Innovation is required.

It is more than two years since AstraZeneca launched a medicine for people with heart problems. In the UK, the authorities judged Brilinta not only safe and effective but also good value for money. Yet its take-up within the UK’s National Health Service has been sluggish.

“Out of the good intention to decentralise decision-making, payers are becoming more fragmented,” says Pascal Soriot, the chief executive of the Anglo-Swedish pharmaceutical group. “That multiplies the number of times you have to explain the value of your product, with requests for more data and discounts. So much energy is spent arguing, rather than being invested in managing patients appropriately,” he adds.

His frustration is a familiar refrain around the world: from innovators working to capitalise on the high-tech revolutions in genomics and electronics to others with just as great a capacity to improve patient outcomes by enhancing distribution systems, provision of primary care clinics or deploying staff better. The topic has become an increasing focus of discussions among international physicians, policy makers and practitioners, from the George Institute’s Big Change conference on sustainable healthcare in Oxford last month, to the World Innovation Summit for Health in Qatar this week.

If the first challenge in healthcare is coming up with innovations with the potential to reduce disease and extend lives, the second is to implement them. The more complex the ideas and the larger the number of systems or countries targeted, the more difficult it is to bring them into effect. Commodities such as new drugs, vaccines, medical devices and diagnostic equipment are difficult enough to launch. Approaches to delivering healthcare more broadly – from safer surgical practices such as checklists to retraining and empowering staff – are still more likely to fall victim to ignorance, cultural differences and vested political, financial, institutional or professional interests.

“The NHS is incredibly slow in taking up innovation. It is unacceptable,” says David Haslam, the new chairman of the National Institute for Health and Care Excellence (Nice), an innovative and much emulated initiative to advise the British health system on the use of new drugs. It is increasingly scrutinising broader treatments and public health programmes.

Sometimes, transformative innovations do get widely adopted. In the latter half of the 20th century, six childhood vaccines that had done much to reduce infant mortality in richer countries were still hardly used in poor ones. It took a combination of leadership, political will and funding to create the Unicef-led Expanded Programme on Immunisation to spread the benefits globally.

Since the start of the millennium, the UN-backed Global Alliance for Vaccines and Immunisation, which channels donor funding to purchase newer vaccines, has helped disseminate products launched in richer countries into poorer ones with a far shorter time lag, such as those which protect against HPV, the cause of cervical cancer.

Last week, donors pledged more than $12bn to the Global Fund to Fight Aids, TB and Malaria, which has helped substantially reduce the infectious disease burden among the world’s poor through better access to proven tools, such as bednets and antiretroviral medicines. Its bulk purchases and pooled procurement mechanisms have a broader impact by stimulating new markets and boosting affordable access.

“Reverse” and often “frugal” innovation from lower income countries is also appearing, rooted in the need for affordability and practicability. In the previous decade, GE Healthcare began developing low-cost, more portable and robust ultrasound devices and CT scanners in and for India and China. Since the financial crisis, it has found ready takers in richer countries too.

“It’s gone from an initiative to being part of the business strategy,” says John Dineen, head of the division. “For a long time innovation was always geared towards the high end. Today, economic value propositions are just as important. “When we develop a product for an emerging market, we are finding twice the demand we expected, because of equal requests from the developed world.”

Many innovations have come from emerging economies rather than being sparked by external catalysts. Indian generic drug companies have helped cut costs with low-cost manufacture and litigation to challenge patents. Discovery Health, an insurance company in South Africa, has developed a model since exported to the UK, the US and parts of Asia, which seeks to drive down claims by promoting better lifestyles with incentives such as lower premiums, and discounts on gym memberships.

Innovation in health systems remains more complex, reflecting fierce national differences. Fresenius of Germany operates dialysis networks in hospitals across borders. Medtronic, like GE, supplies not only equipment but also management to help boost utilisation rates. A few private health groups operate hospitals in several countries. They are exceptions. Yet “task shifting” as a way to respond to severe shortages of doctors has proved important in Asia and Africa, and is increasingly being explored in richer countries: training less specialist health professionals – and even lay volunteers – to improve access to care.

Information technology also has the potential to disrupt and accelerate medical innovation, partly because it taps into the willingness of consumers to pay out of pocket expenses, despite the approaches not always being evidence-based. “As smartphones expand, I believe we are on the verge of take-off,” says Thierry Zylberberg, general manager for healthcare at Orange, the mobile operator. His company offers services from secure patient data storage and remote monitoring to counterfeit medicine identification systems and sexual health information by phone, and texts to remind people to take medicines regularly.

There are also growing non-profit efforts to stimulate, showcase and diffuse innovation. The Gates Foundation has triggered much publicity with its open source “reinvent the toilet” prize. Canada’s Grand Challenges has funded ideas from “diagnosing diapers” to breast cancer detecting smartphones. A gulf remains between good ideas and effective practice. A recent study by the International Centre for Social Franchising highlighted poor information sharing on many good existing healthcare ideas.

It also noted that their quality and ability to reach those most in need was highly variable, and many were difficult to scale or replicate because of the importance of local context. Lord Ara Darzi, the former British health minister chairing this week’s Qatar summit, which he hopes to turn into the future “Davos of healthcare”, says: “Innovation is your survival tool, but the biggest challenge I had in the NHS was that innovation was considered an added cost.”

He says that success requires: identifying champions, harnessing the public including patients; creating spaces for learning; eliminating old ways of working; and providing incentives for new ones to be adopted. Much more innovation is required in the implementation of innovation itself.

VEL.