Tackling Staffing and Funding Issues in the NHS Is Necessary for Improvement but Not Enough. To Support a More Sustainable Healthcare Service Innovation Needs to Be Embedded into Its Mindset, Practices and Policy

• RAND Europe study provides 30 actionable recommendations in six key areas that can increase the likelihood of innovations being developed and benefitting patients and the healthcare service

The NHS could move towards a more sustainable model of healthcare delivery that is fit for purpose if it empowered staff to be able to embrace innovation as a mindset, attitude, culture and practice, according to a new study by RAND Europe and the University of Manchester.

While acknowledging that financial investment and addressing staff shortages are necessary and a fundamental policy issue, researchers argue that the healthcare service cannot respond to the changing and increasing demand for healthcare services without also innovating in how it does things and approaches challenges. This would require accompanying changes in government policy and in the support infrastructure for innovation.

“As in many other countries, the UK has an ageing population, a growing burden of chronic disease and a changing nature of demand for health services. The NHS is under pressure to transform and find more sustainable ways of operating,” says Dr. Sonja Marjanovic, who leads health innovation research at the not-for-profit research organisation RAND Europe and is lead author of the study.

“We need to think creatively about how we can ensure that the NHS is sustainable and can provide high quality care, given the service's limited resources. And innovating has a role to play in this process. This does not mean that everyone needs to be an innovator, but more people need to understand what innovating is about, what impact it can have and what innovations are available,” she adds. “While we also recognise that innovation is not always beneficial, the study focused on cases where the evidence suggested likely advantages.”

The multi-year study, conducted from 2015 until early 2019, found that although there are a number of government policy initiatives that are gradually helping to support a more innovative healthcare system, staff still often lack the appropriate skills, capabilities, incentives, resources, infrastructure and accountabilities to effectively engage with innovation and to support the progression of evidence-based innovations from development through uptake and spread in the healthcare system.

Funded by the Department of Health and Social Care Policy Research Programme, the mixed-methods study sets out to understand what practical changes in policy and practice can support system-wide improvements in the environment for innovation in healthcare in England. Over its course, more than 670 contributions to the study were made by diverse individuals from researcher and innovator to service provider and commissioner, patient representative and charity, policymaker and other communities.

“Healthcare innovations—be they medicines, devices, diagnostics, digital or service model innovations—can help improve the quality and efficiency of care that patients receive. And while we do have a history of excellence in developing healthcare innovations, we have been less effective at their adoption, and so innovations are not benefiting patients as much or as quickly as they could,” says Tom Ling, who leads evaluation work at RAND Europe and is a co-author of the study.

The study provides 30 actionable recommendations in six key areas: skills, capabilities and leadership for innovation; motivations and accountabilities; information and evidence environments; collaboration and coordination; public and patient involvement and engagement; and funding and commissioning.

“To develop and nurture the skills and capabilities necessary for an innovating healthcare system—and to support a change in attitudes and culture—the medical education curriculum and continuing professional development opportunities will need to evolve, so that healthcare staff can be sensitised to the concept and practice of innovation, the opportunities available, and the potential impacts early on in their careers” says Marjanovic. “Training for the private sector on how to effectively engage with the NHS is also needed.”

Researchers say that the range of incentives for people to engage with innovation is gradually increasing but there is little accountability. “The NHS is experiencing immense challenges, and in such an environment motivating people to innovate is not likely to work without some accountabilities in place,” says Ling. “Innovation needs to become more embedded into the regulatory system—for example in hospital inspections and quality assessments—but not mandated.”

The study recommends that decisionmakers across government departments and across party lines work more closely together on delivering innovation in the NHS. Otherwise there are risks of investment duplication, overlap of activities, “siloed” thinking and threats to the sustainability of initiatives. The authors also argue that there is a need to think about combinations of innovations that address a particular healthcare challenge, as opposed to structuring commissioning decisions around individual products, technologies or service innovations.

Policymakers rolling out innovations or innovation-related policies and initiatives could also think about implementation and success criteria sooner in the policy cycle—at design stages. This includes not only financial and infrastructure related criteria, but issues like the acceptability for healthcare professionals and the public, and what the unintended consequences might be.

At present, there are many networks and initiatives working on innovation-related issues, but there is not always clarity on their respective roles and remits. However the report does highlight notable developments in efforts to support more coordinated activities, for example, via Academic Health Science Networks, the Accelerated Access Collaborative, the NHS Innovation Accelerator and the Clinical Entrepreneur training programme.

Other authors of the report, Innovating for improved healthcare: policy and practice for a thriving NHS, are Marlene Altenhofer, Lucy Hocking, Molly Morgan Jones, Sarah Parks, Ioana Ghiga, Carla Cox and Katerina Galai.

This study is funded by the National Institute for Health Research (Evaluation of strategies for supporting innovation in the NHS to improve quality and efficiency, PR-R7-1113-22001) through its Policy Research Programme, and developed in close collaboration with the Department of Health and Social Care, NHS England and the Office for Life Sciences. The views expressed are those of the authors and not necessarily those of NHS England, the National Institute for Health Research, the Department of Health and Social Care or the Office for Life Sciences.

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Notes to Editors:

• To request a copy of the report or to arrange an interview with one of the researchers on the project please contact Cat McShane on cmcshane@rand.org
• RAND Europe is a not-for-profit research organisation whose mission is to help improve policy and decision making through research and analysis www.randeurope.org.