Evaluation of the NHS Innovation Accelerator
21 Aug 2018
Annette Cox, Former IES Director, Employment Policy Research
In July 2015, in the context of increasing pressures on the NHS, the NHS Innovation Accelerator (NIA) was launched to help faster and more systematic adoption of innovation in the NHS. It was established and developed by NHS England, in partnership with UCL Partners, The Health Foundation and five Academic Health Science Networks (AHSNs). They also co-funded the costs for the first cohort of 17 Fellows who were selected through a competitive application process.
The core team based at UCL Partners offered customised and dedicated support to help Fellows scale innovations across the NHS, with the goal of improving patient outcomes while maintaining or reducing service costs. Support and learning offered by the NIA included quarterly learning events; personal one-to-one support; a bursary; access to mentoring; the collaborative communications tool, Slack; ad hoc learning sessions; and peer-to-peer support and communication networks.
IES, in partnership with York Health Economics Consortium and the University of Liverpool Health Services Research Department, was commissioned to undertake a process evaluation and economic impact assessment of the value of the NIA covering the first cohort of Fellows. The evaluation sought to identify the impact of the NIA on individual Fellows and the scaling of their innovations, together with the critical success factors that explain impact and how barriers to innovation scaling can be overcome. It involved detailed interviews with over 100 stakeholders and two rounds of interviews with Fellows.
Fellows’ views of the NIA
We found that NIA core team support, mentoring, bursary, AHSN support, peer learning and learning events were all valued. Overall, Fellows continued to reap the benefits of the NIA support provided in first year, particularly through national endorsement and contacts made. They hoped that in future years the NIA would achieve greater traction at a national level through the Programme Board and influence on key NHS central bodies.
Overall three quarters of Fellows in the first cohort directly attributed substantial progress in scaling their innovations to the NIA. Several experienced extensive scaling and some made moderate progress. One had found the NIA helpful but said it was too early to assess scaling impact. Three benefited personally from the NIA but were unable to attribute scaling progress directly to the NIA, due to particular challenges in NHS contexts for adopting their innovations.
Conditions for success
Success in innovation scaling was dependent on a constellation of supportive factors. The main conditions for success related to the characteristics of the Fellows and of the NIA and wider contextual factors. Fellows’ tenacity, motivation and drive, combined with clear communication, honesty and ability to build and maintain relationships with stakeholders, made them credible ambassadors for their innovations. The main feature of the NIA which enabled success was the NIA core team, through enabling access to influential networks, and key senior figures in the NHS. This combined with the brand of the NIA acting as a ‘quality stamp’ to help build trust among potential users of the innovations in a field where lots of products and services compete for their attention.
Among wider factors, patient involvement was the dominant contributor to innovation scaling through innovation development, user-testing and feedback; encouraging and attracting people to participate in trials and testing; promoting innovation benefits and acting as champions and mobilising demand and pressure for change.
Other major factors supporting innovation take-up were finding routes to identify and access potential purchasers and users, building effective national partnerships with organisations sharing a mutual interest in using or promoting the innovation, gaining key individual champions among senior NHS staff and frontline clinicians, and demonstrating relevance to local and national priorities.
Overcoming barriers to scaling
Fellows had faced a much tougher financial environment in NHS in recent months and their responses to restrictions on expenditure included:
Reducing innovation sales prices, cross-subsidising their businesses through other revenue streams and diversifying into overseas markets.
‘Land and expand’ – starting small within NHS settings to gain interest and tackle purchasing restrictions.
Intensifying their focus on ‘what’s in it for staff?’ when promoting innovations, eg reduced clinical workload.
Developing and targeting communications and ‘how to’ guides aimed at, for example, finance managers, nurses, doctors.
Avoiding health jargon for marketing innovations aimed at community settings outside the NHS.
Strategic added value of the NIA had come from five factors. First was the leadership and catalytic action it has provided to support Fellows. Secondly it exerted influence on AHSNs and encouraged their co-operation with other stakeholders to promote innovations, combined with stimulating development of the Innovation and Technology Payment incentive to encourage innovation take-up. Third, the NIA bursary created leverage by enabling Fellows to engage in marketing and engagement activity with potential purchasers. Fourth, the NIA engaged a wide community of diverse stakeholders through AHSNs, its Programme Board and Evaluation Steering Group which provided access to platforms for Fellows to reach potential users. Lastly, it created synergy through offering a unified voice for identifying and recommending solutions to scaling problems and offering routes for Fellows to reach multiple stakeholders simultaneously.
What next? Recommendations to spread healthcare innovations
The evaluation makes a number of recommendations on how innovation diffusion can be accelerated. This involves firstly developing a commissioning culture based on meeting long-term health priorities and incentivising provider organisations suitably. Secondly, the health sector needs to tackle the ongoing problem of perverse commissioning incentives via continuing dialogue at a strategic level with NHS England, the Department for Health, and Public Health England. Thirdly, at local level, health and social care providers and commissioners need to build an innovation culture to support adoption of innovations demanding new ways of working as well as using new pieces of technology. Innovators need to align and refine innovations to meet priorities in health care delivery through the Vanguards, new models of care, Test Beds and Sustainability and Transformation Plans. Fundamentally, patient mobilisation and activation will be at the forefront of future care models to prevent ill health: patients have a key role to play in mobilising demand for improved/new treatment, equity of access to safe care across providers and shaping wider social movement to support behaviour change to prevent and support self-management of long-term conditions.
Lastly, organisations with responsibilities for setting healthcare policy have a major role to play. Establishing common accepted standards for evaluating innovations through the recommendations of the Accelerated Access Review and adopting suitable methods for undertaking impact assessments of innovations would support consistency when organisations consider adopting innovations for healthcare.