Effective Implementation & Utilisation of Diagnostic Technology in the NHS
Posted 21st May 2018 by Jane Williams
An inquiry by the House of Lords’ Science & Technology Committee has identified several issues that could hamper the delivery of the Life Sciences Industrial Strategy vision1. The critical report (Life Sciences Industrial Strategy: Who’s driving the bus? 1) brings together evidence from industry, academia and the NHS. It highlights several implementation challenges which require “prompt and vigorous action by the government” to ensure that the scope of Life Sciences Industrial Strategy can be achieved.
The Committee also concluded that the Government “has avoided explicit acceptance of responsibility for delivery of Sir John’s recommendations” 2. It is a concern that many witnesses did not think that there is sufficient attention paid to successful implementation; in particular, highlighting the absence of a holistic/connected approach and a lack of a credible implementation and oversight plan.
The Life Sciences Industrial Strategy identifies the NHS (and NHS data) as a central asset for the delivery of healthcare innovations. However, the Lords Committee received consistent evidence that the NHS does not have “the capacity to rise to the challenge of implementation” and is disadvantaged by its embedded structures which make adoption of innovation more problematic. This is made worse by a “lack of co-ordination between NHS bodies”. Indeed, it was Sir John Bell providing evidence who recognised that whilst NHS leaders may have an appetite for delivering innovation, he could not see how this was going to be driven – hence the very apt “who’s driving the bus” analogy.
In a stark admission, the report states what most of us working with/alongside the NHS know: “almost all of the evidence we received said that the NHS was poor at adopting an innovation at scale”. This is a particular frustration for industry and SMEs who would like to see more widespread adoption of innovation, rather than disparate, small-scale trials which make the spread of innovation more difficult to achieve. These are all things I recognise and have emphasised in relation to the adoption of digital pathology3: there is a disconnection of NHS services and bodies which makes devising a national strategy and having a connected approach difficult. The report recognises that this fragmentation does not allow strategic discussions about treatments/pathways across the NHS, and states that “the current structure of the NHS stifles innovation”.
Importantly, the report also pays attention to the workforce skills and training agenda and discusses ideas of “convergent training” to support individuals with dual qualifications in business and science. Witnesses highlighted the importance of entrepreneurship training; the committee recognising an existing NHS England initiative which provides an entrepreneurial training programme for NHS clinicians4.
The Committee report makes several recommendations: implementation and oversight plans for delivery of Life Sciences Industrial Strategy including:
- The delivery of a skilled workforce
- The establishment of a single body to ensure delivery of Life Sciences Industrial Strategy
- The creation of Office for Industrial Strategy to scrutinise implementation
- NHS bodies to prioritise adoption and spread of innovation – including the mandating of uptake for those innovations that have demonstrated benefit to patients.
Is there any light at the end of the tunnel? For me, the call for a robust implementation and oversight plan is perhaps the most important recommendation. The recognition that NHS structure makes innovation at scale difficult is timely, but I did not see a solution to this at present. I think a simplification of NHS bodies/initiatives would be helpful, least of all to industry/SMEs who find it difficult to navigate the complex beast that is the NHS but also for the rest of us who are trying to navigate the myriad of initiatives. The AHSN network is highlighted as an important tool in the delivery of innovation at scale – my impression is that this network seems to focus on commercialising novel innovations; I would ask that it also looks to implementation of existing innovations that we know work.
The recent Industrial Strategy Challenge Fund call to support the “digitisation and Artificial Intelligence to transform pathology and imaging” stream of the Life Sciences Industrial Strategy (Data to Early Diagnosis and Precision Medicine)5 is encouraging. It requires successful consortia to undertake to work together, to provide a clear framework for adoption and to be a “magnet for industry engagement”. This is very important, but how it will be made to deliver is as yet unclear. The objective has to be to use this funding, via the 5-6 proposed centres, to support the connection of diagnostic services across the UK. We have an opportunity in pathology and radiology to provide the NHS with the template for effective implementation and utilisation of diagnostic technology in the NHS.
These are challenging but also exciting times in healthcare: we need, however, to deliver.
As well as being the Director of Clinical Pathology at the University of Bradford, Samar Betmouni is a member of the Philips EU Advisory Board. She specialises in projects involving the implementation of diagnostic digital pathology.
Take a look at the agenda for the upcoming Digital Pathology & AI Congress, to be held in London on the 6th – 7th December 2018.
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