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Company engagement form update july 2024 test

Company engagement form update July 2024 legacy mark-up test

"*" indicates required fields

Relationship with sanctioned states

As a publicly-funded NHS organisation we are required to comply with national policy on sanctioned states. Please respond to these questions.
Is your organisation constituted or organised under the law of any UK Sanctioned State or Regime?
For more information please see https://www.gov.uk/government/collections/uk-sanctions-regimes-under-the-sanctions-act
Is your organisation owned or controlled by an entity based in a UK Sanctioned State or Regime? This may be a Parent Company or Person with significant control.
Organisation size * Required
Organisation type * Required
Please complete one innovation per application.
Is the innovation a product or service? * Required
Innovation type? * Required
Please provide a brief description of the innovation, including its intended purpose, functionality (how it works), clinical setting/pathway, and the opportunity (size of intended patient group).
What are the care settings for your innovation? * Required

What is the primary theme of the innovation? * Required
Please select one option.
Which of the areas below does your innovation impact most on? (please select no more than four options)
1. Describe any engagement you have had with key stakeholders (e.g. clinicians, patients, commissioners)
2. Highlight existing, similar or equivalent technologies, products or services
3. Outline how your innovation is different to existing technologies, products or services.
It is important that innovations are acceptable (informed by what patients want) and accessible (usable) to the people who will use or be affected by them. Assurance that innovations are informed by patient views, improves safety, health outcome and saves money. In this section, briefly describe if and how patients, carers, and the public have been involved in your innovation, including any feedback patients have about your innovation.
Does your innovation have a direct or indirect impact on NHS Net Zero / environmental sustainability? Direct – refers to when an innovation is created solely to reduce carbon emissions / provide environmental benefits – e.g. reusable product / better use of materials and natural resources in creation of product / reduce fossil fuel usage. Indirect refers to when an innovation is created for healthcare use but net zero / environmental benefits are a secondary benefit – e.g. Digital platform to manage patient care – that can help reduce travel / make care more efficient and effective.
Stage of innovation * Required

Progress to date

Tell us briefly about any external funding / support you have received in support of developing your innovation .
Initial idea
Intellectual property protected
User testing
Proof of concept tested
Early prototype
Working prototype / pathway developed
Clinical evidence (or equivalent)
Pilot / real-world evaluation
Regulatory status
Adoption & spread
Other (NICE guidance, case studies, inclusion on any accelerator programmes etc.)

Health Innovation Network Engagement

Have you already discussed this innovation with any health innovation network? * Required
I agree for the above information to be stored securely by UCLPartners * Required
Consent * Required
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