Driving innovation in a modern NHS

Group riding a bike to show driving innovation in a modern NHS

The role of the Accelerated Access Collaborative and how it is driving innovation in a modern NHS is discussed by James Roach and Johnny Skillicorn-Aston of Conclusio. What is pharma’s role and what does it mean for patients?

Innovation in the NHS sometimes takes two steps forward and one back. The one back is often a result of reduced traction in mobilisation and delivery which can constrain positive change and reduce the rate of transformation.

Published in 2016, the Accelerated Access Review set out a multi-faceted outlook to speed up access to innovative drugs, devices and diagnostics for NHS patients along with digital products.

These areas are to be vehicles to deliver better patient outcomes and increase the profile of the UK among the international life science community.

“Faster access to treatments that could improve up to 500,000 lives”

Accelerated Access Collaborative

The result of the Review was the establishment of the Accelerated Access Collaborative (AAC) to drive the uptake and adoption of innovation in the NHS. Under the leadership of Dr Sam Roberts, the AAC is the overarching agency for health innovation, supporting innovators and setting strategy. He has been clear about the challenges faced by the AAC; custom and practice, and ownership of innovation being prime.

The funding dynamics must include how to incentivise innovators, position the right encouragements and inducements; not just for innovators but also for providers and commissioners alike.

Custom and practice also require ground-breaking change to healthcare roles, procurement and clinical settings. However, ownership needs to be the core responsibility so that good innovation can be identified and spread. This is the role of the Academic Health Science Networks (AHSN).

Academic Health Science Networks

The AHSNs are a bridge between research, life sciences industry and healthcare. Relicensed in 2018 as the key NHS transformation arm, in the past they’ve been criticised for being loosely defined in their role and short-termist in their outlook. However, now central to the ambitions of the NHS Long Term Plan (LTP), AHSNs can be pivotal in bringing together formal (top down) pathways to innovation and uptake, and informal (bottom up) pathways.

Perhaps the greatest challenge for both the AAC and AHSNs is how local dynamics influence what happens at a centralised and national level. Without this being hardwired into the process, attempts to innovate and transform will lack meaning.

Pharma’s role

Converting life science developments and innovations into life-changing outcomes is a central objective for the LTP and the prime agency in this is the AAC. Through supporting the rapid uptake of seven high-potential technology areas, it aims to give patients faster access to treatments that could improve up to 500,000 lives and bring £30m in savings to the NHS.

What happens in the pharmaceutical space will be profoundly important in showing achievement against these ambitious plans. It will be the repository of experience and real-world evidence that will increase the rate of innovation, develop and finesse further transformation, deliver better outcomes and reduce health inequalities.

Localising the value of this work is critical and medicines represent a great opportunity to do this.

While we have a multi-faceted outlook in play, for some time innovation in the NHS has been viewed only through the twin lens of ‘device’ and ‘procedure’. Some would argue that this has resulted in medicines becoming the poorer relation.

NHS Chief Executive Simon Stevens recently confirmed: “Preparations are under way to make sure the NHS can adopt the next generation of treatments.”

With an advisory note around price, the opportunity is clear within pharma; a space burgeoning for medicines innovation and optimisation that will contribute to the transformation and savings the NHS wants to achieve as part of its LTP.

Establishing a strong position for biosimilars in the medicines supply chain is a prime opportunity. Key to this are the ambitions and designs of NHS England’s Commercial Medicines Directorate. It seeks to derive maximum value within the increasing spend on medicines, which will be £300m per year by 2021. Biosimilars represent the chance to make significant savings that can be reinvested in frontline services.

Unlocking potential

The key to unlocking this potential is the strength of local system relationships and engagement with patients at local level. In other words, using data drawn from the experience of health professionals, managers and patients to develop a cutting-edge population health model which draws out the clinical, financial and social benefits of delivering transformation.

Unfortunately, the local picture can be as disparate as the national one. To put this right and get the right positive alignment has brought about the merging of NHS England and NHS Improvement at a national level, and locally, moves to establish integrated care systems continue.

However, creating a commonwealth of organisations is currently elusive, as demonstrated by the relatively weak connectivity between the NHS, academic organisations, local authorities, the third sector and industry, which is being addressed by the AHSNs.

AHSN network

The AHSN network is an ideal vehicle for socialising and localising the aims of the AAC within health systems. Its ‘small organisation’ model makes it responsive to identifying and adapting to emerging opportunities and challenges. Operating across a regional network, it can bring both human and system resources together quickly and support innovation that improves patient outcomes, returns value into the NHS and promotes economic and market growth.

The AAC aims to identify future innovations that will bring the maximum benefit to the NHS and its patients. It also acts as a signalling-post of national NHS priorities, drumming up interest and collaboration among researchers and innovators. The AHSN supports at local level and its national reach and link between NHS, academia and industry can drive both innovation and service improvements.

A test-bed approach is a positive basis for innovation, and this is critical for pharma. Understanding the value of new medicines, not just through the clinical impacts for the patient but also through increased wellbeing, social and economic capital, is important in a changing NHS.

“A test-bed approach is a positive basis for innovation, and this is critical for pharma”

Patient engagement

Working with local data provides an opportunity to analyse from the bottom-up and identify impact where it is felt most – in patient gains. Engaging with patients around where this might steer future innovation at a local level commits commissioners, providers and patients to a shared enterprise. This helps to translate the grand strategy of innovation into a universally intelligible language of benefits and improvement. Evidencing cure; the rate at which morbidity and disability is reduced or constrained, and the longevity of impact requires a joint approach at local level around case-finding and how we manage patients.

While the NHS is multi-factorial, patients largely view it as a single entity – after all, it’s what we have been peddling for years. Patients expect and deserve optimal care, but we can’t deliver this without understanding what represents sub-optimal care.

Despite developments in co-design of care pathways, we still need to up the rate at which we operate in partnership.

Operating across academia, industry and NHS, and enshrining the free movement of ideas, opportunity and science, means building a new transformational landscape with innovation superhighways. This also needs to be instituted at a local level as patients deserve to be consulted the moment that pathway redesign or reconfiguration enters the head of a local commissioner.

A quick scan of who is out there reveals, at representative level, Healthwatch, patient groups and voluntary organisations. At individual level, it’s patient participation groups and networks. It is within this space that we can drill down into the felt experience and compare and contrast with what the activity and outcome data tell us. In doing so, we move closer to the patient and place them centrally to our plans and schemes. For pharma, it represents an opportunity to distil what is done at scale into an essence of what is experienced.

Top 5 Takeaways

  1. Medicines innovation and optimisation will contribute to the transformation and savings the NHS wants as part of its LTP.
  2. Biosimilars represent the chance to make significant savings that are then reinvested in frontline services.
  3. Creating a ‘commonwealth of organisations’ is currently elusive.
  4. A test-bed approach is a positive basis for innovation.
  5. Working with local data provides an opportunity to analyse from the bottom-up.

James Roach is Managing Director and Johnny Skillicorn-Aston is Communications and Engagement Director at Conclusio.