So, how would we increase the adoption of innovation in the NHS?
Lord Darzi wishes to increase the adoption of advanced medical technologies in the National Health Service. This looks like a decent enough aim. After all, it is true that the NHS falls behind on such things:
In the UK we are world leaders in healthcare innovation. British doctors and scientists discovered DNA, pioneered the first heart and lung transplants and led developments in modern genomics. We are now on the cusp of a revolution in which novel diagnostic tests, digital tools and biopharma products are becoming available and British doctors and scientists are again leading the way.
But there is little point in our top doctors and scientists developing new drugs, techniques and devices if they are not adopted and used by the NHS. It deprives patients of what can be life-saving therapies and creates frustration for clinicians and innovators.
We don’t enjoy that any of that is true but we’re fine with it as an account of the current reality. And we’d all like to change it too. The NHS is, among rich world health care systems, particularly bad at preventing “mortality amenable to health care”. That is, it’s not up there on the cutting edge of how to save lives.
To speed this process up, a joint government-industry group, the Accelerated Access Collaborative (AAC), which I chair, was launched yesterday in an improved form as an umbrella organisation to promote innovation across the NHS. The group, first announced in 2017, will direct innovators to sources of support, search out the best ideas, and identify cutting-edge treatments to ensure they are fast-tracked to reach more patients more quickly.
In our first year we have identified 12 products in seven areas, ranging from a computer programme to detect heart disease without invasive tests to a simplified procedure for treating enlarged prostate glands in men on a day-case basis. We estimate these products could improve the lives of about 500,000 patients and save the NHS up to £30 million. We will fast-track the use of these products by identifying clinical champions, removing financial and procurement barriers, and ensuring their uptake is supported by national clinical directors, policy teams and programmes.
That’s not the something we would do about it though. A committee to promote central planning isn’t the way to advance innovation. Innovation here being the adoption of new technologies to do interesting things like cure patients. For central planning is famously slow to innovate. From the work of William Baumol we gain the insight that it is markets which promote such, not bureaucracy.
The way to get to Lord Darzi’s admirable goal is for there to be more competition in the NHS. It can all still be taxpayer funded, free at the point of use, even non-profit if that’s what people desire. But competition is what increases innovation so if we desire more innovation we must have the competition.
As ever there are some things too important for us not to use markets. And saving Granny’s life would strike us as one of those very areas of importance whatever the strictures of the national religion.