Health minister Lord Darzi has called for more innovation in the NHS. Nurses already have a proven track record in coming up with practical solutions to everyday problems on the frontline. Jo Carlowe reports
They say necessity is the mother of invention, and when it comes to innovation in nursing that could not be more true. While some inventors may be driven purely by financial gain or the need for personal recognition, it is usually the realisation that a specific problem needs solving or a system improving that has inspired many nurses to come up with innovative ideas.
That was certainly the case when Lynne Phillippo, a nurse practitioner from Norfolk, had her idea. She invented ‘The Danrik Wedge’ – named after her two sons Danny and Ricky – a pelvic cushion that makes patients more comfortable when they have a cervical smear and provides the practitioner with a better angle to carry out the procedure safely.
She came up with the idea because it amazed her that women were expected to either rest on a pillow that invariably sank during the examination, or were asked to prop themselves up on their fists.
Moreover, she felt it was only a matter of time before a spectrum ended up damaging a patient’s bladder because the woman was inadequately positioned, leaving the practitioner open to complaint or prosecution.
‘There had to be something better,’ she said. ‘I knew exactly what I wanted. I knew the width of the cushion, I knew the height and what material was needed – it had to be latex free and easy to wipe down.’
As a result she approached several relevant companies, had a prototype made up and her idea became a reality.
She is not alone. Up and down the UK, members of the profession are similarly identifying problems and coming up with innovative solutions.
In Wolverhampton a team of community nurses came up with Hoo-kOn, a portable lightweight drip stand that allows bags of intravenous drugs or fluids and monitoring equipment to be securely attached so that nurses can safely administer treatment to patients at home.
The device will fit in the boot of a small car and has also proven useful in military operations in field hospitals and at multiple accident scenes. The device was developed to work with a portable drip hook called Hook-it IV – the brainchild of John Edward, a theatre nurse from New Cross Hospital in Wolverhampton.
Indeed, health minister Lord Darzi, has openly recognised the role that nurses have and do play in innovation, describing them as at the vanguard of adopting and promoting new ideas.
‘Nurses have a tremendous appetite for innovation,’ he told Nursing Times in an interview in April ahead of NHS Innovation Week. ‘There’s less conservatism in the nursing community than there is in the medical community,’ he said.
Lord Darzi also noted that nurses were well placed to identify areas where innovation was needed because they were among those closest to the patient.
The success stories are numerous, and yet for every triumph, one can assume that there are thousands of ideas that never come to fruition. Some never see the light of day because their creator keeps the idea in his or her head.
Lord Darzi spoke of a lack of confidence among nurses, suggesting that some were reluctant to come forward with ideas. He also said the organisations in which they worked would need to become more supportive and break down boundaries between professions to create closer teamworking.
But sometimes the opposite problem occurs. The originator is all too happy to talk about their idea – so much so that they risk it being stolen or else make it impossible to patent, thus failing to get the recognition and ownership they deserve.
‘All too often an idea falls at the first hurdle,’ said Janice Sherrad-Brisley, innovations manager at NHS Innovations – the national network set up to champion innovation within the NHS.
England has nine NHS Innovations Hubs – one in each region of the country. They were launched between 2002 and 2005, and are tasked with identifying, protecting, developing and commercialising ideas and innovations conceived by NHS Staff. The hubs receive core funding from the Department of Health and additional funds from the Department for Business, Innovation and Skills and from Regional Development Authorities.
Any NHS worker – from porters through to consultants – can approach their local hub with an idea, and if taken up the hub helps the individual to negotiate with companies and to work out a split of the royalties. These are shared out between the company that ends up producing the product, the NHS trust where the individual behind the idea works and to the person themselves. A typical split may involve the inventor receiving between 60–90% of royalties for the first five years, and 40% from then on.
Ms Sherrad-Brisley said potential inventors lost out more often than not because they did not seek the right advice from the start. Instead they went ahead doing what they believed to be the right thing and shared the information before the idea was protected.
‘Sometimes you hear they have told a “friendly” sales rep about their idea and it gets stolen. There is a huge problem with intellectual property leakage,’ she said.
Intellectual property (IP) is any form of original creation that can be bought or sold – from music to machinery. The four main types of IP rights are patents, trademarks, designs and copyright.
‘Sometimes a person will go to a company and sign away their intellectual property rights and their royalties, but end up having to pay the company to get their idea developed. They are getting fleeced,’ said Ms Sherrad-Brisley.
On other occasions a person may put an idea into the public domain believing it to be original only to find that they have inadvertently breached someone else’s intellectual property rights. They then risk being sued.
Ms Phillippo, inventor of the Danrik Wedge, admits that she was clueless about the process when she started out. She approached a few companies and paid £150 of her own money to have a prototype made. She then began using the prototype in the surgery.
‘I didn’t tell clients that I’d invented it but I did a mini audit and got positive feedback. It worked a treat,’ she said. But by using her invention Ms Phillippo had made it impossible to patent the idea.
‘Because I had used it in the surgery for the sake of patients I was told it could not be patented because it had already been seen. I was completely naïve but then you are at the start, because you do not know where to go for advice.’
Nonetheless, the idea was taken up by Health Enterprise East, one of the NHS innovation hubs, which acted as a broker between Ms Phillippo and the company employed to market the idea.
Certainly the NHS Innovation Hubs appear to be a good option for nurse inventors. They offer the individual some protection, and help you to get an ‘in’ with relevant companies that can test, produce and market your invention. They will also intervene by bringing in a trademark lawyer if your rights are infringed – for example someone abroad attempts to pass your idea off as their own.
Before taking on an idea, the hub will assess whether it is novel, whether the inventor has copyright and whether it has commercial value. If it is not commercial but nonetheless still useful, they can point the nurse to a relevant organisation, such as the National Patient Safety Agency, who may take the idea forward – giving the inventor recognition although no financial gain.
The hubs make it more likely that a good idea will come to fruition, they involve no financial outlay on the nurse’s part and the inventor will get a share of the royalties should the idea prove commercial. The hub will even negotiate with a trust to try to persuade it to invest in the idea should managers prove reluctant to play ball.
However, some people prefer to retain control over their invention. In doing so they may seek to patent the idea, approach a company themselves, have a prototype made, negotiate directly with existing companies and play a role in the marketing. The financial rewards may ultimately be greater, although the risk are also higher.
But former nurse Dr Susan Hamer, director of Norwich Transfer and Enterprise at the University of Leeds, warns that patenting an idea is a laborious and costly exercise. There are several stages of patenting and the costs can run into thousands.
‘There are those who argue that the patent system is only serving patent lawyers, because a patent is only worth having if you can protect it. If someone in China manufactures your idea you have to be able to afford to take them to court,’ said Dr Hamer.
Moreover, she says getting an idea into use can be ridiculously time consuming.
‘If someone discovers something in a laboratory it takes, on average, from discovery to clinical practice about 17 years, and it’s even worse for devices. Everything has to go through clinical trials, be piloted, then you have to persuade someone to develop the idea, and you have to persuade the doctors that it’s a good idea and then get NHS procurement to buy it and get it out there into use.’
Regardless of whether an inventor intended to patent an idea, Dr Hamer advised nurse inventors to license their idea via the Intellectual Property Office before sharing it with anyone else. This is a quick procedure which ensures that you are acknowledged as the originator.
After that, nurses may consider approaching companies directly to see if they will consider taking the proposal forward. They can ask the company to sign a non-disclosure agreement – also known as a Confidentiality Agreement – which prevents them from showing an unpatented idea to another party. The nurse will then need to negotiate who gets what.
Nurses may even want to start up a small business to promote and market their idea – using Business Link – a free business advice and support service – for information on how to go about this.
‘It depends how entrepreneurial you are,’ said Dr Hamer. ‘There is loads of support for people who want to start up a small business. There are also people who just want to see their idea out there and want to be acknowledged for it and to play a role, but who do not want to run it as a business.’
Interestingly, at NHS Innovations, Ms Sherrad-Brisley notes that it is more often than not the consultant inventors who decide that they would rather go it alone.
‘In my experience they are the ones who say they would rather retain control and spend the money on patents. There does seem to be a difference between our nurse and doctor inventors. The doctors seem to want the kudos for their invention whereas our nurse inventors tend to come up with things because they want to find a solution to a problem.’
This chimes with the experience of Ms Phillippo, who now gets royalties from her invention – working out at roughly £27 per wedge sold – but she said the money was not the prime motivator.
‘I just thought it was something I could use in my surgery,’ she said. ‘I wasn’t out to make money from it. I would like to see it more widely used for the benefits of patients and for the physician. It feels weird to have my invention out there – I am apparently in “the book of inventors”.’
|Where to go with your idea:|
|1. Make the British Library Site on Intellectual Property your first port of call.|
|2. If you are business minded and feel confident about going it alone, then visit Business link with a view to setting up as a business.|
|3. Before telling anyone about your idea, register it as your own.|
|4. If you would prefer more support with your idea and would like to see it rolled into clinical use quickly, approach NHS Innovations to see if they will work with you.|