Bolder response needed to innovation

by Terry Whittle

21 April 2022

NHS finance teams have a role to play in creating the right environment for innovation, but changes in the national framework and processes would help too.

As all of us embark upon a new financial year, it is traditional for our organisations to evaluate how we will seek to overcome the many challenges we face – often articulated in pages of planning guidance digested over the festive break!

Whether it be meeting the needs of an ageing population, controlling the cost of rising demand during a period of financial austerity, workforce shortages and now recovery of care backlogs exacerbated by the pandemic – working in the NHS has always been a generous environment for those looking to problem solve.

The temptation if we are not careful can be to slide into established behaviours and practices and simply try to work everything even harder, as if that were plausible. But there are opportunities to use the challenges we face as a springboard to drive innovation. And I believe the finance community can make a significant contribution, using our expertise, to stimulate the innovation debate within our systems.

Before we get on to that – a recap. Increasing policy focus was given to driving innovative practice in the NHS, at scale, prior to the pandemic. NHS England’s 2015 Innovation into action report provided a snapshot of the diverse innovation programmes active across the NHS, such as the clinical entrepreneur programme. The case for change outlined in the foreword remains equally valid. As we now edge towards impending legislative change for closer integration, this should strengthen uptake of high-impact, evidence-based innovation across the NHS.

‘Supporting innovation across the healthcare system is more important than ever and will be central to securing transformation and improved patient outcomes,’ it said. ‘Creating the conditions for more collaborative approaches to innovation and enabling the fast adoption of cost-effective new technologies will be key.’

As an NHS finance community, we must play our part in pushing organisations to embrace the opportunities from innovation.

Finance teams are well positioned to develop and challenge thinking within organisations to support the case for innovation. We business partner across all areas of service, developing real insight into the issues and constraints faced by teams. We understand governance and how investment cases should be constructed to support quality decision making. We can also highlight constraints within the finance regime that stifle or discourage calculated risk taking.

Unsurprisingly, given financial constraints and competition for scare resources, the NHS is often risk averse to investing in innovative solutions. We must guard against a mindset within our teams that views time spent on innovation as a luxury, when there is no shortage of issues that require immediate attention.

How? In Milton Keynes, we are investing in a range of proof-of-concept initiatives that target known constraints. We don’t pretend to possess all the answers, but some examples include artificial intelligence and machine learning techniques for automated clinical coding (a workforce that is traditionally hard to establish). We are also partnering with organisations that can help us to automate oversight and validation of patients waiting for care (typically very manual administration). And we are trialling autonomous delivery vehicles that could aid pharmacy or portering teams, transporting goods around the site to free-up time for other priorities. The common theme to each initiative is always – how can we fix or ease a problem?

Often, a related benefit from exploring novel solutions is the energy this engenders in the teams involved. The NHS is full of intelligent and creative people, and often trying something a bit different sparks teams, which might otherwise be overawed with the extent of the daily challenges we face.

To close – innovation is essential to our success at the current time. But to support the NHS in the uptake of high-impact, evidence-based innovation, there are areas that would benefit from a rethink.

  • The business case framework places great stock in proven technology and ways of working. This is the case even when implementation of favoured options could be constrained by factors such as workforce availability. This approach can hinder organisations with testing proof-of-concept schemes.
  • National bodies should encourage organisations to set-out their risk appetite and investment approach for innovation. Organisations frequently live with risks arising from workforce availability and other constraints, yet they don’t consistently explore novel solutions as part of routine business.
  • We should create space within the national finance regime for the NHS to develop taxpayer value from innovative partnerships. For example, taking equity in new ventures could necessarily score against scarce capital departmental expenditure limits. But it is unrealistic to expect the NHS to prioritise equity over competing priorities such as the replacement of medical equipment.
  • Nationally funded programmes should avoid the temptation to narrowly define or prescribe exact schemes that will be successful in any bidding processes – for example, in the criteria for the award of diagnostic funds. Funding should be made available to support the solution of the issue, rather than the precise approach to be taken.

The NHS will always look to rise to the challenge, however daunting. We undoubtedly face unprecedented challenges today. What we now need is a bolder response.

The HFMA’s delivering value with digital technologies programme, supported by Health Education England, aims to increase awareness among NHS finance staff of digital healthcare technologies.

An HFMA Delivering value with digital technologies online conference on 17 May is free to all NHS staff and is jointly hosted by the Royal College of Physicians and the Federation for Informatics Professionals. See the agenda and book tickets.