Transcript The Challenge of Healthcare in Europe: `value for money`

The Challenge of Health Care in
Europe: “value for money”
Professor Peter Littlejohns
BSc MBBS MD FRCP FFPH FRCGP
Clinical and Public Health Director
Overview of presentation
(i) The challenge
(ii) NICE: brief history and emerging new role
(iii) A new research programme
Patient confidence that they will receive the most effective care
Opportunity costs
You can only spend one
healthcare pound or euro once.
Within in a fixed budget if a health
care system spends more on one
thing, it has to do less of
something else
The ‘opportunity cost’
is the value of the best alternative
use of resources
“What is the most difficult ethical dilemma facing society
and science today?”
Exchange recorded in The Guardian Weekend magazine 11 September 2010
How far do you go to preserve individual
human life? I mean, what are we to do with the
NHS? How can you put a value in pounds,
shillings and pence on an individuals life?
There was a case with a bowel cancer drug – if
you gave that drug, which costs several
thousand pounds, it continued life for six
weeks. How can you make that decision?”
Sir David Attenborough, Naturalist
“Yes, that is a good one”
Richard Dawkins, Evolutionary biologist
Action at all levels of the system
The National Institute for Health and
Clinical Excellence (NICE)
NICE is the independent organisation
responsible for providing national
guidance on the promotion of good
health and the prevention and treatment
of ill health. It was established in 1999
as a Special Authority and in 2005 it was
expanded to include the functions of
Health Development Agency. In 2012
(subject to legislation) it will become the
National Institute for Health and Care
Excellence and cover social care
The Institute encourages cost effective practice by
issuing guidance in three areas
•
•
•
Public health – guidance on the
promotion of good health and the
prevention of ill health for those working in
the NHS, local authorities and the wider
public and voluntary sector
Health technologies – guidance on the
use of new and existing medicines,
treatments and procedures within the NHS
including interventional procedures,
diagnostics and devices
Clinical practice – guidance on the
appropriate treatment and care of people
with specific diseases and conditions
within the NHS.
Core principles underpinning
all NICE guidance
•
•
•
•
Comprehensive evidence base
Expert input
Patient and carer involvement
Independent advisory
committees
• Genuine consultation
• Regular review
• Open and transparent process
NICE makes scientific and social values judgements
“God
forbid that truth
should be confined to
mathematical
demonstration ”
William Blake – English Poet and Artist
A short history of NICE
250
200
Interventional
Procedures
Quality
standards
QOF
Diag
MD
150
QS
Clinical
guideline
s
NHSE
Public health
QOF
PH
100
IP
Technologies
CG
TA
50
0
2000/1
2001/2
2002/3
2003/4
2004/5
2005/6
2006/7
2007/8
2008/9
2009/10
2010/11
NICE’s new role in the NHS Outcomes
Framework
Duty of quality
7
NHS OUTCOMES FRAMEWORK
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing
people from
dying
prematurely
Enhancing
the quality
of life for
people with
LTCs
Recovery
from
episodes of
ill health /
injury
Ensuring a
positive
patient
experience
Safe
environment
free from
avoidable
harm
2
Duty of quality
Duty of quality
1
NICE Quality Standards
(Building a library of approx 150 over 5 years)
3
Commissioning
Outcomes
Framework
6
4
Commissioning
Guidance
5
Provider payment mechanisms
tariff
standard
contract
CQUIN
Commissioning / Contracting
NHS Commissioning Board - Specialist services and primary care
GP Consortia – all other services
Duty of quality
QOF
Value Based Pricing
The UK Government view:
“We need a system that encourages the
development of breakthrough drugs
addressing areas of significant unmet need.
And we need a much closer link between the
price the NHS pays and the value a new
medicine delivers, sending a powerful signal
about the areas that the pharmaceutical
industry should target for development.”
“Over the next three years we will be moving
towards a new system of pricing for
medicines, where the price of a drug will be
determined by its assessed value.”
Working with Policy-Makers around the World
Kalipso Chalkidou
• Empowers decision makers in low
and middle income countries by
identifying and helping them to act on
their own policy priorities
• Focuses on institutional structure,
longer-term capacity building and
system governance
• Offers collaborative problem-solving
and hands-on support, drawing on
people and experience, from the UK and
abroad, to adapt evidence and policies
to countries’ local context
Active or completed projects
Exploring opportunities or
strengthening institutional links
Thank you for your attention