www.wxjiebo.cc
www.wxjiebo.net

Martha, I think you are failing to make a distinction between two important categories of innovation in the NHS: (i) product innovation (developing diagnostics, drugs and devices), and (ii) process innovation (how an organisation like a hospital uses inputs - labour, products(goods), services, and capital - to create outputs and outcomes). You focus on the former, whereas the emphasis in the NHS recently has been much more towards the latter (see the 'Nicholson Challenge'/(QIPP) Quality, Innovation, Productivity and Prevention). Given that product innovation requires huge investment and the payback period is in the decades (timeline to profits between 10-20years), and that the NHS faces a real terms cash constraint in the face of rising demand, the short term innovation priority must be process rather than product redesign.

However, it is true that product innovation is important for UK plc. more generally and that the university sector and the NHS has a big role to play in developing ideas - Demos did an excellent piece on this last year to show that public sector investment is critical in creating the economic returns from 'innovation'). This reflects the fact that the private sector is poor at taking on very early stage investments, because of the high risk and capital demands; for this reason governments in the UK have invested in university and NHS research. However, the private sector tends to be good at managing the commercialisation of products that are 'close to market'. So the appropriate role for the NHS in product development is likely to be in supporting early research and clinical trials.

You are right to say that the public sector should get an appropriate return for that early stage (high risk) funding support, but the practical question is about what form that return takes - is the return made by selling on early IP at high prices, or from negotiating equity/revenue splits so that the public purse gets an on-going return on sales. Doing the former is often preferred but makes it hard for small biotechs to buy the IP (because it is often too expensive), whereas I think the latter aligns public and private interests more comfortably. An additional return comes from proactively supporting the small biotech sector (rather than selling to say Pfizer) because the growth from developing the product is likely to be converted into domestic jobs and therefore corporate and income taxes.

Furthermore, when you challenge the inexperienced NHS boards I think you fail to acknowledge what these boards are attempting to do – which often is around managing the infrastructure required to maintain a research and clinical trial network, rather than in making commercialisation/investment decisions in specific products. The Medical Research Council (and places like the Wellcome Trust and CRUK) has much more involvement in the actual funding of product development. Organisations like the NIHR focus much more on the coordination of databases and tissue banks, researchers, GPs, hospitals, clinicians, and industry (a task that is like herding cats); and it also includes ensuing that research protocols have the right protection for patient information and safety, and that trials are well enough designed to answer the study questions effectively.

And finally, returning to the initial premise of the innovation buzz word – you are right that it is used ubiquitously across the NHS – which is frustrating – but that is because it is a genuinely new concept for many people in the system, particularly clinicians thinking about process innovation. I have been unpleasantly surprised by how unreflective and self-critical clinicians in the NHS have been about their own individual or collective clinical practice (and primary care is an order of magnitude worse), because it is always easier to think about the ‘new’ marvels of medicine rather than getting basic processes right. But in many cases the biggest challenges we have in the system is about getting professionals to talk to one another so that the current diagnostics, drugs and devices are used properly so that good practice translates from being ‘pockets of excellence’ into basic elements of routine care.

'Given a 50 per cent chance of winning the more expensive token and a 50 per cent chance of winning the cheaper one, subjects were only willing to pay an average of $16.'

16 is absolutely correct (should be a lot less than that) comparing with 45 and 26, you are forgetting what they were asked about, *winning*, winning costs and it costs more in 'disappointment', in case you *won* not what you actually wanted to win.

Would be great if probability of success in getting the *right* idea was 50%... and it isn't (and will never be). Success needs lots of investments through long looooooong time continually.
Because success in science is not *winning*, it's hard work and at any time can fail.

'That’s where the money is.', you are wrong. No manager will put money in one long term project which probability of success builds up through the years. They have to put something in their curriculum. Science contra lifespan of a professional.

This is best 'So nobody has every tried to put a figure on the proportion of 'innovations' that can be allowed to fail.' - you don't understand science at all. You understand finances.

So, yeah, private sector comes handy at times, they have more money to invest, but science business is very risky. If there's any further development, it's good. All in all you should be happy that nhs had *something* to sell, otherwise 100% waste.