The Health System Support Framework risks locking buyers into “inflexible and steadfastly expensive” solutions, contrary to NHSX’s principals of an open market, a healthcare software chief has said.

Robert Tysall-Blay, chief executive of WellSky and chair of the TechUK health and social care council, said the framework (HSS) had “courted controversy” from the moment it was released.

He told Digital Health News that industry members, including big-name software suppliers and tech companies, feared Lot 1 of the framework was “too narrow and too focussed on certain types of suppliers”. Lot 1 relates mainly to electronic patient record (EPR) suppliers.

WellSky is one of the accredited suppliers on the framework, in partnership with IMS Maxims. According to Digital Health Intelligence data, IMS Maxims holds a 2% share of the EPR market, with four NHS organisations currently live with its patient record software.

“The framework itself was originally viewed as really anti-SME, anti-innovative, it didn’t really cover the principals that are coming out of NHSX, which admittedly came out after the HSS framework had started,” he said.

“But essentially that, and the restrictive nature and complexity of it, seemed to ultimately narrow it down to a very small number of suppliers.

“Industry thought that this wasn’t a problem, per se, as long as the buyers – the STPs, ICSs, CCGs, whoever they are – are not forced down the road of using this framework. In other words that they have choice.

“The worry with funding was that buyers were going to be encouraged to use this route and that was felt that would then be contrary to the principals of introducing innovative solutions.”

Shane Tickell, chief executive of IMS Maxims, added: “This country has needed procurement to be sorted out for a very long time. I think at best it’s inept and unprofessional and at worst it’s corrupt.

“With the creation of NHSX they have had a look at the HSSF, they do want to create an environment where suppliers can best perform and that the buyers are better informed about their decisions.

“I sense that they want to put a lot of their energy into HSSF going forward for the right reasons – to help control procurements better, through better standards, and stop vendors locking people in in unhealthy manners like not allowing buyers to get data out and not complying with open standards.”

Encouraging innovation in an open market

To support NHSX’s vision of a market that start-ups and SMEs can quickly scale technology across, NHS England has proposed a refresh of the framework, dubbed the “innovation greenhouse”

The refresh, or Lot 0, will provide ICSs and STPs with easier access to “tried and tested innovations for patients, populations and NHS staff”, according to papers issued to trusts.

Suppliers looking to be part of the framework will be tested against a core set of capabilities, including compliance and interoperability standards. Bidders will then be expected to demonstrate the capabilities they could offer under the framework.

The priorities were identified following engagement with stakeholders within NHSE, NHS Improvement and NHSX, as well as a review of the Long Term Plan.

NHSE is currently gathering feedback from trusts, suppliers and others within the market before any changes to the lots are made, but it’s not known when Lot 0 will be released.

“If they deliver on that and it [the framework] opens up to include not only innovators and SMEs, but the ability for organisations to pick and choose elements of the solutions they want, rather than one solution provider, then the problem would probably be okay,” Tysall-Blay told Digital Health News.

He said the procurement process in the NHS was “complex, highly bureaucratic and very expensive”, making it harder for small companies to break into the market or scale their solutions.

Tickell added: “I think Lot 0 is a great idea and you can’t get everything perfectly right but what you can do is try stuff and learn from it.

“We saw during the national programme that lots of companies were locked out, lots of companies were also consolidated into bigger ones so we lost lots of innovation.

“Some of us outside of that had to be more innovative because we had to survive. Good, open standards and healthy competition drives forward innovation.”

What is the Health System Support Framework?

The Health System Support Framework was designed to support integrated care and population health management.

It has been developed by NHS England to help sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) procure integrated care records and advanced analytics needed for population health management, as per NHS England’s Five Year Forward View.

It’s hoped the framework will help create a “one-stop shop” for STPs and ICSs by having “pre-approved” industry suppliers which can help their population health management plans.

InterSystems, Allscripts, Orion Health and Cerner have all be appointed to various lots of the framework.

Risks of a narrow market

A framework that focuses on a select group of suppliers puts the NHS at risk of losing “flexibility of choosing solutions”, Tysall-Blay said.

This ultimately means buyers could end up locked into solutions that no longer work for them or have become too costly.

“If funding is channelled down this route, and buyers are mandated to use this framework, then you end up with a situation where buyers could get locked in for decades into solutions that are inflexible, not really innovative and steadfastly expensive.

“The fundamental thing is the buyers should have an open market.

“The counter argument is that there’s too many buyers in the market, so from the NHS’s point of view, the hundreds of suppliers they have to deal with can be a challenge in its own right.

“But… technology in the market is going to change very rapidly and an open market gives the freedom and flexibility for buyers to plug and play solutions as they transform the healthcare service, and adopt these things in the best interests of patients and care providers.”

WellSky is one of the “hundreds of suppliers” the NHS dealing with and arguably benefits from the framework, being one of the accredited suppliers.

However, Tysall-Blay insisted that having an open market was “right and proper”.

“As much as we are on it as a particular solution provider that doesn’t change the fact that I still believe, not just from a personal business interest but from a market point of view, that these types of frameworks should be open and the marketplace should have the freedom,” he said.

“We have to work in a market and be measured on the solutions we provide and the quality it provides, that’s right and proper.”

The need for a healthcare market that allows for growth and scale of innovation has been reiterated numerous times in recent months by NHSX chief Matthew Gould. Most recently at HETT, when Gould said the newly-formed unit must focus on getting resources to clinicians on the frontline and ensuring it does not “grow an enormous empire at the centre”.

He discussed the importance of working more closely with the health-tech sector to identify the barriers that prevented innovation being adopted across the NHS.

NHSX and NHS England have been contacted for comment.


Tune in to Digital Health’s latest podcast with the DigitalHealth.London accelerator programme, exploring the challenges faced by start-ups in scaling their digital solutions in the NHS.