Sir Hugh Taylor looks at some of the barriers that people have talked about in the Accelerated Access Review's (AAR's) engagement exercise.
As we work on preparing my interim report, I wanted to share with you some of the interesting things people have been telling me and the AAR team about barriers to accessing transformative health technology.
We’ve heard about barriers that:
- occur at specific stages of development and those that run right from the beginning to the end of the pathway
- are making it more difficult for those on the NHS frontline to adopt transformative products
- are slowing down the development processes for innovators whether they are from big companies or start-ups
Some of these barriers are affecting all health technologies, while others are specific to medtech or digital health products.
Some strong themes have been coming out in our discussions, with barriers falling into the following groups:
- data and evidence: a mismatch between what data is required at different parts of the development pathway and what we can collect, store and share
- finance and budgeting: not just the overall affordability of new products, but a lack of flexibility (for example to budget across years or different services)
- culture: issues around leadership, accountability, risk and reward, and a willingness to try new things.
- NHS capacity/capability: lack of the necessary time, skills and training to adopt new products, and limited planning to support this
- complexity of the system: the operational complexity of the NHS makes it hard for innovators trying to sell their products and for those having to redesign systems to adopt them
- over-emphasis on pharmaceuticals: many of our existing systems just weren’t set up for emerging technologies such as digital health products or precision medicines
- uncertainty around existing schemes/systems: schemes already exist that are designed to accelerate uptake, for example the Early Access to Medicines Scheme, the National Innovation Accelerator and the Small Business Research Initiative – but these are still fairly new and it is not always clear where objectives are shared
You can read a full list of the barriers on our engagement website.
A few of these barriers particularly interest me. First, the big question of culture. I’ve often heard people blame slow NHS uptake on ‘clinical conservatism’; but to get to what we really mean by this, I think we need to dig deeper. We have some of the best doctors, nurses and pharmacists in the world. Do they choose not to use certain new products because they don’t think there’s sufficient evidence of their impact, they believe there’s still a risk to patients, they don’t feel empowered to do so, or because they’re under pressure to save money? And is there a bigger role for patients here in demanding new products?
Then there’s the issue of capacity to innovate. Every day, I see hospital staff working in the moment to provide their patients with the best care possible. That’s their priority – and, when it comes to it, the priority that we as patients all share. So this review needs to make adopting innovative products the easy choice. It’s no good needing bucket-loads of energy, free time and the ear of the finance department; instead, adopting innovation should be the smartest, most straightforward option and the system should be given the support – whether time, training, leadership or financial support and flexibilities – to make this a reality.
There’s also something about not re-inventing the wheel – making sure existing processes are transparent and well understood. Whether this is about how we prioritise innovations, how we regulate or value them, or how we use them, it’s clear that sometimes awareness just isn’t there, and sometimes processes are interpreted quite differently by different people.
How can we help innovators identify whether there’s a need for their product at its early stages of development, rather than at the end? How do we make sure that these same innovators understand early on what will be required of them across the pathway, and how they can use existing flexibilities – be these, for example, in trial design, regulation or tariff – to get their product adopted more quickly? And how do we make sure patients, using all the tools available to them, help to speed up innovation at all stages of development?
These are just a few of the issues – we know there are more. But we’ve also been warned many times not to boil the ocean. For the review to have a real impact, we need to focus on the most significant barriers to accelerated uptake. That’s why my team has been speaking to so many people to make sure we’re focusing on the priorities you think we need to address.
Along with identifying the barriers, this review provides an opportunity to come up with solutions too. The review’s interim report, which will be published in October, will give me an opportunity to outline my emerging thinking and to present some of our early stage proposals. We urge you to continue to engage with the review and thank you for all your thoughts to date.
Published: 1 October 2015