‘Slow-tech’ NHS

The MTG is the UK’s largest coalition of patient groups, research charities and medical device manufacturers working together to improve access to medical technologies for everyone who needs them. In a 12-point Action Plan “Medical Technology – Can We Afford To Miss Out” the Group warned that any cuts to NHS technology budgets would cost more in the long-run and risked damaging the quality of life of thousands of patients with diabetes, heart disease and other long-term conditions.
    
The UK’s annual budget for medical technology is almost 22.7bn less than the EU average. The Action Plan highlights examples of slow uptake of technologies including:

  • Implantable cardioverter-defibrillator (ICDs), which can lead to a 50 per cent reduction in cardiac deaths, were implanted in Germany at over three times the UK rate in 2008, despite being recommended by NICE.
  • Less than 4 per cent of patients with Type One diabetes have access to a NICE-recommended insulin pump in the UK, compared with 35 per cent in the US, and 20 per cent in other European countries.

This under-use is problematic for three reasons: Most importantly, it can lead to patients being denied the choice of interventions that can improve and prolong their quality of life and dramatically improve health outcomes.
    
Tina Amiss has cardiomyopathy, and knows firsthand the benefits to be gained from using an Implantable cardioverter-defibrillator (ICD) to control her condition. Tina says: “This powerful but diminutive piece of technology has enabled me to get back to a relatively normal life and has helped stop my family living in constant fear of another cardiac arrest. The ICD is life saving and reduces both the cost and emotional trauma of life threatening cardiomyopathies – it should be available to all who need it.
    
“However, there remains a post-code lottery in provision – often due to variations in the depth of knowledge about ARVC and other types of cardiomyopathy. I was lucky but we still need more specialist centres to ensure that those at highest risk don’t slip through the net.”

Overlooking solutions
The UK’s under-utilisation of medical technology also overlooks potential solutions to some of the major challenges facing today’s NHS – such as infection control, moving care from acute to community settings and delivering cost effective management of long-term conditions. For example, minimally invasive surgery can result in overall cost savings to the NHS. Innovative surgical instruments and equipment allows increasingly complex surgery to be performed minimally invasively, including some joint replacement surgery. Often, minimally invasive techniques allow patients to leave hospital earlier, and require less aftercare. This can offset higher costs of the innovative technology and equipment, resulting in better patient outcomes, improved productivity and capacity at equivalent or reduced cost to the NHS.
    
The third consequence of the under use of medical technology stretches far further than the NHS. Many technologies can help people to continue in the workforce, keep them well at home rather than in hospital, or enable young people to continue in education, leading to overall economic gains. For example, spinal cord stimulation, on which favourable NICE guidance was published in October 2008, relieves chronic (neuropathic) pain and helps patients stay in work. Currently 25 per cent of chronic pain sufferers stop working because of their condition. Appropriate use of technology could allow them to stay economically active, paying tax rather than relying on incapacity benefit.

Recommendations

The MTG Action Plan makes 12 recommendations for enhancing the UK’s uptake of effective medical technologies:

1. Forums should be established to allow dialogue between stakeholders including policy makers, clinicians and patients themselves. This could include formalising links between industry and professional bodies to ensure that new developments reflect clinical need.

2. More opportunities for those working in industry to be seconded to the Department of Health could help to ensure coordination, and the needs of all stakeholders are considered.

3. Patients need to be given better information about treatment options, i.e through NHS Choices or telephone advice for those not online, so they can make an informed choice and get access to the most appropriate medical technology.

4. A comprehensive map of services and specialisms should be made available to GPs and patients through Choose and Book to assist them in making appropriate referrals.

5. Innovation Prizes should be used to encourage and reward progressive clinicians and teams. Training and mentoring programmes should be initiated to ensure that this best practice spreads throughout disciplines.

6. Professional bodies should work with industry to provide regular training on the latest medical technologies and the managers should build time in to work schedules for attendance.

7. Patients’ right, enshrined in the NHS Constitution, “to drugs and treatments that have been recommended by NICE for use in the NHS” should be made legally enforceable. PCTs should not be able to deny treatment of NICE approved technologies on the basis of lacking the supporting infrastructure to provide them.

8. Procurement should have a focus on the value and cost-effectiveness of devices rather than solely the price.

9. Collaboration is needed between government, the NHS and industry to map uptake of medical technologies. This information should be used to identify and address areas of under adoption.

10. We welcome the OLS’ new plans for a SHA Delivery Group to support the early and systematic uptake of innovations in technologies which provide value to the NHS, and urge the government to consider including patient representatives in this Group.

11. MTG welcomes the review by NHS chief executive David Nicholson of the Tariff, and urges the government to set Tariff rates that reflect the actual costs of procedures using the best technologies, so that Payment by Results works as a mechanism to facilitate the uptake of innovation. This will ensure providers are able to carry out high quality procedures, supporting best practice and improving patient outcomes.

12. Patient Reported Outcome Measures (PROMs) should be piloted to include medical devices and allow full assessment of their benefits. The measurement system should be kept flexible to ensure longer-term results are captured.

Political support
Leading politicians have supported the report. Conservative Shadow Health Minister Stephen O’Brien MP said: “I want to build a health service where procurement delivers the best possible patient and financial outcomes, rather than focusing on short:term targets, and where specialist equipment is not treated as just a commodity, but as a value for money use of public money.”
    
Norman Lamb MP, the Liberal Democrat Shadow Health Secretary, commented: “These recommendations focus on key issues which the NHS and the government must address. They provide a very welcome contribution to the debate.
    
“Adoption of medical technologies is often both cost effective and in the patient’s interest. Up until now, the NHS has been slow to recognise the value of technology. This has to change if we are to maximise the effective use of resources for the benefit of patients.”

Case Study – Insulin Pumps
The battle for access to effective medical technologies can affect those of all ages. Thomas Double is 10 and has Type 1 diabetes. He uses an insulin pump that is recommended by NICE to manage his condition, after his mother battled for over two years to get agreement from her PCT to fund the therapy. Thomas says:
    
“Going onto a pump was definitely the right thing to do. Now, instead of having a lot of injections I just have to press a few buttons. It’s easier to spend time with my friends without constantly feeling different and worrying that I won’t be able to do the same things as them.”
    
Thomas’s insulin pump frees him from the need to frequently inject himself, and helps to stabilise his condition, meaning less time is spent in hospital. As well as improving Thomas’s quality of life this generates NHS savings.
    
The insulin pump also allows Thomas more freedom to eat and exercise whenever he wants, not at times dictated by his condition. This helps him to keep up with his friends, and lets his family live a normal life. 

About the Medical Technology Group
The Medical Technology Group (MTG) is a coalition of patient groups, research charities and medical device manufacturers working to improve access to effective medical technologies for everyone who needs them. Medical technology gives value for money to the NHS, patients and taxpayers but uptake of medical technologies in the UK is not as good as it should be. MTG is interested in a variety of clinical areas but has a common objective in securing patient access to the best diagnostic, imaging, surgical and supported living technology.

For more information
Web: www.mtg.org.uk