We've invited Nick to come and talk to say for a number of reasons, really.
And one of the things that we've been talking about this week is what students and health organisations and policy module,
what to do next and what they want to do in the world. And one of the things that they've talked about wanting to do is making a difference,
making it change, improving health services, improving health systems.
Even Nick's actually spent a lot of thought in a lot of different epic tackle change and innovation in health care.
And to tackle some of those transition challenges. So next to the serious career action and you say, what do I say about next?
She says. And Nick has worked with internationally instance health policy,
including a fairly long spell at the European Commission, including being head of the Health Information Unit,
that he's also talked quite like doing a degree and studying, and he's also been an expert on innovation and implementation of policy.
And we met when I was a Dr. Burke, and he's also worked here.
Senior Research Fellow in. Nick was actually the founder of the Health Organisations and Policy Module, which is hosting a session tonight.
It was his brainchild. And we had a happy time teaching together on the hot modules last year,
and Nick then got some sick new job and left me to take over the reins and take it forward in
a slightly different direction to find much building on his brilliant ideas and what he did.
We've invited Nick to come back and talk to US politics. It's really, really nice to see him.
And we're going to have afterwards. But also because it's now got this new job as research groups are active around Europe,
and you're going to say a bit about what it does when you talk.
And it's a really interesting opportunity to hear from him a bit more about the role of research in translational health
sciences and hear about what you can do and work in different settings to make a difference to innovate and change.
So the next positive, empty net? Thank you very much indeed.
All nice things to take with a pinch of salt and many thanks to you for the invitation to come here.
So let me introduce myself just to confirm because course I need to pay credit to a few different organisations from speaking with on behalf of which,
thanks to this evening, I put it that way.
So as James Overby said in CBDs up here, by the way, in case anyone is boring, we will put a version of this up on campus afterwards.
So don't worry about notes and stuff like that. I'll tell you a bit more about what that job for around Europe means, but just to describe up front,
Rand is an independent, non-profit research institutes doing independent research for policy and decision making.
So what we do a lot of history behind that. We're talking about a bit more.
I still have links to the University of Oxford, as you can see up there and to the European Secretary on health systems and policies and colleagues.
You are a little bit of a test group. I don't know if you're if you happy with this, but together with some colleagues at the European Observatory,
we're writing a book on innovation and implementation. And so I am road testing some of the material from that this evening,
which means your comments and feedback and questions will be especially welcome because you'll help to improve the book.
And particularly good questions and insights will get a mention in the acknowledgements section.
And that draws also on Europe's work on health innovation and on my previous role here,
working in particular with Tricia on the theme that she leads on.
If you like the social science part of itself, a really interesting partnership for innovation in health between the university and the hospital.
So credits and background, what am I going to talk about today?
But to talk about this topic of knowledge, too bright ideas, how research can support innovative health systems,
and I'm going to break this down into a bit of an initial introduction.
So I, you know, this is Oxford. I do have to do a little bit of academic theory and background and all the rest of that kind of stuff.
Apologies. But then, because of the space that I now working for, I'm also really interested in is how does this relate to policy questions?
And the three policy questions that I want to talk about this evening are how do we get the innovations that we want?
Because one thing is innovation. We sort of think that innovation is always a good thing, but innovation is not always a good thing.
And also, there are good innovations that we don't yet have.
Yeah. And I think during COVID, we've all seen that the scale of the gaps that exist between what we would like to have and what we actually have.
So how do we get the innovations that we want? How do we make the best use of the innovations that we do have?
And and this is the one that really bothers the national health ministries and the other people in terms of health systems, how do we pay for.
Because colleagues has everybody heard about the challenge of demographic ageing for health systems?
This is the key challenge in terms of long term costs for our health systems, right?
Lots of nodding. I hate to break it to you, but you're wrong. The key challenge, the key challenge facing the future sustainability of health systems.
The reason why they have expanded in cost for the last 50 years.
And the key challenge as to whether or not we will be able to afford them for the next 50 years is not ageing.
Ageing is relatively minor. Lots of evidence on that, which I won't go into tonight.
It's an innovation. It's this. It's new products, new techniques.
Basically, the good part of this story is we have lots of new ways of treating and intervening and improving health.
The backhaul is actually become more and more capable. We have a bigger and bigger size of opportunity that we have to pay for.
That's the key challenge which underpins that third question how do we pay for it?
So. Let's get into.
Start with a bit of background for some of these, this will be extremely familiar territory.
So tell me general funding to skip over this constant.
I think we did go through this in quite that way.
No, no, no. Worth a quick with a quick read diffusion of innovations,
but it's pretty much a quick recap because not everyone in the room has been in the course of a week.
So OK, so let's start with what is an innovation.
And the classic definition of average is book diffusion of innovations, an idea or a practise, or a technology that is perceived as new.
So there's two things to note in that definition. One, it's very broad, quite an idea.
Or a practise or a technology. There's all sorts of things which can be innovations, masks, wearing masks to prevent transmission of COVID.
Arguably an innovation mosques on me must have been around for ages,
but this way of using them in a different way, perhaps more so for some countries than others.
Which brings us to the other point, which is perceived as new. If it's new here, it's an innovation over there.
It might be old hat boring and I do it all the time, but if it's new here, here it's an innovation.
And so isn't some kind of objective thing that has never existed before.
That is two distinguished terms, the very first time that something is conceived of.
We would better call an invention.
The very, you know, that first insight, that first discovery of something like penicillin in a dish or something like that, that is an invention.
But when you can actually take it into something where you or someone else might make use of it, that's when it becomes an innovation.
And that doesn't have to be new ones. It can be new where you are.
Stages of innovation, I'm going to come back to this and we'll talk a bit more about these different stages as we go through.
But I just wanted to sort of talk about that's not terribly clear.
See if we can make it becomes clearer on my screen, which isn't any help to you.
It's just to say that when we talk about innovation and innovation doesn't just sort of arise and then suddenly it is magically everywhere.
You've got stages that we need to be thinking about, stages that this process goes through, and from the point of view of, of course,
like all health organisations and policy, different parts of the system play different roles in these stages as we go through them.
And I'm just going to describe a few of them just as a sort of a framework to have in mind as we're going through the rest of the programme.
Invention is what I talked about is, you know, that very first discovery, where might that take place?
Like most plausible. This is partly a test to see if everyone's awake.
And the answer is no, they're not. What's going on, what he done to them? The universities, for example, yes, I you know,
I would have been very distressed if we'd been sacked in the University of Oxford and if
at least one person hadn't said one place where inventions take place in a university.
Other universities are available here, and obviously this is our city and for a little bit to,
you know, one side of it, where else in health care, in particular thinking about health, where else?
What might there be inventions that brilliant first in pharmaceutical?
Yes, in industry and pharmaceutical companies, in other types of industries.
The number of people? Yeah. I think in time of crisis, we usually come up with solutions, and sometimes that could be an invention.
I love that. So when I was talking about a place in terms of which I was thinking geographical place and you've completely reframed the question into,
as you know, into a situation or a context. But yes, of course, in time of crisis, such as we have just had one where we have a lot of those.
This is a new way of doing it, but we're just going to do it solutions. Where has that taken place in healthcare?
Elsewhere hospital. Yes.
So not in your research setting, not in the people who are making the money from it, but in the people who actually have to fix the problems.
And I think that's really important. We'll come back to. And then you've got your bright idea, can you make it work?
And so actually, you're right. Pharmaceutical intervention doesn't contact tracing pharmaceutical companies,
but actually the real strength of pharmaceutical companies tends to be later on because what tends to happen in this
process of innovation is that let's imagine that you've got a brilliant academic or brilliant clinical researcher,
and they come up with this insight into how it might be possible to understand the disease differently,
or how they created a new light programme that diagnoses things in a way that no one's done before, especially if it's a disease inside.
It's almost certainly not immediately a pill you could give to someone, right?
You've got a lot of work to do to get from your disease mechanism inside to something you could
actually give it to something that tends to be increasingly where the industry steps in.
Because if you're an academic, why would you know how to do that?
You probably don't. Even if you've come up with a device that in principle works, your device typically uses gaffer tape and bits of plastic.
You can't sell it to someone, but you need engineering and manufacturing skills that you don't have because you're not that person.
Why would you? So the next stages are when you turn this into, well, can, is this something that can work?
Typically, this is a a boundary between, say, academia or research into various forms of industry, especially for pharmaceuticals.
That development stage quite often involves lots of evidence generation.
So even once you've got your product, you think it's safe.
You have to generate a lot of evidence to be able to demonstrate the licencing authorities that it is.
Then you get something which you can actually sell.
I've used a very, very good which is realisation, which is an awful word because it means nothing, but that's what I to you because all the different,
because depending on what kind of innovation you're talking about,
what step you have to go through to get from the thing that you think is good to the thing that can be generally used looks very different.
The drugs, it's licencing for medical devices, it's well, that depends what jurisdiction you are in,
but it's quite often a form of certification or standards bodies.
It's not licencing by the national regulator. If it's a surgical technique, you might not need anything or it might be your professional body,
so that that's what's hiding underneath that blue box is lots of different ways of getting to market and then adoption nice and simple.
I've even put it as green because that's the easy bit, isn't it?
We'll come back to that. So does anyone have any questions on those stages before I go any?
You guys talk about the at about how you might bridge those divisions between the two.
Is that something? Yes. However, I have already spent waiting on a single person,
so one of the first bits of feedback to myself is this is far too much material for short talk.
So this is a book thing. So we have confidence and diffusion of innovation.
So I think it's really helpful to say we presented a slightly different way.
And you know, it's good to set that safe and well.
And I am one of the other things I should say before I move on too far is I have presented that in a linear way.
So I presented that as though you start at one end and you go through it and you go to the other.
OK. Sometimes it's like part of the whole message that I'm wanting to try and give to
you is that it is not actually like all of these stages loop backwards and forwards.
You get this far. Oh crap, this doesn't work. Go all the way back.
Sometimes the licencing state, he saw this during COVID. The licencing authorities were quite involved in these early stages.
And so I'm presenting it as a nice, simple set of discrete steps.
It's not like that, and there's a whole ecosystem and outward system is something of a contract.
But for now, I'm going to move on. For health, I think I've already alluded to there being different types of health innovation,
and I'm going to distinguish for the purposes of this three different types.
And I want to distinguish the not because it's theoretically useful and interesting,
but I want to distinguish them because I think it begins to illustrate some of the issues that we have
when we think about the role the research plays and how these different sectors interact with each other.
And I can see from looking at you all that I shouldn't have put all of that up at once. It's everyone is really not a lot of you.
So let's start with biomedical and pharmaceuticals.
This is what we most think of when we think about health innovation, right?
Big multinationals. Mostly not the people doing the initial research, as I said,
but they're the people who step in once you've got your initial idea, but you need millions to take it through clinical trials.
That's their particular role. And as we've also seen recently,
they are also the organisations that they have the distribution networks and the
processing networks to be able to ensure that things become accessible around the world.
In principle, huge product life cycles, huge, very strong intellectual property protection.
There is a whole bit in the book, by the way,
about different types of intellectual property and the difference between patents and copyrights and trademarks.
And I'm not going to do that now. I'm just going to say strong and moderate and weak, but it's really interesting.
OK, it's really interesting to me that we have constructed really different ways of protecting different types of intellectual property,
and it makes a massive difference to the types of innovations we get.
That's why I'm putting it up there because you can invest for 20 years in pharmaceuticals,
because you have intellectual property protection that lasts for decades.
Medical devices is a completely different sector, 95 percent of medical devices, companies are any.
All small. Producing products that last one or two years,
and part of the reason for that is that they don't have anything like the same intellectual property protection.
You can basically imagine I've come up with a pulse oximeter. And I come up with a great pulse oximeters, goes on the end of your fingers,
marvellous if someone else can come it with a slightly differently functioning pulse oximeter.
They can sell it as long as it's made in a slightly different way. So how do you keep your profits going?
You have to make a slightly better pulse oximeter when you have to eat, so you have to keep updating in ways that the pharmaceutical companies don't.
It's a completely different marketplace, and a lot of that comes down to intellectual property and organisational innovations.
So this is typically not all one way of thinking about it, it's mostly not in the private sector at all.
So one group of people who innovate a lot organisation new ministries,
think about things like payment mechanisms and you think about things like organisational structures,
like initiatives like trying to create integrated care systems. It's an organisational innovation.
Well, clinical innovations like how do we get this group of clinicians to work together differently?
How do we redesign this patient pathway? There might not be a different pill.
There might not be a different medical device.
But you're still working differently in a way that creates different health outcomes, and that's an organisational innovation.
How much intellectual property protection? Almost none. So how do you make money out of it?
You don't you don't know which, of course, means if you're investing in innovation in the sector, where does the money come?
Of course, because that's where you get your power. Now I'm not going to spend very long on this.
I've been talking about an innovation as a sort of a thing that just happens.
But of course, governments, funders, all sorts of people don't just want health innovation to just happen.
They really want to be encouraging. Make it happen. And so how do you do that?
Is it as simple as just throwing out lots of money?
Well, to be honest, when you read a lot of national health innovation strategies, the answer is yes, pretty much.
But there is some classical theoretical models.
One of them is the triple helix model, which is that you have that innovation takes place in this intersection between academia and industry.
And it's about how do you create these different spaces between these three different parties and you have what they refer to as hybrid institutions?
How do you create institutions that bring these different ideas together?
And if you looked at what, for example, the Oxford, Stanley, Clorox A, B or C was doing,
some of what it was doing was about trying to create these kinds of spaces.
The thing about those spaces, by the way, is that they're quite uncomfortable. Quite.
Because we were like, Okay, where are we now we're in the universe.
Good thing if we were sort of in the university and sort of in industry brackets, a little bit less.
So it's very interesting the whole field of research around this, which I don't have time to talk about.
But I also think that model is a bit limited as far as health is concerned.
And this is exactly where the answers that some of you gave about where do these innovations come from?
For me is really important because one of the things I want to argue in this book is that actually,
we don't in health, we don't need a three helix model. We need a five helix model.
Which I suppose I should call the quintuple helix model, but that really doesn't sound like a good idea.
So what we're going for? Because yes,
of course you have government setting the rules in the framework of industry doing what industry does and you have research is generating inventions,
but you also have the people within the health system who we discussed. And also, Teresa will be particularly underlining this in her.
We have patients and citizens, so much of the driver of what comes out of our innovation systems comes not from patients and citizens want.
And so for us, I think in health innovation, we need to conceive of where these spaces of interaction are a little bit differently
to the way that we do more typically within innovation systems of the health system.
And that is a little bit more about systems.
Yes. Oh, absolutely. And find the person responsible for a kidney.
There are people beyond everything health system.
Do you mean Minister of health or the like? Do you mean? No, I mean, I mean, people working in providing health care and paying for health care.
So I mean, people within the actual provision of health within the system as a whole.
Definitely, people, very few of them are not people, although knowing some of the surgeons anyway, that's a whole is a whole separate discussion.
Then I'm going to do this really, really quickly, because I think again,
you have almost certainly covered this in the talk in the call so far, which is about that.
Remember I said that last stage of adoption. That's the easy part.
All right, you've got you're right. That is actually possibly the hardest bit of all right.
OK, lots of nodding. I don't need to spend time on this. So I'm just going to say you have all these different models.
I'm sure you've talked about the diffusion of innovation. Fish will kill me.
But the one that I put up here is damn Schroder's consolidated framework for implementation research, which is this one.
Well, we also obviously as the lead author on the Nass framework, which is another way and more up to date way, perhaps of looking at this.
The key point about all of these is just to emphasise that we tend to when we talk about adoption of innovations,
we very naturally, I mean, what's the noun we're talking about? We're talking about the innovation.
If there's one message to take out of all of this work, I would say,
is that the innovation is only one component of a much more complicated context and setting,
and you cannot expect to achieve anything in terms of implementation without looking at them.
We do a lot of work in round, by the way, around exactly this, you know,
understanding why particular innovations did or did not work in particular settings.
And it is always about the sector.
It's almost never about the innovation without going into more detail, which I just put up there was the importance of context.
Jim mentioned the importance of talking about research on what role research plays in all of this,
and I'm not going to have time to talk about this as much as I would want people and leave time for questions.
But I'm just going to say.
When you look back over all of these stages that I described, hopefully you can see that research is important across all of these different stages.
And all of these different types of innovation, right?
The key thing I would say about it is the actual research that he's done is very unevenly distributed across all of that.
So the overwhelming priority of research in terms of the types of innovation, as you said,
is a heavily concentrated on biomedical, somewhat technological, almost not one organisational.
And in terms of the stages, the research is the funding is overwhelmingly up here.
And basically, as you go along this process,
you get less and less actual research engagement with these different stages and with the processes that are taking place.
So yes, research can help with all of these strategies, but in practise, the money will sit in a few parts of this process.
So far, so straightforward. This is the context. This is the background I know half an hour and we're still on background.
I'm really sorry. We're going to get onto the policy questions. So first question, as you know, our vote will do questions as we go through.
First of all, how do we get the innovations that we want?
One way would be to understand what we want. That sounds obvious.
It's actually not so actual research looking at what the needs are that we have.
Is not readily available. There are some obvious ones we have a mapping of burden of disease.
Lots of leading work for years, which was published.
Lots of work out of this. The entire centre about mapping the global burden of disease.
But a burden of disease isn't the same thing as a health need because some of those areas have acceptable treatments and have acceptable diagnostics,
but which aren't implemented. Some of them have no treatment whatsoever.
I hope we don't have this kidnapping about how those different things fit together and what at what stage the research need is is the research need.
We have nothing is research. We have something, but it doesn't work for these people.
Is the research need. We have exactly what we need, but most people can't force people.
Those are completely different research needs in terms of what we need to address.
There are some very obvious areas which always get highlighted mental health as well, consistently under research.
There's the obvious area. If you look at a global level of neglected diseases,
there's the triumvirate which we been talking about rather depressingly for nearly as long as I've been in this business,
which is now too long of HIV, TB and malaria.
I don't need to pick on those three and those areas which have become which have always been Cinderella areas of health and of health and care policy,
and which I think has been really highlighted during the pandemic, which is social, which is non-clinical, which we under-researched currently.
And then, as I said, different stages are really underresourced, different types of areas already onto results,
and we don't I mean, we have these marvellous work that is done here and has been done, for example,
through the Oxford the sea on involving patients in the public and trying to set and define research priorities because fundamentally,
if you're going to put a lot of public money into different areas of research.
To ensure that that actually meets not just the needs that the experts think that the needs of the community thinks are relevant,
you have to have some means of engaging with the community.
But that's that again is itself a topic of research in the one, which is huge as research as it might be.
So first of all, let's understand what we need, then we need to think about how we actually align the system.
One of the things that will have struck you, hopefully, about the innovation structures which I'm talking about is that it is essentially
a mix of actors from different sectors come back to that triple helix model,
its industry as well as government as well as universities.
You have lots of different actors in this, and we think of it as a market and we've tried different solutions.
I should have explained eyepieces, advanced purchase commitment.
This is a topic that's been a tactic that's been used for some particular conditions, such as the neglected diseases.
There are others, such as additional intellectual property protections for things like rare diseases,
which both the EU and the US which have had effect.
But creating a market at the end of a 20 year development cycle doesn't necessarily influence the
behaviour of the academic who is currently researching things or even the early stage development.
Anyone who's ever had any contact with pharmaceutical companies will have heard the Expression Quarterly report.
A market which is 20 years away doesn't do a lot to influence the perspectives, necessarily of the people looking at their quarterly outcomes.
So just creating markets doesn't create solutions. You need to build stronger links between stages.
One other topic slightly skipping for point of time talking about these different actors within the innovation system.
I want to highlight the role of failure. We don't often talk about failure.
We like to gloss over failure as quickly as possible and move on and talk about success.
It's a much nicer thing to be talking about, but failure is inherent to innovation.
Our point about innovation is it's something new and something different.
If you're not willing to fail, trust me, you're not going to be very innovative.
How willing is the public sector to fail? When it's public money on the line, how well is failure tolerated?
Less than five months, I. I was just going to say I, especially from some people who I know have worked in the public sector.
I'm seeing some no room for failure. So.
One reaction that we quite often have as people who come to the health sector with strong values, to universality, to solidarity,
to access for all is we look at the private sector and be a bit like why those people who are they just making all of this money?
But one of the reasons why the private sector is here because failure is much better tolerated in the private sector.
But that's because failure also comes alongside the potential for awards.
And then the question is, how do we balance them?
How do we ensure that the rewards which are being given are the ones that we want and are fair in comparison to the degree of failure?
One other point I'm going to make here is about the globe what this all looks like from a global perspective,
it's very easy for us here just to focus on the UK to focus on Europe, but again, saw very clearly during COVID.
Innovation is something global. Right? If you think about all the different stages about you, think about the supply chain.
Where does it come from? But even more fundamentally, when you are developing your product,
one of the things that you need to think about is, well, where am I going to sell this? Who am I clients?
And the US market? Is as large as the rest of the world put together in terms of health care.
So who do we design our health innovation system? Overwhelmingly, United States.
So if you invent something here in this marvellous University of Oxford and you go to the Oxford University innovation,
which is the technology transfer office,
and they're advising you on where you're going to take your brilliant, life saving invention and how you're going to develop it into something.
Do you know where they're going to advise you to look?
Are they going to advise you to look at the NHS, all they [INAUDIBLE], the NHS insists on really good value for money and wants lots of evidence.
No, they're not going to you. You're not going to tell you to go to. So what are we getting?
It's a global level. We're getting innovation adapted to the US market because that's where the money's.
Nobody designed it. And there are quite a lot of American politicians who would rather it didn't work that way.
But that's what we are. I'm going to skip really quickly through these next two.
That's mainly to Utah in case you're looking at time.
This slightly recap some of the stuff I was talking about before, so I think have you talked about how technology assessment on this module,
but on the student in your neck, would you want to get some comfort from that?
Well, in that case, you can tell me so.
It's very interesting. So obviously, one of the key ways in which we can ensure that we are making best use of the
innovations that we have is to understand the value that those innovations bring.
But one of the key things about health tech or one of the weaknesses about health technology assessment,
said trying to find the relevant bit of the presentation is if you think about that whole chain, that whole process is all for Pete's sake.
I haven't done this in a while, you can't tell. HDR sits about here.
Just normally just off the licencing, you decide something is safe, you give it a licence and then you decide if you want to pay for it.
And that's where I started. How much of the innovation process has happened by that point?
Not much. Well, hit in 1992.
Exactly. You've pretty much defined everything that you're doing by this point.
There's not there's not much left to do. There's not that smart. That's exactly my point.
There's very little room at this point.
So we're standing at the end of this process with our chequebook deciding whether or not we want to pay for it.
But the eight has already been shaped.
So one of the key issues is not just making our understandings of value, making that assessment here, it's building that assessment, in fact here.
And finding ways of doing that, which at the moment, we're not very good at.
So health technology assessment, to be fair to the agencies, they do try and do that.
But there are all sorts of barriers in the way that implementation we've talked about.
One final thing I'm going to say about policy when you switch to the ministry, I have sat in the ministry.
You like to think that you're in charge?
It's a wonderful delusion that you sort of have to have, otherwise he gets very uncomfortable and you think, Well, what am I doing?
And we all participate in this delusion, by the way, because we all hold health ministers accountable for what happens in the health system.
Well, to be honest, if we were completely fair with ourselves and with them,
we would admit that most of what happens in health systems got very little to do with the health minister.
And so what can the health minister realistically control about their health system?
Farm money, that's the big one, how much money if you go.
Can they control what happens in a particular hospital? No, not really.
I mean, they can certainly make it more or less easy and they can influence things.
But actually, policy has much less control over how these processes happen in policy, like think.
So the reality of this is that what does policy do policy should be trying to support processes of local adaptation, local innovation.
And but when you do that, you have to accept that you're not actually in charge and it's the people in each
of these local situations who are in charge and who are making things change.
Now that's very constructive. It reflects complex systems theory and of respect, our understanding of how health systems work.
But if you're a policy maker, it makes you sound almost irrelevant.
And I don't know very many people in ministries who like feeling sorry and then how do we pay?
Well, the easiest way to work out how we can pay for innovation is to get these two things right.
Get the right innovations and make best use of the innovations that we've got.
One thing we could do is we could much better account for the contribution of health
to the wider economy because at the moment we see all the cost of what we spend them,
but we don't build into that budget everything that we gain from health.
And again, have we not seen in the last two years everything that we gain when people are healthy and everything that we lose and people are,
we don't account for that. We could do better. That whole field was kicked off or crystallised by the sacks report on the Global
Commission on my current macroeconomics and Health more than must be 20 years ago.
But the big agenda is creating better links between all of these stages of the health system.
And I'm going to I won't go into the example of other than to say.
If we think about this innovation system and I've described it as a system, I've spent this whole evening describing it as a system.
But if we were to go into it.
No one talks about this entire sets of activities as a system, we don't think of it as a system, we have different policies for different bits of it.
But my fundamental point, the reason why we want to write a bloody book is because I think we should think of it as a system,
because when you start to see that whole process as one in one interlocking set of activities that should be giving us what we
need in a way that enables us to implement it in practise and make use of it in practise and do so in a way that we can afford.
Then you start to see that our current structure of everything from intellectual property to research
funding to orientations and incentives within markets isn't well aligned to achieve those objectives.
And we're doing short of time. We'll come back to questions and say I'm.
And you might if you want a pandemic, example what I would run out of time so I won't go into detail, but I will just illustrate.
We've we've had a very if you like, a very hot pandemic in the last few years, a very urgent and visible one.
What is often described is the slow motion pandemic is anti-microbial resistance.
And when you look at it, you see a system, you see public practise, private actors,
everything from bats to farmers to individual doctors to members of the public.
You see a research base that has to be generating new antibiotics,
but also generating things like point of care diagnostics so that we use the right antibiotic for the particular conditions that people have.
We see a global issue where what happens in one country very much affects what happens in other countries.
And we are only going to overcome that challenge by seeing the overall innovation system as a system.
And at the moment. We kind of don't. And so the reason for writing the book is to try and get us to see that overall system as an innovation system.