Kate Granger Awards recognise inspirational healthcare staff and volunteers spanning 70 years of the NHS

A nurse who started training in 1948 is among the inspirational people and teams receiving special recognition for their dedicated services to the NHS spanning seven decades.
This year’s Kate Granger Compassionate Care Awards, announced at the 2018 Health and Innovation Expo at Manchester Central, were given to individuals, teams and organisations who demonstrate outstanding care for their patients. Click here for full details

Against the odds: successfully scaling innovation in the NHS

This report from the Innovation Unit and the Health Foundation explores the findings of a research project about how to scale innovation in the NHS. It examines 10 innovations that have spread over the past 20 years and lists a set of provocations to consider how these insights build on, and challenge, existing wisdom on how to scale innovation in the NHS.

EpiFix for chronic wounds [MIB 139]

New:  EpiFix for chronic wounds


EpiFix (MiMedx) amniotic membrane allograft is made of dehydrated human amnion/chorion membrane tissue (dHACM). The tissue is derived from amniotic membranes donated with informed consent in the US. EpiFix is terminally sterilised to reduce virus transmission. It is promoted to enhance wound healing, reduce scar tissue formation and modulate inflammation.
EpiFix is indicated for a wide range of wounds; the scope of this briefing is chronic difficult-to-heal wounds including diabetic foot ulcers, venous leg ulcers, arterial ulcers and pressure ulcers.
The company's instructions for use recommend weekly administration. After wound cleaning and debridement in a non-infected wound, EpiFix is removed from the packaging and cut to fit the size of the wound. After EpiFix is applied, a non-adherent contact layer should be placed on top and the wound dressed as usual. EpiFix can be used alongside compression, offloading, negative pressure and hyperbaric oxygen therapy.


The innovative aspect of EpiFix is that it is an allograft of human amniotic membrane that has been processed and purified for use (using the MiMedx proprietary PURION process). This is designed to preserve bioactive components and deliver non-viable cells, multiple extracellular matrix (ECM) proteins, active growth factors, cytokines, chemokines and other specialty proteins present in amniotic tissue with the aim of helping to regenerate soft tissue.

MammaTyper in vitro diagnostic test for determining breast cancer subtypes [MIB 135]

New:  Medtech innovation briefing


The MammaTyper (BioNTech Diagnostics GmbH) test is a molecular in vitro diagnostic test for the relative gene expression quantification of the genes ERBB2, ESR1, PGR and MKI67 in human breast cancer tissue. It is used as a diagnostic test on biopsy samples of invasive breast cancer tissue from surgical resection or pre-operative core needle biopsies. The test is based on reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). MammaTyper classifies breast cancer into 4 subtypes that have different treatments according to St Gallen (2017) guidelines:

• Luminal A-like (oestrogen receptor [ER]-positive and generally human epidermal growth receptor 2 [HER2]-negative); treated with endocrine therapy.
• Luminal B-like subdivided according to the ERBB2 expression into:
  
  • luminal B-like (ER-negative and HER2-positive); treated with anti-HER2 therapy and chemotherapy
  • luminal B-like (ER-positive and generally HER2-negative); treated with endocrine therapy.
  
  
• HER2-positive (non-luminal); treated with anti-HER2 therapy and chemotherapy.
• Triple-negative (generally ER, progesterone receptor [PR]- and HER2-negative); treated with chemotherapy.

Adoption and spread of innovation in the NHS

Briefing from the King's Fund:

The first large-scale clinical trials of statins were held in the mid-1980s and statins became available on prescription from the NHS in the 1990s. By the early 2000s, the English NHS was prescribing around 8 billion daily doses of statins each year, contributing to dramatic reductions in rates of mortality from cardiovascular disease.

Meanwhile, despite considerable progress, the NHS, like other health systems, is still struggling to implement basic hygiene protocols such as handwashing in hospitals, 150 years after Joseph Lister published his observations in the Lancet on antiseptic methods. Some innovations are incendiary, spreading with a spark from funders, regulators, professionals or the public. Others seem stubbornly immobile, no matter how easy they appear to implement or how persuasive the evidence.

Growing innovative models of health, care and support for adults

This briefing from SCIE explains that innovative, often small-scale models of health, social care and support for adults could be scaled up to benefit as many people as possible. It makes a number of recommendations for the Government and national partners

Thinking on its own: AI in the NHS

This report illustrates the areas where artificial intelligence (AI) could help the NHS become more efficient and deliver better outcomes for patients. It also highlights the main barriers to the implementation of this technology and suggests some potential solutions.

NHS supports development of health innovations

The NHS has selected 138 entrepreneurs to design and deliver new technological solutions and innovations in healthcare. This includes the appointment of five healthcare scientists, tackling conditions including sickle cell disease and allergic reactions.

The Clinical Entrepreneurs Programme, run by NHS England, supports NHS workers to work with, and learn from, leading health and technology industry experts to develop their own innovative ideas.

Getting the most from technology requires pathway redesign

The topic of technology led at September’s NHS Innovation Expo conference. NHS England used Expo as an opportunity to showcase the innovation test bed areas, publishing a ‘Story so far’ update. These seven areas test different technologies with the aim of demonstrating how to choose, implement and iterate technology to transform care pathways and the experience of care.

Falling short: Why the NHS is still struggling to make the most of new innovations

The idea that the NHS is slow to adopt seemingly well-evidenced innovations is not new and, for the most part, is accepted as fact. The reasons for this have been extensively studied. Last year, the Accelerated Access Review set out the barriers once again – proposing a number of useful solutions that, if implemented as envisaged, could go a long way to improving the situation.  Report from the Nuffield Trust.

Tonogenchoncel-L (Invossa) Gene Therapy for Regeneration of Cartilage in Patients with Degenerative Arthritis or Osteoarthritis of the Knee

Tonogenchoncel-L is a type of treatment which involves taking cells which make up the cartilage and altering them genetically to help stimulate the growth of the cartilage. These modified cells are injected directly into the knee joint with the intention of helping the lost cartilage regrow. If tonogenchoncel-L was licenced in the UK it could provide a unique treatment for people with knee osteoarthritis which has the potential to help cartilage regrow and improve symptoms.

From NIHR Innovation Observatory

Neridronic Acid (Nerixia) for Complex Regional Pain Syndrome

The cause of CRPS is unknown, but it is generally thought to be the result of the body reacting abnormally to an injury. It is difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed. Currently there are no approved treatments for CRPS. Neridronic acid administered by injection is currently being developed to treat CRPS and early results indicate that it has the possibility to control the condition. If approved neridronic acid will be a potential new treatment for CRPS.

From NIHR Innovation Observatory

Upadacitinib for Adults with Moderate to Severe Active Rheumatoid Arthritis After Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) or Biologic DMARDs Failure

There is currently no cure for rheumatoid arthritis and treatment aims to improve quality of life and to prevent or reduce joint damage. The most common treatment options are steroids to reduce inflammation, medications to reduce pain and swelling, and medications that slow the progression of joint damage from RA. Upadacitinib is currently being developed to be taken orally as a treatment option for those who have active moderate to severe RA who do not respond to certain treatment options. This drug works by stopping the inflammation caused by a specific type of protein and if licensed, it may be an option that can be used earlier in the treatment pathway.

From NIHR Innovation Observatory

Subcutaneous Tocilizumab (RoACTEMRA) With or Without Methotrexate for the Treatment of Inadequate Responders in Systemic Juvenile Idiopathic Arthritis

Tocilizumab is a drug that targets and blocks the IL-6 pathway and is currently used for the treatment of many diseases, including sJIA, rheumatoid arthritis and Giant Cell Arteritis (GCA). It is now being developed for patients with sJIA that may have been treated with, and have not responded to another drug called methotrexate. It is being developed to be administered as an injection under the skin (subcutaneous) as opposed to the usual intravenous infusion preparation and this has the potential to reduce patient inconvenience and clinical burden.

From NIHR Innovation Observatory

Taselisib in Combination with Fulvestrant for Advanced ER Positive, HER2-negative Breast Cancer – Second Line After Aromatase Inhibitor Therapy

Taselisib is investigated as a new oral treatment for ER+, HER2- type of breast cancer. It is being investigated as a medicine to work on a pathway regulating cell growth and cell survival. If taken in combination with an intramuscular injection of fulvestrant, which stops the effect of hormones altering the breast cells, taselisib has the potential to prolong survival. If licenced, this combination of treatments will offer an additional therapy option for those who have already had hormonal therapy but their cancer has relapsed.

From the NIHR Innovation Observatory.

Subcutaneous Tocilizumab (RoACTEMRA) With or Without Methotrexate for the Treatment of Inadequate Responders in Systemic Juvenile Idiopathic Arthritis

Tocilizumab is a drug that targets and blocks the IL-6 pathway and is currently used for the treatment of many diseases, including sJIA, rheumatoid arthritis and Giant Cell Arteritis (GCA). It is now being developed for patients with sJIA that may have been treated with, and have not responded to another drug called methotrexate. It is being developed to be administered as an injection under the skin (subcutaneous) as opposed to the usual intravenous infusion preparation and this has the potential to reduce patient inconvenience and clinical burden.

From the NIHR Innovation Observatory. 

IMCgp100 for the Treatment of Advanced or Metastatic Uveal Melanoma

There are currently few effective treatments available for advanced or metastatic uveal melanoma, including surgery to remove the cancer, radiotherapy or chemotherapy.  IMCgp100 is a drug under development that would enable the body’s own immune system to recognise and specifically target and kill cancer cells. IMCgp100 is given by intravenous infusion and is currently being studied in patients with advanced/ metastatic uveal melanoma. It will offer a new treatment option if licenced.

From the NIHR Innovation Observatory.

Veliparib in Combination with Carboplatin and Paclitaxel for Breast Cancer – First to Third Line

Veliparib is a new oral drug that is being developed for patients with HER2- breast cancer that is advanced and cannot be removed completely through surgery.  The drug acts by targeting specific enzymes involved in the repair of damaged DNA that helps the body to kill cancer cells while allowing ordinary cells to survive. Veliparib is being developed to be used in combination with the chemotherapy drugs paclitaxel and carboplatin. If licenced, this combination will offer an additional treatment option for patients with HER2- metastatic or locally advanced unresectable BRCA-associated breast cancer.

From the NIHR Innovation Observatory

Risankizumab (by Subcutaneous Injection) for Moderate to Severe Chronic Plaque Psoriasis

Risankizumab is a drug which is injected into the skin. It works in a unique way by blocking a specific process which allows the body’s immune cells (specifically T-cells) from attacking and damaging the skin. Risankizumab is currently being trialled in a range of diseases involving the immune system including Crohn’s disease, and psoriatic arthritis.

From the NIHR Innovation Observatory

ALXN 1210 for Paroxysmal Nocturnal Haemoglobinuria

ALXN1210 is an antibody under development that prevents the destruction of red blood cells (RBCs). The drug is administered by intravenous injection that requires fewer dosing regimen compared to current treatment option. If ALXN1210 is licensed for use in the UK, it could represent an additional treatment option for patients with paroxysmal nocturnal haemoglobinuria.

From the NIHR Innovation Observatory