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Horizon scanning – the Darzi review and you


What does Lord Darzi’s review of the NHS mean for medtech sales and marketing on the ground? Ruth Lessar examines the surgeon’s work for clues to market access for the medtech industry – from screening to weight control.

High Quality Care for All, Lord Darzi’s long-awaited review of the NHS, was presented to Parliament in June 2008. It generated a huge amount of professional and public media attention. Timed to coincide with the NHS’ 60th birthday, it aims to take the NHS forward into the next decade.

Those of you who are medical mag junkies will have seen numerous commentaries from a variety of eminent NHS gurus, giving their views on what it all means for the NHS and its patients. These views are very worthy and valid, but the one thing everyone seems to agree on is that Darzi’s report, though full of great ideas, is a little thin on practical implementation aspects.

So where does this leave the medtech industry? Those of you in large organisations may well have been looking at the interim reports and planning accordingly. If you haven’t, don’t panic! For smaller enterprises it can be daunting. Here are a few ideas you might want to explore.

Technology and innovation

Probably, at first glance, one will home in on the paragraphs of Darzi’s tome that address technology uptake. “Hurrah!” we all cry, thinking at last we will find a simple pathway, a route to adoption that can see wonderful new technologies made available to all needy patients. But it’s not, and never will be, that simple.

Darzi’s report acknowledges that our demographics have changed and that the NHS faces different challenges in the 21st century. We’re living longer and we have higher expectations of our health service, and there are advances in technology that we may want for ourselves or our nearest and dearest.

Power to the patient

There are inherent commercial opportunities in technological advance and innovation that should be explored. Patients now have wider access to IT, and this means they can find out more about your products and how these might be of benefit to them. Not to mention those being used in the home to monitor patient’s medical conditions.

Given the fact that Darzi’s report sets out the stall for the first NHS Constitution, the idea of ‘patient power’ may have teeth. The Constitution will set out patient rights and responsibilities together, and will state clearly what people can expect from the NHS regardless of where they live. This could prove to be an opportunity. So update your websites, and engage with patient user groups and appropriate charities that can support the use of your products.

Make it NICE

The part of the document dealing with innovation relates more to ‘how’ things are done (patient pathways for example) than to specific new products. Darzi pays some attention to ensuring that clinically and cost-effective innovations in medical technologies are adopted. NICE technology appraisals are to be speeded up from two years to six months. That’s good news, but it’ll take some doing. The practical aspects are sketchy to say the least. The aim is to end the postcode lottery and bring the best, most clinically effective technologies to patients.

‘NHS Evidence’ will be launched on the NICE IT portal in April 2009. This resource will bring together all the evidence about a product or technology, and will be an effective method for commissioners to analyse the evidence for its use. It would appear that you’ve got to be NICEd to be there.

Have a look at their website. It’s very user-friendly and there’s some really helpful information and application forms, so you stand a better chance of being appraised. You should also look at the Department of Health selection criteria. Filling in the forms is a skill in itself, so think very carefully about content. Remember you’ll need both quality clinical evidence and cost-efficacy data.

Keeping it local

There will also be more advanced horizon scanning for new technologies. Talk to PCTs and PbC groups about your technology, as they’ll be looking out for medical technologies that can address specifi c needs in their region.

Look at your PCT’s Strategic Plan (which must be produced by spring 2009). It will highlight their main focus areas for the next five years, based on evidence-based pathways of care. The emphasis is on local need addressed by local clinicians and local authorities. That doesn’t mean that they’ll definitely use your product, but they’re more likely to listen.

If a new technology is likely to be of benefit to a PCT and is due to be launched, they appreciate being told about it as early as possible so they can address cost and other implications.

New customers

If your product or service is not NICEd – and that’s probably the majority of them – what else can you do?

Darzi is determined to boost PbC. A broader range of clinicians will be incentivised to get involved. PCTs will be obliged to support these groups. There will also be new integrated care organisations commissioned by PCTs. These organisations will provide healthcare outcomes, and GPs involved with them will be working more closely with hospitals and community services so that targets can be achieved. These will be piloted soon, and could potentially provide a new raft of customers for the medtech industry.

Don’t forget: patient services could also be provided by social enterprises. These could be nurse-led companies in direct competition with GPs – another potential source of customers. Don’t neglect other private service providers, as they may be able to help you increase business if your technology is of value to them in their service delivery.

Other new customers may be old ones wearing different hats. If they haven’t already done so, SHAs will be appointing Medical Directors who will play a part in ensuring that World Class Commissioning is delivered. The new Medical Directors will be working with SHA Clinical Advisory Groups, who will team up with PCT PEC Chairs… and the chain goes on.

To future-proof the plan, medical and nursing students will be encouraged to become clinical leaders. This will potentially increase your calling and potential sales circle. Also, don’t forget the Equitable Access Programme and the introduction of new GP services and centres.

Quality Street

Quality is in the review’s title, and is central to it. Quality in the NHS should really go without saying, but Darzi does… a lot. Quality will be monitored in a variety of ways, and if your technology improves quality and patient outcomes then you are speaking today’s language.

Think of any clinical area where healthcare costs a great deal of money. If your technology could help prevent that illness or reduce risk, then I suspect you’ll gain a warm reception. If you have a patient education package, or can support staff training in the use of your technology, that could be a real plus.

Technology plays a major role in detecting illnesses earlier and in preventing them from getting worse. National screening programmes are already contributing significantly to the prevention of illness, and more will be developed. For example, vascular health checks will be offered to the over-40s via GPs, pharmacies and community clinics. Screening is a key area in which medtech companies can help to forge the way forward.

New quality metrics will be established, so all aspects of healthcare can be measured against each other. Ultimately this gives patients more choice, but will it deliver business for medtech? Maybe, if practices or other health providers are vying with each other for top marks in the quality stakes. Especially if heavy-duty incentives are attached to achieving those points!

All shall be well

It’s official: wellness is the order of the day. So if your medical technology stops people from becoming ill – especially in the six target areas of obesity, mental health, drug addiction, smoking, alcohol harm and sexual health – then you really will be on to a winner.

The cheapest patients for the NHS are the ones who don’t consult because they’re just the picture of health! It’s all about keeping them healthy and addressing lifestyle issues. There’s now a real drive for the NHS to become a ‘wellness’ service. Public health and health promotion teams will become more important players – so apply a bit of lateral thinking and take advantage of these changes.

Ruth Lessar is an independent consultant specialising in the healthcare market. She has worked in the NHS as a nurse and practice manager and has many years’ experience of NHS liaison in the medtech and pharmaceutical industries. Ruth has lectured on legal aspects of healthcare and advised businesses on strategy in the new NHS. For more information, e-mail ruth@lessar.fsworld.co.uk.


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