Seventy years after its creation the NHS is considered by many to be one of the wonders of the world. It serves over one million patients every 36 hours, employs more people than the Indian Army and still manages to provide healthcare free at the point of delivery to every resident of the UK. Viewed from the US, where I'm currently setting up an outpost of the digital health company I founded, this is nothing short of miraculous.
Yet the very qualities that make the NHS a global leading light also make the UK a challenging place to innovate in healthcare. A single-payer system enshrines values of public benefit, but constrains the opportunities and incentives for startups to be commissioned. Procurement processes are opaque and ponderous, favouring established suppliers with the right knowledge and sufficient resources. Plus, thanks to decades of political and press scrutiny the culture of the NHS often values risk-avoidance above all else, renewing the vast majority of contracts each year with expensive-but-safe suppliers, especially in technology services.
All this amounts to a hostile environment for innovators. Without a clear route to sustainable revenue investors are wary of betting their money on UK health startups, and the risk is that ambitious would-be healthcare entrepreneurs look to other industries to build businesses.
But all is far from lost. In fact, I believe we are at a turning point - the moment the NHS is presented with golden opportunity to become the world-leader in digital health. Thanks to near ubiquity of mobile technology the public can now self-refer to digital health solutions via their phones without requiring any of their GP's precious (and expensive) time. Evidence-based apps can streamline clinicians' workloads, reducing administrative burden and freeing up time for the patient. No organisation worldwide is better placed to take advantage of these trends, or has a stronger imperative to do so thanks to budgetary pressures, and there are heartening signs that the powers that be are ready to shoot for that opportunity.
For the NHS to succeed in this quest it needs to harness the qualities that make it great and steer clear of its greatest weaknesses. It relies as much upon what the NHS chooses not to do as the things it does. Here are three things I believe the NHS could do to effectively promote a thriving digital health ecosystem, whilst saving money and improving quality care.
1. App endorsement
The NHS is the most trusted organisation in the UK. This makes the NHS brand a powerful tool in encouraging a broad base of the British public to engage with digital healthcare. By bestowing an "NHS approved" badge on apps that meet the very highest standards of clinical effectiveness and safety, this stands to accelerate adoption of digital medicine. But great care must be taken to ensure the trust of the public is upheld. Endorsement cannot be left to the "wisdom of the crowd" - it must be based on published clinical evidence and the highest standards of safety and data security. By enforcing high standards the NHS badge will set a global gold standard for digital health innovators to reach for, and promote a culture of responsible innovation in healthcare.
2. A centralised Pioneer Fund
But endorsement without reimbursement won't work. In order to kickstart healthcare innovation in the UK, the NHS has to commit to paying for digital solutions, and in a way that is easy for innovators with minimal knowledge of procurement processes to apply for. One way of doing this is to create a centralised "pioneer fund" dedicated to commissioning initial rollouts of new digital innovations the NHS could achieve this - a single, clear "way in" for startups, that generates in-practice case studies to give local commissioners confidence and avoids any postcode lottery in offering access to new digital solutions. Of course, any commissioned services must represent good value for the taxpayer, and as a bonus such a fund would allow new, accountable reimbursement models to be pioneered - for example, with fees only payable by the NHS when clinical outcomes are achieved, as tracked by wearable devices.
3. Matchmaking across domains
The biggest leaps forward in any field are often made by outsiders. But in healthcare the stakes are high, and problems complex. So it's critical that digital innovators are paired up with clinicians, academic networks and patients themselves, to create effective solutions to real problems. The NHS is uniquely placed to do this - and is already making a start with its pioneering Innovation Accelerator, of which I'm a proud member.
The NHS was formed amid the challenges of post-war Britain. Now, with immense cost pressure looming, now is the time for a second health revolution. The NHS has a chance to embrace the emerging wave of digital solutions with a spirit of bold experimentation, and in the process establish the UK as a global leader in the next generation of healthcare. The NHS Innovation Accelerator suggests things are moving in the right direction. Now the challenge is for all of us - innovators, academics, commissioners and clinicians - to build on this to create a new golden age of healthcare.
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