APPENDIX 9
Memorandum by the NHS Confederation (MT40)
INTRODUCTION
1. The NHS Confederation welcomes the Committee's
inquiry into the use of medical technologies within the NHS and
welcomes the opportunity to present evidence.
2. The NHS Confederation is a membership
body that represents over 93% of all statutory NHS organisations
across the UK. Our role is to provide a voice for the management
of the NHS and represent the interests of NHS organisations. We
are independent of the UK Government although we work closely
with the Department of Health and the devolved administrations.
3. This evidence has been put together with
The Future Healthcare Network (FHN). The FHN is made up of organisations
that are at the leading edge of thinking about the future development
of health services in the UK. FHN is part of the NHS Confederation,
but with its own board of management and dedicated staff.
4. Overall the NHS Confederation supports
the use of technology to maximise care outside hospital and maintain
the independence of people for as long as is possible. Below we
detail our response to the Committee's Terms of Reference.
THE UTILIZATION
OF TELEMEDICINE
(INCLUDING TELECARE)
AND ITS
FUTURE POTENTIAL
FOR IMPROVING
SERVICES
5. The aging UK population means that fewer
people in the healthcare workforce and fewer carers are having
/ will be available to look after a larger number of older people.
It is clear that the prevalence of longer term conditions eg diabetes
is increasing and this will also have an impact.
6. At the same time, there is readily available
technology available that can:
— maximise the care available in the
home by guarding against falls, flood, fire through movement and
hazard detectors connected to a community alarm service. Specialist
expertise can also be made available in the home through internet
and digital TV. Assimilation of technology in the home, together
with successful partnerships between PCTs, Councils and equipment
providers has increased choice for the elderly and those with
long-term conditions. Many projects have been undertaken to evaluate
how technology can enhance independent living and also assess
what level of technology package should be offered.
— substitute technology for people
where there is a shortage of skilled staff, for example, miniaturisation,
robotics, IT interfaces and digital imaging will all impact on
the location of services and the present workforce.
— empower people to take charge of
their own healthcare management supported by professionals where
appropriate, by allowing people to manage their own health monitoring,
eg weight, lung function, blood and urine and blood pressure.
Studies show that self-management in general leads to better outcomes
in asthma, chronic obstructive pulmonary disease (COPD) and diabetes.
Technology currently being used in the home can be further applied
to the monitoring of chronic conditions, for example tele-medicine
monitors to track the vital signs of COPD sufferers in the home.
— increase the safety of healthcare
systems by improving tracking and identification of individuals
using Radio Frequency Identity (RFID).
THE RECOMMENDATIONS
OF THE
HEALTHCARE INDUSTRIES
TASK FORCE
(HITF) REPORT, PUBLISHED
17 NOVEMBER 2004
7. The NHS Confederation contributed to
the HITF report and is supportive of its recommendations. In particular
we would like to emphasise our support for the following recommendations:
— the development of device evaluation
methodologies and the sharing of evaluation results throughout
the NHS (refs 1-3)
— nationally agreed/accepted best practice
models being developed for procurement processes (ref 5)
— the creation of an innovation network
and funding to fast-track selected innovations and the establishment
of a National NHS Innovation Centre (refs 11,13 and 30)
— that the Department of Health works
with the Modernisation Agency and other stakeholders to ensure
that best practice in commissioning specialised services can be
shared across the NHS (ref 27)
— the strengthening of horizon scanning
to identify systematically useful new and emerging technologies
(ref 36)
— considering how to support the developing
market for `over the counter' medical devices and in vitro diagnostics
(ref 43)
— improving the awareness of manufacturers
of the importance of good design and exploring ways of feeding
back information to them on design issues identified on products
and systems in use (ref 44).
THE SPEED
OF, AND
BARRIERS TO,
THE INTRODUCTION
OF NEW
TECHNOLOGIES
8. There are a number of reasons for slow
adoption of new technologies, particularly those which change
the pattern of care delivery:
— Plague of pilots: There has been
a plague of small pilots which have not established where and
how the new technologies are most cost effectively employed. However
the evidence around what to do next is not very clear.
— Funding: There is a lack of funding
for new types of care both from Social Services and Health. New
models of care often need to be introduced in parallel with existing
services. Unfortunately the financial regime under which health
and social care operate does not allow for the creation of reserves
or borrowing to finance new services. This means that it is necessary
to disinvest or use growth money. Unfortunately, the former is
often difficult and contentious and the latter has many competing
claims made upon it.
— Payment by results: The adoption
of the payment by results system in the NHS could prevent a further
obstacle as the tariff used to pay providers is based on existing
technology. Therefore any change that increases the cost and quality
or undertakes procedure in a very different way will tend to be
under rewarded by the payment system. There is a mechanism to
allow commissioners to recognise new technology where the tariff
has not caught up with new practice but this is, as yet, untested.
— Attitude to risk: The feeling remains
prevalent that whilst the rhetoric supports innovation and risk
taking many of the accountability systems in public services are
intolerant of risks that do not pay off. It is not possible to
have risk free innovation and there will be inevitable failures.
A different response to these events is required if the public
sector is to become as open to technological innovation as other
parts of the economy.
— Change management: Very often the
purchase of new technology is the least of the problems in its
adoption and implementation. Many truly innovative technologies
require professional staff to adopt completely new working practices
and systems may need to be substantially redesigned. The change
management process required to persuade professional staff to
make substantial alterations to their practice is very considerable.
There may be similar issues about expectations and inertia when
it comes to persuading carers and patients that care that they
might have expected to have been provided in one way will now
be delivered in a complete different way using new technologies.
— Professional boundaries: Clarity
about the boundaries and handover between the professional, carer
and personal roles may mean that there may be professional resistance
to change. This is also related to the issue of risk. Clinicians
may be reluctant to hand over responsibility for care to their
patients.
9. One of the most significant potential
barriers to implementation is the extent to which new technologies
fit with existing systems. For example, it will be harder to adopt
devices with an IT interface that are not designed to link with
NHS IT systems to form part of an IT record as is often the case
at present.
THE EFFECTIVENESS
AND COST
BENEFIT OF
NEW TECHNOLOGIES
10. There is still a tendency to ask questions
about the cost-effectiveness of new technologies without a similarly
rigorous approach being taken to the evaluation of existing technologies.
This makes it much harder to disinvest to create financial headroom
for investment in new technologies. There is a particular hazard
in evaluating new technologies in terms of an arbitrarily selected
cost-effectiveness threshold, such as a minimum cost per quality
of life year. The danger is that technologies approved in this
way may be favoured over existing solutions which are more cost-effective
but have not been evaluated.
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