Innovation Health and Wealth Report 2012dh - 134597

Innovation
Health
and Wealth
Accelerating Adoption and Diffusion in the nhs
DH INFORMATION
READER BOX
Policy Improvement & Efficiency

HR / Workforce Commissioning
Management IM & T
Planning / Performance Finance
Clinical Social Care / Partnership Working
Document Purpose Action
Gateway Reference 16978
Title Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS
Author Department of Health, NHS Improvement & Efficiency Directorate,

Innovation and Service Improvement
Publication Date 5th December 2011
Target Audience PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Foundation Trust CEs, Medical Directors,
Directors of PH, Directors of Nursing, Local Authority CEs, Directors of Adult SSs, PCT Chairs,
NHS Trust Board Chairs, Special HA CEs, Directors of HR, Directors of Finance, Allied Health
Professionals, GPs, Communications Leads, Emergency Care Leads, Directors of Chldren’s SSs,
Industry, Third Sector, Academia, Healthcare Scientists
Circulation List PCT CEs, NHS Trust CEs, SHA CEs, Foundation Trust CEs, Medical Directors, Directors of PH,
Directors of Nursing, Local Authority CEs, Directors of Adult SSs, PCT PEC Chairs, PCT Chairs,
NHS Trust Board Chairs, Special HA CEs, Directors of HR, Directors of Finance, Allied Health
Professionals, GPs, Communications Leads, Emergency Care Leads, Directors of Children’s SSs,
Voluntary Organisations/NDPBs, Higher Education Institutions, Universities UK
Description Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, sets out an
integrated set of measures that together will support the adoption and diffusion of innovation
across the NHS and sets a delivery agenda that will significantly ramp up the pace and scale of
change and innovation.
Cross Ref NHS Chief Executive Innovation Review - Call for Evidence and Ideas
UK Life Sciences Strategy
Superseded Docs N/A
Action Required All NHS organisations will wish to make an immediate start by building the actions set out in this
report into your planning processes for 2012/13.
Timing N/A
Contact Details [email protected]
For Recipient’s Use

Contents
04
Foreword
07
Introduction
13
The Review Process
15
Actions
29
Summary of Actions
30
Implementation
32
Annexes
Innovation, Health and Wealth — 3

Foreword
The NHS is a national But now and for the foreseeable future we must meet these
success story. It is woven demands from within our current real terms funding, while
into the fabric of our at the same time improving quality. This means that simply
society, and is a public doing more of what we have always done is no longer an
expression of our social option. We need to do things differently. We need to radically
values. It is part and transform the way we deliver services. Innovation is the way
parcel of our national – the only way – we can meet these challenges. Innovation
DNA. It touches all of us must become core business for the NHS.
and all of us have a stake
in its future. The seeds of what we must do are already there. Up and
down the country, there are brilliant examples of pioneering
For more than 60 years the NHS has been there when we work, great ideas and fantastic improvements in service. But
need it, nurturing and sustaining our health, caring for us so often, these are isolated examples. The Atlas of Variation
in need, extending our lives. It remains true to its founding bears witness to this: at PCT level across the country there is a
principles and to its unique system of primary care, but in 48% variance in the number of people receiving best practice
other ways it has transformed itself through the strength care for diabetes, while the average length of stay in hospital
of its research and the skill of its staff, keeping it at the very for fractured neck of femur ranges from 16 to 36 days.
leading edge of modern medicine.
The opportunities are tantalising. Fluid Management
The NHS has made great strides in recent years to improve its Monitoring Technologies can reduce mortality rates for elective
services, reducing infection and mixed sex accommodation procedures, improve the quality of care for more than
rates, giving patients faster access to care. We have also 800,000 patients a year, and save the NHS at least £400m
seen significant falls in mortality - 14% for cancer and 41% annually. Yet the technology is currently used for less than
for circulatory disease over the past decade - providing 10% of applicable patients. The same is true of Insulin pumps,
the foundation for a more systematic focus on improving CT scanners in A&E, many drugs and diagnostic tests and
outcomes in the future. The scale of the NHS is vast: every other types of therapeutic interventions. There is a revolution in
month, 21 million people visit their GP surgery, while every genome sequencing to monitor cancer and deliver personalised
day community pharmacists dispense 2.3 million prescription treatments; and to transform the detection, diagnosis and
items and 13,000 people call NHS Direct. treatment of infectious diseases, the NHS must harness and
lead this.
At its best the NHS is world class. The Commonwealth Fund’s
regular international surveys consistently score the NHS as
one of the world’s leading health systems for quality, and the What we need to do
very best on value for money. But it can and must improve. We must continue the great progress we have made
in clinical research, working in partnership with the
National Institute for Health Research (NIHR), and link this
The challenge we face together with academic medicine and science and stronger
Throughout its history, the NHS has faced increasing partnerships with industry.
demands: a growing population with an extending lifespan;
an increase in its own capability, fuelled by advances in Searching for and applying innovative approaches to delivering
knowledge, science and technology; and ever-increasing healthcare must be an integral part of the way the NHS
expectations from the public it serves. The NHS has does business. Doing this consistently and comprehensively
responded to these demands in part through the creativity of will dramatically improve the quality of care and services for
its staff to find or devise new tools and better ways of working. patients. It will deliver the productivity savings we need to
At the same time industry, often working in partnership meet the growing demand for services, and it will also support
with the NHS, has made available a constant supply of new our role as a major investor and wealth creator in the UK.
medicines, devices and technology.
4 — Innovation, Health and Wealth

NHS success in adopting innovation helps support growth
© Olena Timashova
in the life sciences industries. That in turn enables these
industries to invest in developing the technology and services
the NHS needs for its development.
This report sets out the actions we must now take to make
innovation and its spread central to what we do. They are
designed as an integrated set of measures that together will
support the NHS in achieving a systematic change in the
way the NHS operates. But they will need immediate, urgent
action from all of us.
Our ambition must be for an NHS defined by its

commitment to innovation, demonstrated both in its
support for research and its success in the rapid adoption
and diffusion of the best, transformative, most innovative
ideas, products, services and clinical practice.
We have the potential to create the best health system in

the world, enhancing the quality of life for people with long
term conditions, preventing people from dying prematurely,
helping people recover from ill health and ensuring that
patients have a positive experience of care.
That is our collective challenge.
I would like to thank Sir Ian Carruthers, Chief Executive of NHS

South of England, for leading this Review, and for the many
hundreds of people who sent us comments and suggestions,
all of which helped shape our thinking. May I also offer my
thanks to members of the External Advisory Group, who have
provided us with valuable advice and support throughout; their
names are recorded in the Annex to this Report.
Sir David Nicholson

Chief Executive of the NHS in England

“There are great people in the
NHS with great ideas. Through
a focus on outcomes, we are
going to enable and encourage
them to turn those innovative
ideas into reality. This will result
in better care and outcomes for
patients.”
Secretary of State for health, Andrew Lansley
Proposals for the NHS Commissioning Board are subject

to legislation currently before Parliament, and references
in this report to these and other matters covered by the
draft legislation should therefore be taken as subject to
parliamentary approval. Any relevant actions arising from
this report will be taken forward in the meantime by the
current NHS Leadership Team.

INTRODUCTION
The purpose of the NHS, and everyone working within it, In order to do this we must work with industry, academia,
is to promote health and wellbeing, and to provide high staff and patients, to set an agenda for change and delivery.
quality healthcare, free at the point of delivery to everyone
who needs it.
The NHS is there to improve our health
The NHS, like many other health economies, faces a
tougher financial climate. Innovation has a vital role to and well-being, supporting us to keep
play in fulfilling this purpose by improving the quality of mentally and physically well, to get
care for patients, releasing savings through productivity,
and enabling the NHS to make its contribution as a major better when we are ill and, when we
investor and wealth creator in the UK.
cannot fully recover, to stay as well as
The NHS is full of brilliant people with brilliant ideas. we can to the end of our lives. It works
It has a long and proud track record of innovation and
creativity stretching back across its 63-year history. In vitro at the limits of science – bringing the
fertilisation, development of MRI and CT scanning, the
portable defibrillator, genetic fingerprinting, the disposable highest levels of human knowledge
syringe and the contraceptive pill are just a few of the and skill to save lives and improve
breakthroughs made by British clinicians and scientists.
health. It touches our lives at times
However, while the NHS is recognised as a world leader in
invention, the spread of those inventions within the NHS has of basic human need, when care and
often been too slow, and sometimes even the best of them compassion are what matter most.
fail to achieve widespread use. The NHS Constitution
This is why the Government’s Plan for Growth, published in

March 2011, announced that the NHS Chief Executive would Health and the Economy
review how the adoption and diffusion of innovations could The NHS contributes to the UK economy in four important ways:
be accelerated across the NHS. The NHS Chief Executive’s
Review and this report forms part of a wider UK strategy for 1
Health Innovation and Life Sciences, alongside a detailed Through the services it provides: a healthy population is more
review of the Life Sciences industry led by the Office for productive, and more economically active
Life Sciences. This wider strategy, led by the Prime Minister,
sets out a comprehensive plan to transform the UK health 2
innovation and life sciences sectors. By adopting innovation to improve its own productivity, it
can deliver more health benefit for a given public resource
This report will inform the strategic approach to innovation 3
in the reformed NHS. It has been prepared in consultation By accelerating adoption and diffusion of innovation throughout
with industry, academia, clinicians and a wide range of the NHS it supports growth in the life sciences industry
other stakeholders, both within and beyond the NHS, and
has drawn on international experience and insight. 4
By exporting innovation, ideas and expertise, working in
The advice we have received has been consistent. We need partnership with UK industry, it provides new business
to create a system for innovation that continually scans for opportunities abroad for UK-based companies.
new ideas, and takes them through to widespread use.
One sixth of the world’s most popular prescription medicines were developed in the UK

c
Ill health impairs economic productivity. The annual The UK shares second place with Germany, behind the US;
economic costs of working-age ill health are estimated to but developed economies are predicted to lose ground to
be over £100bn. The cost to the taxpayer – benefit costs, emerging-market countries over the next few years. This
additional health costs and forgone taxes – are estimated is because these countries are discarding incremental,
to be over £60bn. In simple terms, good health is good for cost-additive innovations, and focusing instead on innovation
business, and good for the economy. that increases and improves functionality or in other ways
improve customer experience or outcomes. Critically, they
The NHS has a crucial role in alleviating the burden of add value but not cost.
ill health, but it also has a wider role in contributing to
economic growth, specifically growth in the health and life The challenge both for the NHS and for its industry partners
sciences industries, for which it is the largest UK customer. is to pursue innovations that genuinely add value but not
Industry needs innovation to help it grow and remain cost – the NHS for its productivity and quality goals and
competitive, both domestically and internationally. industry for its international competitiveness. Indeed,
adding value and reducing cost is the basis of the NHS
Britain is widely recognised as one of the international QIPP challenge. This puts a premium on game-changing
leaders in biomedical science research. It has a strong higher innovations that change patient pathways and traditional
education sector, and has one of the most productive and delivery systems, and that are implemented in a way that
successful biotechnology sectors in Europe. It is, arguably, strips out the processes that no longer add value.
the research laboratory for the world. It also has the
advantage of the world’s largest integrated national health This report has been developed as part of the Prime Minister’s
system, all of which contributes to Britain’s international UK Strategy for Health Innovation and Life Sciences. The
competitive advantage. aim of this strategy is to ensure that the UK maintains and
builds on its world leading position for life sciences, that
But the nature of innovation is changing. PwC’s international the potential of life sciences to contribute to UK growth is
medical technology innovation scorecard measures the realised, and that the UK remains and grows as an attractive
capacity of a group of nine developed and emerging location for investment now and in the future.
economies to adapt to the changing nature of innovation.
1928
Scottish biologist and pharmacologist Alexander Fleming discovers penicillin

What we mean by innovation
There are many definitions of Innovation. For the purposes HEart SURGERY –
of this Review, we have defined it as follows: Reverse Innovation
An idea, service or product, new to the NHS or applied in One US hospital group sends surgical teams each year
a way that is new to the NHS, which significantly improves to work in developing countries. Working with less
the quality of health and care wherever it is applied. resource to deliver heart surgery has helped them learn
how to streamline surgery without compromising the
Innovation has to be more than a simple improvement in quality of care. That learning has been taken back to
performance, and to achieve its maximum added value their parent organisation, which is increasingly able to
to the NHS it needs to be replicable – and replicated – achieve high levels of care at lower cost.
across similar settings. So innovation is as much about
applying an idea, service or product in a new context,
or in a new organisation, as it is about creating something Why innovation is important
entirely new. Copying is good. Innovation is central to the future of the NHS for three
important reasons:
This does not necessarily mean simply adding to existing
processes or practice, or to the battery of diagnostic tests Innovation transforms patient outcomes
available – there is an important role for ‘reverse innovation’ – Innovation in the NHS is about making a real and tangible
decommissioning an activity that is shown to have no added difference to the lives of millions. Keyhole surgery has
value or that has been replaced by something new or better. allowed faster recovery time, and made surgery possible for
patients less fit for more invasive treatment. New medicines,
Innovation is not just about the originating idea, but also the medical technologies and informatics have transformed
whole process of the successful development, implementation patient outcomes. Across the NHS, countless patients bear
and spread of that idea into widespread use. There are three witness to the power of great ideas.
important stages:
Innovation can simultaneously improve quality
and productivity
Invention Given the demand and funding pressures the NHS now
The originating idea for a new service or product, faces, it is widely accepted that more of the same will not
or a new way of providing a service do. More radical changes in the way services are delivered
and how people work will be required. We need to plot a
sustainable course for the future of the NHS. Innovation
can help provide the route-map, improving quality at the
Adoption same time as driving productivity and efficiency in a difficult
Putting the new idea, product or service into practice, financial environment.
including prototyping, piloting, testing and evaluating
its safety and effectiveness Innovation is good for economic growth
The NHS remains a major investor and wealth creator in
the UK, and in science, technology and engineering in
particular. NHS success in adopting innovation helps support
growth in the life sciences industries. That in turn enables
Diffusion these industries to invest in developing the technology and
The systematic uptake of the idea, service or product other products the NHS needs for its development.
into widespread use across the whole service.
The pharmaceutical industry invests £12.1m in Research and Development every day

c
The NHS is full of talented people with brilliant ideas. But It took five years before half of adult patients admitted to
the benefit of this collective creative energy has not been NHS acute care received a venous thromboembolism (VTE)
fully realised because these ideas and inventions have not risk assessment, despite a death rate estimated at 24,000
always been systematically and rapidly spread throughout people every year. But when it was made a national clinical
the service as a whole. priority, risk assessment was routine for 84% of admissions
within a year.
The UK is particularly slow, relative to other developed
economies, in adopting innovative medical technologies. Barriers to diffusion
Despite its pioneering work on the early development of The reasons for the slow spread of innovation are well
MRI scanners, the UK has only 500 out of a worldwide documented, and have been reiterated in the responses
total of 20,000, performing less than 2% of the world’s we received during the course of this Review.
60m scans each year, at only two-thirds of the international
average use per machine. While understanding the barriers is important, the focus of
the Review has been on developing solutions to those barriers.
Barriers to innovation in the NHS
insufficient
Poor access to recognition and
evidence, data and metrics Celebration of innovation
and innovators
1 2
financial
levers do not
lack of effective
reward innovators
and systematic
innovation 6 Diffusion 3 and can act as
a disincentive
architecture
to adoption
and diffusion
5 4
leadership culture to commissioners lack
support innovation is the tools or capability
inconsistent or lacking to drive innovation
1950
British physiologist Richard Doll discovers link between lung cancer and smoking

What makes diffusion happen
A prerequisite for successful diffusion is first, a supply
Top down pressures
of ideas, services or products that demonstrably add
Central requirements, regulation and incentives; and
value in terms of quality and productivity to pre-existing
support, such as guidance and skills development
arrangements; and second, a demand for those ideas,
services or products from organisations and individuals
throughout the NHS.
On the supply side, establishing the ‘added value’ of an

innovation is critically important; not every idea deserves Horizontal pressures
to be replicated, and those that are unable to clearly Peer influence, transparent reporting, collaboration,
demonstrate improvement are unlikely to be taken up. competition and effective marketing from external
Added value might be reflected in clinical or other suppliers
outcomes, including quality measures; patient experience,
timeliness, safety of care, reduction of inequalities; and
productivity and cost reduction. Together these make up
the ‘value proposition’. Bottom up pressures
Patient and public demand for best practice,
On the demand side, potential adopters of an innovation professional and managerial enthusiasm,
need to be aware of its advantage, for example entrepreneurialism and choice
in enabling new ways of working or the ability to deliver
care closer to the patient; and to have the capacity to
implement it. Changes to working practice, roles and even
locations of service may be necessary to realise its full
potential. Most technology innovations will have service
implications, as indeed many service innovations will need
the support of an enabling technology. Often this will require
actively decommissioning the products or services that the
innovation replaces.
The potential added value of an innovation, the ease of its

implementation, and the visibility of its impact can all have
a powerful influence on the rate of diffusion.
Diffusion in systems as large and complex as the NHS

works most effectively through the interaction of the three
sets of approaches shown in the diagram.
Previous attempts to achieve consistent and widespread

adoption and diffusion in the NHS have tended to fail
because all three forces have not been mobilised together.
The actions set out in this report rely on all three approaches
working in combination.
The NHS in England employs approximately one in 24 of the working population

c
“ Breaking an old business
© Emre Ogan
model is always going to
require leaders to follow
their instinct. There will
always be persuasive
reasons not to take a risk.
But if you only do what
worked in the past, you
will wake up one day and
find that you’ve been
passed by.”
Clayton Christensen
1953
Crick and Watson, two Cambridge scientists, reveal the double helix structure of DNA in Nature Magazine.

The REVIEW PROCESS
Sir Ian Carruthers, Chief 1
Executive, NHS South We should reduce variation in the NHS, and drive greater
of England, led the compliance with NICE guidance
Review, which began
with an open Call for 2
Evidence. Over 300 Working with industry, we should develop and publish better
responses were received, innovation uptake metrics, and more accessible evidence and
the majority from the information about new ideas
NHS and Industry, with
the remainder from a 3
mix of academia, the We should establish a more systematic delivery
scientific community, and mechanism for diffusion and collaboration within the NHS
representative and voluntary organisations. The responses by building strong cross-boundary networks
informed both the themes and the specific actions set out in
this report. 4
We should align organisational, financial and personal incentives
In addition, Sir Ian hosted a series of face-to-face meetings, and investment to reward and encourage innovation
roundtable events and discussions to hear first hand, views
from clinical leaders, the research community, the third 5
sector, the pharmaceutical and medical technology industries, We should improve arrangements for procurement in the
the NHS Confederation and the Technology Strategy Board NHS to drive up quality and value, and to make the NHS
and other stakeholder and representative bodies. In all, some a better place to do business
160 organisations and 320 individuals were involved in this
part of the process. 6
We should bring about a major shift in culture within the
An External Advisory Group comprising representatives NHS, and develop our people by ‘hard wiring’ innovation
of these groups and others was established to provide into training and education for managers and clinicians
advice and guidance to Sir Ian and Sir David Nicholson.
The Group advised on both the emerging findings and the 7
recommended actions, and offered insight and challenge as We should strengthen leadership in innovation at all levels
the Review progressed. of the NHS, set clearer priorities for innovation, and sharpen
local accountability
Ultimately, it is the actions of front line organisations and
staff in spreading and adopting innovative practice that will 8
deliver a better service and better outcomes for patients. We should identify and mandate the adoption of high
Our urgent task is to make sure this happens. impact innovations in the NHS.
What we learned
Although responses came from many different organisations
and individuals, with very different interests and backgrounds,
the feedback we received was very consistent, and enabled
us to set out a clear agenda for change. Eight key themes
have emerged:
Every year the NHS conducts over 700m laboratory tests – an average of 13 per person

“ This report is the catalyst for innovation
to flourish at all levels in the NHS and
for all partners of the NHS so that
collectively we can deliver world leading
standards of care for patients, increase
value for the NHS and build a thriving
life sciences sector in the UK.”
Simon Jose, President, ABPI
The delivery agenda

It is clear that to respond to those themes we need to achieve
sustainable change that puts innovation at the heart of
everything the NHS does.
To do this, we need to bring about a lasting change in

culture and behaviour amongst our current and future
leaders, and the workforce as a whole. We need to build
understanding, awareness and advocacy. We need to make
innovation a priority. We need to re-cast incentives and
rewards. We need a systematic approach to drive innovation
through both clinical research and service delivery. We need
to make Boards and Chief Executives accountable for their
organisation’s contribution to innovation. We need to make
innovation everybody’s job, from top to bottom of the NHS.
We need to outlaw ‘not invented here’ and make a virtue
of copying, and continuous development and improvement.
We need to make the NHS easier to do business with,
especially for small and medium sized enterprises (SMEs),
and we need an entirely new relationship with industry
based on partnership, not just transactions.
Our approach has been to focus on a limited number of high

impact, game-changing actions. These are designed not
as a set of isolated mechanisms, but as an integrated set of
actions, that together will achieve a systematic change in
the way the NHS operates. In short, it will become a truly
integrated system defined by its commitment to innovation,
demonstrated both in its support for research and its success
in rapid diffusion of high value innovation. The rest of this
report sets out the specific actions we will take in relation to
each of the eight themes.
1956
The disposable hypodermic syringe is invented by vet Colin Murdoch, a British citizen of New Zealand

Actions
“Where a medicine or technology recommendations, and the Government has also said that it
will retain a funding mandate for medicines with a value-based
is clinically sound and cost effective price from 2014.
for the NHS, patients should have NICE is being re-established in primary legislation, putting
access to it – no question, no it at the heart of arrangements for promoting quality in
the reformed health and care system, and its remit is being
qualification.” extended beyond health into social care.
Baroness Barbara Young, Chair, Diabetes UK
NICE is the envy of health systems across the world, and yet
at home there is considerable variation in the implementation
Reducing variation and of some of its recommendations.
strengthening compliance
In NICE we have a world-class, well-respected organisation •• We will introduce a NICE Compliance Regime for the
that produces evidence-based guidance, including funding direction attached to NICE Technology Appraisals,
Technology Appraisals on the use of specific medicines to ensure rapid and consistent implementation throughout
and technologies. These represent the most authoritative the NHS. This will reduce variation and assure patients of
statement of current best practice; indeed they are often their access to the clinically and cost-effective technologies
considered the international gold standard. and medicines their doctors believe they need.
Technology Appraisal recommendations are backed with We are committed to ensuring that NHS patients have
a statutory funding direction, to ensure the NHS makes access to clinically and cost-effective drugs and
funding for these technologies available and that clinicians technologies, and that NICE appraisal guidance is promptly
are empowered to use them where they consider their delivered throughout the NHS. There should be no local
patients would benefit. The Government plans to introduce barriers to accessing technologies recommended in
new arrangements for value based pricing of new medicines NICE appraisals, beyond a clinical decision relating to an
from 2014 to help ensure that patients can access innovative, individual patient.
effective treatments on terms that reflect their value.
Local formularies have an important role in underpinning
While the detail of these arrangements is still being developed, safe and effective use of medicines. However local formulary
it is clear that NICE will have an important role. The Health processes should not seek to duplicate NICE assessments or
and Social Care Bill contains provisions to maintain the effect challenge an appraisal recommendation and must never
of the funding direction for NICE Technology Appraisal act as a barrier to the uptake of NICE approved medicines.
Rather, they should be seen as supporting timely and planned
implementation of NICE Technology Appraisals.
TRANSFORMING HIP REPLACEMENT Formulary processes should proactively consider the

impact of new NICE Technology Appraisals, and all NICE
The Conquest Hospital has redesigned the hip Technology Appraisal recommendations should – where
replacement pathway, achieving an average length clinically appropriate – be automatically incorporated into
of stay of 2.7 days (the lowest recorded for a hip local formularies. This process should take place within 90
replacement unit in England), with trust level savings days to support compliance with the three month funding
of £180,000 and a 25% reduction in orthopaedic direction and the NHS Constitution ensuring that these
beds. Most patients are able to mobilise within hours medicines are available for clinicians to prescribe, should
of the operation; 50% go home the day after surgery they choose to, in a way that supports safe and clinically
and 99.5% like the service. appropriate practice.
The UK medical technology industry consists of over 3,000 companies with a combined turnover of £15bn

•• We will require that all NICE Technology Appraisal We will introduce a NICE Compliance Regime
recommendations are incorporated automatically to reduce variation and drive up compliance
into relevant local NHS formularies in a planned way that with NICE Technology Appraisals
supports safe and clinically appropriate practice.
Local implementation of NICE guidance can sometimes We will require that all NICE Technology
be complex, technically difficult and financially challenging. Appraisal recommendations are incorporated
In these cases, we will do more to support the NHS to automatically into relevant local NHS
implement the guidance. To do this: formularies in a planned way that supports
safe and clinically appropriate practice
•• We will establish a NICE Implementation
Collaborative (NIC).
We will establish a NICE Implementation
The NIC will bring together the NHS Commissioning Board, Collaborative to support prompt
NICE, the Chief Pharmaceutical Officer, the main industry implementation of NICE guidance
bodies, the NHS Confederation, the Clinical Commissioning
Coalition and the Royal Colleges to work together and
alongside NICE to identify where support is needed and to
develop implementation guidance and solutions for the
NHS. Its first task will be to agree a Concordat that will
govern its operation.
The NIC could have a crucial role to support implementation

of guidance on medical technologies, where there are low
cost high value interventions that could improve patient
care, while at the same time stimulating growth in small and
medium sized medical technology companies. The NIC will
also have an important role in supporting QIPP delivery.
It will:
-- Work with NICE to develop and extend its

implementation advice and guidance on
approaches to disinvestment where necessary and
added support for its use in the NHS
-- Where needed, work with industry to develop a better

‘value proposition’ for the NHS, relying less on
upfront capital or revenue investment, and more on
taking income from downstream revenue savings
-- Set out how use of existing tariff flexibilities at local

level could support diffusion
-- Through the NHS Improvement Body provide direct

support to help the NHS with implementation.
1965
Portable defibrillator invented by Frank Pantridge, an Irish physician and cardiologist

“ The NHS needs an intellectual Patient groups have in some cases been successful in pressing
for improvements at a local level in the NHS, although their
marketplace of ideas, a ‘problems and impact has been variable. In order to pursue a new idea, you
need to know about the new idea, whether you are a patient
solutions warehouse’ – where innovators seeking quality treatment or a member of staff seeking out
can showcase and exchange their ideas.” improvements in the services you provide.
Laszlo Igali, Norfolk and Norwich University Hospital

Both NHS staff and the public need better and more easily
accessible information about new ideas, innovations and
Metrics and Information technologies. A number of organisations provide information
We need to do more to stimulate demand for good ideas, about different stages in the innovation pathway, each
new products or practices, especially where these have covering part of the picture, but this diversity of information
been formally appraised, or simply shown to be successful sources causes confusion.
elsewhere. To do that, we need better and more widely
available information. NHS staff need to know about their •• We will put an end to that by developing a single, high
organisation’s performance in adopting innovation, and quality web portal for innovation in the NHS.
patients and the public need the same information to exercise
choice about their service provider, or simply to demand This portal will be available for NHS staff and the public.
better services. It will not only provide information about the most innovative
clinical practice, medical technologies, informatics and service
To support the NICE Compliance Regime we will publish improvements, but will also offer an “intellectual market
levels of compliance with NICE Technology Appraisals locally. place” for people to showcase and exchange ideas. It will
Working with industry, the Department of Health, NICE, the cover all stages of innovation and all levels of knowledge.
NHS and the Health and Social Care Information Centre:
The portal will include a searchable database of case studies,
•• We will develop and publish a straightforward innovation tools, ‘how to implement’ guides and e-learning based
scorecard, designed to track adoption of NICE Technology practitioner programmes that support introduction of a
Appraisals at local level. new technology or practice. It will also include a discussion
forum for those seeking ideas and solutions, based on a
Consumer and peer pressure can also be effective in creating Wikipedia model, with users able to upload and amend
demand for the adoption and diffusion of innovation, and their own pages. Over time, it will also include the existing
have had a powerful impact in other sectors of the economy. database of current clinical trials for drugs, medical
technology and devices, which enables patients to participate
in clinical studies.
Technology uptake Patient data can provide great insight for health research,
which in turn improves the quality of diagnosis, treatments
A finger-prick blood test device enables patients on and other interventions. It is a key goal of the NHS for every
anticoagulation therapy to self-monitor their blood willing patient to be a research patient, enabling them to
clotting time, saving regular visits to blood clinics. This access novel treatments earlier. The greater the number
is clinically effective and substantially more convenient of patients involved in research, the wider the public benefit.
for appropriate patients; but less than 2% of the 1.25 The NHS could and should do more to explain to patients
million people in the UK on long-term anticoagulation the benefits both to them and to society at large
therapy self-monitor, compared to an estimated 30% of their agreement to participate in clinical trials and
who could benefit. approved research.
Approx 228,000 people go for an eye test each week (equivalent to the population of Derby)

c
We also need to be more open to working with partners to of the timetable. This will help drive service improvement and
develop consumer campaigns to drive the spread of new also enable competition and innovation among supporting
ideas. The idea is to support the public, patients and carers in data and digital service providers.
creating demand locally for high impact innovations. Which?,
for example, has shown interest in working with the NHS The Health and Social Care Information Centre will set
Commissioning Board and its Medical Director to develop up a secure data linkage service by September 2012,
campaigns to raise awareness amongst the public and which will provide data extracts using linked data from
patients of innovations in healthcare. primary and secondary care and other sources on a routine
basis at an unidentifiable, individual level. Linked data is
•• We will work with Which? to develop consumer crucial for a greater understanding of which healthcare
campaigns to raise awareness amongst the public and interventions work, when and why. This insight will help to
patients of innovations in healthcare. support innovation across the healthcare sector to improve
services and outcomes.
Transparency of information and open data are a powerful
means to support accountability, to empower patients and A new data secure service, the Clinical Practice Research
the wider public and to drive improvement and innovation. Datalink (CPRD) will be established within the Medicines
In the health sector our starting point should always be to and Health Care Products Regulatory Agency (MHRA). This
make data and information available unless there are good will service the specialised needs of the research and life
reasons not to do so. In considering this we need to balance sciences communities and will complement the Information
the benefits of openness with our responsibility to protect Centre Service.
patient confidentiality and safety, as well as taking into
account the purpose and relative benefits of transparency, •• We will establish the Clinical Practice Research Datalink
and the costs of providing data. (CPRD),a new secure data service within the Medicines
and Health Care Products Regulatory Agency (MHRA).
All patients in the NHS will have access – where they wish it –
to their personal GP records by the end of this Parliament.
The Information Strategy for Health and Social Care in We will develop and publish an innovation
England, to be published by Spring 2012, will set out details scorecard to track compliance with NICE
Technology Appraisals
We will procure a single comprehensive and

publicly available web portal for innovation
in the NHS
We will work with Which? to develop

consumer campaigns to raise awareness
amongst the public and patients of
innovations in healthcare.
We will establish the Clinical Practice

Research Datalink (CPRD),a new secure data
service within the Medicines and Health Care
Products Regulatory Agency (MHRA).
1967
Cicely Saunders founds the first modern Hospice, St Christopher’s

“ Academia and industry should be Every local NHS organisation should aspire to be affiliated to
its local AHSN, which would act as a high quality, high value
encouraged to manage an ‘innovation gateway for any NHS organisation needing support or help
with innovation, and provide industry with focused points
ideas’ process – which focuses of access to the NHS. Acting as a lead customer, the AHSN
on solving a ‘real’ NHS problem.” would work with industry to scope problems and jointly
develop solutions to key health challenges. The AHSNs will
Sir john bell, chair, oschr
strengthen the collaboration between clinicians and other
practitioners and the medical technology industry on which
CREATING A system FOR delivery innovative product development so often depends.
OF INNOVATION
We need a stronger relationship with the scientific and They would support knowledge exchange networks to
academic communities and industry to develop solutions build alliances across internal and external networks and
to health care problems and get existing solutions spread at actively share latest best practice, and provide for rapid
pace and scale in the NHS. We also need to develop much evaluation and early adoption of new innovations under tight
stronger knowledge exchange networks to share surveillance and monitoring.
best practice.
Academic Health Science Centres (AHSCs) have been home haemodialysis

successful at developing partnerships within their local areas,
but more needs to be done to spread innovation across the Manchester Royal Infirmary redesigned dialysis provision
whole of the NHS. The designation AHSC is distinguished to enable patients to choose home haemodialysis.
by its world class research capability, clinical excellence, Over 15% of their patients now choose to perform
strong collaborative governance, competitive approach to haemodialysis independently at home compared to the
the management of IP, strong track record of productive current UK rate of 1-2%. Projected annual savings at
research collaborations with the life sciences industry and Manchester are approximately £1m. Home dialysis has
emerging clinical data informatics platforms. We will maintain fundamentally changed patients’ lives, enabling them to
the designation of AHSCs, only for those who meet such spend more time with their families.
challenging criteria.
In addition, we shall support these Centres and build on their

models of accelerating adoption and diffusion by designating a We would expect AHSNs to work closely with AHSCs, NIHR
number of Academic Health Science Networks (AHSNs) across Biomedical Research Units and Centres (BRUs and BRCs),
the country. The NHS Chief Executive and the Chief Medical NIHR Collaborations for Leadership in Applied Health
Officer will work with the NHS and industry to designate these Research and Care (CLAHRCs), Health Innovation and
networks with the first to go live during 2012/13. Education Clusters (HIECs) and NHS Innovation Hubs. We
would expect them to build on the leading-edge work and
The AHSNs will present a unique opportunity to align learning of AHSCs.
education, clinical research, informatics, innovation, training &
education and healthcare delivery. Their goal will be to improve •• We will establish a number of Academic Health Science
patient and population health outcomes by translating research Networks (AHSNs) across the country, the first going live
into practice and developing and implementing integrated during 2012/13. Working with stakeholders from across
health care services. Working with AHSCs, they will identify the NHS and scientific community, academia, the third
high impact innovations and spread their use at pace and scale sector and local authorities, the AHSNs will link up the
throughout their networks. system and drive up diffusion of innovation.
In a typical week, 1.4 million people will receive help in their home from the NHS

c
•• We will publish details of the AHSN designation process “The NHS Commissioning Board will
in March 2012.
provide an excellent opportunity to
We also need to de-clutter the landscape. Over the last
decade many new organisations charged with improving lead by example in commissioning
innovation in the NHS have emerged. The landscape is now promising new specialised services,
fragmented, cluttered and confusing. We need to ensure
that innovation investment, development and support products and technologies.”
is coherently organised and focused on delivering the Tim Briggs, Royal National Orthopaedic Hospital
maximum value for money.
•• We will undertake a sunset review of all NHS/DH constant search for new ideas and technologies. And it is
funded or sponsored innovation bodies and make also in a position to influence, by applying the right incentives
recommendations as to their future form and funding. to encourage the systematic development of innovative
behaviours and activity, and by directing investment, to help
•• With immediate effect NICE will take responsibility spread new ideas.
for the evaluation of medical devices and technologies
which is currently managed through the iTAPP Too often incentives can reward the status quo and actively
programme; and we will consider the future hosting discourage invention and change. We know that silo
arrangements for NTAC. budgeting can often be a barrier to the adoption and spread
of innovation, especially where the cost and savings fall to
different budget holders.
We will establish a number of Academic Health
Science Networks (AHSNs) across the country •• We will align financial, operational and performance
incentives to support the adoption and diffusion of
innovation by:
We will publish details of the ahSn
designation process in march 2012 -- Developing and introducing a shared savings formula
to break down silo budgeting and encourage cross
boundary working
We will undertake a sunset review of all
NHS/DH funded or sponsored innovation bodies -- Developing a tariff for assistive technologies
and make recommendations as to their future (telehealth, telecare) that, like Australia and the US,
form and funding. would incentivise rather than block their rapid spread
with immediate effect, NICe will take -- Continuing work on tariff development, especially
responsibility for the itapp programme in relation to payment for outcomes, since an
outcomes focus enables an innovative, cost-effective
means of delivering outcomes to be incentivised
directly through the tariff
Incentives and investment
With a focus on greater decentralisation, and the greater local -- Commissioning the NHS Improvement Body to work
responsibility that goes with that, the centre can no longer with the NHS to help make best use of existing local
just tell the NHS what to do. But it does have a leadership tariff flexibilities, including best practice tariffs at
role in creating a culture that encourages and values the local level to support diffusion
1973
English engineer Godfrey Houndsfield invents the CAT scanner and wins the Nobel Prize in 1979

-- Exploring options for an unbundled tariff for accreditation) with the potential to deliver high impact
diagnostics and other scientific services that would change, and to rapidly test, trial and evaluate their value
drive fundamental changes in the way services are to the NHS. Where appropriate this would enable suitable
delivered, especially when new technology is utilised. patients to have early access to innovative technologies, which
also would help to create a richer research evidence base.
We also need to do more to recognise and reward individuals
and organisations for their achievements in adopting and •• We will establish a Specialised Services Commissioning
spreading innovation. Innovation Fund, top sliced from the specialised services
commissioning budget, overseen by an Advisory Board
•• We will increase the profile of, and maintain investment reporting to the NHS Medical Director.
in, the NHS Innovation Challenge Prizes and permit
modest individual awards.
We will align financial, operational and
But incentives are not just about rewarding people for doing performance incentives to support the
the right things. We also need to be more systematic about adoption and diffusion of innovation
stopping organisations from doing the wrong things.
•• Under the leadership of the NHS Medical Director, we will We will increase the profile of, and maintain
extend the ‘never events’ regime to actively drive ‘old Investment in, the NHS Innovation Challenge
practice’ out of the system, especially where that practice Prizes
is proven to be clinically unsafe.
We will extend the ‘never events’ regime
We will ask NICE to be clearer in their guidance about what and encourage disinvestment in activities
activity and tariff should be de-commissioned or reduced that no longer add value
as a result of new and better practice or medicines being
introduced.
We will establish a Specialised
The NHS Commissioning Board will have responsibility Services Commissioning Innovation Fund
for specialised services commissioning, and is in a position
to identify those technologies (with appropriate safety
cytosponge
An NHS team in Cambridge developed the ‘Cytosponge’,

a simple pill that expands into a sponge designed
to collect samples from the oesophagus to test for
oesophageal cancer. The procedure can be used by
GPs at a cost of £25, replacing the need for a £600
endoscopy, and offers early identification and therefore
better outcomes with a potential increase of 80% in 5
year survival rates for the 6000 throat cancer cases
each year.
A large scale study in 1994 showed a 35% reduction in cholesterol from the use of statins, since their introduction in 1987

c
“The culture of the NHS needs to develop •• We will publish a procurement strategy in March 2012.
The strategy is likely to include proposals to:
so that industry is viewed as a strategic
-- Bring together coalitions of experts to enable open
service partner rather than a transactional dialogue with suppliers in ‘product surgeries’, outside
supplier of goods and services.” of a procurement tendering process
johnny lundgren, chair, ABhi

-- Develop a process to identify supplier technologies that
have been assessed as ‘suitable for use’ on the basis
Procurement of evidence or in-use evaluation, to help Trusts select
A succession of government policies has highlighted the technologies most appropriate for their needs.
procurement as an important lever for economic growth, The aim will be to eliminate the need for multiple
a potential driver for better public service and, equally re-assessments at local level
important, a means of stimulating innovation.
-- Within a procurement process to seek opportunities to
A Public Accounts Committee report in May 2011 consult the market before tendering, to encourage
suggested that £500m is potentially being wasted because the market to propose creative solutions before
of poor procurement. The Department of Health itself specifications are firmed up. The aim is to move from
has identified that NHS procurement could go further and category management to market informed sourcing
deliver around £1.2bn of the £20bn QIPP challenge, and and procurement for outcomes
is in the process of developing a procurement strategy
to be published in March 2012 to help the NHS achieve -- Demonstrate NHS commitment to new technology
these efficiencies. to allow suppliers to invest on the basis of ‘forward
commitment procurement’
The strategy will include new NHS system controls, NHS
standards of excellence in procurement and NHS system -- Work towards standard procurement
support activities. It will also include a focus on innovation documentation and processes to simplify
and support for SMEs. procurement for SMEs, and encourage the NHS to
support and participate in key Cabinet Office initiatives
We need to establish new relationships with industry, based to reduce bureaucracy to SMEs.
on partnerships that deliver mutual value, rather than simple
transactional business. We need to do more with small businesses, to help them
develop the new technologies the NHS needs and then
The strategy will take account of the best innovative to get them into everyday use across the NHS. The Small
procurement practice from across all sectors, and will apply
this to the NHS, incorporating learning from the Health
Care Associated Infection Technology Innovation Programme SBRI funding for small business
and iTAPP (Innovative Technology Adoption Procurement
Programme). Creo Medical have developed a hand-cleaning device
that uses non-thermal plasma to provide swift,
It would also support the local showcase hospital thorough hand disinfection without the need for
programmes, which evaluate the effectiveness of medical scrubbing with soaps or gels. SBRI funding supported
technologies that are safe but do not yet have evidence of Creo through the design and validation stage, helping
effectiveness. The aim of these programmes is to avoid the it ‘across the bridge’ to profitability and growth – and
need for repeat local assessment thereby supporting the further development projects.
rapid spread of proven innovation across the NHS.
1977
First human MRI (which was on a finger) performed by Sir Peter Mansfield’s team in Nottingham

Business Research Initiative (SBRI) provides seed funding “The NHS must build innovation
to support the development of innovative products and
services. It has proved a very successful vehicle for this; in and the concept of adoption and
the last 18 months, there have been 46 SBRI competitions
resulting in 519 contracts awarded to the value of £35.6m. spread into undergraduate and post
Ninety percent of competition entrants had never worked in graduate curricula.”
the NHS before, suggesting there are untapped innovative
professor norman williams, royal college of surgeons
solutions in the wider SME community.
But we need to find a way of ensuring that when products come Developing our People
off the production line the NHS actively procures them. The SBRI Organisations that are able to innovate successfully have
process includes tough requirements for a clear and compelling developed a culture of innovation throughout their organisation,
clinical and financial evidence base, and when they are ready and at all levels. This is about people understanding why
for market they will feed into the High Impact Innovations list. innovation is important, creating time and space for people
to innovate and rewarding innovators. It is about developing
•• We will double our investment in the Small Business Research both capacity and capability.
Initiative to develop innovative solutions to healthcare
challenges, encourage greater competition in procurement Innovative organisations have a number of characteristics
of services, and drive growth in the UK SME sector. in common; they:
The existing Intellectual Property strategy can discourage 1

NHS organisations from sharing new ideas. That simply isn’t Provide space, time and resources for individuals across
acceptable. We need to develop a strategy that rewards the the organisation to generate and pursue innovative ideas
innovator whilst allowing others in the NHS to have access they are passionate about
to their ideas. The existing Intellectual Property strategy is no
longer fit for purpose and needs to be updated. 2
Encourage and incentivise staff to participate in an
Intellectual property alternative innovation process by generating, sharing and
•• We will review the existing Intellectual Property Strategy evaluating new ideas
and develop a model for contracts that is fit for purpose.
3
Actively support and facilitate the generation of new
We will publish a procurement strategy in ideas and the uptake of ideas, practices and processes that
March 2012. have been generated externally or elsewhere in the system
4
We will double our investment in the Small Establish mechanisms to quickly form small, flexible teams
Business Research Initiative to develop with the necessary skill sets to refine and drive innovative
innovative solutions to healthcare ideas from conception to implementation
challenges, and help drive growth in the UK 5
SME sector Utilise partnerships and collaboration to encourage and
support ‘radical innovation’, while simultaneously assessing
We will review the existing NHS intellectual and managing associated inherent risk
property strategy and develop a model for 6
contracts that is fit for purpose Reward and recognise efforts within all stages of the
innovation pathway.
NHS ambulances take 82,500 people to Accident and Emergency departments every week

c
Creating an innovative culture starts with basic training, and best innovators to share their knowledge, learning and
education and induction and continues throughout an expertise with the NHS.
employee’s career through personal and Continuing
Professional Development (CPD). •• We will establish an NHS Innovation Fellowship Scheme
so that the brightest and best innovators can share their
•• We will ensure that innovation is ‘hard-wired’ into knowledge, experience and expertise with the NHS.
educational curricula, training programmes and
competency frameworks at every level. The Fellows will be drawn from a range of sectors and
industries, both nationally and internationally. They will be
-- We will work with Medical Education England and highly regarded and respected in their fields of expertise,
other professional advisory groups (and in the future and will be able to provide coaching and mentoring for
Health Education England), NHS Employers and senior NHS leaders, deliver master-classes, and provide
the academic sector to ‘hard wire’ innovation into advice and support on innovation strategies.
managerial and clinical curricula and CPD.
-- We will build innovation much more visibly into We will ensure that innovation is ‘hard-wired’
competency frameworks like Professional Skills into educational curricula, training
for Government (PSG) and the Job Evaluation and programmes and competency frameworks
Knowledge & Skills Framework (KSF), and into job at every level
descriptions and performance appraisal for senior
managers.
We will establish joint industry and NHS
The relationship between the NHS and industry is critical training and education programmes for
to meeting the objectives of a high quality productive NHS senior managers
and a vibrant internationally competitive industry. Too often
such partnerships fail to meet their potential because of a We will establish an NHS Innovation
lack of mutual understanding of the drivers that affect each Fellowship Scheme
partner. Joint training and better and more regular top level
engagement can increase mutual understanding, encourage
cross-fertilisation and allow the development of much
stronger and diverse personal networks.
•• We will establish and jointly fund an industry and NHS

training and education programme which would
allow the most senior managers and clinicians to learn
and train together with industry colleagues; and we will
also establish a new industry and NHS CEO network to
encourage much more understanding between CEOs in
the NHS and CEOs in industry to promote the spread of
new ideas and innovations.
We need to be able to draw on the best available knowledge

and experience of innovation to support adoption and
diffusion at local level, and to cross-fertilise ideas and
expertise across the NHS. We need to get the brightest
1979
Sir Terence English performs the first successful UK heart transplant at Papworth Hospital, Cambridge

“Leadership for innovation begins The NHS Commissioning Board, through its legal duty to
promote research and innovation, can and will influence
at the Board. An empowering Board is behaviour by setting the right expectations.
one that opens its eyes to the potential •• The NHS Operating Framework 2012/13 asks the
for innovation inside the organisation, NHS to prioritise the adoption and spread of innovation
and good practice. It sets out that commissioners and
outside the organisation and in providers should have due regard to this report when
developing local CQUIN schemes.
collaboration with other organisations.
Staff are amongst the most impressive We will also set clear priorities for commissioning that will
drive the uptake of high impact medicines, technologies,
innovators when they are liberated to devices, diagnostics and pathways.
find new ways of doing things.” The ABPI, the ABHI and the NHS Confederation are
Sir Keith Pearson, NHS Confederation Chair establishing an Innovation Pipeline Project, designed to
increase the adoption and diffusion of proven technologies in
Leadership for Innovation areas of high clinical need to deliver high quality patient
Providing clear unequivocal leadership on innovation at outcome and efficiency gains.
national, regional and local level is essential to creating,
supporting and sustaining the adoption and diffusion of The NHS Commissioning Board will work with the partners
innovation. We need to increase accountability at Board to support the delivery of this collaboration ensuring the
level, throughout the NHS. Searching for and applying partnership projects are prioritised by NHS organisations in
innovative approaches to delivering healthcare must be an their localities and their success is effectively spread across
integral part of the way the NHS does business: ‘hard-wired’ the NHS. An important objective is to ensure a matching of
into the daily work of every member of NHS staff. needs of NHS commissioners and providers with the experience
and expertise of industry partners.
The NHS Commissioning Board must find the right balance
between ‘must-do’, and enabling and supporting the We will support the Innovation Pipeline Project, which
development of innovative behaviours. Some innovations will undertake 15-20 joint working projects between NHS
are so obviously beneficial in improving both quality and providers and ABPI and ABHI member organisations by the
productivity that making them a priority is the best way of end of 2013.
ensuring rapid uptake and spread. For example, in the last
3 years the NHS has reduced MRSA infection by 65%, and
over the last 5 years by 80%. This and other examples show e-consultation
that with the right leadership at national and local level the
NHS can be remarkably effective at delivery. Clinicians in Bradford have introduced e-consultations
between GPs and nephrologists for patients with chronic
We all have a part to play through the actions in this report kidney disease. Sharing primary care records electronically
to create incentives for front line organisations and staff to with hospital specialists asynchronously at times convenient
behave differently. We will work with NHS organisations to each has enabled more informed clinical decision-
and their representative bodies to change the culture in making and reduced outpatient referrals. For GPs the
the service and create a smarter business-to-business service provides timely and helpful advice, and supports
relationship with the life sciences sector. management of chronic kidney disease in the community.
British pathologist Almroth Wright developed the first anti-Typhoid vaccine

c
A common feature of any genuinely innovative organisation systematically to spread them at pace and scale. We will
is clear top-level commitment from the Board. Every NHS make an immediate start:
Board should explicitly invest time, resource and effort in
innovation. Specifically: 3 Million Lives
Early indications from the Whole System Demonstrator
•• We will require Clinical Commissioning Groups (CCGs) to programme show that dramatic (and independently
seek out and adopt best practice, as part of the legal duty evaluated) reductions in emergency attendances, admissions,
to promote innovation, and capacity for innovation will levels of mortality and hospital bed days are possible. To make
be integral to the CCG authorisation process. the most of these possibilities we need to spread the use of
telehealth and telecare across the country.
•• We will require the Chief Executive of every NHS
commissioning organisation, including the NHS Assistive technologies have the potential to deliver
Commissioning Board, to take personal responsibility transformational improvements in the quality of care we
to ensure that arrangements are in place to champion provide, and taken together with service redesign they also
research, innovation and adoption, and that the adoption have the potential to deliver significant cost savings. We have
and spread of proven innovation is central to their the opportunity to adopt these technologies on a scale that
commissioning plans. would put the NHS at the forefront of the management of
chronic disease globally.
the nhs operating framework asks the nhs to However, capital investment costs can be prohibitively
prioritise the adoption and spread of effective expensive. To avoid this we will work with industry to identify
innovation and good practice ways of reprofiling costs so that they can be met from
downstream revenue savings.
Clinical Commissioning Groups WILL BE UNDER •• We will accelerate the use of assistive technologies in the
A DUTY to seek out and adopt best practice, NHS, aiming to improve at least 3 million lives over the
AND promote innovation next five years.
We will strengthen leadership and Oesophageal doppler monitoring (ODM)

accountability for innovation at Board level ODM is a minimally invasive technology used by anaesthetists
throughout the NHS during surgery to assess the fluid status of the patient and
guide the safe administration of fluids and drugs.
In March 2011, NICE published guidance on the use of

HIgh impact Innovations ODM, recommending it for patients undergoing major or
We know the NHS can spread new ideas at pace and high-risk surgery and certain other surgical patients. Despite a
scale when it puts its mind to it. In fact it has a long and comprehensive evidence base, uptake of this technology has
successful track record on this – 4 hour waits in A&E, health been poor across the NHS. Full adoption of this technology
care associated infections (HCAI), prevention of venous across the NHS is forecast by NICE to benefit over 800,000
thromboembolism (VTE), 18 weeks waiting times, to name patients and generate net financial savings of over £400m.
a few. In each case we have succeeded because of Current information suggests that these technologies are used
a single-minded determination to deliver at all levels of the for less than 10% of applicable patients.
Department of Health and NHS.
•• We will launch a national drive to get full implementation
We need to do more of this. We need to scan for those ideas of ODM, or similar fluid management monitoring
that will deliver game-changing improvements and work technology, into practice across the NHS.
1980
UK’s first coronary angioplasty performed at the Brompton Hospital, London

Child in a Chair in a Day
Whizz-Kidz (a wheelchair services charity) set itself the
ambition of getting disabled children into a wheelchair
appropriate to their needs within one day. This compares
to waiting times in the NHS, which can be up to 200 days
or longer. The Whizz-Kidz model combines the best of the
charitable sector with the best of the commercial sector
to deliver high quality, high value and highly responsive
services. The NHS must do more to develop and spread
these types of transformational programmes at pace
and scale. In particular, they should work with local
stakeholders and provider organisations to deliver or
procure wheelchair services that emulate the success of
the Whizz-Kidz model.
•• We will launch a ‘Child in a chair in a day’ programme

to transform the delivery of wheelchair services
throughout the NHS.
International and commercial activity The Department of Health, NHS and UK Trade and
The NHS receives regular requests for help, support and Investment will jointly host a summit in the new year to
advice from a range of established and emerging health develop proposals to realise the huge potential for the NHS
economies. We are the preferred partner of choice for to generate commercial revenue from overseas activity, and
many, but have not always responded systematically to accelerate the pace and scale of existing activity.
those requests. The international healthcare market is worth
more than $4 trillion a year, and the NHS must do more to •• We will require NHS organisations to work with the NHS
exploit the commercial value of its knowledge, information, Improvement Body supported by UK Trade and Investment
ideas and people. The opportunities are significant, and if to explore opportunities to increase national and
grasped they will not only return revenue, expertise and new international health care activity.
ideas to the NHS to improve healthcare, but will also help
drive growth in UK PLC. Digital by default
While face-to-face contact is central to much of clinical
medicine, it is not necessary for every interaction. Attending
WHEELCHAIRS FOR CHILDREN hospital to receive a negative test result is quite often
unnecessary, as well as being inconvenient for the patient.
Whizz-Kidz’s ambition is to give 70% of children the For many people who use electronic media as part of their
equipment they need on the day of assessment – daily lives, the ability to use email for non-confidential
they currently achieve 65%. Tesco helped by sharing communications, or to have a remote consultation using
expertise in bulk buying and customer service, and telephone or online technology, would offer a much more
Accenture introduced lean management techniques. convenient way of accessing NHS services. The NHS can
This enabled Whizz-Kidz to deliver shorter waiting do more to drive down the level of inappropriate and
times, higher patient satisfaction, improved clinical unnecessary face-to-face contacts.
efficiency, direct supply and delivery savings of about
£2,400 per user, and improved quality of life valued at Currently face-to-face contact accounts for nearly 90% of all
between £10 and £65 for every £1 invested. healthcare interactions; every 1% reduction in face-to-face
contact saves up to £200m.
The UK has been awarded 34 Nobel Prizes in medicine, countless lives changed and saved

c
•• We will require the NHS to work towards reducing WE WILL RAPIDLY ACCELERATE THE USE OF
inappropriate face-to-face contacts and to switch to ASSISTIVE TECHNOLOGIES IN THE NHS, AIMING TO
higher quality, more convenient, lower cost alternatives, IMPROVE AT LEAST 3 MILLION LIVES OVER THE NEXT
making use of the transformational improvements in the FIVE YEARS
quality of information technology.
CARERS FOR PEOPLE WITH DEMENTIA We will launch a national drive to get full
There are estimated to be 600,000 people in the UK acting implementation of ODM, or similar fluid
as the primary carers for people with dementia. Caring can management monitoring technology into
be an overwhelming experience, bringing irreversible changes practice across the NHS.
to lives and relationships. Carers can benefit significantly
with comprehensive support, including emotional support,
assistance with day-to-day caring and access to respite and WE WILL LAUNCH A ‘CHILD IN A CHAIR IN A DAY’
short breaks. PROGRAMME TO TRANSFORM THE DELIVERY OF
WHEELCHAIR SERVICES THROUGHOUT THE NHS
The costs of caring are significant. Carers save the UK public
purse £6 billion every year. Without provision of better WE WILL REQUIRE NHS ORGANISATIONS TO explore
support for carers, such as the provision of carer breaks and OPPORTUNITIES TO INCREASE NATIONAL AND
access to a range of psychological therapies, an increasing INTERNATIONAL HEALTHCARE ACTIVITY and will
number will be unable to continue caring and pressure on the host a summit with UK trade and investment
health and care system will continue to grow. in the new year
The NHS must ensure that a range of these psychological

therapies are being commissioned and are available in line WE WILL REQUIRE THE NHS TO WORK TOWARDS
with NICE-SCIE guidelines. As set out in the NHS Operating REDUCING INAPPROPRIATE FACE-TO-FACE
Framework 2012/13, the NHS should also ensure that there is CONTACTS AND TO SWITCH TO HIGHER QUALITY,
better provision of carers’ breaks. MORE CONVENIENT, LOWER COST ALTERNATIVES
•• We will require the NHS to commission services in line with

NICE-SCIE guidance on supporting people with dementia WE WILL REQUIRE THE NHS TO COMMISSION
SERVICES IN LINE WITH NICE-SCIE GUIDANCE ON
CQUIN SUPPORTING PEOPLE WITH DEMENTIA
These are all compelling proposals that can rapidly deliver quality
and productivity improvements, which we would expect every FROM APRIL 2013, COMPLIANCE WITH THE
NHS organisation to address. It is not our intention, nor is it HIGH IMPACT INNOVATIONS WILL BECOME A
appropriate, to make judgements about compliance from the PRE-QUALIFICATION REQUIREMENT FOR CQUIN
centre, but we will require commissioners to satisfy themselves
that all eligible organisations are delivering the high impact
innovations set out in this report in order to pre-qualify for
CQUIN payments. This will take effect from 2013/14. In the
meantime commissioners and providers should work together
to prepare for the new arrangements.
•• From April 2013, compliance with the high impact

innovations will become a pre-qualification
requirement for CQUIN
1988
James Black wins Nobel Prize for inventing beta blockers

SUMMARY OF ACTIONS
Reducing variation and Incentives and investment We will strengthen leadership and
strengthening compliance We will align financial, operational and accountability for innovation at Board
We will introduce a NICE Compliance performance incentives to support the level throughout the NHS
Regime to reduce variation and adoption and diffusion of innovation
drive up compliance with NICE High Impact innovations
Technology Appraisals We will increase the profile of, and We will rapidly accelerate the use of
maintain investment in, the NHS assistive technologies in the NHS,
We will require that all NICE Technology Innovation Challenge Prizes aiming to improve at least 3 million
Appraisal recommendations are lives over the next five years.
incorporated automatically into relevant We will extend the ‘never events’
local NHS formularies in a planned way regime and encourage disinvestment We will launch a national drive to
that supports safe and clinically in activities that no longer add value get full implementation of ODM,
appropriate practice or similar fluid management
We will establish a Specialised Services monitoring technology, into practice
We will establish a NICE Implementation Commissioning Innovation Fund across the NHS.
Collaborative to support prompt Procurement
implementation of NICE guidance We will launch a ‘child in a chair
We will publish a procurement strategy in a day’ programme to transform
Metrics and Information in March 2012 the delivery of wheelchair services
We will develop and publish an We will double our investment in the throughout the NHS
innovation scorecard to track compliance Small Business Research Initiative
with NICE Technology Appraisals We will require NHS organisations
We will review the existing NHS to explore opportunities
We will procure a single comprehensive intellectual property strategy and to increase national and international
and publicly available web portal for develop a model for contracts that healthcare activity and will host a
innovation in the NHS is fit for purpose summit with UK trade and investment
in the new year
We will work with Which? to raise Developing our People
awareness among the public and patients We will ensure that innovation is We will require the NHS to work
of innovations in healthcare ‘hard-wired’ into educational curricula, towards reducing inappropriate
training programmes and competency face-to-face contacts and to switch to
We will establish the Clinical Practice higher quality, more convenient, lower
Research Datalink (CPRD),a new secure frameworks at every level
cost alternatives
data service within the Medicines and We will establish joint industry
Health Care Products Regulatory Agency and NHS training and education We will require the NHS to
(MHRA) programmes for senior managers commission services in line with NICE-
SCIE guidance on supporting people
Creating a system for We will establish an NHS Innovation with dementia
delivery of innovation Fellowship Scheme
We will establish a number of From April 2013, compliance with the
Academic Health Science Networks Leadership for Innovation high impact innovations will become
(AHSNs) across the country. The NHS operating framework asks a pre-qualification requirement for
the NHS to prioritise the adoption and CQUIN
We will publish details of the AHSN spread of effective innovation and
designation process in March 2012 good practice
We will undertake a sunset review Clinical Commissioning Groups will be
of all NHS/DH funded or sponsored under a duty to seek out and adopt
innovation bodies. best practice, and promote innovation
With immediate effect, NICe will take
responsibility for the itapp programme

Implementation
“The potential for the NHS to deliver A single model will avoid the problems of fragmentation
and duplication that have previously beset the system; it will
innovation at scale and pace is underpin a massive improvement approach.
enormous – it is vital and urgent As we move into implementation it is vital that we maintain
that we go on to deliver the benefits” momentum and deliver quickly and effectively. First, we
will establish an Implementation Board to oversee delivery.
Sir David Nicholson, Chief Executive, NHS England
The Board will be chaired by Sir Ian Carruthers, reporting
to the NHS Chief Executive. The Board will be small and
membership will include our most senior stakeholders who
In order to develop the recommendations set out in this report will ensure a relentless focus on delivery.
we have consulted with a very broad range of stakeholders
and interested communities, including academia, the scientific We will also establish a series of cross-sectoral “Task and
community, industry, the NHS, representative bodies such Finish” groups to lead the delivery of individual actions.
as the NHS Confederation, the Technology Strategy Board, Each group will be led by a Board level sponsor with leading
Royal Colleges and many others. That process has contributed practitioners and experts drawn from the public, private,
significantly to the richness and depth of thinking underpinning academic, scientific and NHS communities.
this review and its findings, and has helped shape a set of
actions that have the potential to deliver game-changing
improvements in the pace and scale of change in the
NHS. In particular, the External Advisory Group has been
instrumental in stress testing emerging ideas and helping
finalise the list of actions.
We now need to turn our attention towards

implementation. This will need all parts of the health and
social care system to plan and improve together, ensuring
frontline services continue to provide safe, high quality and
good value care and spreading best practice and new ideas
right across the NHS. To do that in a tougher economic and
financial climate will need strong leadership at all levels.
Though current models of improvement and change

that have emerged in health over the past decade have
delivered benefits, they have also resulted in fragmentation
and significant duplication of effort, with a multiplicity of
different change approaches being used. If the NHS is to
achieve results which are amongst the best in the world we
will need a system that can significantly ramp up the pace
and scale of change and innovation.
The new commissioning system presents an opportunity to

de-clutter, consolidate and streamline innovation activity Where necessary, more detailed assessments of potential
in the NHS. This means ensuring the support, advice and economic impacts (to ensure value for money for tax payers)
guidance available is fit for purpose for the new NHS, focused and equality impacts (to ensure legal equality duties are met)
around a single model for driving transformation and change. will be undertaken as part of the implementation process.
2000
Sanger Centre in Cambridge contributes one third of the human genome sequence

timeline
Launch-3 months
NICE to take responsibility for the iTAPP programme Round two of the Innovation Challenge Prizes announced
International healthcare summit with UK Trade Innovation Pipeline Project launched

and Investment
Department of Health Procurement
NHS Operating Framework published Strategy launched
Whole Systems Demonstrator and NICE Compliance introduced

Three Million Lives launched
Advice on decommissioning in NICE
First meeting of Showcase Hospital group Guidance strengthened
Uptake programme for use of ODM or similar fluid Details of AHSN designation process published
management monitoring technology launched
Sunset Review commissioned
3-9 months
Specialised Services Commissioning Innovation Fund launched Which consumer campaigns launched
Child in a Chair in a Day programme launched Innovation Scorecard published
NICE Implementation Collaborative established Web Portal for NHS Innovations launched
Guidance on best use of existing local tariff flexibilities Extension of Never Events
published by NHS Institute
Guidance on Digital by Default published
Intellectual Property guidance published
Academic Health Science Networks operational
NHS Innovation Fellowship Scheme launched
Joint NHS /Industry training and education programme

established
9 months and over
New managerial and clinical curricula launched Guidance for job descriptions and performance
appraisals published
CQUIN prequalification introduced
Tariff for Assistive Technologies introduced
Competency frameworks published
Shared Savings formula guidance published
Guidance on tariff for diagnostics published

External Advisory Group
Chair
Sir Ian Carruthers, OBE
Chief Executive
NHS South of England
Members
David Albury Bettina Fitt Johnny Lundgren
Co-Chair, Innovation Unit Ltd General Manager UK & Ireland, VP/GM North West Europe,
GE Healthcare Beckton, Dickinson UK Ltd,
Miles Ayling and Chair, Association of
Director of Innovation and Service Nigel Gaymond Healthcare Industries
Improvement, Department of Health Chief Executive,
BioIndustry Association Colin Morgan OBE
Prof Sir John Bell Regional Vice President,
President of Academy of Medical Dr Clare Gerada MBE Johnson & Johnson MDD
Sciences and Chair, Office for Chair, Royal College of General
the Strategic Coordination of Practitioners Geoff Mulgan
Health Research Chief Executive, NESTA
Prof Chris Ham
Kevin Bentely Chief Executive, Kings Fund Sue Slipman
Councillor, Essex County Council Director of the Foundation
Prof Sue Hill OBE Trust Network
Richard Blackburn Chief Scientific Officer,
UK Managing Director, Pfizer Ltd Department of Health Tim Smart
Chief Executive,
Chris Brinsmead Dr Paul Hodgkin Kings College Hospital
Independent Advisor Chief Executive, Patient Opinion
Prof Michael Thorne
Sir Andrew Dillon CBE Prof Peter Johnson Vice Chancellor,
Chief Executive, National Institute Chief Clinician, Cancer Research UK Anglia Ruskin University
of Health and Clinical Excellence
Prof Sir Bruce Keogh Patrick Vallance
Dr Jennifer Dixon NHS Medical Director, Senior Vice President, Medicines
Director, The Nuffield Trust Department of Health Development, GlaxoSmithKline
Bob Driver Mike Keoghan Stephen Whitehead

Director, High Technology Sectors, Director of Skills and Life Chief Executive, Association of
UK Trade and Investment Sciences, Department of Business, British Pharmaceutical Industry
Innovation and Skills
Jim Easton Dr Ian Wilkinson
National Director for Improvement Sir Ron Kerr CBE Chair, Commissioning for
and Efficiency, Department of Health Chief Executive, Guys & Thomas’ Oldham Group
Hospital and Chair Association of
Mike Farrar UK University Hospitals Doris-Ann Williams MBE
Chief Executive, NHS Confederation Chief Executive, British In Vitro
Diagnostics Association

Glossary
Assistive Technologies Knowledge & Skills Framework Technology Appraisals
A product or service designed to A framework which defines and describes The process of developing
enable independence for disabled the knowledge and skills which NHS staff recommendations on the use of new and
and older people. need to apply in their work in order to existing health technologies in the NHS
deliver quality services.
Atlas of Variation Value Based Pricing
A tool to help the NHS identify Never events A system to improve patients’ access
unwarranted variation in healthcare Serious, largely preventable patient safety to effective and innovative drugs by
services. incidents that should not occur if the ensuring they are available at a price that
available preventative measures have reflects the value they bring.
Biotechnology been implemented.
The application of scientific and technical Value proposition
advances in life science to develop NHS Formularies A product or service that adds more value
commercial products. The specification of which medicines or offers a better solution to a problem
are approved to be prescribed based than other similar proposals.
Compliance on evaluations of efficacy, safety, and
The adherence to standards, regulations,
cost-effectiveness.
Variation
and other requirements. Variation in the provision of healthcare
Operating Framework services or outcomes of care that cannot
CQUIN A Framework which sets out the national be explained by variation in patient or
Commissioning for Quality and Innovation
priorities for the NHS on an annual basis. patient preferences
– a payment framework to reward
excellence, by linking income to the Professional Skills for Whole System Demonstrator
achievement of local improvement goals. Government Programme
A competency framework that sets out A research project funded by the
Decommissioning the skills that staff in the Civil Service Department of Health to find out how
A formal process to remove a service,
need to do their job well, at all levels. technology can help people manage
product or process from routine use.
their own health while maintaining their
QIPP independence.
Digital by default Quality, Innovation, Productivity and
The use of Information Technology
Prevention - improving the quality of
to enable faster, more efficient online
care the NHS delivers whilst making
self-service.
efficiency savings.
Fluid Management Technology Regional Innovation Fund

A minimally invasive technique that
A Fund held at regional level aimed at
surgical teams can use to improve
encouraging innovation in healthcare.
the quality of the care they provide to
certain patients. Reverse innovation
A term used to describe a quality or
Innovation Challenge Prize productivity improvement that involves
programme stopping doing something that no longer
Awards given to NHS organisations
adds value.
across the country to recognise and
reward those who have delivered Showcase Hospital Programme
ground-breaking innovations. A programme for selected hospitals to
test a range of new technologies prior
Intellectual Property to wider diffusion.
A term which refers to creations of the
mind: inventions, literary and artistic Sunset Review
works, and symbols, names, images, An evaluation of the need for the
and designs used in commerce. continued existence form or funding
of a program or organisation.

Acknowledgements
The report authors
Alasdair Liddell CBE

Miles Ayling
Graham Reid
The NHS Chief Executive Innovation Review Team
Miles Ayling Vicky O’Regan

Dawne Bloodworth Graham Reid
John Brittain Helen Ross
Rachel Cashman Anna Shears
Susan Fairlie Emma Snowden
Alasdair Liddell CBE
POLICY WORKING GROUP
Giles Denham Lynn Maher

Ian Dodge Inderjit Singh
Russell Hamilton Radhika Sriskandarajah
David Harper John Warrington
Sue Hill Giles Wilmore
Consultation and Analysis
Sylvia Wyatt
Peter Gerry

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Innovation

Policy Improvement & Efficiency

Document Purpose Action

Gateway Reference 16978

Author Department of Health, NHS Improvement & Efficiency Directorate,

Publication Date 5th December 2011

Superseded Docs N/A

Contact Details [email protected]

For Recipient’s Use

Innovation, Health and Wealth — 3

4 — Innovation, Health and Wealth

Our ambition must be for an NHS defined by its

We have the potential to create the best health system in

That is our collective challenge.

I would like to thank Sir Ian Carruthers, Chief Executive of NHS

Sir David Nicholson

Innovation, Health and Wealth — 5

Proposals for the NHS Commissioning Board are subject

6 — Innovation, Health and Wealth

This is why the Government’s Plan for Growth, published in

Innovation, Health and Wealth — 7

8 — Innovation, Health and Wealth

Innovation, Health and Wealth — 9

Barriers to innovation in the NHS

10 — Innovation, Health and Wealth

On the supply side, establishing the ‘added value’ of an

The potential added value of an innovation, the ease of its

Diffusion in systems as large and complex as the NHS

Previous attempts to achieve consistent and widespread

The NHS in England employs approximately one in 24 of the working population

Innovation, Health and Wealth — 11

12 — Innovation, Health and Wealth

Innovation, Health and Wealth — 13

The delivery agenda

To do this, we need to bring about a lasting change in

Our approach has been to focus on a limited number of high

14 — Innovation, Health and Wealth

TRANSFORMING HIP REPLACEMENT Formulary processes should proactively consider the

Innovation, Health and Wealth — 15

The NIC could have a crucial role to support implementation

-- Work with NICE to develop and extend its

-- Where needed, work with industry to develop a better

-- Set out how use of existing tariff flexibilities at local

-- Through the NHS Improvement Body provide direct

16 — Innovation, Health and Wealth

Laszlo Igali, Norfolk and Norwich University Hospital

Innovation, Health and Wealth — 17

We will procure a single comprehensive and

We will work with Which? to develop

We will establish the Clinical Practice

18 — Innovation, Health and Wealth

Academic Health Science Centres (AHSCs) have been home haemodialysis

In addition, we shall support these Centres and build on their

Innovation, Health and Wealth — 19

20 — Innovation, Health and Wealth

An NHS team in Cambridge developed the ‘Cytosponge’,

Innovation, Health and Wealth — 21

johnny lundgren, chair, ABhi

22 — Innovation, Health and Wealth

The existing Intellectual Property strategy can discourage 1

Innovation, Health and Wealth — 23

•• We will establish and jointly fund an industry and NHS

We need to be able to draw on the best available knowledge