How can policy makers support health technology?
Central NHS arm’s-length bodies and government departments have a number of levers and strategies to stimulate the market and de-risk technology decisions for the NHS, but this often leads to confusion. These are our panel’s suggestions on how to best support the growth of health tech small and medium-sized enterprises (SMEs).
Implement technology to improve outcomes, not just for the sake of it or to claim you are tech savvy.
– Tim Kelsey, former National Informatics Director (final advice when stepping down as the chair of the NIB)
One of the interesting themes in our expert group discussions has been the relative absence of long to-do lists for government and NHS England. Our focus was on the very practical things that SMEs and the NHS can and should be doing, rather than waiting for action from the centre. Our discussions reflected a mature recognition of the limitations on what the centre can achieve, though there are of course some important things that can be done centrally to facilitate a more vibrant digital health market.
Who are the organisations that we refer to as the centre? Those that set policy in the NHS are particularly relevant and include NHS England, the National Information Board and the Department of Health. The Cabinet Office sets procurement policy across the public sector, and a number of arm’s-length bodies are also influential in this sphere, including the Academic Health Science Networks (AHSN’s), the Office for Life Sciences (OLS) and Innovate UK.
Stay alive to the importance of the digital health market
It is bad news both for the NHS and the economy that the NHS is often not seen as an attractive market among investors. This is not because of lack of opportunity but because of the slow pace of adoption.
It is also bad news that SMEs are increasingly shifting their focus to the US, where investors are keen and the market is actively seeking out innovations. Tom Whicher, chief executive of DrDoctor, said: “I get more enquiries from the US than the NHS and that is without actively marketing over there.”
The trans-Atlantic market hasn’t been entirely unhelpful. What has worked for us is demonstrating our product in the NHS and using that evidence to secure business and funding in the US.
– Chris Jessop, chief executive, Expert 24
In order to build on the success of strategies and initiatives such as Personalised Health and Care 2020 and the Accelerated Access Review, the SME panel hopes that NHS England and OLS will look at monitoring and publishing:
- Rates of UK investment in digital health SMEs.
- Number and size of NHS digital health contracts let to SMEs.
Information on NHS contracts let to SMEs is hard to come by, although there was a commitment that at least 25 per cent of central government spend should be with SMEs by May 2015. To our knowledge, the only place that has collected this data is Greater Manchester, instigated by the Academic Health Science Network.
It is clear that although the UK is good at generating ideas we are less successful at commercialising them and building companies to scale.
– Digital Health in the UK: An industry study for the Office of Life Sciences, Monitor Deloitte, September 2015
Keep up the momentum
The SME panel welcomes the National Information Board’s focus on setting standards, making digital record-keeping a condition of contract and requiring use of the NHS number. The system needs consistency and interoperability, and they are equally necessary for the digital health market to thrive.
There are some areas where action needs to match the rhetoric. In recent years, there have been programmes and announcements specifically around embracing and enabling SME involvement in key areas (GPSoC and NHS Choices being key examples) but they have had little impact in reality. The centre needs to take action on major system suppliers who put barriers up to interoperability and who fail to offer truly open APIs. It also needs to reinforce the data-sharing messages of Caldicott 2.
– Alex Kafetz, chief operating officer, ZPB Associates
The SME panel welcomes the Accelerated Access Review’s recommendations around ensuring a clear pathway of support and advice for SMEs, taking action to stimulate consumer demand and creating real incentives and rewards. Hard cash incentives are important, and NHS England has made available £260 million over the last three years years to NHS organisations to pump the market and digitise the NHS. But there are lessons to be learnt from previous funds and prizes:
- Avoid timing pitfalls, such as requiring funding awards to be spent in-year or be lost.
- Focus more on incentivising the adoption and spread of existing innovations rather than on discovery and early product development.
- Include support for implementation.
- Require match funding from the organisation at the end of the process to ensure sustainability – and contracts – are the result.
- Don’t fund pilots, fund sustainable projects.
- Make sure cost is not prohibitive e.g. access to data, server space, infrastructure etc.
Too often, funds that are meant to prime the pump end up being the pump.
– Bruce Hellman, chief executive, uMotif
Soft incentives matter too. Creating ‘pull’ from within the NHS is essential and this means creating space and permission for people within the NHS to seek out and adopt innovative solutions.
We would like to see the centre provide active support and recognition for early adopters and fast followers in this space, inspiring others by publicising and celebrating successful NHS/SME relationships.