Health and Social care Committee

Access to medical technologies in Wales

MT ToR 27 Urology Trade Association

Welsh Assembly Health and Social Care Committee:

Inquiry into access to medical technologies

Comments on scope of inquiry from the Urology Trade Association

About the UTA

The Urology Trade Association (UTA) is the leading urology membership organisation representing 95% of urology product manufacturers and suppliers to the urology appliance market. We welcome the opportunity to respond to this initial opportunity for comment on the scope of this inquiry, and look forward to submitting a full response in due course.

An estimated 6 million people in the UK are affected by continence problems and many rely on urology appliances on a daily basis. This includes people with a number of complex long-term conditions such as spinal injury, multiple sclerosis, cancer, spina bifida and other neurological conditions.

High quality urology appliances allow users to manage their conditions, maintaining their quality of life and independence and avoiding repeated medical consultations. A majority of continence services are delivered in the community and this will be the main focus of our remarks.

Comments on the scope of the inquiry

The UTA welcomes the announcement of an inquiry into access to medical technology in Wales. Our members produce a range of medical devices designed to assist those affected by continence problems with living their daily lives with as much dignity and independence as possible. While such devices may form a relatively small part of health spending within Wales, they are vitally important to those who use them, and we would be keen to see full consideration of this issue by the committee.

What particular issues need to be looked at in relation to urology devices?

There is often a perception among commissioning and procurement staff that similar seeming urology products, such as catheters or leg bags, perform the same function for patients in the same way and so can be interchangeable. However, all patients using urology products have very individual needs; product differences which may seem tiny to healthcare professionals may not be so insignificant to patients who have to use the products.

An individual’s quality of life and clinical needs must be taken into account and patients must receive the most appropriate products for them in the long term. In terms of ensuring that patients are able to access the most appropriate product, it would be helpful if NHS staff acknowledged that was not always the cheapest one. NHS bodies need to recognise the full lifetime and wider societal benefits of medical devices, including the ways in which they can help save money in other areas of spending, for example through reduced reliance on social care or reduced incidence of urinary tract infections.

However, as public finances are under an increasing amount of strain, there has often been pressure within the NHS to save money by steering patients towards cheaper products, even if they are not the most appropriate for their needs. This can include through introducing local formularies which narrow down the range of products approved for use at a national level into a reduced set of products for prescribers to recommend to patients. While it is generally argued that formularies do not overrule clinical judgement, if neither the patient nor the clinician is fully informed about a particular condition and the available options, then restriction of choice can be the practical effect of such measures.

This can for example prevent patients being able to access new and innovative products which may have a more expensive upfront cost but which can bring benefits in terms of patient comfort and improved clinical outcomes – which can save money in the long term.

Terms of reference

With the above issues in mind, we agree that the following will be useful as terms of reference for the inquiry:

·  the uptake of medical technology in Wales, and the possible barriers to effective new (non-drug) treatments being more accessible to patients

· current appraisal processes for new medical technologies

· the decision-making process in NHS Wales on funding new medical technologies/treatment

We would also suggest that the inquiry should look at particular at barriers at a local level which prevent patients from being able to access nationally approved medical technology.