A Tariff for Innovation

It’s one thing to innovate. It’s another to spread that innovation across the NHS and that’s exactly what a new tariff system could do, says Tara Donnelly

A new tariff came into play in April this year and for the first time we have a payment scheme to encourage the spread of innovation within the NHS. This is significant, laudable and we need to do everything in our power to ensure that we make the most of the opportunity. Even better, the focus of the tariff in its first year is innovations that make hospital care safer.

Most of the devices that are eligible for the tariff have been developed by innovative clinicians who saw opportunities to improve care – making it safer and more effective.

Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented scissors that make childbirth safer; Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with a device that prevents tragic accidents with blood lines; Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care; Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD an online platform that helps patients self-manage with dramatic results; Robert Porter, a consultant microbiologist at Queen Alexandra Hospital has developed a treatment that cures Clostridium difficile through faecal transplantation.

Accelerating the uptake of innovation

We should be proud that as a country we are not only inventing these superb devices, we are also designing systems to help accelerate their uptake. NHS England’s Innovation and Technology Tariff (ITT) enables NHS Trusts in England to use these patient safety innovations either for free, or to claim a charge per use.

The 15 AHSNs have lobbied for a tariff to support innovation for some time, and it was the NHS Innovation Accelerator – a national programme supported by all 15 AHSNs – which was a key influencer in its development. The AHSNs therefore are delighted with this development, and are working to support uptake of these innovations within their geographies.

Obstetric Anal Sphincter Injuries (known as OASIS) during childbirth is the leading cause of faecal incontinence in women in the UK. It is a devastating injury, requiring surgical repair, with 30% of women having some level of symptoms a year later. OASIS costs the NHS approximately £57 million annually in repair and litigation costs and is on the rise. Dharmesh developed guided mediolateral episiotomy scissors, known as EPISCISSORS-60 that minimise the risk of obstetric injury, they are set to 60 degrees, the optimal angle to avoid serious injury. A number of studies have proven their efficacy.

Maryanne’s non-injectable arterial connector (the NIC) enables conventional arterial line sampling for patients in theatre or intensive care with the huge bonus that it is not possible to accidently inject medicine into it. This prevents wrong route drug administration, which, while rare can have terrible consequences including in the most extreme circumstances, amputation.

Peter’s PneuX invention has also been proven in studies to reduce the rate of ventilator acquired pneumonia (VAP). In its guidance, NICE quotes a plethora of studies including a recent UK randomised control trial which found that PneuX tube halved the rates of VAP after cardiac surgery from 21% to 10.8% patients. Bearing in mind VAP has a 30% mortality rate this is very good news, and would mean many more ITU beds available across the NHS.

Chronic Obstructive Pulmonary Disorder or COPD is the second most common reason for hospital admissions in the country costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% people with COPD are unable to take their medication correctly. Simon’s support system known as myCOPD, has educational, self-management, symptom reporting and pulmonary rehabilitation aspects, all delivered online.

Robert’s innovation helps people with Clostridium difficile, a serious bacterial infection affecting the digestive system, who have a one in six chance of dying within 30 days. Antibiotics are the first treatment and cure the condition in many cases. But for a proportion – about 20 per cent – antibiotics do not work. A frozen microbiota transplantation will cure 90% per cent of these patients.

UroLift is an alternative surgical procedure for the treatment of the common condition of benign prostatic hyperplasia, where the enlarged prostate makes it difficult for men to pass urine, leading to urinary tract infections, urinary retention, and in some cases renal failure. It is considerably less traumatic than existing surgical treatments.

Guidance on the new tariff

Guidance came out from NHS England recently, circulated to Finance Directors. However it will be important to others such as CEOs, COOs, Medical, Nursing, Midwifery and Clinical Directors, Operational Managers and Patient Safety leads are aware so that high rates of uptake can be achieved quickly.

We have in the past bemoaned that the NHS doesn’t support clinical entrepreneurs, and that the period between discovery of an innovation and its widespread uptake at the often quoted time of 17 years is too long.

Here we have a handful of fantastic inventions that improve safety and reduce cost, devised by UK clinicians who have been hugely supported by the NHS to date. Increasing uptake is now down to all of us. What about getting over 50% uptake in 17 months instead of 17 years? Are you up for ITT?