Is the NHS attractive enough?

“Better risk sharing will increase the chances of staying the course”, says Yinka Makinde

Renewed vigour

There’s lots of positivity in the air as the new financial year kicked off on 1st April, and the London team has been reflecting on the progress made in year 1, with a view to continuing to create visible and tangible impact in Year 2.

This renewed vigour was reinforced when I attended a Healthcare Roundtable on the 5th April, which was co-hosted by The UP Group and Silicon Valley Bank (SVB). The discussion was chaired by Nooman Haque, and invited CEOs of some of the more ‘successful’ UK digital health and health tech companies, to share their views on the progress which had been made in the past year in increasing accessibility of the NHS, and ability to scale.

It was a little disheartening to see that may of the ‘challenges’ which DigitalHealth.London (DH.L) had identified at the start of its journey, such as mutually beneficial business models, are still evidently unresolved. Despite the growth in initiatives such as DH.L, Innovation Technology Tariff (ITT); NHS Apps library (launched on the 10th April); Vanguards; and national procurement opportunities such as the Digital Diabetes Prevention Programme, it is clear that companies are still not aware of the support and opportunities they could be leveraging. There was also a strong feeling that finding other markets outside the UK is the prevailing strategy to support business growth. I have to say we were feeling a bit subdued by the end of the event, and it confirmed that there was still a huge amount of work to do on our part.

Motivational Conflict

DigitalHealth.London is beginning to make strides in many ways: bringing providers and commissioners closer to solutions and the organisations already implementing these solutions; providing product intelligence; providing a viewpoint on topical matters such as Cybersecurity, signposting innovators to NHS opportunities; participating in solution evaluations, as we did for the Cancer Vanguard Early Diagnosis Industry Challenge; and the 111 Online national pilots.

However, there remains a long standing cultural issue that slows down progress in this space, and this is conflict in the motivations between the Payors, Providers and Suppliers. An issue which DH.L has yet to influence. The question is, what part can we play to help reconcile this?

This mis-alignment in motivations has never been presented more starkly to me as it was recently during the 111 Online pilots. Digital health suppliers in the most part are driven by traction, revenue and ‘investability’ for survival. Profit comes much later in this sector. Demonstrable traction helps prove demand, boosting ‘investability’. This means that for any implementation, the company is motivated to drive adoption through marketing and incentives. This may go against the needs of the system however, where driving up demand for a service may not be the intended end game, but may just provide an alternative channel for existing demand. Is this an attractive growth proposition for an SME?

Access to data

It is access to data, and lots of it, that will separate the winners from the losers in this challenging market place.  Particularly for companies building solutions based on Artificial Intelligence (AI) and Machine Learning (ML) technologies. This, I’m reliably told by David Kelnar, MMC Ventures at the recent ‘The Future of AI & ML in Healthcare’ event (hosted by Innovatemedtec) is, and will continue to be an important factor influencing VCs when evaluating which companies to invest in. It’s not a secret that digital health companies struggle to gain access to data in order to validate their solutions for both cost effectiveness and outcomes. I’ve seen provider-led competitions being launched in April across our system which explicitly mark down applications where there is a requirement to access data. This is not helpful, for either party.

It is a contentious subject, one where some investors, like those on the panel at the Innovatemedtec event, believe investable digital health companies should spend the first 3 years of their life focused on accessing data. The value of open source access to data via a ‘Data Commons’ was also touched on.

Fostering Risk-Sharing

Not all ‘industry’ opportunities/ calls offer reimbursement to the successful companies during the trial phase. A company, by its very commercial nature, needs to be able to survive financially in order to be able to continue to participate in and support such trials. Is there a way we can foster a better ‘risk sharing’ culture? One where the NHS recognises the frailty of the SME and its need to cover basic costs in order to stay the course for long enough. Where suppliers recognise that the NHS, increasingly, must deliver value from use of public funds, and demonstrate this in as short a time as possible. One of the CEOs suggested at the Up/ SVB roundtable that rather than trying to sell the future to the NHS, digital health companies should focus on giving the NHS something they can use, today. Wise words, indeed.

Opportunities Ahead – a sneak preview

April also gave DigitalHealth.London the opportunity to engage with the Digital Academy Tender; Transforming Primary Care agenda, and Cybersecurity. What do we hope to do in all of these? If either of the two London bids wins the contract for the Digital Academy, DH.L will play a part in the delivery, particularly around masterclasses and mentorship.

The GP Forward View (GPFV) – Transforming Primary Care calls on the GP provider community to actively engage digital solutions that can help to free up GP capacity so that they can focus on cases that really need their face to face intervention. DigitalHealth.London will work closely with NHS England and local provider teams to boost product intelligence to drive informed solution decisions.

And lastly – Cybersecurity. This is an interesting one. Completely outside of my scope of expertise, but pertinent to us all. I believe it’s a subject that ought to be explored either as part of the Digital Academy curriculum, or by DigitalHealth.London as part of our up-coming masterclass series.