9 June 2015
The need for faster access to useful scientific innovations to improve healthcare – making science work for health - has long been a central message of the PHG Foundation, and forms the basis of our current innovation manifesto.
It is therefore heartening to see that awareness of this need has finally taken root at the highest levels, signalled by plans announced earlier this year to ensure rapid uptake of medical innovations in the National Health Service (NHS).
These included an Innovative Medicines and Medical Technology Review supported by the Wellcome Trust , focusing not only on treatments but also on precision medicine and diagnostics as well as new digital devices and apps. Last week it emerged that this review has been snappily renamed the Accelerated Access Review (of innovative medicines and technologies) – and is planning to maintain a suitably speedy schedule, with an interim report in summer 2015 and a final report by the end of the year.
Tackling the translational barriers
The Accelerated Access Review is intended to establish the needs, priorities and principles for innovation, including efforts to ensure it is led by patient needs, and to examine key issues set out as:
Pathways to allow faster access to innovative products whilst maintaining appropriate patient safeguards and evaluation procedures
Affordable, responsive funding models to drive and support clinically and cost-effective innovation
Means to ensure such innovations are commissioned by local NHS bodies and reach patients across the country
Learning to listen
The central importance of patient needs to the whole process is a sound one; for too long the availability of many potentially valuable innovations has been delayed by the lack of involvement of potential end-users (clinical as well as patients). Funding tends to be made available to clinical and scientific experts; whilst these innovators (and their products) are absolutely vital, and their intentions absolutely sound, they are often somewhat removed from other essential players in the process of clinical implementation.
Patients are the obvious end-user, and empowering individuals in the context of personalised medicine is a particular theme within the PHG Foundation’s health innovation manifesto, since patients can and should guide medical innovation.
In addition, the needs and concerns of everyday (non-expert) health professionals, of healthcare commissioners and policy-makers are considered only late in the innovation process, slowing the sometimes rocky path towards reliable implementation for national availability. For example, other health professionals and managers may be concerned with how they fit into existing clinical pathways, priorities and professional guidelines.
Just as the widest perspectives of health professionals (as well as expert views) are needed early in the translational journey, so too the views of society in general as well as particular patient groups can be important. No-one understands the priorities and concerns of patients as well as they do themselves, but in some instances innovative technologies may provoke issues of wider concern that warrant early discussion. For example, many years of discussion and consultation over the potential application of emerging mitochondrial transfer techniques to prevent the transmission of serious mitochondrial diseases paved the way for the UK’s recent landmark legal changes that will permit regulated clinical use of these techniques. Some ground-breaking technologies demand national debate, and not merely patient views, because the decisions made to support or block health applications have wider ramifications.
The need for system change
If timely consideration of stakeholder needs is critical in achieving faster access to innovations, so too is enabling change. This is why the emphasis on reimbursement and commissioning mechanisms for innovations of the Accelerated Access Review is important – streamlining the regulatory and evaluation pipelines will do no good unless processes and systems exist for commissioners to understand their value in the right clinical context, and unless funding mechanisms support their use.
As independent chair of the review chair Sir Hugh Taylor (Chair of Guy’s and St Thomas’ NHS Foundation Trust) himself observes: “21st century healthcare can only be delivered by a 21st century system”. The time is definitely right to make science work for health – and not merely the health of those lucky enough to live in privileged areas of the country where clinical experts are pioneering innovative approaches and interventions, but of any and all members of the population.