We were delighted to be joined for a breakfast roundtable last week by Dr Mahiben Maruthappu, Senior Fellow to the CEO of NHS England and Founder of the NHS Innovation Accelerator (NIA) programme. The session focused on how innovation and partnership could improve access, outcomes and efficiency in the NHS.
Much discussion concentrated on the barriers to adopting innovation. Some are financial, others practical. For the NHS, innovation covers not only technologies and medicines, but also new ways of working and structures. Last month, the Chancellor confirmed plans to frontload an £8.4bn increase in the NHS budget over this parliament, with a £3.8bn real terms increase in frontline services in 2016/17. One of his conditions for extra funding is the NHS delivers £22bn efficiency savings over the same period. With an NHS trust deficit estimated at more than £2bn by the year’s end, many question the health service’s ability to afford to innovate. Yet the need to generate savings demands new ways of doing things.
WA’s health team has thought about this challenge further since our roundtable. Here are some reflections. Namely, could NHS England’s ‘new models of care’ initiative, a centrepiece to its Five-year forward view, coupled with the Government’s devolution agenda be the answer?
These programmes may cater for a longer term thinking on innovation and what it can achieve. The NHS’s ‘vanguard’ sites, piloting the seven new models of care, are incentivised to find efficiencies through scalable, outcomes-focused packages of care that aim to keep more people out of hospital. Furthermore, NHS devolution offers commissioners a prospect of multi-year funding settlements. This may create the contract flexibility, financial incentives and time for providers and commissioners alike to explore – and risk – new methods. Could these developments eventually lead local decision-makers away from short term cost-driven factors?
Yet the trend to devolution may result in further variation in access to innovative treatments and most advanced care packages. People in some areas may have access to these; others may not. This presents policymakers with risks. Hence several national programmes intended to moderate differences across the country. Whether they achieve that goal time will tell.
This week, for example, a National Innovation Partnership was announced as part of the Government’s NHS Accelerated Access Review. The Partnership seeks to “provide a clear path for innovators, based on establishing an early and ongoing dialogue” by bringing together the “bodies responsible for regulation, development and adoption of innovation.” The aim is to streamline the innovation process from development phase through to patient uptake.
Policymakers hope this will foster an increasingly collaborative approach between the NHS and industry. It is aided by the Government stating more clearly than before its support for long-term partnerships between the health service and the private sector in the Spending Review Blue Book document as a way to upgrade NHS capability and deliver required efficiencies.
Arguably the most difficult barrier to overcome is cultural. That’s all the more complex in an institution the size of the NHS. This partly explains the policy of localising healthcare. Investing in innovation to make resources go further, or prevent long-term conditions, can often be inhibited by risk aversion and acute financial pressures. Devolution, multi-year budgets, new models of care and programmes such as the NIA seek to overcome these.
The NHS has always had to strike a balance between investing in innovative technologies and other spending. Breaking the health system down into smaller parts is one policy response. But with huge efficiencies to be found and doubts that trusts will reverse their current deficits, the challenge remains a potent one.