Don’t roll your eyes at the mention of 3D printing - its potential for good in the NHS is huge, write Dan Wolstenholme and colleagues
Lord Carter set out a challenge to save £700m through better procurement. He suggested a range of improvements, but perhaps a radical rethink of manufacturing facilitated by technology is another approach that would deliver the savings required.
His report states: “A sample of 22 trusts covering approximately 16 per cent of NHS spending revealed that in one year they used 30,000 suppliers, 20,000 different product brands, more than 400,000 manufacturer product codes.”
These products range from complex stents to the ubiquitous eye bath and it is very likely that many of them would be amenable to 3D printing. Imagine if just a few hundred of those products could be made in-house, in each hospital, removing transport and procurement costs.
That is just the start – the real power of 3D printing comes in the ability to share designs across the NHS via the internet, to allow designs to be customisable. Each orthopedic patient could have a bespoke splint, created and printed for them in real time. The one-size fits all for products could be banished as a range of personalisable products selected from a central database of designs (an NHS version of www.thingiverse.com) that could be printed to order.
3D printing has come a long way since the introduction of the open-source RepRap printer by Adrian Bowyer in 2004. The open-source development of domestic 3D printing facilitated via the internet means that now a 3D printer can be bought for as little as £350. The quality of print available to consumers now rivals the quality of prints from established brands who only made printers for industrial consumers in the past.
This creation of the domestic 3D printing market has meant the conversation about the possibilities of 3D printing has broadened, with companies such as Stratysis offering bio-compatible materials on the general market, meaning that medically applicable things can be made with a material that costs around £300 a kilo.
3D printing is also known as “additive manufacturing”. Most domestic 3D printers use a technique called “fused filament fabrication”, meaning the digital blueprint for the object is sliced into layers by the printer’s software. Then, a spool of thin plastic filament is heated and squeezed through a fine nozzle onto a build surface.
The nozzle is moved to ‘draw’ a layer of the object in melted plastic, which cools on the bed. Once a complete layer has been drawn, the bed drops imperceptibly and another layer is drawn on top. The 3D printer lays down these levels in sequence until the object is finished.
Hack new solutions
It also plays into the wider explosion of the democratisation of manufacturing, where you’re only limited by the ability of the clinician to communicate what they want and the skills of the technician to create a computer aided design model from which the design is printed.
The community could be created across the NHS to share and refine designs, to share new ideas and to create and hack new solutions to everyday problems. It means that if someone in Newcastle comes up with a new object to improve care, as soon as the design is uploaded someone in Penzance can print it out and use it in their hospital, no procurement, no transport. To illustrate the possibilities, in a recently cited example a small cup used in an ophthalmic procedure costs on average £10 per unit to procure.
A state of the art Stratysis Connex3 3D printer costs about £200,000. The material you use to print costs £575 for two kilos. If we assume the unit weighs 5g to print that cup using our state of the art equipment would cost £1.43 in materials.
The example goes onto say that the trust uses 440,000 of these a year, which if printed rather than purchased would be save around £3.5m, even after the cost of buying the machine, and if the printer were only used to print cups.
The costs speak for themselves – and that is before factoring in the benefits of customisation of individual things, or even the creation and sharing of the skills and expertise of NHS innovators quickly across the system.
The future is here - we can have factories in the procurement department.
You might be tempted to roll your eyes when the answer appears to be “let’s 3D print it”, but perhaps for the savings required by the NHS the answer is not to work harder or smarter but to embrace the technology we think is still beyond our reach but that is closer to hand than we imagine.
Dan Wolstenholme is a nurse and researcher in innovation in health for NIHR CLAHRC YH (@wolstenholme_d), Matt Dexter is a designer and researcher in participatory design and healthcare (@matt_dexter), and Dr Keith Grimes is an NHS GP with a special interest in urgent care, digital healthcare, and innovation (@keithgrimes).