UCLPartners – Written evidence (LSI0059)
Introduction
- UCLPartners welcomes the recently published Life Sciences Industrial Strategy and views this as a pivotal step in linking industry, academia, the third sector, patients and consumers to understand and address the greatest health and social care needs of our population. It is vital in developing, translating, commercialising and implementing innovation at a scale that makes the biggest impact for the greatest number of people and for the UK life sciences sector.
Science and innovation
- Although the United Kingdom scores highly and has historically excelled as a country of medical invention and life sciences discovery, it has a poor track record in commercialisation and in rapid spread and adoption of innovation. In part this relates to relative under-investment in these areas compared to spend on research and development. Whilst we strongly support the recommendation for continued investment in basic science – the NHS and DH currently funds research to the extent of billions of pounds – however, only a planned £30m is allocated for adoption and spread over the next five years[1]. This is in stark contrast to the substantially higher investment in the adoption and spread of innovation by the world's leading commercial organisations.
- With more adequate funding for the adoption of innovation for the benefit of our patients and population, the UK could more effectively raise the profile and value of home-grown products to increase worldwide sales and impact. The additional £38m funding to Academic Health Science Networks (AHSN) through the Accelerated Access Review is welcomed and may help address this imbalance in part. However, to achieve the ambition of making the UK a leader in life sciences, there needs to be a commitment to significant additional and sustained funding for adoption and spread through industry and third sector partnerships with academia and the health and social care system.
- At UCLPartners, we believe that this can be best achieved through the development of regional and linked learning health systems where “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the care process, patients and families active participants in all elements, and new knowledge captured as an integral by-product of the care experience” (NAM/IOM, 2013). As a successful academic health science partnership, at UCLPartners we believe we can strengthen and grow our existing connections to create a learning health system with the capacity to more effectively support healthcare innovation.
- The pace of decision making within the NHS for the uptake of innovation should be addressed as this is a key factor in the UK’s ability to adopt new products and technology, and can inhibit businesses – whether UK or internationally based – to work with the NHS. This is an area in which UCLPartners supports its industry partners. Reviewing the decision-making process could follow a national drive as we have seen in the process for approving research studies.
- Further investment in building workforce capacity and capability would also enable the uptake of innovation. Alignment with the national agenda on quality improvement and work to demystify innovation uptake would result in benefits for staff, their organisations and the patients they serve.
Industrial strategy
- UCLPartners welcomes the creation of the Digital Innovation Hubs as a recommendation within the strategy. The focus on digital and innovation is, however, too narrow and potentially misleading. To deliver the benefits to the UK life sciences industry, these regional hubs must be capable of demonstrating significant added value. This will require bringing together local centres that have demonstrable world leading scientific, research, educational, informatics and implementation expertise that can be seamlessly integrated with health systems that are patient centred, digitally mature, research enabled and focused on addressing significant whole system health challenges through innovation and service transformation. The outcome must be to reduce variation in provision and outcomes; improve health and wellbeing; and reduce costs.
- To function effectively, the Digital Innovation Hubs will need to work in harmony with supraordinate national functions including Health Data Research UK (HDR UK), which is seeking collaborative applications for substantive sites across the UK, and the Alan Turing Institute. This will allow appropriate access to real time and linked datasets from across the biological, clinical health and social care spectrum and beyond into areas of education, environment, commerce etc. To achieve this in the UK will require a new approach to population health management that includes a co-ordinated technology strategy (systems integration), and an harmonised approach to data sharing, governance, public engagement and analytics across providers of health, prevention and wellbeing of populations.
- Learning and expertise can be gained from existing systems that are already working successfully in this regard. For example, at UCLPartners, our model connects academic, clinical and applied research, education and informatics capabilities with healthcare providers that support a vibrant and diverse population of six million people. The partnership includes six sustainability and transformation partnerships (STPs) across metropolitan and rural settings covering some of the most economically deprived parts of the UK. UCLPartners works in collaboration with health and care provider organisations, universities, industry partners, charities and public patient involvement (PPI) groups and harnesses data to transform the experience and delivery of health care and research across our partnership. We work across the innovation spectrum working to a) identify need and communicate priorities b) share knowledge and learning with innovators, patients, providers and commissioners c) validate through research and real world evidence and d) support the scaling, adoption and spread of proven innovation regionally, nationally and internationally. This model could provide significant opportunities for learning, sharing and as a helpful template for the proposed regional innovation hubs.
- UCLPartners supports the recommendation for the Digital Innovation Hubs to correspond to existing Academic Health Science Network footprints that are capable of establishing such hubs. At UCLPartners we are looking at opportunities to facilitate connections between existing areas of expertise that have a track record of successfully linking data for the benefit of a wider population. For example, the Discovery Project in east London, hosted by Queen Mary University of London’s Clinical Effectiveness Group (CEG), aims to expand an integrated data set for analysis to:
Predict, anticipate or inform both individual and population health needs from algorithms running real time.
Enable real time reporting on programmes by providers and commissioners for clinical improvement and new payment mechanisms.
Support research, development and planning to create East London as a research enabled community.
The CEG is currently at the forefront of real-time GP electronic health records use (based on EMIS Health[2]) for research and service development. This has helped propel local GPs to the very top UK rank of NHS quality performance – despite serving some of the most disadvantaged populations in the UK, with City and Hackney, and Tower Hamlets practices either first or second in 25% Quality and Outcomes Framework metrics in 2016. Connecting this work with other areas of expertise, potentially with the Global Digital Exemplars in the region, has the potential to create unprecedented improvements in the way we are able to use health data for disease prevention, early diagnosis and treatment.
NHS procurement and collaboration
- Public procurement can be an effective incentive to attract and support emerging businesses and to grow the innovation in life sciences, however some key procurement frameworks are relatively closed to smaller companies and this must be reviewed and addressed. In addition, central decisions are sometimes made with limited understanding of the impact. For example, the proposal that NHS trusts can now only procure a digital solution that is already in use in a global digital exemplar will limit access to the NHS for thousands of companies that have a product (rather than a specification) focus.
- Initiatives such as NHS England’s Innovation and Technology Tariff and Payment do provide opportunities for SMEs to access the market, and these are based on an innovation specification/theme identified as a need for the NHS, rather than a specific product. This is a fairer and more equitable process which may attract a wider field of industry enterprises and is supported by UCLPartners. Our model at UCLPartners is to work with our partner organisations to help understand and identify a need and then match this to a solution, where available (and this may come from within or outside of the NHS/health care setting).
- The NHS Test Beds are pioneering an approach to develop and test combinatorial innovation in ‘real-world’ community settings where a clearly defined problem is identified from the outset. The learning from the Test Beds, as this emerges, should be taken to help facilitate procurement and uptake of innovations. In addition, Test Beds, or learning health systems, have the potential to have some freedom to operate outside of the current reimbursement systems that exist within the NHS.
- Large incumbent suppliers have in the past threatened to sue commissioners if they fail a procurement. This can, in the example of the NHS Innovation Accelerator, lead to a repeat procurement being run to avoid the risk of legal costs. More support may be needed centrally for local commissioners facing such situations.
- There is a need to trial and then embed/incentivise the use of innovative approaches to procurement, akin to current examples which tend to rely on EU funding for example Nightingale, which involves our partner University College London Hospitals NHS Foundation Trust.
- There is also a need to focus on decommissioning at a greater pace within the NHS. Much of the projected cost savings with the introduction of innovation are predicated on stopping traditional pathways and freeing up resources and expertise.
- UCLPartners supports the recommendations from the Accelerated Access Review (AAR) and has worked, alongside the AHSN Network, to develop these with the Office for Life Sciences. As an established partnership across healthcare, research and academia, with proven ability to deliver improvements, UCLPartners (as both an Academic Health Science Network and Academic Health Science Centre) is well placed to implement the proposals set out in the AAR. The inclusion of North Thames Clinical Research Network (CRN) and North Thames CLAHRC within the UCLPartners governance allows us to incorporate clinical trial and pragmatic research and thus ensure that the innovations we choose for adoption and spread are appropriately evidence-based.
- We are using our connections and influence to co-design local innovation exchanges to facilitate the adoption of innovative new products and work closely with our associated higher education partners and Biomedical Research Centres. UCLPartners is closely aligned with the national AHSN Network to ensure that local innovations can be scaled up quickly and efficiently across the country.
- Success will require the most effective levels of collaboration between the NHS and industry. UCLPartners works very closely between and with these groups and acts as a bridge and catalyst in this important relationship. Spread and adoption of innovation from single organisations or localities has often proved difficult in part due to the ‘not invented here‘ mentality of institutions and individuals. The AHSN Network has established a coordinating and sharing function that may overcome this. An example in London is the establishment of DigitalHealth.London; set up in 2016 by the three London AHSNs, MedCity and supported by NHS England and The Mayor of London‘s office. This initiative speeds up the development and scaling of digital innovation into the NHS in close collaboration with industry.
- There are many examples of successful collaboration between researchers and the NHS. Academic contributions to improvement and innovation projects in healthcare is welcomed and valued by clinical and non-clinical colleagues that work with UCLPartners. Creating stronger links between Academic Health Science Networks and their local academic institutions – as we do at UCLPartners – would support improvements in this area and can be achieved partly through strong and mutually beneficial working relationships.
Responsibility and accountability
- UCLPartners enjoyed a close working relationship with the previous Minister for Life Sciences, George Freeman, and valued his commitment, energy and support for the developing strategy and recommendations. UCLPartners believes that clear leadership, authority and focus from an accountable government representative is imperative to successful delivery of the Life Sciences Industrial Strategy.
- Innovation is largely absent from central and local STP plans, which UCLPartners believes is a risk to addressing the quality and efficiency gap as outlined in NHS England’s Five Year Forward View. In recognition of the pressure the system is under and limited capacity, there needs to be a clear and focused set of national NHS priorities for innovation, that are aligned to the Life Sciences Industrial Strategy.
About UCLPartners
- UCLPartners is a unique academic health science partnership that brings together people and organisations to transform the health and wellbeing of the population. With more than 40 partners from the NHS, social care and academia, we support improvements in discovery science, innovation into practice and population health and focus where the need and benefit is greatest. Our local focus is to support health and care improvements for a population of six million people in north east and north central London, south and west Hertfordshire, south Bedfordshire and south west and mid Essex. Beyond serving the local population, healthcare solutions developed by members are also applied across the UK and globally.
15 September 2017