Professor Gary Ford, Chief Executive of Health Innovation Oxford and Thames Valley and OAHP Board Member.
Innovation Perspectives is OAHP’s Q&A series with OAHP Board Members and partner organisation leads. Speaking with Health Innovation Oxford and Thames Valley’s Professor Gary Ford, we discuss making innovation stick, how clinical research can be more inclusive, and the role of research in BOB Integrated Care System.
“In the next five years, the biggest challenges and priorities will be in caring for children and young people with mental health problems. While there’s lots of early innovation in this area, not enough has been piloted, evaluated and spread.”
From your own experiences, what are the critical factors in making healthcare innovations and new ways of working stick and spread into practice?
While there are a whole host of factors for successful innovation, fundamentally any innovation in healthcare needs to meet a priority need of the healthcare system along with delivering broader benefits, rather than simply improving the outcomes for a particular patient population. This means there’s also a strong value proposition, a clear workforce benefit, or the innovation makes healthcare professionals’ lives easier. Ideally, healthcare innovations should be cost-neutral or cost-saving, so they make sense to commission.
There also needs to be a clear understanding of how innovations will be deployed in a service pathway – though of course, the innovation itself may be a service pathway. You can have a very good product, drug, device or diagnostic, but unless the clinical pathway has been worked out or optimized, it’s unlikely to get into practice.
Clinical champions and patient champions are also helpful, along with case studies from early adopters of how they used an innovation and how it was beneficial, because people often look to the experiences of others, which may be local or further afield.
Good data on uptake is also a factor, along with evidence of impact like clinical outcomes, length of stay, or the patient experience. This data can help to build a case for the value of an innovation.
During the pandemic we saw virtual consultations explode across the whole NHS in a relatively short space of time. What does this show us about how innovation can be deployed at pace and scale?
Typically, healthcare systems are notoriously conservative and organisational change usually carries some degree of risk in terms of following up patients, for example. This means there needs to be a permissive environment that accepts that some things don’t always work out. To facilitate this, there needs to be a way to monitor the capacity for people to change and to build that capacity.
During the pandemic, some of the barriers around data protection were removed so new ways of working like virtual consultations could be deployed more easily.
There was also a clear drive from national policymakers and healthcare organisations to make digital transformation happen, and there was support and acceptance for the possible risks.
So I think virtual consultations were a unique case, because patients and healthcare professionals were looking for alternatives to the standard pathways of care to reduce the risk of covid infection, and wanted to achieve a common goal of how to interact, which I think enabled digital in the way it did.
A lot of virtual services have since rolled back to the traditional models of face-to-face consultation.
How can innovation address health inequalities in the wake of the Covid-19 pandemic?
This is something the Academic Health Science Networkss are looking at across a number of core areas.
The first is to use strategies around your innovation to identify those who have the greatest healthcare inequalities who would benefit, like a comprehensive and inclusive search and patient identification strategy.
Alongside this, it’s important to deliver appropriately targeted communications and community engagement, and provide high-quality patient information, so the right people are engaged.
Secondly, the innovation itself also needs to be accessible. So, for example, not everybody has a laptop or computer at home, but if the innovation is online then how will people use it and access the service?
In my view, there aren’t specific innovations for specific groups, what’s crucial is for engagement and implementation activities to ensure that the right people can benefit. Often, more resources need to be invested in reaching groups who don’t readily engage with health and care services.
You talk about innovation in terms of accessibility and need. From a research perspective, how can clinical research be more inclusive so those needs are identified and catered for?
I think the challenge is that patient recruitment into clinical research studies tends to align with where researchers are located. So, if you want to study cardiovascular disease then you need to go where the populations are and the research needs to be designed to engage with the right populations. This requires the ability to work outside typical university settings and go into the patient community across the country.
When I led a research network, one of the challenges we had was that the hardest studies to recruit for were in lower-performing services which were faced with significant workforce pressures, so clinical teams had less time to participate in research. Paradoxically, this can contribute to health inequality across the country.
More importantly, research needs to answer the right questions, and in my view, there isn’t enough health research addressing the needs of the NHS.
If you look at mental health, there are several big life science missions which are important in the medium to long term, like looking at therapies for dementia. But in the next five years, the biggest challenges and priorities will be in caring for children and young people with mental health problems. While there’s lots of early innovation in this area, not enough has been piloted, evaluated and spread. So how can the needs of this population be aligned with the health and social care system, with the skills and interests of researchers, and with the availability of funding? Additionally, research groups need to be developed and capability increased in this area, and that’s tricky to achieve.
How do you see Oxford’s research assets supporting the developing research and innovation agenda across the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System to tackle the region’s complex healthcare challenges?
I think it comes back to key population needs, which are not fundamentally different to other parts of the country. Although we still have a substantial population of young people in the towns and cities of BOB, the biggest challenge across the three counties is how the research community responds to improving the management of people with multiple long-term conditions. So how can we do more research in the community, and how do we deploy diagnostics that prevent hospital admission?
There are structures like the NIHR Applied Research Collaboration which are very focused on these areas, and we have the benefit of a well-developed mental health research BRC, so I think the answer lies in looking at how the Oxford health and social care research innovation system answers the needs of the population of BOB.
For me, a critical factor here is to develop the right connections between relevant parts of the research community and the BOB community, which is already underway, so the right conversations take place between researchers and those who are delivering and planning health and social care services.
So by all means, let’s do all that blue sky research and the blockbuster work that Oxford is globally recognized for. But there’s a need to expand a more responsive understanding of need, and if we do that for BOB, we will be doing it for the rest of the country.