Mandeer Kataria of the Health Tech Alliance explores the growing role of emerging digital technologies and Artificial Intelligence (AI) in healthcare.
The COVID-19 pandemic has undeniably showcased new ways of delivering care to patients within the NHS, not least through the increased use of digital, technological and AI-based healthcare solutions. The immediacy and necessity of the response paved the way for health tech adoption at a pace unencumbered by prior levels of red tape and underpinned by a desire to work in ‘new’ ways for what was a ‘new’ challenge at the time. Technological innovation has supported health services in numerous ways, including with making significant decisions around capacity and priorities, through the increased remote monitoring of patients, and by allowing more effective communication among the workforce.
Having said this, the long-standing barriers to innovation faced by health tech companies have not been, and are unlikely to be, substantially dismantled. While the market access landscape has evolved for companies over recent years, with a number of positive initiatives within the national architecture acting as a ‘pull’ for innovation, the adoption challenge largely remains entrenched. Long-standing obstacles persist, compounded by new pressures on the system as a result of the pandemic.
The recovery of elective care to pre-pandemic levels faces a bleak road ahead given the resurgence in COVID-19 cases and the ensuing pressures on hospitals and the workforce, including social distancing measures and the need to adhere to strict infection prevention measures. The NHS’s unavoidable focus on COVID-19 has led to the emergence of a patient backlog for ordinary care. At the end of July, NHS England had set rather ambitious recovery targets of reaching at least 80% of last year’s activity for both overnight electives and for outpatient/day case procedures.
Performance data published on 8 October by NHS England did in fact show some signs of recovery in August and September compared with preceding months, with the figures indicating that the NHS had hit a key target for recovering activity; the number of planned hospital inpatient procedures carried out by health service in September 2020 was only 20% lower than the number conducted in the same period last year. Similarly, 96% of last year’s CT scans and 86% of MRI scans were carried out. In any case, irrespective of whether recent performance data pointed to any genuine signs of progress, hopes for further recovery are dampened by the pressures of a second wave of infections combined with the likely onset of winter flu.
The role of health tech in clearing patient backlogs
NHS England and NHS Improvement ought to determine what technological adaptations they can achieve in a climate of resource constraints – and, crucially, identify those which will add value. Notable examples across primary, secondary and community care include the introduction of GP Connect to all practices to enable secure sharing of patient records across primary care; the use of AI to predict critical healthcare capacity, equipment and staffing; and the widespread carrying out of remote GP consultations. Remote monitoring is now crucial for providing care for vulnerable patients who are shielding, as well as those who simply do not feel comfortable visiting a hospital. With regards to an overstretched workforce, health tech can provide remote education opportunities to upskill professionals. It can also alleviate pressures by allowing staff to work remotely and by assisting with administrative tasks, freeing up precious time to focus on caring for patients.
AI and machine learning have a role to play in optimising healthcare provision going forward. In an age of big data, the potential of AI needs to be harnessed to analyse vast quantities of complex information and make powerful predictions. To support the workforce during the pandemic, NHSX announced the rollout of predictive technology in July to help NHS teams forecast COVID hospitalisations. Developed by the AI firm Faculty, the technology has allowed local teams to balance priorities by helping clinicians and scientists to model hospitalisations up to three weeks ahead. More recently, NHSX announced a £50m funding boost for cutting-edge AI technologies, meaning a range of AI-powered innovations which can rapidly and accurately analyse breast cancer screening scans and assess emergency stroke patients will now be tested and scaled, supporting clinicians to deliver the correct treatment faster. Take-home technology could see patients receiving devices and software which can convert their smartphone into a clinical-grade medical device for monitoring kidney disease or a wearable patch to detect irregular heartbeats. At a time in which remote monitoring is a fundamental aspiration of the health system, it is right that these innovations should be recognised for the value they can add.
Ensuring health tech is adopted at pace
Health tech has the potential to provide solutions across the entire patient pathway, from prevention to cure, but systemic challenges preventing adoption remain firmly entrenched. It is widely acknowledged that the NHS struggles to adopt innovation of any kind, with NHS Improvement estimates showing that it takes 17 years on average for a new product or device to go from clinical trial stage to mainstream adoption – a fact that the Secretary of State for Health and Social Care is acutely aware of.
The barriers to entry are numerous. Even those companies whose products do get through, face patchy adoption across a system which is notoriously difficult to navigate. The system is fragmented with national priorities often standing in opposition to local realities, with companies typically having to engage with and convince several layers of decision-makers to achieve product uptake, and a dearth of clear signposting within the national architecture is especially detrimental for smaller innovators. The decision to adopt a product in one trust does not necessarily lead nearby trusts to do the same, thus companies currently must engage on a trust-by-trust basis.
Healthcare providers and policymakers certainly have the ability to enhance the innovation landscape and maintain the UK’s position as a global hub for health tech, and in doing so, ensuring that vital innovation reaches patients quicker. The development of integrated care systems (ICSs) will go some way to helping health care providers to think in terms of population health. ICSs may also think along the lines of value-based commissioning rather than the less effective method of appraising return on investment within the first year, a key tenet of the MedTech Funding Mandate. With this in mind, ICSs, once they are placed on a statutory footing, ought to be appropriately incentivised to drive care quality and improvements to patient outcomes.
Moreover, NHS England and NHS Improvement should encourage the learning and sharing of best practice between regions as to how trusts adopted innovation at pace in the run up to the first peak of the COVID-19 pandemic, so that these lessons are embedded and for the adoption of innovation going forwards. Building on the learnings of the COVID response, Government and NHS leaders should consider developing mechanisms to involve industry, patient groups and charities in work to support the transformation of health and social care services. The sector should work with stakeholders across the healthcare system to retain positive changes in the adoption of innovative solutions, embed new ways of working, ensure the better use of data, and help patients to be diagnosed and treated quicker but also avoid a return to top-down initiatives which unintentionally stifle innovation and collaboration.
With regards to the growing backlog, NHS England, NHS Improvement and their regional bodies should work with providers, charities and royal colleges to identify the ‘true’ patient backlog and current regional postcode lotteries. Doing so will help the NHS and local health services to identify priorities for patient care and potential solutions to tangibly reduce waiting lists. Official figures risk undermining public trust as they appear only to provide a partial picture of the patient backlog due to COVID-19. Using data gathered on the ‘true’ patient backlog, NHS England and NHS Improvement should communicate their priority areas of focus for patient care. This could be accompanied by a series of challenges designed to attract the best innovation and ideas to alleviate the current pressures on healthcare services, keeping people out of hospital settings and ensuring that patients are diagnosed and treated much more quickly. This sort of ‘pull’ and identification of patient need from the system is integral to ensuring that appropriate solutions are built for problems rather than the other way around.
Additionally, Sir Mike Richards’ recent report on diagnostic capacity highlighted the need to deliver a step-change in this area. The government, NHS England and NHS Improvement should endeavour to implement the full recommendations of Richards’ reviews, including community diagnostic hubs. Clearly, the COVID-19 pandemic does not look to be going away anytime soon – but every effort should be made to ensure that patients continue to get the care that they need.
COVID-19 has shone a light on innovation implementation, which must be delivered at pace due to the necessity and immediacy of the situation. These ‘gains’ have to embedded into the health system and taken forward. The UK’s position as a global hub for health tech remains at stake otherwise.
Health Tech Alliance