A complex patchwork of programmes How do we get the balance right to support health technology and innovation?

Technology is one of the great hopes for improving quality and efficiency in the NHS. But the current health technology innovation landscape is fast-moving and complex. To better understand it, earlier this year we undertook a mapping exercise to capture a snapshot of the range of programmes and activity that could support the development and use of health technology innovation in the NHS.

As part of this, we looked at the complex patchwork of programmes run by government and public sector bodies in England, analysing the type of activity they supported, their stated programme focus and budget, whether they offered funding and to whom, and – for innovation-related programmes – the stage of the innovation cycle supported.

During April–May 2021, we identified 98 programmes in total that were either underway or had recently concluded, of which 75 directly supported innovation. While we can be confident our mapping covers many of the organisations and programmes of interest, we cannot claim it is comprehensive. Nevertheless, looking across these programmes, some clear patterns began to emerge, which led us to ask: is the balance right in terms of their focus overall? Here we set out three observations about where the focus is and what might be missing.

Adoption is critical for successful change but still loses out to innovation

In our 2018 report The spread challenge, we called for a greater focus on the adoption and spread of technologies, and in recent years there have been welcome moves by national bodies towards addressing this. Examples of spread-focused programmes include the AHSN Network’s national spread programme and NHSEI’s Rapid Uptake Products programme.

While it is encouraging to see an increasing focus on adoption and spread, our analysis shows the balance is still firmly towards supporting pilots and innovation. Of the 31 innovation programmes we identified as offering funding, 22 offered support for innovators only, compared with four offering support for adopters only (such as the Innovation and Technology Payment, and the AHSN national programme for adoption and spread). Five programmes directly supported both innovators and adopters.

So there is definitely more room to support adoption. Whether through programmes that focus solely on adopters or not, it’s important that spread programmes promote adopter capability and readiness, and provide implementation support – for clinical backfill, staff training, and evaluation, for instance.

The NHS can’t wait years to know what works

Evaluation is critical to understanding what works, what doesn’t and why. In particular, testing innovations in real-world settings is a crucial part of supporting adoption and spread. It helps to understand the impact of innovations on quality of care, including on health outcomes and patient and staff experience, and whether there might be any unintended consequences. It was encouraging to see a growing focus on real-world testing in the NHS Long Term Plan, for example NHSEI’s Test Bed programme, and it is important that organisations continue to provide support for this, through programmes like the AHSN Innovation Exchange and NIHR’s Invention for Innovation Challenge awards.

A major challenge is the speed of evaluation. Given the pace at which technologies are developed and introduced – notably during the COVID-19 pandemic – it is important that there is the ability to evaluate them quickly where necessary, to answer important questions about safety, affordability and effectiveness. Public Health England produced some guidance on rapidly evaluating digital health products during the pandemic, but there are very few national funding programmes offering specific support for this. The NIHR-funded BRACE and RSET rapid service evaluation centres are doing important work in this space, but their total allocation for a 5-year period is around £5m – a relatively small proportion of the NIHR budget.

Given the urgency of change and the speed at which new uses of technology are developing, a greater focus on evaluation approaches that can generate timely results would be helpful. The Improvement Analytics Unit, a partnership between NHSEI and the Health Foundation, is an example of how to provide rapid and robust evaluation of complex changes in the NHS; they are currently carrying out an evaluation of digital first primary care.

Clinical innovation understandably dominates but we shouldn’t neglect administrative and operational innovation

Fostering clinical innovation, such as AI to support diagnosis, is an important route to improving quality of care. But technology can also be helpful in streamlining and supporting administrative tasks (such as processing referral letters or appointment scheduling), which can improve productivity and free up time for other work, including patient care.

Of the 75 programmes identified as directly supporting innovation (either through funding or other forms of support), 39 were focused solely on clinical innovation and the majority of the remainder were focused primarily on clinical innovation (even where they had some eligibility for non-clinical projects). By contrast, while some programmes supported both types of innovation (such as the NHS Innovation Accelerator), only two were focused solely on non-clinical innovation (NHSEI’s Local Health and Care Record exemplars and the NHS Digital Interoperability data design collaborative).

Furthermore, of the three programmes with an explicit focus on improving productivity (NHSX’s Digital Productivity Programme, NHSX’s Innovation Collaborative, and UKRI’s Digital Health Technology Catalyst), only the NHSX Digital Productivity Programme had a focus on how technologies can improve productivity in non-clinical as well as clinical work. While programmes that primarily focus on clinical innovation may of course also improve administrative processes, there is still more that could be done to support the development and application of technology to administrative and operational work in health care.

Getting the balance right

Our mapping exercise and emerging findings show the high volume of programmes and initiatives focused on technology and innovation in the NHS, and the large number of organisations involved. Our exploration of this landscape suggests three areas where a greater focus could be needed:

• making more funding available to adopters, to better support the uptake of innovation
• a greater focus on rapid evaluation 
• more support for innovation focused on the administrative parts of workflows.

While some might question the sheer number of programmes in existence, this is not necessarily a problem if different programmes have genuinely different objectives. What does become clear, however, is that the overall shape of the technology and innovation ecosystem doesn’t necessarily reflect an intentional design: it has evolved from a myriad of decisions and activities by different organisations, each with their own priorities, creating a patchwork of sectoral and thematic programmes. Mapping the volume and nature of this activity can highlight gaps, overlaps and, crucially, areas where action can be taken to improve the balance of the ecosystem as a whole.

Shakira Mahadeva (@shakiraa_km) worked as an intern in the Improvement team at the Health Foundation.

Tom Hardie (@tlhardie1) is an Improvement Fellow at the Health Foundation.

Tim Horton (@timjhorton) is Assistant Director (Insight and Analysis) in the Improvement team at the Health Foundation.