Last week, the long-awaited Accelerated Access Review was finally published. The review aims to make the UK a world-leader in healthcare innovation. However, it acknowledges that it has become increasingly challenging for NHS patients to access innovative treatments, and that the UK lags behind other countries in the adoption of innovation. Therefore, the review sets out how the UK can speed up access to innovative drugs, devices and diagnostics to NHS patients. There is a particular focus on digital products, and the review recognizes the importance of digital technologies, that progress needs to be made more quickly in this area, and that the current systems are not sufficiently flexible to realize the full potential of digital health.
The review sets out 18 recommendations, although not all are relevant to digital technologies. It is also recognized that the recommendations cannot succeed without a significant improvement in digitization across the entire NHS, including implementation of electronic patient records and e-prescribing. The key recommendations are as follows:
- Assessment: A new “transformative designation” will be introduced, which identifies products that have the potential for the greatest impact on patients in costs or outcomes. The aim is to ensure timely review and commercial launch of these innovative products. In relation to digital products, support to facilitate technology adoption will be considered on a case-by-case basis. Award of the designation will be considered after CE-marking, and it is estimated that only around five to ten innovations per year would receive the transformative designation. There is also a need to create a pathway that improves assessment, commissioning, procurement and use of healthcare apps, building on the “Paperless 2020” app assessment process, due to be launched in 2017. The initiative identifies high quality apps that can be promoted to patients, citizens, healthcare professionals and commissioners. The evaluation process takes account of the best practice standards for data security, safety, interoperability, usability and technical stability, as well as evidence to determine the overall position of an app and its impact on the healthcare system.
- Adoption: NICE should take a leading role in assessing digital products that are identified as transformative in order to advise on adoption of the technology. In terms of the data to support NICE evaluation, digitization is viewed as an important technology and enabling tool to facilitate collection of real-world evidence to inform health technology assessment. Around £20-£30m should be available to support the introduction of innovative technologies, where SMEs and not-for-profit organisations cannot afford to generate evidence to prove cost-effectiveness.
- Pricing: A new Strategic Commercial Unit should be established within NHS England to consider a range of flexible pricing models as part of a commercial dialogue with innovators, taking account of a product’s overall affordability to deliver value to the NHS.
- Reimbursement: Some of the apps evaluated by NICE as part of the Paperless 2020 process could be made available through the new Innovation and Technology Tariff, announced in June 2016. This will provide a national route to market for a small number of technologies, and will incentivize providers to use digital products with proven health outcomes and economic benefits.
- Commissioning: The commissioning process should be streamlined, and products that are not assessed by NICE should be assessed only once. NHS England should also develop a framework for app prescription that removes the need for multiple, local systems and that is as easy to use as existing prescribing systems for medicines. Local Academic Health Science Networks should identify areas of unmet need where digital products may assist, and work with providers to introduce relevant products, and generate evidence to support their utility.
- Investment: A new digital health technology catalyst should be established to provide matched public sector funding and private investment to address areas of failure in the digital healthcare market, and help to support SMEs who are developing digital technologies.
The next steps is for the UK government to formally respond to the review and set out how, and to what extent, the recommendations will be implemented.