Established 15 years ago as an NHS innovation hub to help commercialise the health service’s intellectual property; Health Enterprise East (HEE) now supports med tech companies in their quest to gain traction in the NHS.
It does this through two main routes: two funding vehicles, MedTech Accelerator and Medovate, and the MedTech Consulting service. Here, director of medtech consulting and business development Joop Tanis discussed the barriers facing med tech companies seeking to have their innovations procured by the NHS and his top tips for how industry can overcome them.
Allie Nawrat: What are the main barriers to adopting innovative technology in the NHS, and what can be done to overcome them?
Joop Tanis: There is a lot of investment in innovation and research, which is well-funded and well-organised, such as the Medical Research Council, the NIHR and SBRIs. However, this level of investment is not the same for the adoption and spread part of the procurement journey, which is when the product is ready to be adopted and used in the NHS.
This means that, although many products are available, uptake is limited. There are a number of systems and programmes in place to support that, but, even so, available products are not flying off the shelves. There needs to be more support for adoption and spread, which can be achieved by linking investment in research and innovation to a potential adaptor, so you don’t invest in something unless you know someone is actually going to buy it.
Secondly, the NHS is a very fragmented and rationalised procurement market. Companies often ask where to go to sell their product, assuming there must be a central procurement door, but there isn’t. Since the NHS is regionalised, every hospital or clinical commissioning group makes their own decision about what technology they might buy. There are at least 150 to 200 doors you have to knock on to sell your products across the NHS.
Thirdly, the evidence base for incumbent technologies is often not available. For a new and innovative product you are required to present a lot of evidence about whether the product is safe, usable, clinically effective and financially prudent. Interestingly, that knowledge is often not available for incumbent technologies. So as a new company you almost have to do two calculations: what is the existing technology being used and how does my product improve upon its benefits? With limited knowledge of the procurement process of the original, this can be quite a hurdle.
Linked to this, re-procurement is prevalent; for an NHS procurer it is much easier to simply buy the same thing again than to have to change to a new technology. Instead, perhaps those who make procurement decisions should be required, prior to re-procuring, to give evidence that they have considered their existing technological solutions against innovative solutions.
AN: What would be your top tips to a med tech company seeking to convince NHS procurement teams to purchase and use its product?
JT: The first thing I say to med tech companies when I meet them is, although they are excited about their new technology, it is not actually the most important thing for commercial success and particularly for convincing a potential buyer to invest in their product. The customer is the most important thing and that customer is not a single entity. Customers can be segmented into several categories: the patients, clinicians or carers who use the technology, organisations delivering the care, such as hospitals, GP practices or care homes, and finally, the payor who pays for the service.
This is a complex set of customers, whose interests rarely align. This means it is not sufficient to create a product that simply makes patients better; it needs to be something that clinicians will be able to accommodate in their clinical practice, it needs to work in the whole organisation, and somebody needs to pay for it. Often the payor is completely different to those who deliver care.
Secondly, companies need to understand the evidence each type of customer needs to make a decision about a product. It is right for a doctor to say I need this device for the benefit of my patients, but it would be wrong for a financial director to make the decision on the same basis; they need to know it is affordable and works financially.
The third tip is to understand the complexity of the NHS and the related barriers this creates to procurement.
AN: How do you think the NHS Long Term Plan and its focus on digital health can help med tech companies’ success in gaining traction?
JT: The need for innovation in healthcare has been evident for some time; demands and abilities are both growing exponentially. Also, the NHS used to mainly treat acute illnesses, [but] the type of healthcare now required is much more long term as we live longer, and the type and nature of disease at the later stage of life is different.
This leaves a situation where the healthcare system cannot simply grow gradually, there has to be a step change and innovation must play a crucial role.
The future of healthcare is moving away from delivery by professionals and large hospitals to focus more on both self-care and alternative providers supported by technology. All this is reliant on the integration of data systems. The NHS recognises this change and indeed our current Secretary of State for Health has an interest and background in digital technology.
Med tech companies are very aware of this shift, and so [the Long-Term Plan] is an opportunity for med tech companies with digital expertise to demonstrate to the NHS that by using their technology its services can be improved and the needs of tomorrow can be met.
For the med tech companies, having that digital focus explicitly written into the NHS’s own Long Term Plan should give them reassurance they are on the right track.
However, I think the message of the Long-Term Plan is two-fold; it is also a message to the NHS that technology is necessary to evolve. It is remarkable, in my view, the NHS, and healthcare in general, has lagged behind many other sectors in our society in terms of adopting technology.