NHS Innovation and Economic Growth
It’s commonly said that the NHS has an innovation problem; it struggles to adopt novel technologies, is poor at implementing established innovation, and fails to scale what works. I’d argue that this is incorrect; there’s lots of innovation in the NHS, as demonstrated by the numerous pilots. Innovative technology is often found across large parts of the NHS, for example, virtual wards, blood glucose monitoring, patient messaging platforms and online consultations. The problem isn’t necessarily a lack of innovation and scale; it’s the variable impact of technology and incomplete scaling, which means few really benefit.
What’s going on and how can it be improved? There are three aspects that contribute to this: the transformation approach, funding allocations, and procurement limitations. Firstly, it’s common for technology to be deployed under the assumption that it can just slot into existing approaches without changing governance, upskilling staff, and adapting workflows. As a result, technology is often added on top of existing ways of working. This increases complexity instead of simplifying services and providing improvements. The capacity and expertise to transform services to unlock benefits is highly variable across the NHS. So, there’s a need to build this capacity and capability for all organisations.
Secondly, funding covers the cost of the technology and not changing workflows and staff skills. Funding limitations can leave the workforce underprepared to use technology effectively. NHS digital maturity can be different from organisation to organisation. Short-term funding allocations result in digital systems purchased piecemeal, creating siloed systems and data which don’t connect up. Thirdly, missed opportunities to improve procurement hold back innovation. The NHS has a multitude of pilots, but the data from these are not aggregated. Instead, anticipated impact is based on a small number of rigorous evaluations which rarely represent real-world situations. If, instead of siloed pilots, the same data were shared and combined, then it could help to inform the likely range of benefit in the real world. Procurement approaches can then use this data in risk-sharing contracts. This is where payment to the tech supplier depends on successful outcomes, which are defined based on realistic impact metrics.
Despite these problems, there are positive approaches to scaling emerging in the NHS which give a glimpse of a potential future. Some NHS organisations are self-organising to work collectively in order to co-fund, test and evaluate innovation. A nominated lead organisation carries out the evaluation, shares the learning and supports partner organisations to deploy the technology along with the necessary workplace changes. Collaborative NHS partnerships could facilitate better innovation scaling if they are enabled as part of the new regional structures.
Lastly, the above frames the NHS simply as an innovation taker. However, the NHS has an important role to play as an innovation creator. In a small number of places, the NHS and venture capital are coming together to support startups to take innovative approaches and solve NHS problems. The NHS brings clinical and operational insights which, when combined with venture capital, can create innovative technologies better suited to NHS needs. This creates equity opportunities for the NHS, unparalleled insight for the startup, and better income opportunities for funders. This nascent approach of enabling NHS-venture partnerships has the potential to position the NHS as an innovation creator, one that can bring in funding into the NHS and create growth in the economy.
The question for government and the NHS is: how to package up what’s working within the NHS to create a vision, strategy and delivery model for innovation? The growth innovation zones introduced in the 10 Year Health Plan present the opportunity to do just that; unfortunately, significant progress on these has yet to materialise. Growth innovation zones can help to create a more structured mechanism for innovation and spread. They should be developed to combine novel financing mechanisms, venture funding, risk-sharing procurement, data-informed piloting and collaborative scaling. In doing so, this sets a unique opportunity to combine innovation and implementation for patient benefit and economic growth, potentially creating a positive flywheel for change.
Pritesh works for The King's Fund as a member of the policy team, where he focuses on how digital tools and technologies can improve health and care. He is particularly passionate about using evidence-based digital technology as an enabler to improve quality of care and outcomes while critically assessing buzzwords and technology as a silver bullet. Pritesh combines his understanding of technology with the broader picture of the essential ingredients needed for digital change to have an impact. This encompasses culture, unmet need, infrastructure, change management and knowledge all to improve quality, inequalities and outcomes.
