The health and care system we rely on today was created for a very different time. With a focus on treating people in the short term, it’s simply not set up to support and enable people to be healthy in the long term.

At Nesta we’ve worked on health and care for more than a decade. Between 2017 and 2020 our strategy was driven by a vision of a health and care system that enables people to lead healthier and happier lives through people power, smarter use of technology and data, and new innovation methods.

• People power
  Health and care is about much more than medicine. People are healthier and recover faster when their social health needs are met alongside their clinical needs.
• Smarter use of technology and data
  We believe that smart use of digital technology and data can help to empower people to lead healthier and happier lives.
• New innovation methods
  We recognise the need for not only new ideas, but new approaches to how ideas are designed, tested and scaled. We are constantly testing new innovative methods that are more collaborative and inclusive of citizens and frontline staff.

Nesta’s health work grew out of our vision for a people-powered health and care system built on the concept of co-production, in which solutions are designed and delivered with people rather than to and for them.

People power

In 2009, we published our first report - The Human Factor, which explained how transforming healthcare to involve the public can save money and improve lives. That was followed in 2011 by the People Powered Health programme, which explored how health is, and should be seen as, much more than medicine. This 18-month programme took innovations that have been developed over many years and asked what would happen if they became a normal part of life. Six teams from across England took part, and were awarded a grant of £100,000 and access to a range of non-financial support, including a peer network that allowed them to learn from each other.

We summarised what we learnt from the project in our 2013 report, The Business Case for People Powered Health. We found that the NHS in England could realise savings of at least £4.4 billion a year if it adopted People Powered Health innovations that involve patients, their families and communities more directly in the management of long term health conditions.

In 2013, we partnered with the Cabinet Office on the Centre for Social Action Innovation Fund, to further develop and grow people-powered approaches within the health and care system. This programme delivered more than £5.6 million to 21 different projects, some of which have achieved national scale. These include the first-aid app GoodSAM and traditional care alternative Shared Lives Plus.

Other projects we funded took a local approach to people-powered innovation, with places like Stockport pioneering new commissioning approaches and achieving significant reduction in demand for core services. One area achieved a 68 per cent reduction in demand for primary care. The British Red Cross achieved better outcomes for patients being discharged from hospital with a 28 per cent reduction in anxiety, and Shared Lives not only demonstrated better patient outcomes but also achieved a £26,000 reduction in the costs of support from those with a learning difficulty.

Through our report Five Hours a Day, we continued to make the case for a systematic look at how we live in an ageing society, and to create models of living and working which are more fit for the future. We found a large gap between the ageing innovations of the time and what older people actually want.

From 2013 to 2017, we worked with the Cabinet Office, the Department of Health and Social Care and 10 hospital trusts on Helping in Hospitals, which examined the benefits of volunteering in hospital environments. The majority of hospitals found statistically-significant positive results on patient mood, nutrition and hydration levels, and releasing time to care, and some found statistically-significant positive results on patient experience and anxiety levels. We summarised our findings in a final evaluation report.

In 2014 we worked with partners across the NHS and voluntary sector to establish the Coalition for Collaborative Care, a national alliance working towards people-powered health at scale. Today, the coalition comprises more than 60 members.

In 2016 we started our Accelerating Ideas programme. This partnership with the National Lottery Community Fund helped to scale eight innovations that help people age well, feel connected to others, and take part in active, engaged local communities. It demonstrates how high-impact volunteering, neighbourhood networks and peer support can provide the knowledge and connections that older people need to improve their health and wellbeing. British Lung Foundation, Carers UK and Stroke Association have collectively mobilised volunteers across the UK to support more than 65,000 people to date.

From 2015 to 2018, we published a collection of key reports. The NHS in 2030 was an optimistic take on the future of the NHS if it pursued a new people- and knowledge-powered approach. Realising the Value built on the learnings from our previous work and further developed the evidence base and practical tools about how to put people and communities at the heart of health and wellbeing. Good and Bad Help explored the value of shifting the focus of services to be more about providing support that enables people to feel hopeful, identify their own health goals, and take action. Health as a Social Movement proposed the need for new models of engagement between health institutions and social movements. 

In 2019 we began our Social Movements for Health programme - a year-long partnership with Dunhill Medical Trust supporting seven emerging social movements fighting to improve care, equality and justice to improve the health and wellbeing of citizens and staff.

Smarter use of technology

Since 2012, we’ve invested more than £12 million into 26 different health and medtech-related organisations through our Impact Investments fund. For example, we invested in Oomph! Wellness, which aims to enhance the mental, physical and emotional wellbeing of older adults by running exercise classes in care homes for more than 2,000 elderly patients every week. Another investment, Genera (Synopsis Healthcare, exited in 2019), was the market leader in machine-led assessment for preoperative care.

Another recent investment is Skin Analytics, which provides a clinically validated machine learning tool to detect skin cancer. Skin Analytics has taken a different approach to ‘pre-trained’ neural networks (such as Google’s Inception network and Microsoft Research’s ResNet), instead developing a machine learning architecture, training methodology, and data augmentation specifically tailored to the detection of skin cancer.

Most recently, we invested in online healthcare platform Q Doctor, which is helping the NHS deliver patient-centred care amidst the COVID-19 pandemic and is being used for more than 25,000 consultations every month. As Q Doctor scales, it’s laying the groundwork for enhanced development of its clinician support tools, to be driven by AI. Rather than a patient-facing AI approach, Q Doctor’s strategy is focused on supporting clinician decision-making quality and efficiency, taking into account local factors and broader NHS learnings.

In 2016, we ran a €50,000 Smart Ageing challenge prize for products that support older people to participate fully in social life, and in 2017 the Mobility Unlimited Challenge offered a $4 million prize for radical improvements in the mobility and independence of people with lower-limb paralysis through smarter assistive technology.

We also launched the Centre for Collective Intelligence Design, which explores how human and machine intelligence can be combined to solve social problems. The Centre has supported several early-stage but promising innovations in health, including humanitarian mapping with machine learning techniques, and harnessing collective intelligence for more accurate medical diagnostics. One of these projects, Spotlab, has to date engaged over 500 people to label more than 1,600 medical images, which will help train machine learning algorithms for the diagnosis of global diseases.

In 2018 we published Confronting Dr Robot, a report which asked how AI could affect our experience of care and change it for the better. We found a window of opportunity to put in place measures that ensure the technology develops into 'People Powered AI', supporting care that is simple, gives patients control, is centred around an equal dialogue, and is accountable and equitable.

In 2019 we launched the Healthier Lives Data Fund - a partnership with the Scottish Government supporting six technologies that make data available and useful to citizens to help them lead healthier and more independent lives. Through experimenting with ways of engaging users, the fund made the case that co-design of health technologies makes for more useful and used products.

New innovation methods

Throughout the last decade we have experimented with many new innovation methods in the health and care system, ranging from challenge prizes to 100 Day Challenges, to participatory futures.

In 2014, we launched our largest ever challenge prize - the £10 million Longitude Prize, which aims to find a novel, rapid, affordable, diagnostic device that reduces inappropriate antibiotic prescribing.

In 2014 our People Powered Results team also began running 100 Day Challenges, starting with a pilot in Mid Essex where teams tested a number of ideas to improve health and care for people considered to be frail. It led to a 10-12 per cent reduction in unplanned hospital admissions and a new system-wide strategy. We have since undertaken 42 of these challenges, and some of the learning and impact has contributed to local and national guidance on personalisation, and elective care. 

From 2017 to 2018 we worked with the Greater Manchester Health and Social Care Partnership and NHS England to scale up and realise the impact of personalisation, giving people and communities the power to be at the centre of their health, care and wellbeing. We ran 100 Day Challenges in Stockton and Hertfordshire, and worked with local boroughs to scale person and community-centred approaches to care across Manchester.

Our 100 Day Challenge in Essex tested new ways of supporting people with learning disabilities and/or autism to live meaningful and fulfilling lives. People with learning disabilities were in the leadership group and leading challenge teams, co-producing new ideas and initiatives at both a team and strategic level. For example, one team developed new rules, guidance and an assessment tool that will make sure the voice of people with learning disabilities is present in any decision that is made around commissioning.

In 2019, in partnership with Healthcare Improvement Scotland ihub, we launched our first 100 Day Challenge in Scotland, focused on improving mental health and wellbeing for children and young people across Midlothian. This work highlighted the importance and power of working alongside children and young people to co-design the solutions. The effort involved over 175 children, young people, families and carers, and the experience set a precedent for people with lived experience to shape the programmes and services that affect them.

That year, the People Powered Results team also published a learning report on five years of 100 Day Challenges which explored the five ingredients to achieving successful people powered approaches to change and innovation, demonstrated through real-life examples from across the country.

In 2018, we started to explore how UK research and innovation should develop and adapt to accelerate improvements in health and reduce inequalities. We published The Biomedical Bubble, which set out why and how the UK needs to expand beyond the pharmaceutical and biotechnology sectors if it is to realise the economic, social and health potential of new investment in R&D. Downloaded over 3,500 times, The Biomedical Bubble resulted in an invitation to present evidence to a parliamentary enquiry and significant press coverage, including the front cover of The Lancet.

In 2019, we followed up with The Nightingale, which proposed a new centre of innovation and research excellence to equip the UK with the knowledge it needs to improve the social, behavioural and environmental determinants of health. It would draw expertise from across public health and behavioural and social sciences, with best practices from human-centred design, citizen science and asset-based community development.

In 2020, we launched Data Dialogues, a dialogue with Scottish citizens about health and care data. Together with Scottish Government, and five experts in participatory methods, we will use immersive theatre, online social games, speculative designs, and pop-up installations to engage groups from different places, ages, socioeconomic and cultural backgrounds, and people with different experiences of using health and care services.

For more than a decade, Nesta has built a strong network and reputation in health, working in more than 42 local health and care areas. Since 2018 alone, we’ve distributed almost £17 million in grant funding, supported more than 70 innovations in different areas and benefited more than 2.5 million people. Our Realising the Value programme and ongoing partnership with NHS England, has also directly influenced national policy—including NHS England’s Five Year Forward View, the NHS Long Term Plan and Universal Personalised Care.

The original People Powered Health programme supported thousands of people with long-term conditions, for example by shifting the system from being crisis-dominated to one focused on prevention, early intervention and enablement. The team in Lambeth is now supporting up to 500 people each month before they reach crisis point, and there has been a 43 per cent reduction in referrals to secondary care.

Our Helping in Hospitals programme helped lead to growing interest and investment in the development of impactful volunteering opportunities in health settings from organisations including the Office for Civil Society, Helpforce (supported by the National Lottery Community Fund and others) and The King’s Fund.

The organisations we’ve supported through the Centre for Social Action Innovation Fund and Accelerating Ideas have scaled at pace across the UK. For example, GoodGym has grown from a pilot in Tower Hamlets to a nationwide social enterprise with 20,000 members in 58 areas. They've helped over 5,000 older people through regular visits and improved wellbeing amongst both older and younger people. Meanwhile, through their peer support work, the British Lung Foundation, Carers UK and Stroke Association have collectively mobilised volunteers across the UK to support more than 61,000 people to date. 

Over the last six years, our People Powered Results team supported 42 local health and care systems. In Hertfordshire, our work achieved a 19 per cent decrease in A&E attendances, an 11 per cent decrease in zero-day admissions and an 18 per cent decrease in one-plus day admissions. In Stockton-on-Tees, a hospital initiative focused on reducing lengthy stays led to a 35 per cent drop in delayed discharges, contributing to potential annual savings of over £900,000. There are similar stories all across the country.

A decade of work in health has taught us a lot about innovation in public services. Firstly, that innovation is a social process. Focusing on processes and policies will only get us so far. We need as much focus on the quality of relationships and mindset as on the quality of data and infrastructure. The most successful innovations involve people with lived experience and frontline staff as partners throughout the innovation process.

Secondly, that it’s vital to understand the importance of context in a particular solution. Mainstream innovation often assumes that a solution that works in one place should spread as far as possible, but that’s not always true. An alternative model of scaling is mass localism - where multiple locally-developed, owned and accountable solutions add up to large-scale change.

Thirdly, public systems need intermediaries to promote ideas and share learning —like those that broker relationships and market products and services to customers in the private sector. What more can public systems do to provide incentives and mechanisms for spread and adaptation? And how can these incorporate social and behavioural factors and the role of local context?

Finally, some innovation experts frequently call for and celebrate failure - but failure is often unacceptable in public systems like health. It’s more helpful to focus on how innovation methods, like early-stage testing, can reduce failure by tackling current problems and establishing what works at a small scale.

In the coming years, we will harness the expertise that we’ve built up over the last 11 years in the pursuit of specific outcomes that tackle the biggest health challenges and inequalities. In particular, we’re interested in how we harness our innovation expertise and people-powered approaches to tackle the growing gap in healthy life expectancy between the UK’s most and least deprived.

We’ll achieve this by building on Nesta’s heritage and networks, while creating new and deeper relationships with those working at the front line. We’ll combine this approach with Nesta’s proven methods around data science, people power, behavioural insights and innovative financing to develop, test and scale better solutions to entrenched challenges.

Through our work in the health and care system over the last ten years, we’ve worked in partnership with the NHS, Local Government, national and local charities and alongside people and communities to grow people-powered approaches to health and care. Collectively we’ve demonstrated what is possible, and how such approaches can be better for people as well as those on the front line delivering health and care services. 

Our hopes for the future is that this work and commitment to personalise the health and care system through collaboration continues to grow. We know there is much more work to be done for people-powered approaches to achieve large scale adoption, but we’ve been humbled by the passion, resilience, adaptability and commitment of those working at the frontline and within communities to achieve better.