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NHS Reset: COVID-19 has triggered a new era of collaborative working between small and medium enterprises and the NHS with a surge in remote consultations and testing to keep patients out of hospitals, says Ashish Chokshi.

The relationship between the NHS and industry is often viewed with cynicism and scepticism on both sides. The complexity of the NHS and its’ multitude of commissioning and procuring processes is often at odds with small, dynamic businesses. Often start-up companies develop great ideas or products that have the potential to solve big health and social care challenges but they need to be right for the NHS in order to be a success.

At the DigitalHealth.London Accelerator programme, we strive to facilitate dynamic relationships between digital health small and medium enterprises (SMEs) and the NHS. We’re NHS staff who are driven by the potential of bringing digital innovators into partnerships with the NHS to make a positive difference to patients and our colleagues.

Amongst DigitalHealth.London’s co-founding partners are The AHSN Networks three London AHSNs; Imperial College Health Partners, the Health Innovation Network and UCLPartners.

COVID-19 forced dramatic change

Over the past few months, responding to COVID-19, the needs of the NHS in London have dramatically changed. At the Accelerator we curated regular COVID-19 response catch up calls with our diverse array of SMEs. We invited NHS partners, VCs and other stakeholders to hear as many key perspectives as possible and curate opportunities for people to share their experiences of the digital health landscape in London as it was changing.

Surge in hospitals managing patients remotely and removing obstacles

The NHS needed to have a swift response, particularly in relation to key clinical pathways they needed to change and SMEs needed to innovate, fast. There has been an upsurge in hospital services looking to remotely manage their patients at home and to support early discharge. This comes as hospitals are looking to restart elective care pathways and minimise patient time in hospital.

As a clinician, I’ve seen pathways in hospital being reconfigured significantly, and successfully, to ensure patients are in hospital for the least amount of time. In some instances this has been by cutting down non-essential tests or monitoring. In macular disease clinics for example, Optical Coherence Tomography (OCT) scans are now only being done when required, rather than at every visit.

However, in a move to reduce risk of infection of COVID-19 and maintain social distancing guidelines, clinicians are becoming more comfortable proceeding with remote testing and faster decision making when it comes to health and social care delivery. This significant change is seeping into clinician and wider NHS organisational reactions to SMEs and innovations and the relationships between the two. Trusts are for example, are lowering regulatory barriers and Information Governance teams are pushing important innovations, such as tele-consultation apps, through far quicker.

Products development to reflect NHS needs

In terms of product development, companies that had an appropriate product fit have further used the time to align their technologies to the changing workflows. One example of this is MedicSpot, they have managed to create a ‘suitcase pod’, repurposing an existing product to enable it to be transported to patient homes to couple diagnostic tests with a virtual consultation.

Commercial strategies have shifted significantly, where some companies have offered their products at a discounted rate to use for a space of time to tide the NHS over during the pandemic, with a view to gain evaluation data or longer-term contracts.

Clinicians willing to try new tech

Finally, the adoption strategies have changed. The NHS, as we’ve all seen, has had to try new technologies. Clinicians who were averse to trying new technology were encouraged to do so, meaning what previously may have taken months for adoption, has been done at pace. Clinicians have been empowered to enact change. Management within many NHS organisations has had to make decisions laterally and a mandate has been given to try something new.

Although there have been lots of cultural changes that have enabled the adoption of innovation in recent times, the infrastructure deficits remain. There is still challenge in Information Governance (IG) and data sharing for example, as well as the perennial interoperability challenge for which there is no easy answer. The challenges are there, but not unsurmountable if culture continues its transition from ‘what are the issues with this’ to ‘how can we make this work’.

Call to action triggered by the pandemic

The pandemic seems to have ushered in a new era of collaborative working. NHS organisations have tried new innovations and even evaluated them in this short space of time. NHS organisations could use these projects as a template and implement other innovations in similar ways. The culture shift of allowing innovations in and looking for ways to make them work should continue, with the appropriate regulatory safeguards in place. Regulators could use this opportunity to spread examples of good practice and enable organisations to constructively learn from others’ mistakes. SMEs should be heartened by this culture shift and be encouraged to approach NHS organisations at various levels to present their innovations and evaluation data. I can see a new, dynamic relationship emerging between innovators and the health and social care sector, which will hopefully lead to some fascinating collaborations and improvements for the end user, the patient.