Last month MATRIX panellist Dr. Robert Grundy attended the NHS Health and Care Innovation Expo 2016 in order to understand drivers of innovation in the English NHS and learn more about different initiatives and approaches to innovation that could be applied to the Life and Health Sciences sector in Northern Ireland.
The NHS runs this event as an annual conference aimed at showcasing, promoting and facilitating innovation across the service. This year, Health and Care Innovation Expo focused on the biggest health and care issues and developments relevant to the continued implementation of the NHS Five Year Forward View.
Across two main speaker stages, four feature zones, and over 100 workshops in the unique pop-up university, the expo explored the most important aspects of health and care work across England.
The varied exhibition, dedicated learning sessions and satellite events ensured people with particular specialties, experience and interests could drill down further to gain detailed insights and practical support.
What follows is an account of the highlights with as many as the relevant resources provided as possible. Details of the Expo can be found at https://www.england.nhs.uk/expo/
Overall Impression
The Expo was very well attended with 6,000 attendees registered. Many areas of innovation were covered including technology, process and practice. The main feature zones where divided between New Care Models – focussing on local care delivery; NHS RightCare – focussing on the improvement of population health and outcomes; Digital Health – a major focus of the expo as digital technology continues to transform all aspect of NHA operations; and Personalised Medicine – a showcase for all aspects of PM including prediction and prevention of disease, more precise diagnosis, targeted and personalised interventions and increasing the role of patients in participation of their own diagnosis and treatment.
There was a significant emphasis on the role of digital technologies at the expo with many exhibiting companies showcasing ECR technologies, GP patient management tools, patient pathway platforms etc. The Expo included a key note address by Health Secretary, Jeremey Hunt who outlined several new initiatives including 12 Global Exemplar Hospitals each receiving £10m (to be matched) who are tasked with achieving a global standard of IT and digital excellence in healthcare delivery. Mr Hunt also outlined a series of NHS digital academies to be set up in and hosted by a selected number of Universities in England.
Of particular interest to the objectives of MATRIX was a quote from Sir Bruce Keogh, Medical Director for NHS England, in his opening address who asserted that ‘one of the main challenges for the NHS is to act as a driver for economic growth’.
Test Beds
The first wave of seven Test Beds were announced by NHS Chief Executive Simon Stevens at the World Economic Forum in Davos, Switzerland, on Friday 22 January 2016.
Frontline health and care workers in seven areas are intended to pioneer and evaluate the use of novel combinations of interconnected devices such as wearable monitors, data analysis and ways of working which will help patients stay well and monitor their conditions themselves at home.
Successful innovations will then be available for other parts of the country to adopt and adapt to the particular needs of their local populations.
There are five NHS Test Beds:
- Care city innovation https://www.england.nhs.uk/ourwork/innovation/test-beds/care-city-innovation-test-bed/ – which will promote healthy ageing across a million-strong population in North East London.
- Long term conditions early intervention programme https://www.england.nhs.uk/ourwork/innovation/test-beds/ltc-prog/ – which will see the NHS in Heywood, Middleton and Rochdale working with Verily (formerly Google Life Sciences), MSD (a trade name of Merck & Co., Inc., with headquarters in Kenilworth, NJ, USA), Health E Research and the Greater Manchester Academic Health Science Network to help healthcare professionals better identify and support patients at risk of long term conditions using the most advanced new predictive techniques.
- Lancashire and Cumbria Innovation Alliance (LCIA) test bed https://www.england.nhs.uk/ourwork/innovation/test-beds/innovation-alliance/ – which will see the NHS, including two New Care Model Vanguard sites, partner with Philips and a number of SMEs and social enterprises to support the frail elderly and people with long term conditions to remain well outside of hospital and avoid unnecessary admissions.
- PErfect Patient PAthway (PEPPA) test bed https://www.england.nhs.uk/ourwork/innovation/test-beds/peppa/ – aims to create the ‘perfect patient pathway’ to bring substantial benefits for patients in the Sheffield City Region suffering from long term conditions, such as diabetes, mental health problems, respiratory disease, hypertension and other chronic conditions.
- RAIDPlus integrated mental health urgent care test bed https://www.england.nhs.uk/ourwork/innovation/test-beds/raidplus/ – which will see Birmingham and Solihull Mental Health NHS Foundation Trust partner with Accenture, West Midlands Academic Health Science Network, Birmingham Community Healthcare NHS Trust, Joint Commissioning Team, The Strategy unit hosted by Midlands and Lancashire Commissioning Support Unit, West Midlands Ambulance Service and West Midlands Police to offer more proactive support for people at risk of mental health crisis.
There are two Internet of Things (IoT) Test Beds:
- Diabetes digital coach https://www.england.nhs.uk/ourwork/innovation/test-beds/diabetes-digital-coach/ – a project led by the West of England AHSN in partnership with Diabetes UK and technology companies including Hewlett Packard.
- Technology Integrated Health Management (TIHM) https://www.england.nhs.uk/ourwork/innovation/test-beds/tihm/ – a collaboration between Surrey and Borders Partnership NHS Foundation Trust and an array of health technology providers which will help people with dementia to live in their own homes for longer.
The test bed process is managed by four main constituents: NHS England, Innovate UK, the Academic Health Science Networks (AHSNs) and the local trusts. On talking to the test bed managers and operatives they seemed to be governed by a high level board including representation from all constituencies and executed by project managers recruited from the local trusts.
On talking to the companies involved in the various test bed consortia they found the application process generally easy to deal with and the concept very important as it provided them with a doorway into the NHS, a valued but sometimes hard to interact with customer. Even large corporations such as Philips saw real value in the concept appreciating the access the test bed process gave them to the NHS and the short, 2 year, tightly defined projects which allowed them to demonstrate value in a relatively short time frame. Some frustration was felt by participating companies on the speed at which the individual test beds were able to recruit patients into the studies.
Design in Health Care
A very thought provoking session was held by the Healthcare Innovation Exchange (HELIX) http://www.helixcentre.com/ titled ‘how can design transform healthcare?’
This interactive session demonstrated how improvement breakthroughs can occur when people-centred design and scientific rigour collide. Real life examples where shares where HELIX’s work has improved patient care such as impact upon a campaign to improve bowel cancer awareness: http://www.helixcentre.com/projects/improving-compliance-with-the-bowel-cancer-screening-programme/ , asthma management in children http://www.helixcentre.com/projects/helping-young-children-manage-their-asthma/ and awareness of end of life care provision http://www.helixcentre.com/projects/end-of-life-care/ .
Given the power of design thinking in industrial and commercial process, where emphasis is put on existing challenges and customer needs when developing technology and innovation – very much loading the chances of ultimate success – the availability of such a resource should not be overlooked by healthcare innovators in Northern Ireland. The Helix centre staff and management, who are based at St Mary’s Hospital, London, were keen to get involved in any initiatives in NI healthcare and should be considered open to collaboration.
AHSNs
The AHSNs are 15 Academic Health Science Networks (AHSNs) across England, established by NHS England in 2013 to spread innovation at pace and scale – improving health and generating economic growth. Each AHSN works across a distinct geography serving a different population in each region.
The AHSNs connect NHS and academic organisations, local authorities, the third sector and industry, and exist as catalysts that create the conditions to facilitate change across whole health and social care economies, with a clear focus on improving outcomes for patients. They claim to be uniquely placed to identify and spread health innovation at pace and scale; driving the adoption and spread of innovative ideas and technologies across large populations. This Innovation Pathway summarised in the attached diagram demonstrates how AHSNs support the entire innovation life cycle.
The AHSNs where very strongly represented with a significant stand presence showcasing more than 30 examples of SMEs that had been successful in leveraging commercial relationships with the NHS through collaboration with the AHSNs. The CEO of the North Eastern and North Cumbria AHSN, Dr Seamus O’Neill delivered a summary of the AHSN innovation pathway and showcased some positive examples where companies had benefitted from collaborating. Dr O’Neill, originally from Northern Ireland, was very keen to share his experience of the AHSN model with interested parties from NI and as such we should consider availing of this offer via an invitation to have him visit NI and have him address the relevant stakeholders and discuss the model as a driver for innovation and economic growth.
Health Economics
In an age where all spend by providers of health and social care has come under intense scrutiny the ability to draw upon Health Economic analysis when assessing the impact of innovation has become vital. Exhibiting at Expo was the York Health Economic Consortium http://www.yhec.co.uk/ , a University of York based unit of national excellence dedicated to providing analysis of the economic benefits of health innovation. A very useful discussion was had with the YHEC senior management about the prospect of any endeavours to drive innovation in NI availing of the expertise at YHEC. Stakeholders and constituents should therefore seriously consider initiating a conversation with this unit to explore where mutual value can be achieved.
The importance of Health Economics was further underlined in a presentation by Janssen’s (J&J’s) UK Head of Health Economics Jennifer Lee who eloquently described the contrasting mechanisms of health innovation reimbursement across Europe and Canada. This very much underlined the need for healthcare innovators to consider a robust health economic analysis of the impact of their innovations when seeking market access.
NIHR – Industry
As the research arm of the NHS, the National Institutes for Health Research (NIHR) partner with industry to drive and support the healthcare innovation and technology that will benefit patients now and in the future. The NIHR hosted a session where examples of recent partnerships where presented that have led to innovation in the NHS. Particular emphasis was placed on:
- providing access to, and collaborating with, industry advances the global competitiveness of the clinical research infrastructure in the NHS.
- funding the R&D of novel technologies, devices and interventions supports their clinical efficacy and safety for clinical trials and prototypes.
Of particular interest was the i4i translational funding scheme http://www.nihr.ac.uk/funding/invention-for-innovation.htm . i4i supports collaborative research and development projects that have demonstrated proof-of-principle and have a clear pathway towards adoption and commercialisation. The expected output is an advanced or clinically validated prototype medical device, technology or intervention. The aim is to de-risk projects and make them attractive to follow-on funders and investors. This grant funding scheme had apportioned £64m of non-dilutive funds to health innovators over the past 6 years in many cases allowing them the opportunity to leverage many millions more in equity investment.
Medicines Optimisation
Germane to an acknowledged strength in NI was a session on integration of medicines optimisation tools into NHS practice. This session focused on how Medicines Optimisation is being embedded in the NHS RightCare approach. The session focussed on the interactive use of exemplar data sets where prevalence, co-morbidities, patient parameters, prescribing patterns and elective spend impacted on mortality in a given indication from region to region. This showcased how primary care practices can benefit from this type of data analysis to identify and adopt best practice in a given area.
Mention was also made of the Systemic Anti-Cancer Treatment data base (SACT) http://www.chemodataset.nhs.uk/home. The SACT dataset collects information reported routinely by NHS trusts on the treatment of malignant disease in secondary care in England. This database relates to all cancer patients, both adult and paediatric, in acute inpatient, day-case and outpatient settings and delivery in the community. It covers systemic anti-cancer treatment for all solid and haematological malignancies, including patients in clinical trials. Practitioners reported this as an extremely useful resource in developing medicines optimisation strategies in the oncology area.
Concluding Remarks
Although only a snapshot of the many subjects discussed it is hoped that this visit report reflects that the NHS Health and Care Innovation Expo was a very impressive showcase of the innovative work ongoing across all aspects of the NHS in England. The Expo is an excellent opportunity to observe new approaches to shared health and social care problems and make connections with collaborators, key opinion leader and senior NHS managers.