Why is it so hard to introduce digital solutions and services into the NHS?
"Why won't the CCGs, Trusts or AHSNs take up my game-changing solution? It was co-designed with my stakeholders and patients, it has demonstrated clear value and benefit, it has trial data supporting it, and has backing from senior opinion leaders. They just don't seem to get it, despite some great meetings, we keep missing each other in translation."
This is probably the most common complaint from validated healthcare businesses, big and small, but the answer is simpler than it seems. Assuming you have a credible solution, it isn't a matter of commissioners not wanting to take things up. It's about a lack of deep knowledge, capacity and capability that means commissioners simply cant filter out what is good or bad from the thousands of case studies and hundreds of solutions available in the limited time they have to deliver an end-to-end clinical pathway.
For this specialist knowledge they may have to rely on the input of local specialist providers or temporarily hire one in to a support role, but even specialists in niche areas will struggle to keep tabs on every innovation and trial in their space in the UK, let alone beyond.
While we are all out to do the right thing by patients there are significant conflicting interests between providers and commissioners. It is a problem which is politically, financially and clinically sensitive and probably the most common cause of derailment of innovations that make it into a Clinical Commissioning Group’s (CCG) business case. Here is how that can play out:
Consider the rollout of a proven innovation which is a digital patient platform that supports self-management and costs around £30,000 per CCG; the CCGs really like it and are seriously consider paying for it. The platform targets a variety of patient cohorts including some not targeted by current services and has been shown to significantly reduce admissions in those target patient groups.
The funding of such innovations by the CCG most commonly comes from diversion of funds from the budget of the existing provider of the service. Putting this in context, this innovation would threaten to take that £30,000 from the future, say, £300,000 budget of the current local service provider inevitably limiting already stretched resources. The provider pushes back and not only dismisses the credibility of the innovation, but insists its introduction will seriously disrupt the core service offering of the current service contract. The CCG decides to go with investing in "more of the same" services with the incumbent provider rather than innovating by introducing the new product to the pathway.
The dichotomy in interests of providers and commissioners combined with the role of the provider in the decision making process can easily derail discussion on CCG investment decisions. Most often this happens not because providers have an aversion to innovation or prevention, but because the financial implication of adoption of innovations often conflicts with their current business model.
In such cases my recommendation would be to collaborate with a provider on proposal of a blended service offering rather than to go direct to the CCG as first point of call.
Finally, when it comes to the 15 Academic Health Science Networks (AHSNs), the answer is much simpler. These organisations have relatively short-term agendas that are defined by their stakeholders and partners (effectively the commissioners, providers and Universities of their local health economy) and are reviewed annually. It is important to understand what clinical areas each AHSN is covering, and the project timeframes, so that your solution can support delivering on an articulated current or future need of the AHSN in a timely way. Approaching AHSNs cold without this being your initial objective (i.e. expecting the AHSN to sell your product on your behalf and/or to introduce you to procurement and commissioners), will often result in low receptiveness.
Overall there are a number of other key reasons for the low uptake of innovation, some of these you can read in the attached article on Respiratory Futures. Thank you and if you would like to have a conversation about co-design, stakeholder mapping, market entry strategy or any other area mentioned here please contact me at guy@jpmed.co.uk
Dr Guy Gross has an MBBS from Nottingham, an MBA from LBS, and has worked as a corporate innovator, consultant, institutional investor and entrepreneur across a number of industries
As Innovation Delivery Lead at the AHSN for NW London he led several pieces of work across long-term conditions, took several companies successfully into the NHS in London, and remains an evangelist of digital enablement and support of wellbeing both as a speaker and through contributions to DigitalHealth.London.
He now helps businesses understand the "unknown unknowns" in the NHS and supports them to overcome these hurdles. For further information contact Guy@JPmed.co.uk
Enterprise Architect
8yvery interesting perspective (and a possible solution) on why innovative Healthcare solutions can be difficult to adopt even when the benefits are crystal clear - I won't be surprised if other industries face similar challenges...
George, since Microsoft stopped giving free licences/upgrades to the NHS they have difficulty operating on one or several versions of windows. The thought of digital is a dream for them.
I was at a seminar recently where evidence was presented that evidence based clinical practice was said to take around 30+ years to become mainstream. Technology can assist this but many commissioning processes support/restrict change and encourage maintenance of the status quo. Novel practice often risks being reimbursed at a lower tariff, despite potentially costing more in the short term.
Founder at PharmAdvisor
8yIt seems to me that the first thing to do would be to streamline and clarify the process for identifying needs, evaluating applications and giving developers, big and small, a low cost and understandable pathway to the market place. Such a process should clarify the issues such as SCCI and aim to support innovators rather than deter them. Experience tells me that funding routes such Innovate UK and AHSN calls are entirely skewed to serendipity and the issue ‘du jour’. We must avoid front loading the innovation milieu with so much gravity that no one takes the next step. Failed or disappointing exercises such as the National Programme for IT, Connecting for Health and care.data suggest that there is a problem entrusting innovation to the NHS. Identifying needs such as remote out of hospital care, personal health management, medication errors – clearly computationally achievable - have failed to be addressed and account for a significant impact on safety and cost. But innovators can provide solutions. Aviation has become safer because of the analysis of failure and a culture of innovation. Health should be no less protected. Solutions that directly address problems should not ignored because of short term budget considerations or lack of technical understanding. One can envisage a trade group that is dedicated to those involved in health technology innovation (not just mHealth or apps) that could voice the essence of Guy’s concern (and mine for that matter) and help build the bridges between the exuberance of innovators and the constraints of a system that is still largely dependent on Windows XP.
Founder of Medical Intelligency
8yHad the same push back for over 24 years. In 1992 I invented an intelligent system for prescribers using clinical codes (Read version 2) in Electronic Health Records which for existing and proposed prescription drugs alerts them to contraindindications (diseases including renal and liver, pregnancy and breast feeding) , side effects, indications, ingredient/ingredient interactions in the record to prevent the majority of prescribing errors. I have now sold this but no one is using the intelligent systems except for interactions. Such is life.