The Promise of HealthTech : How Digital Innovators are Transforming the NHS

April 9, 2018




Healthcare is facing the kind of transformation not seen since the discovery of antibiotics and anaesthetics. There is scarcely an area of medicine that will not be changed – and improved upon – by new technologies. You can already get consultations online, search for a GP on an app, and use your smartphone to monitor your own health.


Chatbots are being deployed by the NHS in London and Liverpool to answer medical questions and triage patients. Scannable wristbands with medication and patient data, digital care records, and electronic observation charts are being trialled at Leeds Teaching Hospitals NHS Trust.


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The Opportunity


Digitisation is one of the few ways that these demographic and financial trends can be addressed. The reasons are simple: digital applications replace the high cost of labour with the low cost of silicon. What takes doctors and nurses many humans hours of work – for example, collating information, giving out medication, or telling patients where to park – can be done automatically at a fraction of the cost and much faster. Routine tasks, which previously took man-hours to perform, can now be done in seconds. And people, in turn, can be freed up to undertake other work.


Technology is also increasing the accuracy of interventions. Take breast cancer: screening mammography is still considered the most effective method for diagnosing breast cancer and advancing patients to appropriate treatment as quickly as possible. But mammograms are not always 100% accurate and can produce false-positive or false-negative results. Software has long been used to help doctors analyse mammogram images themselves, but recent technologies are taking things one step further, by looking at the doctors’ reports on these scans, as well as a patient’s full medical history, to more accurately determine breast cancer risk. Not only is this 30 times faster, but it operates with a 99% accuracy, reducing the need for unnecessary biopsies.


This year the NHS turns 70 but the digital health market only started a decade ago. Although there were a few progenitors – such as the UK’s mature telecare market which remains globally dominant – it was the sequencing of the genome (2003), cloud computing (2006), and the Apple App Store (2008), that helped fuel the current market for digital health solutions.



Barriers to Innovation


Hospitals have been slow to adopt and scale new technologies, especially robotics and artificial intelligence, into patient care, although both have been widely used and tested in other industries. Medicine has traditionally been slow to change, as safety is at its core and the costs of implementation have in the past been prohibitive. But costs are falling due to cloud computing, wifi and the roll-out of open systems. Digital health solutions really are starting to make financial as well as clinical sense.


With public and private sector investment at an all time high, one of the strongest R&D bases in the world and effective industry support now in place, it is not creating the innovation that is the problem in the UK, or even piloting them in one or two locations. The problem for digital health startups comes when they attempt to access the NHS on a commercial basis and then diffuse their product through the rest of the health and care system. Nor is there a dearth of senior-level support for the introduction of new technologies into the NHS. So why, despite often compelling clinical and financial evidence, have none of the startups working in the NHS achieved genuine systemic uptake? There are number of reasons.


Cost-effectiveness has yet to be universally accepted to be a consequence of digitisation. The legacy of the NHS National Programme for IT (NPfIT), 3 million lives,, and many more abandoned NHS technology programmes provide ample ammunition for the sceptics. At a time of constrained NHS finances and risk aversion, this scepticism is a tough hurdle for innovators to overcome. Regulatory processes remain slow and complex and often changing; in addition to which almost all NHS commissioning is local and varies from trust to trust creating a frustratingly fragmented picture. While some areas and individuals champion innovation, in many more places the cultural differences between innovative startups and risk-averse commissioners mean that selling new products is very hard indeed.


The diagram below published by NHS England demonstrates just how many stages an innovation must pass through – from idea to purchase and diffusion – if it is to succeed in the NHS. Each of these stages takes time and real expertise to negotiate successfully. By their nature, most digital health companies are smaller and have lower budgets than comparable companies in for example the life sciences sector. As a result they have little capacity to invest in large business development and sales teams to go Trust by Trust or to manoeuvre a multi-stage process. Then there is a skills gap. While there are examples of good practice, the ability to understand, let alone trial and then scale digital solutions is variable in the NHS. The number of medical professionals who have the digital skills (or at least the tools) to interpret the huge swathes of data being generated, assess their clinical value and effectively incorporate these technologies into care plans, remains small. We have divided the main barriers into the following categories:





Digital health is as an essential tool for the NHS to deliver efficiencies, improve self-management of chronic conditions and, crucially, to enable more effective integration. But new technologies promise to do so much more – whether it is the Da Vinci Robot, which is helping surgeons to make increasingly accurate incisions when removing tumours, thereby cutting down on scar tissue; or the way in which companies like Babylon Health are offering a fully online GP-like service


It is no coincidence that the big tech players like Microsoft, Google, Apple, IBMs and Facebook have all expanded into healthcare. They see a real opportunity. But the HealthTech 27 list shows just how impressive the UK’s own healthtech ecosystem is; and as we laid out, it is projected to grow further still, on the back of a number of trends. The UK market size is £2 billion and with the right support is expected to grow to £2.9 billion by 2018. Yet despite both sides of the market – i.e. the demand for new technologies and the supply of the right kinds products – being theoretically aligned, there is a problem. Barriers, as outlined in this report, make it hard for new, innovative companies to trial their digital products, expand these into commercial contracts and scale them across the NHS. Large incumbent IT vendors are well-positioned to block innovation, and the NHS itself often tries to compete with private companies, for example, in competing to build the best app. Digital skills vary dramatically. The difference in the appetite for change between hospitals end between GP surgeries is wide.


Rather than fighting one fight, startups risk having to fight 209 fights – one for each CCG in the country. Because of this, the NHS is not able to offer the kind of healthcare that we know is possible. The pay-out of the digital dividend is, so to speak, being postponed. Addressing the barriers to change, should be a top Department of Health and Social Care and NHS England priority.


But startups also need to do their bit. They need to understand the NHS system and to show compliance with the requisite standards. Furthermore, startups would do well to focus, in the short-term at least, on the areas where the NHS is most open to change and new digital solutions. We have outlined the areas we believe are the best to target. We hope the list will grow, but for now we believe it represents the best estimate of where startups should focus their attention. The NHS is a much-loved institution across the UK, but it is under intense and increasing pressure. New technologies, often best provided by innovative startups, can help. Giving them a chance to do so will be critical to the future of the NHS and the health of the nation.



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