Pharma Market Access Insights - from Mtech Access

Innovating for better health – research, collaboration and innovation in the NHS

• Mtech Access • Season 4 • Episode 2

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How and where can innovation drive improvements in care and deliver better health for the population?
How is the NHS looking to collaborate with key partners across industry and academia? What innovations are set to transform care? What role do Academic Health Science Networks (AHSNs) play and how can partners best engage with them?

Prof Phil Richardson (Chair and Chief Innovation Officer, Mtech Access) is joined by Bill Gillespie (Chief Executive Officer, Wessex AHSN) to explore innovation in the NHS, the role of AHSNs and the potential for greater collaboration across our sector, in our latest NHS Whispers webinar.

Learn more at: https://mtechaccess.co.uk/innovating-for-better-health/

The episode was was originally broadcast as a live webinar on 24th February 2023.

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- [Narrator] Welcome to this Mtech Access webinar. At Mtech Access, we provide health economics and outcomes research and market access services from strategy through to implementation. Our unique NHS relationships guide and validate everything we do in the UK. We work with over 80 NHS associates to bring our Pharmaceutical and Medtech clients authentic insights into the NHS. We can help you answer key questions related to the NHS, from how to communicate with integrated care systems, places, and primary care networks, to how to capture pathways of care. Get in touch today to discuss your market access goals. First, though, I hope you enjoy the webinar.- Hello everyone and welcome to this NHS Whispers session. I'm Phil Richardson, and today we have a really interesting session on innovating for better health. There's a great mix of audience, industry, NHS, and academia all coming together to focus on a conversation on innovation. I'd particularly like to welcome our NHS associates who play a key role in what we do. And for those who don't know us well, Mtech Access is a specialist health economics outcomes and market access consultancy. We've got a really strong track record in delivering expert advice and support, particularly focusing on Pharmaceutical and Medtech clients. We're also today working in collaboration with the NHS, and it's great to bring all those themes together as we focus specifically on research, collaboration, and innovation in the NHS. I'm delighted to welcome our speaker, Bill Gillespie. He's Chief Exec of Wessex Health Science Network. And Bill and I worked together in the a AHSN for a long time, so it's a pleasure to be able to bring someone who I've got firsthand experience of working with in the AHSN, and it's brilliant that Bill is with us here today. So welcome Bill, it's great to have you here.- Thank you Phil, great to be here.- Fantastic. So would you just please take a moment and introduce yourself and explain a little bit about your role?- Right, so a bit about myself first. So I've been Chief Executive at Wessex AHSN since 2016. So that's covered the period when we have moved from AHSNs operating very much as autonomous AHSNs, to working much more collaboratively to both support local and national priorities. Before that, I've had a pretty varied career in NHS management, working in most parts of the system. So I've been a PCT chief executive in London and in Kent. I've been a director in a strategic health authority. I've been a director in an old-fashioned district health authority. And at one stage, I was a civil servant, in the days of regional offices and NHS England. So I've been through every sort of reconfiguration and change over the past 30 or so years that the NHS has been through.- Wow, I mean, that's brilliant. So you've seen the skeletons as well as know where they're hidden. And you've got some brilliant experience. So it's fantastic that you're here with us today, and I'd love you to be able to draw on all those things,'cause I'm sure lots of people listening in understand innovation in its broader sense, and understand bringing products and services to market. But there's probably less of an understanding of just how does the NHS work, what role does the AHSN play, and obviously that's changing at a time where everybody's trying to understand. So there's a mix of trying to understand, historically, where things were and currently where things are. And I just wondered if a starting point if we'd start with, well, what is an AHSN? What does the organisation do? How does it fit in the broader ecosystem? I think that might be helpful.- So we've got a number of key briefs. So one is to support innovators in all shapes and forms. That can be large companies, that can be SMEs, it can be clinical entrepreneurs, it can be patient carers who have an idea. So our teams that focus on support for innovation and innovators see all forms of innovation. We also have a brief around supporting the adoption of innovation at all stages, from working with researchers to support early stage work, right through to beginning to test proofs of concept, pilots, right through to beginning to think about, well, this has got market authorization, this is promising, how can we scale this? Alongside that, we work hard to help the service learn about the adoption of innovation. So we have an evaluation function, which both evaluates in terms of what is the impact of the adoption of innovation, but how do we continuously learn about the process of adoption of innovation? And just to reiterate, that's the interesting thing about AHSNs, is the way in which we work both at a local and regional level, but as 15 at a national level. So just to put some quantification on that, if you look at the impact of the 15 across England for our current licence period, our stats show that over 2 million patients have accessed innovation through work that we've been involved in. Companies who report on our economic growth survey annually say that we've supported 1.3 billion pounds worth of growth, over 7,000 innovations supported across the 15. And again, companies reporting five and half thousand jobs either created or supported through the work that we do. So that's an idea of the scale across the 15 working together.- Wow, that's fantastic. That's a huge impact across quite a wide sphere, and I think, I guess, I would struggle to identify an organisation that sits within the NHS ecosystem that does reach out into the patient community, reaches out into the entrepreneur community, works with clinicians on the frontline, works with academia, and actually does it in a scientific way that has rigour. So I think achieving those things, trying to pull those different elements together, is pretty impressive, Bill, frankly. And I've seen firsthand how hard the teams work to do that. One of the things I get asked though is, if that's the role of an AHSN, what's the role of an AHSC? So there seems to be a centre as well as the network. Are they the same, or is there a difference?- Imagine a sort of Venn diagram. And as you know, Phil,'cause I know you were very helpfully involved, we've been in the process of establishing really an embryonic academic health science centre for Wessex, Wessex Health Partners. So the way I would describe it is AHSCs, in our case, Wessex Health Partners, have a responsibility to support and nurture the totality of the research and innovation ecosystem. So they are responsible for doing research in all shapes and sizes that impacts on health. And that's increasingly not just clinical research, although that has clearly remained central, but can be research particularly relevant maybe to this Medtech audience in data sciences, in engineering, in psychology, in social care. And they have a broad responsibility for translation into impact, and they have a responsibility for education as well, and the quality of education. So if you look at the criteria that NHS England and IHR look for in AHSCs, it's that end-to-end leadership around the research and innovation ecosystem. Within that ecosystem, I would say, AHSNs as the leaders around direct support to innovators and in that process of translation into adoption in the system. So we're part of that consortium. We don't do everything. But increasingly we found, well, we found when we did some work two or three years ago in Wessex, we found, I talked to people like you, to clinicians, to academics, and there was no line of sight from research right through to adoption. Everyone was doing terribly well in their bit of the system, but the system wasn't standing back and saying,"How good are we at every part of this," and ensuring that every part of this is joined up to ensure that we're getting great innovation in the first place, and then we're getting great innovation into the hands of clinicians and patients as fast as possible?- That sounds great. I'd love to, in a minute, come back to that, because I think there's definitely questions from the audience today about access, and where to start, and who to go to, and what kind of questions to ask. But I'd like to come back to that in a second. But what intrigues me is, having worked closely with you for a long time, is your philosophy around innovation.'Cause you don't seem to have that sort of fanciful notion that,"Yeah, a lot of things are going to be invented in garages.""It's all going to come together""and we're going to save the world." I think it's really good to get, you know, you have a more grounded view. Obviously you encourage that type of innovation. But I think it'd good to share with people your philosophy,'cause it might help people just reorientate their thoughts less around a product, and much more around how they think about it.- Yeah, I'd be happy to do that, maybe to manage expectations. I think people, perhaps understandably, are constantly seeking a blueprint or a holy grail around,"How do I do this?" There isn't one. I think there's an approach and a set of maybe principles and understanding that help, and I can say a bit about that. So what what I would say is where we sit in the big system, we rub up against policy, and policy around life sciences, and policy around the NHS and social care, and policy around industry. So there's a policy bubble that we rub up against. We rub up against the service. And you, Phil, will know that, but the service, which on a day-to-day basis is massively stretched, simply delivering day-to-day high-quality care. And we rub up against academics and research in the research culture, which is different again. And then we rub up against and work with the community of innovators, as I say, whether it's large companies, SMEs, and so on. And I guess we are trying to facilitate a much stronger interaction between those sectors, in part because out of that in the jargon, out of that cognitive diversity, you're much more likely to get an understanding of the needs that need addressing by innovation and of some sparks between diverse perspectives that leads to innovation. And in turn you're much more likely to get a greater understanding of some of the barriers and some of the levers to support adoption. And the other thing I'd say, kind of in a word around philosophy, particularly around innovation adoption, is think very hard about capability. What is the capability that is the object of the innovation, as opposed to just the technology itself? And by that I mean it doesn't matter whether it's a pill or a piece of Medtech, at the end of the day, there is an interaction with humans, whether it's clinicians, managers, decision makers, or finance, the system, or indeed patient and carers. And the capability that enables full benefit from the Medtech needs to be taken into account as well. If I could plug another podcast, another webcast, I'd strongly urge people to listen in on "BBC Sounds" to an interview that Jim Al-Khalili did with Ken Gabriel on the Life Scientific some years ago. Ken Gabriel was, at the time, he compounds the story where he was the Chief Exec of DARPA in the States, the Defence Advanced Projects Research Group. And they were doing work on the stealth bomber, which of course was invisible, that was his proposition. And he tells the story about where the military were trying to get the budget for this zeroed by Congress because their view of a better bomber was that it was going to be faster and more agile. So there's an interesting example of the military thinking, actually, the technology, what we want is faster and more agile, and an innovator coming in with something completely different. So it's an interesting, I think, probably one of the most starkest illustrations of some of the tensions that we face when we're trying to bring in particularly disruptive innovation into the service.- Yeah, I think that's helpful. I think the key thing I'm drawing from that is there is something around understanding the so what question. There's something about what's the difference you're trying to make? And you know, I've, similarly to you, have lots of people talk to me about the features of the thing, whatever it happens to be. But it's the translation into what impact it's going to have and why it's appropriate to be part of a bigger solution or a replacement or something else. So I think the difference you're trying to make is quite an interesting way of looking at it.- Yeah, the other thing, just to add to that, and I think you felt this when we worked together too, is when we talk to clinicians and colleagues in Wessex about what do they want from us, it tends not to be specifics. It tends to be, we like the space that you create that enables us to try things. To not be focusing on the day-to-day operational pressure. So there was something incredibly important in a highly stressed NHS for agencies, that in collaboration with industry and in collaboration with clinicians and others saying,"You know what, it is really important""to find the time to try things in a controlled way,""but without sometimes the suffocation of, right,""what's the metric for this going to be in three months?" Because actually that doesn't, in the initial phases of development, lead to strong partnerships. You need that space to be able to say, "Let's look at this,""let's work together to test,""and let's do this in an environment""where the partnership is strong enough," whether that's between industry and clinicians or industry and ICS, to learn from as we go along in doing this. It's a difficult space to carve out, but it's a really important one.- Have you got any examples, without breaking confidence of what the product was or the provider, have you got an example where you can talk us through something that came into the the AHSN, looking at how you scored some element of adoption and then looked at how you might have scaled or at least the starting point of scale, just to bring it to life for people here? And some are coming purely from a Pharmaceutical point of view, so they're looking at it from a molecule viewpoint, which may not be a technical one. So they're thinking how do I engage with the changing landscape in the NHS? How do I become relevant in the new conversation, which is less about identified therapy area and much more about holistic patient care? And then there'll be some thinking more particularly about a Medtech intervention, whether it's a plaster at one end, CT scanner, or even a digital app. But I just wonder if there's some way you can bring it to life.- I mean, there are some I can name, because there's sort of public domain programmes. They're part those statistics that I sort of reeled off, and then there's one that I can give, which I can just sort of give the sort of look, here's an archetype. So one relates both to Medtech and to Pharma actually. so Wessex, one of the national products in the rapid uptake products over the past 18 months or so has been FeNO, a diagnostic that supports the accurate diagnosis of asthma. And it's probably a familiar story in that the evidence base for effectiveness of FeNO is long established, but it took some time first to be adopted in secondary care, but then very little by way of adoption in primary care. And for the past two years, Wessex has been the lead AHSN working with all the other AHSNs to support the adoption of FeNO in primary care. And as of January, the market has grown. So we're looking at nearly 1,400 FeNO devices being adopted within primary care, and over half a million consumables. And so the other interesting thing is that's a market, that is an actual market, it's not a single vendor. It's a market in where we've been working with a number of companies in that space to support adoption. Patients are benefiting. What's worked, we've had really strong clinical leadership, coincidentally, from within my patch, and Dr. Tom Brown, Respiratory Physician at Portsmouth, and Dr. Andy Whitmore, GP in Hampshire, who's also a clinical lead for the British Lung Foundation. So incredibly important clinical leadership, fantastic patient engagement. Patients telling the story of how their lives have been transformed by getting an accurate diagnosis and then getting onto the right medication is absolutely compelling. But fantastic links into Health Education England. So the educational packages developed by Tom and Andy. Hundreds of ours, we know from the website statistics have use of that. And that's connected to another theme that we might come onto. So in your old stomping ground, what we are now doing, beyond simply supporting adoption is to say how can we take national policy work on secure data environments? So joining up data across a health system, how can we do that and take FeNO as a use case, endorse it, and begin to federate various bits of data to understand the impact of that increase in adoption in a health system? So the sort of data that we're working with Dorset to join up on FeNO is things like FeNO activity, prescribing trends, medication adherence, emergency department attendances, emergency hospital admissions, speed of diagnosis, unscheduled primary care visits for asthma. So you can see, and Dorset is saying,"Yeah, we think we can join that up." So you can start to see an environment in which, as we build secure data environments, you have the facility in some systems with advanced data skills to join up those data sets and be able to say to our system,"Look, this is the real world impact,""not a clinical trial impact,""the real world impact of adopting FeNO""at scale in primary care." And I'm very optimistic about that. I think that's a huge benefit to systems, and I think if we invest in this and continue to develop it, it will be a huge benefit to industry too.- Yeah, I think, Bill, that's a fantastic example because the essence of this was it was a technology, it was a science that was understood but hadn't been widely adopted. There were clearly solutions available, but I think what you've done has painted a really rich picture around all of the key stakeholders in this. You've mentioned NHS England, you talk about a big school of patient groups, you talked about clinicians in different settings of care, primary care, secondary care, you've talked about needing to work with the digital teams, you've talked about working with trusted environments, and I know you're working with Chris Kipps on a TRE bit, so you're working with an academic input. So all of those things coming together, I think it's really helpful for everybody to understand this really is an ecosystem of key and important players. And I think we compare and contrast that to the traditional world of medicine, where it was key prescriber or some key opinion leaders and then some prescribing for use type approach. You're painting a really different picture, and I think it's really helpful, that's been a great example, too. And we'll share, after the podcast, we'll share out the links to the video you mentioned earlier, the example you mentioned earlier, and to the FeNO project,'cause there's some really good work done today. But I think that's a good case study to help people orientate around how to... You need to be able to mimic this with your partnership model, with your science model, with your clinical model, you to be able to mimic this to engage effectively into innovation. That's my takeaway, I think, from that. So that is really good. If I then come back to some of the broader questions that come from that. You hear some horror stories with Medtech, where somebody's had a great idea, they believe they fully tested it with everybody and everything and it's a great answer to a challenge in a therapy area or a ball therapy area. And then something like 10 years later, or 15 years later, or some massively long time, they're still trying to get access to somebody to do something with it. And then other stories, really positive stories, which is in a relatively short period of time there was traction happened, and it was very quickly into play, and it was in patient's hands and something was happening, notwithstanding the regulatory steps. But there's two sort of different stories. What's your perspective on how such a wide variation exists, and are there things we can maybe think about doing differently that might help that?- That's a good question, and to give people a bit of hope,'cause we all know the horror stories, but pretty rapid market access can happen. So, another example, again, that you'll be familiar with from your Wessex days. So S12 Solutions, so this was a digital platform created by an approved mental health practitioner, who in 2017 said, "Look, my process for securing""section 12 doctors to support assessments of people""who may need to be admitted to hospital""is based on tatty bits of paper." And Amy Manning from S12 Solutions developed a digital platform that essentially digitised the whole process of creating people doctors when they were willing to be on call for section 12 assessments, the process of them making claims to be paid for being on assessment. So it basically digitised that whole process. Wessex supported her, my team supported her through our local health innovation programme. We supported her and the company to go on the NHS Innovation Accelerator. S12 then became one of the one of only two innovation technology payment digital technologies. I just checked the website, their website, there are now over seven and a half thousand approved mental health practitioners, sending us to health doctors and claims processes, use their platform. It's in over 70% of Trust in England. And in 2021, the company was bought by VitalHub for several million. So that was sort of like four years after starting. So that is about as interesting, who spotted the need, actually, someone at the coal face who said there's a problem here that really needs a solution. So it wasn't a sort of solution in search of a problem, it was someone at the front line saying this is a problem. So that's kind of the first lesson for anyone, which is test out that you haven't got a solution in search of a problem, that there is a genuine problem that is causing pain somewhere in the system. Then the other thing that we did with Amy and the team was a real world evaluation in Hampshire. So you began to test, is the value proposition... It's not just... It's important that actually we're getting assessors to access, to provide assessments. But actually there was a whole backend value proposition too in that it saved money around claims processing, it improved governance, et cetera, et cetera. So there is something about trying to ensure you're working with the system to do a real world evaluation. Then the other thing that happens is, particularly with AHSNs, you get that sort of snowball effect on something that's really promising, where people say, "Look, this is a company""that's willing to partner, willing to learn,""it's a really promising innovation," and you start to get a critical mass of AHSNs supporting it as well.- Yeah, that's really good. I think that's a great example. I think what I love particularly about the S12 example is that the people that they needed to talk to to make the change were going to be adversely affected initially by the change that was being proposed.'Cause this was about a sequencing of S12 clinical availability, which was following a different incentive pathway that this new one was proposing. So I think it's a really good example of overcoming quite a key stakeholder group's investment in how they currently worked,'cause it was going to disrupt that whole process. So some people often run up against things take a lot of time, even with willing participants, but this was an example of a critical stakeholder group wasn't necessarily willing, initially anyway, to engage. So I think that was good. But it is a good example of how things can get done. And that was a whole business life cycle, really, in four years, you've just talked us through. So that is phenomenal. I mean, the answer to my next question to you will be, obviously, ring Bill, but if I then sort of ask, or you to perhaps, have a go, as a first, if somebody's really interested in getting engaged, they want to work with innovation, they want to work with the NHS, they can see they can add some value. Even if we stick with just the a AHSNs, where do you start? Where does somebody go? That was my phone Bill, obviously, was my answer, but what would we do?- I mean, the straight answer is speak to your local industry team within your local AHSN as a starting point. Because actually, your local, there's the chance of actually getting in, having a face-to-face meeting, even in these virtual times where it's possible to get a different sort of conversation about opportunities and to truly understand where the company's at in terms of the work it's done, the readiness level of the technology, et cetera, et cetera. The other thing, and AHSNs talk to each other. Well, let me tell you what doesn't work. Sort of mass going out to 15 doesn't work. In fact, it's worse. You get an abreaction because then the industry needs to talk to each other and say,"Well hang on, we've got the same company approaching 15." But what does work is we've had examples where it may be, let me get you... We've got major strengths in respiratory in terms of academic expertise and so on. It may so happen that in the particular quarter, or six months year that we're in, the respiratory academics and so on, or clinical champions have got some capacity, but actually the system itself has got other priorities. Now, that's where you can have AHSNs linking up and saying, "Okay." You may get two or three AHSNs working together to say,"Okay, you've got an ICS,""where this is absolutely top priority,""and we've got some academic expertise""that wants to be part of this.""Can we work together?" So that can work. The other thing I'd say is if the technology is very niche, then do think about the NHS Innovation Service, which has just been established over the past year. It's a national platform, Wessex AHSN and Northeast North Cumbria AHSN, between us, we run the needs assessment service of that service so that the the first bit of assessment, a dialogue with a company about what their needs are is done by us. And the great thing about the Innovation Service is that, is that is linking into, currently, 25 support organisations across the UK. So 15 of those are AHSNs, but other bodies like NICE, like MHRA, like the Scottish Technology Group, and bits of NHS England itself, like Transformation Directorate. And what that is leading to is a much greater understanding across those support organisations of the support that they can offer and a willingness to try as much as possible to join up that support. So the company doesn't have to basically be the entity that joins up the system. The system is trying to join up how it works. Now, it ain't perfect yet, but I would say it's come a long way in the past 12 months.- Yeah, thanks Bill, that's really helpful. So my sense is that there are lots of front doors through different AHSNs, but come through just one door, and the AHSN itself and the connections you've just talked about will help the join up to stop people having to second guess everything, and certainly avoid talking to everybody about the same thing all at once. That feels like that would be unhelpful.- Yeah, and if it's particularly niche, I would suggest NHS Innovation Service, and you've got your automatic bit of triage around,"Okay, where might the best support be?" And an acknowledgement that that might not just be one bit of the system, we might be sort of saying,"Well, you need to speak to NICE""and you need to speak to someone else."- Yeah, do you do any training education and support for people to help them understand what innovation is? So I think I've got the gist of the something coming to you, but is there a bit which is when you've done the triaging, said no, you really have got no idea, really this doesn't fit with anything, you'll need to go in and think about it. Do you then signpost, or help, or educate? What kind of role do you play there?- I don't see those. There are some companies we see, both in Wessex and in that Innovation Service, where we're just saying,"Look, this isn't suitable." And that may be just about the level of development that needs to be done. If people look at the NHS Innovation website, or indeed our own company engagement questionnaire, which is now standardised across the AHSN, there's some basic information that we ask for that enables us to understand how much thought the company or the innovator has done. So that's for two reasons. One's so that we can consider that and prepare to get best value out of any face-to-face or virtual meeting. Also, there'll be some instances, and I haven't got the numbers, where actually if an innovator isn't able to populate some of the most basic fields there, then they need to be going away and doing some further work.- Right, got it. No, thank you, that's helpful.- The other thing I'd say, Phil, is we have done some work across the network, and what what we have seen is it's really what seems to work is AHSNs working across all technology readiness levels. It might be tempting in some circumstances to say,"Right, we're only going to focus on near market,""because that's where you convert it into economic growth""and so on and hit the metrics." But actually the reality is you need a balanced portfolio. Because a lot of this, you'll know. some of the companies we've worked with where essentially we've worked over a number of years with them and partnered with them as their technology has developed through early stage, right through to your class... I mean, regulatory approval at one class and then they're going onto another. And so we work across all TRLs.- Okay, yeah, that is good to really to know, because I think there is sometimes people who think"I've got to have a completely finished answer,""and now I need to try and sell it," is the kind of mental model. And I think you're describing a much more collaborative model to help people get orientated, help people understand what's needed, help set the networking together. So that is my sense. But if we just step back from it for a second, we work with a number of people who say,"We don't necessarily want to innovate""and produce a product ourselves at the moment.""We'd like to work with Hospital Trusts,""or Primary Care Networks, or Integrated Care Boards""to help them on their innovation journey,""'cause we think we have a lot to offer in that space." So they're almost wanting to engage with systems and collaborate. Is that something that you see emerging, or would that be a relatively new thing in, or if it doesn't exist yet, can you see how it could work?- No, we've seen some of that. In fact, we've sort of brokered one or two of those partnerships. Yeah, it's a bit like being a marriage broker. You need a sense of the company and the organisation. But for example, we've brokered a relationship between one large Medtech company and one of our large providers that has subsisted over the past two and a bit years. And that's less about technology per se, and more about we're both in a very fast moving environment, can we take a bit of time out as senior teams to understand each other's world, understand how a large Medtech company is responding to a fast moving market, what it's doing with its staff to motivate them, to energise them, da-da-da, and respond to a moving market? And likewise for the Medtech company to understand what does it feel like to be a medical director and a large provider or a Trust, what are your priorities? It's almost sort of cross-sectoral OD, and my feedback from that has been, it's been very positive. It kind of goes back to this point about cognitive diversity. Actually, how do we start to recognise each other as sort of partners as opposed to just suppliers and customers?- I think that's a really good way of framing it. Certainly there are some perceptions around suppliers and customers that exist. There is conversations that don't happen, which I think could happen if people just thought more broadly. But if we take the mission statement of the NHS, we take the mission statement of industry, they're both saying we want to improve health for patients. So we're all sitting with a common denominator, and I think sometimes the conversations forget that and they get stuck on either internal KPIs, or internal processes, or product pipelines, or the equivalent. And I think what you've described, and certainly the experiences we've got right now, is there is a wealth of talent that wants to sit around the same table to solve a similar problem with a similar purpose. And there is definitely, there is... I would build on your marriage guidance and I'd say there was life partner guidance. Not really just a have got the right two together, it's how do we do it through the full life cycle of relationships? So, and obviously I would be keen to continue with you on that basis,'cause there's a lot of opportunity everybody can take part in that, would be my view. If we have a look at some recent things. So just want to take you to policy now, national policy,'cause we've all had fun with that over the years. And then the very recent launcher, the Medtech Strategy, that has been in play just a few weeks. Just really interested in any early thoughts you have on that, then I'm obviously happy to share, as you know, I'll give you my opinion on it too. But I think it'll be good just to get any take, if you've had any chance to reflect on it.- Yeah, thanks Phil, I saw. So I think it's an interesting read. I think a lot of the diagnosis of the challenges and what needs to be done resonates. I can certainly understand the big emphasis on sort of supply chain resilience, given everything that we've faced over the past two or three years. Interestingly, even in that area, so some of the resonance comes back to specific work that we've been involved in. If I take supply chain resilience, I think, and we ought to be feeding this back into DHSC, some of this is not just about the supply chain, some of the resilience is about how the NHS behaves. So for example, historically Wessex has always been very supportive of electronic repeat dispensing. During COVID, that took on greater prominence, both because electronic repeat dispensing took pressure off primary care, it supported social distancing, but it was also much easier for the supply chain in terms of managing delivery of drugs. So that's an example where the NHS is part of the solution to supply chain resilience as well as the supply chain. Another example is, so there's a lot of emphasis on have we got things right in terms of single use versus repeat use tech? And again, you will know, we've got, in Southampton, considerable expertise in biofilms, considerable research expertise in continence products, and currently underway is a three-year randomised controlled trial on the non-inferiority of repeat use, intermittent use catheters. So it will be interesting to see how that goes, but that offers a sort of opportunity for an innovation that, yes, it disrupts the market, but every disruptor is also somebody else's opportunity. But it also hits NHS sustainability goals if that trial comes through and shows that actually there is non-inferiority. So that resonates. The other thing that resonates is the emphasis on joining up data to support real world evaluation, which we talked about earlier on in this discussion. The bit I think is glossed over is implementation capacity. It's referenced almost as a throwaway towards the end of the document. And I guess what I would say is everything that is in the strategy is great in terms of if it gets taken forward and adopted, but that in itself may not be sufficient. If we go back to the FeNO case study, you can have things with an amazing evidence base, but you still need change management capacity in the system to support a highly stressed system to adopt a skill.- Yes. Yeah, I think that's really interesting. And I think the other bit is that real world evidence isn't just about clinical data real world evidence, it's the patient experience, it's the clinical experience, it's the multidisciplinary teams experience, it's the setting of care experience, it's the overlay of the socioeconomic local data, or it's the employment data. So there's a whole load of layered information that needs to come together to say,"Where does the solution plug into,""the overall solution that's currently in play,""and what needs to change or adapt to come across it?" And I think I quite like your OD view earlier, and I've certainly spent a huge amount of time in the space which says we've got to address things like language. The language isn't quite the same. And coming in with a good data set and saying,"Well, mine definitely works." It often has been done in quite a controlled environment. And then you put into the messiness of how things work. There is often a different result. It's a bit like electric cars. 300 miles is the mileage on this brand new something you might buy, but in the cold weather, when you've been driving spritely, you've got 120 miles out of it. So the real world data is then very different to the laboratory based type data. But your point though about coming in and helping make that work. Are there pointers that you think, just your reflection on the strategy, you would say to people who are thinking about,"Well, how do I then engage?"'Cause there's lots of energy. There'll be people running around, both in industry and in the NHS thinking,"Right, we need to do something with the Medtech Strategy,""it's a new policy that come out,""and we've got a whole lot of things we have to follow." And somebody somewhere will have created a spreadsheet with a hundred things on it for compliance purposes. Is there advice?- Maybe some of my colleagues will shoot me for it as I give this advice, because what it could end up with is a queue of people knocking on various doors. Within the next month or so, various parts of the NHS will be putting bids into NHS England for significant sums of money to support the development of secure data environment. So this this goes back to... So don't know how much all the audience knows about this, but this is about routine data, not just research data. So routine health and care data, and ultimately citizen health data as well around health, and could be a little public health data. How do we create an environment within which people who are supporting research or real world evaluation can go into a secure environment with all the proper governance controls and use that data to understand impact, research, et cetera. So there is something about understanding, wherever you're based in the country, what's happening in terms of secure data environments in your patch and where they might be headed. Now, the reason I'm slightly tentative about this is they're still early days. If I give an example from Wessex, of the use cases in Wessex that we are doing work on, are one, FeNO, two is joining up routine cancer data with genomic data to identify whether there are second in line treatments for particular patients. And the third use case is around pre data in the community before someone's admitted to critical care, so all the ambulance data and so on, because all the evidence shows that actually there's a lot of rich data there that isn't joined up that could inform pathways of care. Now, I think anyone in Medtech should be thinking, particularly if you've got a technology where the cost of the technology may sit in one part of the system, but the benefit sits elsewhere, and therefore you need to join up the data across the system to help make the case. If that's the case, then you might want be talking to your secure data environment leads in the NHS to say,"Look, is this something that is of interest?"- Yeah, that sounds great. So that really just brings... That's a great summary over Medtech,'cause I think it just brings it all to life, which actually what we're trying to do is bring the data together around the technology and around the patient, as I mentioned earlier. And I think that's a good way of doing it. We're getting close to the end of the time, which has just flown by, but I wanted to come back to philosophy and insight really, and just to get your your views on what's the next big thing? What's the next big thing in innovation, in health? What should we all be thinking about, or looking at, or looking out for? What do you think it is?- Yeah, I guess increasingly we see certainly software as a medical device. So it's not the next big thing, it's kind of arrived, arriving. So things like closed-loop monitoring around type one diabetes is already here, and showing enormous benefit to patients and carers. So I think software as a medical device in a pathway that empowers patients and carers, but also enables appropriate escalation where it needs to be within a pathway. It feels like a very fertile area. I think the other area, going back to secure data environments where people have technologies, understanding the particular relevance to particular populations in terms of, this comes back to inequalities, whether it's of inequalities of access or outcomes, understanding that there may be a particular line of approach, which is about addressing inequalities that enhances the ability to partner with the NHS.- Yeah, fantastic. So the next big thing is already here, and we should be...- But it's already here in embryo, I think, who knows what it'll be 10 years from now, how that will look. It feels really important.- Yeah, I completely see that. And I'm really glad that you didn't go down the ChatGPT answer, which says we need to put it all into an AI engine,'cause I think we'd all got quite distracted by that. But the software enablement bit, I think, is really critical. And that, for me, is not just about apps, that's not necessarily an app solution,'cause you can have it embedded quite deeply into pathways, into procedures, into automation. So there's a whole load of things that sit behind that. So I think that was good. Bill, we're out of time. It's been fantastic, as usual. I've never spent an hour with you that's ever felt like an hour. It's been an absolute pleasure today to talk to you about innovation in a broad sense, get your perspectives. It's been fantastic to listen to your answers and there's been lots of pragmatic things. We'll pick out some of the things you recommended we looked at and we'll share those with the audience. And then there's a couple of questions we didn't get time before today, so offline, you and I, if that's okay, we'll just have a go at answering some of those questions and make sure everybody gets an answer. Well, I just want to thank you very much, thank our audience for joining today and sticking with us, and I just want to leave with a I'm very excited about this whole space and I think all of us working together can make it work, and you've given some great examples of that. So thank you for today.- Okay, thanks Phil. It's been a pleasure speaking to you again. Thanks very much.- All right. Thanks everyone. Thanks Bill. All right, goodbye everyone.- [Narrator] Thank you for watching. If you'd like to find out more about our work with the NHS, or how we could support your market access goals, please email info@mtechaccess.co.uk or visit our website at mtechaccess.co.uk.