New technology should be paid for ‘like medicines’, says NICE chief executive

Sam Roberts said this was “the minimum a citizen should expect from a digitised health service” and that she was determined “to get that into the [government’s 10-Year Health] plan”.

She described the different financial arrangements for NICE-approved digital products and services as “outrageous”, and said they should instead be treated “like medicines”.

In a wide-ranging interview with HSJ, the NICE CEO also said:

• She wanted NICE to “lead the charge” in determining which digital innovations the NHS should adopt
• NICE would issue more guidance on which medicines it had previously recommended should no longer be used
• A new approach was needed to deal with the impending wave of expensive “preventive medicines” such as the new wave of weight-loss drugs.

(See also: HSJ’s editorial: The return of NICE)

NICE is responsible for recommending the use of digital tools and services if they provide diagnosis or treatment. These range from tools that aid with ADHD diagnosis to the remote monitoring of people with heart failure. Dr Roberts said the Institute was “doing 30 times more digital appraisals than we did two years ago”.

She told HSJ it was “outrageous” that patients had a legal right to receive any appropriate NICE-recommended medicines, but that it was not the case with a diagnostic device or digital tool that had been approved by the Institute.

She explained the lack of a mandate to follow NICE’s recommendations in this area meant that no NHS commissioner or provider needs to buy the digital tools or services assessed as cost effective.

This, said Dr Roberts, lead to “inequalities of provision” and a situation in which the NHS was using technology which contributed to “real clinical errors” and did not “provide good value”.

The latter was influenced by the fact that NHS providers were buying new technologies individually, and that the service as a whole, therefore, had little idea of the “best price” to pay.

The NICE CEO said she would like her organisation to be given the role of identifying and assessing the technologies in areas where the service had decided there was “a clear clinical need” and in which “patients are not getting the best care that they could”.

Once evaluated and approved, these technologies should be reimbursed by the NHS, “like we do medicines”.

She said NICE had been working on the idea “for two years” and was “all geared up” to implement it, but acknowledged the money and contracting would be the “tough bit”.

Leading the charge

Dr Roberts described the joint working between NICE, the Department of Health and Social Care, and NHS England on medicines regulation as “pretty smooth”.

However, she added there was no one leading the charge on the introduction of new technology into the NHS.

NICE, she said, could do so, “in terms of saying these are the areas where you can provide clinically and cost-effective care digitally”.

However, it was up to others to determine which needs the service should prioritise for digital investment and then, following NICE recommendations, to secure “commercial agreement with these providers, make sure we get the best value, put them on procurement frameworks, ensure that the payments are transacted [etc]”, she added.

Dr Roberts said NICE would like to proactively explore other global systems to identify which technologies were meeting the needs the NHS had identified. This would include talking to “people like venture capitalists or investors or serial innovators and asking, ‘what are you seeing coming through?’”

Dr Roberts also revealed that NICE has been working on packaging its guidance to make it easier to incorporate into electronic health records and clinical decision support tools.

The organisation is also undertaking a series of “early value assessments” to determine which emerging technologies it should investigate.

Those that are not initially approved are subject to a three-year evidence collection process. After this, groups of similar products not yet widely adopted by the NHS are analysed and — if appropriate — approved for use.

One hundred and five products in 22 different categories have been assessed so far. Dr Roberts said a further eight categories covering 70 products were scheduled for 2025-26.

These include investigating the use of digital technology to aid the detection of vertebral fragility fractures, gather information for assessments for talking therapies, support cardiac rehabilitation, and manage mild to moderate hip or knee osteoarthritis.

Helping the NHS to save money

With the NHS facing the toughest financial environment in a generation, Dr Roberts believes NICE could and should do more to help the service by ensuring it is still getting value for money from the many medicines and other interventions approved by NICE since its birth in 1999.

She said: “We need to now look at the innovation [previously recommended by NICE] that is in use and say, ‘is it really [still] offering [the same] bang for the buck’.”

Dr Roberts said the welter of new medicines that have entered the market during the past 26 years means “the poor doctor and patient [might be] sitting there thinking, ‘well, which of these 17 [NICE-approved medicines] should I use?’

“There’s a real role for NICE to say, ‘use this first, this second, this third, this fourth – and these ones probably you don’t need to use anymore.”

NICE has also begun to look at the comparative cost of similar medicines which have been in use for some time and may have seen differential increases in their prices to determine which ones offer the best value for money.

Late stage assessments

NICE has also begun a programme of “late stage assessments” of previously approved and well-established products. It is hoped this will help NHS purchasers identify “the best value products and decommission those no longer supported by evidence”.

Three of eight assessments have been published to date, and another three are due to be published by the end of August. These will cover colostomy bags, compression dressings, and beds.

Dr Roberts said NICE was resourced to undertake a further eight assessments in 2025-26 and could do more if the funds were provided.

Dealing with the ‘game changers’

Dr Roberts also believes NICE must do more to prepare the NHS for the arrival of “game changing” preventive interventions such as injectable weight-loss medication.

“The risk at the moment is that people are treating obesity [medicines] like they’re a one-off,” she said. “But we’re going to go through an age now where we are going to get waves and waves of these. The next one will be for a type of liver disease [and] it’s not just medicines. It can be devices like an artificial pancreas.”

The NICE CEO says that rather than just approving these new innovations and wishing commissioners “good luck” in trying to pay for and deliver them, her organisation should be more active in helping the NHS determine a roll-out programme which provides a sensible compromise between patient expectation and budgetary constraints.

This would involve “rolling reviews” which would look at the impact of the new intervention on patient cohorts deemed to be in the most need.

NICE would seek to develop a “symbiotic relationship” with the NHS, asking: “What are the service models you want to try? Pharmacy-led, digital, GP, PCN, etc?” Then, NICE would collect the relevant data to inform the success of those models and the speed of the rollout.

As well as benefiting the NHS and its patients, Dr Roberts also believes such an approach could make England “distinctive from a life science industry point of view. Very few people have got that structure of cradle to grave, single payer, good, real-world data, where you can actually learn a lot about these innovations.”

The arrival of new, very expensive preventive medicines was an issue every economy and health system was struggling with, said Dr Roberts. She continued, England “could become a great place to roll them out”, because it would not “just push them into the system”, but instead produce an evidence base of best practice.