• Accelerated access review will recommend small number of “transformational” drugs and devices fast tracked into NHS each year
  • Richard Barker says arrival of new products needed to be “wired into the NHS budgeting process”
  • Simon Stevens says pharmaceutical price regulation scheme, NICE appraisals and NHS England commissioning not “interacting optimally”

A handful of drugs and devices with the potential to have a “transformational impact” on patients or NHS efficiency will be fast tracked into the health service each year, under plans being considered by a government review.

The accelerated access review is also likely to recommend changes to ensure new technologies are “wired into the [NHS] budgeting process”, a member of the review said.

Simon Stevens

Simon Stevens

Source: Peter Searle

Simon Stevens said the PPRS was ‘getting a bit leaky around the boundaries’

Richard Barker, the director of the Centre for the Advancement of Sustainable Medical Innovation, was speaking at a conference organised by IMS Health at the end of last month. The comments were his “personal reflections” and were not made on behalf of the review.

He said the review would recommend “accelerated access pathways” for “five or 10” products a year that could have a “transformational impact on the patient… or on the efficiency of the NHS”.

Professor Barker’s comments were echoed by Simon Stevens, the NHS England chief executive, when he appeared before the Commons public accounts committee this week. Mr Stevens said that for “the top 10 or more innovations in each year”, the review would propose a “quick route to getting coverage and diffusion across the NHS”.

Professor Barker said the review would also recommend the closer integration of “technology and innovation planning into the NHS’s annual budgeting system”.

“Unless and until we can get those products wired into the budgeting process then we are still vulnerable to ‘oh, we’ve got a cure for hepatitis C, I wasn’t expecting that’, even though that was well known to be coming years before it actually arrived on the market,” he said.

The issue about the affordability of innovative new drugs has been highlighted over the past year by the introduction of new hepatitis C treatments, which have been judged to be cost effective by the National Institute for Health and Care Excellence but are very expensive and represent a significant financial risk to NHS England.

Professor Barker said the review was also likely to recommend a national “innovation partnership” to guide innovators through the system, and “ideas on flexible pricing formulae” to pay for drugs.

He warned that “affordability” of drugs – not just cost effectiveness – would be increasingly important, and in his view new drugs with a “substantial budget impact” might need “novel financial instruments” from the industry to mitigate this.

Mr Stevens told the committee that the pharmaceutical price regulation scheme, NICE appraisals and NHS England commissioning were not “interacting optimally”.

“There is an issue about the way the [NICE] cost effectiveness hurdle interacts with the pricing negotiations and with the affordability considerations,” he said.

Mr Stevens also said the PPRS was “getting a bit leaky around the boundaries”.

Jonathan Fielden, NHS England’s director of specialised commissioning, said the approach which had been taken to hepatitis C – capping the number of treatments and providing them through “operational delivery networks” – could be a “model” for other drugs.