When the Association of British Healthcare Industries asked us to look at why the NHS has struggled to make the most of medical technology innovations, it became clear that – despite the Government largely accepting the series of useful solutions proposed in the Accelerated Access Review on how to improve things – crucial issues still need to be addressed.
After we reviewed the literature, and undertook two case studies on innovations that have failed to spread, we held a seminar to bring together industry experts, Academic Health Science Networks (AHSNs), NHS procurement departments, clinicians and policy organisations. We’ve published eight key reflections from all our work in our briefing today. I’ve focused on three of those here.
Evidence needs to be generated and applied differently
There will always be a trade-off between adopting new innovations that have had little use in the real world and waiting for the development of a robust evidence base. The Accelerated Access Pathway, which will support generating real-world evidence, may help this issue to some extent. However, much of the problem isn’t about a lack of evidence or whether the evidence stands up to scrutiny: it’s about how different people perceive that evidence.
While the National Institute for Health Research continues to give priority to funding randomised control trials (RCTs), RCT results are likely to be the evidence that clinicians and academics want to see. “Evidence is part of the NHS culture. Anything new is viewed with suspicion,” said one of those we spoke to.
Finding ways for innovations to be tested in the real world may not be enough if there isn’t a willingness to look at different types of evidence and an understanding of how to interpret evidence that hasn’t come from an RCT.
It’s unclear whose job it is
One of the biggest barriers to NHS organisations taking up new innovations is that it isn’t really part of anyone’s day job. Until it’s actively built into job descriptions, it’s unlikely to become business as usual.
This problem was clearly highlighted by the different opinions we heard on the role that NHS chief executives should have in innovation decisions. Where innovations do not affect patient pathways or wider service delivery, some felt that they do not need to be involved.
“I don’t think it’s necessary for companies to see chief execs directly to get their product adopted,” said Tara Donnelly of South London AHSN. “More commonly the support comes from medical directors, clinical directors, chief clinical information officers and operational managers.”
But when those innovations mean significant service transformation in order to save money (such as having a procedure performed by a day clinic nurse than by a hospital consultant), leaders overseeing the whole system often need to be involved.
Some we spoke to felt that if chief executives were not committed to a culture of innovation and rewarding innovative behaviours, they wouldn’t succeed. “If it's not the chief exec’s responsibility, it isn’t going to happen,” one told us.
The system gets in the way
Cultural factors are often cited as reasons why innovations are not adopted, and they are undoubtedly important. But barriers imposed by the system are just as important as cultural factors. Some of the issues we heard include:
- a lack of clinician time to identify pressing problems or innovative solutions (and the lack of incentive to make time)
- judging the success of procurement departments on their ability to produce short-term cash-releasing savings in the decisions they take
- the fact that the tariff does not keep up with new innovations.
Long-term transformational projects, funded accordingly, are where real efficiency opportunities are to be found. For them to be successful, all of these barriers need to be removed. And we need to move away from a focus on cost to a focus on value for the system.
The Government has committed to most of the proposed solutions on how to improve matters, but has sadly not fully financed them. It is worth noting that, unlike the private sector, the NHS spends a tiny amount on innovation dissemination compared to research and development.
So far, policy change has had limited success in breaking down national and local barriers – both cultural and systemic. In making the most of innovation, bodies like AHSNs and the innovation national networks – which will connect AHSNs with clinical and national policy leads – will need to play a significant role in helping the NHS identify its problems, find helpful solutions and implement them successfully.
Castle-Clarke S (2017) "Struggling to keep up: technological innovations and the NHS", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/struggling-to-keep-up-technological-innovations-and-the-nhs