Designs for greater wellbeing

As home to the world’s single biggest healthcare provider — the NHS — and a vibrant scientific research community, the UK has a thriving medical technology industry.

According to business intelligence group Espicom, the UK has one of the world’s largest medical device markets, valued at £4.2bn and growing.

With its emphasis on precision, reliability and innovation, the sector is eager to adopt the best systems and processes from outside its ranks, and presents a potential opportunity for technology transfer and new, high-value business for new operators.

Those seeking to enter the sector will, however, find it very different from other markets, not least because of the formidable regulatory approvals needed and the dominance of the NHS as end-customer, accounting for around 80 per cent of healthcare expenditure.

The market is driven by factors which include the need to reduce surgical trauma, shorten patient recovery times and enhance quality of life, while reducing the healthcare and social costs of managing long-term illness — particularly in an ageing population.

All of this requires consistent and growing spending to ensure the technologies used are up to date and increase efficiency by cutting procedural costs.

Advances in device development, such as the introduction of robotics and miniature cameras to allow minimally invasive surgery and to aid recovery times, are a prime example of how technology can achieve this, as are the use of biocompatible materials for operations such as hip replacements, where repeat or corrective surgery can be avoided if implants are not rejected.

As part of a general upward trend of government investment since 1999, aimed at reducing waiting lists and improving quality of care, the NHS has been promised increased funding until 2008. This should ensure that domestic demand for everything from stents to wheelchairs, prosthetics and drug delivery devices will remain high.

An emphasis on improving patient satisfaction also means that there should be scope for the adoption of new mechanisms, provided they can prove their cost-effectiveness. While the NHS remains the UK’s biggest consumer of medical devices, efforts to reduce hospital waiting lists mean that demand is also being created by the growth of the private healthcare sector. According to statistics from the Health Technologies Knowledge Transfer Network (KTN) the UK medical device industry has an annual growth rate of 15 per cent.

No wonder that US multinational GE chose to site the headquarters of its global healthcare division in the UK, contributing to this country’s reputation as a leading producer of innovative devices.

‘The NHS is not the only driver of market growth,’ said Tony Davis, chief executive of Medilink West Midlands, an association formed to stimulate growth in the medical technology sector by establishing effective and sustainable partnerships between customers, innovators and suppliers. ‘We are seeing opportunities arising from the growth of the private sector, including private hospitals with the “choose-and-book” formula and the NHS’s move towards hiring private contractors. We are also seeing growth within the over-the-counter consumer market.’

Healthcare product design consultant firm Pearson Matthews is well known for the development of a set of male and female fertility tests for home use on behalf of its client Genosis.

According to Pearson’s director Jim Dawton, a third market is emerging in the middle ground between clinical medicine and the over-the-counter sector.

‘At one end of the scale you have the medical market and, at the other, the consumer,’ he said. ‘In the middle of these is the emerging wellbeing market, covering technologies such as home testing and diagnostics.’

This aims to inform customers about their health, allowing them to change their lifestyle to compensate. ‘The trend is for people to manage their health more proactively, with the emphasis on healthcare, not disease management,’ said Dawton. ‘While the NHS is concerned with specification and cost, the consumer market is driven by brand. Design of devices produced for the healthcare market may change once consumer and wellbeing demand is factored in.’

Though it will be some time before the amount of demand created by this new lifestyle market becomes clear, the government is also making efforts to answer criticisms of the difficulty in having a new product accepted by the NHS, no matter how effective.

‘Historically, the NHS has been a slow adopter of technology,’ said Oliver Wells, chair of the Association of British Healthcare Industries’ Research and Innovation Policy Group. ‘We are trying to find ways to make the NHS more responsive. Unless you have a good UK customer it is hard to feel motivated to innovate.’

Though not as concerned with litigation as the US medical industry, regulation and the length of pre-clinical trials is seen as a cause of delay in introducing products to UK patients. The costly regulation barrier particularly affects smaller companies attempting to convert innovative ideas into products, especially in the case of devices such as implantable combination products.

A number of initiatives have been set up to counter this problem by streamlining clinical trials and opening up the market for effective products.

‘The NHS is known as the world’s largest healthcare provider and therefore customer,’ said Prof Mehdi Tavakoli, consultant and technology manager for the Advanced Material & Processes Group at TWI and programme manager for the KTN.

‘However, historically many companies have experienced great difficulties in selling into the NHS. I have had the opportunity to contribute to the development of a website by the National Innovations Centre, part of the NHS Institute for Innovations and Improvement. The site includes excellent support to clinicians and other NHS professionals, academics and healthcare product manufacturers, particularly small companies, to take innovative ideas to products.

‘This portal has been opened to the public since last week, and should have significant impact in promoting innovation within the NHS. It could also help users understand selling to the NHS, particularly with products which may have been originated and accepted by clinicians.’

Medilink’s Tony Davis agreed that such actions have measurable benefits. ‘We are seeing Department of Health and DTI initiatives coming out of the Health Industry Task Force, such as the NHS Innovation Centre, Healthcare Co-operatives, Innovation Hubs, Adoption Hubs and the reorganisation of the Medical Device Evaluation Service. These are positive attempts to change the UK’s status as a late adopter of innovation,’ he said.

However, he warned that despite these advances, trends elsewhere within the organisation could mean that the NHS market is moving backwards on some counts. ‘The supply chain efficiency programme, the procurement hubs and the recent announcements on the selling off of NHS Logistics to private sector providers, as well as the current reorganisation of the Purchasing and Supplies Agency are geared to cut costs across the board,’ said Davis. ‘This is driving innovation out of the NHS supply chain through short-term, low-cost, buy-in-bulk purchasing decisions being applied.’

Device manufacturers see this continued NHS emphasis on cost as problematic as they try to produce devices that can meet the conflicting needs of both the UK and foreign markets.

‘The biggest driver in the UK market is cost,’ said John Tuckwell, healthcare engineering group leader at Cambridge Consultants, which has developed devices including dry powder inhalers and wireless diabetes management systems. ‘But worldwide the emphasis is on accuracy of treatment, especially in the US, which is attractive because of its size. The Japanese market is also large but is concerned with aesthetics as good design is seen as a sign of quality.’

Despite some criticisms of remaining barriers to NHS entry, the determination of manufacturers means technology transfer into and out of the medical sector has been occurring at a steady rate across a diverse range of products.

‘Technologies that have transferred into the sector include inkjet printing, where inhalers require aerosolised liquids containing small particles with a constant size,’ said Tuckwell. ‘Likewise, automotive technology that uses gas to quickly inflate airbags is being explored for developing needle-free injection systems.’

One particular field where there has been a great deal of activity is robotics. Robotic consoles using technology developed for industrial purposes have been adapted to be used in various surgical procedures — for example, those where doctors use remote control to operate in constrained spaces such as the heart, brain, spinal cord, throat and knee. Here, hand tremors can be removed to allow extremely precise, intricate movements without mistake.

The industries from which transferable devices are taken are diverse. A new scanning technology for healthcare applications such as diabetes management that was originally developed for the retail market is about to undergo second-stage clinical trials in the West Midlands, while RFID innovations, designed to track product through warehousing, are being applied to healthcare scenarios.

Transfer of technologies out of the sector is also proving fruitful. An example of this comes from GE Energy, which has adapted the ultrasound technology developed in its healthcare division to create an inspection tool for evaluating the health of liquid pipelines. The UltraScan Duo uses an automated sensor system known as Phased Array Ultrasound Technology to perform comprehensive pipeline inspections, measuring multiple types of defects in a single sweep to reduce costs and minimise pipeline closures.

GE has also developed baggage scanning security tool — the CTX 9000 DSi Automated Explosives Detection System — using technology derived from medical CT. As a conveyor moves each bag through the machine, the system creates a scan projection X-ray image to check for suspicious substances.

This rate of innovation, technology transfer and favourable demographics means the UK’s medical devices industry is one in which the right product can prove extremely profitable, as well as extremely beneficial to a wide range of patients in both social and private healthcare.

Though the market’s main customer, the NHS, still contains problematic barriers to entry, the rate of innovation is increasing at a phenomenal rate.

If you are considering entering the medical technology market, you can attend an exclusive session hosted by The Engineer at the Medical Innovation Forum, to be held at London’s Olympia Conference Centre on 26 October. This event will offer companies a unique insight into the technologies needed by the healthcare sector, its supply chain, and the regulatory implications of doing business in the medical market. There will also be the chance to explore opportunities for collaboration with others already operating in the sector. To find out more visit