Smarter healthcare

Healthcare technology covers everything from high-end hospital equipment to diagnostics and patient implants. The global medical technology sector is growing exponentially and the UK continues to be a centre of innovation, with ideas coming from traditional med tech companies to the hundreds of science and engineering driven start-ups. Remote monitoring, minimally invasive surgical procedures and devices that act on the central nervous system directly to reduce symptoms represent cutting-edge technology applications.
    
New medical devices and interventions are now able to offer patients treatments and diagnoses previously unavailable. For example, they can advance the identification and treatment of disease, provide for more comfortable treatment regimes and reduce pain, offer new treatment options for ill individuals and can provide a safer environment for both patients and providers. In many cases, medical technologies accomplish these improvements cost effectively, and in some cases can reduce costs while improving outcomes.
    
In numerous ways, medical technologies can improve access to and effectiveness of care, decrease morbidity and mortality, speed up recovery, and increase patient comfort. These benefits are not just theoretical, but have been quantified and published in several studies (Wanless Report, 2002 and more recently Medical Technology in Canada, Fraser Institute, 2008).
    
Leading role
An example of this is the leading role being played by medical technology in the fight against healthcare associated infection. A unique silver alloy hydrogel coated catheter has been granted a Recommendation 1 by the DH Rapid Review Panel in recognition of its impact in reducing catheter associated urinary tract infection (CAUTI). Given the prevalence and cost of CAUTIs, the potential savings to trusts are considerable, quite apart from the improved outcomes for patients. The same coating technology is now being deployed to reduce life threatening ventilator associated pneumonia.
    
Procurement in healthcare is an evolving activity and characterised by a series of over-lapping authorities and stakeholders. With increasing localisation and integration of health and social services, the number of organisations involved in procurement could increase considerably: Primary Care Trusts (PCTs), Strategic Health Authorities (SHAs), Cancer Networks, NHS Trusts, Foundation Trusts, local authorities and the independent and private sector providers all have a potential stake.  
    
Whilst procurement has hitherto largely been separate from clinical service planning, the NHS’ drive for ‘world class commissioning’ will increasingly support a move to thinking about procurement in terms of patient outcomes and supporting innovation. The promise of newer bodies like the Centre for Evidence-based Purchasing is that procurement managers could have a deeper pool of advice and support to draw on when procuring on behalf of the NHS. Medical Technology Group members hope this will foster an enlightened procurement culture where professionals have the freedom and quality of information they need to make smart choices to plan and decide what they buy.
    
In the midst of diversity of procurement models and plurality of providers, a key challenge is to establish clear procurement routes that will secure high value, high quality products that support the work being done to drive up NHS standards and patient outcomes.

Post Darzi environment
The NHS Next Stage Review led by health minister Lord Darzi culminated in June 2008 with the publication of his national review ‘High Quality Care for All’, under which each SHA’s regional plan sits. The report sets out ways in which the NHS can improve by giving patients and the public more choice, by staff working in partnership with key stakeholders including industry and by delivering high quality care to all users of services.
    
The Medical Technology Group welcomed the new legal duty created by Lord Darzi for SHAs to support frontline innovation through new regional innovation funds. We also welcome the creation of NHS Evidence, hosted by NICE, as an incentive to improve innovation. The Group hopes this new portal will promote the accumulation of additional research and information about technologies.
    
Whilst the NHS has historically been a great source of innovation in terms of developments in clinical practice and clinical trials, it is less fertile ground for adoption of new cutting-edge technology, as has been recognised by the Health Innovation Council in its work to support Lord Darzi’s Review.  
    
Technology uptake can be hindered by there being no NICE guidance available on its use. When technologies are recommended by NICE there can be delays in it being funded, in spite of the statutory duty on PCTs to fund NICE-approved technologies within three months of the publication of guidance. For example, in the field of heart disease, the NHS continues to implant levels of ICDs and CRT-Ds below those suggested in the NICE cost-effectiveness reviews of both technologies. The result here is that patients experience a ‘revolving door’ of inpatient admission and treatment rather than benefiting from a cost-effective treatment that would reduce hospital admissions. Clearly, the processes in place to secure the uptake of effective technologies could benefit from further improvement.
    
The challenge is to develop a sophisticated yet clear to navigate process which can differentiate between items which are ‘commodities’ and those medical technologies which bestow broader benefits. An intelligent approach to procurement is needed if we are to recognise the benefits of innovative technologies which may have the potential to contribute to improving patient outcomes, reducing hospital stay and lessening the overall burden put upon health and social care services.

About the medical technology group
The Medical Technology Group (MTG) is a coalition of patient groups, research charities and medical device manufacturers launched in 2000 to campaign for patient access to effective medical technologies. The group is committed to supporting wide uptake of proven technologies such as insulin pumps, urinary catheters, pacemakers, radio-frequency ablation of tumours, diagnostic equipment, implantable cardioverter defibrillators (ICDs), orthopaedic implantable devices and cataract treatments. In addition, the group works to ensure the delivery of new innovations, which make a huge difference to the quality of life of people with long-term conditions. MTG also seeks a conducive research environment in which new innovations can be developed, and best practice spread throughout the NHS.
MTG’s objectives are to:

• Advance reforms that will ensure patient access to innovative medical technologies
• Recognise the work and contributions of leading medical professionals and institutions using technology to improve healthcare outcomes for patients
• Provide patients, clinicians and all stakeholders with accurate information about medical conditions and treatment options
• Bring the UK level of patient access to medical technology into line with that of mainland Europe by showing the health benefits and cost savings such technology can bring.