Building on increasingly robust evidence that health innovation has significant potential to reduce inequalities, deliver better health outcomes and drive economic growth, leaders across these Islands and beyond are deepening their investment in the health and economy agenda. This report sets out how, with the right collective leadership, strategy, investment and clear metrics, we in Northern Ireland can align to coordinate health innovation and transform outcomes. In short, we have the potential to move from “good in parts” to “a highly innovative system” to ensure we can deliver for our citizens and play a leading role, alongside other world-class systems.
Bringing the evidence together from the desk top review, interviews, and seminars, and comparing this with the 10 optimal characteristics and feedback from industry leaders, there are a number of issues that require action if the current NI ecosystem is to become world class:
- There is a need for a clear narrative and mindset in senior leadership (political and executive) that sees general spending on health, and specific spending on health and care R&D, innovation adoption and spread as an investment rather than solely a cost
- There is an opportunity for government in NI to strengthen the ecosystem by developing more coherent cross departmental policy and oversight that spans health, wealth and education - setting a collective strategy with a small number of high-level shared goals and priorities
- Alongside a more coherent cross departmental policy position, the ecosystem also requires better practical coordination – NI has some excellent jigsaw pieces but not a coherent jigsaw picture
- There is an opportunity to build on the strengths in the academic and R&D system - at present it’s good but it would benefit from stronger alignment with current service problems and a greater focus on applying its findings in practice and at scale
- The ecosystem would benefit from developing a stronger approach to innovation priority setting including placing greater emphasis on cross-cutting research priorities – i.e., developing more research breadth as opposed to solely focusing on depth in specialist areas
- The health and care system needs to be better at signalling its problems and priorities to potential suppliers and innovators
- The ecosystem would benefit from the investment in and further development of effectively delivered underlying enabling centralised functions and production of a standardised innovation pathway(s) – e.g., horizon scanning, innovation pipeline/portal management, joint research service, procurement, data collection and analysis
- There is a need to engage the general and clinical managers in the health and care delivery system more directly in innovation spread and adoption – at present the system is under major operational pressure and managers are focusing on short term problems
- There is an imperative to ensure that not just the managers of the system but the boards of the Health and Social Care Trusts and the emerging AIPBs own and prioritise R&D, innovation adoption and spread including developing strategy, assurance and culture that supports R&D and innovation as part of their governance responsibilities
- There is a need to increase the marketing and promotion of NI’s commitment to life sciences innovation adoption and spread
The report outlines 10 recommendations for action:
The need for an aligned policy mindset is compelling and urgent. This report should be considered collectively by Departmental leaders at the highest level through a series of interdepartmental meetings or shared policy discussions, rather than separately in individual departments or solely by DHNI.
At the earliest stage in these discussions, leaders should agree and develop their shared vision, mission and purpose of the ecosystem including agreement of its defining operational characteristics.
I recommend the establishment of a Joint Committee, and/or a standing cross-departmental forum for R&D, health and care innovation adoption and spread that includes all the key government departments and also the chairs of each of the Health Board Innovation and Technology Sub Committees (see recommendation 7).
This forum would be served by recognised and accountable executive leadership with absolute clarity on roles and responsibilities. The forum would be tasked with establishing an effective process of priority setting, investment and would have the responsibility for overall strategy (including considering regulatory reform), assurance of delivery and setting/role modelling the appropriate collaborative culture and behaviours.
To inform the work of the standing forum I recommend the development of a cross-cutting, key innovation metrics dashboard that provides data to the forum on issues such as: numbers of patients engaged in clinical trials, speed of establishing trials, roll out of specific priority innovations, interoperability of data, development of clinical academies roles, jobs associated with new innovations, university-based spin out companies etc. The dashboard would be informed by a local version that covers each health trust to reveal variability across Trusts and help to spread best practice in adoption and spread.
Having created the positive mindset to embrace innovation as the key means to transform care and deliver added value for every pound spent, it is important to improve the coherence and efficiency of the current central operating capability.
I recommend supercharging and refocusing the current centralised R&D support but adding to its central support for innovation adoption and spread including the requirement for the development of standardised pathway(s). This should be coordinated through a single senior leadership team/group at NI level.
There is a fundamental requirement to base the new approach on shared and appropriate access to data and analytics. I recommend that the digital strategy for NI explicitly sets out and embraces how it directly supports R&D, innovation adoption and spread, and delivers that functionality for all component parts such that there is a single version of the truth available and an ability to set shared measurable objectives.
This should also serve to speed up the ability to attract and deliver clinical trials and innovation pilots, which in turn can fuel the recruitment of more higher quality clinicians and researchers (as evidenced by the NW SHA initiative to speed up the establishment and delivery of clinical trials).
It is imperative that Health and Social Care Trusts and AIPBs are connected more directly to health and care innovation adoption and spread. I recommend that every Trust Board is asked to set up a Health and Care Innovation and Technology Sub Committee that oversees the activity of the organisation in these areas. The sub committees would be responsible for the production and oversight of their local key innovation metrics dashboard. They would also serve to align digital strategies with service innovation, improvement and transformation.
It is essential that this area is given a higher priority for leaders within the Health and Care system, so I recommend that R&D and innovation adoption and spread is built into the objectives of senior general and clinical managers in the Trusts (and AIPB chairs); and that Health Trusts and AIPBs seek to recruit executive and non-executive leaders/members with wider industry and innovation experience.
It is clear that resources are limited and required to fund diagnostic interventions and treatments, however the targeting of a small amount of resource in this area will have a high return on investment through improved productivity, potential job growth, and inward investment (e.g., in clinical trials and clinical academic posts).
I recommend that a cross-departmental, development budget be identified to support the implementation of this report and its recommendations, should they be accepted. Once agreed, I believe that its value should be evaluated by setting goals for a return on investment being delivered within an agreed timeframe. If successful, as I believe it would be, this will build confidence to invest further on a permanent basis
In order to move swiftly, I recommend that ecosystem leaders set out an organisational development programme that initially draws on external advice (Yorkshire and Humber AHSN have already engaged informally in this process) and commit to building this new ecosystem with a learning culture, focused on continuous improvement