Breaking down the barriers

Despite the Governments recent Accelerated Access Review – barriers to adoption of new technology in the NHS is still stifling medical innovation. We need a mind-set change says Dr Anne Blackwood.

For many onlookers, curing cancer is one of medical research’s holy grails – a top-level goal that has been in the crosshairs for decades and will likely remain there for many years to come.

Alongside budgetary responsibility and other operational issues, such lofty goals must be remembered by those shaping our health services and their research arms, and prioritised through the sensible encouragement of innovation.

Sadly, it is a relatively widely-accepted fact that the NHS is slow to adopt new innovation. Its suppliers are forced to battle against a fragmented marketplace that lacks a clear route to market, budget silos that impact buyers’ ability to realise savings directly, and a short-term focus on cash-releasing savings at the expense of longer-term benefits.

Displaying an awareness of these issues, the Government’s Accelerated Access Review, published in October 2016, assessed the barriers medical technology innovators must overcome to speed up adoption of innovative new drugs, devices, diagnostics and digital products in the NHS. However, the Review may not have gone far enough in dealing with these complex issues.

It named a number of tactics to tackle these challenges, including a newly planned Accelerated Access Pathway (AAP) to prioritise strategically important innovations, a new Innovation and Technology Payment (ITP) to reimburse providers for a small number of selected innovations and more funding for Academic Health Science Networks (AHSNs) to enhance local routes to market. These bodies and systems will ideally help researchers and innovators to actually get their ideas to market.

Bottoms up

These proposals may help to solve some of the current barriers to market, but issues remain. How will the small number of innovations on the AAP or ITP be selected? Picking a handful of winners from across the healthcare technology spectrum is more easily said than done – just ask venture capitalists how frequently they get it right. Meanwhile, what will be the fate of all the other potentially life-changing technology?

Might it be better to work with clinicians in identifying unmet needs and then to co-produce solutions with industry and researchers? This will represent innovation from the bottom up, rather than top-down intervention. In some ways, this is what the SBRI Healthcare programme, funded by NHS England, aims to achieve. Led by the AHSNs, SBRI Healthcare works with local clinical networks to identify needs and then funds technology companies to develop solutions.

Since it started in 2009 this programme has dispersed funding of £73m to innovative technology companies to develop solutions for unmet needs and now has a pipeline independently valued at over £1bn. Solutions now on the market include MyCOPD, a digital tool to help patients with chronic obstructive pulmonary disease (COPD) better self-manage their condition through health app, My mHealth, and the Patient Status Engine, a continuous wireless patient monitoring platform from digital healthcare business Isansys.

Investment in needs-driven solutions and procurement levers are an important factor in driving adoption of healthcare technology. In isolation, however these will not solve the problem when there is little slack in the system to effect change management. New devices, diagnostics and digital health platforms often require service redesign and retraining of staff before they can be implemented.

Providing the time, skills and additional resource required to redesign services and care pathways to accommodate new technology is just as important as getting the structures right. Getting this correct can result in creating innovative products that can truly benefit patients and healthcare staff, such as Ablatus Therapeutics, a medical device company that is developing a novel tissue ablation technology to treat the most challenging and often inoperable, solid cancer tumours. Ablatus started with two clinicians from the Norfolk and Norwich University Hospital who identified an unmet clinical need and developed a solution that has now been taken on by the company.

Similarly, Owlstone Medical’s Breath Biopsy technology could potentially save the NHS millions of pounds by diagnosing patients earlier, with its breathalyser-style test. These companies have been helped to market their inventions by non-traditional funding and research structures and provide examples of how medical technology can offer a chance for great thinking to work towards curing and treating cancer. Moreover, they show the value of being able to move quickly, which in the case of illnesses such as cancer could be literally life-saving.

More haste and more speed

It is worth remembering that clinicians can get paid time away from clinical duties, in addition to being given access to mentors and other networking opportunities, through the National Clinical Entrepreneurs programme led by Professor Tony Young, National Clinical Lead for Innovation, NHS England.

The NHS spends over £1bn on research and development through the NIHR but only a fraction of that on adoption and diffusion of good ideas. The Clinical Entrepreneurs programme is a good step in the direction of supporting front-line staff, who are best placed to identify unmet needs within healthcare, and to work with technology and business experts to co-develop solutions.

Understanding the health economics of the new pathway is equally important, especially early on in the product development process. Healthcare innovators need more support to generate pragmatic cost-benefit analyses of new technology which rely more on real world evidence than that generated through randomised control trials (RCTs).

More standardisation of the clinical trials approval process would also help, speeding up the generation of real world evidence needed to support adoption. This sort of efficiency is key to achieving the long-term goal of cures for different forms of cancer, and furthermore the actual eradication of the disease once cures are created.

The Accelerated Access Review contains some important recommendations and levers that will support accelerated access to new devices, diagnostics and digital technologies for patients. In implementing these ideas we should also think about the people, culture and technologies required to truly make a difference.

One policy framework can have a major impact, but it is arguable that a shift in the mind-set of our healthcare systems is also required. Adopting an approach that prioritises and rewards innovation and that respects the importance of new solutions will be integral to our efforts to research the cures we need.