What APOS tells us about adopting innovation in the NHS

APOS® is a non-invasive, NICE-approved medical device for chronic knee pain and pain associated with knee osteoarthritis. It uses personalised footwear and gait retraining to help manage symptoms and improve function. APOS is included in NHS England’s MedTech Funding Mandate and has received positive patient and staff feedback where it has been implemented. However, access to APOS remains variable, meaning patients’ ability to benefit can depend on where they live and how local adoption decisions are made.
Even with national backing and patient benefit, system-wide constraints on funding, competing priorities and limited long-term evidence can prevent promising innovations reaching patients.

Innovation must fit within complex systems shaped by available funding, workforce capacity, governance, local priorities and existing clinical views. Health Innovations East’s independent evaluation of APOS, in the East of England, found that adoption barriers were often system wide. This evaluation revealed that whilst national guidance can help support implementation and adoption of innovation, local systems still require sufficient funding, an up-to-date evidence base, leadership for decision making and supporting adoption and implementation capacity.

The evaluation identified several conditions that may increase the likelihood of successfully adopting, implementing and sustaining innovations such as APOS in the NHS:

• There being staff resource available to support the implementation of an innovation, which may include project management, information governance support and clinical support.
• There being clearly identified funding available to support implementation of the innovation, which may include funding of the product, staff time and regulatory approvals. Money is available for implementation of NICE-recommended innovations, but often this money is not ringfenced.
• Having short, medium and longer-term evidence available to make case for adoption of innovations as compelling as possible – including cost savings and quality of life evidence.
• NICE has legislative status and thus commissioners’ decisions relating to NICE guidance should be audited and regulated.
• Providers and ICBs would benefit from having a process for considering NICE guidance and a record of how this has been actioned. Governance processes for considering/ implementing NICE guidance, should include periodic reviews to enable re-consideration of adoption as funding opportunities arise, as strategic priorities change and as population needs change.
• Identify a multidisciplinary working group to drive forward implementation and sustainment. This group should be reviewed with any staff changes, and the group should be involved in any re-adoption decision-making.
• Adoption of NICE guidance should be covered by a process rather than the advocacy of individuals. Staff turnover should not impact the process.
• Providers and ICBs should understand the status of different NICE guidance and take responsibility for implementation.
• The ability to redistribute funding to different delivery partners is essential for innovative pathway design.

The APOS evaluation shows that innovation adoption is not only about whether a product works, but whether the NHS can fund, govern, implement and sustain it.

Patient stories, such as the ones we’ve heard from APOS, demonstrate the impact an innovation can have on an individual. Anyone considering adoption of innovations in the NHS should read them alongside the evaluation findings and use the conditions for success as a practical checklist for implementation and adoption.