Barbara Harpham, chair of the Medical Technology Group, considers the mechanisms designed to promote the adoption of innovation by the NHS, and asks whether - at last - we may be making some progress
For over 18 years, successive Secretaries of State have championed the importance of innovation and the adoption of new medical technology by the NHS. In that time there have been over 20 reviews, reports, recommendations and initiatives designed to achieve this goal. But how successful have these steps been in ensuring the NHS takes full advantage of the technology on offer and what needs to be done next to make a significant impact?
Fifteen years of frustration
When we first reported on efforts to promote the adoption of innovative medical technology back in 2016, we branded our report Déjà Review. The title reflected the frustration we felt from what we perceived as a distinct lack of progress, despite countless hours of civil servant time being poured in to solve fundamental issues.
That was before the publication of the Accelerated Access Review. Déjà Review set out nine recommendations for the Accelerated Access Collaborative (AAC). These included a long-term commitment to the AAR by Government, and a central role for Academic Health Science Networks (AHSNs) in supporting the spread of innovative technologies. I am glad to say that much of this advice was heeded.
Checking the pulse of innovation in the NHS
Four years on from the Déjà Review report, we decided the time was ripe to take another look at the health of the NHS’s innovation systems. Our latest report: Our NHS: A spotlight on the Innovation Landscape does just that. Launched at a roundtable event in Westminster hosted by Chris Green MP in January, the report makes for more positive reading. In fact, we conclude that the NHS system for innovation adoption is healthier than it’s ever been.
The AAC is providing leadership and guidance for development of innovation across the health service. It also appears to be gaining the prominence and leadership needed to ensure it makes a significant impact on the innovation landscape. Its remit has expanded from identifying specific products that it supports through accelerated regulatory approval to addressing the more fundamental challenges to the uptake of new technology. It now functions as a ‘single front door’ to the innovation ecosystem, horizon scanning for the best new innovations so we know what’s coming down the track, and developing a local and national approach to demand signalling to send a clear message to the market about what the NHS needs.
Similarly, the AHSNs, established in 2013 to spread innovation at pace and scale across regions and improve health and economic growth, provide a vital vehicle for interactions between industry and the NHS, while connecting the academic organisations and the third sector. This role as ‘catalysts and connectors’ has been enormously successful, and the 15 AHSNs have together helped introduce over 330 technologies which have benefited over 20 million patients. With their licence and funding renewed until 2023, they are well placed to continue to deliver results and build on their crucial regional links.
The vital signs are good, but there’s room for improvement
Of course, there is always more to be done. The good work done by one AHSN is not always replicated well in another while collaboration with industry, essential to ensure that device manufacturers tailor their innovation to the NHS landscape and source of demand, could be improved.
Meanwhile, the AAC has focussed on a limited number of technologies and, although this has produced impressive results in certain fields, the process is unlikely to solve the fundamental issues that slow down the rapid uptake of technology across the wider healthcare system.
In our view the AAC needs greater prominence within the NHS architecture. It needs support, as the key organisation focussed on the adoption and use of innovative technology, so that it can continue to assist in the development of NHS practices that are fit for patient demand. Furthermore, it needs a more formal role in all aspects of innovation, most notably NHS Business Services Authority and procurement. With a clear function, it can ensure innovation is the absolute priority when procurement decisions are made.
Our report explores the six steps set out by the Accelerated Access Review, from horizon scanning to uptake support, and makes suggestions for enhancing them. It also examines the role and performance of the NHS Innovation Accelerator, NHSX, and HealthTech Connect, all of which have the potential to contribute to ensuring the right technology gets into NHS clinicians’ hands. However, we believe there are broader issues to be addressed to reform the system:
Five ways to further boost NHS innovation adoption
1. Early Access to Medical Technology
The NHS still struggles to support and incentivise early access to medical technology. The Medicines and Healthcare products Regulatory Agency (MHRA) already has an ‘Early Access to Medicines Scheme’, alongside the Cancer Drugs fund as a way of allowing early access to medicines. No such scheme exists for medical devices. NHS England should establish an Early Access to Medical Technology scheme that provides funding and support for NHS organisations to give patients early access to medical technology.
2. Joining up the system
The NHS needs to look at the vital elements of the system that impact the use of medical technology and ensure they are joined up. This would require a seamless process that supports all technology through the evaluation, commissioning, reimbursement and procurement challenges. All evidence, data and information on technology gathered during the evaluation phase should also support the latter elements. Doing this more effectively would allow for a reduction in the amount of duplication.
3. Funding mandate
The proposals for a medical technology funding mandate will help support the uptake of proven, cost effective medical technology. The criteria for technologies achieving mandatory funding is initially very narrow, and focussed on in year savings, we would like to see this extended, with a funding mandate similar in operation to that of the system for pharmaceuticals.
4. Change ‘less is better’ mind-set
Many Government initiatives are aimed at reducing the demand on NHS services by removing treatments. Both Getting It Right First Time (GIRFT) and the Evidence Based Interventions programme are focussed on reducing activity. This sends the wrong signals to policy makers. The drive to reduce demand should aim to get people back to full health as quickly as possible. The most effective way of achieving this is through access to effective diagnostic and subsequent treatment for all patients.
5. Creating a culture of innovation
More needs to be done to create a ‘culture of innovation’. A challenge given the NHS employs 1.5 million people. Nevertheless, this needs to come from the very top and the buck stops with Secretary of State for the Department of Health and Social Care, Matt Hancock. Mr Hancock’s commitment to technology has been welcomed, but he needs to look at how he can go beyond the implementation of exciting initiatives to embed a change of culture within the UK health system.
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