23 March 2016
A new report from RAND Europe, commissioned by the Department of Health and the Wellcome Trust, examines the feasibility and practicality of certain recommendations made by the interim report of the Accelerated Access Review (AAR).
In fact, Galvanising the NHS to adopt innovation examines just one of the five main proposals from the AAR, concerning measures to incentivise the NHS to ‘adopt new products and systems quickly and effectively’ via active partnerships.
Specifically, the project investigates the feasibility of implementation by Academic Health Science Networks (AHSNs) for three specific propositions:
It was produced in partnership with NHS England, and was produced on the basis of ‘limited consultation with key stakeholders’ – said to include AHSNs, teaching hospitals, primary care organisations, commissioners and academics. This reportedly took the form of a document review, a workshop with the chief executives and commercial directors of AHSNs, and 23 interviews with senior NHS staff from three different regions of the country. Details are provided in a separate appendix to the report.
The report says that this proposal was generally welcomed, although concerns were expressed about how much of the money would get through to helping frontline clinicians treating patients, and how it could deliver on a large enough scale; on e canny respondent observed: “the funds will be spread too thinly, or it will go to the usual suspects”.
It was agreed that good governance would be needed for such a fund, with payments linked to delivery of patient benefits and / or cost savings. Many were said to support the view that AHSNs had a key role in supporting adoption and diffusion of innovations and should lead the fund – which is perhaps not surprising, given that AHSNs leaders made up a good proportion of those consulted. However, others felt that AHSNs lacked essential expertise in NHS system redesign.
Respondents were confident that clinical leadership was essential for the implementation of innovations within the NHS, and that support for such leadership was needed such as professional recognition of or reimbursement for time spent in this way.
Opinions were divided about the value of existing ‘innovation champions’ espoused by AHSNs (these being ‘star clinicians/academics’ ) or of ‘innovation scout’ networks. Some emphasised the need for more varied and general system leadership and appropriate governance processes; clinical pathways and leadership were noted to differ widely between different disease areas and innovative technologies.
Respondents were generally opposed to the proposal that a single organisation could lead regional adoption of innovation. Rather, championing innovation was suggested to necessitate not just AHSNs and specialist clinicians but also the involvement of primary care, nurses and clinical commissioning groups (CCGs). The latter were thought to have an important role in ensuring a balance between the needs and benefits of targeted patient groups and the wider population. Collaboration was strongly emphasised as needed to ensure widespread uptake and avoid what was said to be a ‘not invented here’ culture in the NHS.
The report authors note that their assessment was necessarily limited by the ‘relatively focused nature of this work’ but propose three conclusions:
The first two of these conclusions seem to conflict with views expressed by non-AHSN stakeholders consulted.
The inherent limitations of AHSNs in diffusion of innovation
The PHG Foundation response to the AAR interim report called for the need to distinguish between the development and testing of innovative products and service pathways by specialist clinicians, and the implementation of innovative products and services across the health service by all front-line health professionals. It was proposed that AHSNs were crucial centres of innovation, but fundamentally unsuited to lead NHS-wide adoption and diffusion of these innovations, especially those that were not commercial products such as therapeutics.
We would therefore reiterate the need for dedicated funding to be made available and governed independently of the AHSNs, both for the national collaborative development work needed to support widespread NHS implementation of innovations, and for the support of individual health professionals to engage in such efforts. Professional recognition and incentivisation (in the form of funded time away from clinical duties) would be good ways to do this, allowing many individual clinicians to engage in ‘diffusion’ work to make innovations more widely available to patients within their own specialty, rather than selecting just a few to be specialist innovation champions.
The framing of the report so firmly around the existing structures of academic health science centres and networks calls into question how open the consultation on interim proposals really was. Building on existing strengths is generally a sound approach, but in this particular instance the complexities of the situation mean that AHSNs should lead on nurturing and trialling healthcare innovations, but not on national deployment.
Rather, dedicated funding and support should be made available for the coordinated and collaborative national-level redesign of NHS processes and pathways, for the development of commissioning and clinical guidelines, and for health professional education. This will ensure that the transformative innovations pioneered in AHSNs and specialist centres and for which appropriate evidence of patient and / or economic benefits is available can be made swiftly available to all NHS patients who can benefit from them - not just those lucky enough to be referred to specialist clinician researchers.