Science and Innovation in the NHS

July’s Care Conversation event heard the Department of Health’s National Clinical Director for Pathology, Dr Ian Barnes, discuss science and innovation in the NHS.

‘If people really focus on improving the way they work, then the 20 per cent savings in the NHS are not a big ask,’ Dr Ian Barnes told Care Conversation delegates. The NHS had a worldwide reputation for science and discovery, he told the seminar, but it was less successful at adopting and spreading that innovation at pace and scale. “It’s about how you get people to adopt new technology and new working practices, because this is about change and people don’t like change. So we give stuff away to other countries to use, and five years later we say ‘we invented that, why aren’t we using it?’

The NHS had 55,000 healthcare scientists across 45 scientific specialisms, including biology, genetics, physiology, physics and bioengineering. ‘These people are gold dust,’ he said. However, innovation itself was not always a good thing he stressed. “Innovation is something anyone can do, but there has to be scientific rigour. Science and research underpins healthcare, and if we lose that scientific basis we are going to be in a very bad position.’

The concept of innovation was a broad one, he said. ‘A lot of it is about service improvement’ removing waste and reducing variation – and it has to stand up financially. It has to deliver value, particularly in the financial climate we find ourselves in in the NHS.” However, the NHS QIPP Programme (Quality, Innovation, Productivity and Prevention) included a specific focus on working practices and technology, he said. The 2011 NHS Operating Framework also clearly stated that research was a key NHS function, and there were a range of bodies and organisations involved in science and innovation, including the National Institute for Health Research, the Technology Strategy Board, the Life Sciences Innovation Delivery Board and the Technology Adoption Centre. ‘There’s still a lot of investment going into this,’ he said.

Some of the barriers to the adoption and spread of innovation were cultural, he said. ‘We have a very strange view that anything coming from France, Germany or America’ even if it comes with an evidence base – has to be proven again. We can be very risk-averse in the NHS, and we can also be bad at disseminating best practice and evidence. ‘We get professional resistance to all sorts of things.’

Other barriers included commissioning and contracting. ‘Some contracts inhibit innovation because you tie yourself in for a long time, short-term planning, silo working, and issues around tariffs and procurement bureaucracy, where costs could be “enormous”. Fragmentation in the NHS was also an issue, he said. “It’s difficult to get large-scale stuff done, because in every little arena they’re doing it themselves.”

“Science and innovation, like everything else in healthcare, is in a state of flux” said Dr Barnes. What was needed was both “push and pull”, he told delegates. “But often in the past it’s just been about push – a national drive from the top.” Performance management would become increasingly important, with much more comparative data, while clinical champions were vital – “people who are willing to put their heads above the parapet”. However, it would be clinical need that would determine future directions, alongside patient choice and equality of access.

“We need better integration of the process of getting to the point of adoption – integrating the evidence and financial and value assessments. We need better collaboration, we need to improve procurement, and we need strong leadership – people who are prepared to sell the vision. At the moment, a lot of people just have their nose to the grindstone and are not willing to do that.” IT technology and connectivity were also fundamental to enabling innovation, he said, and it was vital to identify incentives. “How do we incentivise organisations?”

Private sector providers and industry were also critical players in science and innovation, he told the seminar. “Industry is producing technology that is faster and ever-more reliable, but we need the workforce skills to match that technology. If the private sector wants to be part of integrated healthcare, then they need to work hand-in-hand with us in supporting research and training – if we don’t get that right, we’re going to have real problems.

“The government will only meet its £20bn target by driving through innovation,” he said. “Otherwise, it’s by cut-and-burn. And no one wants that.”