Innovation at Scale

Breakthrough discoveries are only the beginning. For Professor Dame Anna Dominiczak, the future of healthcare will depend not just on scientific excellence, but on the ability to translate research into meaningful change for patients and populations. The Regius Professor of Medicine at the University of Glasgow and Chief Scientist (Health) for the Scottish Government argues that the next era of healthcare innovation will be defined by smarter partnerships, digital infrastructure, evidence-led decision-making and the ability to take proven ideas from the laboratory into everyday clinical practice.As the UK seeks to maintain its position as a global leader in medical science, Dominiczak believes the challenge is no longer discovery alone – but adoption at scale. From precision medicine  and artificial intelligence to prevention and early diagnostics, she outlines why building a truly modern healthcare system requires collaboration between academia, industry and the NHS, alongside a willingness to stop what does not work and invest in what can deliver lasting impact. Entrepreneur UK finds out more…

Is the UK still a leader in medical innovation, or falling behind in delivering it at scale?
I believe that the UK and Scotland are leaders in medical innovation at the level of discovery research, clinical and population health research, application of precision medicine as well as translation from the bench to the bedside. I also agree that the most difficult step of health innovation is the adoption at scale for all patients and populations to benefit. It is difficult, but all 4 Nations of the UK are making progress, at times working in collaboration. One good exemplar here is the Accelerated National Innovation Adoption (ANIA) pathway and the Innovation Design Authority (IDA) in Scotland.

Is the NHS reaching a point where data and digital infrastructure are as critical as clinical capacity?
This is a difficult question as both are very much connected. Data and digital always require skilled people to design, operate and utilise systems. The vice versa is also true, skilled, motivated, research and innovation driven people understand the need and essential nature of data and digital. This is a virtuous circle. 

What is stopping biomedical research from becoming real patient impact at scale?
As mentioned above, biomedical research is very strong in the UK and in Scotland. But there is a need for translation of research discoveries into new drugs and new health technology innovations. This must be enhanced by a readiness and ability to change relevant clinical pathways to lead to adoption at scale. For all the above, we need partnerships between academia, industry and the NHS, aptly described as a triple helix partnerships.

Is UK healthcare innovation being funded and prioritised in the right way to drive impact?
I think we need to invest in health innovation as much as possible, especially in prevention, early diagnostics and better, more precise and thus more effective treatments. This is the only way to improve the NHS, to help patients and communities, but also to invest in our economy. Early prevention is the major way to prevent ill health, assure healthy workforce and increase productivity. There must be more focus and more emphasis on research enabled health innovation. This is an under-appreciated macro-economic force for good. 

Can the UK maintain its global position in medical science if delivery of innovation continues to lag behind discovery?
Yes, but not forever. I regularly participate in major international scientific meetings in my area of research, cardiovascular medicine, and I see very clearly that UK biomedical science is leading on discovery research, clinical trials and all other aspects of clinical and public health research. There is also major strength in guidelines and the use of health data and AI in clinical research. Innovative studies such as Our Future Health are leading internationally in precision public health. This will last for years to come. I think the next step should be the development and investment in well designed pathways to adoption such as the Scottish Accelerated National Innovation Adoption (ANIA) pathway and the Innovation Design Authority (IDA). In many aspects of these adoption pathways, it would be helpful and efficient to collaborate across UK and internationally. We have already started these processes, but more could be done. 

What does it take to turn scientific ambition into real-world healthcare delivery at system level?
It is essential to stop doing things that have looked like good ideas a few years back but have not worked. This is the only way to release the necessary financial resources to innovate at scale. Then we need to assemble collaborative, multidisciplinary teams to encourage a holistic approach to health innovation, remembering that the innovation, even the best AI driven innovation, will only work if we change the entire clinical pathway not just force the technological innovation or new pharmacological intervention on top of old clinical pathway. So, the system requires good and thorough horizon scanning, early prioritisation to progress to a fast strategic case, that would allow inform decisions which innovations would be realistic to adopt at scale. Those selected innovations then undergo a detailed value case development, which is a business case with the patient / community in the centre, full health economic assessment, and financial assessment. This then allows informed decision to go ahead into adoption at scale or not. What I briefly described here is the ANIA/IDA pathway we currently use successfully in Scotland. 

What will define a truly modern, evidence-driven healthcare system in the next decade?
I think that ANIA and IDA as described above are the start of what could be a blueprint for a modern research evidence-driven healthcare ecosystem. It must be informed by excellent real- time electronic health data, machine learning and artificial intelligence. We have evidence that it works, but we need to do more, bigger and better. This would require a learning health system, where each innovation pathway is underpinned by well curated research evidence, careful value cases and intelligent, collaborative prioritisation. This should be followed by full benefit realisation programme and a long-term assessment.  It will also be very important to introduce into this process a value procurement. In addition, stopping things early, if they do not work, is equally important to facilitate accelerated progress. There is also an obligation on all of us to design health innovation in such a way that it reduces health inequalities, this is very important and must be actively included in each step of the innovation pathway. The challenge is great, as far as I am aware no country world – wide has achieved all these components successfully. Thus, national and international collaboration will be a key element of the future success.