipates 77,407 staff hours of capacity released annually at full deployment. Most importantly, discrepancies that could previously remain hidden for weeks can now be surfaced as they occur, allowing investigation while the facts are still fresh.
Recognition matters - but replication matters more
In September 2026, the UHB–Thula partnership won both HSJ Patient Safety Awards for which it was nominated: Digital Clinical Safety Initiative of the Year and Safety Improvement Through Technology. The awards are welcome recognition, but the bigger lesson is that a specialist SME and an NHS organisation were able to solve a long-standing safety and operational challenge together - and do it at scale.
For public-sector leaders, the implication is simple: SMEs should not be viewed only as suppliers brought in after a solution has been specified. Their greatest value can come earlier, as specialist partners in discovery, co-design, testing and continuous improvement. Public bodies hold the domain expertise and accountability; SMEs can bring focus, agility and deep technical capability. When those strengths are combined, transformation becomes something built with public services, not done to them.
Small is not the opposite of scalable
The UHB experience also challenges the assumption that innovation from a smaller company must remain a small pilot. The programme moved from co-design and pilots to 141 live clinical areas across four hospitals, supported by clinical safety assurance, training, business continuity and an ongoing improvement model. Go-live was not the end of the partnership; operational data and frontline experience continue to inform refinement.
That may be the most important contribution SMEs can make to public-service transformation: staying close to a difficult problem for long enough to solve it properly, while remaining agile enough to change as the evidence changes. Small can be mighty when specialist technology, public-service expertise and genuine partnership are allowed to work as one team.
