Co-ordinating and evaluating the HTAAF programme in C&M

In August 2023, NHS England was asked by the Department of Health and Social Care to deliver a £30 million Health Tech Adoption and Acceleration Fund (HTAAF) through Integrated Care Systems (ICSs).  

The aim was to expedite the adoption of technologies that would map to local priorities. ICSs were invited to submit applications to implement technologies covering categories such as: virtual wards, at-home management, elective recovery, clinical productivity, self-management and early cancer diagnosis. 

Health Innovation North West Coast, collaborating with Cheshire and Merseyside Inegrated Care System (C&M ICS), expanded AI-based risk stratification tools (C2AI), health coaching platforms (Surgery Hero), and remote monitoring technologies (using Docobo) to support the “optimisation” of patients prior to surgery. 

There were three services part of HTAAF, and Health Innovation North West Coast led co-ordination and evaluation.  

• Mersey and West Lancashire Teaching Hospitals NHS Trust – Elective laparoscopic cholecystectomy (lap chole) patients: Providing those on the waiting list with prehabilitation and risk stratifying the waiting list before patients need emergency surgery. (55 patients onboarded for prehabilitation) 
• Liverpool Heart and Chest Hospital – Elective thoracic surgery waiting list: Prehabilitation for all elective patients on the surgery waiting list. (145 patients onboarded for prehabilitation) 
• Liverpool Heart and Chest Hospital – Urgent cardiac surgery patients: Use of remote monitoring and prehabilitation to enable carefully selected stable patients to wait for their scheduled surgery at home instead of in hospital (usually 2 weeks). (8 patients onboarded for prehabilitation) 

Laura Boland, Head of Insights and Evaluation, at Health Innovation North West Coast, said: “Our mixed-method approach to evaluating the three prehabilitation offers enabled us to analyse the impact on patient outcomes and to build understanding of the impact on patient, carer and clinician experience.  We have learned a huge amount that will help us to spread the prehabilitation offer and bring benefits to more patients in future.” 

Jenni West, Associate Director for Digital, Health Innovation North West Coast, said: ‘’This HTAAF-funded work has built on a project that was showing benefit to the Trust. There were existing pathways but also new ones formed with managing emergency cardiac patients at home safely, rather than deconditioning on the ward. With the backing of Medical Director Rowan Pritchard Jones, this was an opportunity to do real spread and adoption across Cheshire and Merseyside.” 

Prehabilitation gaining traction 

Rowan Pritchard Jones, Medical Director, Cheshire and Merseyside ICB, said: “We are used to the idea of rehabilitating after surgery, but why not optimise patients before they head into the operating theatre? We've always lived in a retrospective world with this intelligence. Don't tell me what has happened, but tell me what might happen and therefore what opportunity we have to intervene to improve patient outcomes. 

“The challenge then becomes who on the (surgical) waiting list should be worked with. We turn a limited resource around prehabilitation to where it will make the biggest difference. We find those highest risk patients because we have that health intelligence, and it is those that we preferentially put our time and energy into because it will yield the biggest improvement.” 

Reducing thoracic surgery chest infections 

Chest infections are a major post-operative challenge. Rowan said thoracic surgery patients are often at high risk of chest infection, therefore they are a group of patients where it makes a significant difference to improve their pulmonary function and fitness before surgery. He said: “Just two days spent doing pulmonary prehabilitation - blowing a ball up and down inside a plastic tube - makes a difference. In fact, across the cohort we have reduced chest infections by 84% - so this works, and we point it at those who need it most.”  

Building evidence 

Rowan said: “We must find ways of working that harnesses intelligence and focuses our energies. My responsibility as the medical director is to drive through strategic commissioning. If these services are really affecting patients and a really good use of our precious NHS resources, then we should mandate it everywhere across the system.  

“Our Health Innovation Northwest Coast colleagues have been vital in putting arms around this project to help us measure and evidence the impact of the work that we're doing.” 

A final dataset for the HTAAF project will be submitted to NHS England at the end of May 2025. 

​There is now the ambition to expand cardiac prehabilitation offer to all elective cardiac patients at Liverpool Heart and Chest Hospital. British Heart Foundation Healthcare Innovation Fund Grant for early-stage scaling has also been submitted for the urgent cardiac service specifically.