NHS Next Stage Review

Introduction

The Department of Health approach to innovation needs to be grounded in a clear understanding of what has worked and not worked in the past. It needs to learn from best practice in other fields; to integrate innovation with wider improvement and reform agendas; and to embed innovation knowledge and skills in NHS business processes and enabling strategies.

The primary purpose of innovation is to help the Department of Health meet its targets, improve returns on health investment and, above all, to contribute to health gains. However, to the best of our knowledge there has never been a systematic assessment of the contribution of different types of innovation to health gain such as the relative contribution of R&D support for pharmaceuticals, clinical procedures or service measures.  Work globally, led by the WHO and others, has shown significantly less contribution from traditional pharmaceutical R&D than was once believed. It is well known that the greatest health successes of recent decades from the eradication of smallpox to rising life expectancy are explained by a complex mix of environmental factors, management and organisational methods as well as clinical practice.

Our central arguments here flow from this:

That the NHS as a whole depends on a constant flow of innovative new models to help it adapt to changing demands (eg from ageing), changing opportunities (eg from technology) as well as potential shocks (eg from pandemics). However, innovations involve risk and failure. There are strong disincentives for parts of the NHS to take these risks. Therefore, as in other large systems, the performance of the whole depends on the centre sharing the costs and risks of innovation with individual PCTs, trusts, GPs and others.

That the NHS needs to organise service innovation much more systematically rather than solely focusing on hardware and new technology. This needs to include better use of mature or maturing technology. In recent history, innovation in this field has been poorly funded, prone to repeated restructuring, and without much attention to method and what works.

That more systematic service innovation is an alternative to excessive top down reform which can result in resentment felt by many managers, clinicians and frontline staff. The best approach to service innovation is similar to the best approach to clinical innovation – testing ideas and models on a small scale.

That the strategy for innovation needs to fit coherently with the other key drivers of innovative behaviour and core NHS business processes and enabling strategies, including commissioning, audit and inspection and HR.


That an effective strategy for innovation needs to make the most of the many sources of ideas including clinicians, academics but also social entrepreneurs, patients groups, global experience and the experiences of other sectors, from business to other public services.

Finally, that there are some straightforward steps that the NHS could take to put these principles into practice without diverting time and resources away from delivering existing targets including:  more strategic use of existing funding streams; more systematic organisation of pathfinder places to act as test beds and incubators; more systematic organisation of intermediaries to specialise in spotting, developing and disseminating innovations.

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