Secretary of State for Health Jeremy Hunt MP appeared before the Commons Health Committee yesterday to address a number of issues, ranging from mental health funding to dental services.
Members of the Health Committee referred to recent comments by national medical director of NHS England, Professor Sir Bruce Keogh, who recently stressed the need to ‘be clear’ about when recommendations to implement new solutions in the form of new devices or technology “should override the financial considerations”. While Mr Hunt did not provide detail, when asked about whether a more streamlined approach could be applied to introducing new technology or medical devices nationally, the Secretary of State said it was something he was focused on.
The Secretary of State was also questioned on the issue of staff pay rises and his previous comments that linked any potential staff pay rise to improvements in productivity, rather than funding them through additional budgeting. He stressed that he had discussed this issue with the Chancellor, stating ‘the Chancellor will consider extra money if I’m able to secure productivity improvements’.
Meanwhile, NHS England chief executive Simon Stevens, made his views on pay for NHS staff clear by calling the link between NHS pay rises and increased productivity an ‘own goal of the first magnitude’ in a speech at a Managers in Partnership conference also on Tuesday. This echoes statements Stevens made to the Health Committee earlier in October in which he said that pay rises for the NHS should be properly funded rather than offset by other parts of what the health service is doing. Mr Stevens’ sentiments were supported by Jonathan Ashworth, the Shadow Health Secretary, who agreed that it would be counterproductive for the chancellor to try and fund a pay rise from the existing NHS budget.
CQC State of Care report – Challenge for healthtech innovators is to embed safety in new ways of working and collaborating
Tuesday saw a number of interesting health stories, including the release of the annual State of Care assessment from the Care Quality Commission (CQC). The report found that an ageing population and an increased number of people with complex or chronic conditions are among the many factors placing health and social care services in England under immense pressure. In particular, bed occupancy is consistently above the recommended maximum of 85% and between January to March 2017, it was the highest ever recorded at an average of 91.4%.
Despite growing concerns about the strain that NHS staff are under, the report did acknowledge the transformative role that new technology has played in improving health care services and providing patients with a means of maintaining their independence. The report states that ‘technological innovation offers an opportunity to drive improvement in healthcare services and to offer more convenient access for patients to advice, treatments and medicines.’ The report stressed however, that ‘the challenge and opportunity for innovators is to embed safety in new ways of working and collaborating’. You can read the full report here.
Yesterday also saw Health Secretary Jeremy Hunt tell the House of Commons that although the cap on pay rises for NHS staff has been’ scrapped’, this change could be linked to productivity. His answer came as a response to Warrington North MP Helen Jones, who asked whether a rise would be funded through further cuts to services, to which the Health Secretary replied: “That is something I can’t answer right now because the latitude the Chancellor has given me in negotiating future pay rises is partly linked to productivity improvements”. Mr Hunt did not say whether he expected future pay awards to be at or above inflation.
However, hours after Hunt’s statement in the Commons, Simon Stevens, Chief Executive of NHS England and NHS Improvement Chief Executive Jim Mackey both told the committee that staff pay rises would not be able to come from within the existing funding settlement and would require ‘additional funding’. In reference to the Autumn budget, Mr Stevens also noted that “Decisions taken on 22 November will determine the shape of the NHS next year and the year after.”
The Health Secretary Jeremy Hunt MP has laid out ambitious plans to deliver the largest increase in training “in the history of the NHS”. He made the pledge at the Conservative Party Conference in Manchester on Monday, announcing 5,000 new training places for nurses, to lift numbers of home-grown staff. His announcement comes after growing concerns surrounding NHS staff shortages and a 19% collapse in applications for nursing courses at Universities in the past year. Mr Hunt’s ‘historic’ pledge would create an unprecedented 25% increase in nurses training.
The Secretary of State for Health also announced plans for NHS staff to utilise new flexible working hours and the right to buy affordable homes developed on surplus NHS land. The Department of Health states that these decisions will “reduce the reliance on expensive agency nurses and overseas recruits”, as Britain prepares to leave the EU.
Theresa May’s speech on Wednesday was light on healthcare, although she did announce a review of the Mental Health Act and a consultation on introducing an optout system for organ donation but fringe events saw senior NHS decision makers and Conservative MPs discuss the incessant challenges of increasing demand and financial pressures. In particular, the Minister of State for Health Philip Dunne expressed the need for a more prevention-focused approach to patient care within the NHS. Dunne also highlighted the importance of the ‘Getting It Right First Time’ (GIRFT) programme in reducing unwarranted variations in the quality of care and sharing best practice across the health service. You can read highlights of our recent members’ meeting with Rachel Yates, Managing Director of the GIRFT programme here.
The UK Health Show took place this week at the Olympia in London and provided a great opportunity for the Health Tech Alliance to observe and interact with technological suppliers and innovators within the healthcare industry and hear directly from key decision-makers within the NHS, NICE, NHS Digital and the NHS Innovation Accelerator.
Many of these speakers discussed the work they had been doing within their own organisations while others focused on outlining their hopes for an increasingly digital NHS. For example, Dr Maruthappu Co-Founder of the NHS Innovation Accelerator, which is playing a crucial role in the uptake of disruptive new technologies, highlighted the ways in which innovative technology can empower patients while also alleviating pressures on clinicians. Dr Maruthappu admitted however, that at present innovation is not seen as a priority within an underfunded and short-staffed NHS. He therefore emphasised the need for a whole-hearted, cultural change in the NHS’ approach to adopting technologies, while suggesting the possibility of tariffs to incentivise the uptake of new products
His views were echoed by David Corbett, the Head of NHS Wi-Fi. Like Dr Maruthappu, he stressed the need to move quicker in adopting new technologies into the NHS and in doing so make sure they align their objectives to the NHS Five Year Forward Plan. For Mr Corbett, a key benefit of adopting new medical and digital technology within the NHS is the ability it gives patients to better manage their own healthcare.
We also heard from Niall Dickson of the Brexit Health Alliance who outlined his desire to see the UK continue to adhere to close regulatory and research ties with the EU. Dickson said that the body’s main concern was that health policy, which is not currently under the EU’s competence, may not be granted sufficient attention during Brexit negotiations. The Brexit Health Alliance are calling on the Government to provide assurances that the health service will not suffer post-Brexit.
The Health Tech Alliance attended this week’s Labour Party Conference in Brighton. One of the key announcements was Shadow Health Secretary Jon Ashworth’s calls for the Government to supply an emergency £500m “winter bailout fund” for health and care services. During his speech, Mr Ashworth stated the extra money was needed to boost hospital capacities, enable the NHS to hire extra non-agency staff and progress the transfer of patients to social care. Labour’s calls for the fund were in response to looming concerns that the NHS was heading towards another winter crisis. The Shadow Health Secretary also criticised the Prime Minister’s lack of response to these concerns as part of a BBC interview, stating that ‘last winter, Theresa May stuck her head in the sand and refused to give the NHS the money it needed to keep services running properly’.
Jon Ashworth also stated that a Labour government ‘would stop the STPs [Sustainability and Transformation Plans] and integrate health and social care’, calling for a renewed approach to public health that protects people’s wellbeing. He also reiterated the party’s desire to scrap the Health and Social Care Act.
This pledge was the only major announcement directly regarding healthcare from the Labour Party Conference, but Shadow Chancellor John McDonnell’s proposal around PFI contracts has also sparked discussions on how these changes would affect the NHS. On Monday, Mr McDonnell stated in his speech that ‘Labour will sign no new PFI deals’ and that Labour intended to bring staff and contracts back ‘in-house’ when they next form a Government. He went on to say that PFI contracts have ‘resulted in huge long-term costs for taxpayers, whilst handing out enormous profits to some companies’. Labour has so far given little detail on the proposal, but critics have speculated about the potential high cost of buying out the PFI contacts within the NHS. On Tuesday however, ‘Jon Ashworth reassured that only a ‘handful’ of hospitals had a problem and that some deals would need to be renegotiated or reviewed.
Lord O’Shaughnessy, the minister responsible for the uptake of new drugs and medical technologies, confirmed that the Government will respond to the Accelerated Access Review by the end of October
The Parliamentary Under Secretary of State for Health pointed out that the uptake of new, life-changing technologies is a challenge that the government will address in this response, with medtech playing a central role in these plans. O’Shaughnessy pointed to July’s announcement of £86 million to fund the better uptake of technologies as evidence of the Government’s continued commitment to the life sciences sector.
After attending the recent NHS England Health and Care Innovation Expo, Lord O’Shaughnessy reiterated the innovation and diversity found within the UK medtech sector. The challenge moving forward, he stated, is to implement this innovation within the NHS and spread it through the healthcare system. Following the publication of Sir John Bell’s Life Sciences Industrial Strategy, O’Shaughnessy highlighted that work will now start on a ‘sector deal’ for life sciences which will suggest ideas for supporting the sector but also addressing regulatory barriers to innovation and growth.
The issue of Brexit was also touched on, with Lord O’Shaughnessy assuring industry that the UK will continue to play a leading role both in Europe and around the world. He also stressed the importance of products continuing to reach the UK market as efficiently as they do now.
The UK’s role in raising the standard of notified bodies was also mentioned. Lord O’Shaughnessy raised the point that British notified bodies assess a disproportionately high number of medical devices but also acknowledged the mutually beneficial nature of the UK’s existing relationship with the EU, which has led to NHS patients benefitting from Europe-wide scientific expertise.
Zero tariffs on trade in medtech, continued access to overseas talent and pursuing new trade relationships were among the developments Lord O’Shaughnessy expressed a desire to see as Brexit process progresses. He concluded by expressing the government’s commitment to the medtech sector and his confidence that Brexit would provide new opportunities for the life science industry.
The independent Life Sciences Industrial Strategy, written by the Government’s Life Sciences Champion Professor Sir John Bell, has been published.
Bell was commissioned by the Government to put forward proposals for a ‘sector deal’ for the life sciences sector – setting out ideas for how government can support the industry. The strategy will now be considered by the Government and used to work towards a final sector deal. The full report can be read here.
The strategy makes several recommendations which build on the Accelerated Access Review:
Collaboration between the NHS and industry
- Utilising and broadening the AAR to encourage UK investment in clinical and real-world studies. Deliver a conditional reimbursement approval, for implementation as soon as licensing and value milestones are delivered.
- Create a forum for early engagement between industry, NHS and arm’s-length bodies (e.g. NICE, MHRA) to agree commercial access agreements.
Adoption, access and diffusion
- The strategy endorses the following AAR recommendations:
- development of an enhanced horizon scanning process to enable thorough and joint planning between industry, NHS and government, and thereby more predictable NHS expenditure on technology.
- a transformative designation for those innovations with the potential for greatest impact.
- an Accelerated Access Pathway for strategically-important, transformative products.
- a single set of clear, national and local routes to get medical technologies, diagnostics, pharmaceuticals and digital products to patients.
- evolution of the process for assessing emerging technologies so that it is fit for the future.
- a range of incentives should support the local uptake and spread of innovation, enabling collaboration, and creating greater capacity and capability for change.
- broadening of conditional and adaptive approval pathways.
- Government should use the recommendations from the AAR to streamline the processes and methods of assessment for all new products, simplifying and accelerating access and using a single clear decision point.
- Value assessments should be evolved in the long-term with improved patient outcome measures, affordability and cost management data extending beyond one-year timeframes.
- NICE’s funding model for technology evaluation should be set up in a way that does not stifle SME engagement.
- The UK could host 4-6 centres of excellence that provide support for specific medtech themes focusing on research capability in a single medtech domain such as orthopaedics, cardiac, digital health, or molecular diagnostics.
The Alliance’s members were delighted to hear from Rachel Yates, Managing Director and Deputy SRO of the ‘Getting It Right First’ (GIRFT) programme, at our last meeting on 18th July.
Led by frontline clinicians, GIRFT is a national programme designed to reduce unwarranted variations in service and practice, and to improve the quality of medical and clinical care. The programme was born out of a 2012 report by Professor Tim Briggs. Having examined the state of England’s orthopaedic surgery provision, Briggs suggested changes to improve pathways to care, patient experience and outcomes. A first pilot for orthopaedic surgery, hosted at the NHS Royal National Orthopaedic Hospital Trust (RNOH) and NHS Improvement’s Productivity Directorate, has already helped to deliver efficiencies and savings of up to £30 million.
Following the success of the pilot, GIRFT was initially expanded to a further 10 medical specialities and was recently expanded to 30+ specialities. GIRFT is firmly embedded within NHS Improvement’s thinking. NHS England’s ‘Next Steps on the Five Year Forward View’ estimates that the programme will deliver savings to the tune of £400m in 2017/18. Indeed, the programme’s latest report on national general surgery believes that if more acute hospitals introduced consultant-led surgical assessments at their ‘front door’ there could be as much as 30% fewer emergency admissions a year – saving £108m annually.
Despite its widely-acclaimed merits and projected benefits, the GIRFT programme still faces big challenges. The visits first conducted by the GIRFT team, for example, had varying impact and did not always meet with the desire audience – surgeons, most notably. Whilst the project is clinician-led, it requires a degree of buy-in from managerial staff – change cannot occur if both are not on-side. Similarly, it is not immediately clear exactly how GIRFT fits in with Sustainability and Transformation Plans (STPs) and there have been claims of overlap with NHS England’s ‘RightCare’ initiative, the body’s drive to reduce unwarranted variation in the commissioning of services, and to provide patients with better information and tools to decide on their own treatment.
To learn more about the Alliance’s meeting on the GIRFT programme and our forthcoming meetings and activities, please contact firstname.lastname@example.org
Rachel Yates, MD of the GIRFT programme presents the lessons learnt from the programme to members
The Government has today announced funding of up to £86 million as a first step in taking forward the Accelerated Access Review. The funding is split into four packages:
- £39 million of funding to the Academic Health Science Networks (AHSNs), to assess the benefits of new technologies and support NHS uptake of that that deliver real benefits to patients according to local need.
- £35 million Digital Health Technology Catalyst for innovators – which will match-fund the development of digital technologies for use by patients and the NHS.
- Up to £6 million over the next 3 years to help SMEs with innovative medicines and devices get the evidence they need by testing in the real-world, building on existing opportunities such as the Early Access to Medicine Scheme (EAMS).
- £6 million Pathway Transformation Found to help NHS organisations integrate new technologies into everyday practices – which will help overcome more practical obstacles such as training staff on using equipment.
Commenting, Health Minister Lord O’Shaugnessy said: “The government’s ambition is that NHS patients get world-leading, life-changing treatments as fast as possible. That can’t happen unless we support medical innovation and tear down the barriers – like speed to market and access to funding – that can get in the way, especially for SMEs. Our investment in innovation shows how much we value the UK life sciences sector.”