COMMENT
The University of York. Image: Vivan Jayant
Professor John Hutton, director of the York Health Economics Consortium at the University of York, examines NHS innovation.
T
he National Institute for Health and Clinical Excellence was established
in 1999 to improve the quality of clinical decision-making in the NHS through the production of clinical guidelines and the appraisal of the clinical and cost-effective- ness of selected health technologies. In the last 12 years NICE has expanded its scope to include a review of interventional proce- dures, and appraisal of public health inter- ventions, medical devices and diagnostics.
Since 2010, the institute has also had re- sponsibility for producing the 150 clinical quality and outcome standards by which the performance of secondary health- care providers will be judged. Its role has expanded as investment in the NHS has increased over the last decade. Now that investment is being signifi cantly curtailed, what is the future for NICE?
Cost pressures
While the Government has committed to increasing the NHS budget in real terms, increasing cost pressures, such as the age- ing population, mean that the NHS will need to fi nd effi ciency savings of around £20bn by 2014 just to continue to provide current levels of service and quality.
The role of NICE remains one of targeting cost-effective use of new drugs and tech- nology, but there is now a much bigger em- phasis on driving greater effi ciency.
Much of the focus of the Department of Health’s Quality, Innovation, Productivity and Prevention (QIPP) agenda has been around improving quality and productivity but innovation and prevention are equally important. The use of innovative technology and investment in preventative
24 | national health executive May/Jun 11
measures to avoid future costs are vital to ensure that NHS costs are sustainable.
Health technology assessment can help to realise many of the benefi ts of the QIPP concept. For example, reductions in circu- lating blood fl ow can lead to post-operative complications, delayed recovery times and longer hospital stays. This has enormous cost and health outcome implications for the NHS across a wide range of surgical procedures.
Technology’s role
In 2010, the NHS Technology Adoption Centre (NTAC) invited York Health Eco- nomics Consortium to conduct a cost im- pact assessment of a minimally invasive probe which allows anaesthetists to moni- tor the fl ow of blood during surgery and to detect any reduction in circulating blood early. Based on trials at three hospitals we found that use of the new technology could:
• achieve a 19% arithmetic mean reduction in overall post-operative length of stay;
• achieve fi nancial savings for NHS of up to £250m, which equates to approximately £1,500 per patient;
• release hospital bed capacity to allow additional 41,000 procedures;
• reduce the number of patients admitted to critical care.
The new NICE Medical Technology Advi- sory Committee appraisal of the intra-op- erative probe estimated the benefi ts to be similar to the levels calculated in the YHEC work for NTAC, and gave the technology a favourable recommendation.
major surgical
• reduce readmission and re-operative rates by a third;
The YHEC team
Investing for the future
Examples such as this are not a panacea. Technology and service changes can be cost-effective in delivering health benefi ts but they may not reduce the budget cost to the organisation. However, it is important that decision-makers recognise that in- vestment is necessary to save more in the future.
And so to the future. The key uncertainty lies in the advent of value-based pricing for drugs, which is due to replace the current Pharmaceutical Price Regulation Scheme (PPRS) in 2014.
The Government’s consultation on this has thrown up a number of questions and uncertainties around the future role of NICE in the pricing and reimbursement of technologies.
Clearly there will be plenty to keep NICE occupied in the com- ing years, but manu- facturers need to be clear about the new methods and data expectations of NICE and other parts of the new system.
Prof John Hutton FOR MORE INFORMATION
T: 01904 323620 E:
john.hutton@
york.ac.uk
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