Genetic Alliance UK - Views & Policy:
Health Technology Assessment & Commissioning
For a treatment to reach patients in the UK it must be selected for purchase in the NHS. This process works in a different way in each of the devolved nations of the UK. The decision is based on a number of criteria, including: population needs, healthcare priorities, cost of treatments, and the treatment’s relative value when compared with a current therapy, if there is one. The treatment’s cost-effectiveness is calculated in a process called Health Technology Assessment; again, this is done differently in the different devolved nations of the UK.
Both the appraisal and the procurement of new treatments are important to Genetic Alliance UK and its members. It is important that those making these decisions properly take account of the needs and wishes of the patients that will be affected, and often this is not intuitive or simple. Genetic Alliance UK believes patients should have an input at both of these stages of treatment provision, and works to create an environment where this is possible, and where it is possible, Genetic Alliance UK takes a role.
Below we describe the systems which are responsible for health technology appraisal and procurement in the devolved nations of the UK.
Health Technology Assessment in England and Wales
The National Institute for Health and Clinical Excellence (NICE) is the health technology assessment body for England and Wales.
NICE is responsible for recommendations to the NHS on the cost effectiveness of new and existing medicines, treatments and procedures.
Commissioning in England
Commissioning is the process by which treatments are “purchased” for use in the NHS. Commissioners work at a number of different levels, which correspond to levels in the NHS, and are appropriate to the population size which the treatment is used.
Primary Care Trusts (PCTs), which run local groups of hospitals and GPs, receive the bulk of the NHS budget, and are able to decide how they spend their funds. This is called Primary Care Commissioning or Local Commissioning.
A small percentage of each PCTs’ budget is assigned to pay for uncommon treatments coordinated by their Specialist Commissioning Group (SCG). There are ten SCGs in England, and they pay for populations of 5-8 million in regions defined by Strategic Healthcare Authorities’ regions, to have specialised treatments which are defined by the National Specilalised Service Definition Set.
Healthcare Planning in Wales
The purchaser/provider split in Wales no longer exists. In Wales, healthcare is planned and delivered by seven Local Health Boards (LHBs), statutory bodies responsible for the planning and delivery of healthcare to their resident population. This new process was launched on 1st October 2009.
From the 1st April 2010, specialised services in Wales will be planned by the Wales Health Specialised Services Committee (WHSSC pronounced “whisk”), on which the seven chief executives of the LHBs sit. This committee is responsible for deciding which services are planned and paid for on a national level, and which services must be planned and paid for individually by LHBs.
Commissioning care and treatments for many of the patients that our organisations represent can be complicated and/or expensive. Our organisations therefore have a strong interest in the existence of a commissioning framework which is capable of planning and funding many differing types of care: complex therapies for which there will be very few patients; multi-disciplinary care from various specialities for patients with multifactorial conditions; and good quality, timely, expert diagnosis of complex rare conditions are three examples.
Genetic Alliance UK and RDUK believe commissioning of high cost complex services by an expert body in close contact with ministers is a vital component of this framework. This expert body should be in close cooperation with the bodies responsible for commissioning less specialised services to ensure there is a coherent continuous commissioning structure in England.
The commissioning structure should ensure good communication between those commissioning services at the Primary Care Trust (PCT) and General Practitioner (GP) level and those commissioning the most expensive services. All patients contact this level of healthcare provision in the first instance and most will receive a component of their specialised service locally from locally commissioned healthcare providers. Indeed, patients will continue to use PCT and GP commissioned services throughout their lives as unrelated health care needs arise. A joined up commissioning system is essential for a joined up healthcare service.
This consultation affects three key current organisations responsible for commissioning and the successful delivery of these services.
National Commissioning Group (NCG) is a standing committee of the National Specialised Commissioning Group, composed of clinical representatives, local commissioners, public health representatives and R&D experts. NCG is responsible for advising ministers on which services are best commissioned nationally, and then for the commissioning of those services for the population of England and Wales.
Specialised Commissioning Groups (SCGs) are responsible for commissioning specialised services in regions coterminous with Strategic Healthcare Authorities, which have populations between 3 million and 7 million.