The Societal and Indirect Economic Burden of Seasonal Influenza in the United Kingdom.

Seasonal influenza is a significant public-health issue. In the UK, the influenza season is associated with an increased demand for and pressure on the NHS. The direct health and economic impacts of seasonal influenza have received much attention. However, less attention has been given to its broader societal burden, including its indirect economic impact. We first conducted a rapid evidence assessment of the literature to understand the societal burden of seasonal influenza in the UK. Secondly, we conducted analyses of publicly available, aggregated data from NHS England and NHS Digital to better understand the impact of seasonal influenza on the provision of NHS services both before and after the COVID-19 pandemic. We also conducted a geographically representative survey of 1,000 working-age adults across the UK, who reported having influenza or caring for a dependent with influenza during at least one of the past four influenza seasons to understand impacts related to absenteeism and presenteeism in the workplace, lost wages and out-of-pocket costs. Fourthly, we conducted interviews with 20 key stakeholders within the NHS from primary care and secondary care across the four UK nations. Lastly, we used an epidemiologic-economic framework to estimate the number of influenza cases and then applied a macro-economic computable general equilibrium model to estimate the indirect economic costs associated with lost economic productivity among working-age adults who become ill with influenza.

Effect of Beetroot Powder Incorporation on Functional Properties and Shelf Life of Biscuits.

The demand for ready-to-use functional foods is high, which encourages manufacturers to develop new, nutritionally valuable products. As an excellent source of biologically active compounds, beetroot (Beta vulgaris L.) is considered to have highly beneficial effects on health. This research aimed to evaluate the impact of replacing spelt flour (SF) with 15%, 20% and 25% beetroot powder (BP). The physicochemical and functional properties of biscuits baked at different temperatures (150 and 170 °C) were followed at the beginning, and after 3 and 6 months of storage as standard conditions. Moisture content and water activity (aw) gave insight into the biscuits' shelf life. The value of aw from 0.35 to 0.56 indicated appropriate storability. Dietary fiber content in fresh biscuits ranged from 6.1% to 7.6%, protein from 9.2% to 8.9% and sugar from 30.6% to 35.9%. The content of betalain, total polyphenols and flavonoids, and antioxidant activity (DPPH, FRAP) increased with beetroot powder content incorporated. A slight decrease of all the mentioned parameters during the storage indicated satisfied retention of bioactive molecules. The content of prevalent phenolic compounds gallic and protocatechuic acid, identified by HPLC, decreased from 22.2-32.0 and 21.1-24.9 in fresh biscuits to 18.3-23.4 and 17.3-20.3 mg/100 g upon six months of storage, respectively. An increase of the L* and a* and a decrease of the b* coordinate values, compared with the control sample without beetroot values, was noticed as well as the expected level of their change during the storage. The obtained results indicated that biscuits enriched with beetroot powder showed a significantly improved functional, nutritional and antioxidant potential during storage.

Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems.

BACKGROUND: There is growing interest in faecal microbiota transplantation (FMT) as a treatment for recurrent Clostridioides difficile infection (CDI), but evidence on the diverse requirements for safe, effective and accessible services is fragmented and limited. AIMS: To identify key components of FMT provision relating to the patient care pathway, stool donor pathway and wider healthcare system, and to explore variation in practice METHODS: We conducted a narrative review of the literature and consultations with key clinical experts in the field. Evidence is drawn from high-income country contexts, with an emphasis on Australia, Canada, Italy and the United Kingdom as case example countries. RESULTS: We identify and discuss key challenges to do with healthcare capacity (workforce, FMT and stool banking facilities), donors and donations, patient access and choice of FMT delivery routes, regulation, costs and reimbursement. We also identify improvement opportunities to increase awareness of FMT and referral processes, physician training, maintaining patient registries and outcome monitoring metrics, in-country regulatory harmonisation and tackling reimbursement challenges and discuss future research needs. CONCLUSION: Effectively bringing FMT to patients in a healthcare system requires much more than just the existence of a clinically effective procedure. With FMT being a potentially effective treatment option for recurrent CDI for many patients, a well-rounded understanding of how appropriate FMT capacity can be built and nurtured is important for both healthcare providers and policymakers seeking to improve patient care.

The Burden of Respiratory Syncytial Virus: Understanding Impacts on the NHS, Society and Economy.

Respiratory syncytial virus (RSV) is a common respiratory virus that affects large numbers, mainly of children younger than five. The burden of RSV includes not only ill health for the children with the virus, which in severe cases results in hospitalisation, intensive care and even death; but also the emotional and practical burden on the affected families and carers; and the impact that has on productivity in the economy; alongside the costs of providing healthcare. We reviewed recent literature and published data relevant to the UK and used this information to model the costs to the healthcare system and to the wider UK economy in terms of productivity losses of parents/carers. We found healthcare costs and productivity losses in the UK resulting from RSV in children younger than five total approximately £80 million annually. These costs are the consequence, in part, of an estimated 467,000 GP visits per year in the UK for children aged under five with RSV and 34,000 hospitalisations. Our study also presents additional material, identified in the literature review, on the health impacts on affected children and the nature of the burden on parents and families of caring for a young child with RSV. The consequences of RSV are short-term for the majority of cases, but for some there are long term sequelae including poorer respiratory health in later life. RSV is also responsible for the deaths each year in the UK of an estimated 33 children under five.

COVID-19 Genomics UK (COG-UK) Consortium: Final Report.

The ability to sequence and understand different variants of the SARS-CoV-2 virus and their impact is crucial to inform policy and public health decisions. Soon after the UK went into its first lockdown in March 2020, the CCOVID-19 Genomics UK (COG-UK) Consortium was launched. COG-UK is a collaboration of experts in pathogen genomics including academic institutions, public health agencies, the Wellcome Sanger Institute, NHS Trusts and Lighthouse Labs. RAND Europe evaluated how COG-UK delivered against its objectives, for example how it contributed to advancing scientific knowledge about SARS-CoV-2, informing public health decisions, and providing information that can be used to evaluate the effectiveness of vaccines and treatments. The evaluation also examined the diverse factors that influenced COG-UK progress and impact, including enablers and challenges, and considered implications for the future.

Communicating research evidence to boards in health and care organisations: A scoping study.

Boards in health and care organisations in England play a key role in the governance, strategy, direction and culture of an organisation. It is therefore important to ensure that board decisions are informed by the best available evidence from a range of sources, including service evaluations, organisational performance data, research and evidence-based guidelines. However, there is a scarcity of evidence about how boards use research evidence, defined as evidence stemming from generalisable empirical research, to carry out their roles. THIS Institute commissioned RAND Europe and the Health Services Management Centre (HSMC) at the University of Birmingham to conduct a scoping study on how health and care boards use research evidence. The focus was on NHS Trust boards and the boards of Sustainability and Transformation Partnerships (STPs) or Integrated Care Systems (ICSs). The principal data collection method was qualitative interviews with diverse members of health and care boards to obtain insights into the perceptions and experiences of board members in a range of roles and circumstances. The findings are predominantly based on evidence from 17 interviews. Given the importance of the COVID-19 pandemic at the time of this research, we were also asked to consider whether and how research evidence was used by boards in shaping their response to COVID-19. We focused on two areas specifically: (i) personal protective equipment (PPE) and (ii) the use of remote consultations and remote patient monitoring.

Identifying how GPs spend their time and the obstacles they face: a mixed-methods study.

BACKGROUND: Although problems that impair task completion - known as operational failures - are an important focus of concern in primary care, they have remained little studied. AIM: To quantify the time GPs spend on different activities during clinical sessions; to identify the number of operational failures they encounter; and to characterise the nature of operational failures and their impact for GPs. DESIGN AND SETTING: Mixed-method triangulation study with 61 GPs in 28 NHS general practices in England from December 2018 to December 2019. METHOD: Time-motion methods, ethnographic observations, and interviews were used. RESULTS: Time-motion data on 7679 GP tasks during 238 hours of practice in 61 clinical sessions suggested that operational failures were responsible for around 5.0% (95% confidence interval [CI] = 4.5% to 5.4%) of all tasks undertaken by GPs and accounted for 3.9% (95% CI = 3.2% to 4.5%) of clinical time. However, qualitative data showed that time-motion methods, which depend on pre-programmed categories, substantially underestimated operational failures. Qualitative data also enabled further characterisation of operational failures, extending beyond those measured directly in the time-motion data (for example, interruptions, deficits in equipment/supplies, and technology) to include problems linked to GPs' coordination role and weaknesses in work systems and processes. The impacts of operational failures were highly consequential for GPs' experiences of work. CONCLUSION: GPs experience frequent operational failures, disrupting patient care, impairing experiences of work, and imposing burden in an already pressurised system. This better understanding of the nature and impact of operational failures allows for identification of targets for improvement and indicates the need for coordinated action to support GPs.

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective.

Introduction: Arriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery. Methods: We draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base. Results and discussion: We examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries' healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

Characterising and describing postpartum haemorrhage emergency kits in context: a protocol for a mixed-methods study.

INTRODUCTION: Postpartum haemorrhage (PPH) is an obstetric emergency requiring prompt and accurate response. PPH emergency kits containing equipment and medications can facilitate this kind of intervention, but their design and contents vary, potentially introducing risk of confusion or delay. Designs may be suboptimal, and relying on localised kit contents may result in supply chain costs, increased waste and missed opportunities for economies of scale. This study aims to characterise contextual influences on current practice in relation to PPH kits and to describe the range of kits currently employed in UK maternity units. METHODS AND ANALYSIS: This mixed-methods study comprises two phases. The first will use field observations and semistructured interviews to research PPH kits in a small number (3-5) of maternity units that will be selected to represent diversity. Analysis will be conducted both using an established human factors and ergonomics framework and using the constant comparative method for qualitative data analysis. The second phase will use a research and development platform (Thiscovery) to conduct a crowdsourced photography-based audit of PPH kits currently in use in the UK. Participants will tag images to indicate which objects have been photographed. Quantitative analysis will report the frequency of inclusion of each item in kits and the content differences between kit and unit types. All maternity units in the UK will be invited to take part, with additional targeted recruitment strategies used, if necessary, to ensure that the final sample includes different maternity unit types, sizes and PPH kit types. Study results will inform future work to develop consensus on effective PPH kit designs. ETHICS AND DISSEMINATION: Approval has been received from the UK Health Research Authority (project ID 274147). Study results will be reported through the research institute's website, presented at conferences and published in peer-reviewed journals.

Determination of toxic elements in meat products from Serbia packaged in tinplate cans.

This work aimed to examine the influence of the storage period on the content of toxic elements (As, Cd, Hg, and Pb) in five types of canned meat products regularly used in the Serbian Armed Forces. Cans of beef goulash (BG), pork ragout (PR), spam (SP), liver pate (LP), and meatballs in tomato sauce (MB), produced according to military standards and stored under regular conditions, were analyzed. Meat products were packed in tin cans made according to special requirements in terms of tin and varnish application and stored for up to 6 years. The content of toxic elements varied depending on the analyzed product. The highest average content of arsenic was in BG (10.00 µg/kg), cadmium in LP (35.91 µg/kg), and mercury and lead in PR (15.04 and 8.00 µg/kg, respectively). The average concentrations of As, Cd, Hg, and Pb in all types of canned meat products were significantly lower than the maximum permitted levels in food currently in force by local and EU legislation. The storage period did not significantly affect the level of toxic elements, although higher concentrations were found in samples stored for more than 2 years. Examination of raw materials, spices, and additives showed that the highest Cd and Pb concentrations, which can affect the total level of these elements in meat products, were found in red ground pepper (Cd above 150 µg/kg) and dish supplement (Pb of 250 µg/kg). The assessment of the weekly intake of toxic elements through canned meat showed that it is significantly lower than the values that affect adversely to human health, as determined by the FAO/WHO and EFSA. However, as there is a constant possibility of contamination of raw materials and food additives, primarily due to environmental pollution, it is recommended to monitor the content of heavy metals in food permanently and assess their risk to human health.

Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation.

BACKGROUND: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of 'what good looks like'. OBJECTIVE: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. METHODS: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. RESULTS: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. CONCLUSIONS: This large qualitative study has enabled the generation of a new plain language framework-For Us-that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.

Transforming Urgent and Emergency Care and the Vanguard Initiative: Learning from Evaluation of the Southern Cluster.

Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services so that patients receive the most appropriate care at the right time and in the right place, and so that unnecessary admissions to accident and emergency (A&E) and hospitals are reduced. The Southern Cluster comprises three such UEC vanguards. RAND Europe's evaluation examined the impacts of the vanguards, the processes underpinning delivery (and associated enablers and challenges), and implications for future policy and practice. The evaluation used a multi-method approach, including theories of change, document review, workshops, interviews, surveys and data dashboards. The Southern Cluster UEC vanguards have made progress across core activities. Clinical hubs are operational across the sites. Direct booking capacity into primary care is progressing more with out-of-hours than with in-hours services. Gradual but variable progress has been made towards joint planning and governance of UEC services. Efforts to ensure seamless data sharing between providers, and interoperable IT infrastructure are progressing somewhat slower than originally hoped. Vanguard funding, committed leadership and practical mechanisms to support joint working helped drive progress. Public engagement, workforce-capacity and data interoperability will need to be addressed for longer-term impact at scale. The study makes recommendations concerning: (i) UEC health and care workforce capacity-building, (ii) local-national coordination around UEC transformation, (iii) collaboration across localities and professions, (iv) support for an end-to-end UEC pathway with mutually reinforcing activities, (v) cost and outcome data, (vi) an interoperable data infrastructure, and (vii) capacity for evaluation and learning.

Innovation as a Driver of Quality and Productivity in UK Healthcare: Creating and Connecting Receptive Places-Emerging Insights.

The demand for health services in England is both growing and changing in nature, yet resources are limited in their ability to respond to the scale and scope of need. As a result, the NHS is under increasing pressures to realise productivity gains, while continuing to deliver high quality care. RAND Europe and the University of Manchester have been commissioned to conduct a study to examine the potential of innovation to respond to the challenges the NHS faces, and to help deliver value for money, efficient and effective services. "Innovation" in this study refers to any product, technology or service that is new to the NHS, or applied in a new way, aimed at delivering affordable and improved care. The learning we have gained adds considerable depth to the practical discussions presented regarding how innovation can be first nurtured and then made meaningful and actionable in a variety of settings. This is important given the complexity of health innovation systems and the diversity of elements that need to interact and work together for the overall system to function effectively. We share insights related to skills, capabilities and leadership; motivations and accountabilities; information and evidence; relationships and networks; patient and public engagement; and funding and commissioning. We will develop these detailed learning points into a more systematic analysis as the research evolves. The research is funded by the Department of Health Policy Research Programme, in close collaboration with NHS England and the Office of Life Sciences.

Hepatitis C: Understanding Factors That Influence the Physicians' Treatment Decisions.

This study aimed to inform Hepatitis C (HCV) treatment by (1) better understanding the nexus of factors physicians consider when making HCV treatment decisions; (2) investigating the comparative influence and importance of specific factors and the trade-offs implicated in the decisionmaking process; and (3) examining how much thrombocytopenia impacts treatment decisions and how it impacts treatment. To meet this goal, we conducted five analyses, focusing on four European countries characterised by different approaches to healthcare organisation and financing, which alongside cultural differences may have potential implications for treatment pathways for patients with HCV infection. These were: France, Italy, Spain, and the United Kingdom. These analysis included: Review the academic literature and of relevant national and European guidelines;Conduct key informant interviews (KIIs) with national experts to contextualise the data from the literature review and further explore some emerging themes;Map the patient journey in the four countries to identify stages HCV patients pass through once they have entered the healthcare system and map, for each stage, potential points of departure from the typical journey;Design and conduct of Discrete Choice Experiments (DCEs) to quantitatively assess the importance of factors that influence treatment decisions;Conduct expert workshop to help build scenarios identifying challenges to HCV treatment.The five analyses build on one another, with the first three providing evidence that fed into the design of the DCEs and with the DCE results in turn serving as the key inputs into building the scenarios for the expert workshop.

How policy can help develop and sustain workforce capacity in UK dementia research: insights from a career tracking analysis and stakeholder interviews.

OBJECTIVES: To identify research support strategies likely to be effective for strengthening the UK's dementia research landscape and ensuring a sustainable and competitive workforce. DESIGN: Interviews and qualitative analysis; systematic internet search to track the careers of 1500 holders of UK doctoral degrees in dementia, awarded during 1970-2013, to examine retention in this research field and provide a proxy profile of the research workforce. SETTING AND PARTICIPANTS: 40 interviewees based in the UK, whose primary role is or has been in dementia research (34 individuals), health or social care (3) or research funding (3). Interviewees represented diverse fields, career stages and sectors. RESULTS: While the UK has diverse strengths in dementia research, needs persist for multidisciplinary collaboration, investment in care-related research, supporting research-active clinicians and translation of research findings. There is also a need to better support junior and midlevel career opportunities to ensure a sustainable research pipeline and future leadership. From a sample of 1500 UK doctorate holders who completed a dementia-related thesis in 1970-2013, we identified current positions for 829 (55%). 651 (43% of 1500) could be traced and identified as still active in research (any field) and 315 (21%) as active in dementia research. Among recent doctoral graduates, nearly 70% left dementia research within 4-6 years of graduation. CONCLUSIONS: A dementia research workforce blueprint should consider support for individuals, institutions and networks. A mix of policy interventions are needed, aiming to attract and retain researchers; tackle bottlenecks in career pathways, particularly at early and midcareer stages (eg, scaling-up fellowship opportunities, rising star programmes, bridge-funding, flexible clinical fellowships, leadership training); and encourage research networks (eg, doctoral training centres, succession and sustainability planning). Interventions should also address the need for coordinated investment to improve multidisciplinary collaboration; balanced research portfolios across prevention, treatment and care; and learning from evaluation.

The use and impact of quality of life assessment tools in clinical care settings for cancer patients, with a particular emphasis on brain cancer: insights from a systematic review and stakeholder consultations.

PURPOSE: Patient-reported data are playing an increasing role in health care. In oncology, data from quality of life (QoL) assessment tools may be particularly important for those with limited survival prospects, where treatments aim to prolong survival while maintaining or improving QoL. This paper examines the use and impact of using QoL measures on health care of cancer patients within a clinical setting, particularly those with brain cancer. It also examines facilitators and challenges, and provides implications for policy and practice. DESIGN: We conducted a systematic literature review, 15 expert interviews and a consultation at an international summit. RESULTS: The systematic review found no relevant intervention studies specifically in brain cancer patients, and after expanding our search to include other cancers, 15 relevant studies were identified. The evidence on the effectiveness of using QoL tools was inconsistent for patient management, but somewhat more consistent in favour of improving patient-physician communication. Interviews identified unharnessed potential and growing interest in QoL tool use and associated challenges to address. CONCLUSION: Our findings suggest that the use of QoL tools in cancer patients may improve patient-physician communication and have the potential to improve care, but the tools are not currently widely used in clinical practice (in brain cancer nor some other cancer contexts) although they are in clinical trials. There is a need for further research and stakeholder engagement on how QoL tools can achieve most impact across cancer and patient contexts. There is also a need for policy, health professional, research and patient communities to strengthen information exchange and debate, support awareness raising and provide training on tool design, use and interpretation.

Leadership as a Health Research Policy Intervention: An Evaluation of the NIHR Leadership Programme (Phase 2).

In early 2012, the National Institute for Health Research (NIHR) leadership programme was re-commissioned for a further three years following an evaluation by RAND Europe. During this new phase of the programme, we conducted a real-time evaluation, the aim of which was to allow for reflection on and adjustment of the programme on an on-going basis as events unfold. This approach also allowed for participants on the programme to contribute to and positively engage in the evaluation. The study aimed to understand the outputs and impacts from the programme, and to test the underlying assumptions behind the NIHR Leadership Programme as a science policy intervention. Evidence on outputs and impacts of the programme were collected around the motivations and expectations of participants, programme design and individual-, institutional- and system-level impacts.

Treatment for Dementia: Learning from Breakthroughs for Other Conditions.

The past few decades have seen a number of medical breakthroughs that enabled the effective treatment of a range of conditions, transforming them from fatal into manageable ones. Examples include certain cancers and HIV. Conversely, progress on dementia has been limited. There are currently no treatments that will cure or even alter the progressive course of dementia, despite ongoing research investigating new therapies and care options. The UK Department of Health is interested in the potential to learn from other disease areas to better understand the particular social, economic, political, legislative and scientific contexts that have contributed to accelerating progress and breakthroughs in treatment. Such learning could helpfully inform dementia research and innovation efforts, and help identify levers for supportive policy development. This project analysed breakthroughs in the treatment of four selected conditions of ill health and seeks to identify potentially transferable lessons for the dementia context. Using evidence review and key informant interviews we sought to identify the series of "events" that eventually led to a given breakthrough, and the key milestones in the process that have helped improve understanding and potential for treatment. We also aimed to capture the temporal and causal relationships between "notable" events looking at a variety of factors implicated in the breakthrough pathway. The focus of this work was on political, economic, social, scientific and technological, and legal, regulatory and environmental factors.

Evaluating the Role and Contribution of Innovation to Health and Wealth in the UK: A Review of Innovation, Health and Wealth: Phase 1 Final Report.

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitative and qualitative methods: document review, key informant interviews and stakeholder survey. This study also forms the basis for selecting case studies for phase two of the evaluation. Our findings from the interviews and survey suggest broad stakeholder support for the overarching ambitions of the IHW strategy. However, we found variable progress towards the overarching objectives of the eight IHW themes and an ambiguous relationship between many of the themes' objectives and their actions. It was difficult to assess progress on IHW's actions as commitment to the actions, implementation guidance and expected outcomes of the actions were not clearly articulated. The Academic Health Science Networks (AHSNs) and the Small Business Research Initiative (SBRI) were reported to be working well, which may be attributed to their clear structures of accountability and earmarked budgets. However, survey respondents and interviewees raised concerns that budgetary pressures may limit the impact of both AHSNs and the SBRI. The main challenges identified for ongoing action were the resources available for their implementation (e.g. Medtech Briefings), lack of awareness of the initiative (e.g. the NICE Implementation Collaborative) and the design of the actions (e.g. the Innovation Scorecard, web portal and High Impact Innovations).

Galvanising the NHS to Adopt Innovation: The Feasibility and Practicality of Recommendations from the Interim Report of the Accelerated Access Review.

The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on "innovation champion" roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS.