• Four years can be cut off up to estimated 12 years it takes to get some innovative treatments to patients, says review
  • Transformation will require investment, including in ‘new, strengthened’ AHSNs
  • An ‘accelerated access partnership’ should bring together key national health bodies
  • Recommendations also include call for new NHS strategic commercial unit

Patient access to some innovative drugs and other interventions could be brought forward by up to four years by restructuring the NHS’s approval and adoption process, a government commissioned review has concluded.

The long awaited accelerated access review’s conclusion is a damning indictment of existing processes,and the report emphasises that improving them would require investment.

It currently takes up to around 12 years to get interventions through the NHS’s approval and adoption process, but the review estimates this could be cut to around eight years by streamlining the pathway.

It calls for up to an additional £30m per year to go into “new, strengthened” academic health science networks, among other investments to spearhead the process.

Other areas it calls for investment in include the early access to medicines scheme, but it also suggests there should be a greater “system emphasis on disinvesting in outdated products or pathways”.

Health minister Lord Prior said in a statement responding to the review that it gave “a strong basis to make the right decisions” on the long-acknowledged problem of speeding up adoption of innovations, but he made no comment on funding.

The review was supported by the Wellcome Trust, which used its statement to emphasise the need for “dedicated funding from the government to support implementation”.

The review, led by Guy’s and St Thomas’ Foundation Trust chairman Sir Hugh Taylor, makes 18 recommendations to help establish a new “accelerated access partnership” to facilitate a new “accelerated access pathway”. 

The review says: “The [new] accelerated access pathway should allow products with a transformative designation to meet regulatory requirements, agree commercial arrangements, receive revenue and achieve market access as quickly as possible.

“Patient access to drugs could be brought forward by up to four years if a scientific opinion from the early access to medicines scheme is used (saving 12-18 months) and there is no delay at the NICE appraisal stage (which takes around two years) or during the process for NHS commissioning and adoption (which takes two years or more).”

The calls for additional funding for the AHSNs may prove controversial, as HSJ understands the review team was warned its recommendations must not create new cost pressures. The review used an interim report published a year ago to warn that efforts to develop and spread the use of innovative drugs and technologies in the NHS could be threatened by “unprecedented” funding pressure.

The report recommends additional funding of £10m to £20m should be released into the baselines of the 15 AHSNs from 2017 as long as conditions, including them matching the funding, are met.

The “refreshed network of AHSNs” should be “innovation exchanges” which grant effective interventions with “NHS warrants…[badges which are] recognised by commissioners and procurement teams across the NHS, and [can] be diffused across the system via the national AHSN network and with patient input”.

The report adds: “This change needs to be funded, in advance of AHSNs [moving] to new licensing arrangements in April 2018. From 2017, we recommend that government makes available up to £30m per annum for this purpose.”

Other proposals include for a new strategic commercial unit to be be created within NHS England “to enter into commercial dialogue to create flexible arrangements with innovators who are working on transformative new products”.

The recommendation comes just months after NHS England took the decision to axe the commercial advisory unit, the Strategic Projects Team, which was part of one ot its commissioning support units, in the wake of the £750m UnitingCare contracting fiasco on which it was a key adviser.

The report sets out how a new assessment process, called the “Paperless 2020” assessment and due for launch in 2017, will be used to evaluate how well apps meet best practice standards for data security, safety, interoperability, usability and technical stability.

The Paperless 2020 assessment will be used to “identify high quality apps (and in the future other digital products) that are then promoted to patients, citizens, healthcare professionals and commissioners”, the review says.

Recommendations include to develop:

  • A national ‘accelerated access pathway’ for the most transformative products, in which the system would work together to bring these innovations to patients more quickly, including for digital products which are often developed by SMEs
  • An ‘accelerated access partnership’ which would “bring together the key national health bodies in a collaboration focused on bringing forward innovation” and drive the new pathway
  • Better data on the impact of technologies, including on outcomes, and more easily accessible data on uptake of innovative technologies.

Sir Hugh, a former Department of Health permanent secretary, said: “This ambitious plan will prepare the health system for an exciting era in medical innovation…It is clear we need to act now to make the most of the tidal wave of new drugs and technologies that are being developed.”

Lord Prior said: “We are determined to make the UK the best place in the world to develop new drugs and other products that can transform the health of patients.

“The report provides us with a strong basis to make the right decisions about how the health system can be adapted to meet the challenges of the future, attract inward investment, grow the thriving life science industry and use innovation to improve patient outcomes and tackle the financial pressures on the NHS.”

Jeremy Farrar, director of the Wellcome Trust said: ”The review is a first step towards building the right environment and infrastructure within the NHS.

“It sets out an achievable strategy for getting the most promising drugs, devices, digital products and diagnostics to patients quickly, and transforming lives. Its success will depend on the close involvement of all stakeholders, and will need dedicated funding from the government to support implementation.”