Foreword – Roland Sinker, CBE

The UK has a proud record of innovation in healthcare and the deployment of innovations. Every day in the hospital and across the wider integrated care system in which I work, I see how patients benefit from innovations designed by UK life sciences innovators, developed and trialled by NHS staff, and delivered for the first time in the world to UK patients. The NHS pioneered procedures such as intra-ocular lens implants and total hip replacements and introduced novel technologies like CT and MRI scanning. Today exciting innovations are harnessing AI for faster image interpretation, and automation of laboratory and genomic testing to dramatically improve treatment choices. We should be in no doubt that our ecosystem has enabled earlier access to these innovations and transformed people’s lives.

Every day I also see the very real economic benefits innovation brings. I have the privilege of working in a world leading life sciences cluster, bringing employment and skills to the region and the UK – from apprenticeships to Nobel Prize winning academics – a community of energy and creativity that benefits the health of the nation and its economy.

People from across the innovation ecosystem we have spoken to have a clear sense that the UK can, and should, be the world’s innovation test bed. Their confidence stems from our world leading academic institutions, globally respected regulators, amazing patient groups and third sector organisations, and a world leading life sciences sector with established firms and cutting-edge innovators. Where this has come together, we lead the world in emerging technologies like genomics and AI. Our healthcare staff are motivated to lead and drive this. We know that staff undertaking innovation and research are the most engaged and motivated in the NHS.

Innovation is more important than ever. Our healthcare system is changing, and it must. It is estimated that by 2037 there will be 55% more people over 85 and as people age they require more care and more complex care. Furthermore, the proportion of our working age population is decreasing, putting pressure both on the NHS workforce and on public finances. Without embracing innovation, we put at risk having a sustainable healthcare system that meets the needs of our population. I see this in the eyes of the patients and staff on the challenging days in the hospital.

Yet despite this urgent need to act, the staff, patients and wide range of partners we spoke to sensed we were missing the opportunity to respond to the challenge. Many said it took too long or was too difficult to try something new in a way that worked for them. Staff feel they do not have the capacity or the support to test, adopt and scale innovation, and even when they do, they have disjointed policy and regulation hurdles to clear, often within sceptical or risk averse cultures. Industry and academic partners often find it difficult to establish effective partnerships with NHS providers and integrated care boards. We heard that nationally, NHS England and government could do much more to provide clarity and consistency in their policy and priorities, and support to promote collaboration between the healthcare system and industry and academic partners.

If we do not address these issues patients will not get earlier access to innovations, and they may not get access at all. We are starting to see companies planning not to launch medical devices in the UK. Some innovations arising from publicly funded research are benefitting patients in other markets but not here. If the UK has not supported the development and uptake of innovations, they can be priced at levels that do not deliver justifiable value.

The scale of the opportunity is huge and wide ranging: for instance, automation to support the workforce, miniaturisation to allow people to receive more diagnostic tests and care out of hospital, and personalised biomarkers to improve outcomes and pick up disease earlier. The commitment of time and effort from industry members, academics, NHS staff and patients we have worked with during the review gives me confidence that we can make real progress in short order.

Most importantly, I want to emphasise that realising the opportunities will require a greater scale of ambition, with the funding, long-term planning and support to match. Many of the recommendations in this report will not feel new; they will be familiar from past discussions and reports on the topic. What is different here is the consistent, co-ordinated, long-term approach to fixing what is holding us back, and fixing it collaboratively. Delivering the recommendations set out here will take time, and we must therefore focus immediate action on our key priorities – agreeing our core national priorities, enhancing and simplifying our innovation oversight, mobilising our core clusters behind this work and engaging with the innovation leaders of the future.

I am grateful to Amanda Pritchard, Chief Executive of NHS England, for commissioning me to undertake this work, and to those at NHS England and other bodies who have supported me to do so. I am particularly grateful to the members of the Advisory Group, listed below, who have co-led the work with me and to the many others who have given their time generously in interviews, roundtables and developing and testing the recommendations. All have maintained the balance of co-creation and robustly represented their specific stakeholder views. This must continue as we take forward the next stage of work.

Roland Sinker CBE, Chief Executive of Cambridge University Hospitals NHS Foundation Trust and Cambridge Biomedical Campus, and National Director for Life Sciences, NHS England.

The Innovation Ecosystem Programme (IEP) Advisory Group

• Roland Sinker CBE (Chair), Chief Executive of Cambridge University Hospitals NHS Foundation Trust and Cambridge Biomedical Campus, and National Director for Life Sciences, NHS England
• Dr Kristin-Anne Rutter, Executive Director, Cambridge University Health Partners, and the Cambridge Biomedical Campus
• Steve Bates OBE, Chief Executive Officer of the BioIndustry Association (BIA)
• Nicola Perrin MBE, Chief Executive of the Association of Medical Research Charities (AMRC)
• Professor Lucy Chappell, Chief Scientific Adviser to the Department of Health and Social Care (DHSC)
• Dr Sam Roberts, Chief Executive of the National Institute for Health and Care Excellence (NICE)
• Rosalind Campion, Director of the Office for Life Sciences (OLS)
• Dame June Raine DBE, Chief Executive Officer of the Medicines and Healthcare products Regulatory Agency (MHRA)
• Dr Vinod Diwakar, National Director of Transformation, NHS England
• Verena Stocker, Director of Innovation, Research and Life Sciences Strategy, NHS England
• Peter Ellingworth, Chief Executive Officer of the Association of British HealthTech Industries (ABHI)
• Richard Stubbs, Chair, Health Innovation Network and Chief Executive, Health Innovation Yorkshire and Humber
• Professor Gary Ford CBE, Chief Executive Officer, Health Innovation Oxford and Thames Valley
• Dr Richard Torbett MBE, Chief Executive of the Association of the British Pharmaceutical Industry (ABPI)
• Professor Dame Sue Hill, Chief Scientific Officer for England and SRO for NHS Genomics, NHS England
• Will Warburton, Managing Director of the Shelford Group
• Jacob Lant, Chief Executive of National Voices
• Will Field, Head of Policy, Innovation, Research and Life Sciences, NHS England

Introduction

This report summarises the Innovation Ecosystem Programme’s (IEP) findings from the last 18 months and recommends a package of actions to move forward. This work could have been completed quickly but it is the working steadily together that will deliver change. It is a summary of our learning and presents a clear path towards building an ecosystem that can help transform health and care in the UK and support the growth of our economy. We hope it will be an important contribution to the forthcoming 10-Year Health Plan, the Innovation and Adoption Strategy and the Life Sciences Sector Plan.

The recommendations set out in this document are a complex package of work, that if delivered in full will make a significant difference in supporting the testing and adoption of innovation in the UK. But it is this collaborative way of working together that matters as much as the recommendations itself.

We have referred to our work as the Innovation Ecosystem Programme. Throughout our focus has been ‘innovation’ and in particular the real-world testing and development, adoption and scaling of new clinical interventions coming out of the life sciences industry. Given the positive work happening, we have not directly addressed any recommendations to areas of quality improvement or the clinical research system. However, collectively we will need to align all these activities. Often it is the same people leading across a range of activities and functions. This alignment can deliver for patients and for economic growth.

Summary

Context: The NHS faces a pivotal moment of risk and opportunity and there is an urgent need to act

The NHS is at a critical juncture, facing both significant challenges and tremendous opportunities through innovation.

On the one hand, it is grappling with workforce capacity, inefficiencies and widening health inequalities that have a substantial impact on individuals and the nation’s health. These challenges are exacerbated by rising demand for care, an ageing population and stretched resources.

On the other hand, the NHS and its partners – in the patient and charity sector, regulation, industry and universities – have an incredible record of developing life-saving treatments and innovative technologies and setting benchmarks for high quality patient care. They give the UK an unparalleled potential to be the world leader in the testing and adoption of healthcare innovation. The NHS’s scale, deep integration with the UK’s thriving life sciences sector and access to rich health data puts it in a unique position to drive advances in medical technologies. This will deliver transformative patient outcomes and economic impact for the UK. However, to seize the opportunities that come through innovation, NHS England and its partners must be decisive. We need to galvanise action at all levels – national, regional, integrated care system (ICS) and neighbourhood – to overcome the challenges the NHS faces today. Our aim is to unlock the NHS’s full potential to improve patient outcomes through innovation and enhance the nation’s health and economy for the future.

The Innovation Ecosystem Programme was given a mandate to foster collaboration between the NHS and key stakeholders

The Chief Executive of NHS England commissioned the IEP with a mandate to foster collaboration between the NHS and key stakeholders, industry, academia and regulatory bodies. Our objective was to streamline the development and adoption of healthcare innovations by making recommendations but also defining a collaborative way of working – solving problems together as well as agreeing and delivering plans for the future.

Our recommendations stem from analysis of extensive engagement – hundreds of interviews, roundtables and working group discussions – through 4 targeted workstreams led by the chief executives and chairs of many of the key organisations in the life sciences ecosystem.

Findings: Progress is being held back by poor alignment, culture barriers, process and capabilities

Throughout the programme a clear set of 5 emerging findings have consistently emerged from our discussions, roundtables and analysis of the current ecosystem.

There is a solid foundation to build on, but we must expand and translate what we do well. The NHS has many strengths in innovation, in early-stage research and development, real world testing and initial site adoption, and in some cases, such as cancer and genomics, the delivery of flagship national innovation programmes. We already have the ingredients to enable transformation and there is no shortage of innovations being explored in the NHS, as well as in partnership with industry. We also found that stakeholders have a clear, common understanding of what it takes to successfully adopt innovations. We can and must build on the pockets of excellence that already apply this understanding to scale current innovation. But we also need to go further by looking to the future and understanding how emerging technologies give us the tools for a faster shift to prevention, early diagnosis and out of hospital care. New skills and experience in new settings will be required.

We must focus on the biggest priorities. The scale of the challenge to transform our services should not be underestimated, and we will need to make choices about where our scarce resources are directed. The NHS and its partners will need to be less ‘supply side’ in how they identify innovation, instead prioritising innovation and research support for areas of greatest need, aligned to the government’s health and economic growth missions. We will need to move away from the historical focus on individual products to categories of innovation and shifts in care, and from looking at a 1 to 2-year horizon for innovation and research to planning for 3, 5 and 10 years ahead.

The NHS cannot do this alone or from the top down. We need better alignment of innovation and research infrastructure – orientated towards the local and with easier gateways for partners to engage with the NHS. We need clarity on who is responsible for what and when to enable simplified, streamlined access for both testing new things and rolling out. And this infrastructure should be aligned to national ambitions and be supported by national levers. However, national implementation policy should not be so prescriptive that it stifles the mobilisation of collaborative local systems.

Success will come down to getting the culture right, building a skilled workforce and putting the right enablers in place. Innovation only succeeds when it can be effectively adopted locally, and this needs individuals who can drive through implementation in a supportive culture. For the right culture, patient and citizen voice, NHS management and clinical leadership, and strong industry support will be key in sending the signal that innovation and research are important. For effective leadership, enablers will need to be in place to better empower NHS staff on the ground to participate in research and adopt innovation: data, procurement processes, and the time and incentives. We also need to make it easier to adopt innovation by reducing friction in the system with a clear, consistent, standardised and streamlined rules-based approach, and standardise how industry, academia, charities and patients can partner with the NHS.

This will take time, and we will need to be consistent and long term in our approach. The NHS has suffered from a series of short-term projects and approaches (despite the same barriers and enablers being identified over the last 20 years). Success in implementing the recommendations of the IEP will require collective accountability and resourcing for 3 to 10 years, with a clear strategy that all partners are signed up to and eager to support.

Comprehensive recommendations with opportunities for early progress

Our recommendations (summarised below under 4 areas) focus on what the NHS and its partners are already well placed to do to evolve the ecosystem towards meeting the needs of the future through the testing, adoption and scaling of innovation for the benefit of patients and staff. They represent a complex, ambitious programme of work. We are aware that some are already being addressed; others will need further development and agreement before implementation.

There is no single action that can unlock innovation and no individual partner that can deliver change on their own. Instead, we recommend a package of reforms that are designed to work synergistically. Behind the words there will be significant trade-offs and complex policy to introduce, as well as funding changes that require the support of all partners.

The key message from the IEP to all partners is to collaborate, prioritise and align to better meet the needs of patients and the public.

A. Setting the direction: The innovation ecosystem and the NHS must be aligned to support the transformation of healthcare and the government’s health and growth missions.

1. Make innovation core to NHS business: Integrate innovation with NHS priorities alongside education and research and do so in a way that also works for the wider ecosystem.

2. Prioritise and co-ordinate innovation around the shifts and goals for health: Focus on healthcare shifts such as digitalisation, prevention and home care, with priorities harmonised across NHS plans. This will require choices to be made on specific shifts rather than attempting to do everything.

3. Establish co-ordinated oversight and aligned innovation funding: Consolidate funding and oversight to support the innovation priorities with clearer accountability.

4. Develop incentives to support and monitor delivery: Use key performance indicators (KPIs) to track and incentivise innovation adoption within NHS governance and oversight.

B. Structures and tools for delivery: Accountability, oversight and leadership at all levels. This must be supported by standardised tools, policy and guidance for the key enablers of innovation testing and adoption, to support confident local decision-making.

5. Simplify and strengthen the structures and functions for innovation in the NHS: Boost NHS leadership and capacity to test and adopt innovation and develop the missing expertise in collaboration with Health Innovation Network (HIN) support.

6. Strengthen data access and information governance: Expand secure data access for research to prioritise testing and monitoring of innovation.

7. Align procurement to facilitate rollout of tested innovations: Standardise procurement and facilitate easy transfer of innovations across the NHS.

8. Develop commercial approaches to share value and adoption in testing innovations: Update intellectual property (IP) policies and share value through risk-managed partnerships.

C. People, skills and capabilities: Build the skills, capabilities, capacity and culture required to prepare the NHS workforce for future ways of working and to help them collaborate confidently with patients and citizens, industry and academia.

9. Build the right skills and capabilities: Develop innovation skill frameworks and training across NHS roles, with industry and education partners supporting future workforce readiness.

10. Create time in jobs for innovation: Integrate innovation responsibilities into roles, with dedicated time for related activities. Establish joint clinical fellowships with industry.

11. Foster a positive culture and understanding: Identify the next generation of innovation leaders, promote cross-industry exchanges, celebrate innovation achievements, and appropriately manage the different risk profiles and success rates of innovation. Speak well of each other.

D. Acceleration: Alongside action to redesign the architecture and wiring of innovation, the programme partners should work together to mobilise major geographies behind current priorities – working with centres across the UK that have shown excellence in innovation development and adoption.

12. Mobilise local systems behind work: Key localities should lead on priority innovations, collaborate with industry, and share best practices for scaling and implementation.

13. Evaluate what works: Build robust evaluation into innovation efforts to assess health, social and economic impacts.

14. Establish peer-learning networks: Create networks to connect successful innovators with policymakers and others for shared learning and support.

Next steps: Getting on with the priority actions and setting the long-term approach

This report marks the end of this phase of our work together, but there is still more to do. The key partners in the IEP should come together over the next few months to agree when we can deliver the recommendations and how. The forthcoming 10-Year Health Plan, the Innovation and Adoption Strategy and the Life Sciences Sector Plan offer an opportunity to respond to and implement the recommendations from our programme in national long-term strategies, and provide an even firmer grounding for these reforms in support of the wider ambitions for health and care the plan will set out.

But the development of the 10-Year Health Plan should not stop us from getting on with making progress now. We welcome further discussion on where we should focus immediate action, but this must include:

• Embedding recommendations; feeding the report’s recommendations into the development of the 10-Year Health Plan, the Innovation and Adoption Strategy and the Life Sciences Sector Plan
• Enhancing governance; enhancing our cross-organisational governance – including how we may enhance the Accelerated Access Collaborative (AAC), or equivalent, to deliver
• Aligning priorities; agreeing the national priorities and beginning the work to align innovation activity and funding
• Regional acceleration; starting ‘acceleration’ in a set of geographies to further refine the recommendations and to start to make progress

It should be noted that the case studies included in this report represent products and technologies that have been supported in their development and deployment by NHS programmes or have been discussed as part of the IEP work. They are included to illustrate the opportunity innovation can bring to the NHS and the barriers faced. The inclusion of a case study should not be used or taken as a national endorsement of specific products or technologies.

1. The context for our work

The UK is uniquely positioned to lead the world in healthcare innovation and deployment of emerging technologies, driven by the scale of the NHS and its deep integration with the UK’s life sciences sector and access to an extraordinary wealth of health data. The NHS should – and must – harness its potential to deliver cutting-edge care to its population and leverage breakthroughs in a plethora of innovations. Yet, the NHS is hindered in this effort by the confluence of severe issues that threaten its sustainability: capacity shortfalls, growing health inequalities and a workforce stretched thin.

1.1 The fundamentals of the life sciences ecosystem in the UK are strong

The Life Sciences Vision highlights the role of the UK’s thriving life sciences sector as a major partner with the NHS in this effort. The sector generated over £108 billion in turnover in 2022, employs over 300,000 people and remains the largest private investor in research and development (R&D) in the UK, investing around £8.7 billion annually. It also attracts substantial foreign direct investment – exceeding £1.3 billion in 2022. The life sciences sector’s collaboration with the NHS offers a pathway for transformative healthcare.

The Accelerated Access Review highlighted the opportunity from simplifying pathways for innovation and creating incentives to accelerate the adoption of innovative technologies. It emphasised that the NHS could leverage partnerships with this vibrant sector to reduce disease burden, improve population health and support economic growth. Innovations like digital therapeutics, AI-driven diagnostics and genomic medicine can radically change how care is delivered, moving the NHS towards a proactive, preventative model that keeps people healthier for longer. For example, the NHS has begun pilot programmes for AI in radiology and these are showing that AI has the potential to cut diagnostic reporting times by up to 30%.

1.2 The NHS is struggling to meet its challenges with current approaches

Despite its potential, the NHS faces formidable challenges that cannot be ignored, driving a huge demand for transformation. According to Lord Darzi’s Independent investigation of the NHS in England (2024), public satisfaction with the NHS is at an all-time low; a deep-seated dissatisfaction with access, waiting times and overall service quality. Only 29% of respondents were satisfied with their local NHS services, down from 70% in previous years. This falling satisfaction is mirrored by growing health inequalities, particularly in deprived areas and among ethnic minorities [1]. The NHS’s ability to meet its core commitments to the public – timely access to care, high-quality treatment and equity in health outcomes – is under severe strain, compounded by the inevitable impact of the COVID-19 pandemic. Darzi stresses that while hospital staffing levels have increased, inefficiencies within the system prevent these resources from being utilised as effectively as they could be. According to NHS Providers (2023), efforts to boost productivity, such as the ambitious 2.2% efficiency target agreed with the government for 2023/24, face significant obstacles as staff workloads continue to rise and administrative burdens remain high [2]. It is essential that our innovation ecosystem gives the same focus to innovations that enhance productivity and efficiency as it does to those that directly improve clinical care.

At the core of these issues is a fragile NHS workforce that is carrying significant vacancies. With a projected shortage of 260,000 to 360,000 staff by 2036/37 [3], the UK has one of the lowest ratios of key clinical staff to population among high-income countries [4]. This workforce gap is further exacerbated by uncompetitive remuneration for some staff groups, making it difficult to attract and retain talent. The innovation ecosystem must help attract and retain our staff by using technology to make their jobs easier and by providing support from industry and partners.

Innovation must be embraced as a core solution. It offers a route to enhanced capacity, streamlined processes and improved patient outcomes – providing the agility needed to address the demands of an ageing population, complex health needs and workforce shortages. As Darzi states, by adopting a bold, integrated approach to innovative technologies and system-wide improvements, the NHS can meet today’s challenges but also future-proof itself as a resilient and sustainable healthcare system. Immediate investment in innovation is therefore not just beneficial; it is essential to fulfilling the NHS’s commitment to high-quality, equitable care for all.

However, the huge pressure on staff and the system to deliver core care makes it difficult to find time for innovation. With over 1 million people waiting for community services and a backlog of over 7.6 million patients needing hospital care, the system is stretched beyond its limits [5]. While considerable effort is being directed at reducing long waiting times for planned care, median wait times remain longer than they were pre-pandemic, with an average wait of over 14 weeks as of September 2024 [6]. This backlog, coupled with increasing demand, continues to undermine the NHS’s ability to provide timely care, particularly in critical areas like cancer services where the 62-day waiting time standard (85%) for cancer has not been met since 2015, and performance has been below 80% since 2018 [7].

Structural issues also make it harder for the NHS to develop and deploy the innovation that will enable the shift in care from acute settings to primary and community care. Despite policy commitments to shift care in this way, the resources and workforce transformation to achieve this goal have not materialised [8]. Integrated care boards (ICBs), which are expected to play a key role in system transformation, face significant financial constraints, with projected real-term cuts of 30% to running costs by 2025/26 [9].

1.3 Making the NHS an effective partner in life sciences will support economic growth

If the NHS can become a world leader in deploying healthcare innovation at scale, particularly through strategic partnerships with the life sciences industry, as well as benefitting patients it will attract investment in the UK and support growth in employment. 20% of all private sector R&D in the UK occurs in life sciences firms, creating an estimated 50,000 new jobs in the sector in the 5 years to 2022 [10].

The NHS can be a more effective partner to life sciences firms by reducing the time it takes them to market proven healthcare innovations, and the cost of doing so, through effective testing, access to data and faster scaling, benefitting industry, investors and patients. Targeted investment in innovation, such as the 60 high-impact innovations funded by NHS England and the AAC by the NHS Innovation Accelerator (NIA) initiative, can deliver significant benefits for the NHS – a projected £1 billion in cost savings and enhanced care for millions of patients – and jobs in the UK.

2. Overview of the Innovation Ecosystem Programme

The Innovation Ecosystem Programme (IEP) was launched to identify how best to streamline the research, development and adoption of those innovations that have the potential to make the NHS a global leader. The guiding principles for the IEP are to create a framework for future innovation activity that will reorient the NHS to address current, emerging and future healthcare priorities.

It focused on 4 objectives:

1. Delivering improved health outcomes and increased productivity for a changing nation.
2. Renewing the NHS through systematised development, validation and adoption of innovative healthcare solutions.
3. Supporting economic growth and development in life sciences.
4. Improving NHS sustainability by using resources more efficiently and managing environmental impact.

The programme aimed to address the whole innovation ecosystem, with recommendations specifically directed at the NHS, but with asks of other partners. To develop findings, deliver immediate improvements and bring together the final recommendations, the programme established four workstreams.

Workstream 1: Learning by doing

Co-Chaired by Professor Gary A Ford CBE, Chief Executive, Health Innovation Oxford and Thames Valley; and Dr Samantha Roberts, Chief Executive, National Institute for Health and Care Excellence (NICE).

This workstream generated insights from previous innovation projects across the NHS, industry and academia, and captured real-time learning from transformation projects led by health innovation networks (HINs), ICBs and other partners; that is, as innovations were implemented. 8 success factors for the spread and adoption of innovation were identified.

The workstream also developed proposals for a new programme to mobilise localities that are successfully collaborating to drive improvement in innovation and research. The resulting expression of interest (EOI) for locality partnerships is due to launch shortly.

Workstream 2: Immediate actions

Co-Chaired by Dr Vinod Diwakar, National Director of Transformation, NHS England; and Rosalind Campion, Director of the Office for Life Sciences.

To maintain momentum and deliver short-term benefits, the IEP identified several priority areas for immediate action from a very long list, including optimising the architecture of HINs to support better innovation pathways, reviewing existing MedTech support programmes and implementing the O’Shaughnessy report’s recommendations around commercial clinical trials.

Stakeholder consultations, policy reviews and workshops with NHS leaders, regional executives and industry representatives informed the development of the recommendations in this report that stem from workstream 2. A focus in the recommendations was ensuring that the adoption of innovation was more responsive to NHS priorities, reducing bureaucracy and aligning existing initiatives.

Workstream 3: NHS research and innovation blueprint

Co-Chaired by Professor Lucy Chappell, Chief Scientific Advisor to the Department of Health and Social Care (DHSC) and Chief Executive, National Institute for Health and Care Research (NIHR); and Dr Richard Torbett MBE, Chief Executive, Association of the British Pharmaceutical Industry (ABPI).

This workstream was tasked with developing a long-term blueprint for future NHS research and innovation in the NHS by synthesising findings from across the IEP, lessons from international systems and sector-wide analyses.

Workstream 4: Preparing for the NHS of tomorrow

Co-Chaired by Dr Kristin-Anne Rutter, Executive Director, Cambridge University Health Partners, and Cambridge Biomedical Campus; and Peter Ellingworth, Chief Executive, Association of British HealthTech Industries and Chair of Health Innovation Oxford and Thames Valley.

Recognising the fast pace of technological advances, this workstream explored the future of healthcare delivery and engaged leading experts, think tanks and academic institutions to identify the technological trends that will be pivotal in shaping the NHS’s future – for example, within thematic areas such as AI, digital health and genomic medicine. The workstream identified the 8 thematic areas in which innovations could have greatest transformative impact on care delivery.

3. Findings of the Innovation Ecosystem Programme

The 4 workstreams each created detailed outputs and recommendations that have informed the findings and recommendations set out in the rest of this document. In synthesising the outputs of this work, we want to highlight the following 5 findings:

3.1 There is a solid foundation to build on, but we must expand and translate what we do well if we are to deliver the transformation required

The programme found an abundance of development and testing of innovative solutions in the NHS. These are the cornerstone of NHS partnership with life sciences but spreading and scaling their adoption remain our biggest challenge.

There is no shortage of innovative health and care products that have the potential to transform care. In 2022/23:

• the health innovation networks (HINs) engaged with over 2,831 companies and supported over 1,512 innovative products
• the National Institute for Health and Care Excellence (NICE) assessed 190 products with sufficient evidence to go through its guidance programmes
• the thought leadership work by workstream 4 across its 8 thematic areas identified new developments within these emerging areas of technology

There is a flood of innovative ideas that are becoming available to health and care systems globally which is astonishing and exciting.

However, it is also clear that the successful implementation and then the scaling of innovations remain the challenge.

Where national support is provided, we did find evidence of impressive increases in adoption across eligible sites. In 2020/21, adoption of Innovation and Technology Payment (ITP) products supported by HINs increased by an average of 51%, and over the ITP programme’s first 2 years PIGF-based testing for diagnosis of suspected preterm pre-eclampsia, SecurAcath for securing percutaneous catheters and HeartFlow to provide 3D heart scans that speed up diagnosis were adopted across 57–68% of eligible NHS organisations. However, such technologies still face considerable barriers in transitioning from early-stage, site-specific adoption to national scale. Regional infrastructure variability, disparate funding resources and differences in baseline adoption rates between sites all limit the potential for consistent national uptake.

The consequences of not scaling more broadly are seen in unwarranted variation in health outcomes and inequality, and a perception that the UK is not fertile ground for UK companies to develop products beyond the concept stage and grow their business. The message was clear that as much effort, funding and focus on spread and scale of proven products as is required for their early development should be given.

There is strong understanding of how we successfully spread innovation, but it is rarely applied systematically.

Through workstream 1 of the IEP, the HIN worked with a variety of national spread and adoption programme leads in both the HIN, ICSs, providers and the NHS England Cancer Programme to reflect on the key barriers and enablers for 8 innovation-focused programmes. 9 enabling hypotheses were developed from their insights, designed to provide an actionable framework from which to build plans for future spread and adoption work. These hypotheses were tested and refined with a variety of stakeholders including NIHR Applied Research Collaborations (ARC) implementation leads, The Health Foundation and ICS leads doing work in this area.

From synthesis of the analyses, the following enablers for successful adoption and spread of innovation were agreed:

• Pathway – taking a whole-pathway approach, considering clinical, patient, staff and system benefits, to embed innovations is more likely to lead to sustained adoption and spread than a focus on individual products in isolation.
• Utility – perception of the utility of the innovation, including patient benefit; alignment with local needs and existing workflows; simplicity of use; and cultural fit, is crucial for success.
• Evidence – for value in terms of clinical efficacy, return on investment, and health and social care workforce impact, drives support for adoption.
• Leadership – effective clinical and operational leadership at both national and local levels is essential to enable successful spread and adoption. Local clinical leadership is particularly important to mobilise resources, engage stakeholders and be able to drive innovation adoption within individual organisations.
• Change makers – the informal system, defined as people in the workforce who work with their network to drive continuous improvement, is vital for successful innovation adoption. Enhancing the capability and capacity of the workforce with skills in pathway transformation and adoption to grow our informal system will enable more effective spread and adoption of innovation.
• Making the case – participative decision-making across the adopting team is key to ensuring sustained adoption. Managers and leaders should lead this, with involvement of patient groups through the development of robust business cases that can demonstrate clinical benefits and a positive impact on NHS productivity.
• Incentives – spread and adoption of innovation is more difficult without a relevant national strategy, policy levers and funding mechanisms that align with local needs.
• Complexity – spread and adoption of innovation at pace and scale requires a continuous, iterative process in a complex system that learns from local context, adaptation and implementation. It also requires national and local levers, across strong partner coalitions.
• Using data – timely national and local quantitative uptake data, and qualitative information on enablers and barriers to adoptions are necessary to increase contextual understanding, build will, and drive behaviour change in a culture of learning and reflective practice.

The sessions held with the learning collaborative to test these hypotheses had 2 clear implications for our recommendations.

1. There is a need to standardise processes and evidence standards to build a more replicable model for local adoption and then scaling of new innovations. But this must not provide a ‘one size fits all’ approach – it should be a toolbox that systems can take from to implement in a way that reflects their local conditions and communities.

2. There is a need to significantly increase the capacity, capability and skills of the NHS workforce to undertake innovation work – and the skills required should be recognised as distinct and important, akin to those recognised for research and quality improvement work.

3.2 We must focus on the biggest priorities

The scale of the challenge to transform our services should not be underestimated, and that means we will need to make choices about where scarce resources are directed. The NHS and its partners will need to be less ‘supply side’ in how they identify innovation – prioritising innovation and research support in areas of greatest need or opportunity and tackling greatest unwarranted variation in adoption. We will need to move away from the historical focus on individual products to categories of innovation and shifts in care, and from looking at a 1 to 2-year horizon for innovation and research to planning for 3, 5 and 10 years ahead.

To support this, workstream 4 found there is a clear pipeline of innovations emerging that could address many of the NHS challenges and enable big shifts to prevention, personalisation and the workforce of the future. But new capabilities will be required.

Major shifts in how and where prevention and care are delivered are possible with the emerging innovations. The NHS should consider the testing and adoption of innovation in terms of these major shifts, rather than picking individual technologies. This is because individual technologies are unlikely to achieve impact in isolation; a commitment is needed to change entire pathways enabled by the emerging technologies. These developments can be grouped into 3 themes.

Earlier detection, diagnosis and prevention

Innovations in multiomics, wearables, biosensors, data integration and AI can facilitate a shift to an early detection, diagnosis and prevention model, and with this boost NHS sustainability and enhance patient outcomes through the development of proactive healthcare approaches.

Personalisation of therapy

The NHS needs to personalise care – the tailoring of therapy for the individual – more widely to improve patient outcomes, optimises resource allocation, reduce treatment duration and minimise side effects. By 2040, we anticipate treatments will embody the ‘5P’ approach – predictive, preventative, participatory, personalised and precise – with precision and personalised therapies key to restoring health.

• Personalised medicine: a course of care that is data-driven and places emphasis on targeted treatments, aiming to match patients with the most appropriate and effective treatments based on a deep understanding of the underlying molecular and genetic drivers of their condition.
• Personalised therapy: refers to adjusting or tailoring medical care adjusted or tailored to the unique characteristics of each patient that contribute to their health (genetic and molecular make up, sex, age, environmental factors, lifestyle factors).

Several categories of innovation support personalisation of therapy: cell and gene therapy, personalised drugs, vaccines, bioprinting and digital and AI tools.

Slower growth in workforce needs

In the face of an ageing population, the NHS should harness the use of innovation to create a differently shaped workforce that can grow more slowly than it would otherwise under existing models of care. This will be possible with the automation of both processing and manual tasks through robots and AI, as well as the ability to have staff and patients do more complex tasks and reduce training times through supported decision-making. The technologies could also improve quality and staff experience as a point of care solution. They therefore represent relevant avenues for the NHS to pursue given its critical challenges. Opportunities for efficiency are especially relevant for the supporting functions including finance, reporting and human resources.

Some innovative solutions are available now or in the immediate future to:

• provide clinical decision support (for example, mammography) to integrative diagnosis using multimodal AI, which will improve timely diagnosis and patient outcomes
• support auto-population from open-ended notes (free text), natural language processing clinical data capture – applicable across pathways but particularly relevant for mental healthcare (large amount of unstructured information) to enable more appropriate care for individuals
• support AI resourcing/scheduling of workforce for hospitals and community visits rather than manual scheduling, including Geo intelligent scheduling for community visits
• automate and monitor/audit compliance to patient safety, quality standards and tracking documentation (for example, patient tracking consent forms)

Adopting new ways of working will enable earlier delivery of higher-quality care, more delivery of care out of hospital and patient empowerment to manage their own health – while also allowing the NHS to deliver more with its finite resources.

3.3 The NHS cannot do this alone or from the top down

The successful introduction of these new technologies and approaches will require a focus on system-wide transformation, not individual technological adoption; it will require better alignment of innovation and research infrastructure and new ways of working with the large and small companies from where the innovations are emerging.

It will also require the NHS to build capabilities in several specific areas, including technological infrastructure, data sharing, procurement policies and commercial arrangements, and ethical and environmental assessment. This infrastructure needs to be aligned to national ambitions and be supported by national levers. However, national implementation policy should not be so prescriptive that it stifles the mobilisation of collaborative local systems.

3.4 Success will come down to getting the culture right, building a skilled workforce and putting the right enablers in place

All adoption of innovation is local and needs individuals to provide leadership and drive through implementation in a culture that supports this. For the right culture, patient and citizen voice, NHS management and clinical leadership, and strong industry support will be key in sending the signal that innovation and research are important. Enabling this leadership requires fostering elements of culture, clinician time, data, procurement processes, and incentives to empower full-time clinicians to innovate and support implementation planning and effective rollout. For effective leadership, enablers will need to be in place to better empower NHS staff on the ground to participate in research and adopt innovation: data, procurement processes, and the time and incentives. We also need to make it easier to adopt innovation by reducing friction in the system with a clear, consistent, standardised and streamlined rules-based approach, and standardise how industry, academia, charities and patients can partner with the NHS.

3.5 This will take time, and we will need to be consistent and long term in our approach

There is no silver bullet – innovation in the NHS has suffered from a series of short-term projects and approaches (despite the same barriers and enablers being identified over the last 20 years). Success in implementing the findings of the IEP will require collective accountability and resourcing for 3 to 10 years, with a clear strategy that all partners are signed up to and willing to support.

4. Recommendations of the Innovation Ecosystem Programme

The recommendations set out the practical changes needed to evolve the innovation ecosystem so that the NHS can meet the country’s healthcare needs of the future through the testing, adoption and scaling of innovation, for the benefit of patients and staff.

We believe the recommendations should be taken as a package. Our work shows there is no silver bullet that will enable a thriving ecosystem in this country. Prioritisation of work will be needed with clear plans for the delivery of actions over time. The delivery of the recommendations will require all partners to act.

The NHS cannot make these changes alone. The key message from the Innovation Ecosystem Programme is that all partners need to act, collaborate, prioritise and align to better meet the needs of patients and the public.

4.1 Setting direction

What is needed?

The innovation ecosystem must be aligned to support the government’s health and economic growth missions. The ecosystem must focus on the 3 shifts that have been identified: hospital to community, analogue to digital, and sickness to prevention. Activity on testing and adoption of innovation must be a core function of the NHS and explicitly aligned with these priorities. Innovation should be considered part of the NHS mandate with a sharper and more ambitious focus. Government should set clear priorities – and develop these with patient groups, NHS England and other national bodies. National funding, co-ordination and incentives should align to drive activity in these areas.

* NHS fit for the future: that is there when people need it; with fewer lives lost to the biggest killers; in a fairer Britain, where everyone lives well for longer.

Why is it important?

The NHS and its partners need to send clear signals on the major transformations and shifts in care we are driving and prioritising. Innovation must be at the centre of transformation and operational business. Too often incentives, funding and priorities have created a challenging landscape for innovation decision-making.

We must transform whole pathways, moving away from the historical focus on individual products, and seek to move to intentional horizon scanning and demand signalling for the future of innovation and research over the next 10 years, based on what would add the most value to the NHS.

Priorities should also be shaped by both innovation demand – addressing immediate healthcare needs – and innovation supply, informed by emerging high-promise transformative technologies such as cell and gene therapy and bioprinting. This will require us to look earlier in the pipeline, take risks and develop new skills to understand the evidence for how combinations of innovations can be adopted across multiple care settings and in end-to-end clinical pathways.

How to achieve this

1. Make innovation core to NHS business: Government and the NHS should send a clear signal that innovation and working with industry is a core part of how the NHS delivers care, alongside education and research. The NHS 10-Year Health Plan and the Innovation and Adoption Strategy should set direction on the importance of innovation in achieving the NHS’s goals both in terms of improving the nation’s health and driving economic growth.

2. Prioritise and co-ordinate innovation around the shifts and goals for health: The priorities for innovation must focus on delivering the shifts in care required to deliver our goals for health and care: from hospital to community, analogue to digital and sickness to prevention. These priorities should be aligned across the 10-Year Health Plan and where possible include the work of the Office for Life Sciences’s Healthcare Goals programme (formerly known as the Healthcare Missions). Priorities should be agnostic of any specific technology or product but must be ambitious and forward looking to address the NHS’s significant challenges and recognise the radical change innovations can enable.

The NHS, regulatory bodies, charities and government research infrastructure should align their activities and funding for innovation, with activities largely focused on, and funding supportive of, the priorities. This should not interfere with the delivery of core regulation, assessment and adoption of those technologies that do not directly align with the priorities.

In seeking partnership with the NHS, industry will need to work more collaboratively with the health system, working together to get to stronger proposals that show how they contribute to these priorities and share early information on the pipeline of innovation in these areas.

The priorities should be committed to – with funding and delivery plans – over a multi-year period, but with opportunity for review and change in case unintended consequences emerge for example, inequity of outcomes.

All the other systematic recommendations we make apply to all innovations, so that it is also easier to develop and adopt innovation that falls outside the aligned priority areas.

3. Establish co-ordinated oversight and aligned innovation funding: Innovation funders should work together to establish fewer but larger funding pots for the national innovation priorities with a greater focus on the later stages of the innovation process. NHS England, National Institute for Health and Care Research (NIHR), the Department of Health and Social Care (DHSC), UK Research and Innovation (UKRI), Innovate UK and local NHS organisations should collectively align some of their innovation budgets to create co-ordinated funding vehicles that can be deployed to support adoption and spread of innovation that aligns with the national innovation priorities. In the first instance, this alignment should concern existing funding, with the investment case for additional funding developed as part of the 10-Year Health Plan.

To support co-ordination and oversight, government and NHS England should clarify and simplify current national governance for the oversight and co-ordination of innovation activity and funding. This should include enhancing the Accelerated Access Collaborative (AAC), or something like it, so it has clearer accountability to ministers, authority to drive co-ordination of ecosystem activity, including authority to direct funding allocated to support innovation activities. This governance should include transparency on nationally agreed metrics for all partners to track progress against agreed innovation priorities.

Funding mechanisms should be developed – building on existing approaches where possible – to allow both charities and industry to participate by contributing capital for specific innovation programmes or awards.

Programmes must be deployable on a multi-year basis over the course of a spending review cycle and be flexible across years based on milestones. Innovation budgets should span multiple spending reviews. Regular gateway reviews may be needed, recognising that not all funded innovations will be successful and that there is an opportunity for rapid termination of programmes that are not delivering. Robust evaluation and monitoring aligned to the government’s Magenta Book should continue to be in place to assess delivery and new investments must include provisions to deliver this evaluation.

4. Develop incentives to support and monitor delivery: NHS England should derive KPIs for the testing and adoption of innovation and, once agreed through the co-ordinating governance, these should be rolled out nationally and reflected in accountability, oversight and governance frameworks, as well as individual provider board meetings. They should both be set at the outcome level to understand the impact of developed innovation and as a way of monitoring implementation to allow delivery to be adjusted where needed. NHS England should support the development of data sources to support this monitoring.

The testing and adoption of innovation should feature in the objectives of all NHS England directorates and be planned for as part of annual business planning as well as reported on annually.

Requirements and guidance on how ICBs meet their legal duty on innovation should be strengthened to align with research, with relevant metrics and capabilities built into the annual assessment of ICBs.

NHS Payment Scheme changes should reflect the specific prioritised innovation delivery that aligns with the national priorities.

The Care Quality Commission should consider how it can best include the KPIs and broader effectiveness of the development and adoption of innovation in its evaluations.

4.2 Structures and tools for delivery

What is needed?

Accountability, oversight and leadership at all levels. This must be supported by standardised tools, policy and guidance for the key enablers of innovation testing and adoption, with the key aim of confident local decision-making.

Why is this important?

There are complex and often ineffective accountability and oversight structures for health innovation due to the disparate range of innovation programmes, the governance of which often sits outside usual operational routes.

The ‘wiring’ to support innovation is inconsistent across the NHS and is lacking in key areas. This means significant variation in the delivery and capability of systems to develop and scale innovation. Ambiguity around pivotal enabling factors such as intellectual property (IP) and data sharing are often barriers to effective collaboration between the NHS and industry, making testing and adoption harder to achieve.

How to achieve this

5. Simplify and strengthen the structures and functions for innovation in the NHS: To reflect the increasing need to deliver innovation across primary and secondary care, providers and primary care networks (PCNs) should identify leadership and capacity for the testing and adoption of innovation. This will enable mechanisms to respond to both national and local innovation priorities.

Regions should work together to understand how they can most effectively mobilise across their local partners and leadership. The approach will not be the same across areas but should include how ICSs and providers align with, for example, NIHR infrastructure, industry, patient groups and charities. The approach should be set out in local joint forward plans. Health innovation networks (HINs) must support their co-ordination and locality partnerships (see acceleration recommendations in Section 4.4) should be the vehicle that supports this work.

HINs are an essential part of the innovation infrastructure and their role in supporting regions and ICBs should be strengthened. Accountability and oversight of delivery must be better integrated with regional and ICB governance. Clearer agreement is needed on the role HINs can play in supporting ICBs, with consideration of capacity, capability gaps and skills, particularly skills in specialist areas such as IP, data governance, commercial contracting and evaluation.

The central co-ordinating function of HINs should be further strengthened to support the national impact of the network and provide a forum through which industry, charities and national bodies can interact with the HINs on a national basis.

Building on learning from past programmes, including those overseen by the AAC, national and system partners should together strengthen central functions in:

• horizon scanning – pooling resources across NHS England, the Medicines and Healthcare products Regulatory Agency (MHRA) and National Institute for Health and Care Excellence (NICE) to identify the pipeline of innovative products and approaches that align to priorities
• earlier implementation planning for testing and rollout of innovative approaches – building on programmes such as NICE’s Early Value Assessment, and using the appropriate delivery method for the innovation, considering how the HINs, clinical networks, Getting It Right First Time (GIRFT) Programme and commissioning will support this
• identifying the required enablers for access and adoption (for example, digital and procurement) and how agencies (for example, regulatory) understand and put them in place
• monitoring impact, implemented by both industry and the NHS as part of testing and planning

6. Strengthen data access and information governance: We should continue to shift from data sharing to secure data access by default for NHS data, including developing the network of NHS Research Secure Data Environments as the gateway for research and industry to access data safely and securely when they are approved to do so. Evaluation and testing of innovation should be made a national use case within the NHS Research Secure Data Environment Network including case finding and impact evaluation.

All providers, including GPs, should be required to publish standard data on care episodes into an ICS-level linked longitudinal shared record – with the ICS/ICB designated as the data controller, and allow researchers to access a version in accordance with all information governance safeguards, through the network of NHS Research Secure Data Environments.

The NHS should work with MHRA and NICE to identify how to use the Secure Data Environments effectively and safely for effective post market surveillance.

Partners should focus the development of data use on the priority areas for innovation.

7. Align procurement to facilitate rollout of innovations post testing: NHS England should continue to work with NICE to establish, and improve, rules-based access pathways for the procurement of all technologies that are applicable at national levels, building on the recent proposals for the Integrated Rules Based Pathway (IRBP) for MedTech as well as long-standing arrangements for medicines. NHS procurement should support pull through of innovation being developed in R&D infrastructure where there is evidence for its effectiveness.

NHS England should develop a mandated equivalent of the Treasury ‘Green Book’ for business cases for innovation, to give consistency to the evidence requirements for adoption and procurement of innovations yet to be nationally assessed and recommended. This should align with NICE’s assessments of resource impact and include an approach to assessment of environmental and health inequalities impact of innovative technologies.

NHS England, with local systems, should develop a national passporting system for aspects of innovation testing and adoption. This will mean that once an NHS body has issued a ‘passport’ for a particular aspect, that aspect – for example, commercial contracting or data governance arrangements for commercial contracting – can be transferred to another NHS body with less local governance and fewer processes.

Continue to develop and implement a national mechanism, including the necessary skills and capabilities, for ‘decommissioning’ innovations that are not shown to be effective or are superseded, with money saved reallocated for new national priorities.

8. Develop commercial approaches to share value in testing of innovation: NHS England should refresh national IP policy to provide clarity to all partners. As part of this, NHS England should identify appropriate ownership models for IP that can create value for the NHS, and enable benefits realisation of IP, while maintaining robust information governance (IG) safeguards.

Work should be undertaken to explore more innovative commercial models that would help NHS organisations to effectively manage the risk that, following testing, innovations do not deliver the required outcomes. NHS England should provide systems with access to expertise in developing appropriate commercial arrangements to support the testing and adoption of innovation in a way that shares the value created, incentivises delivery of outcomes and allows partnerships to be developed that cross from development into rollout where there is benefit to the system.

4.3 People, skills and capabilities

What is needed?

The NHS must build the required skills, capabilities, capacity and culture to empower and enable its workforce to be prepared for the future and to confidently collaborate with patients, the public, industry and academia.

Why is this important?

For innovation to succeed, everyone in the healthcare ecosystem needs to support the creation, testing, adoption and scaling of innovation, but they cannot unless they have the right skills, leadership and capabilities to support collaboration. Innovation is seen as a ‘nice to have’ rather than a core competency and part of roles across the healthcare ecosystem.

How to achieve this

9. Build the right skills and capabilities: NHS England, professional bodies and the Royal Colleges should develop capability frameworks for innovation for all staff, clinical leadership and board-level executives and non-executives. Skills should include understanding the critical success factors in innovation adoption, undertaking innovation evaluation, managing risk, working with external partners; agile change management; commercial awareness and skills including value sharing arrangements. This work should align with similar ongoing work around research.

The NHS should review the various innovation adoption programmes supporting leadership development for innovation, promoting and integrating them where possible to simplify the offer.

Industry, Royal Colleges and universities should work with the NHS to develop the workforce of the future, one with the skills to use innovations that are on the horizon in their area of practice in the next 5 years.

10. Create time in jobs for innovation: NHS systems should embed innovation expertise in relevant job descriptions and protect time for leadership of innovation alongside activities such as research and education for everyone. Joint efforts are needed to establish dedicated time for education, research and innovation activities, along with integrated training pathways. This approach will help prevent competition for workforce incentives and support a cohesive message on the importance of building capacity in both research and innovation across the NHS.

Leadership and responsibility for innovation should be reflected in the banding process for roles within job descriptions. This could be linked through performance management.

Joint clinical innovation fellowship posts with industry should be introduced to embed expertise in NHS providers and improve collaboration.

11. Foster culture and understanding: National clinical leadership should work to identify and support the 200–300 innovation leaders of the future – those who are going to advocate and drive change in their systems. This should include partnering and working with patient groups to identify citizen leaders.

Education opportunities should be shared across industry and NHS researchers and staff.

Secondments and role transference should be facilitated between industry, academia and the NHS at every career stage.

Innovation testing and adoption should be visibly championed and celebrated not only to staff but the public. Build the testing and adoption of innovation into job descriptions, evaluations and awards.
The recommendations of the Messenger Review should be embedded, ensuring leaders are conversant in the latest developments and implementing innovation. We also need clear, consistent communication on innovation priorities, with leaders articulating what needs to happen and crucially how and why.

We must speak well of each other.

4.4 Acceleration

What is needed?

The recommendations of this report are focused on the architecture and wiring of innovation – these will take time to implement and take effect. However, the NHS, government, industry and academia should work together to mobilise major geographies behind the key priorities now. This should be done with centres across the UK that have shown excellence in innovation development and adoption. We will work in partnership with localities as the first places to develop and implement the changes set out in this report and build the case for further investment. We will put in place a forward-looking approach to evaluation – robustly assessing innovation and the ways of working.

Why is this important?

Throughout developing this report, we have heard of the need to balance top-down direction and local flexibility on delivery. Therefore, major localities need to come forward to lead and show a willingness to partner on national priorities; specifically, to develop best practice for delivering transformation and the adoption of innovation, and to share learning across the system.

How to achieve this

12. Mobilise local systems behind work: Major localities should come forward to accelerate transformation in priority areas and to act on the recommendations of this review, including collaboration with industry to consider life sciences sector-specific recommendations.

National teams should work with these localities to:

• provide insights and evidence for future investment in innovation and adoption, by working with national teams to articulate the benefits from supporting the design, development and deployment of innovation
• demonstrate a mechanism and the agility to respond to national priorities
• demonstrate how different localities can work with industry and other partners to support investment and growth (where applicable)
• identify and share best practice in the practical implementation of success enablers (IP, data, procurement, etc)
• develop standardised innovation pathways and accelerate scaling in priority areas or in response to patient/population needs

Where agreed, these localities will be tasked with accelerating progress on the nationally designated innovation priorities.

13. Evaluate what works: We need a robust approach to evaluation designed from the start, and which is aligned to and supports NICE assessments, to build evidence of both the health, social and economic impact of innovations being developed, and best practice ways of working. Provision should be made as part of new investments in innovation to support this evaluation.

14. Establish peer learning networks: Connecting people doing this successfully with those who want to be powerful. Connecting those who have experienced the challenge of successfully testing, adopting and scaling innovation with those who make policy is also powerful. Both have the potential to spread best practice and provide further support to others. We must establish national peer learning networks to achieve these 2 things.

5. Next steps

The recommendations in this report set out the practical changes needed to evolve the ecosystem to meet the needs of the future through testing, adopting and scaling innovation for the benefit of patients and staff; and to support economic growth. They represent a complex, ambitious programme of work. We are aware that some of the recommendations are starting to be addressed, while others will need further development and agreement before implementation.

The NHS cannot make these changes alone. The key message from the Innovation Ecosystem Programme (IEP) to all partners is to collaborate, prioritise and align to better meet the needs of patients and the public.

This report marks the end of this phase of our work together, but there is still more to do. The key partners in the IEP alongside other relevant programmes within NHS England and DHSC should come together over the next few months to agree when and how we want to deliver. The forthcoming 10-Year Health Plan, Innovation and Adoption Strategy and Life Sciences Sector Plan offer an opportunity to respond to and implement the recommendations from our programme in national long-term strategies and provide an even firmer grounding for these reforms in support of the wider ambitions for health and care the plan will set out.

But the development of the 10-Year Health Plan should not stop us from getting on with making progress now. We welcome further discussion on where we should focus immediate action, but this must include:

• Embedding recommendations; feeding the report’s recommendations into the development of the 10-Year Health Plan, the Innovation and Adoption Strategy and Life Sciences Sector Plan
• Enhancing governance; enhancing our cross-organisational governance– including how we may enhance the AAC (or equivalent) to deliver.
• Aligning priorities; agreeing the national priorities and beginning the work to align innovation activity and funding behind them
• Regional acceleration; start ‘Acceleration’ in a set of geographies to further refine recommendations and to start to make progress.

5.1 Embedding recommendations; feeding the report’s recommendations into the wider national plans and strategy

The 10-Year Health Plan, Innovation and Adoption Strategy and Life Sciences Sector Plan provide the opportunity to set a clear signal of the importance of innovation to the NHS and the role it can play in supporting the government’s health and economic growth missions. The development of these documents should build on the IEP’s recommendations set out in this report and be the vehicle to set a clear long-term plan for delivery. They should also consider whether we can and should go further, setting a bigger ambition for how innovation can support the transformation of the NHS. The stakeholders and partners we engaged with are ready to contribute to the development of these documents.

5.2 Enhancing governance; enhancing our cross-organisational governance, alignment and funding and using this mechanism to make trade-offs as to the focus and pace of innovation adoption

The IEP programme benefitted from the engagement with many leaders and stakeholders who support the testing and adoption of innovation. This engagement must continue through our governance forums, which should be enhanced and given clear authority to drive delivery and direct spend but with transparency over partner actions. We also need to consider their membership – to ensure voices from within NHS systems are represented in the delivery of the recommendations and held responsible.

5.3 Aligning priorities; agreeing the national priorities and beginning the work to align innovation activity and funding behind them

Ultimately given the challenges facing the NHS, the limited government funds available and agendas of different stakeholders, there are likely to need to be trade-offs in the implementation of the recommendations. These are most likely to be around.

• the level and type of funding that can support the adoption and testing of innovation
• how widespread and quickly the NHS can address the structural and capability recommendations, and how it balances the focus on advancing the ‘acceleration’ proposals versus building universal capacity
• the number and breadth of focus areas for the testing and adoption of innovation, and the order and priority with which they are addressed

These trade-offs can best be made by continuing the collective conversation across all stakeholders.

5.4 Regional acceleration; starting ‘acceleration’ in a set of geographies to further refine recommendations and to start to make progress

Given the existing capabilities and networks in the UK, it will be possible to move forward within existing budgets and plans with the acceleration phase of this work, testing out some of the recommendations and further refining them for broader role out. This will allow progress to be made and maintain momentum, as well as helping to inform longer term planning.

6. Concluding statement

This report is the result of many hours of analysis, conversations and insight from a huge range of stakeholders. We have included as many people as we were able in its development, and we are confident in the recommendations. It is now time to get on with it and deliver.

It is a complex, interdependent package of measures and will only be achieved if we can deliver together as partners in the ecosystem – a collaborative, co-ordinated effort will be required with all partners bearing responsibility and reaping the benefits.

We sequenced the human genome and identified monoclonal antibodies. We can do this.

References

1. The Health Foundation (2024) Health Inequalities, The Health Foundation (2024) REAL Centre Health Inequalities in 2040
2. NHS Providers (2023) Stretched to the limit: tackling the NHS productivity challenge, NHS Providers (2024) Burnout forcing doctors to quit NHS as heavy workloads take toll
3. NHS England (2023) NHS Long Term Workforce Plan, 2023
4. Organisation for Economic Co-operation and Development – OECD (2023). Health at a Glance 2023
5. NHS England (2024) NHS waiting times statistics
6. NHS England (2024) Consultant-led Referral to Treatment Waiting Times Data 2024-25, September 2024
7. House of Commons Library (2024) NHS Key Statistics, NHS England (2024) Cancer Waiting Times Standards and Cancer Waiting Times Official Statistics
8. NHS Confederation (2024) How ICSs are meeting workforce challenges – four case studies
9. NHS Confederation (2024) Are people getting less from the NHS?
10. Department of Science, Innovation and Technology, Department of Health and Social Care and Office for Life Sciences (2023). Bioscience and health technology sector statistics 2021 to 2022

Publication reference: PRN1675