New report reveals regional variation in adoption of medical technologies by NHS

Manufacturers hope the publication of a new report revealing variation in the availability of medical equipment and procedures between NHS trusts across England will lead to improvements for patients and increased take-up of life-changing technologies.

The Innovation Scorecard has been published by the Health and Social Care Information Centre (HSCIC) and gives details about the use of technologies recommended for NHS Patients by the National Institute for Health and Clinical Excellence (NICE).

It is intended to identify where variation in adoption may exist between healthcare organisations and for these organisations to understand, be challenged and explain any variation

The document was put together on behalf of the Department of Health and the NHS Commissioning Board and follows the release of the Innovation, Health and Wealth report, which set out plans to improve the adoption of innovative treatments across the NHS.

It is intended to help drive compliance with NICE recommendations and will also be used to ‘identify variation which can then be justified, challenged or acted upon’.

As well as covering 76 medicines, the report outlines the variation in the use of six specific medical devices among health trusts in England.

While individual brands are not referred to, the use of certain technologies is reported, with the limited data pointing to a mixed picture, with a number of areas falling short of the NICE recommended levels. This is consistent with information recently published by the NHS Commissioning Board as part of its consultation on specialised services, many of which include medical device technologies.

If the scorecard is to provide patients with a useable source of information on the performance of their local NHS organisations then data will have to be interpreted and made easier to understand

The six technologies relate to cardiac resynchronisation defibrillator devices or cardiac resynchronisation pacing devices, endovascular stent grafts and cochlear implants, as well as devices used for laparoscopic surgery and spinal cord stimulation, and those used to treat coronary artery disease.

However, while the scorecard highlights significant variation, it warns: “It is not intended to be used for performance management nor for benchmarking purposes. It is intended to identify where variation in adoption may exist between healthcare organisations and for these organisations to understand, be challenged and explain any variation. This is based on the assumption that reduced variation will result in improved quality of care.”

It says variation is not always down to a trust’s refusal to follow the NICE guidance, which is based on indepth technological assessments of emerging and existing technologies. Other reasons for differing take-up rates include the existence of alternative products or procedures, demographic profile, different levels of information being available to help patients decide on relevant treatments, and whether a service is available in primary care settings as well as in hospitals.

The reality is we can only afford to provide new drugs or treatments where they are cost effective and demonstrably add real patient benefits

The publication has been welcomed by industry, but Peter Ellingworth, chief executive of the Association of British Healthcare Industries (ABHI), said more needed to be done to provide guidance for trusts and to support manufacturers. He said: “The publication of the scorecard is a big step forward in making sure all patients can access NICE recommended technologies and identifying the areas where more attention is needed.

“While the publication does signal a step change in attitude towards the uptake of innovation, there is still more work to be done. There are a number of technologies that have received NICE guidance for which the figures are not published; an area we would to see developed in further editions of the scorecard.

“If the scorecard is to provide patients with a useable source of information on the performance of their local NHS organisations then data will have to be interpreted and made easier to understand, consistent with the NHS Atlas of Variation , which has already begun to do this.

“I look forward to working with the Government to help develop this tool. Industry has previously called for a system to monitor patient access to innovative treatments and the scorecard is a welcome first step in this.”

Barbara Harpham, chairman of the Medical Technology Group (MTG) and national director for Heart Research UK, added: “The Medical Technology Group welcomes the publication of the Innovation Scorecard. It is one of the Government’s key drivers to improve patient access to NICE-approved treatments and technologies.

Industry has previously called for a system to monitor patient access to innovative treatments and the scorecard is a welcome first step in this

“Although the scorecard contains limited data, its publication represents an important first step in the journey to ensuring patient access to appropriate new treatments including medical technologies, as well as increasing transparency and accountability in the new NHS.”

But she agreed with the ABHI about the need for the data to be more widely available. She told BBH: “We believe the data contained in future publications of the scorecard need to be presented in a more accessible format, and on local clinical commissioning group websites to ensure that patients and the public have easy access.

"The data is limited and it is vital that the Department of Health, the HSCIC and other stakeholders now work together to produce a more detailed picture of the uptake of treatments and technologies in future scorecards. This will allow local authorities, patients and the public to see how quickly their local hospitals and primary care organisations are providing NICE-approved drugs and technologies, ultimately improving clinical standards of care.

But David Stout, deputy chief executive of the NHS Confederation, warned against a knee-jerk reaction to the publication at a time when the NHS is strapped for cash.

In a statement he said: “The continued success of the NHS depends on the uptake of innovative ideas. We have to keep up with technological advances and provide modern healthcare to our patients if we want the NHS to remain a world leader in healthcare.

We have to keep up with technological advances and provide modern healthcare to our patients if we want the NHS to remain a world leader in healthcare

"Sharing information on these advances is extremely useful for creating new treatments and medicines. It allows organisations to measure their progress and look at new ways of providing care and treatment. It can also increase transparency about which services and treatments are available by different providers.

"But it is important that any new measures do not lead to unnecessary bureaucracy or a duplication of information with no real benefits for hospitals, GPs or patients.

"It is important to remember that the NHS is facing an unprecedented financial challenge and organisations must live within their means while providing high-quality care. The reality is we can only afford to provide new drugs or treatments where they are cost effective and demonstrably add real patient benefits. In a health system with no financial growth, any new costs have to be offset by savings elsewhere. That is why it is crucial that NHS organisations engage their local communities and clinicians in decisions about priorities.”

To access the Innovation Scorecard , click here.