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Policy yet to catch up with innovation in digital health sector, says report

Barriers such as poor procurement practices and lack of consensus about “what good looks like” can hinder NHS innovation, but there are still opportunities for digital health startups

Although digital technologies are changing the NHS, the healthcare system is still digitally risk-averse and fragmented, according to a report by investment firm Public.

The report, authored by former health minister Nicola Blackwood, highlights key barriers to the uptake of digital technologies in the NHS.   

There are many pockets of good innovation in the NHS, with strong backing for digital technologies from the centre, said the report. However, there is a key issue “across the NHS about ‘what good looks like’ with respect to evidence, and so innovators struggle to scale from one trust to another, as each may impose different standards and every company has to prove their worth from scratch all over again”, it said.  

The report added that although the general consensus is that digital systems and applications are “desirable” from a policy perspective, it is difficult for suppliers, particularly startups, to know what data they should gather to demonstrate that their product is safe, as well as economically viable.

“Policy and practice have not caught up with the pace of innovation in the digital health sector,” the report said. “Despite often compelling clinical and financial evidence, few of the startups working in the NHS today have achieved real, systemic uptake. The cost-effectiveness of new technologies has yet to be universally accepted.”

The fact that suppliers are struggling to gain entry into the NHS is nothing new, and has become more and more apparent in recent years as technology has advanced.  

In October 2017, NHS Digital’s deputy CEO, Rob Shaw, called on health and care organisations to improve the way they work with suppliers. 

Shaw said NHS organisations must become “intelligent customers”, adding that the health service has a history of making it difficult for suppliers “to deliver good services because we’ve not really been sure of what we want”. 

Public’s report also highlights this issue, saying that for innovators new to the sector, “regulation and procurement can feel like a minefield”.

Procurement is one of the main barriers to entry, as NHS procurement processes are often long and cumbersome, it said.  

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“Poor procurement practices remain a major barrier to entry in many parts of the NHS and many trusts still rely on large IT vendors, some of whom operate out-of-date business models and closed systems, giving innovators little chance to offer a competitive, agile service,” the report said.

“Many investors stay away from health, citing regulatory challenges – but in fact, if you know your way round the system, these challenges are not insuperable.”

In the report’s introduction, Blackwood said the NHS needs to reform in several areas, including how it requires evidence and evaluates new products, regulation, procurement and how it trains the workforce to understand new technologies.

“There is no other way to put this: the NHS is digitally risk-averse,” she said. “That is not to say that NHS staff are technophobes, and there are some outstanding examples of good practice across the country. But, taken as a whole, there is a collective failure of the organisation to provide the requisite opportunities to scale new technologies.

“This risk aversion is evident in decision-making processes and procurement systems, as well as in attitudes which combine to block innovation and to limit pilots, even if few are consciously opposed or deliberately obstructive.”

Although addressing these challenges is up to the Department of Health and Social Care, NHS Digital and NHS England, the report said startups also need to “do their bit”. 

“They need to understand the NHS system and to show compliance with the requisite standards,” it said. “Furthermore, startups would do well to focus, in the short term at least, on the areas where the NHS is most open to change and new digital solutions.”

According to the report, these areas include procurement and productivity, recruitment and training, prevention, winter pressures and supporting self-care, artificial intelligence in pathology and radiology, patient safety, mental health, social care and research.

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