NHS England announces first medtech devices and apps to join fast track payment scheme for innovation

Medtech devices and apps will for the first time be included under NHS national payment rules helping to accelerate uptake, NHS England Chief Executive Simon Stevens has announced today.  The commitment to create a new Innovation and Technology Tariff was announced by Mr Stevens in June.

Now following clinical review, the first six innovations have today been selected as part of a new Innovation and Technology Tariff, benefiting women giving birth, patients with chronic lung problems, men having urological surgery, and acutely ill inpatients. NHS England is also, in parallel, backing new mobile technology solutions for diagnosing heart problems. We're proud to add that four of the six innovations are either located in the Wessex region and/or have been supported by Wessex AHSN.

The new Innovation and Technology tariff will help cut the hassle experienced by clinicians and innovators in getting uptake and spread across the NHS. It will remove the need for multiple local price negotiations, and instead guarantee automatic reimbursement when an approved innovation is used, while at the same time allowing NHS England to negotiate national ‘bulk buy’ price discounts on behalf of hospitals, GPs and patients.

NHS England Chief Executive Simon Stevens said: “The NHS has a proud track record of world firsts in medical innovation but getting wide uptake has often been far too slow. Our new payment system brings clarity on fast track funding to get groundbreaking new treatments and technologies to NHS patients. Many of them not only improve care but will save the NHS money too.”

The innovation categories are:

Guided mediolateral episiotomy scissors to minimise the risk of obstetric injury – Approximately 15% of births in England require the woman to have an episiotomy. Of these, around 25% experiences a complication called Obstetric Anal Sphincter Injury, which causes anal incontinence and which may require reconstructive surgery. Using acute 60 degree angle episiotomy scissors during childbirth reduces the risk of this life changing complication. Preventing these injuries dramatically increases the quality of lives of new mothers who have undergone this procedure and halving litigation costs alone could save the NHS in the region £23.5million.

Arterial connecting systems to reduce bacterial contamination and the accidental administration of medication - Although rare, accidental injection of intravenous medication into an arterial line can lead to catastrophic injuries which sometimes require major amputations. Innovations that ensure this does not happen will increase patient safety in NHS hospitals.

Pneumonia prevention systems which are designed to stop ventilator-associated pneumonia - 100,000 patients are admitted for ventilation in the UK critical care units each year and 10-20% will go on to develop ventilated associated pneumonia (VAP). Between 3,000 and 6,000 people die from this type of pneumonia every year and prevention would save many lives. Treating VAP costs the NHS between £10,000 – £20,000 per patient and conservative estimates for prevention are savings to the NHS of over £100 million.

Web-based applications for the self-management of chronic obstructive pulmonary disease - Digital applications for the self-management of COPD improve the quality of life for patients living with COPD. They give patients the ability to manage their condition by more effective use of their inhalers, and support for pulmonary rehabilitation without the need for face to face sessions. The savings based on reduction in the need for face to face pulmonary rehabilitation sessions are on average over £140,000 per year per CCG.

Frozen microbiota transplantation for recurrent Clostridium difficile infection rates - Faecal microbiota transplantation is a treatment for clostridium difficile infection. It is an effective alternative to antibiotic treatment for CDI at a comparable cost. High cure rates (90%) and reduced use of antibiotics equal a win-win for patients and the NHS.

Prostatic urethral lift systems to treat lower urinary tract symptoms of benign prostatic hyperplasia as a day case - An alternative surgical procedure for Benign prostatic hyperplasia (BPH), a common and chronic condition where the enlarged prostate can make it difficult for a man to pass urine, leading to urinary tract infections, urinary retention, and in some cases renal failure. This is an alternative to existing surgical treatments - TURP (transurethral resection of the prostate) or laser. These existing treatments involve cutting away or removing existing tissue, require an average hospital stay of 3 days and often catheterisation for many days post-surgery. This procedure uses adjustable, permanent implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. Following the procedure, patients return home after a few hours, typically without catheter, and follow-up is normally by telephone. Patients have significantly fewer side effects (notably 0% risk of permanent sexual dysfunction) and post-operative complications, such as infection and bleeding, compared with existing alternatives. The procedure is increasingly carried out under a local anaesthetic.

Separately from the tariff, there will also be central funding for CCGs to purchase mobile ECG devices, which patients can use to identify and measure arterial fibrillation through mobile ECG technology. Early detection of arterial fibrillation in patients helps to prevent stroke, a serious and life threatening medical condition which can lead to long periods of rehabilitation and decreased independence and enjoyment of life for the patient and huge costs to the NHS.

Peter Ellingworth, Chief Executive of Association of British Healthcare Industries said: “This welcome new approach from NHS England will help ensure a robust, accessible and effective scheme that provides timely patient access to a wide range of medical technologies. We look forward to working with NHS England to implement these changes – and helping to develop an expanded scheme for 2018/19."

NHS England will directly fund the costs of six of the selected innovations in 2017/18 and will evaluate the impact of the Innovation and Technology Tariff in improving patient outcomes and increased efficiency across the NHS. It will expand the number of innovations covered by the tariff for future years, through a wider scheme that has been designed with industry, the NHS and the Academic Health Science Networks.

Dr Liz Mear, Chair of the AHSN Network, said: “AHSNs and their partners provide a key role in getting new treatment innovations adopted into the NHS for the benefit of patients and the population. As a national network we have worked with NHS England to support the introduction of the Innovation and Technology tariff and will support NHS organisations wanting to embrace innovation to help them get the latest medtech devices and services to their patients as quickly as possible.”

Additional notes:

The new scheme goes live from April 1st 2017.

For 2017/18 applications for inclusion in the ITT were received via the National Innovation Accelerator (NIA) programme submission process. Innovators could apply to be considered for the NIA programme, the ITT or both. For 2018/19, the scheme will be widened beyond the NIA programme.

119 applications were received for innovative products or services to be considered for the ITT. The innovation had to be:

• A mature innovation with a validated evidence base, already in use and ready for scaling
  
• An innovation that delivers significantly increased quality and improved efficiency
  

Following the assessment process, involving NHS England, NICE, and UCL Partners Academic Health Science Network, the six innovation groups are to be included in the national ITT, subject to final consultation and commercial negotiation.

Products and innovations that fit with these groups can be used by providers and examples of these themes can be found in Part B of the National Tariff Consultation Document where it is also indicated for each innovation how it should be reimbursed, for example as an exclusion or as part of tariff, and either a mandatory or non-mandatory price. The introduction of any innovation from this list should be agreed between the provider and commissioner prior to implementation.

For prostate urethral lift systems, CCGs will fund it through a new tariff which is a cost saving compared to the existing surgical tariff.

This new innovation diffusion funding mechanism is consistent with policy direction recommended in the Department of Health’s recently published Accelerated Access