PHCN Horizon scanning (Excel)
Document Sample
Healthcare commissioning: horizon scanning
Public Health Commissioning Network (www.phcn.nhs.uk/horizonscanning)
Version date 12/6/2010
National
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 tomporter@nhs.net 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
Contributors
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
