Professor Peter Littlejohns

BSc MBBS MD FRCP FFPH FRCGP

Clinical and Public Health Director

The Challenge of Health Care in Europe: “value for money”

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

• 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.

The Institute encourages cost effective practice by issuing guidance in three areas

Core principles underpinningall NICE guidance

• Comprehensive evidence base• Expert input• Patient and carer involvement• Independent advisory

committees• Genuine consultation• Regular review• Open and transparent process

William Blake – English Poet and Artist

“God forbid that truth should be confined to mathematical demonstration ”

NICE makes scientific and social values judgements

A short history of NICE

QOF

Public health

Interventional Procedures

Clinical guidelines

Quality standards

NICE’s new role in the NHS Outcomes Framework

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

Du

ty o

f qu

ality

Du

ty o

f qu

ality

tariffstandard contract

CQUIN QOF

5

6

Duty of quality

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

Du

ty o

f qu

ality

Du

ty o

f qu

ality

tariffstandard contract

CQUIN QOF

5

6

Duty of quality

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.”

Kalipso Chalkidou

Working with Policy-Makers around the World

• 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