United Kingdom Report


NHS transforming healthcare – the journey continues

The National Health Service in England which was launched in 1948, now services nearly 1 million patients per day ‘from cradle to grave’ free at the point of care, and it is recognized by many to be one of the most efficient healthcare delivery systems in the world. However, the challenges of increasing demand and the need to contain costs, requires innovative ways of thinking and new structures. Central to NHS England’s transformation plan, contained in the NHS England’s ‘Five Year Forward View’, is the development and testing of New Models of Care.

The first initiative under this plan was the selection of 50 vanguard sites to take a lead on the development of new care models across, ‘acute care collaborations’; ‘urgent and emergency care’; ‘integrated primary and secondary care’ and; ‘multispecialty community providers’. Many sites focused on care beingintegrated more effectively around the needs of populations and patients, and a high priority for all the sites, was to strengthen links between general practices and other health and care services. After two years of operation, progress has been faster in some sites rather than others, but there is a common recognition of the need to do things differently, and a palpable enthusiasm to make changes.

Test Beds
In 2016, seven Test Beds were established as ‘real-word’ trials for testing ‘combinatorial’ innovation (new combinations of products and processes) to improve patient outcomes, within current cost constraints. Rather than developing products in isolation of changing patient pathways, this programme was intended to demonstrate that the NHS could work with industry to create cutting-edge digital solutions to support service transformation.

The Test Beds programme was unprecedented in scale, with 40 innovators, 51 digital products, eight evaluation teams and five voluntary sector organisations involved. The programme is still in its testing phase, working with 51 innovations across redesigned pathways and engaging over 4,000 people. When the testing is concluded in the summer of 2018 it is anticipated that 15,000 people will have been engaged in the programme.

An important ‘bottom up’ approach to driving healthcare transformation, has been the development of ‘sustainability and transformation plans (STPs)’ by health and social care leaders, to reflect the needs of specific geographical regions. The plans developed in 44 regions (submitted in October 2016) were required to cover three broad themes: improving quality and developing new models of care; improving health and wellbeing and; improving efficiency of services.

It is widely believed that this approach is the only practical way to bring about sustainable change, and a recent report on four STPs, provided recommendations for refinement in the future, including securing more meaningful involvement of patients and the public in the plans, and focusing on the skills and resources needed to implement STPs, as well as the cultural aspects of making change happen.

Global Digital Exemplars
In order to fast track digital maturity in the NHS (or bringing it into the 21st Century), 16 digitally advanced acute trusts are being supported by NHS England, through funding and international partnerships, to become Global Digital Exemplar sites. Each Global Digital Exemplar has selected one (or occasionally two) trusts to partner with to accelerate their digital maturity. In some cases, this will be sharing softwareor a common IT team. Others will adopt standard methodologies and processes. ‘Fast followers’ will enable Global Digital Exemplars to establish proven models that can be rolled out across the NHS more broadly.

NHS England, like many other healthcare delivery systems have been wrestling with the challenge of how to ensure that patients benefit from technology advances at the earliest opportunity. The publication of the ‘Accelerated Access Review’ Report late in 2016 after an extensive consultation period engaging all major stakeholders including industry, provided fresh momentum to responding to this challenge. Included in its recommendations were:

i) A new transformative designation should be applied to those innovations with the potential for greatest impact

ii) Accelerated Access Pathway should be created for strategically important, transformative products

iii) National routes to market should be streamlined and clarified

iv) a range of incentives should support the local uptake and spread of innovation, enabling collaboration and with greater capacity and capability for change.

Innovation and Technology Tariff
Early in 2017, The Innovation and Technology Tariff (ITT) was introduced to incentivise the adoption and spread of transformational innovation in the NHS. The themes for the ITT were sought in conjunction with NHS Innovation Accelerator programme, with the key themes being funded under a simple zero cost model, whereby providers order the innovations from the supplier at no cost and NHS England reimburses the supplier directly. The Innovation and Technology Payment (ITP) was subsequently launched in the summer of 2017, which aims to support the NHS in adopting innovation by removing financial or procurement barriers to uptake of innovative products or technologies.

Turning to support for companies developing new innovative products, since 2008 the NHS has backed a Small Business Research & Innovation programme (SBRI), which has supported more than100 companies to develop innovative technologies that match the specifi c priority needs identifi ed in competition calls. This provides 100% funding for SME-led collaborations to develop solutions to real needs. A recent independent report commissioned by the NHS has demonstrated significant benefi ts of the programme not only in respect to improved performance and cost savings, but also in respect to economic impact with regard to increase jobs, export sales and investment leveraged.

Invention for Innovation
A Department of Health scheme, Invention for Innovation (i4i) has also recently introduced a 100% early stage funding competition (i4i Connect) which will allow companies to undertake basic proof of concept work. This is intended to provide a platform for smaller companies to be able to apply for the larger i4i Product Development Scheme. The UK’s Innovation Agency, Innovate UK, also have substantial funding available to companies through its Biomedical Catalyst Calls and Health & Life Science calls, which encourage collaboration and provide seamless support through the product development journey to include fi nancial support for patents and clinical trials.

The National Institute of Health Research (NIHR) infrastructure offers signifi cant support for companies that are seeking to undertake clinical trials in the UK, this support spans advice on the use of specialist clinical research networks (e.g. cardiovascular disease), regulation, costing, site identifi cation, recruitment, optimizing delivery, effi cient study set up and performance monitoring. This enables companies to fast track clinical study execution.

Patent Box initiative
The UK Government has created a positive environment for life science inward investment into the UK, with the Patent Box initiative which allows companies to pay only 10% corporation tax on profi ts attributable to qualifying patents with its R&D tax credit scheme. This provides small to medium-sized companies with relief on qualifying R&D expenditure, and through this the initiative provides a major investment in the clinical study infrastructure.

UK Research Councils
An article on transforming healthcare would be incomplete without reference to the underpinning work of the UK Research Councils, which play a major role in contributing nationally and internationally to tackling major societal challenges. The UK Research Councils invest around £3 billion per year in worldleading research, covering all disciplines and sectors. The Medical Research Council has three main aims to: i) Prioritise – addressing the most pressing health challenges worldwide such as infections, brain health and dementia, and regenerating tissue ii) Discover – breaking new scientifi c ground and setting new paradigms iii) Transform – working in partnership to transform health research and innovation, such as Informatics & Stratifi ed Medicine.

Medilink’s mantra is ‘Transforming Healthcare’, and to do this Medilink UK brings together the NHS, Academia and the Life Science industry into a single association, and works with the key UK Government bodies to support integrated healthcare transformation. It also provides specialist consultancy services to UK and overseas companies seeking to fast track product innovation and market adoption.


Strengthening ties between the UK and the Middle East

One again, the Association of British Healthcare Industries (ABHI) are delighted to be the official organiser of the UK pavilion at Arab Health 2018. As the UK’s leading Medical Technology trade association, we are well positioned to showcase the best in cutting-edge MedTech innovation that our country has to offer. With 200 UK companies exhibiting at Arab Health in January, we are excited with the sheer breadth and diversity of the technologies on display. It is a wonderful expression of what our industry has to offer in providing value-based healthcare solutions for patients across the globe.

As most will be aware, the UK is experiencing unprecedented change as it navigates its exit from the European Union. Yet despite this, the MedTech sector remains undeterred. It continues to grow at both pace and scale, and is now worth over £17 billion to the UK’s economy. The industry remains resolute and is actively seeking opportunities post-Brexit.

With Brexit in mind, the UK Government has launched an Industrial Strategy to drive the country forward. As part of this, Life Sciences has repeatedly been highlighted as a key area for future growth, and MedTech identified as a pillar of this strategy. We believe that trade will be vital in enabling this vision to become a reality.

ABHI International Membership
To support our government’s ambitions, ABHI recently became the first UK Life Sciences industry association to create a bespoke membership offering for international companies. We see the launch of the ABHI International Membership category as a direct action on the government’s call and we at the association are very excited as to the possibilities.

ABHI has, for a long time, offered UK companies a variety of support and opportunities to export globally. International membership is making these links more accessible for international companies wanting to partner with their British counterparts. We are signposting and introducing international companies to a highly-developed network within the UK health system with a view to supporting the development of jointventures and distribution agreements. As well as access to written briefings, webinars and market intelligence reports, membership is underpinned by the collective expertise of ABHI’s senior leadership team and the international division of the association. Some companies may even already have activities within the UK, but are looking for that ‘next step’, which is where we are able to provide the assistance needed.

We are delighted to already have several international members on board. A number of these hail from the Middle East, a region we consider to be very much a priority for our association and our membership. We have been bringing UK companies to Arab Health for a number of years and the show continues to go from strength to strength. No longer can the Middle East be considered an emerging market. It's position as a key global player in the healthcare sphere must be recognised.

With the UK's medical expertise and the rising number of Middle Eastern patients visiting our world-class clinics, we are eager to deepen these relationships further. We believe the UK is a great place for both healthcare and business and as our international membership develops we are looking forward to developing these relationships with the Middle East further.

  • For any companies looking to fi nd out more about ABHI International Membership, contact angela.jeffery@abhi.org.uk
  • You can visit the UK Pavilion at Hall 7 during Arab Health 2018.

New surgical approach for total hip replacement allows faster rehabilitation, no muscle damage

  • By Mr Panos Gikas
    Consultant Orthopaedic and Sarcoma Surgeon, Honorary Lecturer, Department of Physics, UCL

Recently there has been an increase in interest in performing hip replacement surgery by less invasive means, and by smaller incisions. Some of these so called minimally invasive techniques however are only reduced skin incision techniques and are associated with the same muscle and/or tendon injury as “conventional” approaches.

AMIS® (Anterior Minimally Invasive Surgery) is a surgical technique used in total hip replacement procedures which follows an inter-muscular and inter-nervous plane to reduce the risk of injury to muscles, tendons, vessels and nerves. By respecting the nerves and because no muscles are cut, this aids rapid recovery for patients following surgery.

What are the advantages?

  1. DECREASED POST-OPERATIVE PAIN: In comparison with “conventional” surgical techniques, the AMIS approach can reduce the post-operative pain as muscles are not cut.
  2. SHORTER REHABILITATION: Rehabilitation can usually start the day of the operation or the day after. Standing up and walking with arm crutches can start immediately.
  3. SHORTER HOSPITAL STAY: The AMIS® technique usually signifi cantly reduces the duration of hospital stay.
  4. SMALL SKIN SCAR: With AMIS®, the skin incision is often shorter than with “conventional” surgery and therefore scar tissue is reduced.
  6. REDUCED RISK OF DISLOCATION: The preservation of muscles signifi cantly improves the stability ofthe hip. The risk of dislocation is minimal and the post-operative limitation of movements, usually prescribed in other techniques, is not necessary. The risk of dislocation is reduced because the anterior approach is performed from the front of your body and dislocation is mainly related to posterior hip structure damage.
  7. PREVENTION OF LIMPING: AMIS® is characterised by a surgical technique that protects the various muscles, blood vessels and nerves encountered during exposure of the hip joint. Minimizing muscle and nerve damage reduces the chances of limping.

What are the disadvantages?
With an incision in the front of the thigh, there can be some alteration in the skin sensation over the front and outer aspect of the thigh. This relates to the anatomy of the small nerves that provide sensation to the skin and their proximity to where the surgical incision is made. Over time the area affected by numbness always reduces signifi cantly.

Does it make a difference in the long-term?
The most important factor for the longterm function of a hip replacement is that the hip implants are inserted correctly so as to reconstruct the anatomy of the hip. Beyond the proven early benefi cial and faster functional recovery after an anterior approach hip replacement, we do not know if the approach itself makes a signifi - cant difference in the longer term.

At the Royal National Orthopaedic Hospital the AMIS Total Hip replacement is being offered by Mr Panos Gikas, who has done a postgraduate fellowship at the University Hospital of Geneva on this approach.

  • For more information contact please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5114 ppu@rnohppu.com / www.rnohppu.com

Innovative lung volume coil reduces severe emphysema symptoms

Royal Brompton and Harefield Hospitals Specialist Care provide pioneering diagnostics and treatment to international patients with heart and lung conditions. Many of our consultants are world leaders in their field and offer some of the most sophisticated treatment available anywhere across the globe.

Early this year a new innovative service was launched at the Royal Brompton and Harefield Hospitals in London, UK to treat severe emphysema patients. Lung volume reduction coils are implanted into the diseased parts of the patient’s lung during a minimally invasive bronchoscopy procedure, typically taking only 30-45 minutes per procedure. Treatment involves two separate procedures, for each lung, 4-6 weeks apart. This treatment helps to reduce hyperinflation in severe emphysema patients, resulting in a reduction in difficult or laboured breathing.

The PneumRx® Coils are made of a shape-memory material called Nitinol, common in medical implants such as heart stents. The PneumRx® coils are implanted into the airways via a catheter, and once in place are designed to gently regain their shape, gathering up loose, inelastic lung tissue and holding open surrounding airways. Ten or more coils are placed at each procedure to tighten the entire airway network and achieve the optimal effects.

The coils improve lung function in three ways. Firstly, they compress diseased tissue, which provides room for healthier tissue to function; secondly, they re-tension adjacent parenchyma, helping to increase the lung’s elasticity, which may enable the lung to more efficiently contract during the breathing cycle; finally, the coil tethers open small airways, preventing airway collapse during exhalation.

Dr Samuel Kemp, Royal Brompton Hospital respiratory physician who performs the treatment says: “Patients with emphysema often have disabling breathlessness which does not respond significantly to drug therapy. Lung volume reduction coil treatment can offer relief from some of these symptoms, giving patients an improvement in quality of life.”

Following the procedure a patient can typically return home after just one night in the hospital and see results almost immediately. Patients treated with coils may experience significant improvement in exercise capacity, lung function and quality of life.


Date of upload: 19th Nov 2017

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