2 May 2019
The Department for Health and Social Care announced today the creation of a new national unit to oversee innovation and medicines
A ‘new and improved’ Accelerated Access Collaborative (AAC) will be established in the form of a new unit in NHS England and NHS Improvement to act as an umbrella organisation for UK health innovation. This revised ‘front door’ for innovators looking to achieve rapid access for their products to the NHS will offer a fast-track clinical development and regulatory approval process through ‘new improvements’.
The AAC was established in response to the recommendations of the Accelerated Access Review commissioned by the government in 2014 to consider how to speed up NHS patient access to innovative diagnostics, medicines and digital products. Somewhat ironically, the process towards accelerated access has been relatively slow; the Review’s recommendations were released in 2016, the government’s response (announcing plans to create the AAC) came in 2017, and the AAC itself didn’t come into being until April 2018.
However, since then the AAC did get down to work. Chaired by Lord Darzi, it brought together representatives from the Department of Health and Social Care and Department for Business, Energy and Industrial Strategy; NHS England and NHS Improvement; major regulators the Medicines and Healthcare products Regulatory Agency and National Institute for Health and Care Excellence; the Academic Health Science Networks; the small (but vital) patient charity National Voices; the Association of Medical Research Charities; and representatives of the pharmaceutical, health tech, digital health and diagnostics industries.
In the last year the AAC has guided approval of twelve rapid uptake products into the NHS said to have ‘the potential to improve the lives of around 500,000 patients and save the NHS up to £30 million’. These include not only drugs but also interventions such as the HeartFlow Analysis system for more personalised cardiac care, the Urolift device to relieve urinary tract symptoms, and various diagnostics, most recently a test for suspected pre-eclampsia. These early AAC approvals are not generally transformative innovations – the preeclampsia test reduces diagnostic time from four days to two, and helps identify women at greatest risk, if used alongside current testing, but it is encouraging to see products that can offer modest but significant improvements for patients and clinicians fast-tracked. Whether they can deliver the scale of potential benefits suggested remains to be seen.
As the process by which the old AAC operated was not obvious to those outside the system, it is not entirely clear what the new improvements or changes are - the overall aims seem to be much the same. However, they may include an expanded remit to act in a similar fashion to the AHSNs or Innovate UK by acting as a one stop shop for innovators to understand and navigate the NHS, and ‘oversee a health innovation funding strategy’ that prioritises innovations with the greatest potential for NHS and patient impact. This does raise questions as to how far the remit and operation of the AHSNs will be affected.
Importantly, the government announcement says that the new AAC will ‘signal the needs of clinicians and patients’ to direct innovators towards solving pressing clinical problems. This is definitely a strong step in the right direction of trying to ensure that innovations meet real world NHS needs, although the patient voice on the AAC could arguably be further strengthened to help achieve this goal. Similarly, innovators ought really to be working with patients and clinicians from inception and throughout development to optimise the probable value of their end products – so will the AAC be trying to seed excellence in this way, as well as streamlining the progress of already highly promising innovations?
Mention of creating a ‘globally leading testing infrastructure’, to generate the evidence needed for NHS adoption is highly welcome – this will certainly have to include cost-effectiveness, as well as clinical utility, and ideally would also produce elements to support implementation, such as information on how the innovations should be used and how they will affect current clinical pathways. This infrastructure is definitely one to watch.
Looking at the bigger picture for health policy, switching the AAC into a unit that sits ‘in’ NHSE and NHSI, but with its own chief executive (Dr Sam Roberts, until now Director of Innovation and Research at NHSI) mirrors the recent (and more visible) launch of NHSX.
NHSX (the X standing for user eXperience, according to Health Secretary Matt Hancock) is intended to lead on digital transformation for the NHS. It too has its own chief executive, Matthew Gould, previously Director General for Digital and Media at the Department for Digital, Culture, Media and Sport, and significant national strategic responsibility, being accountable to both the Health Secretary and the NHSE chief executives (but sitting above NHS Digital). Exactly how the new AAC relates or reports to NHSE and/or NHSI is not yet clear, but strategic rearrangements to underpin more rapid changes appear to be the order of the day for health.
Commenting on today’s announcement, NHSE Chair Lord David Prior said that making the NHS the most innovative health care system in the world rapid uptake of new and innovative products was 'a top priority for the NHS'. There is an urgent need to achieve this, as indeed there is for digital transformation; these new bodies and configurations signal government ambitions clearly, and are intended to facilitate rapid change.
The devil may lie in not just the details but the delivery; these are new configurations intended to facilitate systemic change. How far and how quickly they succeed will depend very much on their detailed remits, the power they are given to achieve them, and the scrutiny of their performance.