As the government seeks ideas to set the NHS on a path for the future, a capacity for innovation must be a top priority. And as RAND Europe's recent evaluation of innovation hubs across England demonstrates, regional innovation ecosystems can support this goal.
The government intends for the 10-year plan to include three main shifts:
- Moving care from hospitals to communities
- Making better use of technology
- Focusing on preventing illness, not just treating it
These should not be seen as a one-off changes; each would require specific learning, innovation, and adaptation over time. What works in year one to shift care from hospitals to communities may not be as effective in year 10. The use of technology in successive years requires continuous changes in skills, communication, information, and regulation. Preventing illness is deeply rooted in a changing social context—which includes social exclusion, inappropriate services, and prejudice—and also requires individuals to develop new skills in self-care to enhance their own well-being. As such, there is a key question to address regarding all three shifts: How do we build a health and care service that has innovation at its core?
As the government seeks ideas to set the NHS on a path for the future, a capacity for innovation must be a top priority.
RAND Europe was asked to evaluate an initiative launched by the Health Foundation in 2021: the Adopting Innovation programme. The programme led to the creation of four innovation hubs designed to act as centres of expertise and support within provider organisations and their local health systems. Ultimately, the aim was to help people within the NHS become more effective adopters of innovation. Learning from this experience offers valuable insights into how the 10-year plan might be delivered.
The Health Foundation's approach was informed by at least two crucial observations. The first was that innovations often need to be adapted to fit local needs and ways of working. By empowering local NHS providers, it was anticipated that innovation adaptation would be prioritised and implemented. The second observation was that, as important as robust research is in developing new innovations, the supply of innovations is only half the battle. Rather, there needs to be an ecosystem that is capable of—and even hungry for—adopting innovation. This, however, is a significant challenge in a health and care system that is under extreme pressure and lacks financial resources.
To explore an approach that encourages local innovation implementation, with appropriate adaptation based on distinct contextual factors, the Health Foundation funded four hubs based in Bradford and Craven, Cambridgeshire and Peterborough, Dorset, and Manchester. The remit of each innovation hub was to help build knowledge, skills, and confidence, create a culture more supportive of innovation, and accelerate the adoption and spread of innovations in health and social care.
The Adopting Innovation programme created a unique opportunity to observe what happens when a novel catalyst for innovation uptake is introduced into a local health system's innovation-implementation ecosystem. Our evaluation highlighted three core functions in which the hubs added value within their existing, complex innovation-implementation ecosystems. These functions—coordinating innovation activities, raising awareness, and building partnership—have lessons for the 10-year plan.
Hubs played a key role in coordinating innovation activities within their local health systems. For example, one hub was described as a “landing zone” for innovation. Hubs also added value by providing a functional support role, striving to understand local demand and national mandates. Additionally, some saw the hubs as extensions of existing entities within the system, such as Health Innovation Networks, furthering their priorities and goals.
Lessons for the 10-year plan: Our evaluation highlighted the benefits of locally supporting a consistent focus on opportunities, the ability to assess their potential impact and local relevance, the capacity to adapt innovations to suit local circumstances, and fostering a culture of considered, intentional innovation. Responsibility for authorising this, we believe, should sit with the Integrated Care Board (ICB) and, where necessary, their regional partners. NHS England should maintain oversight to ensure this is achieved.
Hubs played an important role in disseminating information and raising awareness about innovation. This included fostering conversations and increasing the visibility of innovation; engaging with senior leadership, with examples of innovation now forming part of regular conversations; and chief executives across systems being further involved in discussions. Hubs supported increasing the profile and highlighting the value of innovation adoption through communication activities and their training/educational offerings.
Lessons for the 10-year plan: Senior leadership within health and care will only become the intended target for new ideas and ways of working if they demonstrate their commitment to innovation. Creating a focus for communicating information about the relevance, feasibility, and potential impact of innovations will provide a key driver for local innovation systems. Senior leaders are likely to act on this only if it is part of their mandated work and a key performance indicator. ICBs can coordinate the production and dissemination of information, and incentivised and accountable chief executives can use this to inform their decisions.
Developing partnerships and relationships was another central activity of the hubs, adding value within their systems. This function included connecting and convening key players involved in innovation activities, and the relational aspect helped bring people together around shared ideas or goals. One local system was likened to a large jigsaw puzzle, where the hub moved the different pieces around, seeing what fits and connects. The hubs also enabled some partners to become more aware of what else was happening in their system and possible opportunities to link and collaborate on innovation activities.
The 10-year plan needs a path that supports long-term, continuous, and steady change and adaptation.
Lessons for the 10-year plan: ICBs can coordinate and authorise senior leadership to take action, but much of the energy for cross-organisational work and engagement with wider stakeholders (including in some instances service users and the public) was generated through partnerships. These partnerships are mostly locally based and include the voluntary, community, public, and private sectors. To be effective and visible, these partnerships need only the belief that they can make a difference (and that decisionmakers will take action). However, they also require small investments to coordinate, inform, and engage partnerships in the innovation ecosystem. This might be coordinated and authorised by a working group from or within the ICB (or within a 'hub'-like entity or equivalent).
The 10-year plan needs a path that supports long-term, continuous, and steady change and adaptation. It should not be a one-off service transformation, but rather an iterative and careful redesign of services, guided by the three shifts. This will deliver quicker benefits in the short term and provide a framework for long-term transformation. While a hub model is not the only method for achieving this, a regional innovation ecosystem that utilises the three core functions we identified will play a key role in building a health and care system that is fit for the future.
