The Assembly Health and Social Care Committee’s report on access to medical technologies in Wales will be debated in Plenary on Wednesday 25 February.
During 2014, the Committee took evidence from a wide range of stakeholders, which highlighted the lack of clear process or planned, coordinated approach to adopting technology in Wales. The Committee heard that clinicians play a key role in technology adoption but that, without any strategic or consistent approach to introducing new technologies, it may be the most vocal and persistent whose demands are met, rather than those with the best case for adoption.
It was suggested that a similar situation existed in relation to medicines prior to the establishment of the All Wales Medicines Strategy Group (AWMSG), . Whilst the need to ensure wider implementation of NICE guidance on medical technologies was emphasised, it was clear that adoption of NICE recommendations is by no means a complete solution, and that a more pro-active approach to assessment of technologies in Wales is needed. A key recommendation in the Committee’s report is that, within 12 months, the Welsh Government should develop options for an all-Wales medical technologies appraisal mechanism, to undertake a similar function in respect of medical technologies as AWMSG does for medicines.
Evidence highlighted the differences between medicines and technologies, and that any new appraisal process must involve the necessary expertise, taking into account the diverse nature of technologies, the weaker evidence base and factors such as usability and impact on the care pathway.
A further significant recommendation made by the Committee is that a more strategic approach to commissioning new medical technologies in Wales should be established, particularly given the wider ‘organisational’ impact that adopting a given technology can have. This must be linked to a robust appraisal process. The Committee heard that currently commissioning is weak: decision-making happens in many places, can be protracted and the process is not transparent. Whilst there was support for a national commissioning body to help ensure equitable, timely access to treatments for patients across Wales, the need for an appropriate balance between national and local commissioning, to take account of local needs and priorities, was emphasised.
The Committee’s overarching recommendation is for the Welsh Government to address the need for a more strategic, coordinated and streamlined approach to medical technology adoption that:
- is driven by clinical and population need;
- ensures effective prioritisation of investment in new evidence-based technologies, alongside a programme of disinvestment in out-dated/ineffective equipment;
- provides equity of access to appropriate new treatments for Welsh patients; and
- facilitates the engagement of all stakeholders, including clinicians, patients, industry and research partners.
The Welsh Government accepted all the Committee’s recommendations in principle, stating that it recognises the strength of the AWMSG approach, which will be one of a number of options for consideration during 2015.
The development of options for a national approach to technology appraisal and adoption will take account of how it will link to commissioning and procurement services, so that the appropriate technology adoption route is made clearer and applied consistently across Wales. This will also allow more co-ordinated decommissioning and discard of technology, where appropriate.
Article by Philippa Watkins, National Assembly for Wales Research Service.