Example application form & guidance document

About Smart Solutions for Healthcare

Smart Solutions for Healthcare is a new programme which aims to help the NHS make significant
improvements in quality, innovation, productivity and prevention. The programme will address two healthcare
priority areas - Cardiovascular Disease and Long Term Conditions. We are specifically interested in new
technologies, products and services that enable patients to have a greater role in managing their own health,
help healthcare providers improve staff productivity and eliminate waste.
This could be an ideal opportunity to have your product evaluated for use within the NHS and build evidence
of its effectiveness.
By entering the Smart Solutions for Healthcare programme you will get the opportunity to have your
product, technology or service assessed by an expert panel and successful products, technologies and
services will progress to an evaluation in an NHS setting.
This form has been created to help you to prepare your application in an offline environment and
provide guidance notes (blue, italic text) for applicants to the Smart Solutions for Healthcare
programme. It gives you question-by-question advice on what the expert panel of assessors will be
looking for in a good application. Once you have prepared your application offline you will need to
visit www.nhsinnovationsnw.org.uk/SSHC2011 and complete the online application form.
NOTE: All applications must be submitted online at the address above. This completed form will not
be accepted as a submission to the programme.
Criteria
Applicants should ensure that their application:
1. Addresses at least one of the disease areas listed under Cardiovascular Disease or Long Term
Conditions.
2. Contributes towards at least one of the following: self-care, staff productivity, eliminating
waste.
3. Contributes to at least one of the aspects of QIPP: quality, innovation, productivity and
preventions (see here for more information).
4. If the application is for a large scale change, the submission must be supported by an NHS
organisation (Trust or PCT); this will be checked during the selection process.
5. The applicant must be in a position to provide matched funding in the form of a supply of the
product, training, personnel, cash funding, or a combination of these elements.
6. The product, technology or service must be available to use. If appropriate, regulatory
approval must be in place and the product must be CE marked.
7. The product, technology or service must be novel and must not already be in widespread use
across the NHS.
Applications that do not meet the above criteria will not be included in the assessment process.
General information on submitting an application
Each question is very specific about the information required. Please ensure that you read this guidance and
provide all such information. Please read the questions carefully and only provide the information requested.
Please ensure any abbreviations/acronyms are explained at the start of the application, they may then be
abbreviated throughout the remainder of the application.
Please note that the question numbers & sections below refer to the questions in the online application form.
NB: For questions that require you to select answers from a pre-defined list, please double-click in the
box and select checked from the pop-up menu to enable you to check the relevant response(s).

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Smart Solutions for Healthcare 2011 Example application form & guidance document v1.2

Registration
Product / Technology / Service name (name of innovation you are submitting)

Name of Lead Applicant

Position

Company name

Company address

Postcode

Email address

Telephone number

Which healthcare priority area?

Are you applying with a solution for:
Select one option. The product, technology or service must address Cardiovascular Disease or Long Term Conditions, the
disease areas included in each main category are listed in the application form, more than one area can be selected if
appropriate.

Cardiovascular Disease
Long Term Conditions

If Cardiovascular Disease
Which of the following areas does your solution fit into:
Multiple options may be selected

Aneurysm
Angina
Atherosclerosis
Cerebrovascular Accident (stroke)
Cerebrovascular Disease
Congestive Heart Failure
Coronary Artery Disease
Hypertension
Myocardial Infarction (heart attack)
Peripheral Vascular Disease
Venous Thromboembolism (VTE)

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If Long Term Conditions

Which of the following areas does your solution fit into:
Multiple options may be selected

Cancer
Diabetes
Epilepsy
Hypothyroidism
Renal Disease
Respiratory

Disruptive Change
Would this product, technology or service represent a large scale disruptive change?
If you are submitting an application for a large scale, disruptive change; the application should relate to a product, service
or technology which is likely to have an impact across several teams, specialities, departments, organisations and/or care
delivery providers and may involve working across traditional boundaries. Applicants must demonstrate how their
application fits within the disease areas for this call (Long Term Conditions or Cardiovascular Disease) and must
demonstrate a positive impact on some or all of the following areas: self care, productivity, reducing waste, disease
prevention, improving quality.
To be eligible to apply to the programme as a large scale disruptive change you must have an existing relationship with an
NHS organisation that has demonstrated a commitment to work with you to implement this
product/technology/service/system. The name, position and contact details of the person within the NHS Organisation that
is supporting your application should be provided; this should be an individual at Director level or above. This information
will be checked should your application be shortlisted for funding.

Yes
No

If Yes
a.

Which NHS organisation is supporting your application to Smart Solutions for Healthcare?

Please give the name, position and contact details of the person within the NHS Trust that is supporting your
application? This individual should be at Director level or above. This detail will be checked during the short listing
process.

b.

Please give the name, position and contact details of the person within the NHS organisation
above that is supporting your application; this should be an individual at Director level or
above.

c.

What are the benefits anticipated from implementing the product, technology or service
including; how the innovation addresses productivity; how the innovation will provide value
for money; and any estimated cost savings from implementing the innovation.

d.

Provide information on how this product, technology or service will have an impact on
associated services and care providers.

You may need to think outside the core service/area affected and think about any knock-on effects, both positive and
negative, that could be felt by peripheral individuals or groups. For example, if your solution leads to earlier discharge of
a patient, then this may increase the burden on community staff (e.g. GPs, nurses).

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Application section 2
1a.

Which industry/industries is the product, technology or service being used in?

Multiple options may be selected

Automotive
Diagnostics
Engineering
Healthcare
Manufacturing
1b. Other (please specify)

2.

What is your product, technology or service and how is it used?

Please answer this question assuming that the reader has no prior knowledge of your product, technology or service.
Provide a concise, detailed statement regarding the product/technology/service. A link to a website is not a sufficient
answer (this may be submitted in question 5).

3.
Provide details of the model number or version (where appropriate).

4.

Please upload any additional files to support your application (designs, papers etc).

Maximum file size for uploads is 4MB. Most file types accepted.

5.

If you have a website which will support your product, technology or service please provide
the link here.

Application section 3
6.

Describe the need for your product, technology or service (including whether this is a new or
long-standing need). NB: information about alternative solutions and the benefit(s) of your
innovation over alternatives can be provided in question 12.

Please provide detailed information about why your product/technology or service is required in the healthcare sector;
what need it addresses, how widespread this need is and whether this is a new or long-standing problem. Remember
that we are specifically interested in products/technologies and services that promote self care, improve staff
productivity and improve quality through reducing waste.

7.

Summarise the potential impact your product, technology or service could have within the
disease area. NB: Information about evaluations can be provided in question 14.

Please consider the impact that your product/technology or service may have within the disease area if it addresses the
need that you have identified in question 6. Please consider the size of the problem (e.g. in terms of numbers of
patients, resources used, costs etc) using either actual or estimated numbers (be clear whether you are using actual
figures or estimates to support these claims). If you are estimating impact, clearly indicate how you have reached this
conclusion. Consider the potential efficiencies associated with your product, technology or service (including cost
savings and staff time savings), whether your product/technology or service is for a niche area or has a broader, wide
ranging application.
The applicant should explain whether the innovation will have an effect on prevention, in terms of either helping people
to stay healthy, allowing people to retain their independence, or preventing inappropriate use of health
services/resources.

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8a.

Has your product or technology got a CE mark?

All applicable products or technologies must have a CE mark to be eligible for consideration.

Yes
No
8b.

If yes, how long has the product been available on the UK market?

Provide information on the length of time that the product has had the CE mark.

9a.

Is your product a medical device?

Yes
No

9b.

If yes, what is the MHRA classification?

Medical devices may be classified as Class I, Class IIa, IIb and III, with Class III covering the highest risk products
Additional information about MHRA classification can be found at the MHRA website at this link:
http://www.mhra.gov.uk/Howweregulate/Devices/MedicalDevicesDirective/Classification/index.htm

10a.

Is your product covered by any patent/design rights?

Yes
No

10b.

If yes, please list.

Provide information about patents/design rights.

Application section 4
11.

Who owns the intellectual property (IP) associated with your product or technology?

Information is required regarding all parties claiming IP ownership of the product or technology.

12.

Please describe the advantages of your product, technology or service over similar solutions.

Please consider what other solutions are available that may be similar to your product/technology or service and clearly
identify whyyour solution is an improvement. Consider what advantages your technology/product /service would bring
focussing on self care, eliminating waste, staff productivity, improving quality, disease prevention. If this is an entirely
novel product/technology or service with no similar competitors please indicate this. (The applicant should make it clear
how they have investigated what other solutions to the problem may exist, and if they do exist, what they are and why
they are not appropriate).

13.

Summarise the benefits of the product, technology or service.

Please consider the benefits that your product/technology or service may bring to a healthcare setting; you may wish to
consider this in relation to staff, patients, cost/benefit analysis, reduction in patient length of stay, etc. Be clear whether
you are using actual figures or estimates to support these claims. If you are estimating the benefit clearly indicate how
you have reached this conclusion.

14.

Summarise the evidence gathered from any evaluations (trials, pilot studies etc) or
projections/estimates that demonstrate the benefit(s) of your product, technology or service.

Please provide evidence of evaluations to date, including information about the source of the evaluation (i.e.
independent/company etc).

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Application section 5
15a.

Is the product, technology or service already being used within the NHS or independent
healthcare setting?
Yes
No

15b.

If yes, where is it being used?

Provide details of organisations and departments that the product, technology or service is used in

16.

Please provide information regarding the cost of this product, technology or service.

Consider cost per unit if appropriate, is there a cost reduction depending on the number of units purchased? Consider
consultancy/training costs if applicable.

17.

Is the product or technology listed in the NHS Supply Chain catalogue?

If yes, please give the Supply Chain order number.

18.

Please include any additional information here.

Include any information that you have not already included in your responses that will support your application.

Next step
Now you have completed preparing your answers for Smart Solutions for Healthcare please visit
www.nhsinnovationsnw.org.uk/SSHC2011 to complete the online application process. At the bottom of
the webpage you will be able to start a new application by inputting your email address. Alternatively,
if you are returning to an application which you have previously started you will be asked to enter
your password which will have been emailed to you.
Please note that you will be able to cut and paste written text from this Microsoft Word document into
the online form but any formatting (e.g. bold, underline, bullet points & returns) will not be retained.
Please try to consider how the text will read to the judges you can do this by viewing the pdf version
of your application from the online system, at any time during the application process.
If you experience any problems with the system please contact TrusTECH on 0161 901 2524 and we
can provide assistance with the online application process.
The deadline for applications is 4pm on Wednesday 6th April 2011.
The online application system gets very busy in the last few hours before the deadline, so please
dont leave your application until the last minute!

NOTE: All applications must be submitted online at the address above. This completed form will not
be accepted as a submission to the programme.

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