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NHS: Open for business – Dr Mahiben Maruthappu

The co-founder of NHS Innovation Accelerator (NIA) looks at how technology is transforming the world and says the NHS, although thought by some to be slow at adopting innovation, is seeing progress.

I was recently speaking with a health entrepreneur in Israel who compared the NHS to a gorilla – “It’s big, messy and I can’t work out which part is which”. The choice of metaphor notwithstanding, her description is more accurate than perhaps some people realise.

Innovation is hard. The NHS is under pressure, be it efficiency demands, financial supply, or operational performance. Add to this the common challenges healthcare innovators are facing; from system fragmentation to stakeholder navigation, complex procurement to prolonged regulation; it’s hardly surprising that some may be turned off.

This combination of barriers is what causes healthcare globally to lag behind other sectors when it comes to disruptive technology. The digital revolution has transformed the way people live and work in so many ways:

Hotels: AirBnB is a collaborative consumption platform for booking accommodation that now has more purchases than Hilton or Marriott hotels

Travel: Uber, an app many of us use, is now available in over 50 countries, with over one million rides per day; broadly the same number of daily users as the NHS

Banking: we use our mobile phones to make over 18 million banking transactions per week. Stripe, established in 2011, built the digital payment software that’s used by Facebook, Twitter and ApplePay, amongst other platforms

Dating: Tinder, a date matching app, has over 1.6 billion swipes a day, and has made over nine billion matches

Each of these didn’t exist at the start of the decade, each is based on start-up technology, and each is consumer-focused. When the value of just three of these solutions are combined, it equates to almost the entire annual NHS spend. There are key lessons we can learn from these start-ups:

Speed matters: five years is enough to disrupt an entire sector

Fail fast, fail often: many start-up technologies fail but some are revolutionary; the statistics speak for themselves. Only when we support enough innovators will we see disruptive transformation

Consumer driven: start-ups rapidly iterate based upon user expectations, we need to enable and accelerate this in healthcare through complementary system changes.

Are disruptive solutions present in health?

Yes, but they have not been widely adopted.

For example, agency staff cost the health service over £3 billion a year, with a hefty sum going to the healthy wallets of agency companies. The issue is that most of them are outmoded.

When I practice as a doctor, I receive sporadic text messages and phone calls, asking me whether I’m available to do a hospital temp-shift three days before it’s due. Hardly an efficient consumer experience. Start-ups are now automating and digitalising the process, using on-demand Uber-like apps to match nurses and doctors to available staffing shifts at a fraction of the overhead. However, only a fraction of our providers are using them.

The health service cannot afford to turn off innovators with these types of solutions anymore.

To try to address this, we designed the NHS Innovation Accelerator (NIA) last year. Like many ideas it was taken from another sector. Accelerators aim to support the growth and spread of technologies, in the past developing solutions such as AirBnB and Dropbox. Microsoft, IBM and MIT all have accelerators, and now we do too. Its ambition is to work with innovators to drive the spread of their innovations, unblocking system barriers that they face.

In July we launched our first cohort of 17 innovators in the programme. Their innovations ranged from apps and digital platforms, to devices and new models of care. Crucially, they had already been tried-and-tested, and had already shown to be cost-effective. A support package was designed and led by UCLPartners, the Health Foundation and the Academic Health Science Networks (AHSNs), including mentorship, funding, regional partnership, and national backing.

Although early, our 17 innovators have seen promising results:

  • In just over six months, over three million patients have benefited from NIA innovations.
  • 40+ deals signed.
  • Real rollout with over 60 NHS organisations now using our technologies.
  • Funding raised equivalent to over 50-times NHS England’s investment.
  • Two fifths of innovators reporting a revenue increase up to or over 50% since starting the programme.

For example, HealthUnlocked, a healthcare social network allowing patients, caregivers and health advocates to connect to others with similar conditions, has grown to more than 500 user-generated specialised communities, receiving over four million visits per month.

Nervecentre, a platform that digitalises patient monitoring and task management in hospitals was shown to halve the number of deaths and serious harm taking place in hospitals out-of-hours, also ranking 14th in Deloitte’s fastest growing UK start-ups list. It’s now being used in over 30 Trusts across England.

Joint Dementia Research, which aims to match researchers with members of the public willing to take part in studies, has recruited 15,330 people with over 4,000 now enrolled in clinical trials across 60 studies.

These swift results demonstrate that the NHS has the potential to be agile and adoptive, working with innovators to embrace disruption rather than stifle it. We must now think about how to expand beyond early adopters, and grow from a cohort of 17, to 1,700 to 17,000. The real challenge will be cultural.

There is no magic bullet to innovation, but there is a tipping point. Success over the next five years will depend on stacking system levers in favour of adoption, working with innovators to develop an open platform NHS that’s open for business.

  • This article was first published in the HSJ.

Dr Mahiben Maruthappu is a practicing doctor and Senior Fellow to the CEO of NHS England. He advises on NHS England’s innovation, technology and prevention portfolio, co-founding the NHS Innovation Accelerator and the NHS Diabetes Prevention Programme.

He has advised a range of organisations, from start-ups to multilaterals, including the Swiss government and the Experiment Fund and the WHO.

Mahiben has a strong interest in research with over 80 peer-reviewed publications and 50 academic awards. His work has been featured by BBC News and the international press.

He is Chairman of the UK Medical Students’ Association (UKMSA), and has written three medical books. Mahiben was educated at Oxford, Cambridge and Harvard universities and was the first person from British healthcare to be included in Forbes’ 30 under 30.

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