The below Parliamentary question was asked by Andrew Gwynne on 2016-07-19.
To ask the Secretary of State for Health, how long his Department estimates the Commissioning through Evaluation analysis phase will last for (a) selective dorsal rhizotomy, (b) patent foramen ovale closure, (c) left atrial appendage closure, (d) percutaneous mitral valve leaflet repair, (e) selective internal radiation therapy and (f) stereotactic ablative radiotherapy.
David Mowat
Commissioning through Evaluation (CtE) is an innovative £25 million programme introduced by NHS England in 2013. It specifically aims to generate valuable new evaluation data in promising areas of specialised care where the current evidence base of cost and clinical effectiveness is insufficient to support routine National Health Service commissioning, and where further formal research trials are thought to be less likely.
Each scheme – put forward by senior clinicians and other stakeholders – is funded on a time limited basis in a small number of selected centres, and then evaluated by the National Institute for Health and Care Excellence.
Once the planned number of patients has been recruited across the participating centres, each scheme closes to new patients and analysis begins. This means that the funding identified for each scheme can then be reinvested into the evaluation of additional potentially life changing specialised treatments to maximise the value and impact of the overall evaluation fund for patients. As an example, routinely funding Selective Dorsal Rhizotomy contrary to the currently published clinical commissioning policy and in advance of a formal review of any new evidence would mean that between £2 million and £4 million per year (covering the surgical costs and immediate follow up only) would then be unavailable to support the evaluation of other promising treatments.
The analysis phase for each CtE scheme will typically take between one and two years depending on how long we need to follow up patients after their treatment to identify its effectiveness. The three cardiology based CtE schemes are currently scheduled for a 15 month analysis and reporting phase, after which the data can be used by NHS England to support policy review.
However, CtE is only one form of data that might be put forward in considering a new (or revision to an existing) policy and clinicians do not need to await the final report from CtE schemes if they feel that other new substantive data becomes available more quickly.
NHS England’s published clinical commissioning policies (which set out eligibility for NHS funded specialised care on the basis of the available evidence) can be reviewed at any time where there is thought to be substantive new evidence available, and around 100 such proposals were developed and considered by NHS England during 2016/17.
The policy development process is subject to both informal stakeholder testing and formal public consultation, including the opportunity for patients, clinicians and industry representatives to review and comment on the evidence base considered and the assessed impact on patients, existing services and cost.
Where a new service is routinely commissioned as a result of a policy review, NHS England works with commissioned providers to ensure that sufficient clinical expertise and supporting infrastructure is in place to provide a safe service to patients in line with nationally set requirements.