NICE annual conference 2009: day one

Reports from the conference

How do we value innovation?

US perspectives on how innovation in healthcare is valued were discussed in a session, called ‘International perspectives on innovation and value', and gave delegates the chance to hear from professionals involved with the US healthcare system.

Steve Pearson, President of the Institute for Clinical and Economic Review at Harvard, identified two options for judging innovation. The first is by setting criteria for success before the innovation has been introduced, such as measuring whether an intervention works. Mr Pearson said this would be “difficult to do in a way which makes sense”, as it is hard to define criteria for an innovation's success before the innovation itself has been created.

Another method of judging innovation would be to assess its performance once introduced. This again poses difficulties, as it depends on an agreed definition of “value”. Suggested definitions include the speed of penetration of the innovation into a healthcare system, or the destination of venture capital - which he said could be cosmetic surgery in the case of the US.

Mr Pearson concluded that he would like to see how the impact of NICE on the NHS is measured, and what the potential is for collaboration between UK and US healthcare systems. This could involve developing a common set of criteria for the value of innovation in both countries.

Sean Tunis, Director of the Center for Medical Technology in Baltimore also spoke about how innovation is valued during the session.

Mr Tunis said that “uncertainty is a threat to value and innovation in healthcare” and quoted US legislation on Medicare coverage.

He said that Medicare is required by legislation to provide drugs and procedures that are “reasonable and necessary” and stressed it is not clear what this means.

Mr Tunis posed his own definition of “reasonable and necessary”, as “improving health”, is generally available to the Medicare population and is “good or better” than current treatments.

He produced a light-hearted, illustrative diagram called ‘the molecular diagram of uncertainty'. This illustrated the gaps in knowledge between research and decision-makers that exist in the current US healthcare system.

Questions from the floor included whether NICE guidance is used in the US. Steve Pearson said he believes that NICE has a reputation as a “wonderful” resource for evidence. Sean Tunis added that its processes and structures are being used as a model in US healthcare.

Public health implementation in practice

The challenge of implementing NICE guidance was the subject of a session at NICE 09. Mike Kelly, Director of the Centre for Public Health Excellence at NICE was joined by Dr Tom Scanlon and Lydie Lawrence from NHS Brighton and Hove, to discuss how NICE guidance has been implemented on the ground, and share lessons learned along the way.

Dr Scanlon told how Brighton has earned itself a reputation for getting public health right. This was down to an integrated approach, making it a model for the rest of England. He described the population as “young and somewhat bohemian;” such a lifestyle perhaps being more at risk of smoking and alcohol related diseases, as well as a having a high rate of STIs. Indeed the city has the highest rates of HIV outside London. It also has high number of teenage pregnancies; England has the highest rate in Europe, with Brighton and Hove having a higher number still. Sadly, the city also has a high proportion of suicides a year, and is in the top 5% of all PCTs across England. Alcohol too is a big issue - and Brighton and Hove has the highest recorded figures in the country for alcohol related crime, hospital admissions and mortality. Poverty also has a role to play in the area's health inequalities - the east of the city is very deprived with many of its homes not meeting the decent homes standard.

In attempting to tackle such huge socio-economic and health problems, Dr Scanlon and his team were tasked with looking at three major influencers of health: the individual; social and community factors; and broader, general socio-economic factors.

Public healthcare professionals across the city were encouraged to use behaviour training to try and challenge such issues within their patients. For example, much of the city's population are very resistant to immunisations for their children, with the ugly hangover of the MMR controversy from over 10 years ago still looming. This has proved quite a challenge for the city, and healthcare professionals have had to undertake rather aggressive techniques in trying to urge their patients in getting their children immunised.

In December 2011 spatial planning guidance will be published, which will assess how effective such interventions have been. It will also look at how effective the collaborations between local authorities and PCTs have been.

The health impact screening tool has already measured the impact of wider public health programmes across the city and has, for example, revealed that the introduction of 24 hour drinking in 2003 has, very worryingly, coincided with an increase in domestic violence, and alcohol related hospital admissions. Dr Scanlon suggested that the impact of interventions should be more widely considered, for example, shutting down fast food restaurants near to schools.

The seminar closed by reference to one of the architects of the NHS, William Beveridge, and the five giant evils of Want, Disease, Ignorance, Squalor and Idleness he spoke of in 1940s England. Dr Scanlon suggested that over 50 years later, such problems are still very much in evidence across England today, and for that reason alone, must be addressed.

NICE and the Single Technology Appraisal.

Balancing rigour with timely assessment has been a constant challenge for NICE. A session at the NICE conference looked at how the need for transparency and clear decision-making has been brought into the spotlight by the introduction of the rapid single technology appraisal (STA) process.

Dr Carole Longson, Director of the Centre for Health Technology Evaluation at NICE, introduced an informative session on the ins and out of facilitating speedier technology assessment “the NICE way”.

Meindert Boyson, Associate Director for single technology appraisals at NICE, said that whilst the content of STAs has evolved and expanded since their introduction in 2006, time constraints have remained the same. This has meant creating a fourth technology appraisal committee as well as considerable expansion of the number of NICE staff involved in the programme. Confident that timeliness will not be compromised, Mr Boyson said: “We think that by 2011 we'll be able to produce guidance close to marketing authorisation for almost all significant drugs referred to NICE.” He added: “The STA programme allows NICE to deliver timely guidance for the most clinically- and cost-effective drugs and add value to the difficult decisions local managers have to make in allocating resources.”

Professor Mark Sculpher, Professor of Health Economics at the University of York, focused on rapid assessment methodology and adapting this to meet decision makers' needs when considering the value of new technologies. He stressed the need to adopt the most appropriate assessment approach for each technology and the importance of flexibility at both the scoping stage and following initial assessment, saying: “The speed and source of assessment should vary with the technology and the decision on which approach to take should be driven by the health benefits to the NHS.”

New guide on commissioning launched

A new guide, How to use NICE guidance to commission high quality services has been launched at Conference, and explains how NICE guidance supports the commissioning of high quality services, and describes how the guidance can be used throughout the commissioning cycle. It illustrates the support available from NICE, as well as the benefits using NICE guidance can bring for local populations.

The guide is aimed at all those involved in commissioning health and social care services, as well as public health programmes within the NHS and partner organisations in England, but it may be a useful tool for all commissioners across the UK. Seeking to support commissioners in developing systems and processes that entrench NICE guidance into commissioning, it also highlights sources of further information and practical help.

A Clean Sweep for the West Midlands in NICE's Shared Learning Awards

The West Midlands are celebrating after winning all 3 categories of the 2009 NICE Shared Learning Awards.

University Hospitals Birmingham NHS Foundation Trust won the clinical award for their project, “Saving Sight the NICE Way”. Their aim was to start giving patients easy access to a new, sight saving treatment (Lucentis® photodynamic therapy) the same day as the NICE guidance was published and to make sure the service ran as effectively and as efficiently as possible. So far, every patient is being seen for an initial assessment within 1 week of being referred and more and more patients are benefitting from this new treatment.

The Staffordshire branch of Addaction, the drug and alcohol treatment charity, won the health and wellbeing award for “putting NICE guidelines into practice managing a pharmacy needle and syringe programme”. They wanted to improve the quality of a scheme already running in the county and, by surveying those already using the service, have begun new ways of working to make the service even better.

Last but not least, the winner of the general award was South Staffordshire & Shropshire Healthcare NHS Foundation Trust. Their project was called, “NICE & knowledge: developing an initiative to enable a robust cascade of NICE Guidance backed by documentary evidence of clinician's knowledge”. The trust put systems in place, including e-learning, to make sure their doctors and other healthcare professionals knew about all NICE guidance that impacts on their services to help them treat, and give information to, patients.

Each winner was presented with a trophy, certificate and cheque for £1,000 to help them put NICE guidance into practice.

The Shared Learning Awards

The awards were described by Dr Phil Hammond at this year's conference as” the beating heart of NICE”. They are an eTxtension of the NICE shared learning database, which was launched in 2006, and highlights how NICE guidance is being implemented locally to help organisations share best practice and learn from one another.

Office of Life Sciences and the Innovation Pass

A new ‘innovation pass' that will make innovative medicines available on the NHS for a time-limited period ahead of a NICE appraisal was discussed at the NICE annual conference today. The pass is the latest in a series of new initiatives to come from the Office for Life Sciences (OLS), a cross-Government initiative to bring industry and health policy closer together.

Speaking at the conference, Richard Cienciala, Deputy Director of the Office for Life Sciences, Nick Burgin, Managing Director of Eisai Limited and Adrian Towse, Director of the Office of Health Economics, discussed the OLS's ‘Life Sciences Blueprint,' a package of measures to help maintain a competitive life science sector. The speakers grappled with issues such as the role of the NHS in driving innovation, how to recognise and encourage innovation - a theme running through the conference - and the role of the pharmaceutical industry in helping the NHS cope with the financial pressures it will undoubtedly face in the coming years.

One of the initiatives announced in the blueprint is the introduction of an innovation pass. The pass will make selected innovative medicines available on the NHS for a set period of time, prior to a NICE appraisal. Funding will be drawn from a new ring-fenced £25m budget, set aside exclusively for the innovation pass. A key feature of the pass will be the opportunity to provide earlier access to innovative drugs for patients with the greatest need, Rather than bypassing NICE, the pass would also create a system for collecting data on the drugs' effectiveness and cost-effectiveness that would eventually support a NICE appraisal.

A consultation launched this week by the Department of Health encourages those working in the NHS, industry and other stakeholders to comment on proposals for a pilot of the innovation pass which will take place in 2010.

The BioIndustry Association welcomed the consultation, saying that it will “allow patients with unmet medical needs to gain early access to the innovative technologies being developed by life sciences companies.”

Emilene Coventry reports on the conference's opening session

NICE's 11th annual conference opened with a session on the conference theme - ‘Innovation and value'.

Sir Ian Kennedy started by discussing his recent report to NICE on the value of innovation - a response to the challenge that NICE is seen by the pharmaceutical industry as a barrier to innovation. NICE's response to the Kennedy study is available for consultation until January.

Sir Ian said that it was important to define innovation - and it must be about rewarding innovation itself, and not just the promise of innovation. He compared it to turning water into wine, saying: “You say this water has the promise of turning into wine. I say come back when it has turned into wine.”

Sir Ian's report also said that the cost threshold that NICE uses to evaluate new drugs were set at the right amount, but the challenge for NICE was to ensure that our appraisals in the future had a broader focus, saying that NICE needs to engage earlier with pharmaceutical companies. “If a product is genuinely innovative and effective, the cost threshold should be higher,” he said. “But the flipside is that if a company was not innovating, just producing copies of existing products, the cost threshold should be lowered.”

Guardian deputy editor Polly Toynbee was next. She talked about how ‘new' was the “magic word” - but that new was not always good. NICE was seen as the universal “Mr Nasty” she said, standing in the way of new drugs. Calling NICE a “pivotal linchpin of the NHS”, Toynbee said: “Individual doctors can never be a match for the might of pharmaceutical companies' marketing. NICE's panel of experts and laymen is the only way the NHS can make rational decisions.”

She said that there was a suspicion NICE had gone ‘weak at the knees' with new cancer drugs and that the Innovation Pass was a “nifty compromise” - but should only be a temporary solution.

Finally, NICE's deputy chief executive Dr Gillian Leng hosted an interactive session exploring NHS Evidence's web-based information service - and what healthcare professionals can expect from it in the future. NHS Evidence have today launched a new section on quality and productivity, with a list of 70 recommendations on how the NHS can increase quality whilst saving money.

See the conference programme

See the presentations from the conference

Reports

Read the reports from day two.