Medical Technologies Advisory Committee
Consultant vascular surgeon Professor Bruce Campbell talks about the new Medical Technologies Advisory Committee, which will evaluate new devices and diagnostics for use in the NHS.
This podcast was added on 16 Nov 2009
Interviewer Welcome to this podcast from the National Institute for Health and Clinical Excellence. In November 2009, NICE launched a programme to focus specifically on the evaluation of innovative medical technologies. I spoke to the chair of the new Medical Technologies Advisory Committee, Professor Bruce Campbell. I started by asking him what was meant by ‘medical technologies.
Professor Bruce Campbell Well let’s take some examples. ‘Devices’ might include, for example, some kind of device that can be implanted into a patient to give them their medicines rather than them needing to be connected to a drip. It might mean, for example, in my own speciality, instead of needing to do a major open surgical operation to replace an aortic aneurysm in the abdomen, instead, just through a couple of small incisions a device can be inserted inside the aneurysm. And that is much less traumatic for the patient and they get home earlier.
In terms of diagnosis, it might mean a new kind of scan that replaces a number of other investigations to get to an eventual diagnosis, for example a diagnosis of cancer for a patient.
The important thing to understand about diagnostics and devices is that, by and large, they haven’t in the past been researched as well as medicines. And that’s one of the reasons they’ve been slow to be introduced, and often in a patchy way, into the health service.
Interviewer What is it that’s caused these problems?
Professor Bruce Campbell There’s been no really organised way of doing it. That’s the first thing. And the second thing is, there’s been no mechanism to recognise, and if you like, to foster, those new devices and diagnostics which are likely really to make a difference.
And that’s what we’re interested in. And this is where you come to the word ‘innovative.’ By ‘innovative’ what we mean, is a new device, a new system for diagnosis, which is a step change from what we’ve been doing in the past. There is some new idea to it, which makes it different, and gives it advantages. Sometimes, that may mean a clever modification of something which currently exists. But whatever the device or diagnostic, it offers something noticeably different to patients and the NHS.
Interviewer And this is where the new Medical Technologies Advisory Committee comes in?
Professor Bruce Campbell Indeed. This is, I hope, going to be a very collaborative venture with industry, because the devices and diagnostics that we will evaluate I think will be notified to us largely by the manufacturers, and the system will involve a manufacturer, or occasionally somebody else, notifying us of a device or diagnostic which they think has some major advantage over what goes on in the NHS at the moment. And that will be evaluated against a clear set of criteria to see whether it fits with the programme, and if it will be the kind of device or diagnostic that might benefit from an evaluation by NICE, and then at that stage, it will be considered by the Medical Technologies Advisory Committee, which I will chair, which will do two things:
First of all, it will have another, closer look at each of the technologies, and see whether it really does seem worthwhile, based on the claims of advantage, based on the evidence, for NICE to evaluate them.
And it will then route them into one or another NICE programme, or towards guidance by the committee itself, guidance for the NHS, perhaps guidance for further research.
The committee is made up of a wide range of people. We have representatives of industry, we have lay people, we have a range of clinical specialists from different disciplines, we have medical scientists, health economists, and a range of others so we get a really diverse input into this rather complex decision-making.
Interviewer And what is this going to mean for the NHS, and in particular for patients within the NHS.
Professor Bruce Campbell Well, for patients, we are hoping that many of the devices and diagnostics are going to have very obvious benefits to them. For example, things that can be done more easily for them in terms of being less uncomfortable, less painful, less hospital visits, perhaps things that can be done as an out-patient rather than an in-patient. For the NHS, obviously if things are being done as an out-patient rather than an in-patient, that may save them money. It might be, for example, that a technology requires less staff. And so those staff can be used to do something else. So we are hoping to look at technologies that will benefit patients, in terms of their comfort, their quality of life, better outcome, and in addition, to benefit the NHS because it results in greater efficiencies, better value, because they use the resources of the NHS better.
Interviewer There’s a large number of medical technologies around. How will you decide which ones to evaluate, and what will the process be for how you will work?
Professor Bruce Campbell I think that may evolve to an extent. The obvious, planned way of doing this is a notification portal, through which manufacturers or others can notify us of technologies. I’m bound to say that if, by some means, we spot a technology, people spot a technology that looks to be particularly promising, I can well see that we might approach a manufacturer and say “Have you thought of notifying us?” because it does look promising to the NHS. So we certainly won’t lose any chance of identifying beneficial technologies.
Getting good research done on devices and diagnostics has been historically quite difficult. One of the aims of this pathway is to identify the gaps in research that we need to fill in order to say that a technology really should be used. And we will be doing that by producing research guidance and hopefully by influencing the way in which collaborative research is set up between manufacturers and the NHS. And we hope to make that easier.
Interviewer And so for manufacturers of these medical devices, what do they need to do next in terms of taking part?
Professor Bruce Campbell Well just now, they need to be patient, I’m afraid. Because the final development of the pathway is still underway. The basic building blocks are there, but there are a number of things which are still being developed, and will take a few months before they’re properly active.
Interviewer Why is it that NICE has been asked to take part in this?
Professor Bruce Campbell Because NICE has a reputation of two things: first of all, being evidence-based. All of this needs to be based on the best possible evidence, in terms of evidence I mean not only the published evidence – which is sometimes less good than we like for devices and diagnostics – but also evidence that’s supplied by clinical experts, by users of the service, patients, carers.
And we need evidence from that broad group, both of people and of literature, and NICE has the track record, and the systems to gather that evidence, to have it appraised by independent advisory committees like the Medical Technologies Advisory Committee, which I’ll be chairing, and then a good reputation in terms of producing guidance which the NHS recognises as robust and authoritative.
Let me say one more thing about the guidance, because there may be devices and diagnostics which don’t really need more research, they look promising enough to be introduced into the service. But there may still be some things we want to know. For example, it may look as if they are going to save resources. But will they really do that when they get entered into practice? I anticipate that many pieces of our guidance will include with them a recommendation to collect data. And it’s most important that we arrange systems in the NHS where those data can be collected. So that we know, after a year or two, whether the technologies that we recommend for use really are achieving the benefits that we anticipate they will. And I think that’s another important aspect of the whole system.
Interviewer In terms of setting up this committee, who have you been working with?
Professor Bruce Campbell The committee has been set up by negotiations between NICE and the Department of Health, and a lot of internal work within NICE, but with very strong collaboration with industry, representatives from industry have been on the project board and have been helping all along the way in the development. There have also been a number of working groups, comprising a great variety of interested parties, from industry, through members of the Department of Health, through commissioners of healthcare, to providers in hospitals, and specialists in relevant disciplines. So there’s been a wide range of people. And it has been a very complex process. And that’s one of the reasons it is, as yet, unfinished, even at the time of launch. And even beyond the launch, I have no doubt that this system, this pathway, will evolve as we gain experience of the notifying procedures, having to work with them, collaborating with industry, I think there are many aspects of this which will evolve as we gain experience.
Interviewer Professor Campbell, thank you very much.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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