Meet the innovator: Shaun Azam

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Meet the Innovator

In this series, we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Shaun Azam, CEFO at Sweatcoin; an app that incentivises physical activity by converting steps into points that can be exchanged for actual rewards.

Pictured above: Shaun Azam, CEFO at Sweatcoin.

Tell us about your innovation in a sentence

Through our digital app Sweatcoin, we incentivise people to be more active by converting steps into reward points that have real world value.

What was the ‘lightbulb’ moment?

Realising that modern technology makes us lazy, and as humans we need instant rewards for effort (which is why most of us struggle to go to the gym for sustained periods). Hence, our app that converts steps into points with real value.

What three bits of advice would you give budding innovators?

    1. Listen to your users! You are building your product for them, so listen and take on board what they want.
    2. Don’t test ideas, test a hypothesis – ideas are real life applications and sit above a core hypothesis. When you test a hypothesis, you also test a whole host of ideas, saving vast amounts of time.
    3. I coined an acronym for this – ABA – Always Be Adding. Everything you do should be always be adding value to the business – we’re in a digital age, so use as many tools and apps as you can to create efficiency + cost savings, so you can focus on things that will ADD value to the business. Also, delegate whenever possible.

What’s been your toughest obstacle?

Overcoming the complexity of the healthcare system – we are fortunate in that our product has the ability to improves the lives of everyone in the world. Along with this comes difficulties around ensuring our product accurately caters for these vastly different demographics.

What’s been your innovator journey highlight?

Academics at the University of Warwick investigated the impact of incentives on physical activity – they used Sweatcoin to do this. Their academic study was published in the British Journal of Sports Medicine and found that Sweatcoin helped users walk +20% more each day, even after six months.

That was the moment that we realised that we ARE making the world more active, and that all the struggles were worth it.

Best part of your job now?

Genuinely improving the quality of lives of millions of people, every day. We receive countless messages from our users, informing us that Sweatcoin has motivated them to walk more, and how it has contributed to their improved physical + mental health.

Receiving these messages is truly incomparable.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would include a line item in NHS budgets, that is designated to be spent with SME’s – this would foster the uptake of new digital solutions that have the potential to improve healthcare and patient journeys across the NHS.

A typical day for you would include..

Trying to grow and sell our product – we operate on two week ‘sprints’ – this means we aim to release new features of our product every fortnight. As you can imagine, this means countless user focus groups, product tests, and iterations.

The product is one aspect – selling it is the other! I’m a big believer in ‘people buy from people’ – so most of my remaining day is around meetings, understanding open opportunities, and communicating the value prop of Sweatcoin.

For more information, visit their website at sweat coin.com or follow them on Twitter @Sweatcoin

Meet the innovator: James Flint

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with James Flint, CEO and Co-Founder at Hospify; a compliant, trusted healthcare messaging app.

Pictured above R – L: James Flint, Co-founder and CEO with Neville Dastur, Co-founder at Hospify.

Tell us about your innovation in a sentence

Available for free in the Apple and Android app stores, Hospify puts a simple, affordable alternative to non-compliant consumer messaging services like WhatsApp, Viber, Telegram and Messenger directly into the hands of healthcare professionals and patients.

What was the ‘lightbulb’ moment?

Meeting with the Head of Health for the Information Commissioner’s Office in 2015 and discovering that, while a very big chunk of the NHS was using WhatsApp to communicate while at work, once GDPR arrived in 2018 they were going to have to stop doing this.

What three bits of advice would you give budding innovators?

    1. Be prepared for the long haul. And I mean long.
    2. Keep it simple.
    3. Never miss lunch.

What’s been your toughest obstacle?

Getting sufficient funding, without a doubt.

What’s been your innovator journey highlight?

Getting on the NHS digital heath accelerator last year. It felt like we’d finally been given the official stamp of approval.

Best part of your job now?

Meeting nurses and hearing directly from them what a difference Hospify can make to their working lives.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Implement and support proper health data interoperability standards. I know this Is finally happening, but it’s still the most important single thing that needs to be done.

A typical day for you would include..

Answering a lot of email, talking to my development team, meeting or calling potential investors, networking or promoting Hospify at some kind of health event, answering customer support questions about the platform. Usually all on the same day and sometimes all at the same time!

For more information on Hospify visit www.hospify.com, Facebook, LinkedIn or follow them on Twitter @hospifyapp

Meet the innovator: Lydia Yarlott

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Lydia Yarlott, Co-Founder at Forward Health; a secure messaging and workflow app, connecting care workers around patient pathways.

Pictured above: Lydia Yarlott.

Tell us about your innovation in a sentence

Forward is a mobile communications platform aiming to connect healthcare professionals for the first time.

What was the ‘lightbulb’ moment?

Probably being a first year doctor on my own in an NHS ward at 2am in the morning trying to get help for a deteriorating patient and being unable to contact anyone. Poor communication leads to a real feeling of helplessness, and I want to change that for doctors and nurses everywhere. It’s hard to believe we’re still using pagers and resorting to WhatsApp to get hold of each other in hospitals, so it wasn’t so much a lightbulb moment as an increasing feeling that something had to change!

What three bits of advice would you give budding innovators?

    1. Talk to everyone, and anyone, you can about your idea. You never know what will happen next. My great friend Will worked with me as a junior doctor; he’s now with us on Forward full-time. We never would have had him as part of the team if we hadn’t spent hours on night shifts discussing the problem together!
    2. Find a Co-Founder (or several!) I couldn’t imagine doing this alone. Philip and Barney are both amazing people and amazing leaders, and it’s their drive and optimism that got us to where we are today – 5% of the doctors in the UK and growing. Whenever one of you is losing faith (inevitable at times!) the others can put you back on your feet and help you with that resilience you need in spades to be a successful Founder.
    3. Care about your problem more than your solution. Get as close to it as you can and stay there. Your solution will be wrong first time around, but as long as the problem isn’t solved, you have a chance of something really worthwhile.

What’s been your toughest obstacle?

Personal doubt!

What’s been your innovator journey highlight?

Getting our first real use cases. Watching our product change the way people work, resulting in better, faster care for patients. We have an amazing group of physios and orthopaedic surgeons using Forward to streamline shoulder surgery for patients, and another group who are using it to coordinate the multidisciplinary team in paediatric allergy. I can’t get enough of those stories because I know how tough it can be on the frontline of the NHS.

Best part of your job now?

The great privilege of working as a doctor and as a Co-Founder. I love clinical work, but I get frustrated by outdated systems, and I would hate it if I couldn’t focus on changing that. I care about healthcare at a systemic level and I want the NHS to survive, but I know that for that to be the case things will have to move forward, fast. I want to be a part of that.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Get Trusts talking to one another and sharing what they do. Incentivise knowledge transfer – both successes and failures. Share the ways in which they are working with others, including start-ups and small businesses, to foster innovation at scale.

A typical day for you would include..

A typical day being a paediatrician is just that – looking after sick children! I’m a junior doctor, so I’m still learning a lot, and working closely within a team to achieve the best outcome for the patient. When I’m at Forward, I spend most of my time meeting with the team to discuss progress and strategy, representing the clinical face of the company and the problem we’re trying to solve. The two jobs couldn’t be more different, but ultimately they are focused on the same thing – improving healthcare for everyone. I love what we’re building at Forward and I love the team – even those of us who aren’t from a healthcare background are driven by the mission to improve communication, and you can feel that energy walking into the office.

For more information on Forward Health visit www.forwardhealth.co or follow them on Twitter @ForwardHealth_

Meet the innovator: Vivek Patni

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Vivek Patni, Director and Co-Founder of WeMa Life; an online marketplace that brings customers and their families together with social care and community care service providers.

Pictured above: Vivek Patni.

Tell us about your innovation in a sentence

WeMa Life is an online marketplace that brings customers and their families together with social care and community care service providers; giving choice, accessibility and efficiency in the service procurement and delivery pathway.

What was the ‘lightbulb’ moment?

As an informal carer for my grandfather, I was immediately shocked by the lack of innovation in supporting families to find, coordinate and manage local care services for their loved one, hence WeMa Life was born. I find online marketplaces very convenient and use them for so many aspects of my life – products, clothes, hotels, restaurants – I knew a similar digital environment was needed for care services. Using WeMa Life as a customer I can search, compare, purchase and rate local care services whilst as a provider I can digitise the outdated, manual, paper-based visit records and manage my daily business activity.

What three bits of advice would you give budding innovators?

    1. Stay flexible: it’s tempting to start a business with a clear idea of how things will unfold; but this is rarely the case. Pivot and react to obstacles and have an open approach to finding the best solutions to all your problems.
    2. User experience: test your product constantly and get as much feedback as you can from all your user groups. Simple solutions sit very well in such a diverse industry.
    3. Be creative in your approach to developing tech and running your business. There are so many applications and tools to create efficiency and cost saving in finding resources, marketing and development, so use them!

What’s been your toughest obstacle?

Where I had faced the difficulty from a customer side of social care, I was less aware of the complexity in delivering publicly funded social and community care to different user groups. This meant learning the nuances of each service type/provider and creating a fluid product that would fit all.

What’s been your innovator journey highlight?

Designing the tech architecture from scratch, building an international technology development team and bringing my ideas to life in just eight months is something I am very proud of.

Best part of your job now?

Taking my product into the market! Now that the product is live, I am driving its use through digital marketing and sales. I meet so many interesting people on a daily basis who bring exciting new ideas to what we do – my mental technology roadmap is never ending.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would give more opportunity and financial incentives to SME’s. There are a huge number of SME’s with great ideas and technology, they tend to be more fluid, interoperable and customisable to the needs of the NHS; they would be able to make a real change to the daily lives of providers and customers.

A typical day for you would include..

Typically, my days are devoted to technology and selling. My morning tends to be engagement with my India tech team to make sure we are always refining and innovating our solution. Afternoons will be selling, calling and meeting as many people as I can. I get energised by talking to people about what we do so I try to do that as much as possible.

For more information on WeMa Life visit www.wemalife.com or follow them on Twitter @wemalife

Meet the Innovator

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Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Sukhbinder Noorpuri, Founder and CEO of i-GP, an online consultation platform to allow patients faster access to primary care for minor illnesses.

Pictured above L-R: Dr Sukhbinder Noorpuri with Co-Founder, Dr Aleesha Dhillon.

Tell us about your innovation in a sentence

i-GP provides digital consultations for minor illnesses, using interactive pictures and online questions. It is accessible to patients 24/7 from any device, and 90% of users can start their treatment within just one hour.

What was the ‘lightbulb’ moment?

When I was working as a GP, I met Michael, a 70 year old gentleman who waited three hours to see me at a walk in centre back in 2015. I thought that there must be an easier way to access healthcare. So I started looking into alternatives, and when I found none, I decided to go about creating one. I have been fortunate enough to have a great Co-Founder in Aleesha who has been instrumental in developing creative solutions to all the challenges that we have encountered.

What three bits of advice would you give budding innovators?

  • Have a vision and make it a big one – set your goals globally rather than just locally in the spirit of true disruption.
  • Be relentless in the pursuit of this vision and always try and learn from every experience or opportunity which comes your way – know your market, keep reading about it and stay focused.
  • Build a world class team and inspire them to believe in the company mission. Be confident in your leadership and enjoy the process. A successful entrepreneur may build a well respected company, but a successful team will change the world.

What’s been your toughest obstacle?

Healthcare innovation is very challenging because impact takes time to achieve. However, your clinical experience is really the key differentiator in the marketplace. If you genuinely feel you have a clear perspective on the problem and have created the solution then building the evidence for your product, despite being time consuming, is the clearest way to show its potential.

Some regard regulation as being a tough element of service delivery, but embrace the challenge as a well executed process is the reason you will stand out in the industry.

What’s been your innovator journey highlight?

Over the last three years, we have won or been shortlisted for 22 healthcare awards as a result of the innovations we have developed in digital care. This has led us to international recognition and the opportunity to showcase i-GP at Conferences all over the world.

Learning to adapt and raise healthcare standards has been a reflection of the dedicated team approach to the venture. However, this recognition is secondary to the feedback we receive from our patients as this is our main driving force. Impacting the patient journey to care on a daily basis  is the motivation and inspiration to transform traditional routes of service. For example last week, we treated a patient who was due to catch a flight abroad for her sister’s wedding but was suffering with a urinary tract infection. It was late at night, she was in a rush and her chosen pharmacy was closed. We managed to arrange her prescription at the chemist within the airport just before she was due to take off. When she returned she was so thankful that her trip hadn’t been ruined by illness and she had been well enough to enjoy the celebrations.

Best part of your job now?

Without a doubt, my greatest fulfilment comes from leading our team. We are all passionate about seizing this opportunity in time to showcase the good that technology can bring to healthcare and the NHS. Digital health is still very much in its early stage of adoption and even though smartphones have been commonplace for several years, we are still on the cusp of widespread digital use. The service that we implement today, we hope, will continue for many years to come.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

There has been a real drive recently with Rt Hon. Matthew Hancock advocating technology to modernise the NHS. Accompanying this, are the additional Government funds being made available to trial new products. This combination offers a paradigm shift from previous regimes and as innovators, we are very much looking forward to this filtering down to provide new opportunities. I also feel it is imperative that decision makers utilise patient feedback to help determine the future course and not just rely on industry advisers.

A typical day for you would include..

Most days are very varied due to the wide scope of avenues we are exploring at i-GP. I usually like to hold key meetings in the morning with either members of the team or board to review processes and define our future strategy.

We have a schedule over the week to assign time to all the key aspects of service from marketing to patient outcomes and from technology developments to the financial structure we have adopted. Reflection is part of this process and the opportunity to network with other innovators is often on the timetable to ascertain the potential for collaboration.

Liasing with the Accelerator team and our navigator Sara is also a key part of our time as we look to integrate further into the NHS.

We would like to take this opportunity to congratulate Dr Sukhbinder Noorpuri who recently won the Chairman’s Entrepreneur Award (pictured above) at the TiE Awards Wednesday 5 December. Find out more about the awards here

For more information on i-GP visit i-gp.co.uk or follow them on Twitter @wellness_igp_uk

Meet the Innovator

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Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Nicholas Andreou, Co-Founder of Locums Nest, a staff bank management app; connecting healthcare professionals to temporary work.

Pictured above r-l: Dr Nicholas Andreou with fellow Co-Founder of Locums Nest, Ahmed Shahrabanian.

Tell us about your innovation in a sentence

Locums Nest bridges the gap between hospitals and doctors. Making staff vacancies easier and simpler to fill, without the expensive agency middle man.

What was the ‘lightbulb’ moment?

Working as junior doctors in the NHS and experiencing first-hand the frustrations and inefficiencies of filling gaps in the rota.

What three bits of advice would you give budding innovators?

  • Be tenacious- don’t take no for an answer, have thick skin
  • Hire people with purpose who believe in your message
  • Be kind to everyone you meet.

What’s been your toughest obstacle?

Trying to positively change an established institution, with large long-standing incumbents. Challenging the status quo.

What’s been your innovator journey highlight?

With our help, a Trust managed to staff a winter pressures ward without going to an agency. This meant they saved £1.6m in the first 10 months.

Best part of your job now?

Meeting different people in different environments; realising the NHS is enriched with experience and expertise from a vast range of backgrounds.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Open up the barriers to meeting the right people in the system to support innovation.

A typical day for you would include..

There’s no such thing! One day I could be travelling across the country for meetings, in the office for a full day product meeting or spending the day supporting our NHS clients.

Contact us

W: locumsnest.co.uk

T: @locumsnest

Meet the Innovator

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Meet the Innovator

In our latest edition, we spoke to Mike Hurley, creator of ESCAPE-pain – a rehabilitation programme for people with chronic joint pain. Mike is currently a Professor of Rehabilitation Sciences at St George’s University of London & Kingston University as well as Clinical Director for the Musculoskeletal theme at Health Innovation Network.

Tell us about your innovation in a sentence

ESCAPE-pain “does exactly what is says on the tin”, it’s a rehabilitation programme for older people with chronic knee or hip pain (often called osteoarthritis) that helps participants understand why they have pain, what they can do to help themselves cope with it, and guides them through an exercise programme that helps them realise the benefits that can be attained from being more physically active.

What was the ‘lightbulb’ moment?

Not sure it was a lightbulb moment, it was more like one of the low energy lights slowly coming on! But there were two turning points that have led to ESCAPE-pain.

The first was realising the impact of pain on people’s everyday physical and psychosocial function was as important to them as the sensation of pain itself, and that addressing these impacts is as important as minimising pain.

The second was realising the importance muscle plays in causing joint pain and joint damage. We used to think joint pain was caused by damage to joints that resulted in pain, this stopped people doing their regular activities, which caused muscle weakness and makes the joint susceptible to further damage. However, we highlighted muscles are very important for protecting our joints from abnormal movement and suggested impaired muscle function that occurs as we get older may initiate joint damage. Thus, muscle is a cause rather than simply a consequence of joint damage. If that’s true then maintaining well-conditioned muscles through exercise-based rehabilitation programmes, we might prevent or reduce joint pain and damage, and improve people’s quality of life.

Coupling the first light bulb moment – addressing the psychosocial impact of pain – with the second light bulb moment – experience and understanding of the value of exercise – gives us ESCAPE-pain.

What three bits of advice would you give budding innovators?

  1. Prove your innovation works – if people aren’t convinced it is useful to them why would they use it?
  2. Surround yourself with a team of clever, hardworking people who believe in you and the innovation.
  3. Keep your eyes on the prize – wide implementation – and be prepared for lots of ups and downs and hard work convincing the multitude of non-believers that your innovation works.

What’s been your toughest obstacle?

Some of the conversations we had with commissioners would have been laughable if they weren’t so depressing. Financial pressures mean people delivering the programme continually want to reduce the number of sessions, but we know doing that reduces its effectiveness. And even though commissioners were often convinced about the need for the programme and wanted to do the right thing, the requirement to focus on short term benefits meant that anything taking more than a year to show benefits, whether health or cost, was of little interest. Many felt unable to invest in services where the benefits are felt by other parts of the health system, for example taking the pressure off primary care. Often commissioners could hear the madness of what they were saying even as they articulated it, but that didn’t change anything. It was tough and these issues really do slow the spread of innovation.

What’s been your innovator journey highlight?

Getting the unwavering backing of the HIN. In late 2012, I was about to give up on getting ESCAPE-pain adopted clinically, because there were no channels for innovative healthcare interventions to spread across the NHS and beyond. Then I answered an email enquiring about local MSK research in south London from its newly founded Academic Health Science Network, met with the Managing Director and frankly my professional life took a new, exciting and very fulfilling turn for the better.

Best part of your job now?

There are two:

Working with the MSK team is terrific and fun. They work so hard to make it everything work. It’s a privilege to work with such a lovely group of people.

The second great thing is the kick the whole team gets from the positive feedback we get from ESCAPE-pain participants. It never ceases to make me feel very humble and honoured to be able to help people.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I’d start “NICE Innovations”, a body that would screen potential (digital, models of care and service) innovations, pick the most promising, work with innovators and the health systems to find out what works (or not), why (not), and then actively promote and incentivise the health and social care systems to adopt or adapt effective innovations. Its kind of happening at the moment but feels fragmented, so it needs to be brought together to make it more effectual and “given teeth”.

A typical day for you would include..

The great thing about my work is that there is no typical day. I usually wake about six, make a cup of tea and listen to the news on the radio before heading into the new day. That could involve writing papers, grants, presenting at conferences, attending meetings at the HIN or St George’s, lecturing, mentoring students or clinicians, figuring out how to get our MSK work seen and adopted.

Find out more about ESCAPE-pain by visiting the website at www.escape-pain.org or following them on twitter @escape-pain

Contact us

W: chc2dst.com and ieg4.com (main company website).

T: @IEG4

Meet the Innovator

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Meet the Innovator

In our latest edition of Meet the Innovator, we caught up with Simon Williams of CHC2DST, a cloud based digital solution for continuing healthcare assessments. Simon is currently the Healthcare Director at IEG4 Limited.

Tell us about your innovation in a sentence

CHC2DST supports the digital transformation of the Continuing Healthcare (CHC) Assessment process by digitising the forms used in the national framework and automating workflow processes to improve patient service, boost productivity and control CHC care package allocation.

What was the ‘lightbulb’ moment?

When we saw that a complex national process relied upon the copying and transmission of reams of paper across multiple stakeholders, it was clear that the process would be impossible to manage effectively and, that, through automation, efficiencies and service quality improvements could be realised.

What three bits of advice would you give budding innovators?

  1. Be sure the challenges you are solving are recognised within the NHS and then be prepared for a long gestation period
  2. Find some NHS body/bodies who become early adopters, with whom you can collaborate to prove the solution within the NHS
  3. Promote your innovation at multiple levels within NHS to gain ‘share of mind’.

What’s been your toughest obstacle?

Despite a direct call to action from Matthew Swindells and Jane Cummings in Summer 2017 to drive up performance against the 28 Day National Standard for decision turnaround, the biggest challenge is engaging with the CCGs who are struggling to run the existing paper-based process. From NHS England Quarterly Situation Reports for CHC, we can see that many London CCGs would benefit from digital transformation of the assessment process. We are keen to talk to the CCGs in South London. An hour invested in watching a webinar would bring the digital transformation benefits to life.

What’s been your innovator journey highlight?

When the alignment of NHS bodies came together effectively under the auspices of the Yorkshire & Humber AHSN to create a focussed, specific event targeted at an audience of CHC practitioners. NHS Strategic Improvement for CHC explained the importance of improving the area to NHS England. Cheshire and Wirral CCGs discussed their CHC transformation journey supported by our technology and through collaborative working with us. The result was a further take up of the innovation and an increased awareness amongst the 20-odd Y&H AHSN CCGs in attendance that an alternative to the status quo was available and proven to work.

Best part of your job now?

When people who are working very hard to manage and execute the existing assessment process see how our solution puts them in control of their workload.  The ‘lightbulbs’ go on during the demo and the feedback we receive is positive . It’s great to know that we are helping to making a contribution to improve ‘our NHS’ in this area.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

For all service leads, make exploring and championing innovation part of the job description on which they are evaluated. Create a National Innovation Channel which holds approved content which can be accessed by NHS professionals to make it easier to find solutions in use in the NHS.

A typical day for you would include..

Reaching out to NHS stakeholders in AHSNs, CCGs, and NHS Executive Management to highlight CHC2DST’s capabilities to them and share results visible from NHS Quarterly Situation Reports for CHC. The data shows that CHC2DST helps to improve productivity by reducing unnecessary work activities, improves decision turnaround timeframes and improves CHC care package allocation.

IEG4 runs regular webinars to demonstrate CHC2DST to NHS Professionals working within the CHC area, without obligation. If it works for them, we help build stakeholder support and the case for change.

Contact us

W: chc2dst.com and ieg4.com (main company website).

T: @IEG4

A manifesto for spread

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A manifesto for spread

Innovation – the word is ripe with the prospect of a better future. However for me, the most exciting part of innovation in healthcare is not the invention or discovery element, it is that crucial part of getting the idea to many hundreds or even millions of citizens to benefit their health says Health Innovation Network Chief Executive Tara Donnelly.

While we have a great reputation for discovery in healthcare in the UK, which long predates the existence of the NHS, my recent chapter in Leading Reliable Healthcare argues that there is much more we could do to achieve spread, and that a focus on this would be an important way to achieve legacy from the abundance of entrepreneurial and creative talent that exists in this country in life sciences, digital health, clinical research and process improvements.

This blog expands on this topic further, bringing in thoughts both from the chapter and elsewhere to outline ideas on a manifesto for spread that I think we need to find a way to put in place, as a matter of some urgency.

It is important to acknowledge that there is a variety in the types of innovations; from new devices to digital tools, concepts and processes can be the most significant in changing care design. The chapter starts with a working definition:

“When we talk about “innovation” in the NHS, what do we mean? In the author’s opinion, the most useful is “an idea, service or product, new to the NHS or applied in a way that is new to the NHS, which significantly improves the quality of health and care wherever it is applied” (Taken from Innovation, Health and Wealth, Sir Ian Curruthers, Department of Health 2011).

Spend on spread

Spread has a cost, it is not a free good as clinicians and organisations need some support in adopting any new intervention or product within their practice. In innovative companies they see that communicating and supporting spread really matters and invest in spread related activities. Analysis completed by the AHSN Network indicates that there is a consistent ratio that the most admired companies seem to use.

Regardless of whether you are Apple or GE or a pharma company, the spend on spread activities including sales and marketing is typically over 2.5 times your investment in R&D, so 250-300%. In the NHS, we currently spend less than 1% of our £1.2bn R&D annual spend, on actively spreading it, and this ratio simply looks wrong. It was cited recently in Falling short: Why the NHS is still struggling to make the most of new innovations, a Nuffield Trust publication.

Within the chapter, I interview a range of people to hear their perspectives, particularly on spread and diffusion. Sir Bruce Keogh observes that “the spread can be more important than the innovation in terms of making a difference to people’s lives”. He offers that perhaps the most important single technical innovation to impact the health service is the microscope, invented by the Dutchman Antonie van Leeuwenhoek (“the father of microbiology”) in 1683. But what made a huge difference to adoption was that the president of the Royal Society, Robert Hook, wrote a beautifully illustrated book in English about it called Micrographia, understanding the significance this breakthrough could have in understanding disease. His book became “the first scientific best-seller” and “captured the public’s imagination in a radically new way; Samuel Pepys called it ‘the most ingenious book that I ever read in my life”.

 

Valuing innovation as much as invention

I’m currently reading James Barlow’s comprehensive assessment of “Managing Innovation in Healthcare” where he puts the distinction between invention and innovation beautifully: “an invention is merely a nascent innovation and it may be many years before it makes it to innovation status” p43. He also quotes Schon’s succinct definition: “Innovation is ‘the process of bringing inventions into use’” p25, and I believe we forget this at our peril. James is Professor of Technology and Innovation (Healthcare) at Imperial College Business School and I’d heartily recommend his new book if you’d like to get into this topic in greater depth, details are referenced at the end of this blog.

Elsewhere – in an article entitled “We’re serious about innovation – now let’s get serious about spread” – I state “spread – meaning at scale adoption of an innovation – is the way we will move from unwarranted variation in the NHS; from pockets of poor performance contrasting with beacons of excellence, often in a single geography, to improvements at scale to touch many more lives”. Within the piece I suggested if we were really serious about it we might celebrate and reward spread activities more vigorously, for example, introducing a Nobel Prize for spread rather than only congratulating discovery. Intelligent alignment is also critically important, so that different parts of the NHS and social care systems are set up and incentivised to adopt, including but not limited to financial rewards and methods of tracking data on progress. A transformation fund for hard pressed NHS institutions keen on spread would make a real difference in the current climate. It is welcome that the Office for Life Sciences has announced it will be setting one up, particularly to help parts of the NHS adopt innovations, and interesting that this is coming from a separate part of government than health, as a result of the Accelerated Access Review.

Importantly, that’s not to give the impression the NHS wouldn’t benefit hugely from additional resource as has been articulated clearly by the CEO of the NHS, Simon Stevens. In my view, this is essential, as we face the combined demands of an ageing population and increasing chronic disease burden. But were the NHS to receive an appropriately generous financial settlement, I would like to see proper funding of spread activities, so that we can get the best well-evidenced solutions – that help patients, clinicians and often make better use of resources in the longer term – to as many people, as quickly as possible.

It is interesting to see that across the channel the French government has established 14 regional tech transfer hubs with a budget of one billion euros to draw up, including investing in the strongest digital ideas, many of them in the health sphere. Eight years ago, it also introduced a system to make certain innovations available entirely free of charge to its healthcare system, as referenced by Barlow: “Since 2010, France has operated a system for conditionally covering the full cost of selected innovative devices, services or interventions which appear promising but for which there is insufficient data on the clinical benefit.” (p218)

Reaching many patients as a priority is a sentiment agreed with strongly by all of the interviewees, Tony Young emphasises the unique opportunity we have within the NHS: “The NHS is the single largest unified healthcare system in the history of the human race. This gives us some opportunities that no one else has had the chance to do— and one of them is to innovate at scale. It’s complex and divided— but that’s what gives us the opportunity to say well let’s have a go at it. If you really want to do this at scale, then we can do this in the NHS. Recently, 103 of the brightest clinicians you could ever want to meet were selected to be a part of the Clinical Entrepreneur programme and came together for their first weekend recently. Never before has there been a cohort at such a scale of clinical entrepreneurs who’ve worked together on the planet, ever”.

Skilling up for ‘scale ups’, not just ‘start ups’

Helen Bevan draws a distinction between the skills required for start-up v scale up: “What I think is one of the biggest problems that I see now, is the issue between start-up and scale-up. We have, in my mind, a system that is primarily designed for start-up— and what we keep doing is to put in charge the kind of people that love doing early-stage invention and early innovation. They’re your pioneers, your early adopters. What we keep doing is going over and over the cycle, of start-up again to attempt to spread and scale. But we’ve only got so far. We need a lot a lot of additional thinking … and need to find the people who are good at scale-up, and put them in charge of this activity, not the people who are good at start-up”. Her addition to David Albury’s work at the Innovation Unit, in creating a “checklist for scale” is incorporated as a figure in the book.

Research and data

James Barlow highlights that spread in healthcare has been under-researched to date: “situations involving collective or organisational decisions have been relatively neglected by researchers. Finally, until relatively recently, there was little research on the adoption and diffusion of innovation in the public or non-profit sectors.” P161. The exceptions to this include pioneers such as Trish Greenhalgh of Oxford and Ewan Ferlie of King’s as well as Ritan Atun at Harvard and those in the Imperial group.

Ian Dodge adds “We’re also systemically atrocious at using data systematically. For instance, looking at population outcomes of what’s happening at the end of a service line change, getting rapid feedback, iterating. Some of the initial bit of improvement science is so vital to getting stuff off the ground, but then typically we see really poor engineering discipline, factory style, around how do you actually convert this at scale”.

Clinical innovators and spread

In the chapter, some interesting examples of where spread activity is beginning to work in the English NHS are referenced, calling out the NHS Innovation Accelerator which seeks to accelerate uptake of high impact innovations and provides real time practical insights on spread to inform national strategy. Given publishing deadlines, I wrote the chapter more than a year ago, and it is both fascinating and encouraging to see how the NHS Innovation Accelerator – a programme supported by all 15 Academic Health Science Networks (AHSNs) and NHS England, coordinated by UCL Partners – has gone from strength to strength in this time in terms of tangible results of achieving scale.

It is also striking that many of the innovations on the Accelerator have been developed by innovative NHS clinicians who spotted opportunities to improve care – making it safer and more effective. For instance, Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD, an online platform that helps patients self-manage with dramatic results, Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented Episcissor-60, scissors specifically designed to make childbirth safer, Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with the NIC a device that prevents tragic accidents with blood lines, Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care.

All the products referenced are now eligible for NHS England’s Innovation and Technology Tariff which began in April 2017 and enables NHS Trusts and CCGs in England to use these innovations either for free or to claim a charge per use. It is an important scheme and would be very valuable to see it expanded in future years.

Taking the myCOPD example, it is really interesting to see the impact of this support in terms of scale-up. Chronic Obstructive Pulmonary Disorder or COPD is a progressive disease, meaning it gets steadily worse over time, and people living with it find that exacerbations increase and they are admitted to hospital more and more frequently. In fact, COPD is the second most common reason for hospital admissions in the country, causing a great deal of distress to people and families and costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% of people with COPD are unable to take their medication correctly. The myCOPD on line platform has been found to correct 98% of inhaler errors without any other clinical intervention.

If you have COPD, there is a great deal you can do to help yourself avoid exacerbations, but it can be hard to do these things consistently, alone. The evidence demonstrates that those who manage to quit smoking, do regular exercises known as pulmonary rehab, have optimal inhaler technique and are able to resist the understandable urge to panic when breathless, do much better than those who do not. Simon’s support system for people with COPD has educational, self-management, symptom reporting, mindfulness and pulmonary rehabilitation aspects, all delivered online. Typical quotes from grateful patients include “Since I started using myCOPD, I have lost weight, my depression has lifted, and I see my GP just once a year (compared with twice-monthly visits previously). I have not needed hospital treatment for 18 months”, “last year, before using myCOPD, I had 12 exacerbations. This year I have had just two.”

The programme is now being used by over 55,000 people with severe COPD in England, which is roughly one-quarter of that population, with more CCGs and respiratory teams coming on board each week. I think it is fantastic that people living with this chronic condition that responds well to regular exercise and relatively simple interventions, now have a tool in their pocket that can help them better manage it, and it is very appropriate that this is NHS funded. What’s more, this expansion has been pacy and achieved in around 18months.

I discuss this further in a blog entitled “Finally, a tariff for digital innovations” – you can perhaps hear the note of impatience in the title – and state that while it is a much needed start, we need to go further faster and expand the scheme to accelerate the adoption of great tools like these that are essential for patients with long term conditions seeking to stay as well as possible. Funding six devices/tool types in its first year, only one of which is digital, the programme has started very modestly compared to the scale of investment of our counterparts in France for example.

 

Patient-led innovation

There have also been some great examples of patient-led innovations succeeding recently. The three London AHSNs founded Digital Health.London with MedCIty in 2016 and established an accelerator focused on spreading the best digital health solutions across the capital. On our founding cohort was Michael Seres, an incredibly entrepreneurial patient who had designed a tool to link stoma bags with smartphones via Bluetooth, to increase the dignity of the user and ensure alerts were provided when bags were reaching capacity, who is now CEO of 11 Health. The ostim-i had achieved sales in other countries but not the UK when Michael joined our programme and we were delighted that the first NHS contract has been achieved in west London. It is also available to patients to buy direct, as is the myCOPD tool. The ostim-i has been a beneficiary – as was myCOPD – of the development fund we have to support interesting UK concepts, the Small Business Research Initiative or SBRI fund – subject of my most recent blog “Why SBRI matters”.

But there are many more ideas out there, developed by patients, parents of patients and carers alongside entrepreneurs and clinicians and we need to radically increase the capacity to give them the support they need. I am encouraged that the Office for Life Sciences, part of the Department for Business, Energy and Industrial Strategy, is investing in creating Innovation Exchanges, hosted by AHSNs to increase the support to local innovators, with funding due early in this new year and committed to for three years. The need to provide stronger support to UK companies and ideas is felt all the more intensely given Brexit.

I conclude the chapter “While there is plenty to do, it feels as though there is reason for optimism that the entrepreneurial zeal at the heart of our health system will continue to burn brightly and that more recent learning and focus on collaboration and scale will help us to ensure that the best ideas in health and care are disseminated more widely across the NHS.”

A system for spread

A year on, I remain optimistic; we’ve had commitments made as a result of the Accelerated Access Review, it has been announced that AHSNs will be relicensed to operate as the innovation arm of the NHS and we have strong spread and progress particularly through our major collaborations – the NHS Innovation Accelerator and in the capital through Digital Health.London, NHS England has made an important start in a tariff for innovation.

However, my view is that we need many more including our regulators, politicians, NHS staff, patients and their representatives to join this movement if we are to achieve the change we need to take place, and be much bolder about our commitment to spread. To see all NHS organisations join the best in  moving beyond “not invented here” to truly rewarding adoption and diffusion activities and acknowledging that change needs support to be durable, and happens at the speed of trust.

We need our inspection regimes and regulators to really get this and understand the behavioural insights we now know about achieving sustainable diffusion and change, and leaders supporting staff through these changes not resorting to an over simplistic and non-evidence based paradigm that telling will result in adherence.

If the spread movement was to achieve this level of support across the NHS, we would then be able to enact all aspects of the manifesto for spread and with support for these principles, and the action required, including investment in supporting NHS organisations scale up innovation, and I believe it could be possible to make significant change happen quickly.

Acknowledgments

I am very grateful to all those people I’ve discussed this topic with and particularly Suzie Bailey, Richard Barker, Helen Bevan, Ian Dodge, Sir Bruce Keogh, Becky Malby and Tony Young for the generous support they have lent to the chapter and to Stephanie Kovala for all her assistance in compiling it.

Suzie Bailey is Director of Leadership and Quality Improvement at NHS Improvement, Richard Barker is Chair of Health Innovation Network and CEO New Medicine Partners, Helen Bevan is Chief Transformation Officer, Horizons Group, NHS England, Ian Dodge is National Director, Strategy and Innovation, NHS England, Sir Bruce Keogh was Medical Director, NHS England to Dec 17, Becky Malby is Professor Health Systems Innovation at London South Bank University and Tony Young is National Clinical Lead for Innovation at NHS England as well as Consultant Urological Surgeon within the NHS. Stephanie Kovala was my Business Manager and is now Project Manager within the Strategy Team at NHS England.

Author: Tara Donnelly is CEO of Health Innovation Network, the academic health science network for south London. Health Innovation Network exists to speed up the best in health and care, together with its members in south London, and is part of the AHSN Network and Digital Health.London.

Follow Tara on Twitter at @tara_donnelly1­­­­

References:

AHSN Network: ahsnnetwork.com

Al Knawy, B. Editor, Leading Reliable Healthcare, Chapter 12 – Health System Innovation and Reform, Productivity Press CRC, Dec 2017

Barlow, J. Managing Innovation In Healthcare, New Jersey: World Scientific, 2017

Castle-Clarke S, Edwards N, Buckingham H. Falling short: Why the NHS is still struggling to make the most of new innovations. Nuffield Trust Briefing Dec 2017

Curruthers, I and Department of Health, NHS Improvement & Efficiency Directorate, Innovation and Service Improvement, 2011. Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS

Digital Health.London: digitalhealth.london

Donnelly, T. Sept 2016. We’re serious about innovation— now let’s get serious about spread. Health Service Journal

Donnelly, T. Nov 2017. Finally, a tariff for digital innovations. Healthcare Digital

Donnelly, T. Dec 2017. Why SBRI matters

Health Innovation Network: healthinnovationnetwork.com