The COVID-19 virus has had a profound impact on global healthcare provision, focusing care on the virus and causing the postponement of many routine and serious operations for other conditions. It will likely take years for health services to catch up. Yet amid the chaos, the virus has kickstarted a fast-tracking of innovation that could be the key to delivering a level of healthcare provision in the future fitting to the changing demographics of the global population.
There is, as the saying goes, no harder taskmaster than necessity. The past 12 months have seen unprecedented disruption to multiple industries, but the COVID-19 pandemic has also led to change taking place in months that would previously have taken years. Restaurants have pivoted overnight to home delivery services offering chef-created food to be finished off at home, while Tesco doubled its number of weekly delivery slots to 1.2 million – a figure that, before lockdown, was planned to take at least two years.
Unsurprisingly, frontline health services also had to change rapidly to face the crisis: students were thrown into frontline services; former staff were recalled; NHS workers were re-deployed from non-essential services and business facilities were repurposed into new hospitals in weeks. Healthcare systems, typically wary of untested change, sprang into action to address the crisis.
But perhaps the most remarkable success story has been that of vaccines. Less than a calendar year after the world woke up to a global pandemic, there are three vaccines approved to be used in the UK and USA with several others lined up for regulatory approval. The speed of the global rollout has been nothing short of sensational – quite unlike a typical rollout of new vaccines that, in ‘normal’ circumstances, might take more than a decade to come to market.
The pandemic has acted as a powerful impetus for change in the healthcare industry. Recent research from McKinsey has shown that two industries which have most increased their focus on innovation are the pharmaceutical and medical device sectors. But why is this so important and will it continue once COVID-19 is under control?
Rebalancing the scales
Innovation in medical technology (medtech) is uniquely important to the future of healthcare for two fundamental reasons. On an economic level, costs associated with the pandemic led to a £5.1bn deficit for the NHS in England in the first four months of the financial year, compared with the pre-pandemic budget. Some of the factors which have contributed to this deficit include extending the workforce to meet the healthcare demand; absences from sickness; providing extra bed capacity; and, at the beginning of the lockdown, higher costs of prescribing.
But healthcare systems around the world were battling the demographic odds even before the first outbreak of COVID. Over the course of a century, from 1950 to 2050, it is estimated that the proportion of people in employment, compared to those in retirement, will change from 14 adults in work to every one in retirement, to two in work to every one retired. An ageing global population causes strain for healthcare systems for more than one reason: older people generally need more care but, with less people employed and more retired, there are fewer taxpayers to fund this.
This is further complicated by the advances in medicine which are continuing to take place. There are now medical conditions that people can happily live with (assuming the right treatment is given), which only a few decades ago would have had a significant impact on life expectancy. This is cause for celebration, but the increased longevity of patients places yet more burdens on healthcare systems which were already squeezed, even before COVID-19.
This is where technology has an important role to play. Innovation in medicine has historically been driven by pharmaceutical interventions that are expensive to develop, take time to gain regulatory approval and require significant clinical testing to ensure the interventions do no harm. Medical technology promises an alternative – using innovation in technology to develop electronic devices that can be deployed simply and effectively to address multiple medical issues without the risk of harmful side effects. This has the potential to transform both the effectiveness and the cost of healthcare in the 21st century.
Technology is increasingly being seen as the bridge between unlimited demand and limited resources – enabling healthcare systems to develop new ways to treat conditions and rebalancing the scales to reduce the financial pressure on healthcare services, while at the same time enhancing patient outcomes.
Before medical technologies can be introduced into healthcare settings, companies are obliged – quite rightly – to gather the evidence that products are safe and effective. Bringing a medical device to market requires rigorous testing, regulatory approvals, clinical studies, and healthcare professionals willing to support and champion the product – all of which needs money, time and commitment. Critical to medical device adoption is the need to meet the regulatory requirements of different health services around the world and to generate positive patient data through a programme of clinical studies.
There is no doubt that regulation is necessary, and bodies such as National Institute for Health and Care Excellence (NICE) and the US Food and Drug Administration (FDA) should be commended for ensuring innovations are safe. However, if global healthcare systems are to continue adopting innovation, a reasonable balance needs to be found between regulation and innovation. This is perhaps particularly true for medtech devices, which are not drugs or medicines per se, and which are therefore different to traditional pharmaceutical interventions.
Sky Medical Technology’s own geko™ device, for example, is a wearable bioelectronic device about the size of a wristwatch, which is applied, much like a sticking plaster, to the lower leg. It gently stimulates the common peroneal nerve, activating the calf and foot muscle pumps, resulting in increased blood flow in the deep veins of the calf at rate equal to 60% of walking. There is no drug to swallow or be injected and there are no negative side effects to increasing blood flow in the lower limbs. Despite this, the device has gone through the same regulatory process that any new medical treatment needs to, a process that takes years and requires solid evidence of successful outcomes for patients in addition to success in the testing labs.
Collaboration in innovation
To have a tangible impact on healthcare delivery, the clinical and economic data and the benefits offered by novel products must be clear for clinicians to see; and medtech companies need to be sensitive to the process through which innovation is adopted. Just because a medical innovation creates better patient outcomes, this is not in itself enough of a reason for adoption. It needs to be considered alongside the alternatives, the economic implications and – perhaps most importantly – the cost of change. As part of this, medtech companies need to support the entire process of product adoption, from user training to information manuals and product videos.
Often medtech companies want to be seen as ‘disruptive’ in their field – but new medical technologies should be anything but. The success of a new technology often depends on its fitting as seamlessly as possible into existing workflows, rather than delaying or interrupting them. A consultant surgeon may love a new technology, but if it adds too much work for frontline staff, an adoption hurdle will loom. There are clever, evidence-based, fundable, well-published innovations that still fail to achieve adoption because they are not straightforward to integrate into clinical practice. Equally, the burden of adoption cannot continue to fall on the shoulders of frontline staff who – on top of their full-time jobs, and in a challenging environment – can sometimes feel that they stand alone in their willingness to give up additional time to pursue innovation for better patient outcomes.
Carrying the torch
New technologies and innovations have the potential to improve patient outcomes, reduce the strain on healthcare professionals and, ultimately, save healthcare systems money across the globe. The pandemic has been pivotal to enacting changes to the infrastructure of healthcare which has assisted healthcare professionals in making the switch to innovation-enabled care. This momentum must now be maintained. Healthcare systems do not have an innovation problem; the issue is about replication: in the past, successful projects and changes to clinical practice have rarely been reproduced elsewhere in the system. The pandemic has changed this, allowing innovation to break through with greater pace. Long may it continue. Health Europa