Annual Review

Transcription

1 Annual Review

2 All Wales Medical Consumables and Devices Strategy Group Annual Review Draft Contents 1. Foreword/ Welcome The pressures facing the NHS are well documented and understood. We face a challenge to meet the increased demand on our services from a growing ageing population with more complex healthcare needs. Traditional measures of cost improvements through cuts will no longer meet this challenges and a focus on patient outcomes wherever possible is necessary. Value based healthcare approaches to procurement will help the NHS deliver to the optimum health outcomes that matter to patients and communities. The All Wales Medical Consumables and Devices Strategy Group (AWMCDSG) is comprised of different clinical disciplines and organisations coming together with a common purpose to actively avoid wasteful care that is not to the patient s benefit - the central premise of prudent healthcare. It is not often that we are given such an opportunity to challenge clinical practice, embrace innovative change and add value to the Healthcare system in such a demonstrable and dynamic way. It is essential the people of Wales received the best possible care from the available resources and the care provided delivers outcomes valued by the patient. The Carter report provided a challenge to NHS Executive Boards and Chief Executives to place a stronger scrutiny on their procurement strategies to ensure they were not wasteful and adding real value to patient care. I feel the group has and will act as the enabler, and the clinicians engaged in the group will input expertise that will prove essential to achieving the value based procurement agenda. We know that procurement can play a valuable dual role in driving quality and value and stimulating the economy. Whilst some recent improvements in NHS procurement are evident, the pace of change is not sufficient to meet the financial challenge facing the NHS. In order to support this ambition and ensure the effective use of NHS resources it is vital to ensure that we use products which are clinically effective and that there is good clinical evidence which supports their appropriate use.

3 2. About Us Currently the NHS in Wales uses NHS Wales Shared Services Partnership Procurement Services to purchase consumables and devices. Procurement services provide a complete procurement to payments system, comprising of four areas: strategic procurement, sourcing, accounts payable and supply chain. Procurement Services delivers significant cost savings for NHS Wales, and supports key healthcare service improvement and patient safety priorities. An important part of the prudent healthcare agenda is a drive towards more value based approaches to Procurement. In order to support this ambition and ensure the effective use of NHS resources clinical leadership is needed to cement the need for value based healthcare approaches to procurement. This will help the NHS deliver to the optimum health outcomes that matter to patients and communities. Following discussions by Directors of Finance and Chief Executives it was agreed that the AWMCDSG should be wholly owned by the NHS and established as a sub-committee of the NHS Wales Shared Services committee. In addition it should be chaired by a senior Clinician and membership should be made up of senior professionals from across NHS Wales and various disciplines. The membership should also include senior colleagues from appropriate research bodies. The strategy group should be given the remit to embrace innovation and to challenge clinical practice. Welsh Government have supported the work of the strategy group from its inception for the first meeting the Cabinet Secretary for Health recorded a video thanking the group members for dedicating their time to the group. Dr Andrew Goodall attended the first meeting and has taken an keen interest in the progression of the work programme as it is central to his Efficiency board. Value based procurement is the cornerstone to meet the prudent health care agenda and to ensure the people of Wales receive the best possible care from the available resource by reducing inappropriate variation through evidence based approaches. The strategy group aims to examine where possible reduce variation and add value to patient care by advising on the use of medical consumables and devices with low value base/poor evidence. Additionally, the group will look to encourage prudent practice around individual elements of procurement and encourage and appraise innovation. The strategy group work programme will develop and evolve based on these principles; 1. Raising the quality of care or clinical value through value based procurement 2. Reducing the overall unit cost of care if feasible and suggested by evidence 3. Providing more equal access to care 4. Potential for improving procurement through co-production 5. Reducing demand and need for items of low relative value

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5 3. Reflection on Following the establishment of the strategy group and the initial work programme, clinical research was required to ascertain the clinical effectiveness of the following medical consumables or devices; Compression Garments for Scar Treatment Compression Wraps for Lymphoedema Antimicrobial Urinary Catheters Hip Prosthesis Intraocular lenses Following the agreement of urinary catheter preliminary primary care analysis the strategy group made their first recommendation that silver alloy urinary catheters should NOT be used within NHS Wales. After further review at the third meeting the strategy group were confident to make recommendations on Compression Garments for Scar Treatment and Compression Wraps for Lymphoedema advising application of clinical parameters in decision making for the best value outcomes for patients. The strategy group continued to review the evidence on hip prosthesis to gain further understanding on the variance in cemented vs cementless in different age groups. The group considered the NICE guidance recommendations and how they could shape a prudent recommendation. It was felt important across Wales that we consider a prudent system that benefits patient outcomes in the use of hip prosthesis based on rationalisation. Hip prosthesis is notably a greater challenge for a recommendation to be made due to the large variation in clinical practice. The strategy group appointed a deputy chair; Dr Stephen Edwards, Consultant Anaesthetist. The role of the deputy chair will be crucial in the continuation of the work acting as the central point for discussion with nominated clinical representatives from each Health Board. Following the recommendation on silver urinary catheters it was agreed the group would consider the benefit of the use of Silver dressings on patient outcomes. From the review of the extensive literature provided the strategy group felt confident to make a recommendation that silver dressings should not be used on chronic wounds unless use was deemed necessary through internal exceptionality processes. A presentation was made on the use of cardiac stents and across Wales considering the findings of variations within the Lord Carter Report which commenced a bigger piece of work similar to the work undertaken on hips prosthesis. Further understanding is required on drug eluting vs non drug eluting stents and the international practice related to this and additionally procurement services have scheduled to meet with Tim Briggs to ascertain the work in cardiac

6 stents in England. Additionally further research is required into the unwarranted variation in trocar procurement across NHS Wales. Following the fourth meeting the Chair agreed it was vital that we took stock and evolve the direction of travel to increase clinical engagement within the recommendations of the group. To facilitate this sub groups will be established through Medical Directors nominations. The sub groups contain multi disciplinary clinical expertise in the four areas of hips and knees, trocars, cardiac stents and silver dressings. The sub groups will be led by the appointed Deputy Chair of the strategy to support in-depth clinical discussion which will be documented and put forward to the strategy group for recommendations. Engagement across NHS Wales is paramount to the successful implementation of a prudent procurement model Medical Directors have a key responsibility in ensuring communication and compliance to the prudent procurement agenda. Following a presentation at the All Wales Medical Directors peer group, each of the Medical Directors was contacted individually to request names from their organisation. Through the engagement presentations there is ongoing work with organisations across Wales to ascertain how they can shape the future work programme of the strategy group. A Strategic Partnership was signed between NWSSP Procurement Services and ICHOM, International Consortium for Health outcome Measurement, which will develop a process to contract with providers/supplier on outcomes as opposed to volume. A cataracts pathway is being used as the pilot to commence the work between NWSSP, Aneurin Bevan and ICHOM and a Workshop was held on 20 th July 2016 to commence this work. This provides an opportunity to model optimum value for patients and marrying this with the cost of products leading the way in value based procurement. A clear expectation is needed for value based procurement; this will be developed in partnership with ICHOM to ensure transparency of the work programme going forward. Cataract surgery will provide us with the real example of the procurement contract informing the definition of value around a whole pathway approach. This year has seen the establishment of a multi-disciplinary clinical forum to discuss and shape the procurement of medical consumables and devices across NHS Wales. To wisely deploy medical consumables and devices a multi-faceted approach is required - where Clinicians lead the way driving change through NHS Wales with world class patient care at its core. The AWMCDSG has in its self been an innovation centred on reducing inappropriate variation and focusing on positive patient outcomes.

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8 4. Our people and infrastructure OUR CHAIR Dr Paul Buss, Medical Director, Aneurin Bevan University Health Board Dr Paul Buss, a consultant Paediatrician since 1993, is based at the Royal Gwent Hospital and has been involved in clinical management roles since 2003 undertaking an MSc in healthcare management at HSMC Birmingham. His previous role was Assistant Medical Director of Quality and Professional Standards for Aneurin Bevan Health Board. Previous roles include Deputy Medical Director of Gwent Healthcare Trust in a combined role as Medical Director of Powys Local Health Board from He has recently taken the lead role in developing a DNACPR policy (Do Not Attempt Cardiopulmonary Resuscitation) for NHS Wales. He is currently also Co-Chair for the review of orphan and ultra-orphan medicines in Wales. Other activities included - Chair of the All Wales Medicines Strategy Group ( developing an All Wales Policy - on the usage of medicines, Copayment policy, and also Chairing a Task and Finish group on the non-surgical cosmetic procedures in Wales. Dr Buss has a chief interest in the alignment of clinical policy with evidence based, financially sound, decision making and the need to increase senior clinical involvement in decisions relating to NHS resources. He is a council member of the Institute for Costing Value and sits on the UK Responsible Officer Reference Panel for the General Medical Council. OUR DEPUTY CHAIR Dr Stephen Edwards, Deputy Medical Director, Aneurin Bevan University Health Board Dr Stephen Edwards is Deputy Medical Director of ABUHB. He has previously been seconded as Interim Medical Director of Powys THB as a joint appointment whilst working as Assistant Medical Director for Quality, Patient Safety and Medical Workforce in ABUHB. He has been involved in quality improvement work around sepsis, and mortality reviews. He works clinically as a consultant in anaesthetics and critical care.

9 Member Name Profession Organisation Mr Neil Frow Managing Director NWSSP Mr Mark Roscrow Director of Procurement Services NWSSP Mr Andrew Smallwood Head of Strategic Scourcing NWSSP Prof. Sam Evans Cardiff University Prof. Harold Thimbleby Professor of computer science Swansea University. Mr. Gordon Staple Consultant Anaesthetist ABMUHB. Ms. Pippa Anderson Ms. Melanie Thomas MBE Director of Centre for Health Economics National Clinical Lead for Lymphoedema in Wales Swansea University. ABMUHB Ms. Jan Green Theatre manager ABMUHB. Dr Grace Carolan-Rees Director CEDAR. CEDAR Mr. Alun Tomkinson ENT Surgeon C&VUHB Dr. Paul Morgan Consultant Intensive Care C&VUHB Ms. Jane James Tissue Viability Nurse HDUHB Ms Tracey Gauci Assistant Director of Nursing Infection Control ABMUHB Prof. Haray Consultant Surgeon CTUHB Mr. Pete Phillips Director SMTL Mr. Mark Stacey Obstetric Anaesthetist C&VUHB Mr Stephen Edwards Asst Medical Director ABUHB Dr Sara Harrison Consultant Radiologist C&VUHB Mr Huw Llewellyn/ Paul Gilchrist Asst Finance Director ABMUHB

10 5. Looking ahead The future work programme will be formed by the continuation of the work on hips, knees and three other variation across Wales; trocars, cardiac stents and intraocular lenses. Through addressing these areas this will increase the pace and spark debate on how an efficient value based system will procure in a prudent manner. It will allow the group to start to explore a whole system approach facilitating an all Wales discussion on a medical issue. The work of the strategy group will close link to the NHS Wales Efficiency, Healthcare Value and Improvement Group chaired by Dr Andrew Goodall. The purpose of the NHS Wales Efficiency, Healthcare Value and Improvement Group to understand the Welsh context for financial benefit arising from the Carter Review and to highlight variations in costs and expenditure across Wales, that could be better targeted through local and national mechanisms. The future work programme of the strategy group has been closely linked with the 4 product areas where a differing procurement approach has had to be utilised. Whilst the savings delivered to date have been substantial there remains a significant spend in these areas. The NHS Wales Efficiency, Healthcare Value and Improvement Group are in support of this approach they see the strategy group as a delivery mechanism for Value Based Procurement and system wide change in the deployment of medical consumables and devices. The work programme will continue to evolve and be aligned to the NHS Wales procurement contracting work schedule. The group will also take the opportunity to review the work from other similar organisations such as Scottish Health Technologies Group or Canadian Agency for Drugs Technologies and Health in order to assess whether or not there is any material already available of interest/ value for NHS Wales. SMTL have been integral partners in the All Wales Medical Consumables and Devices Strategy Group undertaking rapid review into medical consumables and devices to understand their value base for NHS Wales. The landscape for Procurement in clinical areas is developing and informing how innovation can be encouraged within NHS Wales through a number of pathways Health Technology Wales was established as a part of Velindre NHS Trust to establish a streamlined, strategic, nationally and co-ordinated approach to medical technology. Over the next year this partnership will grow exploring opportunities to share practice, processes and topic areas. A review of the structure of the strategy group and required sub groups will be undertaken over the next year to understand how further momentum can be added. As the strategy group matures it is also expected that so will their branding and membership. This will include the design and establishment of their communications and a website. It is essential the strategy group is guided and driven by a committed membership who will champion value based procurement across NHS Wales.

11 The role of the strategy group in enabling system shift changes cannot be underestimated. It is a critical enabler and delivery mechanism for value based procurement through a multi faceted clinical evidence based approach. The forthcoming year will be an exciting time for value based healthcare approaches to procurement which will help the NHS deliver to the optimum health outcomes that matter to patients and communities. 6. Contact us If you would like any further details on the AWMCDSG please contact;marie- Claire Griffiths, Project Manager Marie-Claire.Griffiths@wales.nhs.uk