European venture capital entered 2025 with $31 billion of dry powder, the second-strongest year on record after 2022 (Funds Europe, January 2025). European healthtech specifically pulled in €6.21bn across H1 2025 in equity, debt and grant funding (Sifted, H1 2025). In Q3 2025, UK digital health attracted $409m, around 41% of the European total, on the back of Series B and C rounds at Charm Therapeutics, Numan and Ultromics (Galen Growth, Q3 2025 report).
The capital is in the room. It has been for some time. What is harder to find is the conversation about what happens to that money once it lands inside a company.
We are co-bylining this piece for a reason. Luke runs Forge Together, the marketing arm. Fredrik runs Forge Evolved, the embedded operator arm. We see the same gap from opposite sides of the table, and we wanted to put both views in one piece before HLTH Europe in Amsterdam on 15-18 June.
The gap, in numbers
The numbers describing this gap are now public and quotable. Nelson Advisors put out a piece in late December 2025 framing what they call the Series A Off-Ramp. It is worth reading in full.
The headline finding is that Series B healthcare investment in Q4 2024 was 84% below Q4 2021 (Nelson Advisors, December 2025). The median time from Seed to Series A has risen to 774 days, an 84% increase on three years prior. At the 75th percentile, founders are waiting close to 1,000 days. Bridge rounds accounted for nearly 37% of all Series A funding events in Q4 2024.
For an operator, the implication is direct. A company that closed a Seed round in early 2023 and is still chasing Series A in mid 2026 has spent the intervening period burning runway on a thesis that has not yet been validated commercially. By the time the next round arrives, the cap table is heavier and the operating margin for error is thinner.
HSBC Innovation Banking's analysis of the same period uses the phrase "pilot purgatory" for the UK healthtech version. Startups secure NHS pilots, fail to convert them into recurring revenue, and stall before Series B. The Health Tech Alliance's procurement report from July 2025 identifies the structural reasons: "complex central infrastructure, fragmented local communication, unclear pathways and guidance, and stretched decision-makers".
Capital is not the constraint. Operational maturity, buyer literacy and commercial process are.
The marketing side of the gap
Forge Together has spent the last three years inside healthtech, medtech and pharma-adjacent marketing teams. The insight we keep coming back to is this: most healthcare campaigns do not die at the MHRA. They die at internal medical-affairs review, two weeks before launch, when a phrase implies an off-label benefit or a clinical-evidence claim the data does not yet support.
Teams that treat compliance as a creative ceiling produce work that survives review and changes nobody's mind. Teams that treat compliance as the credibility floor produce work that is clinically credible and procurement-relevant within the rules. The brief is the place to fix this, not the sign-off.
The second pattern we see, almost weekly, is marketing teams writing campaigns to a single NHS buyer that does not exist. The NHS buyer architecture is being re-cut in real time. As of 1 April 2026 there are 36 Integrated Care Boards, down from 42, following the Phase 1 merger programme. By April 2027 the count will fall to 26 under Phase 2. On top of that, NHS England itself is being abolished, with functions absorbed into the Department of Health and Social Care. The NHS Modernisation Bill was introduced in the King's Speech on 13 May 2026, with target completion April 2027 and a 50% headcount reduction at both NHSE/DHSC and ICB level.
ICB-level work is strategic and slow. Trust-level work is operational and faster. A campaign written to a generic NHS buyer converts none of them. A campaign written to a digital director at a specific trust, against their actual procurement window, converts at a different rate entirely. NHS trust IT spend reached £4.1 billion in 2025, up 9% year on year, and the government has committed up to £10 billion to bring the NHS into the digital age over the spending review period. The money is there. The marketing motion that earns it is buyer-specific.
The operator side of the gap
Inside the company, the gap looks different. Forge Evolved runs an exercise in the first week of every portfolio engagement. Five operational checks. They reveal whether a business has a growth problem or a structural problem.
Pipeline visibility is the first check. Can the CEO say, right now, what revenue looks like in 90 days. Not a guess. A number backed by weighted probability. Most cannot. Most pipeline problems are definition problems dressed up as data problems.
Bid/no-bid discipline is the second. Most sales teams do not have a bid/no-bid process. They have a culture of yes. The cost of that culture is wasted senior time on opportunities the company was never going to win.
Third, customer health. When was the last proactive conversation with the top five clients that was not about a problem. Quiet accounts are the ones that leave first.
Then revenue concentration. If one client is more than 25% of revenue, everything else is secondary. We have walked into businesses where a single contract departure would have meant redundancies within 60 days.
The fifth is leadership bandwidth. If the founders are spending more than 40% of their week on operational coordination, they are not leading. They are firefighting. Most leadership bandwidth problems are permission problems, not headcount problems.
Inside a healthtech portfolio, each check has a sector-specific shape. Pipeline visibility means: can the company name the NHS trusts and ICBs it is in conversation with, what stage each conversation is at, and what the next gate is. Bid/no-bid means: does the company evaluate NHS pilot invitations against a structured commercial-fit scorecard, or does it accept every pilot that lands. Customer health means: has anyone had a non-problem conversation with the procurement lead at the trust where the pilot is live. Revenue concentration means: if the largest contract is a single trust, what is the plan to diversify across the ICB.
If two or more of those checks come back negative, the conversation is worth having sooner rather than later.
The cases
Gilytics: scattered focus to strategic acceleration
Gilytics is an HTGF-portfolio company with strong technology that had spread itself thin. Market focus was scattered across multiple segments and growth marketing was running without a clear ROI. Board updates remained backwards-looking and status-only, with limited visibility into pipeline or cost trajectory.
The Forge Evolved engagement narrowed market focus to two segments with clearly defined ICPs. Strategic initiatives were defined and run end to end. Pipeline and cost projection systems were built. Lead generation was rebuilt around CAC discipline, supported by video case studies. Regular strategy sessions replaced ad-hoc updates.
The visible shift was from lumpy execution to predictable delivery. Forecasting became reliable enough to support fundraising, and board meetings moved from reporting status to driving future strategy. Investor relationships strengthened on the back of both. Over the engagement, Fredrik moved from advisor to board member.
"Forge Evolved didn't just advise us. They became part of our team and delivered results in record time."
Credentially: growth inside a regulated category
Credentially is a healthcare credentialing software platform serving NHS, private and US healthcare buyers. The brief was to expand market presence and acquire customers in a competitive B2B healthcare environment where the buyer is sophisticated, time-poor and procurement-led.
Forge Together built the growth marketing strategy from positioning through to channel mix. The work covered an overhaul of organic social, a cornerstone white paper that re-anchored the category framing, a scalable lead-generation engine and the conversion architecture to turn traffic into qualified pipeline. The outcomes published on the case study are 3x monthly organic web traffic, a 150% increase in web users from social, and a scalable lead generation engine driving consistent customer acquisition.
A UK public sector IT services business
The third case sits between the two. A UK public sector IT services business, c.£2.5M revenue, 23 staff. The brief was a full operational stack rebuild. We delivered 14 strategy documents covering public and private sector expansion, dual pipeline model, bid scorecard, revenue bridge, partner architecture, customer success cadence and a 90-day action plan.
Same model as Gilytics. Different sector. The operator who diagnoses the bottleneck stays in the seat to deliver against it. No handover deck. No second invoice for execution.
What we will be asking at HLTH Europe
From the marketing and regulatory chair
The first thread is enforcement of the ABPI Code 2024 and the refreshed PMCPA social media guidance, both of which materially affect how pharma marketing teams plan digital activity in 2026. The Code came into effect on 1 October 2024 with full enforcement from 1 January 2025. The PMCPA published refreshed social media guidance in early 2026. The MoU between ABPI, PMCPA and HRA, effective 1 February 2026, also reshapes which body adjudicates HRA-approved clinical trial recruitment materials.
The second is the DTAC Form 2.0 transition. DTAC 2.0 was published on 24 February 2026, with old-form retirement on 6 April 2026. By HLTH week, the new form is approximately four months into live use. We want to know how healthtech founders are positioning DTAC alignment in sales conversations now.
The third is what NHS England abolition and the Phase 2 ICB consolidation mean for vendors selling into NHS over the next 18 months. The buyer architecture is being re-cut. Vendors that read the new map win; vendors that wait do not.
From the operator chair
Where European VC is concentrating dry powder into healthtech, and where it is sitting on the sidelines. The headline $31bn figure is real, but it does not deploy evenly. Some funds are leaning into infrastructure and data plays. Some into therapeutics. Others are sitting on capital while waiting for clearer exit pathways.
A related question, and one harder to get a straight answer on. What does the realistic commercial timeline look like for a Series A healthtech entering NHS sales conversations in 2026. The benchmark figure is 12-18 months. With ICB consolidation, NHSE abolition and DTAC 2.0 in transition all running at the same time, that benchmark is under pressure in both directions.
Underneath both questions is the operator readiness gap inside post-Series-A portfolios. The Series A Off-Ramp framing from Nelson Advisors is the macro picture. Inside a single portfolio company, it shows up as the absence of a senior operating layer between the founders and the next stage of growth.
We are bringing these as open questions. The aim is to come back with answers.