UK assisted living specialist Hewerdine has launched a website for retail sales of the Invacare range of manual and power wheelchairs, scooters and accessories.

Occupational therapists, nursing and care home staff and individual users of mobility aids can now look in a single place to order the technologies.

The new, easily navigated website www.hewerdinehomecare.co.uk lists the products in the categories used by Invacare.

The products can be purchased directly through the website; or care professionals and care homes can contact Hewerdine Homecare to arrange an account, allowing multiple users to order the products.

“The Invacare homecare range has been chosen by us as they are the trusted manufacturer of homecare products used by healthcare professionals, and for its affordability, reliability and functional design,” said Geoff Gane, Director of Hewerdine. “We have had a tremendous response to the new website, and such positive feedback from OTs in the field.”

Hewerdine supplies mobility aids and homecare products to over 20,000 customers in the UK.

Partnership is increasingly vital for the medtech industry as it seeks to engage more closely with a changing market. Dr Anne Blackwood, CEO of Health Enterprise East, the NHS Innovation Hub for the East of England, discusses how industry can work with the NHS to develop new healthcare solutions.

 

Why is the crossover of innovative ideas from the NHS to the medtech industry important? How do both industry and the NHS benefit from it?

It’s important because the ideas clinicians put forward are in response to unmet needs they have identified. One of the things industry always says to us is that they develop products they think the NHS wants, but when they try to sell them to the NHS clinicians say “Sorry, that’s not what we need.” Bringing ideas identified by clinicians out of the NHS, developing them and selling them back in improves the chance of a company’s commercial success by accelerating NHS adoption and wider use. It’s really a win-win outcome for both sides – the clinicians identify the need and address local, regional and national priorities, and the company sells its products.

Can you point to any examples of medtech companies that have achieved major success by developing products or services in collaboration with the NHS?

There are a number of good examples in telehealth, including a successful collaboration between the telehealth company Doc@home and NHS South East Essex to help COPD patients manage their long-term condition at home. [See the case study in the next issue of Medtech Business.] But it’s something that needs to be done more: I don’t think there are enough examples of real collaborative working at the moment.

Part of the problem is that industry tends to present a product or a technology, it doesn’t present a business solution. Often the reason why a product doesn’t achieve widescale uptake in the NHS is not necessarily that it’s not a good idea, what usually fails is the implementation. If industry can be assisted to present business solutions to the NHS, in other words to make a business case to the commissioner that helps the NHS to understand how to implement the technology within a care pathway and a service – answering the questions ‘How do I actually use this? How do I change the care pathway to take advantage of this technology? What are the knock-on effects on the service?’ – then we can achieve greater uptake of technology within the NHS, which is generally considered to be a slow adopter of new technology.

Are there examples of industry working with the NHS to redesign services and change care pathways? What outcomes have these achieved?

The telehealth projects [see the case study in our next issue] are among the best examples of that. Their outcomes have to do with patients managing their own conditions better, so that they have fewer A&E admissions and are more likely to be able to remain in their own homes and continue to be productive both socially and in a work environment. So there are a number of identified outcomes that you can achieve through projects such as that.

How do you see the relationship between the NHS and industry developing at a time of reduced public sector spending on healthcare and medical research?

In an ideal world I’d like to see greater collaboration between the NHS and industry, and I think what we’re looking for is win-win outcomes. The NHS has some enormous economic pressures coming to bear in the next few years, and industry is going to find it harder to get new technologies adopted. We’re also moving towards a more fragmented commissioning marketplace with GP commissioning coming on board, so that’s going to make it quite difficult for industry in terms of the new commissioning landscape. So what I’d ideally like to see is greater collaboration and more use of innovative business models.

Perhaps industry needs to think harder about how it can help the NHS to get over some of the initial hurdles around adoption of new technology, and particularly around capital spend – and whether there’s a way, in terms of how industry sells products to the NHS, that rather than having up-front payments they can take a share of potential cost savings downstream. So, for example, there are lots of NHS trusts that would like to buy telehealth equipment, but the person who’s purchasing the equipment and making the capital spend doesn’t get the benefit of the cost savings: that benefit goes back to the commissioner, but it’s the provider who’s making the capital spend. So there’s a disincentive for the provider to purchase the equipment.

One possible way around that is for industry to try to work with commissioners and providers in order to get around the issue of capital spend, particularly for telehealth, and look at ways of providing the equipment on ‘loan’ initially and receiving payment when the cost savings have been realised. That method is commonly used in the R&D stage: we’re often approached by companies that want to donate equipment so they can gather the clinical evidence base for the effectiveness of their devices, and in order to encourage people to trial their devices they’ll often give them away for free. I don’t think it’s commonly used once the evidence base is in place: the company moves straight to a sales model. But in the current climate we need to be as innovative as we can, and within the economic framework and the way money moves around the system, we’ve got to try and be creative to ensure that we can still get new technologies into the NHS.

What kinds of healthcare innovation are most needed at this time? How are the NHS Innovation Hubs working with industry to target those areas?

There’s a very large agenda around managing long-term conditions and moving care closer to home. That’s something that we’ve been talking about for ten years, but still aren’t really much closer to achieving. In terms of innovative technology, we’re looking at information management systems in primary care, telehealth, point of care diagnostics – things that will enable us to move healthcare out of the acute sector and into the community. Technologies around that agenda are certainly required at the moment.

The way we’re working with industry is to work closely with our NHS partners and try to identify what those individual needs are. For example, at the moment I’ve been working with some of the GPs in our region to identify their needs around point of care diagnostics, and we’ve developed a specification for blood tests that we’d like to see industry develop. As innovation hubs, our role is to try and help identify what the needs are and then communicate them to industry, so that when industry develops those solutions they have a much better chance of commercial success and wider uptake because they’ve been designed and developed against needs that the NHS itself has identified.

At a global level, above the whole primary care agenda, QIPP dominates the NHS at the moment, so any innovation that’s going to achieve widescale uptake has to take cost out of the system while at the same time driving up quality. That whole QIPP agenda – quality, innovation, productivity and prevention – has to be addressed by medtech innovations if they’re going to be adopted and diffused.

Why is collaboration – across professional boundaries and across disciplines – so important for meeting the healthcare challenges of the coming years?

It’s fairly clear that with an ageing population, and one that’s healthier and living longer, we’re going to be unable to meet the healthcare needs of the future unless we start doing things differently. The only way that we’re

 

going to achieve that is by working together, and recognising that industry and the NHS need each other in order to meet these challenges. So I think if we can’t foster greater collaboration and open innovation, then we’re going to fall well short – and we simply can’t afford to, because this is the future!

A new partnership between the NHS and industry that addresses some of the issues discussed here is the Small Business Research Initiative (SBRI). This is a national programme run by the TSB, and it’s essentially a pre-commercial procurement programme that started in the US and came over to the UK a few years ago. Essentially it asks government departments to identify priority unmet needs, and then puts a call out to industry with some associated funding for them to develop solutions against those needs.

SBRI East is a regional health pilot under the SBRI programme, funded by the SHA, the East of England Development Agency, the European RDF and the TSB. It was a £2.5 million programme that asked industry to develop technologies against three priority unmet needs: patient safety, managing long-term conditions and keeping children active. In phase 1 of the programme, which lasted for six months, 11 companies were given up to £100,000 each to carry out technical feasibility studies in order to develop products against those three priority areas. We’ve now gone into phase 2 of the programme, which will run for two years: four companies are sharing £1.5 million between them to continue developing their products. So when these solutions come to market there is a much better chance of them achieving commercial success, because the NHS has specified the need for them.

 

The NHS has been called a ‘slow adopter’ of innovative technologies. Daniel Steenstra of Innovations Factory looks at why service innovation is the only way forward for the NHS – and how industry can help.

The performance of organisations can be described in terms of a hierarchy of capabilities. The psychologist Abraham Maslow identified four levels of need that individuals have to fulfil before reaching their full potential. These needs form a hierarchy, with some (such as food) being more basic than others. The same model can be applied to organisations: in order to be sustainable and in control of their own destiny, organisations need certain competences and capabilities that form a hierarchy (see Figure 1). But many are not able to reach the top level.

Most public sector organisations are rigid and reactive, under top-down political control. Woolworths is a good example of a company that focused on reducing costs by offering cheap products in a cheap retail environment. However, it was not able to deal with changes in consumer behaviour brought about by online shopping, and went bust. Toyota seems to have invented ‘lean’ business by continuously improving its processes, but is still struggling with quality issues and has had to recall many of its cars. Not too long ago, British Airways was considered the world’s favourite airline, with the fastest aeroplane and the best First Class. It had an agile strategy of adapting to the changing market. However, since the Terminal 5 disaster – a failure to innovate by delivering a new system effectively – the company has lost status. However, BA is still managing to adapt – for instance, by developing joint ventures.

Apple is an example of a company that is consistently able to innovate and offer breakthrough products and services. It is very capable of doing the lower-level things right, such as managing costs. Apple spends a third of Nokia’s R&D budget, yet with the iPhone Apple is leading the ‘smart phone’ market. What differentiates Apple from its competitors is its leadership, vision and commitment to innovation throughout the organisation.

 
Figure 1: Hierarchy of competences and capabilities

Why innovation is vital

There are no prizes for guessing at what level the NHS functions today. The Coalition’s White Paper Equity and excellence: Liberating the NHS outlines the need for the NHS to become a truly innovative organisation. This is a big step and the NHS needs all the help it can get to achieve this.

With 1.4 million employees, the NHS is the largest healthcare provider in the world. It has to deal with rapidly growing demand: more people are living longer, due to advances in medicine and improved welfare. Patients have better access to knowledge and expect a higher level of service. Clinical and administrative processes are more complex, with an increased use of advanced technology. However, the worldwide economic crisis is having a significant impact: with the failures in the banking system, governments are generating less income through taxation, which causes an escalating deficit. This crisis is driving cuts in public sector expenditure.

Healthcare providers have developed a culture of ‘damage repair’ with expensive hospital interventions, and depend heavily on management structures. In order to remain sustainable, they need to become more effective and reduce costs, which means focusing on ‘wellness’: preventing illness and providing care in the community.

We know from examples in industry that increasing productivity and cutting costs are not enough. The only way the NHS can deal with these challenges is by innovating its services.

Fear of the unknown

The NHS is a service organisation, focused on delivering patient experiences. It is centrally led by the Department of Health (DH), with rigid bureaucratic structures. The DH controls England’s Strategic Health Authorities (SHAs); each SHA supervises all the NHS trusts in its area. Hospitals and GP practices have to meet ambitious targets and improve financial performance. Paradoxically, they have a considerable amount of operational freedom to decide how these targets will be met. Governance is also dealt with locally, which partly explains why there are considerable differences in efficiency and effectiveness between services.

There are no mechanisms to encourage Trusts to adopt new processes or products. Measures such as awarding Foundation Trust status to financially sound organisations, outsourcing services to the private sector and PCT commissioning has led to competition between Trusts – but there is no lateral ‘joined-up’ structure between Trusts, so any initiative of successful change remains stuck at a local level and takes a long time to diffuse.

The NHS is a complex and disparate organisation, but there are some common features. Being controlled in a ‘top down’ manner, it is not strategic. Its leaders are focused on managing operations, not on entrepreneurship and service innovation. Staff are cautious when it comes to taking risks. There is a strict hierarchy and a tribal culture. Due to the increasing demand and the lack of time, funding and supporting structures, they do not develop and implement service improvements. There is an immature relationship between managers and clinicians, with lack of trust and respect on both sides.

Inertia creeps

Something changes in people when they become patients. As consumers they are informed and empowered and can easily assert their choice by shopping elsewhere or changing service providers. As patients they are weak and no longer autonomous, and depend on their clinician. In this position, patients seem to accept inefficient services and ineffective products; they are not up to date with new products or services that could support them better. Consequently, patients are not able to drive product or service innovation. This makes it difficult for the health service, and for industry, to develop better products and services.

Compared to the car industry, for instance, the medical technology sector has experienced growing demand and lack of competition. Healthcare providers have not driven industry to develop new products: they have been focused on service operation, and patients have not demanded better services. Large companies can still afford to ignore requests for modified, customised products from clinicians, or opportunities for licensing in new technologies. Procurement systems are geared towards high-value and high-volume products, not potentially disruptive innovations.

When it comes to developing and commercialising new healthcare technologies, universities are experiencing the same problems as the NHS: it is difficult to engage with patients and Trusts for market research and evaluation. Universities have been able to get funding for research without clear practical application: ‘technology push’ rather than ‘market pull’. They have not focused on the needs of the health service or industry: they were ‘inventing’ rather than innovating. As a result, industry is not keen to take on intellectual property (IP) coming out of universities.

Innovation: the recent story

Over a 10-year period, the previous government doubled taxpayers’ investment in the NHS. Recognising the importance of innovation, it set up a joint task force with industry (HITF). This led to the regional NHS Innovation Hubs helping Trusts to manage IP, with the Medilinks supporting industry. The Government also set up a national support structure for innovation, merging the Modernisation Agency with the NHS Leadership Centre and NHS University to form the NHS Institute for Innovation and Improvement.

The attempt to combine different aspects of innovation (leadership, education and service improvement) was not successful. The Institute focused on developing ‘products’ for productivity improvements, based on Toyota’s lean principles (e.g. ‘The Productive Ward’). Trusts could take or leave these products: there was no way of forcing adoption. After Lord Darzi’s NHS review, the SHAs became responsible for innovation. But they had no experience or capability in that area.

In summary, the current innovation capability in the NHS is fragmented: product innovation is not integrated with service innovation, leadership and organisational development (see Figure 2). The result is too little innovation, too late and too expensive. This leaves the NHS in desperate need of innovative services and products, with established industry and academia that are unlikely to satisfy that need.

 
Figure 2: Aspects of innovation

Window of opportunity

The Coalition government wants the NHS to focus on patient choice and outcomes. It wants to empower clinicians, decentralise the NHS, and dismantle management structures such as SHAs and PCTs, with care being commissioned by GP consortia. It has scrapped the NHS Institute, breaking down the already fragile innovation infrastructure. It wants the NHS to become innovative, but has not provided any guidelines, frameworks or support.

In order to deal with these challenges, the NHS needs to change fast. It needs to reduce costs and become a lean, agile and innovative organisation. Many aspects have to be integrated: developing new and more effective services will drive the use of new technologies and products, and so will changing the staff attitudes, organisational structures and leadership.

There is a window of opportunity for industry to lead the way in building a new model of innovation and collaboration. This has to focus on services, integrated with new products and organisational changes that are equitable and deliver bottom-line impact. The NHS needs to work with industry, building partnerships with providers of technologies and services, like BA with Boeing (in developing the Boeing 777) or Toyota with its technology providers.

At Innovations Factory, we have developed a novel platform for NHS organisations and industry to work together in developing the capability to innovate. We are trialling this concept and will explain it in more detail in a future issue of Medtech Business.

 
Professor Daniel Steenstra is Royal Academy Visiting Professor in Medical Innovation at Cranfield University and Managing Director of Innovations Factory Ltd, an SME based in the NHS at Heartlands Hospital in Birmingham and dedicated to helping individuals and companies develop their ideas from basic concept to full commercialisation within the healthcare sector. For more information, visit www.innovationsfactory.co.uk

European medical device industry association Eucomed has advanced its online communications to reach a wider audience.

Changes to Eucomed’s website www.eucomed.org and to its online newsletter, blog and Twitter account are intended to reflect the shift of European healthcare systems towards a more patient-centred model.

Eucomed’s digital strategy aims to educate all relevant stakeholders and the wider society about the benefits of medical technologies.

The new website features a combination of easy-to-understand content and multi-media presentation. All of Eucomed’s social media platforms are now integrated with full sharing capabilities.

“We believe that knowledge about the role that our industry plays in people’s lives is vital to empowering people and improving their understanding of the benefits that medical technology has to offer for individuals and society at large,” said John Wilkinson, Chief Executive of Eucomed. “By fine-tuning and optimising our communication efforts, we are doing just that.”

As well as relaunching its website, Eucomed has revisited its other communication platforms. Ingmar de Gooijer, Director of Communications, explained: “By taking this multipronged approach, we want to offer everybody interested in the healthcare and medical technology the content they are looking for in the least amount of time, presented in an attractive and modern manner. We have increased our visual communication efforts and simplified our messages where we now focus more on the receiver of the information.

“The platforms we have optimized in order to suit everybody’s need are our website, our blog, our newsletter and our Twitter feed. This fine-tuning of our communication vehicles is not limited to our digital efforts, but will also clearly manifest itself during other activities including the MedTech Forum 2011, Eucomed’s yearly medtech event.”

Eucomed represents directly and indirectly 4500 designers, manufacturers and suppliers of medical technologies in Europe.

 
www.eucomed.org

A new screening tool could help to prevent strokes and heart attacks by diagnosing atherosclerosis (the build-up of fatty material in arteries).

Unimedic claims its new Arteriograph product could save the NHS around £4.5 billion over five years.

The Arteriograph is a non-invasive catheterisation method of providing cardiovascular risk assessment. It uses a single cuff and only takes 2 minutes.

The device measures essential structural and functional parameters such as central blood pressure and aortic stiffness, enabling surgeons to identify asymptomatic but high-risk patients and evaluate the effects of therapy.

Cardiovascular diseases kill 200,000 people in the UK and cost the NHS nearly £15 billion every year.

Dr. Rajendra Sharma, Medical Director of the The Diagnostic Clinic, London, commented: “The research by Unimedic led very swiftly to The Diagnostic Clinic acquiring an Arteriograph. The expertise taught to us by Dr Tamas Hodosi has led to over 350 patients being screened since we started using the Arteriograph over two years ago.

“The use and availability of this technique of arterial screening has led to the early detection of arterial disease in around 15% of patients tested, many without symptoms. Many of these patients might not otherwise have had problems detected with non-invasive conventional screening until much later in the progression of their disease.

“Investigations such as the exercise treadmill or resting ECG may not detect issues until 70% or greater coronary artery occlusion is in place. My experience to date enforces my belief that this is an invaluable tool for any screening centre or general practice.”

 
Arteriograph

Bayer achieved its Group’s financial targets last year, according to Chairman Dr Marijn Dekkers.

Sales climbed by 12.6 % in 2010 to a record €35.1 billion after hemophilia medicine Kogenate passed sales of a billion Euros for the first time and cancer drug Nexavar were up by 11.7%.

Dr Dekkers said that Bayer had “scored many achievements” last year, but “also faced challenges”.

Despite the record sales, the Group posted a reduction in net income by 4.3% to €1.3 billion.

Its pharmaceuticals division raised sales by 4.2% to €10.9 billion after the business expanded significantly in the Asia/Pacific and Latin America/Africa/Middle East regions. However in America, sales were down after the YAZ line of oral contraceptives faced generic competition. Sales of its multiple sclerosis drug Betaferon/Betaseron were also down by 5% compared to last year.

According to the chairman, 2010 was marked by factors the company could not have predicted as the performance of the CropScience and HealthCare subgroups were both below expectations.

But Dekkers expressed optimism for the company’s continuing development after a bright start to 2011. “We are confident for this year, which has gotten off to a successful start.” he said.

The company now plans to invest some €15 billion for research and development, and for property, plant and equipment until 2013.

Bayer also published targets to raise the proportion of female managers in the Group by a third by 2015. “We are convinced that greater human resources diversity is good for the company,” the Chairman added. “We are optimistic that we can achieve our target within five years.”

Novo Nordisk is to celebrate its Investors in People (IIP) Bronze Standard award by sponsoring a guide dog for its first year.

The pharma company achieved the Inspiring Business Performance accolade after increasing its amount of employees by a third in 2009.

Liz Chaddock, Project Manager at Novo Nordisk, says the decision to sponsor a guide dog puppy “demonstrates the responsibility we feel as a company to our society”.

Novo Nordisk was presented with the award in November 2010 after originally achieving the Investors in People Standard a decade earlier.

Diabetes is one of the most common causes of blindness in the UK. The company has an extensive portfolio of diabetes products and said it was “fitting” to sponsor the guide dog named Vicky.

“Achieving Investors in People is a completely positive experience,” said Liz Chaddock.

“The feedback from our assessor allows us to make continuous improvements, whilst the process itself flags up areas we need to work on. We have already implemented some improvements on our way to the Silver award, and are aiming for Gold in 2012, in time for the London Olympics.”

The company, which has its UK headquarters in Crawley and has nearly 500 employees in the UK and Ireland, hopes to achieve the Investors in People Silver award this year, and continue celebrating achievements in ways that help the community.

Medtronic has revealed plans to cut up to 2,000 jobs globally, despite reporting an 11% increase in third-quarter earnings.

The cuts will represent a workforce reduction of 4-5%, but the company has yet to reveal details on which areas will be targeted, though there has been an indication that the focus will be on back-office and administrative roles.

“It could have an impact in terms of not needing as many employees in certain areas,” said CEO Bill Hawkins, who is to retire in late April.

The medtech company said that various industry-wide challenges, such as market-share pressure and pressure on product prices amid tougher bargaining from hospitals, are the reason for cutting costs.

In its recent reported earnings, Medtronic’s heart-rhythm medical devices business shrank slightly, while growth in spinal devices improved by 2.3%. The company hopes these will improve due to the FDA’s recent approval of a pacemaker that is safe in MRI scans and once current quality-systems issues are resolved with regard to its new defibrillator product.

Plans have also been revealed to sell the company’s Physio-Control external defibrillator business, following a four-year delay due to quality challenges.

NICE has opened consultation on potential new clinical and health improvement indicators for the 2012/2013 Quality and Outcomes Framework (QOF).

Anybody with an interest in health is encouraged to contact the Institute and to consider any implementation challenges, impact on health inequalities or the possible consequences for the proposals.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, says the consultation is “a clear opportunity” for “everyone to take part” in the process.

Introduced in 2004, the QOF framework is an annual incentive scheme that rewards GP practices in the UK for implementing systematic improvements in quality of care for patients. NICE took over managing the process of developing indicators and reviewing the existing indicators in April 2009.

It established a new independent Primary Care Quality and Outcomes Framework Indicator Advisory Committee responsible for reviewing existing QOF indicators and recommending new ones.

Following recommendations from the December 2009 and June 2010 Advisory Committee meeting, a series of new indicators has been developed. The developmental process for potential new indicators, such as those relating to asthma, cardiovascular disease, obesity and smoking, includes pilot schemes across the UK and public consultation.

Feedback from consultation and results from the piloting process will then be presented to the Committee to consider and a “menu” of approved indicators which will be published later this year.

Are pharma companies learning to listen? Di Spencer charts the love-hate relationship between the industry and social media.

Are you feeling the love? The last few weeks have seen pharma step blinking into the bright light of online interaction with more determination than ever before. The blogs are alive with whispers that the industry has “turned a corner” and “the silence has been broken”. Like Colin Firth in The King’s Speech, it seems that pharma is ‘finding its voice’.

As Pharmaphorum‘s Emma D’Arcy (@darcyemma) puts it: “2011 seems to have been appointed the year that pharma finally finds its voice about using its voice. No more hoarse hiding behind the regulatory purgatory excuse nor blaming a lack of interactivity on legal.”

Perhaps the most momentous and daring move was AstraZeneca’s decision to host a live ‘tweet chat’, which saw the company challenged by various critics on prescription drug costs. The reaction to the decision was positive on the whole, accompanied by a general surge of goodwill from social media advocates. You can follow the chat on the #rxsave hashtag.

However, in her first blog, Emma D’Arcy’s ‘gold prize’ (or perhaps we should go for ‘Oscar’ to be topical) went to sanofi-aventis for its efforts in establishing itself in the SM universe and for a focus on health “not just treatment”.

Other companies have been praised for the establishment of online communities and support tools for specific patient groups. Merck Serono recently launched an international social networking site for multiple sclerosis (MS) patients, ‘Unite MS’ (@uniteMS). In a statement Dr Roberto Gradnik, Executive Vice President for Neurodegenerative Diseases at Merck Serono, said: “As the MS community continues to look to social networks to stay informed and connected, we see it as our responsibility to provide a vehicle that helps them do so more efficiently than ever.”

On International Rare Disease Day, it only seems right to also draw attention to the large number of resources for patients with hereditary angioedema (HAE), managed by ViroPharma, CSL Behring and Dyax, which provide information and services to patients that would otherwise feel considerably isolated.

So, for once, everyone is talking about what pharma is doing right in the social media world. Love is in the air. Let’s hope it lasts.

Contact the author: diana.spencer@healthpublishing.co.uk