Using evidence to unlock innovation

25 March 2021

Rob Berry, Head of Innovation at KSS AHSN, suggests that what AHSNs refer to as Real World Evaluation (RWE) is a missing piece of the innovation landscape jigsaw. Undertaken well RWE will, in due course, reduce if not eliminate ‘pilot-itis’ – the extracted process of successive trials or pilots to prove a product’s worth – and in doing so accelerate access to the NHS and wider health system.

When it comes to the purchasing of products or services that enable delivery of better patient outcomes and/or healthy system efficiencies, there isn’t a threshold of evidence that can be simply met by the supplier and used by the buyer to make that purchasing decision.

In reality the decision to purchase is fundamentally based on judgement rather than rules, and as likely to be influenced by a positive or negative review from clinical or managerial peers as by empirical diagnostic accuracy data.

RWE brings together a combination of evidence and insights that increase confidence in the buyer that the intervention (not just the product) will result in the benefits being realised at the scale, time and cost, that the supplier indicated.

The inherent challenge

As the case studies in AHSN support in action show, AHSNs are already, individually and as a national network, offering a RWE service to health tech innovators. The benefits of innovative health technology correctly deployed in the NHS are significant. However, there are potential significant negative consequences and costs to both the innovator and purchaser of a poor or misjudged decision.

For the innovator, delays in bringing their product or service to market, or excessive spends on evidence generation, may impact on their business sustainability.

The NHS will similarly wish to ensure any innovation brings meaningful patient benefits and or operational cost savings efficiencies at scale and pace, while ensuring that their patients are safe, and that the implementation of any innovation is financially sustainable.

The consequences

These challenges can create tension between innovators and the NHS. This may result in neither party having their expectations met, and further requests to repeat (or enhance) existing evidence. This in turn contributes to the perception that innovators overpromise and that staff in the NHS are risk averse or over cautious.

Real World Evaluation: The way forward

A RWE assessment will take into account the evidence generated to date, along with an assessment of NHS or wider health care interest, and will broadly asses innovations on the following criteria:

• Unmet need assessed by relative priority nationally including assessment of potential health gain
• Affordability assessed by available resources and appropriate economic assessment (ROI)
• Feasibility assessed by likely ease of spread, including technical and operational elements.

If a product is not of sufficient priority or cannot be afforded, even if health benefits could be gained, there is little or no point in undertaking a RWE. To do so is one cause of pilot-itis. Other causes include undertaking an incomplete, poorly considered or poorly executed RWE.

There are already pockets of excellence in RWE across the AHSN Network – for example Oxford AHSN has a strength in cardiovascular disease, and a history of impactful RWE work in this space. Similarly in Yorkshire, with expertise in Point of Care diagnostics, we can see high value work impacting on spread and adoption at pace and scale.

The future of RWE

There remains an opportunity to enhance these RWE processes. AHSNs within their region could draw on and broker RWE playing to the strength of clusters of organisations locally. Regions are likely to have different combinations of strengths and experience, which will be beneficial as a national approach. Those strengths may be in parts of the pathway or clinical areas, or strengths in technology types – digital, AI, diagnostics or med tech for example.

Importantly these regional strengths can be shared nationally, with the regional AHSN able to provide appropriate support to all innovators in need of this service by helping to set out and work to principles and standards of RWE.

The AHSN Network is unrivalled in its ability to pull together, catalyse and manage cross sector working with a range of public sector organisations, including NIHR MICs and providers and commissioners of health and care services, to rapidly engage in RWE in partnership with commercial organisations.

By building a more formal coordinated network of regional hubs with expertise in rapid RWE, the AHSN Network will put the UK at the forefront of innovation implementation science. The future landscape will see strong, successful SMEs creating jobs in, and bringing investment to, the UK, helping to increase our reputation and influence globally. And, most importantly, all of this will be done to deliver increased benefits to patients and the health system, at pace.

Rob Berry

Rob is Head of Innovation for KSS AHSN. He has an MSc in Health Care Management and has been working with health technology companies for over ten years. He supported the development of the National AHSN guidance and the establishment of KSS AHSN. His role at KSS AHSN includes engagement with industry, and support for development and implementation of technology-based innovation.

More from this issue of Innovate

The innovation landscape

AHSN support in action