The UK’s National Health Service (NHS) has set its sights on digital innovation, announcing a digital-focused long-term plan in January of this year as well as rolling out a nationwide app.

But that doesn’t mean innovation in the NHS is easy. At MEDinIsrael in Tel Aviv earlier this month, NHS Director of Digital Development Sam Shah laid out several barriers to innovation the system faces.

“Our system’s complex,” Shah said. “We’re made up of more than 15,000 organizations in the NHS. … We have more than 206 hospitals in the UK. And we have seven and a half thousand primary care providers spread out across England. It’s a complex ecosystem. It’s a complex environment for anyone to work in. It’s hard. You have to knock on every single door and try to convince those individual organizations of how your product, your service, your technology can make things better. But I say don’t give up. We have a system that’s in need and we certainly need your help.”

One barrier is the complexity of the system itself, which innovators, especially those who come from outside the UK, sometimes underestimate.

“When anyone tries to release innovations into our system, the first barrier they come up against is the fact that we have a disparate infrastructure. It’s not one thing but many things. And the challenge for a tech provider, anyone with a tool or product, is how to integrate into that environment when you have on one side an organization that still uses paper records all the way through to others that happen to have electronic health records? And then you’ve got the patient side of things. How many patients want to have multiple devices, multiple applications? We have to be citizen-centric and build these things around the patient. So we have to get our infrastructure right.”

On top of that, he said innovators have to grapple with the UK’s regulations and technology standards.

“Someone might come to me and say they have the best solution possible with the best technology available,” Shah said. “But ultimately what happens is those solutions can’t be integrated across the system because they’re not designed in an environment using our standards.”

This a barrier the NHS can address by adopting open standards, Shah said. And the regulatory barrier can be addressed by modernizing some of the system’s regulations.

“The regulations are based on history,” he said. “They were designed over the last 70 years. So in the digital era we have to redefine those, change the rulebook, and sometimes we have to agitate. I welcome everyone to help me agitate and help modify the regulatory environment. Because that’s the only way we can really bring about some change.”

But perhaps the biggest barrier, Shah said, is a culture barrier, which is actually several different barriers as it relates to the culture amongst providers, administrators, and patients.

“There’s a culture in our population and among our citizens,” Shah said. “That relates to everything: data, security, privacy. There’s the culture amongst our clinicians that relates to liability regimes, current ways of working, historic practices. And also, in part, fear. And that’s an important aspect of it. And then there’s the culture around management. They also have their own agenda around what their objective is and the outcome that they need to achieve.”

The cultural problem around management, he elaborated, is one that’s far too focused on incremental change and not geared toward radical re-invention.

“We have 130 million in funding each year, but against that we’re operating at 97 percent and beyond in terms of capacity. So the amount of head space someone has to spend on any kind of digitization is a challenge, because that funding isn’t spare in the system. There isn’t a lot of excess there that we can repurpose and use for something else. So generally it has to come from making processes better.  Making a process a little bit better is not reinventing healthcare. If I want to completely revolutionize the way I do healthcare I’m sometimes going to have to take components and pull them apart and put them back together again. That’s a hard discussion to have.”

The NHS is taking steps to change each of these cultures, however. These include the NHS Digital Academy, a training program to generate digital leaders. The first cohort from that program is set to graduate soon.

And while it might be hard to change the culture among patients, the NHS can steer into cultural changes that are already happening, gradually rolling out digital offerings as citizens become more comfortable with and ready for those technologies.

“The important thing for me is optimization,” he said. “Provide the optimal channel for the need for that part of the population. We’re never going to take everything away and say ‘Everyone must use a particular channel’ but we’ll tailor those channels to the problem we’re trying to solve. Do I use a digital channel? Do I use a physical channel? Do I use another remote channel?”

Speaking to an audience of innovators in Tel Aviv, Shah’s takeaway message was to acknowledge the challenges of his system, but invite innovators to brave those difficulties.

“The UK is a complex place,” he said. “England is difficult at times. But we are willing, we are here to listen, and our door is open, and we certainly want to benefit from some of the most amazing technology solutions that you’ve come up with, that we haven’t yet even thought of, that will benefit us for many years to come.”

Editor's note: This story was reported in Tel Aviv, Israel on a trip paid for by the Israeli Export Institute, an organization funded in part by the Israeli government, which covered airfare and lodging for reporters. MobiHealthNews Editor in Chief Jonah Comstock also participated as an onstage speaker at MEDinIsrael 2019. As always, MobiHealthNews maintains its editorial independence and made no promises to the Israeli Export Institute about the content or quantity of coverage.