By Dr Anne Blackwood, CEO of Health Enterprise East
It is a well-accepted fact that the NHS is slow to adopt new innovation. Suppliers to the NHS must battle with a fragmented marketplace with no clear route to market, budget silos that impact the ability of buyers to realise savings directly and a short term focus on cash-releasing savings at the expense of longer term benefits.
The government’s Accelerated Access Review, published in October 2016, assessed the barriers medtech innovators must overcome to speed up adoption of innovative new drugs, devices, diagnostics and digital products in the NHS.
Among the solutions proposed by the Review to these challenges is a newly planned Accelerated Access Pathway (AAP) to prioritise strategically important innovations, a new Innovation and Technology Payment (ITP) to reimburse providers for a small number of selected innovations and more funding for Academic Health Science Networks (AHSNs) to enhance local routes to market.
While these solutions may go a long way to solving some of the current barriers to market, issues remain. How will the small number of innovations on the AAP or ITP be selected? Picking a handful of winners from across the healthcare technology spectrum is easier said than done – just ask venture capitalists how often they get this right. What will happen to all the other potentially life-changing technology that patients may have to wait to gain access to?
Wouldn’t a better approach be to work with clinicians to identify unmet needs and then co-produce solutions with industry? Bottom-up innovation rather than top-down intervention. In some ways, this is what the SBRI Healthcare programme, funded by NHS England, aims to achieve. Led by the AHSNs, SBRI Healthcare works with local clinical networks to identify needs and then funds technology companies to develop solutions.
Since it started in 2009 the programme has dispersed funding of £73m to innovative technology companies to develop solutions to known unmet needs and now has a pipeline independently valued at over £1bn. Solutions now on the market include MyCOPD, digital tools to help patients with chronic obstructive pulmonary disease (COPD) better self-manage their condition from ‘My mHealth’, and the Patient Status Engine, a continuous wireless patient monitoring platform from ‘Isansys’.
Investment in needs-driven solutions and procurement levers are an important factor in driving adoption of healthcare technology. In isolation however these will not solve the problem when there is little slack in the system to effect change management. New devices, diagnostics and digital health platforms often require service redesign and retraining of staff before they can be implemented.
Providing the time, skills and additional resource required to redesign services and care pathways to accommodate new technology is just as important as getting the structures right.
Clinicians can get paid time away from clinical duties, in addition to access to mentors and other networking opportunities, through the National Clinical Entrepreneurs programme led by Professor Tony Young, National Clinical lead for Innovation, NHS England.
The NHS spends over £1bn on research and development through the NIHR but only a fraction of that on adoption and diffusion of good ideas. The Clinical Entrepreneurs programme is a good step in the direction of supporting front-line staff, who are best placed to identify unmet needs within healthcare, to work with technology and business experts to co-develop solutions.
Understanding the health economics of the new pathway is equally important, especially early on in the product development process. Healthcare innovators need more support to generate pragmatic cost-benefit analyses of new technology which rely more on real world evidence than that generated through randomised control trials (RCTs).
More standardisation of the clinical trials approval process would also help, speeding up the generation of real world evidence needed to support adoption.
The Accelerated Access Review contains some important recommendations and levers that will support accelerated access to new devices, diagnostics and digital technologies for patients. In implementing these ideas we should also think about the people, culture and technologies required to truly make a difference.