Flexibility needed in funding for new technologies
In their stimulating piece on NICE, Cookson et al suggest consistency in decisions on rationing might be achieved by establishing a “fixed growth budget for new technologies” This fixed growth budget, which it is argued would concentrate the mind of central policy makers on the cost-effectiveness of new technologies, could be distributed to Health Authorities and Primary Care Trusts in proportion to the estimated net costs of the new technologies. However, this approach would fail to acknowledge different “distances” from implementation in different health care systems.
There is currently no straightforward mechanism by which the position of any local healthcare economy with regard to the use of the health technology can be known to the Department of Health. Nor is there likely to be one. An alternative, and more locally sensitive option, would be through a system of bidding. This has been carried out at least twice recently, in the case of the extensions to the NHS Breast Screening Programme and the pilot studies of Neonatal Hearing Screening. In both cases, local systems were required to identify and justify the resources required to meet reasonably clear policy objectives in terms of technology implementation – in the former case extending the use of existing technology and in the latter case moving to implementation of a new technology. This process has benefits for both the central and local elements of the NHS.
The bidding process can improve the quality of local information and bring together different parts of the NHS where implementation is required across organisational boundaries. For the centre, it provides a “reality check” for the relatively crude estimates of budget impact that are sufficient for prospective Treasury accounting purposes. It also provides an opportunity to consider the extent to which other policy goals, such as equity, are being incorporated into the implementation plans at local levels.
A significant drawback to this approach would be delays in the implementation of technologies. However, without such a system the implementation of NICE Guidance remains susceptible to the vagaries of local prioritisation and allocation systems. Furthermore, the need to provide a clear implementation plan, supported by clearly justified resource requirements, provides a template against which the Commission for Health Improvement might be able to fulfil its objective of ensuring the implementation of NICE Guidance.
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Flexibility needed in funding for new technologies
In their stimulating piece on NICE, Cookson et al suggest consistency in decisions on rationing might be achieved by establishing a “fixed growth budget for new technologies” This fixed growth budget, which it is argued would concentrate the mind of central policy makers on the cost-effectiveness of new technologies, could be distributed to Health Authorities and Primary Care Trusts in proportion to the estimated net costs of the new technologies. However, this approach would fail to acknowledge different “distances” from implementation in different health care systems.
There is currently no straightforward mechanism by which the position of any local healthcare economy with regard to the use of the health technology can be known to the Department of Health. Nor is there likely to be one. An alternative, and more locally sensitive option, would be through a system of bidding. This has been carried out at least twice recently, in the case of the extensions to the NHS Breast Screening Programme and the pilot studies of Neonatal Hearing Screening. In both cases, local systems were required to identify and justify the resources required to meet reasonably clear policy objectives in terms of technology implementation – in the former case extending the use of existing technology and in the latter case moving to implementation of a new technology. This process has benefits for both the central and local elements of the NHS.
The bidding process can improve the quality of local information and bring together different parts of the NHS where implementation is required across organisational boundaries. For the centre, it provides a “reality check” for the relatively crude estimates of budget impact that are sufficient for prospective Treasury accounting purposes. It also provides an opportunity to consider the extent to which other policy goals, such as equity, are being incorporated into the implementation plans at local levels.
A significant drawback to this approach would be delays in the implementation of technologies. However, without such a system the implementation of NICE Guidance remains susceptible to the vagaries of local prioritisation and allocation systems. Furthermore, the need to provide a clear implementation plan, supported by clearly justified resource requirements, provides a template against which the Commission for Health Improvement might be able to fulfil its objective of ensuring the implementation of NICE Guidance.
Competing interests: No competing interests