UK NHS: Evaluating Innovation, Health and Wealth

Will the UK learn from past efforts to champion innovation in the NHS? Leela Barham assesses the Phase 1 evaluation of its Innovation, Health and Wealth initiative. 

Innovation remains a buzzword in the UK. Much is debated about innovation but it’s clear everyone wants more of it, and faster too. Accelerating access to innovative technology is the focus of the ongoing Accelerated Access Review (AAR). This review was set up in November 2014 and is due to report later this year. The government has committed to implementing the recommendations that the AAR makes, so industry is closely watching the progress and trying - with many others - to influence those final recommendations.

Learning from the past

The AAR is not the only time that Government and everyone else with an interest has tried to get the National Health Service (NHS) to take up innovation. Back in 2011, Innovation, Health and Wealth tried to take a strategic look at innovation too. It set up Academic Health Science Networks (AHSNs), which are currently earmarked for taking up one of the AAR’s most concrete proposals, a new Innovation Partnership. This would be at the national level and link a network of Innovation Exchanges. The AHSNs would facilitate these exchanges.

Now, some five years on, the final report of the Phase 1 stage of evaluating IHW is due out this week. (Worth noting that the evaluation only started in October 2014… Cynical maybe, but was that to limit the real potential to influence policy?) The evaluation is a joint effort between the University of Manchester and RAND Europe. Based on a Freedom of Information response from the Department of Health, together they will paid £1.4million for the full evaluation. RAND Europe were also part of a collaborative who have supported the AAR, producing Insights on earlier adoption of medical innovations, published back in July 2015.  

Support for the ambitions of IHW

The evaluation draws on interviews (with 37 people) and an online survey (with 179 respondents) to get a feel for what stakeholders think. They found that people support the ambitions of IHW. Then again, who wouldn’t when they included eight core themes covering:

•       Reducing variation and strengthening compliance with National Institute for Health and Care (NICE) guidance;

•       Improving innovation uptake;

•       Metrics and the accessibility of evidence and information about new ideas;

•       Establishing a more systematic delivery mechanism for diffusion and collaboration within the NHS;

•       Aligning incentives and investment to reward and encourage innovation and improving procurement;

•       Encouraging a change in culture within the NHS and embedding innovation into training and education for both managers and clinicians;

•       Strengthening leadership for innovation throughout the NHS and increasing local accountability; and

•       Identifying and mandating the adoption of high impact innovations in the NHS.

Hard to assess progress….

Ambitions need to translate into action if the potential of innovation is to be realised. The evaluation points out that “it’s proved difficult to conclusively assess the progress made given that the IHW’s commitment to actions, its implementation guidance and the expected outcomes were not clearly articulated.” The evaluators suggest that there is a need not only for better communication, but for new frameworks and metrics.

…but disappointing?

Although the word disappointing isn’t used by the evaluators, it’s perhaps not a stretch to use it. They instead talk about challenges and concerns and a lack of awareness. They also point out that even some positives reported by those they spoke to – such as improvements in compliance with NICE guidance – were not believed to be due to IHW. However, the evaluators conclude that “the IHW strategy may nonetheless have been important as a symbol of the shift towards innovation in the NHS.”

More to learn?

The evaluation still has over a year to run, with the evaluation due to end in December 2018. That will coincide with the last 18 months of re-negotiating the Pharmaceutical Price Regulation Scheme (PPRS) – a voluntary agreement between industry and Government on pricing of branded medicines. Over time the PPRS has increasingly taken on policy issues relating to access to innovative new medicines, so there may be lessons to apply there. But it will also mean that the full evaluation will be over a year too late to inform the AAR, which will likely trump IHW with a new set of actions. Maybe the Department of Health needs to shift the focus of the evaluation and instead ask the evaluators to focus on evaluating the actions that will come out of the AAR?

Leela Barham is an independent health economist and policy expert. You can access her website here and contact her at leels@btinternet.com