On 25th February 2016,The Astellas Innovation Debate™ will explore the financial challenges facing the world’s health services. While innovation is often put forward as the solution to funding problems, getting support for new ideas is often difficult. Here Ben Gowland, formerly a Chief Executive of a Clinical Commissioning Group in the NHS in England, talks from personal experience.
It was my first week as CEO, and I was meeting a local GP, Dr James. I had been warned about him: maverick, IT geek, talks too much, get him in and out as quickly as you can. He wandered in, a caricature of himself, half with me, half in his own world. He spoke at a hundred miles an hour, overpowering me with his energy and enthusiasm, but underneath it sat a great idea. And not just an idea. A fully worked up piece of software that could help every GP in the county. Was I interested?
Dr James was, and is, an innovator. Health services need innovators. They need them for many reasons, but not least because of the financial problems they face. When Monitor, the NHS regulator, looked at the funding gap facing the English health service, not only did it identify that innovation was necessary, it estimated that, “introducing applicable innovative models of care to services in primary and secondary care could deliver £1.7 billon to £1.9 billion of productivity gains by 2021”.[i]
Nobody working in the NHS, however, believes the £1.7bn Monitor estimate. They don’t believe it because there is no track record of it ever happening before, and all the evidence suggests it won’t be happening any time soon. Where, they will say, are the innovators?
Peter Hames founded a digital health start up in London in 2010. But in 2015, he and his company moved to San Francisco. He had the backing of doctors, patients and venture capitalists for Sleepio, an online insomnia treatment. But despite attracting $3.3M of funding[ii] he couldn’t find a way into the NHS. In California, in contrast, he has insurance companies queuing out of the door.
- 85% of UK-based entrepreneurs identified barriers such as excessive decision-making times and difficulty finding the appropriate person to speak to within an organisation
- More than 80% thought that procurement processes were too complicated
- Nearly 60% claimed there was NHS resistance to working with private sector companies
While innovators struggle in the NHS, in other countries they thrive. Dr Govindappa Venkataswamy (popularly known as Dr V) founded the Aravind Eye Care System in India. His company delivers at-scale cataract surgery with higher quality outcomes and fewer complication rates than the NHS, at one-sixth of the unit cost (even after allowing for the different cost bases in England and India).[v]
The Indian government supported Dr V by launching a cataract blindness control programme with World Bank funding so that they could offer a subsidy for the patients.[vi] This enabled Aravind to increase the number of beds, and so the overall capacity. But the NHS’s own bureaucracy prevents it from helping its own Dr Vs, its Peter Hameses, its Dr Jameses. If it can’t support its innovators then either they will go elsewhere or there will be no innovation, and no £1.7bn productivity gain.
I was excited by what Dr James was saying. We were a small GP-owned organisation, and we needed something like this to make a mark. Straight away, we linked his product to the company, and started to roll it out to all of our member practices. We smoothed out a few bumps along the way, and after over a year of hard work GPs were using it – they liked it, and it was improving care for patients.
But then we became a statutory NHS body. We grew rapidly in size. Suddenly the NHS pressures of finances, targets and regulation meant I could no longer provide the active support I had previously. Dr James’s innovation got lost three layers down the organisation, and I no longer heard anything about it. Updates to his product happened more slowly. Changes were introduced not to further empower GPs, but to try to control their behaviour. Enthusiasm waned, and slowly but surely, an innovation that had started with such promise began to wither on the vine.
I bumped into Dr James recently. He is still full of ideas, still innovating, looking for support for his latest brainchild. These innovators are made of tough stuff. Ultimately, whether health services can find a way of changing themselves so that they can support Dr James and those like him, will be key to whether they can meet their funding challenges.