Beyond Ambition: Implementing the Life Sciences Strategy
The UK Life Science Sector Plan is an ambitious vision, but how can we ensure it delivers?
Welcome to the fifth instalment of Chai With Aditya. Slight delay with this week’s post due to the bank holiday.
While reading the Government’s new Life Science Sector Plan, I was interested in seeing the ambitious tone and vision set for the sector. The Government promises to “unlock the full potential of health data” and “streamline the adoption of innovation into the NHS”. But remembering a conversation with a Clinical Director, we still have systems in the NHS which don’t even talk to one another. This highlights the disconnect between high level policy and front line reality. So how do we ensure this Plan is meaningful to patients?
The Strategy-to-Impact Gap
Through my time observing digital health and other novel initiatives (like a new clinical pathway) across a variety of setting, I've noticed a recurring pattern: the announcement of a grand strategy, a promising pilot, and finally its titanic demise through insufficient system-wide adoption and scale. The Plan will need to over these same challenges if it to succeed. The quality isn’t the issue, it’s the gap between strategy and impact, and the last mile problem which I’ve talked about frequently in the blog.
The "Last Mile" Problem for Life Sciences
In my previous analyses, I've explored healthcare's last mile problem - the challenge of connecting national ambitions and strategy with frontline delivery. The Life Sciences Sector Plan faces its own version of this challenge, which from my experiences I pin to three fundamental barriers:
Misaligned incentives
Fragmented infrastructure
Workforce capacity
Misaligned Incentives
The first barrier is misaligned incentives. The Plan focuses on generating economic value and R&D investment. However, the issue is Trusts are incentivised to balance their budgets and meet immediate operational targets (A&E 4 hour standard, Referral to Treatment, and Faster Diagnosis and more). Having worked in one of the most financially challenged Trust’s in the country, I saw the increasingly difficult decisions which must be made and the trade-offs associated. Technology which could deliver long-term savings often required upfront investment or a temporary dip in efficiency & performance. For a resource-strapped Trust which is already under the spotlight for performance, the costs cannot be justified. The Plan’s focus on creating a "pro-innovation regulatory environment" doesn't address the immediate operational and financial pressures that prevent an NHS trust from adopting the very innovations that environment is meant to foster.
Fragmented Infrastructure
The second barrier is fragmented infrastructure. The Plan points to a vision where data sharing is seamless and technology is rapidly adopted. The reality on the ground is we use systems which do not talk to one another and yet information is needed from multiple systems for patients. Making things worse, one Trust can have brilliantly interlinked datasets and warehouse setup, while a neighbouring Trust in the same ICB doesn’t and so there is post code lottery in care as one Trust doesn’t have access to the same data. This makes implementing a single technology, such as an EPR system across a single patch very difficult, requiring bespoke IT and consultancy support. There have been developments however through the Federated Data Platform from Palantir, but more needs to be done.
Workforce Capacity
The third barrier is workforce capacity. Adopting new life science innovations such as novel and more accurate diagnostics, procedures or digital tools requires more than access to the technology itself. It requires training, new clinical pathways mapped to NICE guidelines (or other national standard setting organisations), and more importantly, the mental bandwidth for clinical and operational teams to implement. There is no spare capacity in time and resources and so transformation, no matter how transformative (unless its patient safety driven), is seen as a burden and unnecessary luxury.
Pathways to Success
In an effort to cut red tape, the Plan calls for streamlining clinical trial support and establishing a single front door for industry. But to achieve this, there needs to be a focus of moving away from a top down approach to a co-designed implementation pathway.
One suggested way for this is to create joint implementation teams that bring together policy experts, clinicians and operational managers. NHS operational managers have extensive knowledge on the wiring of the health system which clinicians and policy experts don’t.
The value of NHS Operational Managers is very understated, which is why I’m co-leading a roundtable with IPPR in September to explore how to get the best out of this group of individuals.
Furthermore, the health system must move beyond funding pilots, to funding adoption with central, targeted investments covering integration, training and overheads for staff. Success shouldn’t be measured by how much you’ve been able to CIP (cut in NHS financial language), but in improvements in patient outcomes and released clinical capacity.
Strategic Implications
Saying all of this, the Life Sciences Sector Plan represents a strategic commitment by a new Labour Government to healthcare innovation. Its success will depend not on the brilliance of the policy framework, but on our ability to bridge the gap between industrial ambition and healthcare system reality.
This implementation challenge is huge but it requires us to treat the "last mile" with the same seriousness and investment as the first.
If you could put one specific implementation mechanism in place to ensure this strategy succeeds, what would it be?