Talking NHS innovation

Doing business with the NHS can be challenging but a special gathering of experts in Lancashire looked to ease some of the pain and point the way to a successful outcome.

The Innovation Agency and Lancashire Business View brought together NHS decision-makers and business owners from across the county to the event at Brockholes. It examined the commercial opportunities and challenges of doing business with the NHS in front of an audience of more than 60.

And the clear message was that support and access to the healthcare market is available to help companies navigate the complex health service systems and structures. Finding the right decision-makers can be the key to starting to make a real difference to patient care. And, as delegates heard, there are “huge opportunities” for businesses prepared to put in the hard work to succeed.

The role of the Innovation Agency in the process was explained - its work in signposting, supporting, facilitating engagement and being “an honest broker and critical friend” was highlighted to the audience. The agency’s aim is to create commercial collaboration that brings about improvement in health care.

Part of the NHS, it is one of 15 Academic Health Service Networks set up to accelerate the spread of innovation, improve the health of local communities and generate economic growth. Delegates to the special summit were also given a valuable insight into NHS procurement and some of the inner-workings of the organisation.

The Health professionals

Dr Matt Orr: Clinical Commissioning Groups (CCGs) have a geographical footprint and are made up of GPs with some lay members. A committee oversees the spending of your local health budget. Some is procured centrally but nearly everything these days is then devolved to your local CCG.

We do still say we would like ‘a thing’. Don’t be put off. If you think ‘that’s not the product I really sell’, what we sometimes end up with through the tender process and roll-out is something completely different. Getting into the bidding process is your time to shine. To say ‘you’ve asked for X but actually we might be better providing something that is slightly different’.

• Dr Matt Orr - GP and former board member of Chorley and South Ribble Clinical Commissioning Group
• Sharon Robson – procurement director, Lancashire Procurement Cluster
• Karen Swindley – director of workforce and education at Lancashire Teaching Hospitals NHS Foundation Trust
• Dr Amanda Thornton – digital health and activation, clinical lead for Healthier Lancashire and South Cumbria ICS and director of public health at Lancashire County Council
• Talib Yaseen – transformation director of Lancashire and South Cumbria ICS 
• Carole Spencer - transformation director, Innovation Agency

Talib Yaseen: We spend £3.1bn currently in Lancashire and South Cumbria on healthcare services. There are difficult barriers to entry. If you are not getting your proposal or idea in front of an executive team, whether that’s a CCG or a provider like Lancashire Teaching Hospitals, it is very difficult to know how you are going to get traction. Although we talk about one NHS, we don’t always collaborate with each other well. If you haven’t read it you need to read the NHS Plan and see what its themes are.

There is going to be a huge agenda going forward on keeping people in the community, ways of making clinicians’ jobs easier. Working with the Innovation Agency and other partners is really important to us. Sometimes you don’t see what is possible until you do.

Dr Amanda Thornton: As a busy clinician in the NHS, the question is how do you get to us? We are the very people that need to connect with you, so the solutions you are forming are based on what we need. The challenge is that there is no natural forum.

We are thinking a lot about an integrated system, how we can create a community that does bring us together. Some kind of ‘innovation alliance’ that creates a route between us.

I’m not interested in you making money but I am interested in you helping to save the NHS. It’s really important that you get into the psyche of the people you are trying to connect with, and how you message to us what you are doing and why you are doing it. You need to really switch me on rather than switch me off.

The NHS is the largest employer in the region and probably the largest economic powerhouse.

Karen Swindley: One question is, how do people who have ideas get them tested by the people who might use those ideas?

We see people who have done a lot of work in developing something and then come to try and sell it. They probably don’t know that 15 other people before have tried to sell the same thing. How do we get that relationship to start at the ‘identifying needs’ stage rather than at the selling stage’?

We are developing an innovation pathway where people who have ideas can come to us and ask if we think it will work. It really is about how we make those pathways accessible and have discussions at that ‘need’ stage.

The NHS is looking for continuous improvement. It is really important for SMEs to make use of the mechanisms and the right contacts, that will get you into the organisation. Use people that know people.

Carole Spencer: The NHS is the largest employer in the region and probably the largest economic powerhouse when you add all the components together. The NHS is not a single entity, it is formed from many individual entities. If you can develop a strategy to deal with it as a sector there are significant outputs you can deliver as a result.

In the NHS generally there are big central structures and that can work against a local strategy. If we know each other and know what each other provides, there is nothing to stop us having more flexible local arrangements.

The approach we take is ‘solution finding’. How do we take a need and knowledge and find a solution and give choices back to our colleagues? It is a bespoke approach. If your product is trying to create a shift come and talk to us and we will try and navigate the system and find the best places to talk about that.

Sharon Robson: The surprising thing for me coming into the NHS is just how centrally focused a lot of the procurement policy is, for all of the right reasons. Increasingly there will be more centralisation. The key is to try and extract out the areas where we do have some choice and flexibility to work with the local community.

Also, it’s directing local businesses as to how they can actually get onto those very national frameworks and have an opportunity to sell at national level. From my perspective it is about getting more engagement between clinicians and SMEs. We have recruited clinical procurement specialists. They are the bridge between procurement and the nursing and clinical community. There is a vast gamut in terms of the services that we are interested in.

The suppliers

Stuart Hendry: Trading with the NHS is a difficult and complicated process. Even if you are on top of all the different organisations it can be confusing. You have to give people reasons to buy. You need evidence that your innovation is actually improving outcomes and/or efficiencies.

If your product is going to be successful, ultimately it will be compared with existing treatments or products, unless you’re are completely disruptive and that brings with it other challenges.

• Heath Groves – managing director Sundown Solutions,
• Aoife Ni Mhuiri – CEO and founder Salaso
• Fenner Pearson – managing director Meantime
• Andrew Leeming – programme manager Boost
• James Flint – Hospify
• Lorna Green – chief operating officer Innovation Agency
• Stuart Hendry – CEO Rinicare

It is the responsibility of the company from pretty much day one to understand how the product impacts on the existing treatment pathway and to come with evidence. There are other challenges, like talking to the right people. My advice is that it is all about understanding the customer. And come with some evidence about your product.

Fenner Pearson: We’ve been working very hard to get the system we have built for trusts to manage and track their audits to market.

The real challenge for me is that every  trust we go into, we get a lot of enthusiasm from the clinical audit team, but it’s the number of people we have to talk to in order to get it over the finishing line. The real frustration is that it is difficult getting to see the people in the NHS. You get the meeting, you get the enthusiasm and you think ‘that is brilliant, I’m in’ – but that is where the hard work starts. Our product is very disruptive and requires a culture change - that is where you have to get the hearts and minds.

The biggest problem in the NHS is people’s time. It is an organisation that is underfunded. People are really busy. The NHS is a wonderful client to have but don’t underestimate the cost of getting yourself into the NHS in the first place in terms of time and money.

Aoife Ni Mhuiri: Most of our work with the NHS has been with pilots. We have capacity for increasing our work. Unless you really work with teams to look at how processes can be changed by technology it is not going to work.

Even though the amount of business we are getting from the NHS is quite small, we like to align ourselves with the NHS because it has evidence-based best practice. The biggest challenge is that clinical people are very busy, they are firefighting all of the time, they have busy caseloads. Our technology supports the individual in doing exercises at home; for people to own their own health and take responsibility.

You have the challenge of proving it in a pilot. You prove it with one health trust but actually the next trust you go to wants you to prove it all over again. You need to understand the need and the problem  you are solving but also the workloads and processes that need to change in order to adopt the solution.

Lorna Green: The NHS is complex. You need to understand that system and find your way through, find your clinical champions. At the Innovation Agency can help with that and provide support with it. It is not what you think the system needs or what patients need, or whether there is a gap in the market. It is about really getting underneath the system.

It is being able to articulate the need and then clearly articulate how your solution meets that need. You need to be able to show why it is different to competitors, how it might save money or drive efficiencies, and how your solution makes the lives of those very busy clinicians easier.

And then you might be onto something. If you can really articulate that, it takes you through the traffic to that market. Simply put, understand your customers’ needs and how you can address them; not just show what your product’s benefits are but how it can fit into that complex system.

If you are getting into this just to make money, get out now, it is not for you.

James Flint: Hospify is a community platform designed specifically for health teams and patients. Our strategy has been to give the product away, allow people to see it and then get them to lobby for us in their organisation.

We are now rolling out the paid version and as a result we are hitting the same problem as everyone else when it comes to the need for quantified pilots. It is a massive hurdle to get over. Bringing on new products brings risk, so we understand why the process needs to be difficult.

As a business you need to be prepared for that and have a strategy to help you because it is going to be a long haul. Keep it really simple, make it really easy for people to understand why your product is cheaper, more efficient, whatever it happens to be. Make it really easy for people to decide.

Heath Groves: You can’t come into this sector if you think: ‘A, I’m just going to make money and B, we’re just going to run away’. You have got to be prepared to stick in it for the long game. There is no such thing as a National Health Service, the only ‘National’ thing is the word at the beginning. What you have is thousands of different businesses all conjoined together to create this massive organism.

Technology works against that model. You are not going to change that structure, but if you understand it and build your solutions around that structure you will become successful. The NHS is THE people business. People talk to people. We back everything we do with human service desks, with human operatives.

If you are getting into this just to make money, get out now, it is not for you. You need to genuinely want to help and if you are, you will be found.

Andrew Leeming: If you are a business thinking about going into the NHS you should be talking to the Innovation Agency. Its role is to act as the translator when it comes to where those opportunities might be and how you can drive some of your innovation into the NHS.

But you shouldn’t be coming to the NHS and expecting them to make your business work. If you are looking for the NHS to be the saviour of your business you need to rethink why you are doing business with the NHS. You have to know what the triggers are for your customer and what benefits you’re actually selling into the NHS. This will not happen overnight. You need to plan this as part of your business development process.

If you’ve got a completely disruptive product you know that is going to be a much bigger conversation, requiring more thought. It’s realising that there are going to be lots of knock-backs and you have got to be resilient as a business.