The and medtech: Four things to look out for in 2023

Oli Hudson, content director at Wilmington Healthcare, explores some key themes and developments in the NHS for 2023.

The NHS seems to go from crisis to crisis. My last article for MedTech Innovation News in October explored this in depth – and the problems seem more acute since then.

Issues in capacity, workforce, finance, and integration are creating a perfect storm, causing unprecedented numbers of patients to experience suboptimal care: a backlog in screening, diagnosis, treatment and care, extensive waits and issues with access and equitable services.

The NHS is trying to address these issues by policies intended to improve activity levels, enhance collaboration, and maximise efficiencies.

However, the struggles are plain to see and the impact on industry is wideranging. Here, we highlight four areas of change and how medtech should react.

This is throwing up new networks of decision-makers and stakeholders which exist in unfamiliar groupings, including clinical networks, provider collaboratives, and place-based partnerships, whom medtech needs to understand and access, and with whom they must build new relationships to ease access for innovation.

For companies seeking to partner with the NHS on patient identification or pathway change, other roles may need to be sought such as transformation leads. If your innovation depends on digital technology, you may need to work with a programme lead for digital at integrated care system level.

Outsourced procurement management seems to be coming to an end at a national level with NHS Supply Chain to take in the majority of medical procurement and clinical supply in-house.

“We are now operating in a more challenging economic environment, and we need to simplify how we operate and partner more expertly with our stakeholders,” it explained.

In this financial climate, more efficiencies are likely to be needed from procurement and more will be asked of suppliers to improve their offer on sustainability – including on long-term viability of NHS services.

HSJ reports that NHS trusts will have to receive Cabinet Office approval for any clinical and non-clinical spending over £10 million. NHS England in London will introduce the new controls first and then roll out to the other regions over the next two years.

This will apply to NHS and foundation trusts, shared procurement services and procurement hubs, and subsidiaries where the majority shareholder is a trust. It will cover framework call-offs and agreements, contract changes or extensions, and collaborative trust procurements awarding to a single supplier.

All expenditure over £10 million will be in scope, including new or replacement contracts or call-offs from frameworks, contract changes or extensions, framework agreements themselves, and collaborative procurement between multiple trusts with a single supplier.

For high value procurements this is going to present another set of criteria to deal with in contracting and tenders for industry.

In the planning guidance released in December 2022, NHS England states a core priority is for systems to break even by year-end.

This is a tall order when the majority of trusts are in the red and much resource is being taken up dealing with emergency services, hiring agency staff and attempting to deal with elective backlog.

Some payment for trusts is now being carried out on a payment-byresults basis, intended to encourage activity and this could change some trusts’ focus on how much work they do in certain clinical areas.

Wherever medtech does engage, value for the NHS will become ever more important. The value proposition will need to be honed to establish how your device can create efficiencies across the whole system, with all the costs of a pathway or service line considered. Staff time, theatre time, the mix of HCPs required to operate, and length of stay will become relevant to the sell as delayed discharge takes over some systems and leaves hospitals unable to operate at full capacity.

The planning guidance also prioritises service transformation. This could involve digital technologies and virtual services, preventive care models, new care settings such as community care models, and self-referral and selfmanagement.

Unfortunately, the stress on the system means there is little time for improvement and learning from best practice when enormous effort must be expended by NHS staff just to keep basic services going.

This means medtech must try to build projects locally where there are the opportunities, drawing on what has worked and where there is real-world evidence to suggest change could benefit other parts of the NHS.

Industry can help by engaging with four key areas:

1. Developing meaningful multilevel partnerships with the right stakeholders – understanding the who’s who of your clinical area

2. Investing time in developing a multidimensional value proposition –covering sustainability, accessibility and efficiency

3. Developing pathways for cost and clinical effectiveness, building in quality improvement with a focus on improving outcomes, and

4. Assisting the NHS to develop new delivery models that disrupt traditional ways of thinking, allowing us to rethink our current way of delivery.

Success in these areas will make a company stand out, as we go into a most uncertain year for the NHS.