I was recently speaking with a health entrepreneur in Israel who compared the NHS to a gorilla - 'it's big, messy and I can't work out which part is which'. The choice of metaphor notwithstanding, her description is more accurate than perhaps some people realise.
Innovation is hard. The NHS is under pressure, be it efficiency demands, financial supply, or operational performance. Add to this the common challenges healthcare innovators are facing; from system fragmentation to stakeholder navigation, complex procurement to prolonged regulation; it's hardly surprising that some may be turned off.
This combination of barriers is what causes healthcare globally to lag behind other sectors when it comes to disruptive technology. The digital revolution has transformed the way people live and work in so many ways:
• Hotels: AirBnB is a collaborative consumption platform for booking accommodation that now has more purchases than Hilton or Marriot hotels
• Travel: Uber, an app many of us use, is now available in over 50 countries, with over 1 million rides per day; broadly the same number of daily users as the NHS
• Banking: we use our mobile phones to make over 18 million banking transactions per week. Stripe, established in 2011, built the digital payment software that's used by Facebook, Twitter and ApplePay, amongst other platforms
• Dating: Tinder, a date matching app, has over 1.6 billion swipes a day, and has made over 9 billion matches
Each of these didn't exist at the start of the decade, each is based on startup technology, and each is consumer-focused. When the value of just three of these solutions are combined, it equates to almost the entire annual NHS spend. There are key lessons we can learn from these startups:
1. Speed matters: five years is enough to disrupt an entire sector
2. Fail fast, fail often: many startup technologies fail but some are revolutionary; the statistics speak for themselves. Only when we support enough innovators will we see disruptive transformation
3. Consumer driven: startups rapidly iterate based upon user expectations, we need to enable and accelerate this in healthcare through complementary system changes
Are disruptive solutions present in health?
Yes, but they have not been widely adopted.
For example, agency staff cost the health service over £3 billion a year, with a hefty sum going to the healthy wallets of agency companies. The issue is that most of them are outmoded. When I practice as a doctor, I receive sporadic text messages and phone calls, asking me whether I'm available to do a hospital temp-shift three days before it's due. Hardly an efficient consumer experience. Startups are now automating and digitalising the process, using on-demand Uber-like apps to match nurses and doctors to available staffing shifts at a fraction of the overhead. However, only a fraction of our providers are using them.
The health service cannot afford to turn off innovators with these types of solutions anymore.
There are at least six reasons why startups find the NHS challenging:
1. Limited rewards for prevention: innovations providing a means of cost-avoidance, or those preventing the onset of long-term-conditions are not always captured or reimbursed by current commissioning, stifling traction. This can be due to fragmented pools of funding, or cycles unable to reimburse innovations delivering savings in more than a year's time. Mechanisms are required that permit such benefits to be appropriately rewarded.
2. Culture and perception: amidst growing operational pressures, change and innovation are seen as nice-to-have rather than must-have. This causes innovation to be peripheral to, rather than core to delivery of efficiency savings and the means by which these are achieved. If we are to build a sustainable NHS over the next five years, this perception must change.
3. Challenging deployment of of self-care: there are numerous apps and digital platforms that enable patients to manage their own health, accompanied by robust evidence and evaluations. However, capabilities are needed to support deployment of these platforms such as the prescribing, and reimbursing of apps, if they are to be used.
4. Siloed best practice: examples of best practice when it comes to collaborating with startups are rarely celebrated or shared across the NHS, resulting in pockets of innovation, rather than nationwide quality improvement. We need to identify and spread such examples - products that are highly cost-effective, and platforms that allow for efficient procurement and adoption.
5. Firm information & technology architecture: lack of interoperability between IT systems and complex information governance varying between providers can decelerate traction. We need a fully interoperable system coupled with slick IG that enables startups, users and consumers to benefit from new technology.
6. Lack of a financial case: startups can forget that while they may have a viable product, they also need robust evaluation and the development of a watertight financial case; a proposal that speaks clearly to NHS commissioners and providers. The evaluation required for this however can require significant investment. High-potential startups need to be better supported in building their case, for their businesses, for the NHS providers who'll use them, and ultimately for patients who'll benefit.
To try to address some of these challenges, we designed the NHS Innovation Accelerator (NIA) last year. Like many ideas it was taken from another sector. Accelerators aim to support the growth and spread of technologies, in the past developing solutions such as AirBnB and Dropbox. Microsoft, IBM and MIT all have accelerators, and now we do too. Its ambition is to work with innovators to drive the spread of their innovations, identifying system barriers to be unblocked, addressing some of the abovementioned challenges head-on.
In July we launched our first cohort of 17 innovators in the programme. Their innovations ranged from apps and digital platforms, to devices and new models of care. Crucially, they had already been tried-and-tested, and had already shown to be cost-effective. A support package was designed and led by UCLPartners, the Health Foundation and the Academic Health Science Networks (AHSNs), including mentorship, funding, regional partnership, and national backing.
Although early, our 17 innovators have seen promising results:
• In just over 6 months, over 3 million patients have benefitted from NIA innovations
• 40+ deals signed
• Real rollout with over 60 NHS organisations now using our technologies
• Funding raised equivalent to over 50-times NHS England's investment
• Two fifths of innovators reporting a revenue increase up to or over 50% since starting the programme
For example, HealthUnlocked, a healthcare social network allowing patients, caregivers and health advocates to connect to others with similar conditions, has grown to more than 500 user-generated specialised communities, receiving over 4 million visits per month.
Nervecentre, a platform that digitalises patient monitoring and task management in hospitals was shown to halve the number of deaths and serious harm taking place in hospitals out-of-hours, also ranking 14th in Deloitte's fastest growing UK start-ups list. It's now being used in over 30 Trusts across England.
Joint Dementia Research, which aims to match researchers with members of the public willing to take part in studies, has recruited 15,330 people with over 4,000 now enrolled in clinical trials across 60 studies.
These swift results demonstrate that the NHS has the potential to be agile and adoptive, working with innovators to embrace disruption rather than stifle it. We must now think about how to expand beyond early adopters, and grow from a cohort of 17, to 1700 to 17,000. The real challenge will be cultural.
There is no magic bullet to innovation, but there is a tipping point. Success over the next five years will depend on stacking system levers in favour of adoption, working with innovators to develop an open platform NHS that's open for business.
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