Innovation: 'Silver bullet' solutions are out and test beds are in

Surgeon, writer and recent Reith lecturer Atul Gawande tells the story of how Boston surgeon Henry Jacob Bigelow revolutionised medicine in 1846 with the discovery of anaesthesia. By the following year, Bigelow’s innovation had spread across most of the world.

‘Good ideas do not spread themselves. This is as true in the NHS today as it was in Lister’s time’

Contrast this with Joseph Lister’s publication of the antiseptic effects of carbolic acid in 1867. Although sepsis was the single biggest killer of surgical patients, it took another generation before Lister’s innovation became common practice.

Gawande’s point is that good ideas do not spread themselves. This is as true in the NHS today as it was in Lister’s time. In our visits to hospitals or family doctor surgeries there is rarely a shortage of good ideas. But too few spread beyond where they originate.

One reason for this is that technologies have all too often been piloted without complementary changes to existing working practices in the NHS, curtailing their value. For example, although wearable devices offer great potential for generating rich, personalised data and motivating people to live in healthier ways, they will be even more powerful if they connect people to health professionals, creating the platform for truly personalised care.

A related reason is that the NHS invests comparatively little in understanding what works in real world settings. There are many channels to support academic and early stage research. But what works in research settings does not always match what works in the complicated context of NHS services.

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Limited insight

Even where “whole system” innovations have been tested, the design has usually been weak, with an absence of control groups and disciplined implementation. Without this rigorous design, these innovations have generally yielded limited insight into their potential to improve NHS services.

These shortcomings are all the more important because the era of blockbuster “silver bullet” technologies or treatments is probably drawing to a close. A recent analysis of American patent records shows that while new patents continue to increase, the introduction of entirely new technologies has levelled off, replaced by combinations and recombinations of existing technologies.

‘The era of blockbuster “silver bullet” technologies or treatments is probably drawing to a close’

This is true in healthcare too. Innovation is increasingly about combining new technologies with other necessary components such as workforce changes, new ways of engaging people and patients, informatics and digital channels.

Even more exciting is the prospect of colliding technologies from other sectors with healthcare in the way we’re already starting to see with mobile health, big data and even gaming. Multidisciplinary and “combinatorial” innovation will shape the future of healthcare more than standalone technologies.

That’s why, late in March, we issued a call to global innovators to express interest in our test bed programme. Their reply was a shout - more than a thousand have attended a series of “live” and virtual events over the past couple of weeks.

From mobile technologies that measure the “small data” of our individual lifestyles and biomarkers, to innovations that exploit the “big data“ created by population level data sets, the appetite of this burgeoning community of healthcare innovators to partner with the NHS was there for all to see.

Unlocking potential

But we’re not after innovation for its own sake. In fact, many new technologies add more cost than they create value.

The test bed programme aims to catalyse innovations that – combined with new ways of delivering NHS services – could unlock better value for patients and taxpayers alike.

Consider Gnosall Surgery in Stafford, where hospital consultants work alongside social care professionals and GPs to improve dementia care. Patient centred plans are managed using mobile technology, and “eldercare facilitators” – who are often retired healthcare professionals – act as advocates for patients and help to coordinate services.

‘The programme aims to catalyse innovations that could unlock better value for patients and taxpayers alike’

The results? Higher dementia detection rates, shorter diagnosis times, near perfect patient satisfaction – all for less overall cost and reduced hospital use.

So we’re issuing a challenge to NHS providers that want to innovate better value healthcare, working with new technologies that could transform how services are delivered.

These NHS test beds will combine and share data across multiple sectors – primary, community and social care as well as hospitals.

They will be enthusiastic about rigorously testing innovations at scale, and ready to complement these innovations with new ways of delivering NHS services to unlock their full potential. 

Matchmaking process

If this sounds like you then express interest online by 12 June. 

For our part, we will be running a brokering or “matchmaking” process, together with our academic health science network partners, to help NHS sites partner with innovators offering potential solutions to the big challenges in delivering healthcare.

‘The NHS should be the best place in the world to test multidisciplinary or combinatorial innovation’

We will also support these partnerships with national sponsorship, problem solving and a bit of investment. 

The NHS should be the best place in the world to test multidisciplinary or combinatorial innovation, with its universal coverage and diverse population. The test bed programme will make a start towards realising this ambition.    

Please get in touch at england.innovation@nhs.net.

Michael Macdonnell is NHS England’s strategy director