Closing the health innovation gap – a rural and coastal challenge 

By Jon Siddall, CEO, Health Innovation South West

In early April we were pleased to welcome to the South West Peninsula, Dr Vin Diwakar, Clinical Transformation Director for the NHS. For Dr Diwakar it was part of regular programme of visits to meet health innovators around the country to see their work in practice. For us, it was a powerful opportunity to highlight the breadth of health innovation we’re supporting across the region; and the distinct rural and coastal context that shapes everything we do with partners to drive lasting impact. 

The South West Peninsula’s rural and coastal demography, distance and sparseness presents specific and significant challenges.  

• People – we have one of the lowest population densities in England with 2.3m people scattered across a mix of coastal communities, isolated rural areas and urban centres, experiencing health and health and care services in very different ways. People are on average six years older than the England average and it’s a rapidly growing older population, especially in Cornwall and Devon, due to the number of retirees and elderly residents. Nearly two in three will be over 65 by 2045.  

• Place – with over 600 miles of coastline, the Peninsula has an expansive geography and no major urban centres. This results in significant challenges around access to care (e.g. travel time to a Type 1 Emergency Department is twice the national average).   

• Prosperity – the South West has some most deprived areas in the country, with high levels of economic inactivity and some of the lowest levels of investment in research and innovation in the UK. Health and prosperity in our coastal towns is a particular challenge, where the prevalence of bad or poor health is 25% higher than the national average. 

As a place-based health innovation organisation, this context creates challenges for health innovation that are different to our urban and suburban counterparts. While other regions also face elements of rural and coastal challenges, it’s the universality of these for the South West that is distinct. 

We work at the centre of the South West’s innovation ecosystem:  

• Helping to find, test and prepare solutions for adoption at scale, aligned to national and local priorities, but adapted for our people and our rural and coastal place. For example, in our rural market towns and coastal communities where access to secondary care is a significant issue, the model for an integrated neighbourhood providing proactive and preventative primary care will be different to one in a major metropolitan areas. 

• Focusing on supporting partners to tackle the immediate NHS operational priorities. As well as supporting the three major shifts required to develop a health and care system fit for the future: from hospital to community, treatment to prevention and analogue to digital.  

• Focusing on the priorities that matter to our population, our work also directly contributes to economic growth – improving the productivity of health and care services, driving the growth of life science companies and helping people get back to work.   

It’s always great to showcase what we’re doing with partners across the South West and hearing from teams about how they are using innovation to improve the health of people living here is really energising.  For this visit, we brought together partners and projects to bring this context and our work to life: 

• Point of care testing to speed up blood tests and provide rapid results for respiratory patients at home or close to home setting, reducing hospital visits, travel time and costs.  Led by Somerset NHS Foundation Trust and University Hospitals Plymouth in partnership with Devon, Cornwall and Isles of Scilly and Somerset ICBs. 

• Digitally enabled integrated neighbourhood care providing proactive and preventative primary care for populations in place. Utilising BraveAI to identify high-risk patients, enable early multi-disciplinary team intervention, improve care coordination, reduce repeat GP visits and avoidable hospital admissions. Led by Cornwall and the Isles of Scilly Integrated Care Board in partnership with Integrated Care Areas and Primary Care Networks (and supported through South West Digital Neighbourhoods Programme and Health Technology Adoption and Acceleration fund). 

• AI enabled remote monitoring that enables patients to have their condition monitored at home and reduce risk of admission. This enables the heart failure team to triage and efficiently and rapidly optimise medications, reducing the need for appointments and travel. Led by Royal Devon University Hospital in partnership with Devon ICB, NHSE and Spirit Health (CliniTouch). 

• Neonatal Oral Antibiotics at Home (NOAH) which enables eligible babies to go home earlier on oral antibiotics rather than staying in hospital for IV antibiotics. Existing implementation is showing a reduction in the average hospital stay per baby from 5 to 2.3 days and an annual cost saving to the NHS of £66,000. A transformative experience at this crucial time, given the distance to hospital for many families. Led by Royal Devon University Hospital in partnership with SW ODN PenARC and Exeter University. 

• And CareLoop, a digital platform that helps predict severe mental illness relapse and reduce admissions through early support. Supporting people with serious mental illness including psychosis, schizophrenia, and bipolar disorder through real-time monitoring and support, improving both patient outcomes and healthcare efficiency. Plus evidence suggests a 33% cost reduction for admissions. An important innovation for the South West where long travel times and high costs to access primary and secondary care mean many residents are without specialist mental health services. Led by Cornwall NHS Foundation Trust in partnership with Livewell and Devon Partnership Trust.  

These partners and projects highlight the progress we’re making together in this crucial context. And they demonstrate our biggest collective challenge – the need to bridge the gap between the distinctive healthcare needs of our region and the required scale and approach to innovation. I was interested to hear Dr Diwakar’s reflections on the challenges and opportunities, and importantly, on the need to adapt innovation and care models to meet the needs of our rural and coastal communities.  

“Our biggest healthcare challenges facing society can only be addressed through innovation. I was impressed with how Health Innovation South West is supporting innovators to tackling diverse regional challenges and fostering a more equitable health system.”

Dr Vin Diwakar, National Clinical Transformation Director, NHS England

The discussions we had throughout the day powerfully encapsulated the challenge but also energised me about the role we can play in closing this innovation gap. I came away reflecting on three things:     

• Why innovation in rural and coastal places needs to be prioritised, understood and supported in national policy 

• The importance of approaching health innovation as a system 

• The need to create the right conditions that drive the adoption of innovation 
  

1. Why innovation in rural and coastal places needs to be prioritised, understood and supported in national policy – there is significant potential for our context and expertise to create opportunities for impact nationally. Across England, around 30% of people live in rural and coastal places. So, while the South West Peninsula’s universal rural and coastal characteristics are distinct, we share similarities with other areas across the country. In particular, parts of the East of England, South East and West Midlands. By collaborating, sharing learnings and progress with others beyond our region, we can drive wider impact. 

2. The importance of approaching health innovation as a system – to drive impact at scale by sharing focus, maximising resources and better reflecting the patient pathways that aren’t limited to organisational remits and boundaries.  

Everything we do is in collaboration with others, but in our Peninsula Research & Innovation Partnership we’ve built an integrated, place-based, approach that has the potential to drive innovation at scale. It unites and strengthens our innovation ecosystem by bringing us together with our three integrated care systems, major universities and National Institute for Health and Care Research networks. With a willingness to work across organisational boundaries to overcome structural barriers, this partnership will help avoid layering on added cost into existing pathways. Instead driving the transformation of services and care pathways for the future.   

It is an ambitious and exciting approach that will help us go further, faster by harnessing innovation firepower within and outside the region. It also marks a key step-change in our potential to contribute to Government’s health and economic growth missions and critical big shifts. 

3. The need to create the right conditions that drive the adoption of innovation – translating research and technological advances into real world impact on health and for the economy.  To drive the scale of transformation and impact that innovation could deliver, there needs to be change at both national and place-based levels. Nationally, reducing the barriers to innovation by aligning policy, regulation, accountability, incentives and funding flows. Combined with place level capability and capacity in innovation adoption, delivered through the partnerships and structures across sectors (industry, academic, NHS etc), that will drive real world impact at scale. 

These reflections are front of mind and central to our strategy, which aims to improve the lives of people in the South West through innovation. Innovation that is rooted in our rural and coastal context, shaped by the experiences of people living across the region, and fuelled by the collective expertise and experience of partners and across our innovation ecosystem.  

I’m really proud of the progress we’re making – from scaling up GPs use of AI to predict the risk of hospital admissions (with partners) to testing new approaches in coastal towns to improve early detection of cancer. I’m excited about the crucial role Health Innovation South West can play in closing the innovation gap in our place. And I can see huge potential in our ability to support the transformation of the health and care services for other rural and coastal areas and help shape the conditions needed to drive impact.