Methods that involve investing and incentivising enable the spread and scale of innovations and improvements by linking funding to their uptake and use, by utilising new procurement and contracting agreements for pricing and providing additional funding.
Eight methods have been identified in this category and are summarised below.
The effectiveness of these methods will vary depending on context, but key strengths of methods which utilise investing and incentivising include:
- Can target commissioners and have substantial impact that can be implemented rapidly in some cases[i]
- Can support up-front costs or double running costs[ii]
- Although financial resources are required, overall spend may be cost-effective depending on intervention
However, there will be limitations to these methods which may include:
- If funding or incentive is time limited, may not be sustainable
- Incentive effects cannot override clinical belief about the efficacy and may struggle to overcome some structural issues
- Design of financial structures and systems can be a bigger barrier to adoption than incentives are a push to adoption[iii]
- Not all financial incentives have equal impact due to effects such as loss aversion, goal-gradient effect and anchoring that can impact perceptions beyond objectives values
- Some funding models may favour organisations which are already high-performing, further disadvantaging reluctants
- Resource implications can be significant
- Physical infrastructure funding may also be required
Methods and Levers
Performance related funding
Drives uptake of proven interventions, funding (or an additional bonus) dependant on uptake against expected numbers.
Examples include CQUIN, QOF and Best practice tariffs.
Flexible commercial deals
Creating new methods of procurement to allow lower/more flexible prices and service and resource support to be offered by industry or open new procurement routes for parts of NHS.
Examples include Inclisiran, and other commercial deals.
Use of national purchasing power to achieve agreement with commercial company to enable other incentives/levers. Often using central power to achieve lower costs, handle more complex agreements, or to agree price/volume agreements.
Examples include Strategic category management, other commercial deals and use of NHS Supply Chain for MedTech Funding Mandate products.
Creating natural incentive for use of products by linking price to levels of adoption and usage – usually through tendering but could be through central subsidy.
Examples include Programmes using tariff changes, Best value biologics and Innovation and Technology Payment.
Additional funding provided to early adopter sites to manage pathway transformation costs and mitigate risk for early adopters- covers costs including double running, additional equipment or training needs to adopt
Examples include Pathway transformation fund.
Setting of estimated/target uptake numbers and direct oversight of delivery monitored at national or regional level.
Examples include the Innovation Scorecard, AAC Scorecard and High Intensity Use Programme.
Comparative data on performance by parts of NHS – at Trust, ICS, regional and National levels, or international. Can be made part of performance oversight to create behavioural incentives or drive patient advocacy.
Examples include the Model Health System, System Oversight Framework and Life Sciences Competitiveness Indicators
Technical Standards and specifications
Setting out of national standards and interoperability – usually common in digital but also for technical and diagnostics equipment. Enables choice in technology and future upgrading. This can also include shared standards/passporting for Information Governance requirements.
Examples include CareConnect Open APIs, SNOMED CT diagnostic coding and DTAC.
Practical considerations for use
|Method or Lever||Stage of development *||Audience and scale **||Resources needed||Timeframe|
|Performance related funding||Spread||National, local, targeted to clinical specialty/ intervention||Financial frameworks and resources||1-3 years|
|Flexible commercial deals||Spread||National, targeted to groups of products or individual products||Commercial support and agreements||Can be implemented rapidly within months|
|Commercial agreement||Spread||National, targeted to products||Commercial support and agreements||Variable depending on nature of intervention|
|Pricing incentives||Spread||National, targeted to groups of products or individual products||Procurement support and expertise and financial resources available to support||6-18 months|
|Pathway funding||Prototype/testing and spread||Local; targeted to intervention||Funding and local engagement/capacity||1-3 years|
|Uptake tracking||Spread||Local; targeted to intervention||Monitoring data and systems; analytics support||1-2 years|
|Benchmarking||Spread||National, regional or local, targeted to clinical specialty /intervention||Monitoring data and systems; analytics support||1-2 years|
|Technical Standards and specifications||Spread||Regional or local, targeted||Variable, may require local or national investment in technology and data/digital systems; support from Interoperability leads||1-3 years|
* Stages of intervention development – Ideation, Proof of concept, Prototype/Testing, Spread
** Audience and scale – national/regional/local, targeted by clinical speciality / product/ problem
[i] RAND Europe. Galvanising the NHS to adopt innovation. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/509629/nhs-adoption.pdf
[ii] The Health Foundation. The Spread Challenge: How to support the successful uptake of innovations and improvements in health care. Available from: https://www.health.org.uk/publications/the-spread-challenge
[iii] Department of Business, Innovation and Skills and Department of Health. Accelerated Access Review: Interim Report. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/471562/AAR_Interim_Report_acc.pdf