Written evidence submitted by Health Innovation Kent Surrey Sussex (IGR0089)
Introduction
Health Innovation Kent Surrey Sussex is the health innovation network for the Kent and Medway, Surrey and Sussex regions. There are 15 health innovation networks across England, established by NHS England in 2013. We support health and social care teams to find, test and implement new solutions at scale to the NHS’s greatest challenges, driving economic growth.
Our vision is to drive a healthier and more equitable society across our region. We are reimagining health and care by enabling innovation to spread rapidly, connecting people to transformative ideas and working with partners to give patients access to the health and social care they need.
We act as an honest-broker and connect citizens, NHS and academic organisations, local authorities, the third sector and industry to facilitate change across whole health and social care economies. Our impact comes from our ability to bring people, resources and organisations together, delivering benefits that could not be achieved alone.
As the Health Innovation Network, we tackle national problems, with local understanding and local problems, with national expertise. Each health innovation network is fully-embedded in their local health and research ecosystem.
Our reason for submitting evidence
We are supportive of the Government’s review of the role that the UK’s innovation ecosystem can play in driving economic growth across the country.
Health Innovation Networks have over 10 years of experience of innovating in the NHS, alongside industry and academic partners. Our national innovation pipeline features over 3,000 high promising innovations being supported to deliver against areas of unmet need. We believe this experience can provide important examples and learnings of where innovation has worked well and where change should be considered to support a strong economy.
We believe by submitting evidence, we can demonstrate how innovation can solve the NHS productivity challenge, support economic growth and the growth of the health and life science industries.
Our Chief Executive, Professor Hatim Abdulhussein, would be happy to present information which builds on the content of this submission and discuss how government policy can help.
1. How does the Government drive research and innovation in our regions?
The UK’s health and care system is highly complex, involving a myriad of interconnected elements such as people, equipment, processes, and institutions (Clarkson et al., 2018). For innovators to navigate this system, which is also highly regulated, is challenging. Successful innovation in healthcare is characterised by a journey, rather than a single event, involving processes of adoption, implementation, sustaining, spreading, and scaling up. (MacInnes et al., 2023).
AposHealth (Apos®) is another example of a company with a successful innovation journey with the NHS. Apos® is a biomechanical footwear-based therapeutic device, which can be offered to patients that are eligible for joint surgery but as an option in place of surgical treatment. Health Innovation KSS has supported Apos® on their innovation journey since 2017. Apos® received CE regulatory approval as a Class 1 Medical Device in 2014, but it was not until 2017 that their first services were commissioned within the NHS.
Over a few years, the organisation entered the NHS Supply Chain, gained NICE accreditation, and established a growing footprint within the NHS. By 2020, Apos® had been submitted as an innovation to the NHS Innovation Service, NICE and the AHSN Network pipeline (now the Health Innovation Network). In 2022, NICE published MIB284, naming Apos® as a potential alternative to joint replacement surgery. In April 2023, NICE published MTG76, recommending Apos® as a cost saving option versus joint replacement for eligible patients.
In May 2023, Apos® was selected as a technology to be scaled nationally across all Health Innovation Networks on the NHS MedTech Funding Mandate (MTFM) for knee osteoarthritis in 2024-225. The MTFM programme aims to help the NHS and patients to benefit from clinically effective and cost-saving technologies faster and more equitably. Led by Health Innovation Kent Surrey Sussex, MTFM leads from the 15 Health Innovation Networks support the spread and adoption of Apos® by developing and coordinating resources, guiding commissioners, providers and clinicians on the pathway transformation required to embed Apos® within their Musculoskeletal (MSK) services.
In a December ’24 review conducted by Health Innovation KSS, Apos® was acknowledged as making a positive impact on workforce challenges, keeping people in work or bringing others back to work, which aligned with national priorities such as the ‘WorkWell’[1] Vanguard Programme.. It is noteworthy that the Office for National Statistics estimates 38% of economically inactive individuals due to long-term sickness reported having five or more health conditions, which often include MSK issues.
The Apos example illustrates the multi-year journey encompassing nearly a decade (2014-2024) required to demonstrate the clinical and cost-effectiveness of a healthcare technology, followed by the navigation of the complex pathways to adoption within the NHS. Whilst some innovators can sustain this, many struggle, and this can result in innovations that are beneficial to patients and the healthcare system failing to be adopted at scale, and many potential businesses looking at markets outside of the UK (Clark et al., 2019). Access to funding during the development and adoption phases, along with navigational support through the complex landscape, are key challenges that must be addressed (Judd & David, 2018) (Scarbrough & Kyratsis, 2021) (Clark et al., 2019). Venture capital funding, regional and national innovation funding schemes, and targeted support from organisations like the Health Innovation Network and Innovate UK are all important mechanisms that can help healthcare innovators overcome these barriers to successful adoption within the health and care system. However, in our experience, venture capitalists are not keen to invest in infrastructure, in particular where the supply chain and route to market is complex and challenging to navigate. These organisations are very keen to lean on the strong regional and national innovation infrastructure, support programmes, and subject matter expertise that do exist in the UK.
2. How does research and innovation in our regions drive growth and prosperity in those regions?
Health Innovation KSS is an effective regional innovation hub that supports regional growth and prosperity. We drive growth and prosperity by supporting health and care teams to find, test and implement new solutions to the NHS’s greatest challenges, driving economic growth. In 2023-24, we have supported 393 innovators to develop their ideas for adoption and spread, as part of our Commission from the Office for Life Sciences (OLS). Through our support of innovators, in 2023-24, the national Health Innovation Networks have collectively contributed over £475M in inward investment to the economy and created over 500 jobs.
In Kent, Surrey and Sussex, an example of how we work with local innovators to drive economic growth is demonstrated by our work with Leo Cancer Care. Leo Cancer Care, based in Sussex, is an innovative radiotherapy company, developing revolutionary upright radiotherapy products for cancer treatment. Our long-term support to Leo Cancer Care has included facilitating new connections, evaluation and validation reports, leading to cost-benefit analysis and budget impact model. We have also support detailed horizon scans, scoping discussions, market feedback from local Cancer Alliances, and strategic planning for NHS access. Most recently, we have supported Leo Cancer Care to leverage strategic funding from Macmillan Cancer Support, part of the Macmillan Innovation Impact Investment Portfolio. As a result of their success, Leo Cancer Care has brought significant economic growth to our region by creating 60+ jobs and generating £20 million in total revenue. Leo Cancer Care has also secured circa $110million in private investment. However, Leo Cancer Care has found the route to adoption within the NHS more difficult that securing partnerships with overseas health systems, in particular in the United States of America, with organisations like Stanford Medical and the Mayo Clinic.
More broadly, whilst we see incredible success with organisations like Leo Cancer Care, we find there is an increasing demand from innovators for innovation adoption support that may eventually exceed our current capacity. We act as an honest broker providing 1:1 support to innovators with potential and who have solutions that align to the regional needs and priorities of our local Integrated Care Systems (ICSs). Our support covers a wide-range of topics including market analysis, intellectual property, clinical trials, procurement, sustainability, scaling and financing. We are also seeing demand for additional innovator support in areas like bid writing, funding support, real-world evaluations, etc. More investment in innovation enabling hubs, such as the Health Innovation Network, is required to meet growing demand and build the infrastructure, capabilities and capacity to support the UK's next generation of health and care innovators.
3. How is research and innovation diffused or supported to drive productivity and growth in the regions, wherever it may come from?
Ensuring innovation investments deliver tangible outcomes in terms of productivity and growth
The NHS Long Term Workforce Plan recognised the challenges the health system faces, reflecting the growing needs of an ageing population, with the number of people above the age of 85 expected to grow 55% by 2037. This will inevitably mean increasing demand on the health and social care system. Inaction is projected to leave a shortfall of between 260,000 and 360,000 by 2036-2037. Productivity in the public sector has been seen to fall, yet the NHS Long Term Workforce Plan outlines an ambitious labour productivity assumption of 2%. At Health Innovation KSS, we see one of the key levers to boosting productivity being greater adoption and scale of innovative solutions, with clear alignment to the NHS’s greatest challenges. We have identified workforce transformation as cross cutting theme that spans all our work programmes and this is a focus area that we recognise is key to unlocking productivity. We also need greater incentives across our ecosystem, to collaborate on workforce planning and innovation adoption initiatives, driven by clear metrics, aligned to health system goals.
One area of innovation we are particularly excited about is the role that intelligent automation and artificial intelligence can play in supporting productivity. With greater investment, we believe this is an area that can deliver tangible productivity outcomes. AI tools are already being used in clinical practice to automate repetitive or administrative tasks, freeing up clinicians' time to focus on patient care. One such example can be found in our recent evaluation of Rapid Health’s Smart Triage tool at The Groves Medical Practice, which found that when used in primary care, there was a 73% reduction in waiting times, and improvements in patient care and practice efficiency. GPs at this practice now spend more time with each patient by moving from 10 to 15-minute appointments, as a result of the improved demand and capacity management. 70% fewer patients needed a repeat appointment, having received the right care on their first visit. It would be helpful to see investment in these areas so everyone can benefit from the outcomes these tools help to drive.
As the technology continues to evolve, the promise of General Purpose AI is significant, with the potential to augment and scale the capabilities of the health and care workforce. We will see further movement to agentic AI systems that could autonomously assist in planning, coordination and decision making, truly augmenting the NHS workforce. However, this transformation will need to be balanced with appropriate oversight, transparency and accountability mechanisms, to ensure that these powerful AI solutions are delivering for patients and clinicians in an ethical and equitable way. For the healthcare system to realise the full potential of these technologies, we need to look at our regulatory landscape. Without setting meaningful requirements for the biggest and best resourced technology companies to adhere to, too much risk falls on the end users in the NHS and social care.
Investment in testing and de-risking of AI technologies
Effective adoption of a technology in any setting, let alone high risk, requires gradual testing and de-risking through test and learn cycles. This is core to our methodology of innovation adoption at Health Innovation KSS. It ensures the technology is being used properly and with engagement with end users, increasingly likelihood of it driving efficiencies and benefits and minimising something which we have seen all too much of in the NHS; not realising the true impact of technological transformation. From a human resources perspective, it ensures that the workforce is being upskilled to use it effectively and take corrective action, and it makes jobs more meaningful by ensuring it is user-centred for doctors, nurses, administrators, and consequently empowering them in their work, not disempowering.
Test and learn cycles cannot begin effectively without the AI model developer having provided documentation on how the AI model was built, how it was tested; basic transparency and technical documentation one would expect in any sector. A framework for developing healthcare worker confidence in AI was developed by NHS England, with key considerations around liability, external and internal validation, strategy and cultural implementation, user centred design and workflow integration.
The key will be striking the right balance between the pace of innovation and the equally important considerations around safety, security, transparency, accountability and ethics. Take for example a general-purpose AI system being adapted by an application developer to read referrals from GPs, and suggest and book new outpatient appointments with consultants in the local hospital. This might seem like a straightforward use of generative AI systems which would free up admin time. However, this model will need to distinguish between the urgent and routine referral to ensure patients are seen at the right time, so it can pose risks. For the application developer to tackle this, they should have information about the training data used, how the AI system was trained, how it was fine-tuned, what tests were completed by either the AI company or external evaluators to test for hallucinations or errors, data drifts or other issues with Frontier AI solutions. In addition to this, we need to consider cost, latency and sustainability of these solutions.
Currently, there are such limited requirements on developers of the most powerful AI systems that all of the work adapting and de risking these AI models to use cases falls on the downstream application developer. And because of the black-box of AI models, they have to do this with very imperfect information. Under current legal framework, many believe that the risk would sit entirely with the downstream application developer who are often small businesses or clinicians trying to solve a problem they see locally; so in this way, our current legislative framework discourages innovative problem solving. Increasing scrutiny and requirements of AI models in collaboration and coordination with enterprise through joined up research, development and implementation projects would fast track application development that could effectively address many issues in the NHS.
We will continue to work regionally to drive values and purpose driven AI growth in our region, continuing our work with innovators who are developing solutions that are designed specifically for our local health system’s needs, and ensuring that the innovative solutions we support satisfy the core requirements of transparency, accountability, validation, user-centred design and engagement with clinicians and patients. We are supporting our health and care systems on AI implementation and strategy, and will keep advocating nationally for a balanced regulatory approach that enables innovation but prioritises patient safety and clinician trust, but also allows for local change and growth.
24 January 2025