Testing your digital health innovation in the NHS

As many digital health innovators will understand, getting innovation into the NHS can sometimes be difficult. Megan Morys-Carter, director of TheHill discusses the topic of testing digital innovation in the NHS.

Please stop emailing me to say that you can fix [insert known pressure] with an [insert AI or ML] solution which is [insert vender x cloud] based, when it’s a non evidenced opportunist based pitch of 👇 pic.twitter.com/9VyfVMEgsn

— David Walliker (@InsideHealthCIO) October 24, 2021

Recently, a CIO on Twitter asked innovators to stop sending him “non-evidence –based opportunistic pitches”.  An innovator responded with “how can you build the evidence without trusts willing to review and test your products?” and there was an extensive conversation showing frustration on both sides.

It’s easy to see why both NHS staff and innovators can be frustrated. You shouldn’t need to knock on the door of the most senior IT person in an organisation to sell your product – nor is it appropriate for that person’s time to be taken up with sales pitches. And yet, that’s what happens, leading to the kind of exchange above.

Facilitating this interaction is a big win for the UK. The data and expertise of the NHS could be a fantastic resource for UK companies growing new digital health ideas – helping them compete in a global marketplace. And as citizens, patients, and NHS staff everyone in the UK could benefit from the latest in cutting-edge care and time-saving technology.

Knowing the right steps to take

So how do you get your product tested before it has evidence? More appropriate front doors to the NHS exist: quite a few of them in fact. (full disclosure: I run one of them, TheHill).

Answering these three questions will help you find the right entry point and have a constructive conversation:

• What benefits does your product bring? What problem are you trying to solve?
• How does this align with the strategic priorities of the NHS (or the bit of the NHS that you’re interacting with)
• What stage are you at?

Firstly, benefits (not features). Articulating the benefits of your product should be second nature to any entrepreneur. Make sure you think about these from the point of view of patients (improved outcomes, better experience), staff (as above plus ease of use, time saving, solving their problems) and the institution (add cost saving, hitting specific targets, strategic priorities/urgent requirements). Although everyone in the NHS is focussed on improved outcomes for patients, if you can’t help them release the funds to pay for your product, it might be difficult for them to say yes.

Once you’re clear about benefits, think about how these fit with the strategic priorities for the NHS. This can be at a political level (for example, you might realise that mental health has gained in prominence and has been recognised as underfunded, or that social care has become a government priority), an NHS national level (start with the NHS Long Term Plan) or a priority for the institution you’re talking to. Priorities will vary from one institution to another, depending on their patient mix, level of resourcing and current status quo, so don’t assume that because you address a national priority, that’s also the local or regional imperative. If you have a genuinely useful innovation, it’s likely that someone somewhere agrees it’s important, so seek out those individuals and institutions to connect with in the first instance.

That brings us to the third question: assessing what stage you’re at. Investors tell me that the NHS is a difficult first market, and they’re right:. The reason for that being that the NHS requires a high level of evidence – proof, if you like – of efficacy and safety claims before it will purchase a product. The NHS is funded by public money and is naturally risk-adverse and safeguards that money to ensure best value for patients. However, the NHS is also full of innovative people interested in cutting edge technology and can be a great partner in developing products if you approach in the right way.

If you’ve got a product idea and some basic efficacy data, but you haven’t yet got large cohort data showing it has measurable effects, or if you know it’s safe and has an impact, but you’re not sure if it’s cost effective for the service, you’re probably looking for a research collaboration. This a great news, as the UK spends over £2billion on medical research every year, and there are lots of skilled academic clinicians who could partner with you. To set-up a useful project, you’ll need to think carefully about the previous two questions – benefits and strategy – to define your metrics to be convincing for a later sale. There are lots of research grants available from the likes of Innovate UK and NIHR [National Institute for Health Research] as well as the academic research councils, and you can also self-fund research. You should look for partnerships with some of the research-active trusts in the NHS (often, but not always, with ‘university’ in the name).

If you have strong efficacy and safety data, the relevant regulatory approval and health economic analysis, maybe even sales in another country or the private sector, you may feel like you’re ready to make a sale, and in some cases that might be right. However, if you haven’t tested it in any NHS settings, or sold to any other NHS institutions, you might come across some reluctance to take a punt on what seems like ‘untested’ technology. What if it doesn’t work in an NHS context? Here, your best bet is a service evaluation or pilot project, to test it out in a real live operational environment, get valuable feedback and metrics you can take on to NHS sales. Pilots can be grant funded (Innovate UK for example), “no-cost pilots” (everyone covers their own costs), self-funded (you fund the costs) or paid pilots (effectively wrapped into a procurement process, where you get paid for the pilot period at a reduced rate). Service evaluation projects can be a great way to get a foot in the door and prove your worth, especially if your fit with NHS strategic priorities isn’t clear from your efficacy data – but can be shown in a live setting – or if it’s not the urgent priority right now, but will be in a year’s time.

Finally, if you’ve already got your safety, efficacy, health economic and regulatory data; you can show how your product works in an NHS institution, either through a service evaluation or pilot; AND you fit with the strategic priorities of the institution you’re selling to, you’re at the procurement stage. There will often be a specific call for technology that you can respond to, or you may need to create a desire for your product specifically by working with frontline clinicians and other influencers. Getting yourself onto a national framework, keeping an eye out for relevant grants, tenders, and procurement exercises, and forming relationships with the relevant procurement professionals are all useful activities – most important is being in the right place at the right time, with your homework done and your evidence available.

Not sure where to go from here? Try the following steps:

1. Contact an NHS innovation hub and ask them to help you decide what stage you’re at. This could be one of your local/regional teams (check online to see if there is an innovation hub near you), teams that run national programmes such as TheHill or one of the Academic Health Science Networks
2. Build relationships with your regional institutions, and read their strategic plans and priorities (Oxford University Hospitals has a five-year strategic plan, for example). Can you help them achieve their goals? Do they have a research team, innovation team or procurement team who should be your first point of contact? (hint: not usually the CIO! ????)
3. If you have a relatively well-developed product, search for national funding streams, frameworks or programmes that align with your product benefits and apply to them (the innovation hubs can often help you do this)
4. If you’re at an earlier stage, consider an NHS-based Accelerator programme to help you get off the ground quickly. (TheHill Market Access Accelerator, Digital Health, London Accelerator and the NHS Innovation Accelerator all offer NHS-linked acceleration)
5. Most importantly, network, build relationships and put yourself in the frame. Attend networking events and conferences, build relationships online and don’t be afraid to ask for advice and support – the NHS is keen to engage with your innovation and there are open doors if you look for them.