Dear Health Secretary
Firstly, welcome Wes Streeting to your new office, a fresh start and new spirit of optimism for the NHS. I can say this after many years as a Conservative voter (lapsed), and many more years of disappointment in the leadership of the Department of Health and the short-termism that has dominated policy.
I have worked in health and care for 30 years, initially for big pharma, but for the last 10 years as a consultant, specialising in helping SMEs bring new technology into health and care. In a forward-thinking health and care economy my business would not exist, because there would be a straightforward route to test, demonstrate and sell innovations that can improve population wellbeing, patient outcomes, patient/service user care, staff wellbeing and costs but there isn’t.
Access to stakeholders and decision makers is pitiful. The costs of bringing new technology to market can usually only be met by large companies, leaving smaller innovators to fall into the “value of death” when the product is ready for market testing or launch but not generating sufficient revenue to interest investors.
New companies and SMEs struggle to gain public sector contracts. Although recent procurement legislation says that a tenderer should not be disadvantaged for being an SME, the documentation required for submission can be monumental. When your company consists of up to five people, dedicating two of them to responding to a tender full time for weeks can just be unachievable. I appreciate that should a company win a large contract, depending on the product/service, delivery will require more staff, no company can afford to employ staff to bid for a contract on the chance that they will be successful. However, I hate to shock you, but large companies don’t usually have the required staff at hand either and recruit on confirmation of a new contract. A typical example of barriers to SMEs is the paperwork required to meet Modern Slavery regulation, which does not apply to SMEs but must be completed for NHS Supply Chain, or a bid will not be evaluated. The list of policies and procedures which are required, is quite frankly ludicrous from a company of less than 10 staff, where everyone knows each other personally.
If these companies can bring innovations into the NHS for validation (without the fees required by NICE, which for many are unaffordable), they represent a huge opportunity for economic growth and export to other health and care economies. The growth of small and innovative companies will lead to growth in graduate employment opportunities.
These companies are driven by improving lives. Although profit is essential for any company, they do not have large numbers of shareholders wanting fast substantial returns on investment.
The innovation structure we have at present means that for most SMEs the most sensible exit strategy is to sell to a larger company. This frequently leads to the stifling of innovation as new technologies can negatively impact on sales of existing products.
The NHS learnt to say no to industry during the pandemic. This means no to visiting hospitals to demonstrate products, no to speaking to staff about innovative products, no to commissioners even opening emails. This means that the only people who can access NHS stakeholders and decision-makers are people working for companies with existing relationships or those with trade stands at conferences (again, these are very expensive), which a small proportion of NHS staff can attend.
To gain access to hospitals, those representing the company usually need to be Medical Industry Accredited (MIA). This requires that they have passed ABPI or ABHI exams (up to 2 years study + cost of study and exams), completed all the associated update training (more training costs), have a registered vaccination record, and internal and external training (more training costs). For an entrepreneur with a single product, who is performing multiple functions within a company, this often unachievable. Realistically a company needs to be a big pharmaceutical or MedTech company to meet these requirements.
The UK is second in the world in the International IP Index. The report says the UK has a strong and sophisticated national IP environment. However, the UK is not even among the top ten countries in terms of new patent applications. From there the conversion to in-market products is pitiful. Why? Because the cost of market entry is so high, the risk/reward ratio makes decisions to invest in innovation weighted against progress.
If commissioners of new products and services don’t know about some of the amazing new technology that is out there, how can they write service designs and specifications which can embrace the potential that they offer to patients, staff and the economy?
There needs to be a free or low-cost national forum where innovations can be shared with the NHS and methods of accessing hospitals without an MIA registration for SMEs.
We have a current structure where the NHS can talk to those companies that they already know, each of which has its own portfolio to promote. Where is the space for the really innovative entrepreneurial enterprise?
The current support systems for innovation through the Health Innovation Network rations support to a limited number of companies to battle through the multiple hurdles for access. What could be achieved if this money was spent on removing or reducing the hurdles?
- Funding NHS trust posts with KPIs of reviewing a target number of innovations per year, with a minimum of 50% from SMEs. Using a minimum of five system challenges per year.
- Regular innovation events which commissioners must attend as part of their job description (the last “meet the commissioners” meeting I attended had one commissioner).
- NHS trusts forming partnership arrangements with SMEs that both support and promote new technologies and return money to the trust
- Less emphasis on the requirement to list three previous relevant contracts (you have to have one to win one), and more flexibility to accept the risk of working with new companies
- Paid consultation and engagement opportunities so that SMEs can afford to work with NHS trusts over a prolonged period to develop whole-system solutions
- Partnering of innovative companies so that really exciting niche products can combine effectively for whole-system solution
The industry welcomes you intent for a long-term approach and a revolutionary implementation of technology-enabled care to meet the challenges of a modern NHS.
We are here to support you all the way.
