12 April 2017
The House of Lords Select Committee’s report The Long-term Sustainability of the NHS and Adult Social Care recommends action to enable necessary ‘transformational change’.
This excellent report pulls no punches, and while it would have been easy to shy away from technology to focus solely on issues that warrant more political and media attention - such as funding, models of care and workforce planning - the Committee instead lamented the absence of a ‘credible strategy to encourage the uptake of innovation and technology at scale across the NHS’, seen as an essential element in NHS sustainability – as set out in the PHG Foundation’s Health Innovation Manifesto in 2015.
PHG Foundation Chairman Dr Ron Zimmern is quoted in the report as saying: "No matter what technology you look at…in the end it is about data and data sharing. To do that properly, you have to engage the citizen, you have to break down silos and you have to actively develop leaders"
Many difficulties in driving the widespread adoption of beneficial new technologies are noted in the report; the PHG Foundation evidence highlights contributory factors including fragmentation of the health system, localism and risk aversion. Localised trials (such as the NHS Test Beds) can work very well, but a subsequent failure to share learning or to create standardised national approaches results in inequitable implementation of technologies that in some cases rely on scale to provide maximal patient benefit and cost-efficacy. Similarly, these benefits cannot necessarily be demonstrated until national uptake is complete.
The recent update to the NHS England Five Year Forward View did emphasise the importance of harnessing technology and innovation, citing the Genomic Medicine Centres as an example of success along with the NHS Innovation Accelerator, Clinical Entrepreneurs Programme, Small Business Research Initiative Programme and the new Innovation and Technology Tariff intended to ‘expedite uptake and spread of innovation across the NHS’. Looking forward, the document says that the Academic Health Science Networks (AHSNs) and NHS Test Beds ‘will take collective responsibility for driving national adoption of proven innovations, in line with the Accelerated Access Review’.
Collective responsibility is difficult to achieve in practice; the AHSNs may prove better at providing incentives for individual clinicians, departments or Trusts to innovate than to share their learning and help others to implement similar approaches. As PHG Foundation Director Dr Hilary Burton has observed, consistent national implementation requires more than encouraging ‘diffusion’ but instead national strategic development such as redesigning systems and patient pathways, developing clinical guidelines and patient resources, and training health professionals. The Committee seemed similarly unconvinced, saying: ‘It is not clear who is ultimately responsible for driving innovation and ensuring consistency in the assessment and the adoption of new technological approaches’.
Another problem highlighted by the PHG Foundation and others, and noted in the report, is the lack of incentives (positive or negative) to innovate within the NHS. The report concludes that the Government should ‘make it clear that the adoption of innovation and technology, after appropriate appraisal, across the NHS is a priority’ and decide who is ultimately responsible for driving this agenda, as well as taking steps to assess how well different parts of the NHS are meeting this aim and impose ‘funding and service delivery consequences for those who repeatedly fail to engage’. That is, harness technology and innovation – or lose out to other Trusts and organisations which do.
The PHG Foundation has argued that a major barrier to the consistent uptake of innovation and the use of big data in the NHS is the ‘slow and uneven pace of digitisation’. This view was echoed by many in their evidence to the committee, which concluded that using data effectively ‘is of critical importance for the long-term sustainability of the NHS’, to make the most of spending and provide consistent levels of care.
Increasing digitisation and sharing of records was also regarded as an aid to patient engagement and improvement in outcomes. Wider public engagement was seen as a vital key to successful data collection and sharing. The shadow of the clumsily implemented care.data scheme and the resulting public backlash was acknowledged, and the report calls for NHS Digital and others to ‘engage the public effectively’ on large-scale sharing of personal data – and at the local level rather than via ‘remote national bodies’.
PHG Foundation Chairman Dr Ron Zimmern is quoted in the report as saying: “No matter what technology you look at…in the end it is about data and data sharing. To do that properly, you have to engage the citizen, you have to break down silos and you have to actively develop leaders”.
Multiple witnesses called for better leadership and management to support th e technology and innovation agenda within the NHS. NHS Digital Chief Executive Andy Williams said: ”…this is not a technology challenge; the technology largely exists and will continue to exist. Like everything, it is a people challenge, so the one thing I would point to is to get the leadership at all levels across the system“.
Dr Ron Zimmern agreed, commenting: ”…although innovation is necessary, it is not sufficient. There are huge barriers at the moment to diffusion - although we should not use that word because it is passive and, if you allow it to be passive, it will not happen. Change management is the thing”.
To address this gap, the report calls for formal integration of learning on the testing and adoption of new health technologies into ‘medical and non-medical NHS leadership, education and training at all levels’. NHS England is also charged with creating a system to financially reward organisations and leaders for improved productivity, uptake of innovation, effective use of data and adoption of new technologies.
This all amounts to a challenge from the Select Committee to the NHS to go much further with technology, despite the immense pressures on them. The question is, how will the Government respond? Will NHSE be given a mandate to do more, working with Health Education England to actively develop leaders who take risks and embrace innovation, with NHS Digital to engage the public on data sharing, and leading commissioning organisations in the implementation of prioritised health innovations to benefit patient and population health?
It would be a lot easier to hide behind the (positive, but limited) recommendations of the Accelerated Access Review and rely on the collective responsibility of AHSNs and Test Beds to diffuse innovation to the rest of the NHS. But true success, as the Lords envisage, is more likely to be achieved through a combination of bottom-up (locally driven and supported) and top-down (nationally incentivised and enabled) approaches.