Fixing Healthtech #3 Great Expectations

Over the next few months I’m going to focus on shorter punchier articles under 1000 words, as part of a series focusing on the big changes nationally, and what we ACTUALLY need to fix if we’re to actually do this healthtech / medtech / AI revolution in care that we keep batting on about. These are deep topics, which I’ll go into less depth than usual so bear that in mind. 

In the past couple of articles in this series we have looked at the wonga (capital punishment), and also the additive mindset (addiction to addition).

Next up on the very long list (!) is the huge expectations and requirements that can be imposed upon earlier stage companies, that are unreflective and unsympathetic of their stage in the journey.

But first… I get it… 

The NHS is in crisis, and beleaguered NHS organisations don’t have time to be pissing around with imperfect solutions, or where providers don’t have all of the answers to their many requirements and questions. 

They don’t have time to be undertaking a different process for different kinds of companies just because they’re not in 7 other trusts. 

It’s not their job to transfer all of the unknowns and uncertainties onto the NHS organisations, and require them to answer the questions that the company can’t…

The NHS is the customer after all.

Or is it?

The keen eyed, and my frequent readers, among you will no doubt spot that I’m being a little bit facetious.

But these are all genuine versions of comments I’ve heard from NHS colleagues, on more than one occasion. 

There may be degrees of truth in all of these, but they also represent an inability to see the wood for the trees.

And to see that there is no reality where we can expect perfect solutions built in isolation of the NHS.

Whilst of course the NHS and tech are both on separate sides of the public private divide, but the simple fact is that whether we like it or not the survival of the NHS requires an acknowledgement of the mutual interdependence between these two. 

I recently had the privilege of chairing a session for the NHS Innovation Accelerator where we got leaders from the NHS and from industry in a workshop to discuss and generate ideas for how we could solve frequent challenges that negatively impact both parties (directly or indirectly). Surprisingly this kind of thing rarely happens, so it was a unique afternoon (which we’ll be writing up and sharing soon).

One quote we explored was very pertinent:

“To get a first contract, we’re being asked to demonstrate things that we could only demonstrate with a secure and established contract - how do we get through this?”  

This. Problem. Is. Endemic.

In my NHS Ready course I tackle how to deal with this (in detail) as often companies are faced with a chicken and egg / catch 22 scenario, that is seemingly impossible, and I’ve had to be creative with numerous clients to tackle examples of this, where it can manifest in various ways.

But here are some frequent ones:

1. Being asked to evidence impact well beyond the period of a traditional pilot.
2. Being asked to answer questions or prove things that would only be possible once permanently situated and deployed in an NHS organisation.
3. Being asked to fulfil specific obligations that are blanket imposed upon larger suppliers, even when there is no legal requirement (e.g. modern slavery requirements below required threshold).
4. Being required to integrate into a specific trust clinical system, when the only way to leverage or influence that is nationally or by the trust.
5. Being asked to be able to provide additional technical capability that has been seen in other suppliers or has come from an unvalidated, unfiltered internal wish list whilst also driving down price.

There are numerous others, but these are just a few common examples.

Without getting tangential this is also something I see imposed on innovations internally, but let’s leave that rabbit hole for now.

The point is that as a system we do not value or respect or acknowledge innovations at a very critical time in development. This stage I call level 1, but we’re talking about the teenage years, when we want and need to integrate them, but can’t have the same expectations about full development.

I could write more about the problem, and if you want to solve it for your own company, check out my course (PLUG!).

Fix

Across the NHS I have seen literally zero mechanisms to routinely support at this stage. The only example is national pump priming (e.g. HTAAF // but also a sticking plaster), but culturally there is no guidance, support or process for either side at this critical stage. The proposed national Medtech pathway did suggest some interesting possibilities for ‘contingent’ solutions but I’m now assuming that this project is down the proverbial pooper after the post election purge and the mass exodus from that national team.

Quite simply we need cultural support, guidance and possibly some supportive levers to navigate this stage. 

As a bare minimum = guidance around proportionality to counter the risk aversion, and vocal support for the NHS to support companies at this key stage. Working with the NHS Innovation Accelerator on this would be an obvious win, since they have a bucket of credible level one companies who face ‘a bit of the old chicken and egg’.

If we were to really try and fix this centrally, then one simple mechanism would be for some central funding to be allocated towards match funding (or some reasonable contribution) for those companies who need to get in to prove in situ, with some clear short term funding to access these.

Whilst I’ve written before about the NHS needing to be clear around what it does and doesn’t wish to support, if there are areas that the NHS really wants to develop, then we need a strong emphasis that it is the collective NHS’ responsibility to take a proportionate view on expectations for earlier stage but commissionable solutions, if we want the eventual solutions.

The more that this is backed by light, but reasonable levers, the quicker we can stop talking about 'pilotitis'.

Thanks for reading! So I'm not going to be an engagement beggar, and I'm not going to chuck in questions and sneaky tricks to hack engagement. But quite simply - agree or disagree - if you value the content I put out, then the best way to acknowledge is to take a few seconds like, comment or even reshare - as it helps others see it and the Linkedin algo promote it more widely. If I've managed to provoke some thoughts, then debate and engage with me, add your context, add your ideas, tell me why you disagree. Engagement turns my monologue above into a discussion.

Oh and since I was also flogging my damn (highly rated) course like a horse in the carnival, here's more information on that: