Three articles have diagnosed the structural failures of the NHS digital pathology programme. This one asks what recovery looks like. Bent Flyvbjerg, whose Iron Law of Megaprojects has framed this series, does not only describe how large programmes fail. He also describes how the best ones succeed — and the leaders who deliver them repeatedly. He calls them Masterbuilders: not heroic individuals, but disciplined thinkers who define the destination before committing resources, plan slowly before acting fast, learn from comparable programmes rather than assuming their project is unique, and build from repeatable components rather than bespoke experiments. These principles did not shape the first wave of NHS digital pathology investment. They must shape the next one.
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The conversation focuses on OYDN, an AI-powered computational pathology model developed through a collaboration between the TIA Centre and the University of Sheffield. Adam and Hanya discuss how the technology supports more objective diagnosis, improves risk stratification for patients at risk of developing oral cancer, and is helping uncover novel digital biomarkers that could shape future treatment strategies.
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