Sustainable models for non-commercial innovations
The NHS Innovation Accelerator (NIA) supports a breadth of innovations from a range of organisations (including from social enterprise, private and public sector). Some originate from “profit making” companies, others are not-for-profit.
NIA Fellows developing spread and sustainability strategies for non-commercial innovations have highlighted a relative lack of support infrastructure when compared to that available for commercial innovations.
Key challenges identified by Fellows
- Innovation development: Lack of expertise, ownership and capacity within local NHS organisations to nurture and facilitate innovations developed in-house
- Innovation funding: Identifying investors in social enterprise ventures which are seeking to scale into the NHS; securing long-term funding and understanding how best to achieve this; lack of incentives within the NHS to pay for service or pathway improvement innovations;
- NHS decision making: Gaining access to decision makers; securing sponsorship or endorsement that facilitates decision making; disconnect between local and national decision-making in that adoption within individual organisations does not necessarily facilitate wider spread.
Therefore, one of the priorities for the NIA over the last year has been to understand what approaches are being utilised to spread non-commercial innovations, what resources are available and to share, where relevant, recommendations for further support with NHS England.
In June 2019 we brought together a range of national and international experts working in this space to provide thoughts, examples and advice to the Fellows. One of the sessions saw NIA Fellows circulate panels of experts to help inform their own strategy and approach to sustainability.
Background to ChatHealth
ChatHealth started five years ago. It provides a messaging service to and within public health nursing teams, largely in the community, and currently specialising in adolescents and mental health issues. The service is backed by secondary care nursing teams and additionally offers installation, support and continuing technology development/support. Two million teenagers currently have access to ChatHealth (of a total market of 6 million). The service currently supports 45% of the public health nursing teams in the country. It is now self-funding using a licensing model. ChatHealth was developed within the NHS, and its intellectual property technology belongs to the NHS under its innovation policy of shared funding.
Panel 1: Social Franchising, The Health Foundation and Spring Impact
Questions: How do we impress a commissioner? How do we best use NICE evidence as an effective framework? How do we compute the value of deploying innovation in a key area?
- First find out what the commissioners want to know (e.g. this may be clinical outcomes, or the number of contacts the innovation currently has).
- Be flexible, and always tailor your evidence to meet commissioner requirements.
- Commissioners often have current strategic/ priority projects which you should try to align with. There is considerable value in knowing as much as possible about the current strategy in advance.
- Be ready to answer three key questions – Will it make it better? Will it save money? Will it fit in with what is already happening?
- Consider the implications of implementation (e.g. time, resource, and cost). Look at re-purposing existing resource and consider the positive and negative impact on all aspects of implementation.
- Use evidence for comparison – Is it new? Is it better? (better than what?)
- Use numbers in your presentation. Powerful infographic style visuals are a worthwhile investment. Leave behind a one-page summary document.
- Be specific about cost/efficiency savings (how much? / to whom? by when?). Include all the savings, not just first-line. Be realistic about potential costs: what is the saving? (time to care? increased headcount?)
- Consider how your innovation will make current NHS resources go further, so not just cost or job savings.
- Use the NHS Long Term Plan and show how your innovation aligns with the strategy and implementation plan.
- Storytelling is important. Use the experiences of users and provide qualitative service feedback.
- Demonstrate your capacity to learn, develop and be flexible.
NHS Long Term Plan
- NHS England. NHS Long Term Plan. London: NHS England. 2019.
- NHS England. NHS Long Term Plan Implementation Framework. NHS England. 2019.
- The Kings Fund. The NHS long-term plan explained. London: The King’s Fund. 2019
- The Health Foundation. Reflection on the NHS Long Term Plan. 2019.
Panel 2: Support Available, UnLtd and Young Foundation
Questions: We have a licensing model; how do we spread it? If the mission is to spread healthcare widely, is the locality of the host Trust relevant? We are driven by health benefits; do we need to make money?
Option 1: Create a case for stepping outside the NHS.
Option 2: Consider whether if you can create a better business model, would the NHS be happy with the benefits accruing from its ownership of the intellectual property.
Option 3: Consider the ‘share issue’; would your legal structure allow it? (Look at the legal structure of social enterprise, e.g. socially conscious re-investment)
- Read legal documentation, including readily available legal guide sheets.
- Get a lawyer.
- Use free pro-bono services.
- Speak to people who have experience of doing it.
- Research possible investors with social enterprise credentials.
- Carefully research who you work with.
Note: There are lots of new ideas and concepts gaining traction, and many possible ways to place yourself in the spectrum of commercial vs charity.
- Purposely – Free tool that guides founders through the necessary steps to create companies and embed purpose into their DNA
- Unltd – Organisation supporting social entrepreneurs to start up and scale their impact
Panel 3: International Examples, Global Health Innovation Centre, Duke
Question: What can we learn from elsewhere?
- Frame limitations as positives for the user.
- Learn from similar services e.g. other mental health support networks.
- Consider mutual benefits of splitting off from the NHS development hub/ host.
- Use free test online platforms and advice sharing.
- Consider European/overseas spread (ChatHealth has already been advised against this).
- Mitigate risk (competition) by diversifying your market.
- Look for ‘live’ funding opportunities.
- Innovation in Healthcare – Resources from an organisation that works with leading healthcare innovators, corporations, foundations and government organisations, around the world, to scale and replicate innovations that aim to solve priority healthcare challenges.
Panel 4: Social Financing and Resourcing, Social Finance and Big Society Capital
Questions: Is social investment just venture capital with an interest in a particular type of enterprise? What does a social investor look for?
- There are many types of social investment: e.g. venture capital with a social purpose, or financial and social return on investment. The unifying factor is the search for some good social impact.
- Look for opportunities to develop laterally (e.g. ChatHealth has a generic platform with multiple potential uses).
- The investor will look at the level of profit the innovator takes e.g. a proven model is 1/3 back to employees, 1/3 to investors and 1/3 to remain with the generating organisation (e.g. NHS, Government).
- Look at the specific investor requirements for innovators, e.g. sustainability to keep on scaling and generate reinvestment, and the speed of scale-up.
- Have brand equity sufficient to spin-out and survive.
- Look for the social enterprise departments in venture capital companies.
- Access support for creating work which will unlock funding.
- Make sure your investor brings something to the board.
- Look for an investor who has experience in similar social projects.
- Eastside Primetimers – Organisation providing support to increase the sustainability and effectiveness of social enterprises
- Good Finance – Organisation helping social enterprises to navigate the world of social investment
- Access Foundation – Foundation increasing access to social investment, supporting social enterprises to become more financially resilient, self-reliant and impactful
Panel 5: Sustainability and Demonstrating Value, South West and Wessex AHSNs
Question: How do we achieve sustainability and demonstrate value in our innovation?
- Look at the case for change: demonstrate return on investment at three levels of potential investment.
- Play smart – use psychology in terms of your audience’s comfort with high or low risk.
- Aim for 70% confidence in the assumptions you make.
- Test your hypothesis/numbers/scenario modelling.
- Use outside (non-NHS) input.
- Bear in mind that reinvention of the wheel may look more appealing than loss of control (to the NHS).
- Establishing Notable Behaviours – Osterwalder A, Pigneur Y. Business model generation: A handbook for visionaries, game changers and challengers, John Wiley & Sons; 2010.
- South West AHSN, Billions Institute, NHSE England and NHS Improvement’s Spread Academy – Immersive training to equip health and social care teams and leaders with the skills and confidence to lead large-scale change, whilst providing the space to build practical plans to achieve and sustain scale
- Billions Institute – Organisation that creates transformational learning experiences for social change agents
Panel 6: Action Planning, Adrian Downing (NIA Mentor)
Question: What next?
- Look carefully at financial projections.
- Consider status quo vs change or investment when projecting the future.
- Continuously de-risk.
- Head for the top.
- Study successful pitches and develop yours accordingly.
- Access accelerator programmes.
- Find yourself a really good mentor.
- The Social Tech Trust – Charity
For more information, download our Sustainable Models Resource Guide.