How can a fragmented NHS embrace the innovation it needs to survive?

Working with the NHS is like doing business with a shoal of fish, each with differing structures, interests and demands. This complexity makes it difficult to deliver the innovation projects the service so desperately needs.

Innovation, whether delivered through pioneering new therapies or digital health approaches to care, is often hailed as the saviour of our over-stretched, under resourced healthcare systems.

But as anyone working in the sector will know, having a visionary initiative isn’t always enough to ensure adoption. And variations in funding models, skillsets and priorities present a huge barrier to roll-out across the wider NHS ecosystem.

That’s why research by RAND Europe and the University of Manchester, on behalf of the National Institute for Health Research (NIHR) Policy Research Programme, has called on policymakers to provide a less fragmented environment for innovators to work within.

“Innovation offers opportunities to help respond to the challenges the NHS faces and to support high-quality, efficient and effective healthcare,” said Innovating for Improved Healthcare: Policy and Practice for a Thriving NHS.

“However, both policymakers and wider stakeholders often lack appropriate information and data to inform policy and practice, and the development, commissioning and use of innovations remains patchy... Some proven innovations swiftly spread while others get limited traction.”

Centralising knowledge 

The report found that there was a need to “align policy design with implementation and success criteria” across several areas, including skills and leadership, patient and public involvement, and accountability.

Some of the publication’s recommendations focus on ensuring innovators have what they need to be able to work in partnership with the NHS in a meaningful way.

One suggestion, for example, is the creation of a national framework and infrastructure for overseeing and coordinating data, information and the evidence individual projects generate.

“Current sources of information and types of evidence about specific health innovations and opportunities to engage with innovation initiatives in the health system are multiple and diverse, but they are also fragmented, and the communication and targeting of such information could be improved,” said the authors.

“Private sector and clinical entrepreneurs need information on health system demand – innovation needs, push and pull funding schemes, points of contact for support on legal and intellectual property issues, adoption discussions and commercial negotiations, and institutions that can help broker networks.”

Currently, most of this information can be drawn from a number of disparate sources, ranging from institutional websites, such as NICE and NHS England, and quality improvement networks, to conferences, trade shows and journals.

But a framework that focused on “shared learning” could substantially improve the information and evidence environment, benefiting everyone.

Said the report: “A system focused on learning could provide a shared data and evidence platform for disseminating information and exchanging knowledge to identify successful innovations, provide evaluations of innovations to support embedded knowledge in the system, and prevent reinvention of the wheel for each innovation.”

Clearer funding and commissioning pathways

The study also said that a clearer, more aligned funding and commissioning landscape could support innovation across the healthcare system.

“Funding for health innovation comes from multiple sources at the national, regional and local levels,” it said.

“Although some diversity helps to promote a competitive innovation landscape, the current system is too fragmented. As a result, funding efforts are often unable to achieve the critical mass required to support innovations across the pathway.”

Historically, funding schemes have concentrated on the development, rather than the adoption and diffusion, phase of innovation.

The need for a more balanced approach has been recognised recently, leading to schemes such as the Innovation and Technology Tariff, the Innovation and Technology Payment, and the NHS Innovation Accelerator programme, the report explained, adding that this was a step in the right direction.

“We have seen a greater focus recently on coordinated funding, but there is more to be done,” it went on.

“A key risk in the current environment is that each funding mechanism addresses a specific need, but does not affect the wider innovation system, or potentially weakens that system by confusing decision makers and distracting from strategic goals.”

A “whole-systems approach” to the innovation funding portfolio would help achieve scale and ensure promising innovations progressed, said the authors.

They added that policy makers also needed to “raise awareness and provide clarity to stakeholders about available funding schemes and how funding schemes are related”.

Ending siloes, accelerating change

The authors concluded that the NHS’ innovation ecosystem had been substantially strengthened in recent years – but more needs to be done before innovators have the environment they need to flourish.

“Policymaking has a crucial role to play in realising a vision for a health system where innovating contributes to the quality and efficiency of delivering care and to improved patient outcomes,” said the authors, adding that policy makers “neither make nor spread innovation”.

“A balanced and ‘hybrid’ model of governance and leadership for innovating in the health system – which supports both top-down and bottom-up actions – is already emerging, and the possibility of a truly innovative health and care system is achievable.”