Professor Wendy Tindale, of the NIHR Devices for Dignity MedTech Cooperative, shares her thoughts about the world of healthcare technologies.
The National Institute for Health Research (NIHR) Devices for Dignity MedTech Co-operative (D4D) is one of 11 NIHR Medtech and in vitro diagnostics Co-operatives (MICs) – a series of centres across the UK that aim to build expertise and capacity in the NHS to develop new medical devices and healthcare technologies and provide evidence on commercially supplied in vitro diagnostic tests. So, how does the network of NIHR MICs support the development and adoption of healthcare technologies for the NHS?
D4D works collaboratively with patients, carers, clinicians, industry and others to develop technologies for chronic health needs that are often overlooked and that are typically associated with loss of dignity and independence, and poor patient outcomes.
To this end, D4D works to identify and validate unmet clinical needs, produce, refine and evaluate prototypes, and support the commercialisation and adoption of innovative technology solutions for the NHS.
Health Europa spoke to Professor Wendy Tindale, D4D’s clinical director, to find out more about the work of the NIHR MIC and the challenges involved in translating ideas into viable healthcare technologies.
What factors influence whether healthcare technologies are likely to reach the clinic or marketplace, and how does the D4D approach ensure this outcome?
Whether or not a technology is likely to reach the clinic or be used by a patient depends on whether that technology solution responds to a validated unmet medical need, i.e. does it solve a problem that needs solving? Once we understand the need, we can seek to understand whether it’s a technology or service redesign that’s required.
If it is a technology, innovators need to invest time understanding the service that they’re trying to embed the technology into and how it’s going to influence the patient care pathway. They also need a clear plan regarding how they will evidence the positive impact of using innovative technologies in a new or existing care pathway and a health economic case that is realisable in practice – i.e. they need to demonstrate that the technology offers value for money.
It is also important that innovators understand the ‘route map’ from invention through development to evaluation and adoption and can transition along the process in an agile way.
They should also have a clear grasp of the adoption barriers early in the development process and be able to identify the right stakeholders and influencers to partner with in order to remove those barriers; for example, clinical champions can be hugely helpful to create a market pull, rather than a reliance on a technology push.
D4D has a proven methodology for working with stakeholders throughout the entire development process. We begin by identifying the unmet need, which we validate alongside a range of stakeholders, including patients, carers and clinicians.
From this foundation, we work collaboratively to co-design the technology, plan robust evaluation and move to commercialisation with our partners, thinking about adoption and mainstreaming use wherever possible.
We ‘hand hold’ companies through that entire process, but whether or not a technology will be successful ultimately comes down to that unmet need. Having that principle in place from the start makes the pathway into the healthcare setting and to patients that much easier.
Europe has previously faced criticism for failing to turn promising research and ideas into commercially viable products – how does D4D tackle this issue?
For me this comes back to effective partnerships. D4D operates in a multistakeholder network of partners and associates (including industry but also academia, clinicians, patients, charities and funding bodies) and as part of the national MIC network and NIHR infrastructure.
The NIHR MICs concentrate on medical technology development; however, our connections enable us to hand over to other parts of the NIHR infrastructure – for example the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) – to support evaluating a technology.
In addition to the NIHR, the NHS now boasts quite a comprehensive national innovation infrastructure which is underpinned by the 15 Academic Health Science Networks (AHSNs). Having that web of infrastructure in place really helps to accelerate the translation of ideas into commercially viable healthcare technologies.
What is the importance of involving patients and care providers in the technology development process?
Patients, carers and the public have been at the core of D4D’s work since its inception. It’s the patients who are able to tell us about the daily challenges of living with a long-term condition. Having patients as partners helps us to shape the technologies we develop according to what the end user needs and is the only way we can ensure that our products are fit for purpose.
Co-production also helps to create equity between the users and the healthcare professionals.
In addition to the validation stage, patients are involved in D4D throughout the development and evaluation processes and help to disseminate the progress and results of our work to the community.
It comes back to the principle of those who use the technologies being integral to helping design the technologies that can help them. We’ve enjoyed huge success in terms of acceptability of devices and technologies because we have involved patients in their design from the outset.
For that reason, all our patients are full members of our team and receive training, support and remuneration as appropriate for their inputs.
Are there particular challenges for businesses when it comes to launching healthcare technologies into the NHS market? How does D4D work with industry to maximise its success?
Launching a technology into the NHS comes with plenty of challenges. Common challenges for companies are not knowing which part of the innovation infrastructure to approach, what evidence of their technology’s use and effectiveness they will need, or what evaluation questions they should be asking to create their value proposition. Funding is another challenge, as are NHS timescales – they aren’t always as rapid as we would like. The fact that the NHS isn’t just one organisation but is instead made up of multiple organisations is also a source of confusion.
Fortunately, I do think that things are changing. The infrastructure that we are starting to develop nationally – e.g. the NHS Test Beds, the NHS England incentives for technology adoption (such as the Innovation and Technology Payment (ITP)) – is beginning to drive adoption and remove some of the obstacles companies face in the development process.
In terms of where D4D comes in, we help to make sure that companies have a robust evidence base in place and that the technologies being designed align well with the corresponding patient pathways. We participate in funding bids and partner on grant applications, and we also help companies to identify useful clinical champions. Because we are absolutely embedded within the NHS, it is much easier for us to do this because these clinical champions are our colleagues – it can be much harder for a company to make those connections by itself.
Can you tell us about some of the projects D4D is working on at the moment?
We have recently launched a novel neck collar that is suitable for people with neck muscle weakness as a result of neurodegenerative diseases. It was developed with and for people with motor neurone disease, a devastating condition characterised by progressive muscle wastage. Many patients with the disease become at a certain point unable to hold their heads up properly, feed themselves, or make eye contact, all of which has a severe impact on their quality of life.
Through our networks, patients came to us and asked if D4D could help to develop an alternative to the collars that are currently available, which either don’t offer enough support because they are too soft or are too rigid because they have been designed for trauma patients. Patients needed something that was in between those but could also be adaptable as their disease progresses.
We worked in collaboration with patients, as well as engineers, designers and clinicians, to develop the new collar, and I’m very pleased to say that it is now being manufactured by a company called TalarMade and in use in about 140 NHS trusts. It is also being sold worldwide. I’ve heard some really great stories from patients about the difference the collar has made to their lives; for instance, some patients are now able to drive again when they’ve previously had to stop because of their disease. I’m very proud of that.
D4D has also been working with a small company called Tookie on a pocketed vest for children who need chemotherapy via a central line. Often those lines can get dislodged or accidentally removed, causing complications. The vest is designed to prevent that from happening so that children can play safely and reach their normal developmental milestones while undergoing treatment.
Tookie came to D4D with the idea, and we helped to guide them through the process of introducing it into the NHS and evaluating it, and also helped to raise awareness of the vest through our various connections. The vest is now on the NHS supply chain and being bought by many NHS Trusts. As a result of our involvement, Tookie is beginning to find other applications for the vest, for instance in people on dialysis.
Something else we’re working on is a project to diagnose silent aspiration following stroke. Silent aspiration is a condition by which food or fluid that should be going into the stomach instead goes into the lungs. There are no outward symptoms of the condition, but it can lead to chest infections and is associated with an increased mortality rate.
Current diagnostics are invasive and/or hospital based, so we’re working on a simple portable device that utilises acoustic-based approaches for detection and can be used in a home setting to better assess people who might be at risk.
More about Wendy Tindale
Wendy Tindale (OBE, MSc, PhD, CSci, FIPEM, ARCP) is consultant clinical scientist and scientific and innovation director at Sheffield Teaching Hospitals. She holds a professorship in medical physics at the University of Sheffield and nationally is director of the NIHR ‘Devices for Dignity’ MedTech Co-operative.
She has an interest in combining clinical academic excellence and patient benefit with business opportunities through the translation of innovative medical technologies and has worked with both public and private sectors to facilitate successful collaborations. Tindale has contributed to numerous national and international committees.
She received a Beacon Award for outstanding contribution to healthcare and was honoured in the Health Service Journal’s inaugural Inspirational Women awards for outstanding leadership in her field, becoming Healthcare Scientist of the Year in 2016.
Please note, this article will appear in issue 9 of Health Europa Quarterly, which is available to read now.