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All’s fair in health and care?

How real-world learning and insight on spread is helping combat health inequalities.

In our latest guest blog, Laura Boyd, Deputy Director for the NHS Innovation Accelerator (NIA), reacts to the revelations of the Medical Technology Group’s Ration Watch campaign, and explains more about the role of the NIA.

As a child growing up with a younger brother and always having to share, I learnt the concept of everything being fair at a young age.  Even my father often reminding me that life is not fair did not dissuade me from a life-long mission to make it fairer for others.  This is one of the reasons I wanted to work for the NHS Innovation Accelerator (NIA), which aims to spread innovation faster for greater patient benefit.

If one segment of the population is receiving better health outcomes due to a new (cost-effective) practice, service or product, it is our duty to ensure the whole population can access them.  As patient Anna Doherty recently said at the launch of the NIA’s fourth cohort: “It’s not innovation, it is common sense.”

Each year the NIA has an annual call for evidence-based innovations led by exceptional individuals or ‘Fellows’ willing to share their experience in spread. The 52 innovations supported to date include:

  • Episcissors: a pair of scissors ensuring a 60-degree episiotomy is given as per professional guidelines
  • PneuX Prevention System: preventing ventilator-associated pneumonia in intensive care
  • io: smartphone-based urinalysis device meaning people can avoid travelling into a clinic to undertake urine testing
  • Coordinate My Care: ensuring a person’s wishes about their care are enacted upon during a crisis and / or at the end of life

All deliver better outcomes, improve patient experience, and reduce cost to healthcare.

However, our experiences of supporting the NIA Fellows (reflected in much of the literature about innovation spread) reveals and highlights the complexity of scaling proven innovation.  Even when major barriers such as funding or procurement are removed, uptake can be sluggishly slow.

At the Parliamentary launch of the MTG’s Ration Watch campaign just before Christmas, I was shocked to discover that many proven procedures – services that were innovations of their time (first hip replacement in 1940; first cataract removal in 1748) – were being stopped.  Not because they have been superseded by other techniques, nor because need has dwindled: access is now limited to control budget.

The irony in this is that stopping some of these procedures simply adds cost to the health and social care system further down the line.  As Ian Eardley, Senior Vice President of the Royal College of Surgeons said: “…patients will spend more time in pain with potential deterioration of their condition, thereby generating further costs for a system already under acute financial strain.”

I had naively imagined that the challenges of access to innovation applied to new things – not to existing, routine procedures where there is strong clinical evidence.

It struck me then that the learnings and insights generated through the real-world experiences of the NIA Fellows are just as applicable to ensuring the sustainability of existing procedures and services as to the new technology and models entering the market place.

A powerful enabler highlighted through the evaluation of the first year of the NIA is the role of patients in enabling innovations to spread – from design and development of the innovation, laying the groundwork for acceptability and inspiring the innovator, to actively demanding that new services are implemented.

It becomes apparent that the role of the patient is even more important in holding services to account.  Ration Watch exemplifies this.

At the NIA, we look forward to sharing learning and insight to ensure that not only is innovation spread, but that expected patient outcomes remain fair and equitable for all, and that access to proven procedures continues.

April 2019


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