1. Innovating out of the recession in the NHS Steve Barnett, Chief Executive NHS Confederation 28 th October 2009 Foundation Trust Network - Primary Care Trust Network - Mental Health Network - NHS Partners Network – Ambulance Service Network - NHS European Office - SDO Network - Health Services Research Network - The Welsh NHS Confederation – Northern Ireland NHS Confederation

2. Where are we now?  NHS needs to plan for real terms funding cuts of £15bn over five years from 2011.  Taking into account cash releasing requirements, the actual impact could be up to £20bn.  Roughly equivalent to the annual NHS drugs bill and mental health bill combined.  Additional rising healthcare costs, questions about size and skills of NHS workforce, and the changing needs of the UK population.

3. Innovation and recession  Promoting and nurturing innovation is critical for the NHS in the future.  Recession will put major focus on delivering efficiency gains within the NHS  Identifying opportunities to innovate should be central to any efficiency drive.  Impact of the NHS on the rest of the economy.

4. Innovation in the NHS - history  NHS Next Stage Review highlighted poor record of the NHS in exploiting innovation.  High-level inquiries including two taskforces set up with the pharmaceutical and medical devices industries were set up.  Focus on invention and adoption and spread of new technologies/service models.  NHS Confederation paper ‘Leading Innovation’ suggested that some barriers to adoption of new ideas are within organisations rather than at national level.

5. National Innovation Centre NHS Innovation Hubs National Institute for Health and Clinical Excellence (NICE) Centre for Evidence-based Purchasing (CEP) NHS Confederation and other organisations sharing good practice models and policy thinking Staff crossover from other parts of the NHS Specialist societies and journals Commercial sector Universities & medical schools etc…. Where do new ideas come from?

6. Challenges for innovation  Evidence – lack of good randomised control trial-based and/or cost effectiveness evidence.  Pilots often too small or in too narrow a part of the system – integrated treatment centre pilots.  Cultural issues with technology - impact on structure of clinical work – changing social structures of organisations and power relationships.  Skills – innovation frequently requires clinical champions - don’t have skills or knowledge required to write business case.  Innovations fall into category of ‘growth’ money and compete against each other.

8. What can we do? Boards and leadership key to promoting innovation, adoption and quality improvement – creating ‘safe to innovate’ environment:  Protected time for staff  Using patients and front-line views on improvement  Support in sourcing innovation  Visits/secondments to other organisations  Learning networks  Benchmarking/peer review  Links to appraisal system

9. Paving the way for innovation  New vs old – subject existing therapies, systems etc. to same level of scrutiny as innovations.  Innovation budgets and time, plus personal and organisational incentives.  Costing and evidence-bases.  Maintain active database of best practice, innovation, quality and outcomes  Create supportive context for innovation

10. Conclusion  As cost pressures increase need for significant changes in practice.  Innovation, adoption and flexibility more vital skills of leaders and competencies of organisations.  Vital to clear away barriers, create culture of continuous redesign, improvement and challenge to existing practice.