The National Health Service (NHS), in common with most other healthcare systems in high-income countries, is under pressure to meet the growing demand for healthcare services with limited resources. NHS England anticipates that the population's need for healthcare services will continue to grow faster than the funding available for those services. The Department of Health has identified improving the uptake and diffusion of innovation within the NHS as a potential solution to this increasing demand. The Innovation, Health and Wealth (IHW) strategy makes the case that innovation can improve both quality and productivity and that, in the context of increasing demands for care in a financially constrained system, innovation can help improve efficiency, and thus the sustainability of the NHS. However, there is no single and agreed strategy to deliver innovation. Instead, a more plausible way forward may be to develop a variety of approaches, monitor and evaluate these, and ensure that learning is fed back into future actions. This variety of policy instruments and actors characterises IHW. Whether the IHW actions have been designed and planned effectively, and whether they were well delivered and actors effectively mobilised, are questions addressed in this evaluation.
This study covers the first phase of a three-year evaluation to determine whether IHW actions are (i) working as planned and (ii) delivering their intended outcomes.
Innovation, Health and Wealth: A Welcome Attempt to Address a Complex Policy Agenda
IHW is made up of eight core themes relating to different parts of the health system: 1) reducing variation and strengthening compliance with NICE guidance; 2) improving innovation uptake; 3) metrics and the accessibility of evidence and information about new ideas; 4) establishing a more systematic delivery mechanism for diffusion and collaboration within the NHS; 5) aligning incentives and investment to reward and encourage innovation and improving procurement; 6) encouraging a change in culture within the NHS and embedding innovation into training and education for both managers and clinicians; 7) strengthening leadership for innovation throughout the NHS and increasing local accountability; and 8) identifying and mandating the adoption of high impact innovations in the NHS. Under these eight core themes, the IHW strategy identified 32 actions that collectively aimed to improve the adoption and diffusion of innovation in the NHS.
Doubts were expressed by some interviewees and survey respondents about whether the package of measures and actions considered in this evaluation will in future be packaged within the IHW framework or whether the current alignment of policy initiatives will be reconfigured. However, there appears to be a consensus that innovation is vital to the NHS and that a variety of new actors and actions are necessary to understand how best to maximise positive benefits from technical and social change.
Interviewees echoed the view put forward in IHW documents that innovation is essential for the sustainability of the NHS. Interviewees were positive about the objectives that IHW set out to achieve and its recognition of the need to improve the uptake and diffusion of innovation in the NHS. Some survey respondents highlighted that IHW was an ambitious and innovative strategy in and of itself. However, underlying these positive views there is very limited available evidence that innovations have improved the quality of care in the NHS, improved productivity or saved costs. This study details both positive and negative feedback on IHW and also makes the case that shortage of evidence is in part a reflection of gaps in the available data, which raises the question of whether existing mechanisms for data collection and analysis are sufficiently well developed.
Was IHW Well Designed? A Need to Better Articulate and Communicate the Strategy
IHW was originally conceived as a national plan for embedding innovation into the NHS, but it evolved into a more fluid mechanism for supporting innovation. In innovation strategies there are many varied policy instruments and multiple actors that create a complex landscape where there is a high likelihood of inconsistencies and redundancies. It is important to understand the success, or otherwise, of IHW in this light and not to use a yardstick of unattainable coherence, consistency and strategic uniformity. It is unsurprising that IHW evolved in unanticipated ways and that some actions seem to have been successful while others have slipped from view.
However, from the original documentation it appears that such flexibility and adaptation was only weakly locked into the design of the programme. This is a pity because the diversity contained within IHW does appear to have been built on some sound foundations. The eight IHW themes were not arbitrary, but rather built on stakeholder engagement and judgements of what was feasible and acceptable. They also reflect an appreciation of the diverse barriers to innovation in the NHS. However, the causal chain linking the actions to delivering innovation is unclear. The current scope (or even continued existence) of IHW was also unclear.
In including a variety of actions and approaches, IHW reflected the realities of supporting innovation in the healthcare system. However, the impression from stakeholders is that the evolution of IHW has not been sufficiently informed by an overall strategic sense of direction, has not been effectively communicated and is not grounded in learning and emerging evidence which would facilitate better communication.
Did IHW Deliver Its Intended Outcomes? Patchy Evidence and a Need for New Frameworks and Metrics
Progress towards the overarching objectives of the eight IHW themes has been variable. Interestingly, assessment of progress does not appear entirely straightforward. In the case of themes 1 (reducing variation and strengthening compliance), 2 (metrics and information) and 5 (procurement), respondents reported positive progress towards some of the actions within the themes, but not others, such that overall progress towards the theme's objectives was mixed. For themes 3 (creating a system for delivery of innovation) and 8 (high impact innovations), respondents reported some progress on almost all of the actions within the theme, and towards the theme's overarching objectives. For themes 4 (incentives and investment), 6 (developing our people) and 7 (leadership for innovation) there appears to be an ambiguous relationship between the theme's objectives and its actions. For themes 6 and 7 positive progress was reported towards the themes' objectives and this was attributed to IHW, even though we found little progress on the implementation of any of the actions within the themes, while for theme 4 very little progress was reported towards the theme's objective, despite positive progress being made towards two out of the three actions. For theme 1, while most respondents reported improvements in compliance with NICE guidance, few survey respondents attributed these improvements to IHW or reported there to have been overall improvements in reducing variation in care.
A number of challenges exist in the assessment of many of IHW's actions and objectives. Some actions have been completed, but IHW's ongoing involvement in, and the expected outcomes of, those actions is not clear. Similarly, some actions have been implemented, but it is often still too early to assess their impact because they were not expected to deliver measurable outcomes in the short term. This variability in the implementation of individual actions may stem in part from the paucity of implementation guidance and ongoing monitoring for the individual IHW actions.
Overall, achieving progress in terms of the aims of IHW and each of its eight themes is more complex than simply implementing the actions within those themes. The relationship between actions and achievement of intended outcomes within IHW is not linear and progress is mixed (see Table 1). Furthermore, where there has not been measurable progress towards actions or themes, the IHW strategy may nonetheless have been important as a symbol of the shift towards innovation in the NHS.
Table 1. Summary of Progress Towards IHW Actions
|Theme 1: Reduce variation and strengthen compliance|
|NICE Compliance Regime (Publication of NHS Formularies, NICE guidance called “Medicines Practice Guideline”)||Active|
|NICE Implementation Collaborative||Active; pilot stage|
|Theme 2: Metrics and information|
|Clinical Practice Research Database (CPRD) datalink||Established March 2012|
|Innovation Compass||Active; pilot stage|
|Web Portal (Innovation Exchange)||Active|
|Which? Consumer campaign||Not implemented|
|Theme 3: Creating a system for delivery of innovation|
|Academic Health and Science Networks (AHSNs)||Established May 2013|
|Sunset Review||Not published|
|Innovation Technology Adoption Procurement Programme (iTAPP) (renamed Medtech Innovation Briefings)||Active|
|Theme 4: Incentives and investment|
|Innovation Challenge Prizes||Active|
|Never Events||List updated in February 2012|
|Specialised Services Commissioning Innovation Fund (SSCIF)||Suspended|
|Theme 5: Procurement|
|Intellectual Property Strategy||Not published|
|Procurement Strategy||Published May 2012|
|Small Business Research Initiative||Active|
|Theme 6: Developing our people|
|Hardwiring innovation into education and competency frameworks||Not documented|
|Innovation Fellowship Scheme (renamed NHS Innovation Accelerator)||Competition opened January 2015|
|Joint industry and NHS training for senior managers—ITW Innovation Network||ITW network established. No information on content or outputs|
|Theme 7: Leadership for innovation|
|CCG legal duty||Written into Health and Social Care Act, March 2013|
|Innovation Pipeline Project||Launched in February 2012. Ongoing progress not clear|
|NHS Operating Framework||Superseded|
|Strengthening Leadership and Accountability||Strengthening Leadership and Accountability for Innovation published August 2013|
|Theme 8: High Impact Innovations|
|High Impact Innovations (HIIs)||Varies by area|
|CQUIN pre-qualification||Superseded by Service Development and Improvement Plan|
The research described in this article was funded by the Department of Health Policy Research Programme was conducted by RAND Europe.