Driving quality and productivity in the NHS

The recently published White Paper Equity and Excellence: Liberating the NHS, makes 90 references to quality and productivity and 23 to efficiency, but only mentions technology three times. Given the NHS’s need to release up to £20 billion of efficiency savings to enable reinvestment to support improvements in quality and outcomes, innovative, proven healthcare technologies can make an invaluable contribution to the delivery of the quality and productivity agenda.

Coordinating innovation
The NHS Technology Adoption Centre (NTAC) has experience of working with over 70 NHS organisations to coordinate the adoption of technology-led innovation at a national and regional level.

“Evidence based technology has a pivotal role to play by facilitating change in the NHS with the express aim of improving patient care which in turn drives improvements in efficiency,” says Sally Chisholm, NTAC
chief executive.

Based in Manchester and launched in September 2007, NTAC exists to help organisations to identify technologies that will provide cost effective improved patient outcomes and to navigate the complexities of the NHS adoption landscape. NTAC works with a range of NHS organisations to support the sustainable implementation of new technology as an integral part of service and system solutions, identifying where changes to the patient pathway or service may be needed to unlock the full benefits of the technology.

Technology Implementation Projects
Sally points to the success of NTAC’s pioneering Technology Implementation Projects (TIPs) which cover a broad spectrum of clinical areas including cardiology, diabetes, urology and cancer. The experiencee from these projects have enabled NTAC to develop a phased programme, led by an NTAC project manager who works collaboratively in the chosen NHS setting, be it primary or secondary care, to equip clinicians, managers and stakeholders with the tools and resources to put innovation at the heart of their organisation.

Each TIP takes place at three or more host organisations in order to expose the technology to different adoption issues and enable the NHS to gain an improved understanding of the impact of implementation for patients, clinicians and managers. At the end of each successful project NTAC produces a detailed online How to why to Guide, which provides comprehensive, relevant information for clinicians, managers, key decision makers and other stakeholders, on how to implement specific technologies. These highly accessible road maps set out the evidence base in addition to the benefits to both patients and organisations that can be achieved. They provide an overview of the impact on key policy areas from quality of care to improved patient outcomes, advice on procurement and even a template business case.

Over the past two years NTAC has reviewed more than 200 healthcare technologies from NHS partners and medical technology companies through its TIP programme. Ten technologies have been selected for implementation and to date three guides have been produced covering perioperative fluid management, insulin pump therapy and a new technique for suprapubic catheterisation, which enables the procedure to be carried out in an outpatient setting and so reduce hospital stays for elderly, vulnerable patients.

Another five guides are due out shortly covering an innovative breast lymph node assay, 12 lead ECG in primary care using telemedicine, cardiac resynchronisation therapy for patients with moderate to severe heart failure, non invasive bladder analysis for men, and photodynamic diagnosis of bladder cancer.

Expertise in action
NTAC’s systematic approach to implementation and development of local capability is graphically illustrated by its work to implement an innovative technique to guide fluid management known as oesophageal Doppler monitoring (ODM), which improves patient outcomes following major surgery. Despite a comprehensive evidence base comprising eight randomised controlled trials demonstrating significant improvements in surgical outcomes, uptake of the technology has been poor across the NHS with only five per cent of major operations using ODM.

“We wanted to see if the outcomes achieved in clinical trials could be replicated in the real world and to explore the barriers to facilitating national adoption, if the project was successful,” explains Colin Callow, NTAC’s
programme director.

A model of TIP in action, the project involved three implementer sites representing a broad spectrum of clinical practice; Manchester Royal Infirmary, Derby Hospitals NHS Foundation Trust and Whittington NHS Trust. Each organisation incorporated ODM into routine clinical and operational practice through a structured programme
of implementation.

Patient benefits
NTAC set out not only to measure the impact of the technique but also to identify the potential benefits, costs and practical issues associated with the routine implementation of Doppler guided perioperative fluid management.

“We also wished to provide relevant information to help providers and commissioners make informed choices about how the technique could make a positive difference to the wellbeing of patients and NHS performance while at the same time offering significant potential to reduce healthcare costs,” says Colin.

The results from the three implementer sites clearly demonstrated that the effectiveness of the technique had indeed improved patient outcomes, achieving a 3.5 day decrease in post-operative length of stay, a 23 per cent reduction in the use of central venous catheters, and a 30 per cent decrease in re-admissions and re-operation rates. The direct benefits to patients were equally significant – minimally invasive monitoring, low risk of cardiac complications, reduced risk of catheter related infection, shorter hospital stays and fewer
post-operative complications.

“If these findings were replicated across the NHS, it has been estimated that overall financial savings would be between £170-£370 million per year realised by accuring the above benefits. This equates to financial savings of between £300 and £700 per patient. Alternatively, the released hospital beds could provide the capacity for the NHS to undertake an additional 140,000 major surgical procedures a year,” says Colin in a powerful counter to the common stumbling block for many trusts when it comes to adopting new technologies – lack of evidence of their effectiveness in routine clinical and operational practice.

National experience, localised response
NTAC’s work with SHAs through the Innovation Adoption Procurement Programme (iTAPP) is funded by the Department of Health and aims to bring coherence and clarity to technology adoption. Part of the ambitious National Innovation Procurement Plan, iTAPP involves NTAC in supporting innovation and commercial support unit leads in SHAs to collaborate with partners across their own health economies with the aim of identifying, understanding and dismantling systemic and commercial barriers to adoption. The work will be underpinned by robust programme leadership, a systematic management approach and rigorous coordination of the innovation adoption processes in participating SHAs.

The initial focus will be on the rapid adoption and diffusion of selected technology-driven innovations that already exist and are proven to bring benefits in efficiency and quality of care. Technologies have been identified by the Procurement Investment and Commercial Directorate at the Department of Health, in collaboration with NTAC and the medical technology industry, as having the most potential for helping the NHS to meet the quality and productivity challenge.

Taking technology forward
Independent insight into the potential barriers and delays to their adoption will be provided by stakeholder groups, established by each SHA which will select technologies to take forward to implementation. To help ensure the most appropriate technologies are being selected for implementation within each region, a number of key criteria are being considered within the local assessment and selection process which respond to White Paper imperatives. These include: the potential to enhance productivity and efficiency through improved quality; better health outcomes; the delivery of personalised care; the potential to reduce the burden on acute services; and the opportunity to empower GP led commissioning of new services and provide care closer to home.

To ensure sustainability and efficiency into the future each SHA will share learning, with NTAC’s support, from the commissioning and implementation of innovative medical technologies. They will work collaboratively to provide initial and ongoing assessment of innovation submissions from the medical device industry with a view to selection for implementation. They will also agree an initial list of technologies to take forward to implementation and develop and agree concurrent procurement and implementation plans. Using a systematic approach and reporting they will achieve widespread adoption of selected technologies and undertake benefits relisation analysis, tracking and reporting. In addition, they will carry out health economic analysis and modelling, develop clinical utility evidence and an adoption and diffusions methodology to ensure successful diffusion across all areas in the NHS.

Forging effective partnerships
NTAC is working with a wide range of partners both inside and outside the NHS in order to overcome the barriers to technology adoption. These include the NHS Information Centre, NICE, ABHI and BIVDA, Trustech, the North West’s Innovation Hub, The National Innovation Centre (NIC) as well as NHS procurement organisations and NHS and Government quality, regulatory and performance agencies. In conjunction with academic partners NTAC is establishing a professional development programme to increase the capacity and capability of managers so that they can support frontline clinicians with rapid adoption of innovative healthcare technologies.

In partnership with health economies NTAC is assessing the current levels of adoption of a range of healthcare technologies to enable them to determine the level of adoption required to realise maximum efficiencies and improvements in service.

NTAC also has its eye firmly on the future following the setting up of 17 Health Innovation and Education Clusters (HIECs). The aim of the HIECs is to encourage innovation in the NHS through partnerships with higher education and industry. Established in nine SHAs and backed by more than £11 million in funding, they will also provide professional education and training.

“We are already actively collaborating with these clusters to ensure the successful implementation of selected technology-driven innovations proven to bring benefits in efficiency and quality of care,” concludes Sally Chisholm.

For more information
Tel: 0161 276 5263
Web: www.technologyadoptioncentre.nhs.uk