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As the direction of healthcare services and spending moves away from local Trusts and Clinical Commissioning Groups and towards STPs and Integrated Care Systems, the NHS has the prospect of overhauling its approach to the procurement of medical technology. But is the health service at risk of missing a golden opportunity?
Commenting on the long-term sustainability of the NHS and adult social care, Lord Willetts once famously described the NHS as a ‘late and slow adopter of technology’. There is substantial evidence to support this assertion. Numerous examples highlight where the NHS lags behind the rest of Europe in its adoption of innovation. The UK has fewer CT scanners and MRI scanners than most other European countries for example, while the rate of implantable cardioverter-defibrillators (ICDs) is three times higher in Germany than here.
Subsequent governments have recognised the issue and have tried to address it. In fact there are have been no fewer than 17 different organisations or initiatives launched with the aim of promoting innovation in the health service over the past twelve years. Yet the NHS repeatedly fails to learn anything from them and the problem remains.
The creation of regional organisations to define plans for revolutionising local healthcare systems and delivering the NHS’s Five Year Forward View offered new hope. However, the Medical Technology Group has analysed all 44 STP plans. We found that just four of them include any meaningful reference to the use of innovative technology, despite it being a requirement by NHS England.
The issue lies at the very heart of the way the NHS is structured. Budget silos in the NHS procurement system for example, mean that if the benefits are realised in a different part of the system, budget holders have no incentive to invest in innovative technology that can improve patient outcomes and reduce costs. Advanced less-invasive therapies in an operating theatre for instance can lead to savings in the number of bed stays on a ward as patient recovery times are shortened.
Meanwhile our study found that most regional NHS plans put greater emphasis on the recommendations set out in the Carter Review, rather than the adoption of cost-saving technology. In our experience an overly aggressive focus on unit cost is too often the key decision factor when determining which technology to use. The result is that short-term financial gain is placed ahead of long-term benefits to patients, the health service, and wider society.
Regional NHS organisations should be perfectly placed to address these issues. They have the ability to assess the total system cost of technology across the healthcare system and amend their procurement processes. Unfortunately, they have sacrificed the opportunity to make a real impact and remain restrained by a system that is not properly prepared for the adoption of innovation.
Until it puts an end to its perverse incentives, the NHS will never truly embrace technology and realise its benefits.
Barbara Harpham is chair of the Medical Technology Group (www.mtg.org.uk), a not for profit coalition of patient groups, research charities and medical device manufacturers working together to improve patient access to effective medical technologies.