The great NHS unfreeze – putting innovation adoption at the top of the agenda

Many voices have heralded a great NHS ‘unfreeze’ following the general election – a moment where longstanding systems, structures and policies begin to shift. This may mean not only new investment but new opportunities for transformation and the adoption of new care models that align with the service’s evolving needs. 

As the government develops a long-term vision for the NHS through its forthcoming 10-Year Health Plan, a critical challenge will be understanding what is needed to accelerate the adoption of innovation. The UK does not suffer from a lack of cutting-edge ideas and innovations. However, our ability to successfully adopt, spread and embed these into the NHS at scale has long been a challenge.

While there is limited appetite for ‘big bang’ change, we need to ask how the current system can better work to make innovation happen at pace and scale. This is partly a question of health system strategy and design: what organisations, functions, support, policy levers and financial incentives do we have at our disposal? What might we need to design afresh? And how do we make adoption happen in a more bottom-up and sustainable way? 

In its recently published report, the Innovation Ecosystem Programme urges the NHS to collaborate alongside key innovation stakeholders to test, adopt and scale new ideas, building on its strengths within the life sciences sector in terms of research and development, together with its rich data environment. It is also important to consider how the health and care system can effectively marshal its various roles and functions to accelerate adoption. 

Here at the Health Foundation, we are launching the Accelerating Innovation Systems initiative to explore the role integrated care boards (ICBs) might play in advancing the adoption and spread of health care innovation. Over the next 12 months, this initiative aims to examine how ICBs and their accompanying stakeholders – with their system-level perspectives, relationships and resources – can collaborate to drive meaningful change. 

How regional innovation ecosystems can help

Regional innovation ecosystems – networks of interdependent actors, resources and relationships within a specific region – present a promising opportunity to support coordinated innovation adoption at pace and scale. Under the right conditions, these systems can drive the creation, development and adoption of innovation. With an eye toward broader service transformation, they can accelerate the uptake of proven ideas. At a regional level in England, this will include individual ICBs working in partnership with their health innovation networks, Academic Health Science Centres, universities and voluntary, community and social enterprises and industry.

ICBs have a statutory duty to promote innovation in the provision of health care services, giving them an important stewardship role within this emerging landscape. Their deep understanding of demographic needs makes them well placed to signal demand –encouraging innovators to tailor solutions to meet local need. Furthermore, they have the potential to re-design care across multiple pathways, thinking about adoption through the lens of system transformation. Indeed, their financial stewardship and system-wide accountability make them uniquely placed to reconcile competing incentives while using a range of financial mechanisms to promote change. This will be critical to drive the transition to new care models that enable the government’s planned ‘three strategic shifts’: hospital to community, analogue to digital and treatment to prevention. 

What role could ICBs play?

In the face of mounting financial pressure, ICBs often struggle to reserve the headspace required for innovation and transformation. They will need the time to think through the various roles and responsibilities they could – and should – play given their specific local contexts. Amid operational challenges such as staff retention, urgent care waits, winter pressures and a persistently long elective waiting list, carving out this time and headspace will be no small feat.

Collaboration will also be important – ICBs don’t work in isolation. In driving innovation and adoption, they’ll need the expertise of their regional partners, such as their related health innovation networks, to interface with industry and identify high-potential innovations. 

No two regional innovation ecosystems are alike. Each has a number of actors bringing together a range of capabilities. The strength of such systems is dependent on the types of partners involved and how they work together toward a shared mission. This means there’s unlikely to be a one-size-fits-all approach to how ICBs support innovation and spread; each will need to go with the grain of the resources, capabilities and relationships that exist within their patch. 

The importance of building skills and capabilities 

Our experience drawn from funding innovation programmes, such as Adopting Innovation Hubs, highlights that building the necessary skills and capabilities, as well as fostering a culture of innovation, will be critical to supporting innovation adoption within ICBs. The technical skills required to identify and invest in new ideas, and adapt them to the system’s local context, are just as important as winning the hearts and minds of front-line staff. There are also practical questions about the types of hands-on support required. Adapting innovations through small-scale testing and iteration is often time-consuming and meticulous. It can take a while for innovations to become part of business as usual, especially at scale at the system level.

We know that for innovation adoption to be successful, a range of capabilities and approaches are needed, such as co-production – requiring the NHS to make key decisions and work in equal partnership with citizens and staff – or the creation of learning networks for people across the system to share insights and learnings. The Adoption of Innovation Wheel developed and designed by the Innovation Unit in collaboration with our four Adopting Innovation Hubs, highlights four essential categories of skills and capabilities required to support the uptake of innovation (see figure 1).

Figure 1. The Adoption of Innovation Wheel

Those involved in regional ecosystems will need to consider how they coordinate the various skills, capabilities and learnings of the adoption activities taking place. While hubs are one possible approach, ICBs will need to determine what mechanisms best fit their own context.

The Accelerating Innovation Systems initiative – what’s to come?

As ICBs assess their roles in this evolving landscape, we are excited to work with them to uncover how they can accelerate the adoption of innovation. Our Accelerating Innovation Systems initiative will bring together ICBs and their regional partners to discuss and enhance adoption practices. By interviewing, observing and convening several ICBs and their associated health innovation networks, we will identify the key resources, capabilities, policy levers and financial incentives needed to support accelerated innovation; seek to better understand the various governance structures, methodologies and approaches that foster change; and explore how these factors relate to the broader health care system. Together, we’ll examine and report on how strategies and daily practices can transform ambitious goals into tangible impact, offering practical tools and insights to support other ICBs on this journey.