In recent years, digital innovation has transformed virtually every aspect of our digital lives – from banking to fitness to communication. Yet the health system has remained broadly resistant to disruptive change, despite all sides agreeing on potential bounty and the NHS theoretically having the scale, levers and information to drive rapid change. So how can we foster a culture of large-scale and safe digital disruption in healthcare in the UK? A recent Portland-Tech UK event, chaired by Professor Mike Bewick, former Deputy Medical Director at NHS England, offers some instructive lessons.
First, there is now universal support for digital innovation. The fear of the unknown is subsiding and the constituent parts of the NHS – from NHS England down to Accountable Care Organisations, Integrated Care Systems and Clinical Commissioning Groups – are opening up. As Bob Ricketts of NHS England set out, this includes putting in place the data architecture, such as integrated care records, and the structures, such as new frameworks for digital products, to facilitate new innovation. The message was clear: the system will embrace innovative change.
Second, disruptors are ready and waiting to engage. Steve Tope of Tunstall spoke of their history of transforming local services through digital products, Julia Ross of PredictX spoke of bringing real intelligence to population health data, and David Orbuch of Optum outlined how they are offering clinicians clean data to identify and solve latent health challenges, in the same way as clean water helped reduce typhoid and diphtheria in a bygone age.
In my own experience working on a digital mental health start-up, Bolster, and working in 10 Downing Street, there is a wealth of exciting early stage startups desperate to bring new technological solutions to bear on health and social care. However, as Steve Tope made plain with examples, it remains hard to diffuse established and proven technologies, let alone unproven and experimental ideas.
The false division between disruptors and the system means it is necessary to bridge the gap – to make the system intelligible to disruptors, and for disruption to be made intelligible to the system. Only then can we create safe routes for innovation at scale.
A number of ideas were openly discussed. Regulators such as NICE and CQC could be made more innovation friendly – embracing sandpits to allow startups to test products in simulated environments with real patient data and establishing accelerated access pathways for digital treatments. Alongside, digital treatment could be put on an equal footing to pharmaceutical and physical health treatments – allowing prescribing of apps and digital services alongside or in place of more conventional treatments.
Finally, the system should learn to embrace disruptors, because it is outsiders, not incumbents, that deliver systemic change. There are a host of ways to achieve that, but panellists pointed in particular to making better use of the Academic Health Science Network and using NHS England to match-make between early stage startups and clinical commissioners keen to innovate on particular issues.
In all, it was an immensely positive discussion, bringing together the leaders of the existing healthcare system with those that seek to transform it for the better, on equal terms. Both sides – the system and the disruptors – now need to work to bridge the gap to unleash a wave of innovation to improve care, save lives and reduce costs in this country and beyond.