An ailing NHS needs an injection of innovation to survive. PharmaTimes speaks to the bright thinkers helping to transform the UK's health service
If there's one figure that could convince anyone of the need for disruptive change in the NHS, it is the £22 billion funding gap faced by health Trusts over the next five years. While more money is almost certainly needed, eyes are increasingly turning to innovation and technology to stop the NHS being pulled into the black hole in its finances.
"Over the past year there were 23 million attendances at A&E, a million more than the previous year and a significant increase in pressure," says Mahiben Maruthappu, senior Fellow and advisor to the CEO of NHS England, Simon Stevens. "It's time to innovate for several different reasons and the NHS is coming to realise that this is the only way forward."
However, integrating innovation into the NHS is no easy task, says Amanda Begley, director of innovation and implementation at academic health science partnership, UCLPartners. "There is a culture around risk-aversion where people find it very difficult to stick their heads above the parapet. That culture isn't due to bad people, it's a reflection of a system; the way people are paid, the way they're performance-managed and the way they're regulated."
There are fantastic people in the NHS, she says, but they are "caught in the whirlwind" of the day job. "They are being asked to make £22 billion savings while also dealing with increasing demand, so it is understandably very difficult to make the space to think about how to do things differently."
Begley is also co-founder of the NHS Innovation Accelerator (NIA), which was established in 2015 to introduce and support new innovations in the NHS and is delivered through a partnership between NHS England and the Academic Health Sciences Networks nationally. It is currently supporting 17 Fellows, each of whom has developed an innovative technology or service aimed at improving patient care and putting the NHS on a more financially sustainable footing. Fellows receive help through funding, networking, and learning and development programmes.
"The focus is on mature, evidence-based innovation," says Begley. "Any innovation must have already been used in a health system and be ready to scale-up across the NHS."
Maruthappu, who co-founded the NIA, adds: "Innovation is not something that is just 'nice to have', it's a must-have. It's something that everyone in the NHS needs to be thinking about in the same way as they think about quality improvement, research and teaching. It needs to be a key principle.
"I'm hoping that through this programme and other initiatives, we will deliver that cultural change. It's only when staff are really enthusiastic and passionate that we'll see doors opening to innovation. Not only will people try to innovate themselves, they'll be more open to the adoption and utilisation of these life-changing innovations."
Priority #1: Prevention
Innovation can help the NHS achieve three of the key priorities outlined in the Five Year Forward View – prevention, better integration and efficiency – says Maruthappu. "With prevention, we want to stop people from becoming unwell or developing preventable long-term conditions like type 2 diabetes by enrolling them on evidence-based, lifestyle-modification programmes, allowing them to engage better in self-care," he says. "Technology is a phenomenal way of doing that; we can see how other industries have used technology to revolutionise previously face-to-face processes, such as with online banking or travel booking. We think there's a similar movement in healthcare that we can take advantage of."
Brush DJ – a free app developed by NIA Fellow and NHS dentist Ben Underwood – is an example of how innovative technology can help with prevention. The app plays two minutes of music to motivate toothbrushing for an effective length of time. Brush DJ, which has already been downloaded in 193 countries on to 1/4 million devices, also gives evidence-based information and prompts to help users improve and maintain their oral health.
Brush DJ had simple origins, says Underwood. "Every year In England - 26,000 children aged between 5 and 9 undergoing a traumatic and expensive general anaesthetic to remove decayed teeth. Tooth decay is a completely preventable disease. The cause of tooth decay and the self-care tasks everyone needs to do to prevent it are known; the challenge is ensuring children, parents and carers are aware of this evidence-based information and are motivated to carry it out – at least twice a day".
The idea came from dental school, where he and his fellow students were told to encourage their patients to listen to two minutes of music, but the practicalities were an issue in the 90s, he says. "People were not going to take a stereo into the bathroom back then but now we have the technology to access and listen to millions of songs on a device you've already got in your pocket."
Underwood says he applied to the NIA partly for the funding but mainly to get Brush DJ distributed through the NHS and help more people, especially children. "It's very difficult to find funding for something aimed at prevention – people want an innovation with an immediate effect," he says. "Firefighting is where the money tends to go in the NHS – treating rather than preventing, although with the NIA programme the tide is turning."
Yet, Brush DJ is completely free. "The vast majority of the population have a mobile device and that cuts across socio-economic and cultural boundaries. It seems like a no-brainer to get the NHS to adopt the app but that's what the whole NIA programme is about; working out why the NHS doesn't adopt things that are no-brainers"
Priority #2: Integration
The second priority from the Five Year Forward View, better integration, involves blending two services, for example, primary and specialist care, mental and physical health, or health and social care.
"Innovation will play an instrumental role here, be it point-of-care diagnostics that allow GPs to conduct more tests in primary care services without referral to specialist care, or electronic medical records and data platforms that span primary and specialist services," says Maruthappu. "These innovations will allow a better flow of information between two health areas that will be critical as we try to achieve better integrated care."
Another NIA Fellow, Lloyd Humphreys, is vice-president of business development at Patients Know Best (PKB), a software platform that gives patients access to their electronic medical records and allows them to show the records to any health professional they want.
"This approach overcomes a lot of the problems healthcare providers currently face in terms of sharing a patient's information across different organisations or geographies," he says. "A few years ago, we were seeing a lot of government policies that talked about patient ownership and patient interaction even though we had been doing it for many years."
Because of this, PKB joined the Accelerator programme to raise awareness. "Awareness is often a challenge because innovation usually happens in rabbit holes where innovators focus on creating their solution, making it work and then getting people to use them," says Humphreys. "They don't open up to the wider world and many tend to be fairly isolated so other organisations don't know what they're doing, they don't realise that solutions already exist and that they're successful."
Another challenge is cultural change, he says. "Patient ownership of information is a relatively new phenomenon, yet it now permeates every policy from the Forward View to Personalised Health and Care 2020. We wanted to look at how to shift culture from a patriarchal model of healthcare delivery – doctor says, patient does – to a collaborative approach. For us, it was important to have the NIA programme behind us to say the cultural shift not only should happen, it needs to happen."
Priority #3: Efficiency
Efficiency is perhaps the most important of the Forward View's priorities where innovation will have a role, says Maruthappu. "To plug the funding gap we can't just have gradual, incremental changes in parts of the NHS, it's going to require disruptive thinking, new models of care and innovations that allow us to provide the same quality of care – or better – for lower costs."
One example of efficiency innovation is clinical collaboration tool Nervecentre, which was created by Paul Volkaerts five years ago after he noticed a gap in how hospitals communicate.
"There are only two ways to call a doctor in a hospital today," he says. "You can put out the cardiac arrest call, which brings everyone running, or you can send out a beep, which brings no one running. There's nothing in between the extremes, but what do you do if you're a nurse who wants a doctor because a patient's temperature is a little high or they've run out of painkillers?"
With the Nervecentre approach, healthcare professionals are given mobile devices with software that understands who everybody is in the hospital. "All a nurse needs do is use his or her phone to list what the patient needs and the system knows which doctor to contact. It adds the task to the doctor's work list, the doctor's phone buzzes, and then when they have finished whatever they're doing they know where they need to go next," says Volkaerts.
The technology has already been adopted in over 30 Trusts and studies show that Nervecentre can reduce the time doctors and nurses spend in the backroom by 60 percent, giving them more time to spend with patients.
Volkaerts hopes that the future will see greater integration of similar innovations within the NHS. "There has to be an IT culture in the NHS where all systems work together and the onus is on everyone to make that happen. It has to be equal as well; we can't have a situation where a hospital can only deploy an innovation if it happens to be compatible with its electronic patient records.
"All of the NIA innovations are saving lives in some way, shape or form, whether they are IT or devices or models of care. They're all making the service much better. And the challenge for IT really is to create a architecture that allows these things to co-exist. We are very willing and able to integrate, but integration is not a one-sided story. It requires all parties to come to the table and agree to work in that way."
Looking aheadThe pharma industry has a role in improving innovation in the NHS, says Maruthappu. "Innovations are most powerful when combined – for example, a new therapeutic with a video consultation platform or a monitoring device that a patient can wear. Pharma is a key partner in deploying and designing innovations that will improve the health system. We need to work together to identify solutions to the challenges facing the health service as well as to work with start-ups and SMEs that are often extremely innovative." The opportunities for the NHS are countless, so it's no surprise that the NIA has big goals for the future. "We need to think about how we go from 17 Fellows to 1700, to perhaps 17,000. The NHS has huge scope for innovation, it's got a great track record, but with major changes like the genomics revolution, data/digital revolution and wearables, there are unprecedented opportunities for us to embrace a new class of innovation and change the face of medicine."