NHS acute trusts need a lot of technology. Infrastructure – cloud or physical servers to host software applications, broadband and wi-fi networks, and devices for professionals to use them on, enterprise IT systems to manage their operations and help clinicians to do their jobs, patient facing systems – from basic portals to more sophisticated personal health records or virtual ward platforms, along with innovation to streamline operations and patient pathways.
However, the process for finding out what is on offer, and then procuring it, is complex – for trust IT leaders and vendors. For a start, Ian Hogan, the associate director of digitally integrated care of the Northern Care Alliance NHS Foundation Trust, pointed out there isn’t just one health tech market – each class of IT effectively has its own.
“A lot depends on what you are in the market for and whether there are restrictions imposed by policy, or procurement guidelines, or things like that,” he said. “The electronic patient record market is a really good example. A lot of trusts will only enter the market when there’s a national initiative and funding.
“When they do, there’s only a handful of vendors. So, the whole process becomes very focused on procurement. You know what you are going to get, but it’s much harder to know what else you might want or need.”
Tight relationships, wildly competitive markets
Other sectors of the market are shaped by other factors. For example, the advisory board felt that when it comes to infrastructure, trusts tend to work with trusted suppliers, who already understand their IT estates, and can advise on upgrades and new partnerships.
Whereas, when it comes to apps and innovation, trusts can find themselves in a crowded market in which EPR vendors offering extensions to their systems, SMEs offering products developed at the start of the web 2.0 era, and new entrants are all competing for their attention.
Yet, even here there may be other forces at play. For example, ministers and policy makers may want to prioritise specific technologies such as flow systems to “address winter pressures” or virtual wards to “expand capacity” – which may slow progress in other areas.
Or, NHS trusts may be encouraged to buy from framework contracts intended to show that companies are financially stable, have met certain standards, and can offer specified functionality – but in doing so shut out new entrants or innovators who don’t know about or can’t comply with them.
Or, integrated care systems may be looking to establish IT strategies for their areas that encourage providers to converge systems by running joint procurements – which may lead to one solution being ‘picked’. Although, board members agreed, that won’t guarantee it will be deployed.
James Norman, who has worked on both the NHS and the supplier side, said: “Shared procurements can fail if there is a ‘not invented here’ mentality or they’re seen as ‘the big tertiary hospital trying to throw its weight around. Plus, there are genuine challenges in getting the resources together to implement and keeping them together if people are at different stages of readiness.”
Structural change needed to support innovation
The common theme was that, one way or another, the complexities of the NHS’ tech markets tend to favour bigger players with older technology than smaller players who may have more innovative ideas. The advisory board identified a number of things that could be done to improve the situation.
One would be for trusts to develop – and perhaps publish – long-term IT and procurement strategies. This would give those responsible for delivering them more time to scan the market and give suppliers a better idea of what they would be looking for – and when.
Nicola Haywood-Alexander, a former integrated care system CIO who now works for the police in Lincolnshire, said she had been able to start moving in this direction. She has established a target architecture and design priorities, and secured senior agreement that no technology will be bought that doesn’t fit with them.
But, at the same time, she is establishing arrangements to give vendors access to her team. “We have ideas for what we want to maintain and what we want to procure in each area [of our strategy],” she said. “We want to identify a number of strategic partners and work with them, so everybody knows where they are, and what we’ll be looking to buy, and where we’ll need development and innovation to succeed.”
However, to move in this direction, the NHS would need a much more stable policy and funding environment than it has experienced for the past decade or so. Ian Hogan said that as things stand “it is hard to plan more than 12-months ahead, because you only know what money you are going to get in-year.”
Even that money can come through very late. By the time NHS England has signed off on its plans and the Treasury has rejigged its budgets, a trust can get the money to run a procurement just weeks before deployment has to start.
Marketing works – if it’s impactful and focused on solving problems
Other ideas for addressing the challenges of the health tech market included: rebooting the Academic Health Science Networks, which were set up to champion innovation, but have a mixed record on helping SMEs; setting up new company and product directories; and revisiting the requirements of framework contracts.
Ian Hogan said: “From my point of view, the best thing the NHS could do is create a forum to improve visibility. The AHSNs haven’t really delivered what was hoped. We need a new way to promote technology and its benefits to trusts and to give organisations a way to reach us.”
In the absence of these changes, marketing and PR are going to play a big role in helping health tech companies to get in front of potential influencers and customers. The advisory board had strong views on what doesn’t work in this respect.
Cindy Fedell, a former NHS CIO who now works in Canada, said: “The chance to talk to a bunch of vendors, when I was refreshing or researching something, was great because they knew about the latest and greatest stuff and what is going on.
“But the flip side of that was getting sales calls when I had my head down. I got some terrible calls. Somebody wanted me to put something into one of our departments, and all he could say about it was that it was cheap! I said it might be, but it doesn’t fit with what we are trying to do.”
When it comes to what works, advisory board members said they still valued conferences and exhibitions. And they felt that direct marketing has its place. However, they argued that emails or calls need to come from a trusted contact, a sales lead with a good knowledge of the NHS, or a company with some name-recognition to stand a chance of being opened or answered.
Ian Hogan said: “I really value Rewired, HETT, the big IT shows, but there are a lot of stands, so you have got as long as it takes me to walk past your stand to grab my attention. That probably means you’ve got two or three seconds to tell me what you have got to offer. It’s the same with email. If I don’t know you and you don’t grab me, it’s likely to be deleted.”
The CIOs on the panel also emphasised that companies that want to sell to trusts need to do their research, understand their specific problems, and focus in on how they can solve them, rather than on what they want to sell.
In a very, very tough financial and working environment, they also emphasised that companies must be able to show return on investment, after accounting for the considerable cost of change that can be incurred from asking IT and clinical teams to retrain and adopt new systems or pathways.
Engage clinicians – but don’t sell to them!
Meantime, another approach that was not well received was companies going direct to clinicians or encouraging “shadow IT” – systems that have been bought by departments and put on the network, without the procurement, security, and IG safeguards that need to be followed.
James Norman said: “If you can engage your clinicians to act as another pair of eyes for what is coming onto the market, that can be very valuable; and clinical engagement is essential when it comes to implementation. But the CIO needs to work out where things fit into the business strategy and the infrastructure.”
Many of the challenges discussed by the board are not new. Chair Jeremy Nettle said that when he was involved with techUK: “I tried to find a way to put small companies in front of the service integrators [that had been employed by the National Programme for IT to digitise the NHS] because it was clear even then that we needed some kind of dating agency to show off what they were doing.” He believes this is still relevant in the market today.
Ian Hogan said: “We still need a beauty parade, because without one we don’t have time to go out and about to find the new ideas and the niche providers, and that keeps us stuck with what we know.”
