The NHS has a strong history of pioneering health innovations, but has traditionally been better at developing them than adopting them. To address these challenges, Sir Hugh Taylor, former permanent secretary at the UK Department of Health, is leading the “Accelerated Access Review.” The review team recently released its interim report. It puts forward five propositions for improving current pathways for the development, assessment, and adoption of innovative medicines and medical technology in the NHS.
The UK Department of Health and Wellcome Trust asked the not-for-profit research institute RAND Europe to work with NHS England to conduct a short consultation in December 2015 and January 2016 with key stakeholders, about the practicality of the proposed recommendations in the interim report – under the heading “Galvanising the NHS.”
This took the form of a workshop with directors of Academic Health Science Networks across England, (the 15 AHSNs were set up by NHS England in 2013 to spread innovation, improve health and generate economic growth), and 23 interviews with senior NHS staff in three regions (South West, University College London Partners, and North East, North Cumbria).
The interim report’s recommendations were intentionally designed to tease out the issues and interpretations important to healthcare providers and stakeholders in the wider healthcare community. The aim was to understand potential factors that could help or hinder the successful implementation of each recommendation.
While acknowledging the limited scope of the study, RAND Europe suggested two achievable and workable high-level approaches to help innovation take place within the NHS. These focused on mobilising people, and systems within the health service.
The people element looked at mobilising the influence of clinical leaders to champion change and encourage secondary care organisations to take on “innovation champion” roles linked to financial incentives and a new emphasis on accountable care organisations.
The systems approach focused on a new earmarked fund to encourage AHSNs and other clinical networks to redesign systems to embrace innovation.
Our findings showed that innovation leadership is considered a double-edged sword. Clinical leaders can play different types of roles in the innovation process, whether acting as innovation scouts for new ideas and opportunities, or “innovation champions” to lead particular projects. However, their impact could be limited unless the NHS further develops appropriate systems to ensure that innovation competencies and capabilities are in place – for both individuals and organisations, and ensures a critical mass of connected innovation leaders.
A collaborative approach was recommended to improve the chances of successful leadership of innovation. Obtaining the widest possible buy-in for the uptake of innovation pilots would ensure that projects are replicated and taken up by others within the NHS. Such collaboration and coordination could avoid some challenges from the beginning and overcome issues that could emerge when innovation disrupts existing process and practice.
Academic Health Science Networks
AHSNs and other clinical networks were identified as important institutions to drive innovation and incorporate it into existing and new infrastructures and systems.
These institutions could assume oversight and coordination roles, reduce administrative demands on the NHS and support innovation projects by bringing relevant representatives of providers, clinicians, commissioners, industry, academia and patient-representative bodies to work together to support innovation. Stakeholders generally also trusted AHSNs to play a leading role in channelling innovation funding provided that they are appropriately resourced, have clear governance structures in place for managing dedicated innovation funding, and can ensure appropriate relationships with commissioning groups.
Overall, those working in the NHS said that innovation needs to be given the time and resources to become embedded in day-to-day activities and considered as a core strand of clinical career development. Development of skills and understanding of how to successfully implement innovation would be needed. Also additional incentives and accountabilities would likely be needed to support individuals, organisations, and the system more generally, as previous RAND Europe research has highlighted.
The insights from this report, as well as other issues critical to an innovation-friendly NHS, are being explored further in a two-year embedded evaluation of innovation in the NHS, currently underway and conducted by RAND Europe and the University of Manchester. The work is evaluating how key drivers of innovation work in practice across the nation, as well as in different regional health economies. The study is also exploring the impacts of innovation on the NHS, including the role of innovation in contributing to value for money and high quality care.
Such research will ultimately enable better understanding of how national policies can support regional success, and how regional policies and practice can shape national policies and strengthen the implementation of innovation. The end goal is an NHS that is increasingly adopting high-value innovations to deliver a more effective and efficient service to patients and an improved standard of care.
Sonja Marjanovic is a research leader for RAND Europe and Stuart Parris is a RAND Europe Associate.