The current context and ways forward for quality and productivity in the NHS
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The UK National Health Service is under pressure to meet the growing and changing demand for services with limited resources. Innovations may provide opportunities to respond creatively and effectively to growing health demands, but these innovations need political and financial support from decision makers.
The NHS is under pressure to meet the growing and changing demand for services with limited resources. Innovations spanning technologies, products, services and new ways of working provide opportunities to respond creatively and effectively to growing health demands across all age groups. However, such innovations need to be accomplished within well-recognised resource constraints, and both policymakers and wider stakeholders often lack the appropriate information, evidence, capabilities, resources, relationships, incentives and accountabilities to inform policy and practice.
In light of the challenges facing the NHS, RAND Europe and the University of Manchester were asked to conduct a study on the potential of innovation to help deliver an efficient and effective healthcare service. This independent research was funded by the National Institute for Health Research (NIHR) Policy Research Programme, in close collaboration with the Department of Health and Social Care, NHS England and the Office for Life Sciences.
The study proceeded in two stages. Stage 1 examined the implementation and outcomes of the Innovation, Health and Wealth strategy. Stage 2 examined four interrelated research questions:
Over the course of the research, from 2015 until early 2019, we conducted:
Diverse social and technical skills and leadership capabilities are needed to help create an environment in which innovation can be effectively managed and implemented. We identified key areas for action, including embedding innovation training into medical education curricula and continual professional development and establishing programmes for the private sector on how to effectively engage with the NHS.
The system of motivations and incentives for engaging with innovation has strengthened in recent years, but there has been less progress with ensuring accountability for innovation. Stronger accountabilities could be achieved through more focus on robust ‘adopt or explain why not’ practices; potentially embedding innovation into regulatory regimes and improvement schemes and more accountability within formal roles for innovation (e.g. in Trusts).
Decision makers across the health system have differing information and evidence needs. Current information and evidence is fragmented. The information landscape could be improved by development of a national framework and infrastructure to support coordinated information flows. The report expands on associated requisite criteria and elements of such a framework and infrastructure.
There is a need for better alignment of activities and greater clarity on respective roles and remits of different initiatives. A number of initiatives support collaboration for an innovating healthcare system, many of which are nationally governed but implemented regionally, and which support relationships that span multiple stakeholder groups. Improved coordination requires political and policy structures that are conducive to cooperation and coordination over silo working and that can support cross-departmental and cross party working. A more stable platform for success also requires a focus on supporting portfolios of innovations with different cost and quality profiles.
Additionally, policymakers need to pay attention to reconciling goals for healthcare improvement and those for economically competitive life science sectors. This could be done through closer working between healthcare policy and industrial strategy.
The current landscape for patient and public involvement and engagement (PPIE) has evolved but could be better. The value of service users’ personal experience and knowledge is recognised, however, a coordinated strategy for PPIE with innovation in the health system in England is yet to be developed. We identify the key principles that should underlie such a strategy and associated actions.
A variety of funding schemes support innovation in the health system, but there is a need to improve the coordination, sustainability and stability of funding flows. Efforts to map the funding landscape are a first step for improved funding coordination. There is also a need for reflecting on the spread of resources across innovation supply and uptake funding and new pull mechanisms that are more responsive to demand. We also identify various flexible pricing and adaptive risk-sharing arrangements that can be considered in commercial negotiations between the NHS and private sector.
Policymakers need to consider implementation and success criteria at policy design phases, to ensure policies have traction on the ground. There is a need for more timely focus on implementation, such as specifying what financial and human resources will be required, and identifying and communicating the relationships and infrastructure that are needed to support success.
There is a need for more sophisticated evaluation evidence for both the performance of individual innovations and for the performance of an innovating healthcare system. We propose four types of indicators assessing the progression of an innovation across different stages of health innovation pathways; the adoption and diffusion of innovations through the healthcare system; the impact of an innovation on patients, the population, the health system and the wider economy; and capacity for innovating in the healthcare system.
