Oli Hudson, content director at Wilmington Healthcare, explores some key themes and developments in the NHS for the coming year.
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Hospital corridor
As we commence a new year the NHS seems to go from crisis to crisis. My last article for Med-Tech Innovation News in October 2022 explored this in depth – and if anything the problems have got more acute since then.
Issues of capacity, workforce, finance, and integration are creating a perfect storm, causing unprecedented numbers of patients to experience sub-optimal care: a backlog in screening, diagnosis, treatment and care, extensive waits and issues with access and equitable services.
The NHS is trying to address these issues by various policies intended to improve activity levels, enhance collaboration, and maximise efficiencies.
However, the struggles are plain to see and the impact on industry is wide-ranging. In this article we will look at four areas of change, and begin to assess how medtech should react.
Working in the new integrated landscape
The new integrated landscape is throwing up new networks of decision-makers and stakeholders which exist in unfamiliar groupings, including clinical networks, provider collaboratives, and place-based partnerships, whom medtech needs to understand and access, and with whom they must build new relationships to ease access for innovation.
For companies seeking to partner with the NHS on patient identification or pathway change, other roles may need to be sought such as transformation leads. If your innovation depends on digital technology, you may also need to work with a programme lead for digital, at integrated care system level.
Changes to procurement
Changes to procurement are also having an impact and this will continue in 2023.
Outsourced procurement management seems to be coming to an end at a national level with NHS Supply Chain to take in the vast majority of medical procurement and clinical supply in-house.
“We are now operating in a more challenging economic environment, and we need to simplify how we operate and partner more expertly with our stakeholders,” it explained.
In this financial climate, more efficiencies are likely to be needed from procurement and more will be asked of suppliers to improve their offer on sustainability – not just in terms of net zero but in terms of long-term viability of NHS services.
HSJ also reports that NHS trusts will have to receive Cabinet Office approval for any clinical and non-clinical spending over £10 million. NHS England in London will introduce the new controls first and then roll out to the other regions over the next two years.
This new control regime will apply to NHS and foundation trusts, shared procurement services and procurement hubs, and subsidiaries where the majority shareholder is a trust. It will cover framework call-offs and agreements, contract changes or extensions, and collaborative trust procurements awarding to a single supplier.
All expenditure over £10 million will be in scope, including new or replacement contracts or call-offs from frameworks, contract changes or extensions, framework agreements themselves, and collaborative procurement between multiple trusts with a single supplier.
For high value procurements this is going to present another set of criteria to deal with in contracting and tenders for industry.
Tightening budgets and delivering value
In the planning guidance released in December 2022, NHS England states that one of the core priorities is for systems to break even by year-end.
This is a tall order when the majority of trusts are in the red and much resource is being taken up dealing with emergency services, hiring agency staff and attempting to deal with elective backlog.
Some payment for trusts is now being carried out on a payment-by-results basis, intended to encourage activity and this could change some trusts’ focus on how much work they do in certain clinical areas.
Wherever medtech does engage, value for the NHS will become ever more important. The value proposition will need to be honed to establish how your device can create efficiencies across the whole system, with all the costs of a pathway or service line taken into account. Staff time, theatre time, the mix of HCPs required to operate and – in particular – length of stay will become relevant to the sell as delayed discharge takes over some systems and leaves hospitals unable to operate at full capacity.
Challenges in service transformation
The planning guidance also prioritises service transformation. This could involve digital technologies and virtual services, preventive care models, new care settings such as community care models, and self-referral and self-management.
Unfortunately owing to the stress on the system, there is little time for improvement and learning from best practice when enormous effort must be expended by NHS staff just to keep basic services going.
This means medtech must try to build projects locally where there are the opportunities, drawing on what has worked and where there is real-world evidence to suggest change could bring benefits to other parts of the NHS.
What medtech can do
Industry can help by engaging with four key areas:
- Developing meaningful multi-level partnerships with the right stakeholders
- Investing time in developing a multi-dimensional value proposition
- Developing pathways for cost and clinical effectiveness, and
- Assisting the NHS to develop new delivery models that disrupt traditional ways of thinking
On the first element, this means a thorough understanding and grounding in the who’s who of your clinical area, taking into account local variation, with a clear plan for engagement.
On the second, ensuring your value proposition covers sustainability, accessibility, and efficiency to not only the patient and clinician but the service and the system.
On the third, building in quality improvement with a focus on improving outcomes as well as making cost efficiencies.
And on the fourth, disrupting traditional delivery models. The current burning platform challenges the status quo and allows us to rethink our current way of healthcare delivery.
Success in these areas will undoubtedly make a company stand out, as we go into a most uncertain year for the NHS.
Wilmington Healthcare will be exhibiting at Med-Tech Innovation Expo on 7-8 June 2023 at the NEC, Birmingham. For more information, visit www.med-techexpo.com.
