Written evidence submitted by The Health Tech Alliance (CBP0018)

About the Health Tech Alliance

The Health Tech Alliance is a coalition of health technology companies and stakeholders from across the NHS and wider health system. This focus on partnership is integral to the Alliance’s overarching objective of industry and the NHS working collaboratively to ensure that vital HealthTech innovation reaches patients.

Our response to this inquiry

The Health Tech Alliance welcomes this timely inquiry. In our short response, we have chosen to focus on those questions most pertinent to ourselves and our members – namely those focusing on the role that HealthTech innovation can play in meeting and addressing the unfortunate care backlog that has emerged due to the Covid-19 pandemic.

What positive lessons can be learnt from how healthcare services have been redesigned during the pandemic? How could this support the future work of the NHS and care services?

There are several positive lessons that can be learnt from the way healthcare services were redesigned at pace during the Covid-19 pandemic. Overall, a sense of urgency and singular focus of responding to the pandemic, meant that culturally, individuals had the autonomy to find solutions to challenges and explore new means of delivering care. This cultural change is a key learning from the pandemic, and it appears that healthcare professionals would like to retain some of this new-found autonomy and creativity. As the NHS Confederation report[1] on the NHS reset states, the regulatory burden on local leaders was reduced, leading to more agile ways of working.

The pandemic also saw:

• Rapid evidence-gathering – for example with NICE using rapid guidelines and rapid evidence summaries to provide timelier analysis of critical treatments. It will be interesting to see how NICE’s updated methods and processes will impact on this in the future.
• The health and social care system harnessing the insights and expertise of industry. The pandemic demonstrated that industry could mobilise to great effect in supporting the delivery of essential products. Industry has flexed global manufacturing and supply chains to respond to acute demand spikes caused by the pandemic. Going forwards, this partnership approach is essential if the NHS is to tackle the mounting patient backlog.
• A big shift towards the use of digital technologies to facilitate the use of remote consultations in primary and secondary care, remote monitoring, and virtual wards. These positive changes will need to be embedded to help tackle the patient backlog but also ensure digital inclusion for the whole population and help drive patient pathway adaptations and service delivery. This could also help free up capacity in other areas to be redistributed to help overcome the backlog.

What can the Department of Health & Social Care, national bodies and local systems do to facilitate innovation as services evolve to meet emerging challenges?

HealthTech innovation and innovators continue to face a plethora of systemic challenges when seeking adoption of their product or service. These include:

• A fragmented system with national priorities differing from local realities – this is a consequence of the changes introduced by the 2012 Health and Social Care Act which means that the direction set by NHS England & Improvement cannot always be delivered on the ground.
• The challenges associated with some HealthTech products being able to gather real-world evidence which in turn may be necessary to give evaluation bodies and trusts the necessary confidence to adopt those products.
• A focus on short-term affordability over long-term benefits to patient outcomes and care – some products tend to require initial upfront investment and may deliver a return on investment beyond their first year of adoption. Despite delivering savings and efficiency gains over the long-term, investment in such products may not be deemed wise in the short-term – an issue that is compounded by one-year funding cycles.
• A lack of signposting especially for smaller innovators – the system is complex and difficult to navigate, with multiple decision-making bodies, sometimes with overlapping remits. The system could also do more to communicate patient need so that innovation can be developed to meet existing need.
• A postcode lottery for adoption – the decision to adopt a product in one trust does not necessarily lead nearby trusts to do the same. Companies currently have to engage on a trust-by-trust basis. Additionally, within each trust, the adoption of a product triggers a series of changes in diagnosis, treatment and the roles of the workforce and patients, a lengthy process of refinement.
• The need for clinical time and resource – even when products are accompanied by robust evidence demonstrating their positive impact on patient outcomes and efficiency savings, they can face challenges in their adoption as they require upfront clinical time and training as well changes in patient pathways.

We hope that some of the aforementioned challenges are resolved through the development of Integrated Care Systems (ICSs) and implementation of the Health and Care Bill which should help break down traditional silos to foster service redesigns across patient pathways.

The Health Tech Alliance welcomes the recently outlined Life Sciences Vision[2] which sets out a strategic goal of making the UK “the best place in the world to discover, develop, test, trial, launch and adopt new treatments and technologies”. We are keen to ensure that the Government, NHS England and other key healthcare bodies support this rhetoric through concerted action to harness the vibrant life sciences sector. As the Vision rightly states, “the NHS is central to every element of [the] Vision, and the NHS’ partnership…is a precondition to its success”.

To facilitate innovation, the Health Tech Alliance recommends:

• The Department for Health and Social Care ensures ongoing dialogue with the HealthTech sector about future regulatory plans including the direction of travel and clarity as to how much the UK will align with EU regulation and possible divergence.
• NHS England and in future ICSs communicate priority areas of need for patient care. This could be accompanied by a series of challenges designed to act as a ‘pull’ on the best innovation and ideas to alleviate certain disease prevalence or to reduce pressure on healthcare services.
• Ensure that trusts and ICSs have the appropriate expertise and are incentivised to drive care quality and improvements to patient outcomes. Adoption of innovation is not a passive activity – it is one that requires expertise in service transformation and bandwidth with clinical services to engage in an adoption agenda. The Covid-19 pandemic has demonstrated that an unhealthy focus on unit price and reducing manufacturing costs, over patient outcomes, can lead to unnecessary expenditure on poor-quality or in some cases malfunctioning PPE.
• Full implementation of the recommendations set out in the Independent Review of Diagnostic Services for NHS England as compiled by Professor Sir Mike Richards CBE. This includes continued investment in community diagnostic hubs to prevent patients from bouncing around the system, rapid evaluation of new diagnostic technologies and concerted efforts to expand the imaging workforce, as well as capacity to meet demand in diagnostic services based in hospital or other healthcare settings (often subject to capacity constraints) which can often create bottlenecks in patient treatment pathways.
• Transform the UK’s clinical research processes to enable the rapid approval, set up, recruitment and delivery of research across the NHS. This is also includes facilitating commissioning through evaluation pathways. Doing so will ensure that NHS patients are the first to benefit from clinical breakthroughs and health technologies. The Government should commission independent research on the performance of the NHS internationally on clinical research, trials, and evidence generation pre-COVID, and how well the system harnesses partners and collaborates with industry when required to do so.
• Work with industry to provide clearer signposting, including how companies of all sizes can navigate ICSs and the shifting innovation bodies landscape.
• Fast-track the work of the Accelerated Access Collaborative (AAC) as the ‘front door’ for innovation through a multi-year funding settlement, ensuring that the AAC delivers ongoing support to Rapid Uptake products, harnesses efforts to horizon-scan for innovation which will deliver savings and/ or significantly enhance patient outcomes, as well scaling as up its dedicated support to those innovations with the greatest potential.
• Expand the MedTech Funding Mandate in 2022, delivering mandated funding for a broader range of products and supporting trusts to adopt them. The AAC should also share best practice from the products supported since the launch of the Mandate in spring 2021.
• Ensure that all bodies working to drive the uptake of innovation in the NHS have clear remits and any unnecessary duplication is removed.
• Expanding the use of NICE rapid guidelines and rapid evidence summaries to provide companies with timelier analysis of their treatments and healthcare professionals with information on the latest products prior to their eventual adoption.

Sept 2021

3