November 2018 saw the first cohort of Fellows ‘graduate’ from the NHS Innovation Accelerator (NIA). A Mentor to nine Fellows since the inception of the NIA in 2015, Dr Robert Winter reflects on how attitudes towards innovations have changed, shares his top tips for innovators and adopter sites, and looks to the future of the NHS.

Do you think that attitudes towards innovation have changed within the NHS in the past three years?

Yes, I do think so – just not fast enough! More than 30% of medicine changes every ten years, so we always have to run just to stay still. With the NHS grappling huge issues of escalating cost and demands, a change in attitudes towards innovation is vital.

Are we starting to achieve a culture shift towards embracing innovation or do we still have a way to go? What more could be done to support this?

Yes, we are starting to – with a number of organisations leading the way. For example, in Cambridge – where I have spent much of my working life – over the last 25 years a rich partnership has been nurtured between the NHS, clinical academics and industry. Organisations such as Health Enterprise East have played a significant part by helping enterprising clinicians, industry and the NHS work together. Hopefully, as people begin to see the benefit of these partnerships – to patients, NHS organisations and to innovators – a tipping point in culture shift will be reached.

How do initiatives like the NIA help with this?

The NIA has been a breath of fresh air, each year bringing a select group of talented people to share their energy, expertise and to provide peer support and individual mentorship. The best is yet to come, but its impact to date speaks for itself – huge credit to Laura Boyd, Amanda Begley, and to UCLPartners and the AHSN Network.

Another initiative that has been helpful is SBRI Healthcare (Small Business Research Initiative) that I worked with Karen Livingstone (Eastern AHSN) to set up and is now being run through the AHSN Network. SBRI has delivered 60 SBRI Healthcare-funded products to the market, helped create (or safeguard) 1,050 jobs – predominantly in innovative small companies – as well as saving the NHS more than £30 million.

In your experience as a Mentor for the NIA, what have been some of the key challenges that Fellows have sought support for?

Our challenges have been in two overlapping areas – support on the late development of the innovation, together with engaging clinical and NHS opinion leaders and patient organisations.

Could you describe the types of support you’ve been able to offer and provide? How has this varied depending on the Fellow’s background and the type of innovation?

My support has been tailored to the nature of the innovation and the individual NIA Fellow. So, with AliveCor – a brilliant and cheap device for measuring cardiac rhythm using your smartphone – the breakthrough came after a meeting with the British Heart Foundation (BHF) and, through them, active support of a group of interested GPs across the NHS. With WaitLess – an innovation that uses real-time activity data to smooth emergency attendances – the key was engagement with the Royal College of Emergency Medicine and the support of National Clinical Director, Keith Willett.

In almost every instance we have involved a partnership with patients, often through organisations like the BHF or British Lung Foundation, and this – together with the support of clinical leaders – has been a vital catalyst.

What have been some of the most important insights and learnings you’ve gleaned from Fellows working to spread their innovations across England’s NHS?

I think that we have all found that the NHS is divided in quite a binary manner between the ‘can do’s’ – those who will see a way to get things done – and the ‘can’t do’s’ – where there are always problems, difficulties or 101 reasons why something can’t be done. The NIA Fellows are in the ‘can do’ camp. The NHS England Board is also very much in the ‘can do’ camp and has been really supportive. I was absolutely delighted when three of the Fellows’ innovations that I have been mentoring were included in Simon Steven’s speech to NHS Confederation in 2016. My old friend Bruce Keogh, from when we were junior doctors together at Hammersmith, has been a great and consistent backer and support, and I know that Stephen Powis shares his enthusiasm and energy for NIA. And Ian Dodge, for including a number of the NIA innovations in the Innovation and Technology Tariff, has been hugely helpful. The AHSN Network has also provided valuable support – I hope they will be able to do even more in future!

What three top tips would you share with innovators and entrepreneurs looking for uptake and adoption of their innovations in the NHS?

Others have said it far better than I can – it’s the ‘same old’

“Winners never quit, and quitters never win” (Vince Lombardi)

“Survival can be summed up in three words – never give up. That’s the heart of it really. Just keep trying.” (Bear Grylls)

“It always seems impossible until it’s done.” (Nelson Mandela)

To which should be added: “Illegitimi non carborundum!”

What three top tips would you share with NHS sites looking to adopt innovative solutions for patient, staff and organisational benefit?

  1. Identify an issue in your organisation that people know can be and should be much better.
  2. Bring together a small group of your most able clinicians, your best managers and most supportive patients.
  3. Frame the problem to be solved, including timescales, allow the group a free hand and then stand back – and don’t ask too many questions!

This simple formula works time and time again. Interestingly, this is the principle behind immense benefits to patients bought about by the NHS clinical networks. E.g. ‘door to needle time’, improving cancer outcomes, better stroke services, etc. So the evidence base for this approach is impeccable!

What does the future of the NHS look like?

I don’t have a crystal ball but having spent almost all of my life working hard for the NHS, I desperately hope it will survive and thrive because all the fundamentals are so good. I am convinced that to achieve this in difficult times, we – patients, public, politicians, media and professionals – must all remove our rose-tinted specs and get real

2014 saw the publication of the Five Year Forward View, which contained a perceptive analysis and presented a plan for innovation and change towards a more integrated system of care. Four years on, the painful reality is significantly worse waiting times for emergency care, lengthening and worrying delays for cancer diagnosis and urgent treatment, mediocre outcome data for common cancers compared with other OECD nations, a prolonged junior doctors strike (much of the future talent of our NHS) and a workforce and morale crisis in primary care, with the target of 5,000 more GPs by 2020 viewed as ministerial hubris.

Recent and current evidence shows that the NHS is good at vision, not so good on delivery. The expensive and extremely damaging Health and Social Care Act of 2012 has set the NHS back hugely, as it effectively stymied and neutralised the brilliant work of Professor Lord Darzi, who set out a perfectly clear and achievable blueprint for the future of the NHS that I hope will be revisited, because I believe that all the principles within it still apply.

If the upcoming NHS long-term plan links these principles to ideas for sensible integrated care for long-term conditions and co-morbidities, then the future could look good – but it should look very different. I believe that the biggest untapped resource the NHS has is its patients, and they must be used to the full. Just imagine, innovative services in a future NHS – for COPD or lung cancer or strokes or diabetes or maternity – designed from scratch by patients and professionals working together!

Dr Robert Winter has been closely associated with the NHS Innovation Accelerator from its inception and has been a mentor for nine NIA Fellows. He was previously a director of Cambridge University Health Partners, playing a key part in setting up the AHSN Network. A respiratory physician by background, he was appointed the first National Clinical Director for Respiratory Services (2009-2013). Before that, he was the medical director of Addenbrooke’s Hospital in Cambridge until 2008 – the year the hospital was named HSJ Acute Provider of the Year.