From “prizes” to “exchanges”, “Expos” to “scorecards” and everything in between, national innovation initiatives have always been at the forefront of the health service transformation agenda. But who and what really drives innovation? And how can the health service ensure that new solutions are adopted in a way that truly transforms the NHS and brings benefits to patients across the board?
These were some of the questions that we explored when we were joined by Dr Mahiben Maruthappu, Senior Fellow to the Chief Executive of NHS England and Founder of the NHS Innovation Accelerator programme, for a breakfast roundtable with senior business leaders to discuss innovation and the NHS.
Much of the discussion focused around the ‘how to’ of maximising opportunities for innovation. Mahiben’s insights reaffirmed NHS England’s commitment to driving service change through the Five Year Forward View and making it easier for the NHS to adopt innovative ideas that are being propelled through the Innovation Accelerator. For example, to help drive the adoption of these ideas, from April 2017 the national tariff system will be extended to cover new med tech innovations that have been shown to be cost-saving or to help patients with supported self-management.
As the conversation turned to the barriers for innovation, one conclusion that emerged from the discussion was that arguably the hardest challenges to overcome are local pressures and internal cultural issues. It is clear that there is no shortage of cutting-edge interventions and breakthrough technologies but uptake and spread of these ideas is often inhibited by risk aversion and acute financial pressures at a local level. As one attendee said, “everyone’s too focused on keeping the lights on”.
Following the breakfast, I was left with the strong sense that when thinking about innovation in healthcare, local context matters just as much as national policy. Indeed, the recent swathe of headlines on temporary closures of A&E departments and rationing of treatments remind us that it is the local decision-makers who decide how and to whom they deliver care within the available resources. The 2012 Health Social Care Act ensured that.
While Richmond and Skipton House may set out the innovation policy and incentives, these must be aligned with local frontline practice if we are to see innovation spread beyond the small pockets of best practice. Arguably policy-makers have sought to achieve this through an agenda of devolution, multi-year plans and place-based care delivery and much hope is being pinned on the NHS Sustainability and Transformation plans as a vehicle for local service innovation. We’ll have to wait and see whether STPs survive their submission later this month to truly deliver transformed services (the press are already seizing on the plans as vehicles for secretive cuts) but we can expect the trend towards localised decision making to continue.
Theresa May dampened any hopes over the weekend for a cash injection for the NHS in the Autumn statement. One thing’s for sure though: if and how the NHS innovates in order to achieve sustainability within the current spending envelope will play out very differentially in different geographical areas. For those offering innovative products, methods and technologies understanding local decision-making patterns and context will be more crucial than ever.
When it comes to innovation, it’s still about location location location.