Ensuring that the NHS can make the most of new, well-evidenced technologies is a policy priority. The Test Bed programme is an initiative that tries to do just that. It brings NHS organisations and industry partners together to test combinations of digital technologies with new ways of delivering services in real-world settings, and provides funding for them to do so. The ultimate ambition is to harness the potential of these technologies to improve the delivery of health care and the sustainability of services.
The Nuffield Trust has been commissioned to evaluate Care City’s Test Bed based in north east London. This is the second wave of the Test Bed programme, which consists of three focused on diabetes, commissioned by NHS England and NHS Improvement, and four, including Care City, focused on a broader range of priorities, commissioned by the Department of Health and Social Care under the auspices of the Office for Life Sciences (OLS).
Since September last year, we have been evaluating the process that Care City has been going through to implement eight technologies in three different health and care settings. The evaluation is formative – meaning that we feed back any emerging issues to Care City as and when they arise, enabling changes to be made as the Test Bed progresses.
To date, policy initiatives to support innovation in the NHS have largely focused on the supply-side of innovation – that is they have concentrated on supporting innovators to enter the NHS more effectively. A recent example is the commitment by OLS and Innovate UK to invest up to £1.5 million to support small and medium-sized enterprises to evaluate their product in a real-world clinical setting.
As we’ve argued before, relatively little policy attention has been paid to addressing the demand-side of innovation – how and why NHS organisations adopt technologies. That includes understanding how to remove the cultural, operational, structural and regulatory barriers that can prevent NHS organisations adopting certain innovations (as Heitmueller and others have also described).
The Test Bed programme, while focusing on implementing particular innovations, provides the opportunity to offer resources and support to enable NHS organisations to adopt innovations. Most Test Beds are based within clinical organisations, or networks of them, enabling a platform for genuine co-development of new pathways and services to embed technologies – and potentially a process to support better use of innovations in the future.
Care City is a little different in that it is an independent Community Interest Company, although it can still draw on a good clinical network having been founded by North East London NHS Foundation Trust.
Testing innovations in practice
An important piece of learning for Care City from their Wave 1 experience was the importance of speaking to health care professionals and patients about how using digital technologies might work best. They found that while the innovations they were working with hardly changed at all during the project, the pathways to deploy them changed markedly – from offering an ECG (electrocardiogram) in a GP practice to making it available in community pharmacies, for example.
However, even though the Care City team recognised the benefit of co-development, the reality of a competitive bid process to enter the Wave 2 Test Bed programme made extensive early engagement very difficult. Patients and members of the health and care workforce were involved in developing the aims of the bids and selecting innovations. Senior leadership across the STP also took ownership of the bid as it developed.
But testing the combination of selected innovations then required adjustments to the wider workforce and implementation sites, who were not involved at this stage. The nature of a competitive tender process made investment of time and resource before securing the funding difficult to negotiate amid ever-present service pressures.
The consequence for Care City has been that a lot of engagement and co-development has taken place after the start of the Test Bed. This has proved difficult given the pressure to implement technologies as quickly as possible, and to report on progress.
The benefits of formative evaluation
Part of the purpose of our evaluation is to enable the best possible implementation of Care City’s vision by identifying potential problems early and offering solutions. So far we have been able to support Care City in key implementation decisions and problem-solving during the set-up phase, particularly by drawing on evidence from previous research and evaluation tools such as logic models.
It is also important that individual evaluations shed light on the constraints that all Test Beds are working under, which is part of why they were built into the programme from the beginning, alongside the open feedback loop that the NHS England and NHS Improvement programme team has with all Test Beds.
It may be that asking for less specific plans to implement specific innovations at the bid stage, and seeking a greater focus on local priority areas, would better enable genuine co-development of solutions with a much wider range of stakeholders. Of course the trade-off is that the programmes would need to run over longer time periods and reporting milestones may need to be more flexible – while still ensuring public money is well spent.
Care City is a Wave 2 Test Bed in north east London with a particular focus on using new technologies to support people with long-term conditions.
Castle-Clarke S (2019) “Funding innovation in the NHS: Early observations of a Wave 2 Test Bed”, Nuffield Trust comment.