A Complex Structure• Currently 8230 General Practice Surgeries in England mannedby 34,101 GPs supported by practice nurses and otherprofessionals 164 Hospital Trusts Operating 350+ Hospitals 152 Local Commissioning Bodies holding the budgetsPlus Opticians‘, Dentists and Pharmacies deliveringcommissioned services on behalf of the NHS
Decision Processes in NHS The interdependencies within the Healthcare Economy Providers are InCommissioning general hospitalsBodies Hold Budget. They and other Suppliers ofThey Commission clinical Organisations equipment,services on behalf of Contract to deliver atheir Local ICT services range of services inHealthcare economy primary, secondary Support services and tertiary care for Care
Systems Impact It is critical that Companies understand the impact of their device on the system as well as on the patient. Who benefits v Who pays? Impact on tariff? Pathways v Episodes of Care? Quality Standards? Impact of QIPP Programme? What is the role of procurement?
Multiple Decision makers ..... Require Different evidence and information Clinicians - Clinical Efficacy - Safety - Skills requirements - Who else is using the device Hospital Management - Tariff Impact - Implementation time - Resource Changes - Realising the benefits
........And Commissioners- Head room in current tariff- Creation of a local tariff/ innovation payment- Impact on overall cost of managing patient
... And Finally Procurement OrganisationsNational - NHS Supply Chain - Buying Solutions - Drug Tariff Regional - Shared Business Services - Procurement Hubs Local Individual Hospitals - Likely demand DAILY READING – OJEU TENDERS Specification and PRICING STRUCTURES
Technology Appraisal - The Role of NICE The National Institute for Health and ClinicalExcellence (NICE) is the independent organisationresponsible for providing national guidance on thepromotion of good health and the prevention andtreatment of ill health. NICE reviews - Pharmaceuticals - Interventional Procedures - Devices and Diagnostics - Cost Effectiveness , Efficacy and Safety
NICE programmes for MedtechMedical Technologies Evaluation Programme(MTEP) and Diagnostic Assessment Programme(DAP) There was limited capacity for medicaltechnologies in existing programmes Not designed to assess early in life cycle Particular challenges for diagnostic technologies Intense interest in technology/innovation andUK as ‘slow adopter’.....
Key Issues MTEP understands and adjusts for: - medtech industry has limited experience of health technology assessment - medical technologies often have a sparse evidence base - there are significant differences between devices, in-vitro diagnostics and imaging - technical considerations (safety, compatibility, procurement, maintenance, calibration, training, upgrades) need careful consideration - the need for flexibility for different value propositions
Patient/system benefits of published guidance Topic Patient System Cost saving benefits benefits (per patient*)MTG 1 Sequent Lower rate of restenosis and Fewer repeat 450Please balloon reduced need for re-treatment procedurescatheter for and major cardiac adverse eventsrestenosisMTG 2 Better treatment planning (and Fewer skin grafts 1248moorLDI imager for less prodding !)medium-severe Avoidance of unnecessary surgeryburnsMTG 3 Fewer post-op complications Reduced length 1100Cardio Q ODM for Earlier mobilisation of stayintraoperative fluid (No increase in repeat surgery ormanagement re-admission)
Cost Consequences Not always looking for cost savings. Improved patient outcomes at a higher may also gain positive approval Also considering cost consequences across the pathway and acknowledging there will be winners and losers in the funding stream
QIPP Quality Innovation Productivity and Prevention Aim is to create $30Bn of savings in 4 years by ‘doing things differently’ Multiple Work Streams Main ‘game in town’ . Now talk about products being Quippable www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/
QIPP Work Streams Commissioning Provider System Enablers pathways efficiency • Primary Care •Safe Care Back Office Commissioning Efficiency and •Right Care management • Clinical Commissioning •Long Term Procurement Groups Conditions Clinical Support •Urgent and Emergency Productive care •End of Life care Medicine Use and procurement
Health and Social care Bill Establishes an independent NHS Board to allocate resources and provide commissioning guidance Increases GPs’ powers to commission services on behalf of their patients Strengthens the role of the Care Quality Commission Develops Monitor, the body that currently regulates NHS foundation trusts, into an economic regulator to oversee aspects of access and competition in the NHS Cuts the number of health bodies to help meet the Governments commitment to cut NHS administration costs by a third, including abolishing Primary Care Trusts and Strategic Health Authorities.
Changing Incentives within the System Previous targets set around activity Success measured against number of patients treated, waiting times and cost Budget holders commissioned for quantity and Cost not improved outcomes Quality of patient outcome and quality of patient experience become the main measures of success.
Private Healthcare Provision and the NHS Budget holders can commission services from any qualified provider Private patient cap removed from NHS Trusts
Innovation: Health and Wealth Commissioned by Sir David Nicholson CEO of NHS Delivered by a team led by Sir Ian Carruthers CEO of SW SHA and Chair of the NHS Innovation Delivery Board Substantial consultation with industry, clinical groups, commissioners and researchers 27 Key Recommendations 15 Task and Finish Groups now working on these
Key Role for NICE We will introduce a NICE Compliance Regime to reduce variation and drive up compliance with NICE Technology Appraisals We will require that all NICE Technology Appraisal recommendations are incorporated automatically into relevant local NHS formularies in a planned way that supports safe and clinically appropriate practice We will establish a NICE Implementation Collaborative to support prompt implementation of NICE guidance We will develop and publish an innovation scorecard to track compliance with NICE Technology AppraisalsFrom April 2013, compliance with the high impact innovations will become a pre-qualification requirement for CQIN Paymentsi(CQIN = Commissioning for Quality and Innovation)
Setting the Incentives We will align financial, operational and performance incentives to support the adoption and diffusion of innovation We will increase the profile of, and maintain investment in, the NHS Innovation Challenge Prizes The NHS operating framework asks the NHS to prioritise the adoption and spread of effective innovation and good practice Clinical Commissioning Groups will be under a duty to seek out and adopt best practice, and promote innovation We will strengthen leadership and accountability for innovation at Board level throughout the NHS