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Innovation in the NHS

Volume 672: debated on Tuesday 3 March 2020

[Mr Philip Hollobone in the Chair]

I beg to move,

That this House has considered innovation in the NHS.

It is a delight and a pleasure to have secured this important debate. We are going through an incredible time, with advances in technology across so many different fields, and there is a big question about how the national health service can adopt this important technology that makes such a difference to people’s lives. There is so much potential in the healthtech sector that has led to a transformation in patient outcomes, and that capacity must be expanded within the national health service. Some good work has already taken place to deliver innovation within the NHS, through the structures and approaches established by NHS Digital, Health Data Research UK and NHSX, which is creating the right framework to deliver innovation. However, if the true potential of the NHS is to be harnessed and if innovation is to feed through to trusts right across the country, there needs to be a dramatic acceleration of health technology.

Despite the presence of innovation accelerators such as HS. and bodies such as the Accelerated Access Collaborative, designed to find ways to help innovation products reach patients more quickly, there remain barriers that restrict the ability of healthtech businesses to scale effectively and get their products to market. The first challenge is the speed of the pathway to adoption. NHS Improvement estimates that it takes an average of 17 years for a new product or device to go from successful clinical trial to mainstream adoption, a figure that was highlighted by the Secretary of State earlier this year. Considering the rapid pace of technological change, that is a very concerning statistic for the healthtech business.

Historically, a good deal of that time was taken up by National Institute for Health and Care Excellence appraisals. In 2012, statistics released about the timelines for appraisals showed that the average time for multi-technology appraisals was 5.5 years, and about 2.5 years for single-technology appraisals. The Minister might be interested to know that I will host an event in a couple of weeks, in conjunction with AbbVie, to launch a report entitled “Bridging the Gap between Clinical Trials and Real-World Practice”. That research found that breakthrough medicines that might address high unmet medical needs and have been earmarked for fast-track approval are approved on average one month later than non-prioritised medicines, meaning that patients have slower access to those medicines.

Overall, that report found that approval processes take significantly more time in England than in other European countries, including Germany and France. It also found that NICE is more likely to place restrictions on new medicines than are other countries. On a more positive note, although NICE takes longer to assess medicines, it has one of the highest approval rates among health technology assessment bodies, meaning that a greater number of medicines are available. Although there have been significant positive improvements to the process since 2012, which have greatly accelerated it—for example, the medical technologies guidance, as well as the digital health technologies pilot scheme within that guidance—a lot more needs to be done so that those benefits can reach across the entire health sector.

A bigger concern is the funding opportunities available to healthtech businesses when they have an appraisal. Funding is obviously one of the most important building blocks for growth, but even if a healthtech business has had a NICE appraisal, there is no guarantee that its product will be adopted within the national health service. The medtech funding mandate and schemes such as the AI innovation award within the AAC are welcomed, but there should be greater emphasis on ensuring that centres are allocated the required funding from the NHS, so that they can pay for the devices and services and utilise them to improve patient outcomes.

Furthermore, the current criteria for the inclusion of new medical devices are based on how savings are generated within one year, which can be challenging given the higher up-front costs. For example, complicated surgical implants can be expensive, but can save money for the system through reduced spending on drugs and social care. There are also incoming regulatory barriers that will harm the healthtech sector’s ability to sell its products and the UK’s ability to be a competitive market for innovation. At present, medical devices are operating within the three-year transition period that ends in May 2020, after which devices on the market must fully comply with the medical devices regulation. There is a concern that the lack of notified bodies designated under the MDR may prevent the industry from getting life-changing products to market.

Currently, at a time when the industry will be rushing to ensure its devices are compliant with new regulations, only six notified bodies across the EU are authorised to accept work related to the forthcoming MDR. It is of concern that there is only one notified body in the UK, the Medicines and Healthcare Products Regulatory Agency. There are growing concerns across the industry that a bottleneck will emerge, potentially causing innovative and cost-effective technologies to be taken off the market as they wait to be certified again under the MDR. In a recent Med-Tech Innovation survey, only 4.8% of businesses said they were sufficiently prepared for the new MDR, despite 55% of businesses having begun preparations for those changes over 12 months ago. That shows the extent to which the lack of notified bodies is affecting the sector.

The UK’s departure from the EU presents an opportunity for the UK to establish itself as an international hub for certifications. Furthermore, with both the NHS long-term plan and the Government’s prevention Green Paper highlighting the importance of technologies in easing pressures on health services, it is vital to ensure that new regulation does not instead stifle innovation or discourage global medical device manufacturers from entering the UK market. I am also pleased by the Government’s ambitious strategy to maintain the UK as a global leader in the life sciences, reflected in the life sciences sector deal and their commitment to spend 2.4% of GDP on research and development by 2027. We must make sure that the medical devices sector and the life sciences sector more broadly get their fair share of that investment in R&D.

There are therefore positives that we can point to, but there are still challenges that are holding back innovation. Although the work of the academic health science networks in spreading and driving innovation across the regions of England is welcome, large variations remain, especially in individual centres’ attitudes towards health technology. AHSNs continue to play an important role in spreading best practice and therefore reducing variation across regions; however, the challenges facing healthtech companies in this area should not be underestimated. One challenge faced by technologies as they attempt to become adopted across the NHS relates to the differing nature and characteristics of individual centres. Due to the differing priorities and attitudes of centres across the country, medical device companies must employ different approaches as they roll out across the country. That inevitably delays the adoption of new technologies across the NHS, since individual companies must develop complicated strategies for each local business case. Some areas have more streamlined processes for adopting innovation, but it is by no means uniform, and will further the inequalities in healthcare between different regions. If a more joined-up approach towards innovation adoption were implemented across the NHS, medical technologies could be rolled out more quickly so that centres with the most need could access them.

In health and other sectors, it is always important and necessary to have leadership. I often hear about different trusts and centres that have strong leadership and that can, therefore, drive change. Other centres without such strong leadership are holding themselves back. I will discuss the chief innovation officer position later.

The UK’s great potential for data research is well known. The UK has some excellent datasets, globally leading data scientists and the ambition to make the UK the home of data-driven life sciences research and innovation. In terms of data collection, however, the national health service does not behave as a single organisation. The potential of health data cannot be fully realised until structures and processes enable the interoperability and straightforward accessibility of datasets across the country.

Moreover, health data is globally competitive, with significant investment being made in improving the health data environment in other countries, including the USA, Germany, Israel, France and China. It is not an exact science, but NHS England estimates suggest that harnessing data and delivering on digital plans for the NHS could unlock productivity benefits of about £10 billion a year, allowing for greater investment in other priority areas.

An example of the industry working closely with health service bodies to tackle those challenges is the academic health science networks’ production of an atrial fibrillation toolkit that concisely outlines the relevant data for innovators working to prevent AF-related strokes. The toolkit provides innovators with data on the proportion of patients in a local area diagnosed with AF who have not been anticoagulated and encourages innovators to gather local knowledge on waiting times, pathways and referral criteria.

Unlocking the potential of patient data is key to driving forward research and innovation. The NHS is a rich and unique source of patient data, but public trust and confidence in the use of data is vital. The public need to feel that they can trust and have confidence in the health and social care system to share their information with care and confidence. People want to share their data, but they want to be confident that when their data is being shared, it will be used in the right way by the right organisations.

People are not necessarily hugely concerned by the private sector having access to their data, but they need more reassurance and more confidence in the anonymity that is provided in the data and in the control of the extent to which the data is given to companies, so they cannot just pass it on to other organisations. If the public do not trust the system, they will be unwilling to share their data for research. Ultimately, everyone is a loser from that—charities, the NHS and patients; there will be significant disadvantages across the sector in the UK.

It is essential that we continue to enhance the UK clinical research environment to ensure that global companies look to the NHS first when setting up trials for breakthrough therapies. An essential element for attracting R&D investment into the UK and reaching the Government’s target of 2.4% of GDP is to enhance the UK’s commercial clinical research offer.

Despite the significant size and growth of the global market for clinical research, the UK’s share of clinical trial applications and patient recruits has fallen since 2016, with the UK falling behind the USA, Canada, Germany and Spain for commercial clinical trials. We must build on our strong scientific base and on existing NHS infrastructure and expertise to grow the UK’s share of the global market and improve its commercial clinical trials offer.

The industry already supports the Government’s commitments to clinical research in the life sciences industrial strategy, sector deals and the NHS long-term plan. To be at the forefront of clinical research, however, there needs to be a simplification of the processes for setting up and running clinical trials, harnessing the UK’s data infrastructure for medicines and R&D, embedding patient involvement in clinical research and ensuring continuing high standards for transparency.

In my view, the challenges of adopting innovation in the NHS result, to some extent, from a lack of leadership in the NHS. The Secretary of State leads the way on getting health technology into the system. We need that culture to be better established in the national health service. No one within NHS trusts is specifically addressing the issue as part of their job. If more people were appointed to the chief innovation officer position in NHS trusts, the adoption of innovation might be accelerated. At the moment, about 20 chief innovation officers are in place. More such appointments would do two things: first, accelerate the adoption of innovation in the national health service and secondly, drive innovation and improvement to challenge and bring up to date legacy systems in the NHS.

In conclusion, I reiterate that there are many positives and much good practice to draw on, and there is no lack of ambition to place the NHS at the forefront of innovation. I look forward to the Minister’s remarks.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Bolton West (Chris Green) for bringing the issue to Westminster Hall. I have heard him speak on the matter several times. In fact, hon. Members in the main Chamber yesterday will have heard him make those points and others with the passion that he showed today. As well as passion, he has something that makes us nervous—absolute knowledge and understanding of the subject. That is welcome, and his depth of knowledge on tech and innovation in the NHS makes him a welcome addition to the House.

My hon. Friend mentioned the AI award that has just been announced, the adoption of new products, data and clinical trials. I will make a few points about each of those topics at the end of my speech. As he said, not just the Secretary of State for Health and Social Care, but everybody in the Department is passionate about high-tech innovation. Only yesterday, I heard about a new app called Skin Analytics. It has a phone attachment that takes an image of someone’s mole or skin that can be sent through and almost instantly diagnosed as to whether it is skin cancer and requires further treatment. The rate at which AI and technology are accelerating daily is phenomenal.

We can transform the health of millions of patients, improve health outcomes, reduce cost and reinforce the UK’s position as a global hub for life sciences and health tech within the Department, because we are so passionate about it. We can take advantage of those opportunities by seeing what can be achieved by using the technology that is becoming available daily. The UK has a world-leading single player health system, covering 65 million people and—I know that my hon. Friend knows this; I am almost embarrassed saying it—we are the biggest single buyer of medicines in the world. We have some of the world’s best clinical researchers leading universities, charities and life science companies. Indeed, 25 of the world’s 100 most used medicines were developed here, using a public and philanthropic research infrastructure that is, pound for pound, more effective than anywhere else in the world. We should be really proud of that, but we know we must go further.

The NHS long-term plan and the life sciences industrial strategy have set out an ambitious set of actions to create the most collaborative health innovation system in the world—one that gets the best new treatments and technologies from the bench to the bedside faster than ever before. It is beginning to make a difference, first through the Accelerated Access Collaborative, where leaders from across the NHS, patients, charities, industry and the Government are now coming together to tackle the major systemic barriers to the adoption and spread of innovation within the NHS. My hon. Friend is quite right to raise the fact that there have been barriers, but we are tackling the barriers now.

The AAC is supporting greater use of a range of proven innovations, which have the potential to benefit up to 500,000 patients and save the NHS up to £30 million; developing co-ordinated plans to ensure that the NHS is ready for transformative new technologies, such as the advanced therapy medicinal products—ATMPs—and the use of AI technologies in diagnostics and screening; and launching a new medtech funding mandate to drive the best value and most innovative medtech projects across the NHS. With long-term funding for the NHS in place, that collaboration is also now being backed by increased commercial flexibility—flexibility to ensure we can make the best new treatments and technologies available to patients, while ensuring long-term affordability for the NHS.

The impact has already been felt, with Europe’s first access deal for Kymriah and the breakthrough of the CAR-T—chimeric antigen receptor T-cell—therapy, just 10 days after the treatment’s European marketing authorisation, and a pioneering Government collaboration with pharmaceutical company Novartis for the drug Inclisiran to tackle heart disease, which could save up to 30,000 lives over the next decade.

The 15 regional academic health science networks continue to support the local adoption of cutting-edge technologies. More than 3,500 innovations from more than 2,500 companies have benefited from support from the AHSNs in recent years, ranging from new blood tests for pre-eclampsia, which can significantly reduce life-threatening complications in pregnancy, to devices that improve bowel cancer screening.

Finally, we are working to digitally transform the NHS to unlock the technologies for the future. The plans are already being delivered by NHSX. For example, we recently announced a £250 million artificial intelligence lab, which will build and rapidly test cutting-edge prototypes, but the real focus will be on finding and boosting existing technologies and ensuring they can be adopted across the NHS. Over the next three years, the lab will support the £140 million AI Award, led by the AAC, which will be designed to speed up the testing and adoption of the most promising new AI-enabled technologies. It will cover stages of the product cycle from proof of concept, to real-world testing, to initial adoption in the NHS.

By working together across the health system, Government and industry to deliver improvements, we can ensure NHS patients are some of the first in the world to benefit from the best new treatments and technologies. We will ensure that the UK continues to have world-leading life science hubs, where the best innovations get from bench to bedside faster than ever before.

My hon. Friend made a number of specific points. He mentioned AbbVie and its “Bridging the Gap” report. I thank AbbVie for its valuable contribution to the work in this area and I thank my hon. Friend for his support of its report. I know my officials and the Office for Life Sciences have been engaging with the report’s authors, as it has been developed, and they will be closely considering its recommendations. We have made a number of improvements to National Institute for Health and Care Excellence and Medicines and Healthcare Products Regulatory Agency processes since the data on which the report is based and published, including reforming the cancer drugs fund. I hope we are already beginning to see the benefits of those changes through quicker assessment rates.

I am going to speed up, so that I can get everything in. My hon. Friend mentioned the AI award. We believe the funding mandate and the AI award are a fantastic step forward in driving higher adoption of some of the most exciting new medtech in the NHS, but we know we may need to do more. We will learn from the first year of introduction, and we will continue to review how the schemes can be developed to support a wide range of projects in the future.

In terms of the adoption of new products, we recognise that in some cases new products will require a trust to adapt its care pathways or to train staff, and that is why we provided an additional £2 million a year to the AAC through our pathway transformation fund, to support adoption of the products it has selected for support.

I fully agree with my hon. Friend’s comments on the importance of the UK’s clinical trial system to patients and to our economy. The Government are committed to creating the best environment for clinical trials, both in achieving the ambitions set out in the life sciences industrial strategy and as we agree new future trade agreements. The system is coming together to deliver that. We have streamlined the Health Research Authority approval process to make clinical trial set-up faster. NHS England’s long-term plan sets out an ambition to see a million people registering to participate in health research by 2023-24 and to treble commercial research in the health system over the next 10 years.

The National Institute for Health Research clinical research network has also recently completed a competition to establish five purpose-designed centres, dedicated to last phase commercial research within the NHS’s capacity to deliver research. They will enable significant growth and provide more opportunities for patients to benefit from early access to innovation.

Finally, on making the best use of data for the NHS, which is of particular interest to me at the moment, with regard to the women’s agenda and using datasets within the NHS, we fully agree that the better use of NHS data promises significant benefit for patients, including better ways of predicting and diagnosing illnesses and the development of more effective treatments. We have set up NHSX to drive forward the digital transformation of the NHS and to ensure it can make better use of its data and new technologies. The Government have also invested £37.5 million in the digital innovation hubs programme, which will improve the access to and the quality of NHS data through seven health data research hubs, but it is absolutely essential that we build and maintain public trust in this area. That is why the Office for Life Sciences sponsored a robust piece of public engagement, led by Understanding Patient Data, on the commercial uses of healthcare data.

We are also developing a policy framework, which makes it clear that all commercial uses of healthcare data must have an explicit aim to improve the healthcare and welfare of patients in the UK and address the key concerns of the public, such as robust governance processes and transparency requirements.

I shall end where I began, which is to thank my hon. Friend for bringing his depth of knowledge and expertise in this subject to the debate. As I said, from the Secretary of State to the Ministers involved in the Department of Health and Social Care and officials working there, we all see innovation and technology as a way of improving access for patients, improving patient outcomes, reducing costs and enabling access to better and quicker treatments. Because of that, we are totally supportive of both the innovation and the high-tech agenda. It is debates such as this one, and the subject being raised regularly in the House in the way that my hon. Friend does, that keep pushing that agenda forward.

Question put and agreed to.