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AHSN support in action
25 March 2021
We take a look at some examples of innovations that have received support from AHSNs – and the success they’ve achieved.
“The UK has one of the most thriving healthcare and life sciences innovation communities anywhere in the world. It’s not only our extraordinary scientists and clinical academics but also our rich collaborative environment built up between academia and industry over many years, supported by our infrastructure for clinical trials, data analytics and medicines manufacturing.”
Piers Ricketts, Chair, AHSN Network and Chief Executive, Eastern AHSN
An NHS that has a real appetite for innovation. Industry that can design, develop, and deploy innovation that can be life-changing for staff and patients. So why is it so hard to get effective solutions adopted at scale?
The AHSN role of bridging the gap between the two sides – industry on one hand and the health and care system on the other – often means helping to guide both sides to a place where partnership and collaboration can happen.
Process
AHSNs have been doing this for nearly eight years. In that time we’ve refined our approach by listening to the needs of both industry and the NHS. We’ve built a four stage model, shaped around the Innovation Exchange process, through which we offer support:
1. To enable the NHS to articulate its needs to industry
2. To help industry to develop innovative products and services
3. To bring industry and the NHS together to collaborate on real world evaluation
4. To use the evidence from that real world validation as the basis for wider spread and adoption.
It’s through this process that we support the adoption and spread of late stage innovations into our health and care system. But it’s not something we do by ourselves, as Piers Ricketts describes:
“We’re part of the Accelerated Access Collaborative, the umbrella partnership set up to bring together government, the NHS, industry, regulators and patients to remove barriers and accelerate the introduction of new diagnostics and treatments which can transform care.”
Our case study about Mendelian’s innovative solution for rare disease diagnosis shows how AHSN support is helping the company navigate the system and widen the number of patients benefiting from life-changing diagnosis.
Innovation passport
The support that innovators receive direct from AHSNs can also be a passport to growth and success. These include initiatives such as the NHS Innovation Accelerator (NIA), the Medtech Funding Mandate and the AHSN Network’s own national programmes.
Our case study about a placental growth factor (PlGF)-based test for preeclampsia shows how a combination of the right partners and evidence, in response to an articulated NHS need, can lead to national adoption of innovation that’s been proven at a local level.
Practical insight and guidance
In a complex landscape of changing needs and priorities, the AHSNs offer a practical, solution focused approach.
As Piers Ricketts says,
“We work with you to develop your pitch; we introduce you to the clinicians we think will be most relevant and we help you to obtain the real-world evidence that will be necessary for the NHS to purchase your products at scale.”
Our third case study shows how KSS AHSN’s data modelling and support has enabled Dr Julian to demonstrate the evidence that their mental health app brings benefits to patients and the healthcare system. Doing this in a way that resonates with commissioners and service providers has helped to overcome some of the barriers to wider adoption.
Case study 1
Mendelian: scaling up from a pilot with practical AHSN support and advice
It takes seven years on average for a person with a rare disease to get the right diagnosis. Mendelian is reducing this time, bringing high-quality care faster to those who need it – “enabling doctors to help patients earlier”. The company mission is “to improve clinical care for rare disease patients everywhere”. The majority of these patients are children.
Rare diseases can present with a range of complex, seemingly disconnected symptoms over the course of many years. This makes them difficult to diagnose and a recent Mendelian-commissioned report revealed that the costs to the NHS to provide care before diagnosis are in excess of £3.4 billion.
Diagnosis is key: it brings a prognosis, referral to treatment, and the chance to connect with other people affected by the same disease; and more than that, it brings hope. As Rudy Benfredj, Co-Founder and CEO, Mendelian, says:
“Rare disease patients often tell us that the best day of their life was the day they got their diagnosis.”
MendelScan: how it works
The MendelScan algorithm captures disease features from electronic health records across a patient population.
The software scans medical records of patients. When it finds a match against a certain threshold, established by guidelines for rare disease diagnosis, an alert is sent to the GP. This includes information that will help with referral to the right specialist service or clinician. Rudy describes it as being “a lot about giving the right information at the right time to the right person.”
Patients are matched to published diagnostic criteria for hundreds of rare diseases. Mendelian’s own clinical team and disease specialists then perform an extended medical history review.
Healthcare providers receive a report describing the suspected disease, why it’s suspected and the diagnostic pathway, enabling them to offer the best care for that patient more quickly.
Moving beyond a pilot
Eastern AHSN worked with Mendelian to establish a pilot with a small subset of 90,000 patients in collaboration with the Lea Valley Federation of GP practices in NHS East and North Hertfordshire CCG.
Rudy believes the support from the AHSN helped to bridge the gap with the NHS:
“For us at the very beginning the brokering was really where the AHSN added value. Who do we talk to? What is it that they want? I don’t think we would have been able to run the first pilot without them. Then it’s down to you to show you have done the work and are a serious contender. But to start with it’s really a matter of having the backing of these people who understand the system better than us.”
The first pilot provided proof that the MendelScan approach was effective. It also showed the need for a larger scale pilot to understand how to operationalise the solution. Mendelian are able to take the learning from their experience in Lea Valley into a collaboration with the Modality Partnership, which cares for around 450,000 patients in eight regions of England.
So how have Mendelian avoided the pilot-itis that often affects innovators? According to Rudy, it’s all about understanding what a pilot is aiming to do:
“Sometimes people don’t understand what a pilot is all about. It’s fundamentally very different from the exercise of being commissioned. A pilot, by definition, you don’t have your evidence yet, so it’s very difficult to get in. The pilot is made for you to get your evidence. Once you have your evidence you’re in a completely different position. The main reason that people can’t get in after their pilot is that their data isn’t good enough. The NHS has very stringent processes so you need to understand what’s required, do your homework, then come back and show the evidence; it may take time but I don’t see any other barriers really.”
Wider scaling up
The recently published rare diseases framework sets out a national vision for the UK to improve the lives of people living with rare diseases. It’s very much aligned with what Mendelian advocates – large population health, digital approaches to find patients much earlier. The company anticipates further regional work followed by scaling up nationally, a journey which AHSNs would be delighted to support.
“Even with a great product, successful deployment can only be achieved with effective stakeholder and change management, staff training, and public engagement. That’s why we offer practical advice to support innovators to develop, implement and scale technologies to deliver positive health impact.”
Louise Jopling, Commercial Director, Eastern AHSN
For more information
Case study 2
Scaling adoption: how an innovative test for pre-eclampsia spread from 3 trusts to more than 100
Pre-eclampsia (PE) is a serious hypertensive condition that complicates up to 1 in 20 pregnancies, usually during the latter stages. It can affect both mother and baby and can lead to small birth weight babies, organ damage and – in extreme cases – death. Delivery of the baby is the only ‘cure’. It is not unusual to induce the baby early, even with mild pre-eclampsia.
Correctly diagnosing PE is notoriously difficult. Clinical teams have a high degree of suspicion for PE and a low threshold to admit pregnant women with suspected PE. However, only a small proportion of these go on to develop it. This highlights the importance of a more accurate test.
Partnership
In 2017 Oxford AHSN partnered with Oxford University Hospitals and Roche Diagnostics to prove that a new placental growth factor (PlGF)-based test developed to help in the diagnosis of PE delivers real world benefits. Offering the test to women suspected of having PE meant that clinical teams were better able to identify those women who did not have the disease. These women could safely be sent home – avoiding unnecessary hospital admissions for monitoring.
By being able to show the real world benefits, PlGF-based testing was adopted into standard clinical practice at an initial three trusts. This provided the platform for its wider spread and adoption.
National adoption
In 2019 the Accelerated Access Collaborative provided support for the national AHSN Network to support adoption of the test across England. By February 2021, 119 maternity services had adopted the test – which equates to around two thirds of maternity units in England.
From April 2021 PlGF-based testing will be one of four technologies included under the new NHS MedTech Funding Mandate.
“Adoption of new technologies in the NHS can be slow, but success can deliver transformational change. AHSNs understand the challenges faced in achieving adoption of a new technology in a healthcare setting and can help innovators develop strategies to overcome them.”
Guy Checketts, Interim Director of Strategic and Industry Partnerships, Oxford AHSN
For more information
Case study 3
Dr Julian: how practical help from KSS AHSN has helped the company to grow
There are many reasons why NHS organisations can struggle to meet the demand for mental health support. This include premises, staffing, budgets or rigid operating hours, all of which can contribute to patients having to wait longer to see a therapist.
The Dr Julian platform aims to increase accessibility of mental healthcare, connecting patients almost immediately to mental healthcare therapists by secure video consultations to a therapist most suitable to them and their needs. Recognising that people respond differently, the technology allows for more options for citizens in the matching of patient and therapist and can support in addressing health inequality challenges that exist.
The platform links into NHS Improving Access to Psychological Therapies (IAPT) services in England, providing effective alternatives to face to face therapy and offering appointments times that suit the individual.
Health economic model
KSS AHSN created a health economic model to compare outcomes between the Dr Julian platform and current IAPT services. Using data across four providers currently using Dr Julian, and the extensive public IAPT dataset, the health economic modelling showed an NHS return of £1.33, and a total return (including social benefits) of £2.83 for every £1 spent over five-years. The modelling also outlined a range of beneficial patient outcomes from Dr Julian, as compared to the current NHS IAPT service approach.
Innovator journey
The company’s journey with KSS AHSN began when its CEO attended an AHSN Network Market Insight Briefing. This was followed by a series of 1:1 surgeries where KSS AHSN was able to help Dr Julian to identify its value proposition, and review the evidence of outcomes. This identified a number of evidence gaps and informed the design of the health economic model.
“From the start KSS AHSN has acted as a critical friend to Dr Julian, providing insight and advice on a range of issues – from helping the team prepare for a key member of staff’s maternity leave, to exploring potential new markets, and supporting development of a marketing strategy to engage with universities.
“Support is now being provided to explore how the technology could be used to address the gap sometimes felt by university students between their own home based GP and university location.
“We’re now working with them to use the health economic model effectively, as well as brokering conversations with the mental health trusts in the KSS region and feeding back valuable insights from commissioners and clinicians to the company.”
Nuala Foley, Industry Engagement Manager, KSS AHSN
For more information
More from this issue of Innovate
The innovation landscape
Using evidence to unlock innovation