NHS Innovations South East – Written evidence (LSI0010)

 

  1. Question 1: How can investors be encouraged to invest in turning basic life science research into new innovations in treatment? Why has investment been lacking in this sector? Does the research base have the necessary infrastructure to be world-leading?

 

  1. Response: The fundamental reason why investors do not support life science research in the UK is because the NHS is a slow and late adopter and investors want to realise a return within their lifetimes. To encourage investors, the NHS has to be seen to adopt innovations more quickly. I.e. a more agile and responsive market.

 

  1. Question 2: Why has the UK underperformed in turning basic research in the life sciences into intellectual property? What needs to be done to address this historic weakness in the UK and grow new companies to commercialise new research and related technologies in the life sciences?

 

  1. Response: The UK has underperformed in turning basic research in the life sciences into intellectual property because the NHS is ignorant of the value of IP, UK university academics are more interested in publishing their research than seeking to exploit their research commercially, and they do not appreciate the patient benefit that could arise from their research being commercialised.

 

  1. Question 4: How does the UK compare to other countries in this sector, for example Germany and the United States?

 

  1. Response: Industry often finds it difficult to understand the NHS and in particular articulate the benefits of their products and services in a way that the NHS understands. A straightforward cost saving pitch or a return on investment from a company is often not accepted by the NHS, partly because the NHS distrusts industry, partly because the NHS does not understand the technology / offering, and partly because the financial benefits being presented by the company are not substantiated in a way that the NHS accepts. In addition, there are many patient benefits that innovative technology can deliver that are not acknowledged by either party or recognised. Enabling the NHS to be a more equal partner in collaborations and industry to understand the nuances of the NHS procurement decision making processes and criteria is key to unlocking the significant synergies and mutual benefits of the relationship.

 

  1. Several health technology companies have cited the relative ease in conducting their commercial activity in the US compared to the UK and the NHS. An illustration of such differences between the UK and USA can be found with Deltex Medical who have been a leading UK healthcare technology company and developer of the oesophageal ultrasound doppler device. The company spent over a decade developing the technology and building the clinical evidence base to satisfy the needs of the UK market and to improve uptake within the NHS. Despite a favourable NICE assessment and designation as a High Impact Innovation by NHS England, the company struggled to substantially increase its NHS sales to the dismay of other industry observers. In the last few years the company has adjusted its commercial strategy and decided to pursue opportunities in the USA to great success. Utilising its UK experience and evidence base the company has grown its potential and increased the utilisation of its technology to improve patient care and provide enhanced recovery for patients.

 

  1. Question 10: How can public procurement, in particular by the NHS, be an effective stimulus for innovation in the Life Sciences Sector? Can it help support emerging businesses in the Life Sciences sector?

 

  1. Response: The SBRI Healthcare initiative is already in existence and has been running for several years with significant investment to try and encourage new technology development and its adoption by the NHS. It would seem sensible to undertake an audit of this initiative and establish it true return on investment to the taxpayer before continuing to support or re-engineering any new procurement initiative. Likewise the AHSNs have received significant investment over the last six years and their real effectiveness in supporting NHS adoption should be audited for value for money and what they have actually delivered as against what they claim to have delivered.

 

  1. There have been various initiatives to address procurement in the NHS (e.g. NHSE Directory of Innovations, ITAPP, CQUINS, High Impact Innovations) but they have all come out of NHS England which has failed to follow through. There is a legacy of half-hearted initiatives from NHS England to stimulate awareness and uptake of emerging technology. The initiatives have lacked leadership and there have been no processes to incentivise staff to engage. Previous financial incentives have been gamed by NHS organisations resulting in little or no effect on adoption of the technology.

 

  1. Question 12: How can collaboration between researchers and the NHS be improved, particularly in light of increased fiscal pressures in the NHS? Will the NHS England research plan help in this regard? How can the ability of the NHS to contribute to the development of and adopting new technology be improved?

 

  1. Response: Currently relationships between the NHS and researchers are dominated by University researchers. The University knowledge exchange function is well funded by BEIS / HEFCE (i.e. Higher Education Innovation Funding £185m 2017/18) to exploit innovations that are readily commercilisable by either spin-outs / start-ups or licencing to an existing company in the appropriate sector. However, the NHS is a service delivery organisation i.e. it provides a health service to UK patients and it is not skilled or experienced in supporting research collaborations with universities well. In addition there are many lower value innovations that originate  in the NHS from service delivery that are not supported either by the NHS or by Universities. This is because the NHS does not have its own infrastructure to support innovation and the university knowledge exchange function does not really understand the NHS and does not have specialist who are dedicated to the NHS, their technology transfer staff are generalists. Many of the innovations that originate in the NHS do not have significant revenue generation potential, but they do have very significant patient impact through a variety of measures (i.e. better outcomes for patients, higher quality, improved safety, cost savings and efficiency savings within the NHS)

 

  1. This situation could be improved if the NHS had its own knowledge exchange infrastructure that could support the NHS to interact with researchers, facilitate research collaborations, ensure that innovations that originate from the NHS are supported and exploited. The potential for the applied innovations (ie those addressing identifiable market needs) typically generated by the NHS should not be underestimated, particularly at a time when it is challenged to think creatively about future healthcare provision. Although some AHNSs claim to be active in this space, the majority of them do not have the required skills and expertise and their focus has been and should be on adoption. A separate knowledge exchange infrastructure should be set up for the NHS with a single focus – evaluating early stage NHS ideas and helping them become reality, so that AHSNs can pick them up and ensure they are adopted. Putting this function within AHSNs has the potential to cause conflicts of interest and would add to the already long list of AHSN deliverables.

 

  1. Not only would the NHS be a better research partner and assist in the development of technology, but the infrastructure would also assist in the adoption of new technology. There are many barriers to the adoption of new technology across the NHSSH which have been identified and articulated elsewhere, and there have and are many attempts to address this issue. However, until the NHS is seen and treated as an equal partner by Universities and industry, these barriers will persist. Part of the issue is the NHS culture which distrusts industry suppliers and does not treat them as collaborators.

 

  1. AHSNs are the latest attempt to address the adoption challenge, but they are an incomplete solution. NHS Innovation hubs pre-date the AHSNs, being setup in the early 2000’s and were the NHS infrastructure that provided the early NHS idea validation and IP protection / commercialisation service as well as assisting healthcare companies to engage with the NHS . Unfortunately the NHS Innovation hubs have been neglected and allowed to wither, despite attempts to gain support form a wide variety of stakeholders including various ministers and the NHS: http://www.innovationssoutheast.nhs.uk/files/8415/0186/1107/141024_NISE_press_release_FINAL.pdf

 

  1. These NHS Innovations hubs were a part of the innovation landscape that facilitated identification and protection of NHS IP and also helped industry to engage with the NHS collaboratively in a mutually beneficial research relationship. Consideration should be given to this aspect of the innovation landscape within the Life Sciences Strategy.

 

  1. There is little appetite and capacity to undertake evaluation of early stage innovations. From our experience the majority of NHS organisations are unwilling or uncomfortable to undertake clinical research and evaluation of emerging technology innovations. We have seen this first hand with devices formally CE marked and placed on the market i.e. are compliant with EU regulations.

 

13 September 2017