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Health sciences and the NHS #1 Innovation
Key themes and learning from our member discussion – Spring 2014
Health sciences and the NHS
The NHS “works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.” – NHS Constitution
Is the NHS operating at the limits of science?
Time and again we see wonderful developments in healthcare sciences in the NHS which have the potential to bring real value – both financially and in patient care.
However, these are often not embraced by NHS leaders, and not picked up at pace to improve patient care.
We are exploring how NHS boards get the most from healthcare scientists working in the NHS.
The NHS Confederation’s Health sciences and the NHS project brings boards and scientists together to help create the right environment to support scientific breakthroughs.
Over the course of the year, we will be running a series of four meetings and producing three learning packs for our members to explore the value of healthcare sciences and understand how they can support this in their organisations.
Highlighting the potential of healthcare sciences to innovate and improve patient care.
Examining the barriers to developing and implementing innovations.
Examining the role of NHS leadership in supporting developments in healthcare sciences.
Health sciences and the NHS
This slide pack brings together the learning from the first of four meetings on 16 April 2014, and focuses on innovation in healthcare sciences.
This is a resource for NHS boards to consider:
Health sciences and the NHS
• three case studies of innovation in healthcare sciences which have transformed patient care
• the key themes from our discussions on the day
• key challenges for NHS organisations on how they can better support innovation in healthcare sciences.
From the bench to bedside: innovations in genomics and breast cancer care
Keith McNeilChief Executive Cambridge University Hospitals NHS Foundation Trust
Case study 1
From the bench to bedside
Cancers of apparently the same type vary considerably in how they behave. For a long time it was thought that people with a cancer in the same organ all had the same disease.
Yet some would die and others would survive, even when given the same treatment.
In April 2012, healthcare scientists in Cambridge began to study 2,000 breast cancer pathology samples taken from patients in the local hospital.
They looked at the genetics of the individual tumour cells – the mutations that characterised those cells and caused the cancerous tumours to behave in the way they did.
From the bench to bedside
The researchers discovered they could categorise the mutations they saw into ten different groups.
Each category behaved differently when it came to prognosis and response to treatment.
Indeed, the ten groups have markedly different survival rates: 40 per cent in the lowest group, and 80 per cent in the highest (see picture).
Using this understanding, clinicians in Cambridge have been able to refine the way they treat breast cancers and personalise treatment for each patient.
From the bench to bedside
less toxic treatment can be prescribed, minimising side
effects for patients.
less toxic treatment is
shown to have a higher success
rate
Where the patient is in a
good prognostic group
Clearly, such developments impact morbidity and lengths of treatment, with improved survival rates expected.
a more intensive therapy can be given up‐front, increasing
the chances of effective treatment at an earlier stage.
less toxic treatment is shown to have a much lower success
rate
Where the patient is in a bad prognosis
group
From the bench to bedside – reasons for success
Proximity of scientists and cliniciansBoth bench and bedside are on the same site. Cancer Research UK has a laboratory on site at the hospital. This ensures scientists are placed right at the heart of healthcare, enabling clinicians to pose them challenging questions, and scientists to develop answers which really have an impact on patient care.
Leadership and a culture to support innovation It is vital that the leaders of NHS organisations recognise how important innovation is to the future of healthcare, and to set up systems to allow innovation to happen.
Part of this is creating the space and head‐room for innovation, and having the courage to fail while having faith in the long‐term benefits.
Find out more and download the full presentation on our website: www.nhsconfed.org
Applying genomic knowledge into the NHS
Angela Douglas Scientific Director Liverpool Women’s and North West
Case study 2
Applying genomic knowledge into the NHSGenomics is the study of the genes and their functions. It is widely acknowledged that it may revolutionise treatment of illness such as cancer. By understanding the gene mutations involved in an individual’s illness, we are able to give better diagnoses and develop more effective, personalised treatments.
While the genomics is improving patient care, the way the NHS is set up doesn’t always help.
Organisations are often conducting work on genomics
in isolation
advances made in one organisationare not shared with others
and nor are the costs, duplicating the financial costs across the system.
Applying genomic knowledge into the NHSIn the North West, several like‐minded healthcare scientists decided to set up a genomic network in an attempt to speed up the development of genomic technology, and reduce costs.
The proposal was presented and agreed by the board of Liverpool Health Partners – a strategic partnership between universities and major general teaching hospitals and specialist trusts across Merseyside and Cheshire to support healthcare innovation, and the local academic health science network.
All services in the local area were scoped
The potential benefits of sharing of risks and
rewards were considered
A proposal of a network was developed
Applying genomic knowledge into the NHSThe network now has a series of initiatives cut across all partner organisations in the area, bringing together a broad range of knowledge on genomics and sharing the financial costs.
There is also an educational group, which ensures all health professionals in the area are familiar with genomics.
working groups
service groups
research groups
NWC Genomics board Academic health science
network
Liverpool Health Partners
Local NHS organsiations
Improved patient care
Sharing financial risk
Improvements in genomic
understanding
Applying genomic knowledge into the NHS – the challenges
Getting buy‐in from across the local NHS and partners
For the network to succeed, buy‐in is needed from across the local NHS partners. Success depends on shared knowledge and progress in genomics leading to further breakthroughs. However, in a competitive market NHS organisations can often be reluctant to share progress.
Buy‐in is also required from wider strategic partners such as Liverpool Health Partners. It’s important to convince partner organisations about the likely success of the venture, and the benefits for themselves and the local health economy.
Applying genomic knowledge into the NHS – reasons for success
Meeting the core objectives of Liverpool Health Partners The three main priorities of Liverpool Health Partners are genomics, big data, and personalisedmedicine – all areas in which the network would have relevance and impact. This made the pitch an attractive one to both Liverpool Health Partners and the local academic health science network.
Making the network attractive in a competitive NHS The network was successful in developing ways to share the risks and rewards of progress in genomics. This was vital in securing buy‐in from partner organisations across the local NHS.
Applying genomic knowledge into the NHS
There is no doubt that the NHS will have to embrace genomics if it is to meet its future aims.
The question becomes how best to share the risks and rewards of this field across organisational boundaries.
Networks such as this one in the North West could prove a valuable answer.
Find out more and download the full presentation on our website: www.nhsconfed.org
PneumaCare: non-invasive, non-contact respiratory assessment
Dr Richard IlesConsultant paediatricianCambridge University Hospitals NHS Foundation Trust
Case study 3
PneumaCare – non‐invasive, non‐contact respiratory assessmentMeasuring lung function is an important part of diagnosing respiratory illness. Traditionally it has involved ‘laying on of hands’ which can be invasive, especially for children and new‐borns where it can be necessary to use sedation.
Following consultation with parents of a patient, Dr Richard Illes and his team sought to develop a way to measure the lung function of a child without the need for touch or sedation.
What if…
you could monitor a child or infant’s respiratory status without sedation, or a face mask
you could do this in a clinic within 5 minutes
from start to result
PneumaCare – non‐invasive, non‐contact respiratory assessment
Joining with colleagues across the trust and Cambridge University, he developed a non‐invasive, non‐contact medical device called the Thora3Di TM. This is now produced by Pneumacre Ltd – a spinout supported by Cambridge Enterprise.
The device shines a grid of light onto a patient’s chest. As he / she breathes, the grid becomes distorted. By measuring these distortions, clinicians are able to measure lung function and the severity of the patient’s condition.
Not only does this device improve customer experience by making an invasive procedure non‐invasive, it produces accurate results and new intuitive interpretations quickly, in any age group, and any environment, thus saves staff resource.
The development of the product was very speedy by general standards. It took just two weeks from initial idea to creation of prototype, and the product was on the market within four years.
PneumaCare – the challenges
• Finding time: it was on occasion very difficult for the clinicians involved in the project to balance the work with their NHS commitments. At one stage, Dr Illes had to stop working in his NHS role to gain time to develop the product. Having the head space to develop this work was key to its success.
• The challenge of a small business: small businesses have a finite amount of money with a high‐burn rate. The generally slow progress of medical device development is a real problem in this context, especially when the NHS moves at a much slower pace. Support from a number of sources, including the trust, university and Cambridge Enterprise was vital to success.
• Clinical trials and committees: getting proposals through trust committees can take several months – downtime which often can be very difficult for a fledging enterprise. Clinical trials are also extremely time consuming, not least because patient recruitment can be difficult. Creating a national database of those interested in clinical trial participation would help here.
Key learning – reasons for success
A culture conducive to innovationThe university is tied closely to the hospital, and both are tied to other medical research institutions.
Cambridge is an environment in which it is taken as read that good ideas will be commercialised, and ideas are allowed to fail.
This has been referred to as the ‘Cambridge phenomenon’.
Careful assessment of the marketThe device was initially developed for paediatric patients. However, as paediatrics is less than ten per cent of any market, it was crucial to understand how it could be commercialised in other market segments as well.
Download the presentation on our website: www.nhsconfed.org
Innovation and healthcare sciences
Health sciences in the NHS
Challenges and key themes: how can boards get better value from healthcare sciences
Key learning – innovation and healthcare science
We came together with healthcare scientists and NHS leaders to explore the:
• key barriers to innovation • key reasons for success • role of NHS leaders.
tendency to focus on immediate concerns
reaching a critical mass within the NHS
the barriers…
The following key themes came out of our discussions:
Key learning
Foster a culture which values innovation (and take risks!)There is no shortage of good ideas in the NHS. A culture in which innovation prospers is one where managers constantly talk about and encourage new ideas. Formal structures are not necessarily required – but encouragement is.
It is also important to become comfortable with taking risk. This is not always easy –healthcare is by its nature risk adverse – but only by making mistakes can progress be made.
Create headroomInnovation requires space and time. Often in the NHS, this can feel as though it is sorely lacking. A culture in which innovation prospers is one where managers find ways to create that space and time.
View innovation as wealth generatingThe reality is that although there may be short‐term costs, successful innovation generates new revenue streams. Recognising this makes innovation an even stronger solution to the NHS’ current challenges.
Key learning
Connect scientists and managersIn many organisations, scientists and managers rarely, if ever, meet.
Finding opportunities to bring together scientists and managers – as well as clinicians – makes it far more likely that breakthroughs will be quickly translated into practice.
Recognise the importance of communicationScientists and managers are often two groups which speak different languages. NHS boards therefore need to learn to ask appropriate and relevant questions to scientists – to explain what the problem is – and scientists need to find appropriate layman’s terms with which to explain the proposed solution.
Key learning
Understand scientists’ transferable skillsBalancing finance and quality has been seen to be the role of managers, and more than ever we are seeing clinical leaders stepping forward. New solutions could be developed by applying the knowledge and experience of scientists to this challenge.
Recruiting for innovationThere are already many creative and innovative people working in each NHS organisation – and many of these in healthcare sciences.
We should appoint clinicians and healthcare scientists with an eye towards innovation and developing services.
This also applies to appointments at board level, where we should appoint those who have the experience and skills to support innovation.
Key learning
Connect scientists and managers with other scientists and managersTruly innovative organisations do not just spread breakthroughs within their own boundaries – they spread it beyond. It is important to build local, regional and national connections.
Use academic health science networksThey have an important role to play in supporting developments in healthcare sciences. By demonstrating and discussing breakthroughs more openly, innovation will spread more quickly.
Understand the role of commissionersThe commissioning agenda is currently not always tightly tied to the innovation agenda. There is value in commissioners seeing their role in innovation, and encouraging their providers to innovate.
Clinical commissioning groups (CCGs) have the scope to encourage and support a culture of innovation within its partner providers. CCGs are also strategically places to encourage sharing of new developments and best practice across its service area.
Key learning
Supporting the small business The toughest part of any innovation is often during the small business stage.
Clinicians and scientists aren’t necessarily business people. The NHS should provide support during this stage – such as providing head space and supporting clinical trials.
Sometimes NHS organisations lose out to their university partners who can provide preferential contracts, thus securing revenue streams from these innovation.
Having seen key learning from across different areas in the NHS, how is your organisation prepared to support innovation in healthcare sciences?
Does your organisation have a
culture which encourages innovation?
How do you communicate with your healthcare
scientists, and what could you do to communicate
better?
Do you employ clinicians / scientists to innovate?
NHS boards bring together an array of
skills and experience. How can you support
the ‘small business’?
