Can innovation really be the raison d'etre of every NHS employee as David Nicholson hopes?: The chief executive of the NHS wants to make innovation the core business of the health service, but there is still a long way to go.
This time last year, the Department of Health launched the Innovation, Health and Wealth initiative, which was to drive the NHS into the bright sunny uplands of perpetual innovation.
Sir David Nicholson's goal for the programme was to make innovation core business and the "raison d'etre of every NHS employee". He set up sticks and carrots to nudge providers into being innovative, and punish them for staying luddite.
He created fancy new departments to drive innovation and a healthcare innovation industry was born. Marvellous.
According to the Health Service Journal, a year on, only six of the 26 actions due to be completed under the programme by this September have happened. This does not entirely surprise me. Innovation in the NHS is a hard row to furrow. A rather frustrated Westminster Health Forum last month on "accelerating innovation in healthcare" spent more time listing the inhibitors to innovation than describing the accelerators.
Sally Chisholm of the NHS Technology Adoption Centre blamed "budget silos", as narrow funding streams often present financial disincentives to changing the way of working. She also described the European tender process as "problematic and difficult for people".
Nishan Suntares, from the Association of Healthcare Industries, blamed the "incredibly fragmented and diverse landscape" of procurement, which delayed the marketing of innovative devices often by a year or more.
Other healthcare suppliers expressed their frustration with the regulatory processes.
Last week, Richard Quine of the software house InHealthcare put the procurement problem in small innovative companies even more forcibly to me. To him, the NHS had closed its procurement lists six or seven years ago, excluding him from tendering. But, he said, "new innovative products were coming on the market every week" from small, young companies like his. Thus, the NHS was wilfully shutting itself out from the newest products.
Sally Chisholm surprised me by worrying about the delays caused by "the need for real world evidence before procuring".
In the same vein, I have been going on about what seem to me interminable delays in publishing the findings of the whole systems demonstrator (WSD) programme on telehealth.
James Barlow, chair in technology and innovation management at Imperial College, who was involved in the WSD programme, delighted me by saying at the forum that:
It's nice to find a distinguished academic agreeing with a poor geriatric patient like me.
Speakers cited other inhibitors, like the chronic lack of implementation experience across the NHS; the difficulties of getting different bits of the NHS to talk to each other; the way innovation is neither recognised nor celebrated. Innovation is just not part of the NHS leadership culture.
I, in my most offensive mode, asked whether the big reason for lack of progress might be the hostility of clinicians and the inertia of the BMA and royal colleges towards any form of innovation. The panel did not appear to understand my question, or perhaps the question was too shocking for them to handle. I got no answer.
I sensed, however, that there were people at the seminar who would welcome innovation, the more disruptive the better. James Barlow forecast the "inevitable decline in the hospital-centric model".
This filled me with hope for the future, because it is only disruptive thinking that will raise the NHS from its current bureaucratic quagmire into a clinically and financially better place. Otherwise you get into a situation where, as Einstein said, you are "doing the same thing over and over again, expecting different results".
Possibly the most disruptive speaker was Rob Dyke of Handi (Health Apps Network for Development and Innovation), who helps clinicians to write apps. He is scornful about "big IT" in healthcare. First, it doesn't work very well. It costs billions, and, worst of all, does not talk to other big-IT systems. Handi's apps, he claimed, are open-source, and consequently do work together.
More disruptively, he believes that an "Institute of Innovation" is the ultimate oxymoron, because "you cannot institutionalise innovation". Instead you have to "be agile, hack things together, funnel ideas, forge solutions, tweet about them, blog about them; fail lots, win some".
From time to time, he and some friends corral software people and geeky clinicians into one room, and write, in a "Hackday" weekend, clinical apps that solve "real-ward" problems. The speed and the co-operation have been, until now, unheard-of in the annals of healthcare IT. For once, clinicians are on the inside, putting up ideas, not carping from the outside.
In my book, the Handi approach to innovation, although piecemeal and informal, is more likely to change the culture of the NHS than Sir David's stately institutions for innovation.
The next NHS Hackday is at the John Radcliffe hospital in Oxford on the weekend of 26-27 January 2013. Guardian Professional.
This time last year, the Department of Health launched the Innovation, Health and Wealth initiative, which was to drive the NHS into the bright sunny uplands of perpetual innovation.
Sir David Nicholson's goal for the programme was to make innovation core business and the "raison d'etre of every NHS employee". He set up sticks and carrots to nudge providers into being innovative, and punish them for staying luddite.
He created fancy new departments to drive innovation and a healthcare innovation industry was born. Marvellous.
According to the Health Service Journal, a year on, only six of the 26 actions due to be completed under the programme by this September have happened. This does not entirely surprise me. Innovation in the NHS is a hard row to furrow. A rather frustrated Westminster Health Forum last month on "accelerating innovation in healthcare" spent more time listing the inhibitors to innovation than describing the accelerators.
Sally Chisholm of the NHS Technology Adoption Centre blamed "budget silos", as narrow funding streams often present financial disincentives to changing the way of working. She also described the European tender process as "problematic and difficult for people".
Nishan Suntares, from the Association of Healthcare Industries, blamed the "incredibly fragmented and diverse landscape" of procurement, which delayed the marketing of innovative devices often by a year or more.
Other healthcare suppliers expressed their frustration with the regulatory processes.
Last week, Richard Quine of the software house InHealthcare put the procurement problem in small innovative companies even more forcibly to me. To him, the NHS had closed its procurement lists six or seven years ago, excluding him from tendering. But, he said, "new innovative products were coming on the market every week" from small, young companies like his. Thus, the NHS was wilfully shutting itself out from the newest products.
Sally Chisholm surprised me by worrying about the delays caused by "the need for real world evidence before procuring".
In the same vein, I have been going on about what seem to me interminable delays in publishing the findings of the whole systems demonstrator (WSD) programme on telehealth.
James Barlow, chair in technology and innovation management at Imperial College, who was involved in the WSD programme, delighted me by saying at the forum that:
"I just don't think you can really evaluate something like that [the WSD] using narrow conventional evidence-based methodologies. I think in the WSD example, we've shot ourselves in the foot frankly, by going down a very narrow road, trying to get some sort of gold standard evidence for remote care, which we just can't get, and that's actually pulling back its uptake."
It's nice to find a distinguished academic agreeing with a poor geriatric patient like me.
Speakers cited other inhibitors, like the chronic lack of implementation experience across the NHS; the difficulties of getting different bits of the NHS to talk to each other; the way innovation is neither recognised nor celebrated. Innovation is just not part of the NHS leadership culture.
I, in my most offensive mode, asked whether the big reason for lack of progress might be the hostility of clinicians and the inertia of the BMA and royal colleges towards any form of innovation. The panel did not appear to understand my question, or perhaps the question was too shocking for them to handle. I got no answer.
I sensed, however, that there were people at the seminar who would welcome innovation, the more disruptive the better. James Barlow forecast the "inevitable decline in the hospital-centric model".
This filled me with hope for the future, because it is only disruptive thinking that will raise the NHS from its current bureaucratic quagmire into a clinically and financially better place. Otherwise you get into a situation where, as Einstein said, you are "doing the same thing over and over again, expecting different results".
Possibly the most disruptive speaker was Rob Dyke of Handi (Health Apps Network for Development and Innovation), who helps clinicians to write apps. He is scornful about "big IT" in healthcare. First, it doesn't work very well. It costs billions, and, worst of all, does not talk to other big-IT systems. Handi's apps, he claimed, are open-source, and consequently do work together.
More disruptively, he believes that an "Institute of Innovation" is the ultimate oxymoron, because "you cannot institutionalise innovation". Instead you have to "be agile, hack things together, funnel ideas, forge solutions, tweet about them, blog about them; fail lots, win some".
From time to time, he and some friends corral software people and geeky clinicians into one room, and write, in a "Hackday" weekend, clinical apps that solve "real-ward" problems. The speed and the co-operation have been, until now, unheard-of in the annals of healthcare IT. For once, clinicians are on the inside, putting up ideas, not carping from the outside.
In my book, the Handi approach to innovation, although piecemeal and informal, is more likely to change the culture of the NHS than Sir David's stately institutions for innovation.
The next NHS Hackday is at the John Radcliffe hospital in Oxford on the weekend of 26-27 January 2013. Guardian Professional.
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