NHS0022

 

Written evidence submitted by The Health Tech Alliance

 

About The Health Tech Alliance

 

  1. The Health Tech Alliance is a coalition of health technology companies and stakeholder bodies from across the NHS and wider health system. This focus on partnership is integral to The Health Tech Alliance’s overarching objective of industry and the NHS working collaboratively to ensure that vital health tech innovation reaches patients. The Health Tech Alliance is chaired by Dame Barbara Hakin, the former Deputy Chief Executive of NHSE and works with our membership and the wider health system to engage with key stakeholders and ensure regular communication across the entire health system.
  2. To contact The Health Tech Alliance, please email the Secretariat: secretariat@healthtechalliance.uk

 

Introduction

 

  1. The Health Tech Alliance welcome this Call for Evidence into managing the NHS backlogs and waiting times. Our member’s independent sector and industry insight allow us to share a unique perspective on how DHSC and NHSE are delivering on their recovery plans.
  2. The NHS is at a crossroads, facing record-high backlogs, unprecedent staff vacancies and a difficult economic situation. Members of The Health Tech Alliance are committed to work with the system to support them in tackling this health crisis.
  3. It is undeniable that Covid-19 shone the spotlight on the important role of HealthTech during the pandemic. The Health Tech Alliance therefore welcomed the national recovery plan, its acknowledgement of HealthTech and the important role it should continue to play in tackling the record-high backlog.
  4. The Health Tech Alliance are responding to this Call for Evidence as there are steps to be taken by both NHSE and DHSC in delivering on their pledge to use technology to free up capacity and reduce the backlog. Our members are extremely keen to share with the system the life-changing solutions technology offers, however continue to be help back. This response emphasies that a better use and uptake of innovation goes hand-in-hand with delivering more effective and efficient patient recovery.
  5. This response explores four key areas, addressing the barriers in the uptake of innovation, the importance of flexibility for patients in waiting lists, the decrease in R&D funding and the current pressure on finances within industry.
  6. The Health Tech Alliance works closely with vital innovation advocates including NICE, NIHR, AHSNs and the Accelerated Access Collaborative (AAC). The Health Tech Alliance urges both NHSE and DHSC to continue working with The Health Tech Alliance and industry, understanding the specific health areas and the concerns they have regarding the uptake of innovation across the system, as outlined below.

 

 

 

 

 

 

1.      Remove the barriers in the uptake of innovation

 

The innovative technologies our members produce are life-changing for patients. From providing orthopaedic support through to storing patient data, technology has never been so crucial in delivering a high standard of patient care and reducing the backlog during this health crisis. However, it seems there continue to be major barriers across the NHS in the uptake of this crucial technology. Currently NHS Improvement estimates that it takes an average of 17 years for a new product or device to go from successful clinical trial stage to mainstream adoption.[1] Although The Health Tech Alliance welcomes the presence of vital innovation accelerators such as bodies including the Accelerated Access Collaborative, significant barriers continue to restrict the ability of our members to deliver important technology to the front line. A key barrier for these crucial innovations is the speed of the pathway to adoption. According to research conducted by BMJ Open Medical Research on timings of Technology Appraisal, the average time for Single Technology Appraisals (STA) sits at 48 weeks versus Multiple Technology Appraisals with a median duration of 74 weeks.[2] Given the rapid pace of technological change across the UK, this slow pace in the uptake of innovation is concerning. The Health Tech Alliance acknowledges that NICE are continuing to improve the pathway over time, however this barrier remains, holding back vital technologies from reaching patients and targeting the elective backlog.

 

When discussing the guidance process with membership, Boston Scientific, a global medical technology company focusing on oncology, venous and arterial disease, addressed their recent STA regarding interventional oncology. Their new intervention was approved by NICE in April 2021, having waited over a year, and by NHSE’s regulation, gave the service only three months to implement the technology. However, due to the slow speed of innovation uptake across the NHS, these crucial phase one centres have only just been implemented, as of Summer 2022, with little communication over timelines for the next phase 2 centres. These NHS implemented timelines are setting unrealistic timeframes for themselves, inevitably leading to delays. To mitigate this, NHSE must be more realistic with industry on the speed of the technology’s implementation. This example is one of many from our membership where the speed of the pathway to adoption is holding back technologies reaching the frontline, and implementing the recovery plan. The Health Tech Alliance understand that technology adoption often requires a change in pathway, which can take time. However industry would like to work with both DHSC and NHSE to find effective solutions to adopt technology safely, but in a more efficient way without disruption to the frontline.

 

Alongside delays within the evaluation process, members have shared concerns on the role played by differing and disjointed ICS sytem, where national priorities differ to local realities. Although the recovery plan acknowledges the use of innovation for freeing up capacity, in practice navigating the new ICS system is extremely difficult for our membership. As each ICS differs in their priorities for HealthTech and innovation, members are having to engage with several layers of decision-makers on an ICS-by-ICS basis. This takes significant time and resources, with companies developing different strategies and approaches when engaging with providers- fuelling this delay in the mainstream adoption of needed technology. To improve this, NHSE should better their demand signalling, signposting which ICSs need this vital technology, reducing the amount of time between member’s approach and its adoption. In bettering demand signalling the system will be able to target the postcode, indicating to industry which ICSs need more crucial technology, in turn helping to reduce the prevalent health inequalities. Additionally, national leadership across NHSE and DHSC should consider a more joined-up approach for the uptake of innovation, removing this case-by-case basis and driving forward in its commitment to HealthTech. Communication at both a local and national level with industry is essential. Our members feel current engagement is very ad-hoc with vasts room for improvement. For the recovery plan to be implemented effectively, frequent dialogue with industry around these barriers to innovation, and where the innovation is really needed, are extremely important.

 

To transform patients outcomes crucial HealthTech must be harnessed. Access to effective data, digital infrastructure and diagnostic tools provide ICSs with opportunities of reducing repeat appointments and driving earlier hospital discharge, all reducing the record-high backlog. With these benefits in mind, The Health Tech Alliance urges both NHSE and DHSC to reconsider the evaluation time and time taken to adopt HealthTech into the NHS. By increasing communication and demand signalling with industry across the national and local level, the recovery plan can be delivered more efficiently.

2.      Right treatment at right time

 

According to the most recent NHSE performance figures, patients waiting for elective care has reached 7.07 million, 60% larger than before the pandemic.[3] With predictions that the backlog may exceed 10 million by 2024, headlines of these record-breaking wait times are becoming daily across the UK. The role that HealthTech plays in tackling this ongoing health crisis is essential. In particular, our member, AposHealth, provides an innovative treatment that helps patients with knee, lower, back and hip pain live well. Their product can delay the rate of surgery by 75%, in some cases reducing the need for surgery all together. This in turn frees up vital resource and capacity for trauma and orthopaedic surgeons, as well as ensuring early discharge for patients. For innovations such as these to play a part in tackling the waiting lists, the Health Tech Alliance urge DHSC and NHSE to consider whether patient surgery is always the best, and right route. The case study from AposHealth is one many shared by our members highlighting that often patients waiting for elective care prodecures do not always need surgery. By making this distinction, and considering prescribing these innovative technologies to patients that don’t need surgery, this frees up capacity within the waiting list for those high priority patients to access the essential surgery needed. In turn this not only accelerates patient time spent for life-threatening procedures, but reduces the overall backlog. With the ongoing workforce crisis and a predicted seven million additional people looking for healthcare, using innovative technology has never been so crucial to freeing up capacity.[4] For the recovery plan to be implemented effectively both DHSC and NHSE should be distinguishing between the needs for surgery for patients.

 

3.      Addressing the decrease in R&D funding

 

According to the IPPR’s recent report on the state of life sciences and R&D in the UK, currently the UK’s R&D investment of 2.4% of GDP sits significantly behind that of the average for other OECD nations, making it 6th amongst G7 nations.[5] Although The Health Tech Alliance welcomes ongoing support for vital R&D funding, particularly the recent announcement to increase funding to £20bn by 2024-25, this investment is not sufficient to support the development of new technologies within the current economic context. Equally, for NHSE and DHSC to successfully and effectively implement their recovery plans, alongside “use technology more effectively”, addressing this decreasing support of R&D funding is essential. The Health Tech Alliance recognises that although R&D is not specifically mentioned within the elective recovery plan, our members believe that it plays a crucial role in paving the way for the development of life-changing technologies- a clear mechanism recognised within the plan to tackle the elective backlog.  Like the NHS, our members are facing difficult supply chain issues and ongoing financial constraints, alongside increasing costs of vital evidence gathering. As a result many are having to release their R&D budgets to foot the bill of these increasing costs. This is sadly resulting in the slowing down of the development of new technologies, closing off the opportunies

these innovations raise to tackle the elective backlog and improve system-wide efficiencies.

 

To successfully implement the recovery plan, both DHSC and NHSE must address the decrease in R&D support by engaging with industry to assess the best pathway ahead. The Health Tech Alliance welcomed the DHSC’s strategy to maintain the UK as a global leader in R&D and life sceiences, with their commitment to spend 2.4% of GDP on R&D by 2027. However both NHSE and DHSC should work in collaboration with the HealthTech sector, assessing the best path ahead. Additionally, to combat this issue our members shared insights that NHSE should better their demand signalling, working alongside industry to signpost which patient areas need more effective R&D. In turn, this will help industry to use the funding availble to them to develop vital technologies in the most effective way. Our members would welcome wider communication between industry and the system, providing greater clarity on the role they can play in addressing the current health crisis.

 

4.      Pressure on industry financial resources

 

As recognised by NHSE’s recovery plan for tackling the elective care backlog, investment in technology is essential. It supports life-changing technologies such providers of remote monitoring, which in turn accelerate early patient discharge, freeing up vital capacity for the stretched workforce. Without funding, many of these technologies are hindered from reaching patients, as well as implementing the current recovery plans for the NHS. However, although both NHSE and DHSC have acknowledged technology’s benefits in theory, our members feel that in practice there is limited financial recognition and support for industry. This is particularly the case during technology’s pathway to the frontline.

 

For life-changing devices to even reach the patient, products and industry must journey through a complex, changeable and long pathway to patient. Most challenging is the real-world evidence process, and the strain this puts on industry’s financial resource. There are common perceptions that industry has significant financial backing, with the ability to conduct expensive and lengthy randomised trials, at request. However, this is not always the case. From speaking to membership, there is frustration that arm-length bodies (ALBs), such as NICE and GIRFT (Get It Right First Time) have an expectation that industry can frequently conduct real-world evidence and randomised trials without taking into account the extreme financial burdens this has. Like both DHSC and NHSE, industry is facing extreme costs within the current context of rising inflation, global supply chain shortages and changes in compliance regulations following Brexit. As a result, members are releasing their budgets from other crucial workstreams, including R&D, to bare the costs. The financial aspect of this evidence generating process must be recognised across the system, with ALBs and industry engaging in frequent dialogue over the economic context. The Health Tech Alliance welcomes the Treasury’s recent decision to increase the budget by £3.3bn in each year for the next two years.[6] With this increase in mind, The Health Tech Alliance urges both DHSC and NHSE to prioritise innovation when spending this investment, looking at cost saving mechanisms across the evidence gathering process for both industry and NHSE.

 

With this financial context in mind, our members have flagged the huge reliance industry now has on current HealthTech funding mechanisms including the AI Award and the HealthTech Funding Mandate. Although The Health Tech Alliance welcomes these vital investments, the funding rounds are short and far between, with little consideration of future support for this ground-breaking technology. To combat this, it is essential that both DHSC and NHSE consider sustainable long-term funding solutions, so that funding for adoption of medical devices should be considered over the life of the product and with the longer-term cost savings in mind, as opposed to focusing solely on the upfront costs. Similarly, although The Health Tech Alliance welcomes current funding mechanisms, there needs to be greater awareness of what happens to the adoption of these products once the funding period ends. These devices should be able to fully integrated into trusts, as opposed to short-term integration. Addressing these funding issues would not only allow both NHSE and the DHSC to successfully and effectively implement their recovery plans, but it would also allow the UK to lead the way in HealthTech innovation.

 

As addressed, investment in technology is crucial. Without it, HealthTech and innovation are limited in their ability to implement system recovery plans and address the record-high backlog across the service. The Health Tech Alliance urge both NHSE and DHSC to prioritise innovation following the announcement of the future budget increase, providing industry with the opportunity to improve efficiency and support eary hospital discharge.

 

November 2022

 

 


[1] Better tech: not a ‘nice to have’ but vital to have for the NHS - GOV.UK (www.gov.uk)

[2] untitled (bmj.com)

[3] NHS Activity Tracker 2022 (nhsproviders.org)

[4] Build Back Better: Our Plan for Health and Social Care - GOV.UK (www.gov.uk)

[5] 1666626317_science-or-stagnation-oct-22.pdf (ippr.org)

[6] AUTUMN STATEMENT 2022 (publishing.service.gov.uk)