The recently released Accelerated Access Review (AAR) sets out proposals to ensure that NHS staff and patients can access useful innovations sooner.

There is a strong focus on commercial innovative ‘products’ and health system markets. This is not surprising, since it was the brainchild of the first (and unfortunately last) then Life Sciences Minister, George Freeman MP, who bridged the Department of Health and then Department of Business, Innovation and Skills to ensure that the National Health Service (NHS) and the life sciences sector worked effectively together for mutual benefit. 

The AAR was always intended to play a crucial role in this endeavour, and post-Brexit political and imperatives have made establishing the UK as a global centre for the development, application and evaluation of innovative health technologies more important than ever. The NHS, dear to the hearts of UK citizens, must also take on a new role as a uniquely valuable test-bed for getting innovations to market. This is not a new concept – a 2010 report from the Academy of Medical Sciences noted the UK’s ‘unparalleled competitive advantage’ for commercial medical research linked to the NHS. 

It makes sense for life sciences and the NHS to work together for better medical research and the development of innovative products of all kinds to improve patient care. The AAR proposals go a good way towards this goal to create, as the report puts it, a ‘win-win scenario’ and a ‘win:win for all, improving the competitiveness of our country in life sciences and improving investment in the UK’. 

Balancing act

The opportunities for win-wins are certainly there; patients and health professionals want access to the best tests, treatments and interventions, whilst companies want to develop, trial and sell (at home and abroad) innovative solutions to health needs. Given the immediate (negative) financial impact of Brexit plans, boosting UK PLC should also be of interest to all UK citizens, not least to boost flagging health and social care funding.

The AAR proposals explain how innovators will be able to collect ‘real world as well as clinical trial data’ on efficacy and outcomes, gaining faster access to the NHS market as well as valuable data to help them access other markets. This could nicely address the PHG Foundation recommendation that the review should ‘include requirements to generate evidence that measures the results of accelerating access to innovations in both faster patient pathways and improved health outcomes’. The AAR report also strongly emphasises patient involvement in determining which innovations are important to them, as well as receiving information on the outcomes from accelerated access. 

The real challenge may lie in ensuring that the two interests (health and wealth) are suitably balanced; this is where the roles of patients and charities will be vital – but also where commissioning and healthcare public health skills and oversight will be badly needed. 

Pleasing patients (and tax-payers)

Patient groups and charities, not to mention specialist clinicians, are likely to focus on particular innovations to address particular problems – for example, rapid access to a specific therapeutic – and this often coincides with the desire of a company developing the innovation to see it trialled and ideally eventually commissioned and paid for across as much of the NHS as possible. 

However, the biggest challenge to the NHS at the moment is to maintain current care levels in the face of ever-rising demand. The price tag and outcomes for innovations will therefore need to be very carefully weighed up when it comes to widespread uptake; the price of success for the best innovations may (and arguably must) be failure for less effective ones, at least within a financially constrained health system. 

Everyone rational can see that rapid access to biomedical innovations is desirable, but who will foot the bill if the price tag is overly high? Could it mean that access to other (perhaps less innovative, but potentially higher impact) interventions for larger numbers of other patients will fall by the wayside? There is a duty to UK tax-payers and citizens – all of whom are, whether they realise it or not, potential and indeed probable future NHS patients – to ensure value for money across the health service, as well as boosting national wealth generation.

Counting on commissioning

It would be short-sighted indeed to ignore the potential for better, more personalised and potentially therefore more cost-effective care offered by innovations, all the more so where they also meet patient preferences more effectively (for example, wearables such as the mobile ECGs and apps for self-management of COPD that are among the first innovations to be approved under or in parallel with the new national Innovation and Technology Tariff). But care may be needed to ensure that patient representation in AAR approval processes remains broad and cannot be inappropriately driven by individual interests.

This is why another of the PHG Foundation’s recommendations to the AAR to provide additional NHS commissioning capacity to ensure that AAR approval decisions ‘cannot bypass decisions regarding implementation, affordability and prioritisation by individual hospital trusts and commissioning bodies’ is important. Fortunately, the AAR report introduction by NHS England CEO Simon Stevens says that they agree on the need for ‘better alignment between regulatory approvals, NICE HTA assessment, NHS England commissioning/reimbursement, and local innovation diffusion processes’. This could work.