Improving Quality and Services:

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Improving Quality and Services

• The role of the Scottish Health Technologies
  Group in supporting NHS Scotland
• 25th June 2008

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• GENESIS
• ROLE
• REMIT
• MEMBERSHIP
• DELIVERY OF REMIT

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• GENESIS

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• ROLE
• The group will ensure the availability of
  technology and device assessments and appraisals
  relevant to the needs of the NHS in Scotland
• The group does not make recommendations to the
  service, but aims to provide information to
  support planning and decision making
• The group will communicate information through
  the various networks represented on the group
• The group is advisory and not an appraisal or
  assessment group

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• REMIT
• To identify existing and new technologies,
  including devices which are likely to have
  significant implications for patient care in the
  NHS in Scotland, and areas where there may be
  evidence to support disinvestment
• To ensure that assessment and appraisal of the
  effectiveness of technologies is carried out as
  needed, taking account of assessment and
  appraisal work being carried out elsewhere, for
  example, by NICE, but the Canadian Agency for
  Drugs and Technologies in Health or by the
  Swedish Council on Technology Assessments in
  Healthcare and others
• To facilitate the implementation by the NHS in
  Scotland of evidence-based recommendations on
  technologies including NHS QIS Health technology
  assessments and NICE technology appraisals

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• MEMBERSHIP
• Andrew MacLeod Division Head, Patients Quality
  Division, SGHD (Chair)
• Sara Davies Medical Advisor, Patients Quality
  Division, SGHD
• Tom Divers Chief Executive NHS Greater Glasgow
  Clyde
• Harpreet Kohli Medical Advisor, NHS QIS
• Stella MacPherson Lay Representative
• Philip Rutledge Consultant in Medicines
  Management, NHS Lothian
• Lesley Wilkie Director of Public Health NHS
  Grampian
• Derek Yuille Assistant Director of Finance, NHS
  Ayrshire Arran
• Nicki Scammell Admin Officer, Patients Quality
  Division, SGHD
• Colin Brown Branch Head, Patients Quality
  Division, SGHD
• James Barbour Chief Executive, NHS Lothian
• Lesley Holdsworth Head of Health Services
  Research Effectiveness, NHS QIS
• Heather Knox Regional Planning Director, West of
  Scotland
• Fiona Ramsay Finance Director, NHS Forth Valley
• Alison Graham Medical Director, NHS Lanarkshire
• Paul MacIntyre Clinical Lead, CHD Strategy, SGHD
• Andrew Marsden Medical Advisor, National
  Procurement

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SCOTTISH HEALTH TECHNOLOGIES GROUP

• In order to deliver its remit, the SHTG is
  supported by NHS QIS and National Procurement
• NHS QIS provide briefing reports to SHTG, which
  identify areas where further work may be
  required. This may involve maintaining or
  providing implementation advice. This advice
  would be provided by both QIS and National
  Procurement, where NP can add value through
  strategic sourcing and managing the supplier to
  customer processes.
• National Procurement are also expected to report
  on implementation activity to enable SHTG to
  monitor take up rates of new technologies and
  displacement rates for disinvestment products.
• The briefing reports rely on Horizon Scanning to
  identify technologies with significant
  implications for patient care. The Horizon
  Scanning summarises information from the
  following resources-
• Non-drug technology briefings issued by the
  National Horizon Scanning Centre, University of
  Birmingham
• New HTAs that have entered the NHS QIS Work
  Programme since last Horizon Scanning Report.
• Non-drug HTAs published by (a) NHS QIS (b) All
  NICE HTAs (c) those HTAs published by other
  international agencies
• SIGN guidelines that have been consulted on since
  last Horizon Scanning Report
• NICE Interventional procedures
• NHS QIS evidence notes
• Topic proposals by group members
• Topic proposals by National Procurement on new
  technologies and disinvestment

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Sources of Advice

• Harpreet Kohli
• Medical Advisor
• NHS Quality Improvement Scotland

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May feel a bit like this!
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Definitions and Status Document

• NHS QIS
• Standards, SIGN guidelines, HTAs, Evidence Notes,
  Best Practice Statements
• SMC
• NICE
• Multiple technology appraisals (MTAs), single
  technology appraisals (STAs), Interventional
  Procedures Guidance, clinical guidelines
• Other
• Confidential enquiries
• Guidelines from Royal Colleges, specialist
  societies etc

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NHS QIS Health Technology Assessments (HTA)

• Technology (effectiveness benefits,
  disbenefits)
• Patient (psychological, social, ethical)
• Organisation (staff, equipment, centralisation)
• Cost (economic evaluation for Scotland)

To provide a bridge between scientific evidence,
the judgement of health professionals, the views
of patients and the general public, and the needs
of policy-makers
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Evidence Note 10 Cardiac Resynchronisation
Therapy
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NICE

• Technology appraisal guidance (EW processed in
  Scotland)
• Interventional Procedures (E,W S)
• Safety and efficacy
• Clinical cost effectiveness
• Clinical guidelines (EW)

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NICE Technology Appraisal Guidance (Appraisals)

• Health technologies advice on the use of new
  and existing medicines, treatments and
  procedures, including interventional procedures
  used in the NHS
• 143 appraisals published 125 MTAs 18 STAs
• Mandatory in England (within 3 months)

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NICE Technology Appraisal Guidance (Appraisals)

• 42/143 (29) devices, procedures etc
• 139 Continuous ve airway pressure fro sleep
  apnoea
• 120 Cardiac resynchronisation for heart failure
• 105 Laparascopic surgery for colorectal cancer
• 102 Parent-training/education for children with
  conduct disorder
• 97 Computerised CBT for depression anxiety
• 15 NICE appraisals p.a.

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What is an interventional procedure?

• One used for diagnosis or treatment that involves
  incision, puncture, entry into a body cavity,
  radiation or ultrasound
• Anyone can notify new procedure used in NHS
  (usually clinician)

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IP Guidance May 2008

• Canaloplasty for primary open-angle glaucoma
• Endoaortic balloon occlusion for cardiac surgery
• Single incision mid-urethral tape insertion for
  stress urinary incontinence in women

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SHTG and Prioritisation of Topics

• Choosing interventions bariatric surgery vs
  learning disability vs specialised care for DM in
  ethnic minorities
• SHTG Scotland-wide perspective

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National Procurement

• A division of NHS National Services Scotland

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National Procurement

• to ensure cost improvements and efficiency
  savings
• to ensure products and services are fit for
  purpose and of top quality
• to ensure current and future generations of NHS
  products remain up to date and valid
• to provide more effective supply chain solution,
  reducing stockpiling and wastage and improving
  timely distribution
• to provide continuous quality assurance
• to lead procurement reform across NHS Scotland

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Components

• Strategic Sourcing
• better buying developing a clear and
  comprehensive understanding of products purchased
  and the supply market
• Logistics
• understanding and improving the end-to-end order
  to delivery cycle from the supplier to the end
  user
• e-Procurement
• the harnessing of electronic technology to
  underpin and enhance the supply process

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The Procurement Process
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Procurement Process and Technology Innovation
linkages
Procurement Process
Strategic Procurement
Tactical Procurement
Market Research Supply
P2P (Purchase to Pay
Define Requirement
Tender / Product Scoring
Supplier Selection
Contract / Implement
Manage Supplier / Monitor Uptake
Technology Innovation Process
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Strategic Procurement
Tactical Procurement
Market Research Supply
P2P (Purchase to Pay
Define Requirement
Tender / Product Scoring
Supplier Selection
Contract / Implement
Manage Supplier / Monitor Uptake
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Our input to SHTG

• Horizon Scanning and Strategic Collaboration
• Using supplier expertise and knowledge to
  identify technology pipelines
• EXAMPLE Flexible endoscopy
• Per-nasal endoscopy
• Double balloon colonoscopy

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Our input to SHTG

• Horizon Scanning and Strategic Collaboration
• Applying end-user market analysis to facilitate
  a procurement opportunity
• EXAMPLE CPAP in Obstructive Sleep apnoea
• A tertiary centre provided service versus
• commodity delivery to the patients home

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Our input to SHTG

• Implementation and Disinvestment
• The national contracting process ensures
  standardisation, releases efficiency savings for
  re-investment and tracks and monitors the uptake
  of new technologies
• EXAMPLE Diabetes Mellitus Products
• Linked contracting for Insulin Pumps and Home
  Blood Glucose Monitoring

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Evidence for decision making

• An example Surgery for obesity

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• What information/evidence would you need to
  introduce gastric banding surgery for your
  patients?
• From what perspective are you responding eg NHS
  planner, surgeon, service manager
• How would you obtain this information?
• DISCUSS

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Health Technology Assessment
Clinical effectiveness
Organisational aspects
Issues for patients
Economic evaluation
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Clinical effectiveness

• Questions
• How is the condition currently treated/ managed?
• How effective is the treatment compared to
  alternatives?

• Sources of information
• Expert input
• HTAs
• Systematic reviews
• Trials
• Surgical morbidity data

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Patient issues

• Questions
• Are there ethical or psychosocial considerations?
• What information will patients need?

• Sources
• Qualitative research studies
• Focus groups with patients
• Voluntary organisations

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Cost effectiveness

• Questions
• How do the costs and benefits of the intervention
  compare with other treatments
• What resources are required to provide the
  treatment?

• Sources of information
• Economic evaluations
• Modelling results
• HTAs
• Local reviews
• Cost accounting exercises

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Organisational issues

• Questions
• What is current service provision in Scotland?
• What training will staff need?

• Sources
• Surveys
• Professional opinion
• Guidelines
• Professional opinion
• Local reviews

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Current evidence

• Clinical effectiveness evidence NICE, HTAs,
  large trial, NHS QIS Evidence Note
• Patient issues not evaluated
• Organisational issues patient pathway
• Cost effectiveness evidence economic model not
  validated

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SHTG request for further work

• Evaluate cost effectiveness evidence for patient
  pathway in Scotland
• Liaise with regional planners
• www.nhshealthquality.org

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Exploring ways to engage to changepractice

• Joyce A Craig
• Health economist QIS
• Joyce.craig_at_nhs.net

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• Evidence on barriers to change
• Costing tools
• Communication
• Education
• Evaluation

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• Evidence - what are barriers?
• - what works to overcome
  these?

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• Awareness and knowledge
• Skills
• Institutional cant vire funds between sectors
• timeliness
• savings not real and
  uncertain
• tight budgets, little
  new money

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• Costing tool eg sleep apnoea

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• Communications website
• key people in the
  NHS
• members and other
  networks
• local co-ordinators?

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• Education on the latest findings
• - on methodologies?
• - share learning?
• - workshops or lectures?

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• Evaluation base line stakeholders needs
  and practices
• technologies how to
  measure take-up?
• Implement SHTG processes
• Re-evaluate engagement and take-up

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• Discussion