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21 October 2015

The Dragon’s Den model has been mirrored across several sectors and has also found its way into the primary care setting

The Dragon’s Den model has been mirrored across several sectors and has also found its way into the primary care setting

Back in 2011 Dragon’s Den was a TV phenomenon. It was just after an election that had brought a coalition to power determined to ‘balance the books’. Amidst the mood music of Prime Minister David Cameron’s yet to be rejected ‘big society’, British people seemed to be taking to austerity with a zeal resurrected from the post war years. ‘Keep calm’ slogans and ‘upcycling’ were the order of the day. So it was no wonder a TV show that appeared to give anyone with a decent idea and business plan a leg-up, rewarding the desire to ‘get on’ was hauling in viewers.

The CCG approach
So as the NHS geared up for reorganisation and greater pressure and scrutiny of budgets, some started to wonder if they could snag a ride on the Dragon’s Den bandwagon to harness innovative ideas outside of the NHS, thus tapping into Cameron’s big society, and delivering greater value and better services as a result.
Oldham Clinical Commissioning Group’s (CCG) managing director and lead manager, Denis Gizzi, said the idea to try and actively seek innovative ideas to help the CCG commission better, more efficient services for a diverse population with large areas of deprivation, was central to it’s whole launch strategy as an organisation.
“When we looked at what the Government was expecting from these newly formed CCGs, we realised it was the first of many reorganisations I’ve been part of that said, rather than a new policy coming out and existing organisations metamorphisising into a new one, it was a very deliberate strategy to create something new and authorising them to operate within an organisational framework. Part of that was around a CCG’s ability to understand innovation and how it applies to a commissioning organisation. So that’s what we did.”
Gizzi said Oldham seized the opportunity to develop its NHS community’s natural tendency towards supporting innovation, and created a “bespoke innovation strategy” that put a three-phase dragon’s den process at its heart. “This wasn’t an addendum to a broader commissioning strategy, it was central to it. So it was: ‘How do we think about innovation? Where does it fit into our business modelling? Where does it fit into our culture? Let’s describe it very clearly,’” he said.
Similarly, Darlington CCG introduced an innovation fund totalling £50,000 in 2013 designed to encourage private and voluntary and community sector organisations, which could support its strategic objectives to start supplying local NHS providers. The move followed a realisation that the group needed to find ways to discover potential new answers to old NHS needs; to replace outmoded and inefficient ways of delivering services. Like Oldham, it wanted to seize the opportunity to reach out and draw in innovative ideas rather than wait for them to hit their desks.
Durham Dales, Easington and Sedgefield CCG (DDES CCG), meanwhile, decided to use the dragon’s den brand to attempt to encourage new partners in mental health services, and specifically looked to community and voluntary groups to come forward to compete for a mental health and wellbeing grant worth £100,000.
The only CCG to have attempted the move in the southern half of the country was Canterbury and Coastal, which called on voluntary and community groups to compete for a £25,000 pot to continue existing services or present new ones to any population group in its constituency. Unlike the other three, it encouraged each bidder to prepare proposals for as much or as little of the pot as they deemed necessary for the service.

Where it all began
All of the CCGs used a similar model, based on an idea first floated by Mike Farrar, then chief executive of the now defunct North West Strategic Health Authority, specifically encouraging community and voluntary organisations to present novel ideas for existing service delivery needs. The formats used resembled the TV show namesake, with hopeful applicants presenting to a panel of CCG members, including local GPs.
In Darlington, where each project could bid for between £2,500 and £25,000, five bidders were successful in 2013, offering community services to disadvantaged children, people with dementia and the homeless among others. Three were from local grassroots organsations, while two were national organisations Age UK and the Alzheimer’s Society.
The success of the process led to a second round the following year, which
was designed around a more focused theme of engaging local children and young people in “creative and inspiring ways to enhance their quality of life, confidence and health and wellbeing”. Four projects received funding, two of which were new services from providers that had successfully bid in 2013.
The outcomes
DDES CCG’s process led to 12 new services being commissioned in early 2014 to support mental health, ranging from a Mencap local branch introduction of a Duke of Edinburgh style achievement award for people with learning disabilities to the creation of a community garden by a local church group to ‘me time’ sessions for local mums to help relieve the pressure of parenting for those on the edge.
Following a similar first round with small to medium enterprises (SMEs), community and voluntary groups in 2012, Oldham CCG decided to apply the model to encourage pharma and medtech companies to come forward with innovations that could benefit the people of Oldham.
Recognising that the process needed to be as objective as possible, and stand up to ‘Department of Health (DH) level procurement’ standards, the CCG decided to bring in its local innovation hub Trustech to run the second two phases as a broker. As a result, the NHS branded non-profit body, which started life as one of seven DH funded innovation hubs, is about to start evaluating eight medtech innovations within Oldham CCG’s population groups, once they have completed diligence testing by the end of September.
The companies, which are a mixture of local, national and international players, were whittled down from more than 200 initial applications when the process was launched at the end of 2013. They include inventions as diverse as hip packs to break falls, to sensors in medication that lets the GP know if it has been taken or not.
The pharma industry was the least interested in participating in a dragon’s den style process, perhaps because it is dominated by large corporates with well-established routes to market already, unlike, say, an emerging market dominated by startups such as medtech.

Next steps
However, despite the success of each scheme, particularly in Oldham, none of the CCGs are currently planning a repeat of the process, although Gizzi said it may just be a matter of time: “Now the learning is [that] we should evolve the dragon’s den approach to be a systematic process so if anyone comes to us with an innovation, we shouldn’t say the next round is going to be Feb 2017 – so keep it warm. We have to have a systematic way of going through and the strengths and weaknesses and make quick decisions.”
He added: “There are so many capacity restraints within CCGs, how many innovations can you have going at one time and keep your eyes on them? This is where it links to another learning, where an innovation partner is needed to help oversee and regulate.”
Other areas are clear that the dragon’s den approach already belongs to a bygone era: “Much publicised budget cuts mean that money from slippage that was previously available now has to go into funding our core contracts,” said DDES CCG’s, head of finance Mark Booth.
He added that although the exercise was beneficial, their effectiveness has been difficult to properly evaluate due to a lack of resources. Moreover, Booth says that the advent of the Better Care Fund means the responsibility for commissioning from the voluntary and community sector will now lie in partnership with Local Authority Area Action Partnerships, “who have long established processes and boards for evaluating and approving bids for such work”.
Oldham’s Gizzi is planning to write a paper on the CCG’s experience for publication in the Autumn, but for now his broker Trustech’s business development and partnerships director, Raj Purewal, says the overall message is this model can work if you have two basic ingredients: an independent body who can run the ‘back end’ for you and a visionary and committed board.

Mary-Louise Clews, freelance journalist and consultant.

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