Innovation in Health and Care - Pritesh Mistry

What is the NHS for?

Pritesh Mistry -

What is the NHS for? At first glance, it’s a question with such an obvious answer it’s not worth even asking. Surely the NHS is about treating and preventing illness. But scratch beneath the surface, and it turns out the answer to this question is evolving. The NHS is actively preventing and treating illness, but is also an anchor for entire communities by being a large employer.

And now, with the government’s new Life Sciences Sector plan, the NHS is being asked to contribute to the economic growth of the country. The Life Sciences sector plan has three pillars, one is “Driving Health Innovation and NHS Reform” which places the NHS clearly as part of the UK’s growth agenda.

The Big Push: Three Headline Actions

  • Health Data Research Service (HDRS): Funded through £600 million from the Government and Wellcome Trust, the plan is to build an AI-ready health data platform that fuses genomic, diagnostic, and clinical data.

The timeline is: a new Chair and CEO will be in post at HDRS by end of 2025; the first minimum viable product launches, with iterative data inclusion planned by end 2026 and HDRS becomes a single gateway to comprehensive, linked datasets by 2030.

Making this work will require legal reforms for the secondary uses of de-identified data, (eg research, service development, planning, and assessment) as well as an overhaul of data access approvals and information governance. The intention is that the national and regional systems will be more active in determining who gets access to data and for what purposes. To say national data sharing initiatives in the NHS have a bumpy history would be quite an understatement! But, there are standout local projects where clinicians and communities are working together to build trust, unlock data, and make responsible sharing of data a reality.

  • Clinical Trials: both research and clinical trials elevate care quality, create career paths generate revenue, and speed up patient access to innovation. Unfortunately the NHS isn’t keeping pace with other countries and is losing its edge as a clinical trial destination. The target is to have less than 150 Days to set up clinical trials and have more clinical trials in the NHS.

The approach is to standardise contracts for speed and roll out monthly Trust-level reporting on trial performance.

The gap? Primary care. The NIHR has long championed research in general practice developing the evidence base as well as real tech and tools. Unfortunately it seems as though primary care trials are currently out of scope. As healthcare shifts from hospital to community, building trial capacity with GPs and in community settings is both a pressing need and a major opportunity. This should and could link with the governments interest in wearables and the NHS App to develop decentralised clinical trials capabilities.

  • Create Low-Friction Procurement and use NHS procurement to drive innovation: The NHS is not a single procurement machine so for innovators it can feel glacial and repetitive to roll out a new technology or tool.

The solution is the “Innovator Passport” which is intended to be one evaluation with all the necessary components, accepted everywhere and no repeated evaluations.

The snag? This model implicitly assumes trust across providers in the processes and standards. It also assumes there is little variation between providers. Both are quite a leap in today’s fragmented system. For simple tools, it might work. For anything complex, expect only a modest reduction in duplication. And as for how effective it will be for primary care, the jury’s out.

In addition to the dream of low friction procurement there is another anticipated change in how the NHS will buy technologies and tools in future. The medicines and supply chain procurement process will need to factor in growth not just value for money. It’s not clear what that means but could be a consideration of how procurement supports job growth and local economy and business.

Radical Devolution: The Regional Health Zone Experiment

Perhaps the boldest idea on the table is radical devolution or what is being designating “Regional Health Zones” (as an aside there are a number of these geographically constrained regional initiatives all with different labels and it’s unclear how each one differs!). These Regional Health Zones are intended to be trailblazer areas for innovation, system redesign, and procurement reform. The plan anticipates 2–3 pilot zones that are able to build cross cutting partnerships such as: ICBs, providers, mayors, Health Innovation Networks, NIHR infrastructure, and industry to experiment, test, and generate evidence for complex interventions. The freedom means new commissioning models, redesigned care pathways, and procurement of innovative technologies.

The NHS: Anchor, Engine, and Innovator

The NHS has been given an expanded role: helping to power the life sciences sector one of the UK’s “big eight” sectors identified for driving economic growth. To get there the government has identified action on clinical trials, introducing new rules for data, and a proactive approach to buying, adopting and spreading innovation. This is all on top of reducing the waiting lists and tackling the three big shifts: hospital to community, sickness to prevention, and analogue to digital.

This new role for the NHS is laid out as part of the Life Sciences Sector Plan which differs from the NHS 10-Year Plan by having hard metrics, clear milestones, and named leaders responsible for delivering on these milestones.

The NHS’s remit is widening again. The next chapter is about preventing illness, saving lives and doing more to power up the UK’s economic engine as well.