Making the NHS more receptive to new medical technologies is a complex challenge in a time of budgetary restrictions. Mark Wilkinson, NHS Director of Life Sciences Innovation, discusses what the medtech sector can do to help the NHS inject more innovation into its services.
Mark Wilkinson is the Director charged with promoting life sciences innovation in the NHS. He is an NHS leader with 10 years as an executive member of various NHS boards (including five years as a PCT Chief Executive). More recently he has worked for AstraZeneca, with roles in Global Marketing and Global Government Affairs.
The NHS has established a Life Sciences Innovation Delivery Board to increase the uptake of cost-effective medicines and medical technologies and to improve the strategic relationship between the life sciences sector and the NHS. Mark is a full member of the Board and leads a small unit supporting its work.
What are the main barriers to the uptake of innovative medical technologies by the NHS? Are the problems internal to the NHS, or does the industry's relationship with the NHS need to improve?
I'm sure there are challenges for both 'sides'. Let's begin with the problems of navigating our respective worlds. A successful business-to-business relationship requires contact at all levels and across all functions.
In my past role as an NHS Chief Executive, I confess, I had zero contact with medical technology companies - I suspect this was also the case for most of my senior team. There are many valid reasons for this that we need to overcome. The propensity of the NHS to engage in frequent large-scale structural change makes it hard to develop relationships over the length of time that is required for effective partnership. The medtech industry is diverse and fairly fragmented, meaning that even when there is an appetite to engage, it can be hard to work out with whom and how to start. The good news is that it isn't about lack of trust or lack of interest.
NHS procurement is also a fairly fragmented process compared to other sectors: the person who chooses the medical technology is frequently not the person who pays for it - and both are frequently in a different organisation from the one that undertakes the procurement. This fragmentation is much more marked when innovative technologies are being procured. To respond to this (and for many other reasons), there is an ongoing need for NHS leaders to connect clinicians and clinical leaders to decision-making within NHS organisations. One manifestation of this in future will be an easier route for a clinician, perhaps after discussions with a range of medtech suppliers, to be able to influence what the NHS procures.
Finally, both the NHS and industry need to move away from a focus on buying 'widgets' and towards building solutions - that is, redesigned healthcare services. For suppliers, the challenge is about aligning service offerings to health needs in specific geographical or service areas. For the NHS, the challenge is about not seeing innovative new technologies as simply cost-increasing. Frequently, new technologies will cost more - but if they are accompanied by service redesign and a focus on releasing costs, they can deliver big overall benefits to the NHS.
Ultimately, both industry and the NHS need to be looking out for increased uptake of cost-effective medical technologies - that's the common goal. More specifically, I think that given the worsening resource outlook for all UK public services, the focus of the NHS is going to be on faster and wider spreading of proven technologies. I'd like to see a shortening of the time it takes for a useful new product to move from early adopters to broad diffusion across the NHS.
Can you point to an example of successful partnership working between the NHS and medtech to develop new healthcare services?
In a previous role I chaired a network of NHS organisations looking to develop cardiac services across Lancashire and South Cumbria. The network worked with a range of other partners, including Broomwell Healthwatch (a private sector company), to take advantage of new equipment and ways of working to provide support and care for patients in their own homes. Broomwell had already developed a telemedicine ECG interpretation service, and the aim of the project I was involved in was to establish whether there were any benefits to be gained from this new way of working.
We demonstrated that using this service, patients could avoid unnecessary hospital attendances and instead access care locally. The medical equipment proved easy to use, was portable and saved time for managerial and clinical staff. Clinicians gained prompt, round-the-clock access to expertise in ECG interpretation, supporting their clinical diagnostic processes. For the participating health systems, inappropriate hospital attendances were reduced.
A growing number of health organisations now use this service. It was estimated that financial savings from the widespread use of the same technology across England could be a minimum of £45m per annum. The scheme received a number of awards for innovation, as well as for public and private sector partnership. One thing that strikes me about the scheme is that the private sector partner brought a total solution to the NHS, not just a technology, and that perhaps made it easier for the NHS to adopt.
Does medtech need to focus more on primary care as the NHS evolves?
To address the challenges facing the NHS involves moving care further 'upstream': from hospitals into community settings, from community settings into health professionals going into patients' homes, from professionals supporting patients in their own homes into self-care, from self-care into prevention and health promotion. To that extent, there is undoubtedly significant NHS interest in using medical technology outside of hospital settings. But there will, of course, also be many opportunities for innovation in hospitals.
As important as the setting in which technologies are used is the question Are the costs and benefits aligned? The example I gave above of a remote telemedicine ECG interpretation service incurred costs for PCTs on equipment, staff training etc. Those same organisations would also reap the benefits from less spending in secondary care under payment by results funding mechanisms. The same proposal presented to an acute hospital would probably not have been as attractive - at least to those people motivated by organisational incentives such as payment by results.
Over the next few years we are likely to see community services integrated into hospital trusts as PCTs focus on their commissioning responsibilities. So in future, organisational incentives may work in a different way. The key points are: a) it is complicated and dynamic, and b) understanding all this is essential for knowing how to present your offerings to the NHS.
How can medtech companies engage practically with SHAs and PCTs to build what might be called 'the new regional innovation architecture'?
I should perhaps start by defining some of the essential features of the new architecture. SHAs have a statutory duty to promote innovation in their geographical areas. With this duty has come additional funding from the Government. Regional innovation services have been established to maximise the potential of innovation for the innovators themselves, to assist NHS organisations in managing innovation, and to help industry access NHS innovation and expertise. Finally, the National Technology Adoption Centre works with individual local NHS organisations to implement specific new technologies, and then produces guides for the NHS aiming to support implementation across the Health Service.
Perhaps the most significant, though unplanned, feature of the new NHS regional innovation architecture is the move, after nearly a decade of significant real-terms increases in resources, into a new phase where there is almost no new money and yet the NHS has to respond to the increasing demands of an ageing population and more demanding customers. The NHS is about to enter an extremely challenging period. One of the opportunities this presents, however, is that it may become easier to achieve service change.
In terms of how companies can engage to build this architecture, I think that in a word the answer must be 'collaboratively'. Particularly in a sector made up of so many small to medium-sized enterprises, it seems to me that trade associations such as ABHI and BIVDA have a central role to play. It must be incredibly challenging for companies with limited resources to try to navigate the complexities of the NHS. Acting collectively to share information is a win-win for all involved. For the NHS, this is also attractive as it simplifies our approach to the sector and minimises concerns about being anti-competitive or not following procurement rules.
For a number of years, the NHS and the pharmaceutical industry have been developing a concept of joint working. Joint working is sponsored by both the Department of Health and the ABPI. It has its own definition, codes of practice etc. By definition, it is clearly differentiated from the competitive aspects of the relationship between the NHS and the pharmaceutical industry. It allows for learning on both sides, and the development of collaborative projects with clearly articulated benefits for both parties - and most importantly, for patients. I think this has been incredibly helpful, and I think the model may have applicability to medtech.
You are a member of the NHS Life Sciences Innovation Delivery Board. What is that trying to achieve, and how is the medtech industry involved?
The Innovation Delivery Board came out of the Office for Life Sciences and the recognition of the need to make the NHS a champion for innovation if it is both to achieve its health goals and to support UK economic policy goals. Specifically, the Board is tasked with increasing the uptake of cost-effective medical technologies and medicines, increasing the attractiveness of the UK as a site for clinical trials and other forms of product development, and finally improving the relationship between the life sciences sector and the NHS.
The Board is positioned at the heart of the NHS, accountable to its Executive Team. It is a globally unique partnership that brings together senior NHS leaders, regulators (NICE), senior policy makers and industry leaders to work collectively in order to address these challenging issues. Medtech is ably represented by Colin Morgan (Johnson & Johnson Medical Ltd) and Jeff Watson (Ortho Clinical Diagnostics).
We've had our second meeting and are starting to put in place a work programme. One of our main aims is to support the QIPP (Quality, Innovation, Productivity and Prevention) programme in the NHS. QIPP is being put in place to meet the requirement of achieving between £15 billion and £20 billion efficiency savings over the next four years. For medtech, this means identifying innovative and cost-effective technologies, then looking to ensure they are speedily implemented across the NHS.
We are also looking to support the work of the National Technology Adoption Centre and see how it can become more embedded within the NHS.
A big part of what the Board can do is facilitate conversations that may not otherwise have taken place. I'm not sure that innovation or collaboration can be 'commanded' from the top of any organisation - but bring people together, and if they can see a mutual benefit they will work it out for themselves. With that in mind, we are looking to bring together medtech leaders and NHS leaders for a 24-hour workshop to explore collaborative opportunities. This will be a unique event for the medtech industry and the NHS in this country. We are expecting it to take place this summer.
What does the term 'disruptive innovation' mean to you, and why is it an important concept?
Disruptive innovation means some kind of step change innovation. It marks a radical departure from what has gone before and establishes an entirely new order, though it may not initially be seen as such. A non-healthcare example is Apple's iPod, which redefined how people listen to music on the move and heralded the start of music downloading - which in turn has fundamentally changed how people buy music. A healthcare example might be the introduction of remote monitoring technology for peoples' homes that allows people to monitor their own conditions. This has the potential to transform the way in which community health services are delivered into patients homes, and could even change the boundaries between the care we provide for ourselves and the care provided by the state.
Incremental innovation is perhaps more prosaic, but it's no less important to the NHS. Something like 85% of all innovation is evolutionary rather than revolutionary, so we need to ensure we are ready to pick up incremental improvements that are of proven benefit to patients.
I'd like to highlight another way of thinking about innovation that seems as important as the level of disruption it introduces into a system, and that is whether innovation is informed by a deep knowledge of customer requirements or whether (at the other extreme) it is 'a technology in search of a solution'. The Innovation Delivery Board is sponsoring the Small Business Research Initiative in the NHS. This is a form of pre-commercial procurement whereby the NHS defines its challenges and opportunities, then invites responses from companies who think they have a technology (possibly from another sector) that could help. Under the SBRI, the NHS then provides small-scale funding to allow the technology to be developed.
What I take from this scheme is the need for innovative medical technologies to meet genuine NHS need - and the best way to ensure this is the case must be early engagement with customers. This offers real benefits to both parties. The companies don't spend time and money developing products that are unlikely to be purchased by the NHS; and the NHS gets to think about what it needs, and gains an early insight into how technologies may change the way services are provided in the future. In the remote monitoring example I described above, widespread adoption of such technology would have profound implications for the NHS in terms of its staffing, its premises and its investment in IT.
Mark Wilkinson can be contacted at firstname.lastname@example.org.