ICS0045
Written evidence submitted by Medical Technology Group
The Medical Technology Group
The Medical Technology Group (MTG) is a UK coalition of patient groups, research charities and medical device companies working together to improve access to medical technologies for patients.
The Group benefits from a wealth of experience in working with the NHS and associated bodies to promote access to medical technologies for patients. The Group wishes to ensure that the patient voice is heard in the conversation about the NHS backlog and waiting times worsened by COVID-19, and that positive changes seen during the pandemic are taken forward to ensure benefit to patients in the future.
Inquiry Details
The Public Accounts Committee launched a consultation into the development of Integrated Care Systems (ICSs). During the inquiry, the Committee will question senior officials and executives at the Department of Health and Social Care (DHSC) and NHS England on progress in establishing Integrated Care Systems in England: examining whether the new system is being set up in a way which allows them to achieve the aims in the Health and Social Care Act 2022.
ICSs are being set up with the core stated objectives:
Inquiry Response
The Medical Technology Group agrees with the principles underpinning Integrated Care Systems – a locally driven system of integration to plan and deliver health services, which improve the health of the local population.
As they are established, Integrated Care Systems are presented with an array of structural and historical issues:
As a group, the MTG is calling for three key opportunities to be explored and addressed to help increase patient access to efficient, effective and safe treatments:
The Issues facing Integrated Care Systems
In its 2022 report Tackling Regional Variation in Healthcare: Inequalities, Innovation, and Integration, the MTG analysed the completed pathway data of the ICSs predecessors, Clinical Commissioning Groups. The report focussed on regional variation in the number of patient procedures performed. This work compares the data on four key clinical areas across each NHS region, looking for consistency of service across a CCG.
Through this research, the MTG looked to highlight variation in performance, and present a number of solutions to the NHS’ structural issues, including through the use of medical technology.
From MTG analysis of NHS England’s Referral to Treatment data, it is clear that a patient’s ability to access care varies depending on where they live.
The total impact of ICSs on the delivery of care is not yet known. However, from the variation in the outcomes from CCGs, each ICS has inherited a wide spectrum of quality of practice, with very different patient outcomes. How ICSs deliver for their patients will depend on whether the best models of care from their component CCGs can be used as exemplars to bring the performance up of the poorest performing CCGs.
Through the transition from CCGs to ICSs, and the subsequent shift to internal structures, many commissioners will see a change in how they are seen to perform nationally, while also gaining an ability to better address issues affecting their populations.
A number of CCGs integrated their services throughout 2021 while maintaining the old CCG model, for example, South West and South East London. In comparison, others such as the Greater Manchester Health and Social Care Partnership, will have integrated the 10 local CCGs for the first time in July 2022.
We have found, that there is variation across every ICS that did not integrate services prior to March 2022. According to MTG analysis, in the Greater Manchester Health and Social Care Partnership, the completed pathway rankings of the component CCGs range from 7th to 92nd, in the Cheshire and Merseyside Health and Care Partnership, 2nd to 93rd and in Sussex ICS, 15th to 82nd.
Given the size and scale of ICSs, it is likely that CCGS with varying performance levels will be brought together to form a single organisation. For example, the West Yorkshire and Harrogate ICS includes Wakefield, which had the best output level per head of population across the country. However, it also includes Leeds and Bradford that were 83rd and 77th respectively. It is critical that West Yorkshire and Harrogate focusses on spreading best practice from Wakefield and levelling up all areas.
Variation in care will still be evident in the move to Integrated Care Systems. However, by bringing more patients under single bodies with additional control, there is the opportunity to make use of centralised decision-making, for ICSs to share best practice and implement positive change.
Good practice is evident within established ICSs, whether through improved referral pathways, rapid technology uptake or moves towards digital health solutions. However, it is clear that no formal mechanism exists for this to be shared nationally.
Patient Involvement
It is clear from the current economic situation, current NHS waiting lists and financial outlook for the system that tough choices will need to be made as priorities are developed. It is critical that there is a clear and consistent patient voice in all these conversations. Where local priorities are developed, local patients should have a formal role in all decision making processes.
The MTG supports the move to ICSs and believes that a joined-up health system that removes organisational barriers between different care settings can greatly benefit the patient.
The MTG is pleased with the move towards collaborative working, and that local authorities will be aligning with NHS policy areas to tackle the biggest healthcare challenges faced by communities, such as improving cancer care and reducing health inequalities. ICSs will be in a positive position to work towards the objectives in the NHS Long Term Plan and NHS Elective Backlog Plan.
However, the MTG is concerned about the lack of vision for embedding the patient voice in the arrangements for integrated care, which should be an core part of the shift from centralised targets to ICBs. As a group, the MTG believes that the patient voice has a large part to play in providing consistency across the safety and quality of care at ICS level.
Patients should have access to the necessary treatment, regardless of where they live, and ICSs should have the flexibility to meet the regional specific needs of the population. However, there needs to be sufficient accountability structures within an ICS to ensure that patients have access to all necessary treatments, including approved innovation and technology; and that there are appeal mechanisms put in place for when that treatment is not made available to them.
As a dedicated coalition of industry and patients, the MTG works to put the patient voice at the heart of conversations about the UK’s health service.
The group believes that plans fall short of ensuring that patients have a clear role to play as partners and/or decision-makers in a future system of integrated care. Whilst decisions will be taken ‘closer to communities’ there is no indication whether these are patient communities or local populations and why such decisions cannot be taken ‘with’ communities. Plans should be reviewed with the objective of placing the patient at the heart of the decision-making process, and far greater emphasis should be placed on co-production.
The MTG believes the patient voice should be mandated in decision making processes and on ICS boards. Prioritisation decisions will need to be made to address the backlog post-covid. However, patients are those who are most affected and must be brought into the decision-making process regarding prioritisation.
Medical Technology as a Solution
The MTG believe the NHS is in a unique position to adopt existing good practice systemwide to improve results. Medical technology is well evidenced as a potential tool to some of the challenges the NHS faces.
NHS Financial Sustainability
Medical technology can help NHS financial sustainability by providing long-term financial savings through increasing efficiencies, and reducing long-term dependencies on the health system.
Since 2018, University Hospitals of North Midlands NHS Trust (UHNM) has undertaken a significant drive to improve continence care for their patients. This drive was prompted by initial concerns regarding rates of Catheter Associated Urinary Tract Infections (CAUTIs) that were being reported through the National Safety Thermometer.
On the basis of a baseline audit, the stakeholder group at UHNM oversaw a transformation of continence care which included the introduction of a Catheterisation Tray as an essential resource to help standardise and elevate patient care across clinical departments, both in the community and in acute settings. The Tray is designed to aid wider education efforts and ensure ease and consistency of patient catheterisation by its intuitive process of catheter insertion, and by its collation of essential products for catheterisation into a single pack. The decision to introduce the Tray was made on the basis of a value-based procurement proposition. This prioritised improvement of patient quality of discharge and experience and reductions in hospital readmissions as key metrics of successful pilot implementation.
Following the implementation of the Tray,
NHS Workforce Issues
Medical Technology can reduce the pressure on workforce by reducing human errors, increasing efficiencies in time, making savings on joined up care and reducing repeat admission.
Digital and artificial intelligence (AI) approaches to care will increasingly support rapid interpretation of radiology imaging and individual patient characteristics to assist healthcare professionals in making rapid and accurate diagnosis.
Robotic-assisted surgery (RAS) is a form of minimally-invasive surgery performed by a surgeon using a computer-assisted system to operate through small incisions. RAS aims to enhance a surgeon’s capabilities to allow for more precise, repeatable, and wide-spread minimally invasive care.
RAS systems used for “soft-tissue” surgical procedures have been in use for more than 25 years, with millions of procedures performed worldwide. Today, specialty areas that use these systems include urology, gynaecology, and coloproctology, in addition to other specialties outside of the pelvic area.
A growing body of research suggests that minimally invasive, robotic-assisted surgery may offer patient benefits including less blood loss, fewer complications, less time in the hospital, and lower chance of readmission compared with open surgery. These benefits of robotic-assisted surgery can confer associated cost savings, thus helping to reduce the total cost to treat.[1]
RAS systems provide the opportunity to bring information and communication technologies, robotics, digital features and data together to help improve surgical training, performance, and patient outcomes.
Elective care backlogs
COVID-19 has contributed to record waiting times, with over 7 million people on NHS waiting lists. The Government has announced that the backlog and waiting lists are a key priority moving forwards. The next election will likely focus on the NHS, and waiting lists, as a key political issue, meaning this will remain at the top of the political agenda for some time to come.
Likewise, in the NHS, the growing waiting list and backlog of care is an increasing concern, balanced against COVID-19 management and infection prevention control methods. This means capacity to increase the number of procedures is a challenge. This is resulting in pressure on the system to increase capacity and the number of procedures that are taking place, against a growing waiting list and a stretched workforce.
Medical technology can be a key enabler in helping to overcome this challenge and support the NHS to tackle waiting lists.
Day case procedures and minimally invasive procedures are examples of how procedures and treatments can be sped up to enable more people to be treated. Minimally invasive procedures result in treating people with interventions which require a less complex recovery, and often less time in theatre. This means patients can be discharged more quickly from hospitals, freeing up beds within hospitals to enable more procedures to take place. Day case surgery has a similar impact, enabling patients to move quickly through the system. Often minimally invasive procedures and day case procedures result in patients having a quicker recovery. This reduces time required in the community caring for those who are recovering from high-impact surgery.
Health Inequalities
The challenges which are presented as a result of ongoing inequalities and regional variation are significant, and include the exacerbation of poor health and care outcomes in areas of multiple deprivation; higher economic inactivity due to ill-health; and burnout for health and care staff. As such, it is imperative that NHS organisations are given the information and tools necessary to tackle their elective backlogs.
The benefits of technology within this include:
How NHS England can combat issues surrounding patient access to medical technology within ICSs
Sharing Best Practice
The move to Integrated Care Systems (ICSs) adds another layer of complexity when working to end variation in access to vital treatment. A fundamental principle of the shift to ICS is giving greater power to local healthcare systems. This includes budgeting and the development of commissioning policies. Whilst there are huge benefits to this shift, there is a clear risk that patients will mis out as the ability of NHS leaders to promote the spread of best practice is diminished.
Having become statutory bodies in July 2022, ICSs are faced with the challenge to benchmark good practice against the top performers in their area, and look to set standards alongside these good outcomes.
These changes present an opportunity to use both the funding and guidance from the elective restart plan, as well as good practice from across the country, to tackle the remaining backlog, deliver for the present needs of patients and create a high performing health service for all.
The MTG is aware that this will be challenging, particularly as pressures continue to mount for hospitals and their staff. However, there must be a formal structure for best practice to be shared nationwide. It is imperative that NHS organisations are given the information and tools necessary to tackle their elective backlogs.
Tackling the backlog will also require collaboration and working across natural boundaries and borders to tackle common challenges. This has been demonstrated most acutely through provider collaboratives, where providers have worked together to tackle waiting lists and common challenges. This is a key tool in the fight against the backlog, and one which may be used increasingly as the ICS system embeds, and collaboration across areas is promoted.
For local NHS bodies, the MTG recommends:
For NHS England, the MTG recommends:
For Government, the MTG recommends:
October 2022
[1] MTG., 2021. MTG Manifesto- MedTech the Solution. Medical Technology Group