Health and Social care Committee

Access to medical technologies in Wales

MT ToR 8 – Dr Peter Groves

The National Assembly for Wales’s Health and Social Care Committee

Comments regarding the scope for an inquiry into access to medical technologies in Wales

Professional context of my comments

• I am Consultant Interventional Cardiologist at Cardiff and Vale UHB and Lead Clinician for the Structural Heart Disease Interventional Programme
• I personally undertake a variety of percutaneous cardiac procedures including coronary intervention (percutaneous coronary procedures in an acute and elective setting), heart valve intervention (mitral balloon valvuloplasty and transluminal aortic valve implantation) and closure of atrial septal defects including patent foramen ovale.  All of these procedures involve the use of technologies that are changing and developing

· As Lead Clinician for the Structural Heart Disease Interventional Programme, I and my team remain vigilant for the availability of new technologies that either improve the safety and efficacy of the procedures that we already undertake or extend the potential to manage cardiac disease in a percutaneous rather than open surgical manner

• I have been actively involved in the NICE Medical Technology Evaluation Programme (MTEP) since 2006.  From 2006-2009 I was the National Cardiology representative on the Interventional Procedures Advisory Committee (IPAC) and since 2009 have been Vice-Chairman of the Medical Technology Advisory Committee (MTAC)

Comments

· I welcome the proposed review of access to medical technologies in Wales

· The scope of the review will inevitably need to touch on the relevance of NICE guidance to NHS Wales.  My own perspective, as a result of first hand involvement in both the generation of NICE guidance and the delivery of healthcare in Wales, is that NICE technology guidance is highly relevant to our practice in Wales.  I would suggest that the review seeks an understanding of NICE MTEP processes to satisfy itself that guidance is generated in a rigorous, balanced and evidence-based fashion and this will also provide insight into the complexities associated with the development of any alternative models for guiding technology implementation in Wales

· From the perspective of a clinician involved in a rapidly changing area of medicine, I would advise that the review should mainly focus on understanding and defining the means of overcoming barriers to the timely and equitable implementation of NICE technology guidance in NHS Wales.  Challenges include the effective dissemination of NICE guidance; the adoption of pro-active strategies for implementation; the appreciation of longer term benefits of technology adoption to patients and the service; flexible approaches to commissioning

· Understanding the financial implications of technology adoption is of utmost importance.  The NICE MTAC process is based on identifying and promoting new technologies that are beneficial to patients and lead to overall cost savings for the NHS.  I would advise that the review include an analysis of how costs should be considered in the context of NHS Wales.  Challenges include capital investment to accrue future savings; budgetary flexibility that acknowledges that savings and investment may be relevant to different budgets; the appreciation of the time course over which clinical benefits and savings are likely to be realized; approaches to the adoption of new technologies in which safety, efficacy and clinical benefit may be proven but in which overall financial savings may not be evident.

Dr Peter Groves, MD, FRCP             

Consultant Cardiologist,

Cardiff and Vale UHB,

Heath Park,

Cardiff,

CF14 4XW                                         28^th September 2012