Scaling Inquiry: rewarding innovation and establishing infrastructure

As part of the NHS Innovation and Life Sciences Commission, the Commissioners held a rich discussion on the need to reward innovation and build the infrastructure to support adoption.

Chaired by Lord James O’Shaughnessy and Professor Mike Bewick, the fourth and final inquiry session of Curia‘s NHS Innovation and Life Sciences Commission focused on improving the scaling of health innovations, bringing together the recommendations of leaders in the NHS and life sciences industry.

The first half of this inquiry session centred on establishing the necessary culture, workforce and digital infrastructure to support the scaling of health innovations. The panel for this session were:

  • Professor Ian Dodge – former National Director of Primary Care, Community Services and Strategy, NHS England
  • Dr Rowland Illing – Director & Chief Medical Officer, Amazon Web Services (AWS)
  • Charlotte Augst – former CEO, National Voices

NHS mechanisms and resources to facilitate innovation uptake

The first topic of discussion focused on the environment the NHS must establish to allow innovation uptake and scalability. Opening the session, Charlotte Augst discussed her experience working with the Accelerate Access Collaborative (AAC), noting the focus on innovation was localised within the AAC. Instead, she argued this focus and the presence of innovators should be dispersed across the NHS at every level.

Dr Rowland Illing furthered this point, highlighting this localised focus exists in health systems across the globe, and the challenge of integrating innovations from research into the real world. He noted the importance that scaling innovations has for population health and stimulating economic growth for economies. Dr Illing added incentives must align between the NHS and life science sector to scale adoptions, but also highlighted the end-user must be brought into the equation.

Professor Ian Dodge noted the importance to “distinguish innovation with adoption and wider spread” as there is a customed dependency to become focused purely on innovation, instead of reproducing innovative success elsewhere. He added local systems have entrenched behaviors to seek national answers which do not always fit local contexts. It is therefore vital to get the balance between national and local contexts correct when working to uptake innovations. Professor Dodge explained the example of Covid-19 Antivirals, arguing the NHS should move away from a quality-adjusted life year (QALY) calculation to estimating how local hospital capacity would be impacted instead.

Rebalancing funding from research to scaling

Led by Dr Keith Ridge, the next topic of discussion centred on whether the UK is correctly balancing the funding between research and development (R&D) and the scaling of innovations. Charlotte Augst noted her experience as CEO of National Voices in dealing with this challenge, noting a clear dissemination problem and

that awareness is currently below the needed level. She added that alignment between the NHS and National Institute for Health and Care Research (NIHR) has not yet been achieved to allow progress in dissemination and the prioritising of research effectively. Augst stated the need for the innovation adoption problem to be felt and understood in local health systems, which will help to push adoption higher up in priority.

Professor Dodge agreed with the need for clearer demand-signalling into what clinical research is prioritising, moving away from traditional academic research models into answering “how do you understand the nature of a hypothesis around a problem with an expected benefit that has been defined”, utilising real-time data to provide clarity. He noted the disparities between clinical research funding and the application of that research, particularly between the Government and life sciences industry, which unfortunately dwarfs adoption drivers such as the Academic Health Science Networks (AHSNs). Professor Dodge added there are difficulties in adopting models from one area for another, noting there is always opportunity costs relevant to the region which must be considered cautiously.

Regarding international comparisons, Dr Illing noted other countries are also finding adoption extremely difficult, yet the UK has good examples of centrally coordinated, national scale programmes such as Genomics England. He applauded Genomics England for their achievements in communicating with the wider bodies and ecosystem, establishing significant data access with privacy and security. Dr Illing emphasised that real-time accessibility and implementation is vital in allowing health issues to be dealt with quickly and effectively.

Dr Illing detailed his experience working in Lancashire and South Cumbria, helping to develop their Integrated Care System (ICS), providing holistic support for patients, and allowing access to patient health data at the point of need. However, he furthered Professor Dodge’s point that scaling models directly to other regions and particularly nationally is very difficult. Dr Illing also explained the incredible work he saw in India, establishing tele-medicine consultations in four states within 19 days. The clear, reproducible method the system was built allowed other states and eventually the whole country to adopt the system, which was vital during the pandemic in linking patients to clinicians. He concluded the UK can certainly learn from the repurposing of structures and systems that has been seen internationally.

NHS measures to ensure standardised evidence generation

On Professor Gillian Leng’s question on the measures necessary to ensure standardised evidence generation, Dr Illing noted there again has been great examples within the UK of ground-level data generation achieving outcomes, specifically the recovery trial during the pandemic. If the NHS could move towards a more flexible approach with a stronger data architecture, the UK could see marked improvement in adoption of innovations.

Professor Dodge added the primary focus in ensuring effective and standardised data, is “to have the data in the first instance”. He argued the Covid vaccination programme showed the feats possible in health data, providing accessible insights to both clinicians and the population. In some instances, these insights provided incentives for specific groups to get vaccinated. Professor Dodge noted that if health innovations themselves aren’t clear in what expected benefits to patients are, including specific metrics to measure success, then the NHS and wider patient population aren’t going to push for those innovations. He added to previous comments that this must go beyond using a QALY to measure, instead looking at the impact on GP appointments, bed capacity and other pressures.

Alignment between clinicians and decisionmakers to support adoption

On the fostering the alignment between clinicians and decision makers to ensure adoption, Charlotte Augst noted that funding should be contingent to “evidence that the group asking has worked with patients in

communities and understands the problem on the ground level”. It is therefore necessary to have coordination not just between clinicians and decision-makers, but also with patients within the line of communication. Augst added the importance of the inverse care law. During the pandemic, the UK saw a more diverse collection of data which provided granular insights into different groups. Such granular data is no longer apparent within primary care or secondary care.

Dr Illing furthered the importance of demand signalling on the ground level and the data architecture he referenced previously. He also explained patient engagement must develop alongside this alignment, citing examples in the U.S. and South Africa which produced citizen engagement platforms that allowed patients to access support during the pandemic. These systems also provided feedback for patients to describe their experience, which constitutes a powerful tool for governments to learn and adapt their health systems.

Professor Dodge concluded the topic in re-emphasising the importance of fixing the UK’s data generation issue, as other mechanisms will not allow adoption without adequate health data. Augst added the inequalities mechanism within the AAC doesn’t go far enough in ensuring inequalities are reduced and marginalised communities are left behind. Professor Dodge noted the importance of health equity, suggesting the formation of an organisation that focused on medicines equity and the improvement of data.

Final thought

The first hour of the Commission’s final inquiry session provided key insights to the UK’s innovation adoption problem, focusing on the NHS and infrastructure needed. The panellists emphasised the UK has the tools to become a world-leader in adoption, improving population health and reducing burden on the NHS. To ensure progress, the UK must rebalance the weighting between research and adoption and focus on achieving the alignment seen during the Covid-19 pandemic.

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