Opinion: The Health System Support Framework: Is it killing the digital transformation that NHSX promised to achieve?

By Dr Michael Brooks, co-founder and chief medical officer, Patient Source and Emergency Medicine Consultant

With great anticipation, NHSX was launched to bring modern technology to the NHS and turn the health service into a world leading innovator. Following the introduction of the Health System Support (HSS) Framework, has NHSX fallen at the first hurdle?

Like any other institution that has been around for generations, the NHS has practices that are far from modern. To an extent, this is understandable; large, complex, tax-funded organisations are naturally less nimble or willing to take a risk.

However, when it comes to the healthcare industry, patient welfare becomes a compounding factor. Not upgrading last century’s technology means patients missing out on new and effective treatments, patients being exposed to risks that are now avoidable, and healthcare organisations missing out on modern, time-saving innovations.

The launch of NHSX, in a bid to “combine some of the best minds” from among the NHS, leading innovators and government, and to “set national policy, remove red tape and create a culture of innovation to allow the best innovations to flourish” was initially greeted with positivity and anticipation. Unfortunately, recent developments – most notably the HSS Framework – threaten to stifle the very innovation and digital transformation that NHSX promised to encourage, which is disappointing to see in such early days.

According to NHS England, HSS Framework was created to help NHS organisations “access support services from innovative third-party suppliers at the leading edge of health and care system reform”. How this works in practice is that the framework ranks suppliers on a number of criteria and announces which suppliers are accredited to work with NHS bodies.

The issue with HSS (and other frameworks) is that they are lengthy and bureaucratic exercises and that alone can shut out numerous suppliers. On top of that, they rank companies on arguably irrelevant, outdated criteria that correlate poorly with product quality. The market is then closed to new entrants for several years, while giving the successful bidders scope to massively increase their prices, potentially providing little of value to the taxpayer.

In the market there are some with a track record of failure, which has previously cost the NHS. Meanwhile, there are still a number of others that are hostile to interoperating with other suppliers or are using technology that was designed decades ago.

Even though Matt Hancock has expressed a clear desire to modernise the NHS and has spoken flatteringly about a number of ‘disruptive’ SMEs over the past year, the group of accredited EPR suppliers on the HSS framework is almost exclusively comprised of large, established suppliers. It’s disappointing that we are led to believe that NHSX will be innovative and yet this first major announcement is anything but that.

The NHS has been given access to new procurement frameworks many times before. Notably, G-Cloud but since it’s 2012 inception it’s scarcely been used by NHS bodies. Consequently frameworks have failed to close the technology lag UK healthcare and the NHS has behind other industries.

The procurement process needs to be revised in a way that finally promotes innovative health technology. As it stands, NHS Trusts are still asking for “tried and tested” solutions from big companies with an existing track record of selling to other NHS Trusts. The result is that they are buying old technology, from old companies, in old ways. The system is simply not working for patients and is instead slamming the door in the face of new ideas and innovations and causing innovative suppliers to look to other geographies where they are genuinely encouraged to flourish.

There seems to be an inherent fear of potential new risks caused by new solutions, while failing to take into account the vast reduction in current risks new solutions can provide. We are still using fax machines, pagers and second class post envelopes in the NHS at considerable volume in 2019.

The problem is compounded by the fact that new companies cannot get customer revenue from the NHS within the typical 18-month lifespan of a seed invested start-up. This means that despite the lure of the size of the NHS, investors are running away from any companies proposing to get revenue from the NHS, even if they have a realistic chance of getting through the framework-guarded door.

In May, I attended a Clinician Entrepreneurs panel session featuring Dr Andy Richards, one of the most prolific investors in the UK in the health and biotechnology space. His words: “if you tell an investor you’re planning on making money from the NHS they are just not going to take you seriously”.

Frameworks simply limit choice, cause prices to increase and squeeze actual innovative solutions out of the market. We did not bid directly because the bureaucracy was just too onerous for SMEs. We instead chose to focus on building partnerships with new customers directly and demonstrating the utility of our service. We’re already on G-cloud, we are already exceptionally interoperable and you can already buy and deploy PatientSource in a modular fashion. Despite NHSX’s decision, it can often be the established suppliers that are playing catch-up.

The NHS needs to start showing faith in new solutions by new companies if we want innovative health tech start-ups in the UK to survive and the NHS to finally achieve its digital transformation.