Against the Odds: Successfully scaling innovation in the NHS

news | 24 Jan 2018


New research published today calls for new approaches that ensure more tried and tested healthcare innovations reach those who could benefit.

Innovation Unit and The Health Foundation have joined forces to call on system leaders and policymakers to do more to create the right conditions for innovations to spread in the NHS.

Their new report, ‘Against the Odds: Successfully scaling innovation in the NHS’, reveals new insights from research into ten case studies of innovations that have successfully spread in the NHS, highlighting why some innovations are not just scalable, but do actually succeed in scaling up.

The report calls on system leaders and policymakers to do more to create a better environment for innovations to spread, including:

1. The ‘adopters’ of innovation need greater recognition and support. The current system primarily rewards innovators, but those taking up innovations often need time, space and resources to implement and adapt an innovation in their own setting.

2. It needs to be easier for innovators to set up dedicated organisations or groups to drive scaling. Scaling innovation can be a full-time job for an individual, and difficult to do alongside frontline delivery. Often dedicated organisations are needed to consciously and strategically drive scaling efforts, including when innovators ‘spin out’ from the NHS, and innovators may need support to set them up.

3. System leaders need to take more holistic and sophisticated approaches to scaling. Targets and tariffs are not a magic bullet for scaling; while they can help, they don’t create the intrinsic and sustained commitment required to replicate new ideas at scale. System leaders need to use different approaches, including articulating national and local healthcare priorities in ways that create strategic opportunities for innovators, and using commissioning frameworks to enable rather than hinder, the sustainable spread of innovations.

For many years, frustration has been expressed that the spread of innovation in the NHS is slow and laborious, and that even when new ideas are taken up elsewhere it proves harder to replicate their initial success. But whilst existing research has provided an increasingly sophisticated understanding of the problems facing those trying to scale innovation, solutions have remained unclear. The report says that the NHS’ traditional approaches to promoting spread, such as pilot programmes and targets, often prove insufficient to the task.

The report also highlights what actions innovators (those that developed the idea) and adopters (those that implement the intervention in a different setting) need to take to enable more innovations to spread.

“In order to improve patients’ experience of care and their health outcomes, reduce variation in the quality of care across the country, and relieve the immense capacity and financial pressures on the NHS, we need more tried and tested innovations to reach more of those who could benefit from them. This will require new approaches, not just from innovators themselves, but from policymakers and system leaders in the NHS, who create the environment in which scaling takes place, and who can provide the support needed to make it happen.”David Albury
Board Director, Innovation Unit

“We hope that those who want to support the spread of innovation – innovators, system leaders, charities, and others – will find inspiration and learning from the stories told by the people who led these successful innovations, and that the perspectives offered in this report can help complement and move forward both conversation and action on scale and spread. The report holds out a tantalizing glimpse of what improvements in patient experience and outcomes might be possible if we were to devote as much attention and resources to the process of adapting and applying what we already know as we do to the development of new ideas and technologies.”Will Warburton, Director of Improvement, The Health Foundation

The full report, including more detailed recommendations for innovators, adopters and system leaders, is now available on the Innovation Unit website –

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Notes to editors:

● ‘Against the Odds: Successfully scaling innovation in the NHS’ will be launched at a breakfast meeting at The Health Foundation on 24 January 2018.

● A range of contributors will share and discuss the findings of the report, including; David Albury (Board Director, Innovation Unit), Will Warburton (Director of Improvement, The Health Foundation), Axel Heitmueller (Managing Director, Imperial College Health Partners), Paul Bate (Director of NHS Services, Babylon Health) and Halima Khan (Executive Director, Health Lab, Nesta).

● The case studies featured in the report, which were selected through a crowdsourcing campaign, are:

Altogether Better Health Champions and Collaborative Practice

Dose Adjustment for Normal Eating (DAFNE)

Enhanced Recovery After Surgery (ERAS)

Florence (Flo)

High sensitivity troponin testing

Implantable Cardioverter-Defibrillators (ICDs)

Improving Access to Psychological Therapies (IAPT)

Macmillan Cancer Nurse Specialists

Rapid Assessment Intervention and Discharge (RAID)

Schwartz Rounds (UK)

● For an interview with David Albury (co-author of ‘Against the Odds’ and Board Director at Innovation Unit) please contact Sarah Dew at or 020 7250 8090

About Innovation Unit
Innovation Unit is a social enterprise that grows new solutions to complex social challenges. By making innovation happen we help create a world where more people belong and contribute to thriving societies. We build alliances with ambitious places, organisations and systems around the world to adapt, adopt and scale innovations that deliver lasting impact and reduce costs.

To create the kind of impact we want to have in the world, we focus our energy on three areas:
1. High impact innovation consultancy – Applying and sharing our expertise in what it takes to have impact through innovation at scale.
2. Initiating and growing new ventures – Leading and contributing to alliances for change, and securing investment to grow new solutions ‘on the ground’ where we can make a significant impact.
3. Generating the demand for innovation – Actively sharing what we think, believe and know about where innovation is needed and the positive change it can create.

About The Health Foundation
The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care that can be equitably accessed. We learn what works to make people’s lives healthier and improve the health care system. From giving grants to those working at the front line to carrying out research and policy analysis, we shine a light on how to make successful change happen.