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Combining innovations: NHS test beds and Formula One – Dr Mahiben Maruthappu

The co-founder of the NHS Innovation Accelerator looks at how the NHS can learn from the world of motorsport:

When it comes to innovation in British healthcare, three truths are frequently forgotten:

  • First, the NHS is unique. In England it serves over 53 million people, with around one million patient contacts every 36 hours. It is the largest part-integrated health system of its kind globally, with a tradition of leading and developing medical innovations, from in vitro fertilization to electric cardioversion.
  • Second, healthcare is unique. It entails provision of services that improve the quality of, or saves lives; sitting at the nexus between payors, providers, patients and professionals.
  • Third, step-change improvements require several innovations operating in combination – a complex blend of patient engagement, clinical expertise, technology, monitoring and research – to provide patient care. This combination is unique.

Despite this, innovations in the NHS and in healthcare globally, have predominantly been tested in isolation. The isolated impact of a device, drug or workforce model; rather than the synergistic value gained when combining these.

This focus on isolated rather than combined innovation has occurred for a number of reasons. Across all industries the status quo of testing has classically been unilateral rather than multilateral, be it in manufacturing, banking or education, as this arguably enables more robust and feasible determination of an innovation’s impact.

In many sectors it has been challenging to develop an infrastructure that permits combinatorial testing, as this requires integration, flexibility, real-time monitoring from differential vantage points, coupled with the capacity to adopt and rigorously test new innovations; creating a tension between flexibility and rigour.

Specific to healthcare, integrated services internationally are few and far between. Systems are typically entangled rather than enabled by governance and payment models such as fee-for-service, that can at times preclude innovation, integration and real-world testing at pace.

Finally, if testing in combination is possible, a sophisticated data collection system is needed to distil the contribution of each innovation, be it positive or negative.

Formula One racing is one field that appears to have resolved many of these challenges. Like healthcare, it involves people and technology operating in a potentially high-risk environment, at times needing continuous monitoring, while depending on the combined effort of experts from multiple disciplines.

From a testing standpoint, cars are developed in innovation hotbeds, where several modifications and innovations are evaluated simultaneously to optimise performance. This entails rapid prototyping, real-time testing, high-resolution data collection, with strong alignment between disciplines including developers, engineers, drivers, mechanics, managers, and aerodynamicists, amongst others.

This fine-tuned, accelerated ecosystem has led to several game-changing innovations such as four-wheel drive and paddle-shift gearboxes. It’s understandable why a large degree of innovation in the automotive industry has stemmed from Formula One developments.

The time has come for similar centres of real-world combinatorial testing to be established in healthcare.

In March 2015, building on the NHS Five Year Forward View, a call to develop ‘test bed sites’ was launched by NHS England, HM Government and the Academic Health Science Networks (AHSNs).

Test bed sites will serve as real-world locations with the specific task of evaluating combinatorial innovations, that integrate new technologies and novel approaches for better care. This could include a new service delivery model for patients with dementia, combining wearable devices linked into mobile technology, implemented alongside technology-enabled housing, and a lower-cost nursing workforce model, operating in synergy to achieve improvements in care.

Innovators from across the world are invited to apply, with emphasis on prevention, behavioural change, management of long-term conditions, diagnostics and medicines optimisation.

The test beds will provide:

  • Tight alignment between front-line staff, local stakeholders and leaders.
  • Robust and rapid data collection with sharing capability.
  • Coverage of populations in excess of one million.
  • A commitment to real-world demonstration and evaluation.
  • Enabling governance that permits decision-making at pace.

With the right quality, and scale of delivery, this presents a unique opportunity to test and combine innovations. Provided there is suitable infrastructure, test beds could offer a new dimension to healthcare innovators internationally, enabling development and dissemination – perhaps at Formula One speed.

This blog was first published in the HSJ.


mahiben-maruthappuDr Mahiben Maruthappu is a London-based doctor and Senior Fellow to the Chief Executive of NHS England, focusing on national policy and strategy.

He co-founded the NHS Innovation Accelerator (NIA), and was recently the first person from British healthcare to be included in Forbes’ 30 under 30.

He has advised a range of organisations, from startups to multilaterals, including the Swiss government, the Experiment Fund and the World Health Organisation.

Mahiben has a strong interest in research with over 60 peer-reviewed publications and 50 academic awards. His work has been featured by BBC News and international press.

He is Chairman of the UK Medical Students’ Association (UKMSA), and has authored three medical books. He was educated at Oxford, Cambridge and Harvard universities.

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