The Friday Blog: A Pennyfarthing for Your Thoughts
In case nobody made a joke of it in earshot (lucky you), Monday, apparently, was officially the most depressing day of the year. Depends on your perspective I suppose. For a lot of people, it might be Christmas, or the anniversary of a loved one that has passed. For me Monday was not so bad, I got a half decent Italian in Fitzrovia and a couple of pints in the Crown and Anchor on Drummond Street Euston bound.
I was in London for our latest audience with the Chief Officers of the AHSNs. This is a fixture which now dates back five or six years after ABHI’s Board of Directors questioned the value of our continued engagement with the 15 organisations that cover England. It was not an unreasonable question. However well resourced you are as an organisation, you plead poverty of resources, and one thing that is an absolute requirement in life is to prioritise. You simply cannot do everything. It is one of the great challenges of Industry Association life. When I worked in a company, my network was limited by what was in my bag, here I have everything in my bag, so decisions on what to prioritise are a constant. It is, of course, what makes it so much fun.
The AHSNs, or Academic Health Science Networks, were a product of the December 2011 report Innovation Health and Wealth; Accelerating Adoption and Diffusion in the NHS. It is, with a decade plus of hindsight, a very interesting read. The NHS, it says in the document’s introduction, is known to be world leading in invention, but the spread of those inventions through the NHS is often too slow. IHW set out plans to address many of the unresolved issues that were getting in the way, and was effectively commissioned by the new Government’s Plan for Growth earlier that year. The AHSNs came out of the action labelled Creating a System for Innovation Delivery. They had the trickiest of starts. The idea, dreamed up by a new government who had no idea about what had been going on for the previous 13 years, was to run a sunset review of all the organisations in the innovation adoption space, which would liberate some £150m to fund the shiny new AHSNs. To be fair to new ministers, Andrew Lansley, who was a fan, and all, civil servants in the Department of Health and elsewhere must have known where the review was heading. Poverty of resources. Double, triple, quadruple counting had arrived at the £150m figure, and most of the organisations in line for being sunsetted, had, er, already been sunsetted. So, the £10m that was heading to your local AHSN, became £5m if you were Manchester and £2m if you were down on the South West Peninsula where I began my time posing as a Board level operator. What did not change was the expectation that this was the answer to those unresolved issues. Maybe that was part of the perceived problem, indeed, the then Medical Director of NHS England, Sir Bruce Keogh, said that we had to stop treating the AHSNs like Christmas trees. Hanging everything on them. Geddit? There was also the issue of what the AHSNs actually were. Was Academic the optimal word, and if so why? They certainly sounded a lot like the AHSCs and how did they relate to the CLAHRCs? (As an aside, look up CLAHRC, memorise what it stands for, and 30 seconds later try and repeat what it stands for. Impossible. It is the worst acronym I have ever encountered. It does not actually really even work as an acronym, being pronounced as Clark).
Then there was a sense of where they fitted in the world and how they organised themselves. Some decided to become companies limited by guarantee and others were hosted by NHS organisations. Geographies were large, so where you were based influenced how you were perceived by your constituents. If you set up in one city in a big region, those outside the city would regard you as being very much of that city and nothing to do with them, whilst those in the city would look at your name and regard you as being very much of the region and nothing to do with them.
Despite these early teething troubles, the AHSNs have survived, more or less in tact. They have always done a good job in answering their commissions, even when that has been challenging and conflicting. Granted, on occasion, many of you have scratched your heads and wondered what they were there for, but some of that is what our regular gatherings have been all about for these past few years. Avoiding the great things they have all done getting lost in translation. Our relationship is now mature enough that they are happy to take on the chin the challenges that we throw at them, and equally we have a job to do in, Keogh like, managing expectations.
Their greatest challenge may well lie in the months ahead. Beginning life with a five-year license in 2013, subsequently extended, they should now be finalising the plans for the next half-decade. But, as it stands at the moment, they are looking at a one year extension while a more detailed landscape review is conducted. Yes, another one, and presumably as and when we get a new administration, there will be another one not far behind. Like many other initiatives, including much heralded and much needed digital transformation, they are in the firing line as funding is being diverted towards the operational frontline, and the relatively new incumbents in high office in NHS England wonder if 15 goes in to either 7 (regions) or 42 (ICBs). (The answer is it does not need to). But there is cause for at least some optimism. Independent, Green Book accounting from the Treasury suggests that the return on investment from the AHSNs is exceptionally high in driving jobs and exports. And then there is the brave new world of Integrated Care Systems. Competition replaced by collaboration, hitherto battling provider organisations having to get their heads together to decide how to divvy up next year’s flat financial settlement to ensure that they can meet the pressure to increase productivity. Pressure which will ramp up significantly as we approach a general election. What the AHSNs have to contribute is that wonderful British construct, soft power. ICSs are going to need trusted interlocutors with reach into all their organisations, and it is the kind of trusted broker role that the AHSNs have been honing for the last ten years. What we can do is support the transition to whatever is next, remind the AHSNs where they came from and what they were designed to be, a system for innovation delivery. Adoption initiatives, the small wheel in the pennyfarthing of overall research spending, have had a tendency of being cut and reshaped, but at a time when financial pressure on the NHS really does need us to tackle those unresolved issues getting in the way of adoption, to dismantle the AHSNs would make little sense.
More protected than that small bicycle wheel is the large one, the one relating to early stage clinical research infrastructure and funding. I thought of the juxtapose this week as a good chunk of my time was taken up with the National Institute for Health and Care Research. I had agreed to join an independent panel to assess applications for a new NIHR initiative to support the development of HealthTech. Launched in 2018, the MedTech and in Vitro Diagnostic Collaboratives (MICs) are being replaced by new HealthTech Research Centres (HRCs). It is good news on two fronts. The definition of HealthTech, devices, diagnostic and digital health technologies which we have championed, has now entered the mainstream, and the funding allocated to the HRCs is twice that of the MICs. Between you and me it was hard work, and being surrounded by some vey big brains is always a daunting prospect for a middling sales guy like me. Still, I regarded it as a form of public service and hope I was able to contribute in some small way. I hope so, because a bit like the winter, it is far from over. Two days of, relatively, light touch scrutiny will be replaced by five days of full on forensics in August as we move to the next stage of selection.
It is all well intentioned and represents a genuine attempt to realise much of the ambition of the Life Sciences Vision to build on our heritage of science and research, make the NHS a real driver for innovation, and create an outstanding business environment for the HeathTech sector. But many of those unresolved issues remain, some, despite being well understood, seem beyond our wit to fix. I spoke to a company yesterday that reminded me of this. They are in the cancer diagnostics space and ought to be a poster child for their region. A spin out from a local University, the potential of the technology is mind blowing. Their founders are highly credible, and they have assembled an impressive Board and array of advisors. The greatest threat to roll out and rapid adoption for them, and this will be apply to any data-driven technology, is information governance. The company requires a Data Sharing Agreement (DSA) from every Acute Trust Lab that wants to run the test. This is because the company is a data processor of patient blood analytes which are inputs for the propriety algorithms. Before a Trust can sign off a DSA, they have to complete a Data Protection Impact Assessment (DPIA), some 28 pages long. Invariably, lack of capacity in Information Governance teams means there are significant delays in completing and receiving feedback on the DPIA, and even when approved, obtaining a final signature can take several months.
Within the local area which includes a formal NHS Provider Collaborative, each Trust has to complete its own DPIA and all are different, of course they are. The energy and duplication required is unnecessary and hardly ticks the Life Sciences Vison box of creating an outstanding business environment for our sector. It is a real barrier. And everyone, from the NHS England Transformation Directorate down knows it, unresolved issues getting in the way. There is much work still to be done.
As there is with the new puppy. At least she is finally allowed out of doors and tomorrow we start training classes. Wish us look as you enjoy a Saturday lie in.
