With the introduction of a new tariff in April this year, for the first time we have a payment scheme to encourage the spread of innovation within the NHS. This is significant, laudable and my belief is that we need to do everything in our power to ensure that we make the most of the opportunity.
Most of the devices and digital tools that are eligible for the tariff have been developed by innovative clinicians who saw opportunities to improve care – making it safer and more effective. For instance Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented scissors that make childbirth safer Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with a device that prevents tragic accidents with blood lines, Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care.
One of the innovations is digital: Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD, an online platform that helps patients self-manage with dramatic results, which will be the focus of this blog.
Simon, Dharmesh, Maryanne and Peter and their products have been part of the NHS Innovation Accelerator, or NIA, which is a programme supported by all 15 Academic Health Science Networks (AHSNs) and NHS England, coordinated by UCL Partners. It accelerates uptake of high impact innovations and provides real time practical insights on spread to inform national strategy.
Their products are also eligible for NHS England’s Innovation and Technology Tariff (ITT) which enables NHS Trusts and CCGs in England to use these innovations either for free – which is the case with the digital example - or to claim a charge per use.
Chronic Obstructive Pulmonary Disorder or COPD is a progressive disease, meaning it gets steadily worse over time, and people living with it find that exacerbations increase and they are admitted to hospital more and more frequently. In fact, COPD is the second most common reason for hospital admissions in the country, causing a great deal of distress to people and families and costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% people with COPD are unable to take their medication correctly. The myCOPD platform has been found to correct 98% of inhaler errors without any other clinical intervention.
If you have COPD, there is a great deal you can do to help yourself avoid exacerbations, but it can be hard to do these things consistently, alone. The evidence demonstrates that those who manage to quit smoking, do regular exercises known as pulmonary rehab, have optimal inhaler technique and are able to resist the understandable urge to panic when breathless, do much better than those who do not.
Simon’s support system for people with COPD has educational, self-management, symptom reporting, mindfulness and pulmonary rehabilitation aspects, all delivered online.
Typical quotes from grateful patients include “Since I started using myCOPD, I have lost weight, my depression has lifted, and I see my GP just once a year (compared with twice-monthly visits previously). I have not needed hospital treatment for 18 months.’’
Another says “last year, before using myCOPD, I had 12 exacerbations. This year I have had just two.”
The programme is now being used by over 52,000 people with severe COPD in England, which is roughly one-quarter of that population, with more CCGs and respiratory teams coming on board each week. I think it is fantastic that people living with this chronic condition that responds well to regular exercise and relatively simple interventions, now have a tool in their pocket that can help them better manage it.
Before the ITT, there was no clear way for the NHS to purchase digital solutions such as myCOPD. They don’t fit well into the traditional funding model being neither part of hospital care, nor a piece of IT infrastructure, nor a drug.
While in its first year the ITT is limited to a small number of product types and a relatively modest budget, it strikes me that it is a brilliant way of supporting the spread of proven innovations, and could, if expanded, become a key part of the aim of all AHSNs to make the NHS the place for speedy healthcare innovation adoption.
Simon is indebted to his local AHSN for their initial support, and subsequently the AHSN Network and NIA for the scaling assistance he has received. Of the ITT he says; “it has been a massive success for us as a company, although we experienced some delay as some areas waited for it to come into effect, since then the response has been almost overwhelming; with many CCG areas and one complete STP in Essex, going for a whole systems change and purchasing extra licenses to be used in areas outside of the tariff, such as in primary care and at the point of diagnosis. We are now operating in over 35 CCG areas and would like to thank in particular the Wessex AHSN, and their CEO Bill Gillespie, for having been hugely supportive in the rollout locally.”
myCOPD also has a strong self-pay market and seeks to price as low as possible so that people on all incomes or none can purchase, the cost is £20 for a lifetime licence. The team are noticing that many of the people buying their own have milder COPD and are seeking to do all they can to stay as well as possible and slow progression of the disease. For more information include some great short videos see www.myMHealth.com.
We have in the past bemoaned that the NHS doesn’t support innovation or its clinical entrepreneurs. Here we have a handful of fantastic inventions that improve safety and help people self-manage, devised by clinicians and innovators who have been hugely supported by the NHS to date. We should be proud that as a country we are not only inventing superb devices, we are also designing systems to help accelerate their uptake, and we can all play a role in doing that. These are indeed exciting times and I will leave the clinical innovator to close, in Simon’s words “I think we are on the verge of a fundamental change in the way healthcare is being delivered, we term it the fourth tier of healthcare which will underpin, empower, and improve the quality of care for patients and the professional lives of clinicians in primary, community and acute care.”
Tara Donnelly | Chief Executive | Health Innovation Network
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Emile Holba is a portrait and documentary photographer working worldwide with a range of clients from non-profit organisations to commercial enterprise.
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