Innovation challenges in the NHS

Written by Dr Laura James, Technical Director at Doteveryone

We were impressed during our discovery work to find many interesting examples of innovation both in and around the NHS. Sadly though, many are limited to a single local area or site, with very few able to scale up even if they are proving useful and valuable.

Organisational complexity

There are many different organisations involved in delivering care, each with different IT systems, which can create difficulties for innovation using technology. In addition there are regional variations, and differences in priorities and needs.

An individual patient may experience quite a few different services: a GP, perhaps two different hospital trusts, a local pharmacy, plus other health services. For patients in the last phases of life, with multiple conditions, this is especially the case.

Each organisation may have its own choice of IT systems, and this does not simply mean one system. A hospital trust may have around 500 IT systems covering administration, clinical functions, information sharing, data handling and more.

There are also innovation units and other forms of research and development (R&D), with organisations such as the Academic Health Science Networks developing that R&D for the market. As R&D becomes more software and data oriented, the potential links and overlaps will only grow.

Innovation in practice

There are many local pilots of products, services or systems, developed by clinicians or ex-clinicians or by startups and SMEs. It seems that clinicians (like many software developers!) are often problem-solvers by nature, and when faced with a problem or a system that performs less well than it could do, they are driven to make improvements through pilots and local deployments of new systems, which may work well, or less well.

Innovation frameworks and processes

It is the nature of innovation that not all initiatives will work out, and that some should fail or stall and not grow outside of one specific problem domain.

Good innovation frameworks for large-scale endeavours include ways to evaluate new activities, and to do further testing and scale up activities that work, whilst learning from those that do not – it isn’t about supporting all new projects to scale up.

Nationwide health and social care systems need to support innovation so that they can improve and adapt to changing circumstances.

One type of innovation is that where an innovator sets out to solve a specific problem they have. They may create a new system that works brilliantly for them, in their local environment, and even for others locally who interact with it, but which simply does not work for others because the local needs are quite specific, and what they have built addresses them very specifically.

This is not necessarily a bad thing, in that a small problem has been solved, but there are two somewhat negative consequences. One is that further energy must be expended in each local area to address the same problem – the work cannot be reused.

Secondly, more highly local solutions leads to an increasingly complex regional and national environment where there are not common points for integration, making larger-scale change more challenging.

Another problem is that even great new ideas, piloted locally, which could in fact apply well to other areas, very rarely scale up at present.

Challenges in scaling innovation

There are three major challenges to innovation scaling within health services in England today:

  1. The project must be able to scale up beyond its original location, which means the team must have the ability to reach out and make contact elsewhere. The profusion of regions, organisations and IT systems makes this difficult especially for small providers (SMEs and startups, who are often the most innovative). Finding the first partner to work with, perhaps a local GP practice, may be fairly straightforward; extending to other regions, CCGs and trusts, is a lot harder.
  2. NHS projects must meet high standards of quality, with appropriate certifications and accreditation. They need governance structures (around processes, ethics and information) and the processes to support all of this are designed for large corporate service providers. It is very hard for startups and SMEs to go through all of these processes. It is not that the quality is lacking, but the bureaucracy and business functions required to demonstrate that quality are very challenging for smaller organisations, which do not have the same teams, resources and structures as large corporations.
  3. As we have seen, NHS IT systems are complex and complicated so a new product or service needs to interoperate with the services it connects to, which is interoperability. This interoperability is essential but not sufficient to improve an overall system which is made up of hundreds of different elements. To create effective improvement and innovation, we need orchestration, meaning richer working together of multiple parts.

Systems change

Some innovations, which use today’s established technologies, cannot be deployed or adopted in an NHS environment because infrastructure is not available or accessible; for instance, a simple register of GP surgeries and doctors would enable all kinds of new apps, but is still not available.

Significant changes, needing multiple parts of an ecosystem to change or adapt, are particularly difficult when there are many systems interacting, and may need different techniques to succeed.

It’s important to remember that a ‘system’ may not simply be a software tool, but includes how people use that tool in practice, the constraints and motivations on their work, and so on. Ecosystem change is very hard and it is tempting to avoid it altogether if possible. And it can be hard for local organisations to know how best to communicate the benefits of innovative services and generate demand for them from the public and professionals.

What will the market do? What can we do?

With our interest in more socially and digitally excluded groups, we note that the market will rarely serve these communities, as richer populations are more fertile ground for new businesses which must at least cover their costs.

More complex business models may support companies serving less privileged socio-economic groups, but these can be harder to operate and to raise capital for, even in today’s business environment with greater awareness of social enterprise.

We’ve continued thinking about how to overcome challenges to innovation, because unlocking technologies (and other new things!) to be used at scale has significant potential help improve care in the last phases of people’s lives, and will share more of our ideas around what could enable this soon.

This blog first appeared on the Doteveryone blog. Read more at:

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