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.