PHCN Horizon scanning (Excel) by fanzhongqing


									Healthcare commissioning: horizon scanning
Public Health Commissioning Network (
Version date                                     12/6/2010

Prog budget                                                  spend £ bn
category       Title                                         2008/9       Current major time-consuming/unresolved issues
      1        Infectious Disease                                     1.4 Immunisation - Child Health system data accuracy
                                                                            Barriers to parents giving consent for immunisation
                                                                            Increasing prevalence of HIV and maintaining people on ART
                                                                            Changing demographic of people with HIV

      2        Cancers and Tumour                                     5.1 New drugs especially monoclonal antibodies
                                                                            Cancer drugs fund - spend vs health gain

      3        Disorders of Blood                                     1.3
      4        Endocrine, Nutritional and Metabolic                   2.5

      5        Mental Health Disorders                              10.4 Growth of alcohol misuse and related hospital admissions
                                                                            Lack of data on needs and outcomes for mental health services

                                                                            No agreed dataset of mental health indicators
                                                                            Evidence base on primary prevention could be strengthened

      6        Problems of Learning Disability                        2.9 Children with LD disengaged from GPs & wider primary healthcare

                                                                            Unmet primary health care needs; premature death
                                                                            Access to acute mental health services
                                                                            Parents with LD; people with LD in criminal justice system
      7        Neurological                                           3.7 NICE CG on neuropathic pain medication not affordable
                                                                            Thresholds and variation in interventional pain procedures
                                                                            Gaps in tier 2 pain management and self care
      8        Problems of Vision                                     1.7 Lucentis vs Avastin
      9        Problems of Hearing                                    0.4 ? Rising pt demand for bone-anchored hearing aids, middle ear implants
                                                                          and cochlears
                                                                          Paediatric audiology - no workforce plan, no trainees
     10        Problems of Circulation                                7.4 Transcather aortic valve implantation (TAVI)
                                                                            NICE guideline CG 94 (NSTEMI/unstable angina)
                                                                            NICE guideline CG 95 (chest pain)

     11        Problems of the Respiratory System                     4.2 Increasing access to pulmonary rehab, early discharge/care at home

                                                                            NICE CGs on asthma and COPD probably unaffordable
12    Dental Problems                        3.1 Commissioning services in prisons
13    Problems of Gastro Intestinal System   4.1 ? Use of anti-TNFs for IBD outside NICE TAG for Crohns
14    Problems of the Skin                   1.8 ? Use of anti-TNFs outside NICE TAGs
                                                   Developing safe and efficient pathways for minor skin lesions
15    Problems of Musculo Skeletal System    4.2 Cementless hips
                                                   New anti TNF drugs; increasing spend of existing anti-TNFs
                                                   Newer osteoporosis drugs
                                                   Diagnosing RhA earlier to reduce/delay need for anti-TNFs
16    Problems due to Trauma and Injuries    3.3 Fragmented care pathway - need better link with primary care and rest of
                                                 bone health
                                                 Regional trauma networks - working party Keith Willets 2011
17    Problems of Genito Urinary System      4.0 Pressure on IVF

18    Maternity and Reproductive Health      3.1 Achieving reductions in interventional (CS and assisted) deliveries

                                                   GP role in antenatal care (deskilling; lack of clarity in contract)
19    Conditions of Neonates                 1.1
20    Adverse effects and poisoning          0.9
21    Healthy Individuals                    1.9 Using sustainability in commissioning

22    Social Care Needs                      3.2 Social care for people with HIV - surviving longer
                                                   Social care for people with HIV - loss of AIDS support grant ringfence

23    Other incl Primary Care Contracting

n/a   Cross-cutting programmes, no £ data          Cheap unlicensed vs expensive licensed drugs
                                                   Evidence base for surgical procedures
                                                   Palliative care access to 24/7 care - national programme 2011
                                                   Systematic management in community of those with LTC

n/a   Children                                     ADHD - GP prescribing
                                                   ADHD transition to adult services

                                                   Complex health needs transition to adult care
                                                   Young people in custody - mental health assessment
                                                   Paediatric audiology - no workforce plan, no trainees
                                                   Reconfiguration of acute paeds services (see RCPCH docs)
                                                   Child protection networks (see DH doc)
                                                   Reconfiguration of neurosurgical services
                                                   Reconfiguration of cardiac services
n/a   People with physical disabilities

n/a   Frail elderly people                         Over-medication of frail elderly in nursing and residential homes

                                                   Preventing inappropriate emergency admissions
n/a   Homeless people
n/a   Imaging   NICE guidelines CG 94 (NSTEMI/unstable angina); CG 95 (chest pain)

n/a   Labs      NICE guideline - use of pro-BNP for screening heart failure
Got anything to add? Please email if you have any suggestions on upcoming
major commissioning issues

Possible future time-consuming/major issues
Newer HIV drugs
Continued increase in prevalence of HIV with longer survival
Should HIV be on the LTC agenda?
Wider prescribing of non-ARV drugs in secondary care for HIV
Earlier drug prescribing for HIV and associated cost pressures
New drugs especially monoclonal antibodies
Need more robust evidence base for early awareness/diagnosis initiatives
Affordability, ROI and benefit/harm ratio of screening programmes

Criteria for type 2 diabetes
? New insulin pumps
Dementia care
Newer dementia drugs

Lowered NICE threshold for AChE drugs
Impact of housing benefit reform on those with MH problems
Managing very expensive out area MH placements
Defining responsibility for commissioning alcohol interventions?
Measuring and incentivising individual and population-level outcomes for alcohol

Integrating substance misuse agendas
Fetal alcohol spectrum disorders

Increase in people with LD caught up in criminal justice system

Chronic pain

New licenced indications for Lucentis

New NICE guideline (CG108) on heart failure - significant change to current practice
General growth of vascular technologies (medical / surgical)
Assistive technology for heart failure
Unscheduled services spend on heart failure
Scope to increase access to effective treatments and improve outcomes for heart failure
Angina management NICE guideline expected 2011
Heart disease decreasing
Dabigatran (and other newer anticoag agents); anticoag clinic commissioning
Where will commissioning of FH and hereditary cardiac disorders sit?
Change in alteplase licence for acute stroke, extending window from 3h to 4.5h
Continuous positive airways pressure (CPAP) ventilation
Liver disease increasing

Hip arthroscopy

Provision of specialised replacement artificial limbs for ex-military personnel

Rising GUM activity associated with high tariff - ? use community more
High cost sexual health screening programmes should be nationally agreed
Workforce pressures - midwifery (recruitment & retainment)

Workforce pressures - obstetrics (reduced training places, targets)
? Over-coding of neonates as 'unwell', earning higher tariff

Significant potential for NHS/GPCC to disengage with agenda with move to LA
Pressure to significantly increase capacity for bariatric surgery for morbidly obese
Affordability of bariatric pathways in general
Tension between tobacco control and smoking cessation
Services required by increasingly dependent smokers in future, to help quit
Housing benefit reform - housing conditions and affordability, impact on at-risk groups
Impact of welfare reform, including incapacity benefit review
Affordability, ROI and benefit/harm ratio of screening programmes
Move to local authority
Increased demand, personalisation and reduced funding

Ensuring independent assessment of VFM of new primary care pathways locally
Need net transfer of healthcare capacity from secondary to primary care
Explosion in genetic testing
Medical devices - industry lobbying, and little evidence?
Value-based pricing
Continuing evidence appraisal for new interventions while PH potentially scattered

NICE TAGs and CGs are often unaffordable; not implementing those of marginal benefit

Cousin marriage/consanguinity in some BME populations
Autism-spectrum disorder (ASD) assessment and treatment - NICE guidelines 2011

Provision of specialised replacement artificial limbs for ex-military personnel
Complexity and expense of limb prosthethis

Housing benefit reform - housing conditions and affordability
Cardiac imaging, especially MR

Explosion in genetic testing
Healthcare commissioning: horizon scanning

Many thanks to...

Greg Fell
Janet Cobb
Val Billingham
Daphne Austin
Frances Mortimer
Liz Bailey
John Soady
James Morris
Sharon Yellin
Eugenia Lee
Helen Miller
Anita Roy
Vicky Hobart
Lesley Talbot
P Badrinath
Simon Lenton
Nicolay Sorensen
Chris Weston
Andrew Rix
Judith Bell
Veena de Souza
Sheila Paul
Jane Wells

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