You may characterise the NHS as many things, but I’d wager that being bold and having the ability to surprise is not one of them. Yet here we are, with another unexpected development in the world of Digital Health that is further evidence that the NHS is finally going to walk the walk, and not just talk endlessly about innovation.
I’m referring to last week’s announcement of an Innovation & Technology Tariff. Up until now, MedTech innovations had a rather convoluted and indistinct path to the patient’s bedside, with great variability between regions and no single, clear method of getting there. Even where technology has been demonstrated to benefit patients, scaling it has been frustratingly tough. At times it appeared that the NHS was actually acting against innovation, with perverse financial incentives not to change.
Simon Stevens, Chief Executive of the NHS England, presented the first details about the new tariff to the audience of the Annual NHS Confederation meeting on Friday 17th June. Details are slightly thin on the ground at present, but the basics are as follows: from April 2017, innovations that have been approved can be purchased in bulk by the NHS to drive down the cost. There will also be guaranteed reimbursement for when innovation is used.
The initial selection of approved innovations will be taken from the 2015 NHS Innovation Accelerator Programme (which featured sleep CBT platform Sleepio, smartphone ECG Alivecor, and respiratory disease management app MyCOPD). The panel will also consider developments from the national Test Beds & commissioning through evaluation programmes. Over the coming weeks I expect we’ll have more detail provided, but for now the clear message is that the NHS is dismantling one of the final barriers to change.
The mysterious new tariff became one of the talking points at the Digital Health panel at the 8th annual Future of Wireless festival. I was invited to talk about my ‘coal face’ experience of innovation in primary care, alongside Francis White (@francisww – AliveCor), Shamus Husheer (@susheer – Heartfelt Technologies), and Steve Feast (@drstevefeast – MD Eastern Academic Health & Science Network). Chaired by Nick Hunn (@nickhunn – WiFore), it was an honest and fascinating view of developing and implementing MedTech innovation in the NHS and across the world. Turns out the NHS is not quite the technological backwater we all thought it was, with markets across the planet providing their own unique challenges.
Getting set up for #digitalhealth panel at #FWIC16 #theta360 – Spherical Image – RICOH THETA
In my talk I described my own journey of discovery, from finding out about Alivecor at an innovation event in Scotland hosted by the Digital Health & Care Institute (@dhiscotland), through to testing it on myself and my patients, to finding a local specialist champion and working with him and my CCG to find the funds, and finally distributing the devices to the practices of Eastbourne Hailsham & Seaford, and Hastings & Rother. And then….nothing. Uptake of the use of the device has been slow, even in the face of good local evidence of benefit. Why is that?
It seems that just providing the device and having enthusiastic supporters is not quite enough. Alivecor is very much one of the stars of the current crop of approved innovations, but to embed it into routine practice requires many more steps – the development of a clear protocol for use by clinicians, implementing processes by which the data are reviewed and actioned, and the finding additional hardware and support resource. I’ve found all of this out at the coal face, and Alivecor have been great in working with me and sharing the knowledge to their user base. Partnering with front-line users is key.
Will the new tariff fix this? In short, it’s too early to tell, and while I’m enormously encouraged by the development, it’s clear from my experience thus far that just paying for progress is not enough. The old issues of change management are still there, and speaking from a primary care perspective, the enormous workload burden means that any innovations have to be implemented with the minimum extra investment of time and effort, whilst at the same time improving care quality AND reducing workload. No small feat.
Yet I am optimistic. I’ve seen the incredible passion for invention and delivering world-class healthcare in the NHS from patients, clinical & non-clinical staff, management, and the host of SMEs and startups basing themselves in the UK. We have the finest academics on the planet. In my own area, the East Sussex Better Together programme is bringing health and social care together to radically transform our ability to work jointly on the problems faced by local people. The new tariff might open up new possibilities here too.
There is a lot of talk about ‘Unicorn’ organisations in business – those companies that achieve a magical ‘ $1 Billion’ valuation. I’d like to reclaim the term and apply it to my NHS. It is a rare and mythical beast, with magic where it counts: a comprehensive healthcare system, provided free at the point of delivery based on need, not ability to pay. With some of the last barriers to a 21st century upgrade being removed, there’s no limit to what we can do.
You can read more at about the Innovation & Technology Tariff at
If you’re interested in finding out more about the National Innovation Accelerator Programme (and you should be), you can read more here. The deadline for application to the 2016 cohort is 1st August, 2016.
Declaration of interests: I was invited to speak by WiFore Wireless Consulting. I received no fee for my attendance at the event, and self funded all expenses.