- The Urology Trade Association wishes to highlight in its response its strong support for the Drug Tariff, which provides confidence to all parties that devices listed are effective, safe, cost-effective, with price certainty.
- The UTA notes that it is essential that commissioning staff understand the differences in seemingly-similar products, which can impact on a user of such a medical device, ranging from mild discomfort to infection, leading to hospital admission.
- We suggest the Committee should investigate the value of developing partnerships between continence advisers and commissioning staff, so commissioners always have access to expert advice.
- We also believe the Committee should make a strong recommendation that especially in times of limited public resource, it is essential that patient choice is preserved, so that patients can remain independent and dignified and the health service does not have to deal with the consequences of short-term decision making.
Introduction and background
- The Urology Trade Association (UTA) welcomes this opportunity to respond to the Health and Social Care Committee inquiry on access to medical technologies in Wales. The inquiry is particularly important in light of the significant positive impact medical devices to assist those affected by continence problems can have, and the consequences for individuals who do not receive the correct product for their condition.
- The UTA’s member companies produce a range of products including catheters and leg bags, which help individuals affected by continence issues live their daily lives with as much dignity and independence as possible. The UTA comprises 95% of urology product manufacturers and suppliers to the urology appliance market.
- An estimated six million people in the UK are affected by continence problems and may rely on urology appliances on a daily basis; including people with a number of complex long term conditions such as spinal injury, multiple sclerosis, cancer, spina bifida and other neurological conditions.
Assessment of new medical technologies
- New products designed by urology manufacturers, including UTA members, must be entered on the Drug Tariff before becoming available for prescription. The UTA believes that the Drug Tariff provides confidence to all parties involved – patients and health professionals can know that devices listed are effective and safe, commissioners know the devices are cost-effective, the price to be paid for devices and that they are appropriate for prescribing, and manufacturers receive certainty regarding the price they will be paid.
- The UTA notes that the National Institute of Health and Care Excellence produces a range of guidance, appraisals and standards which have different geographical applicability throughout the different countries in the UK. In particular, the UTA notes that medical technologies guidance and quality standards produced by NICE do not apply to Wales.
Commissioning and procurement
- As noted in the UTA’s submission to the consultation on the scope of the inquiry, there is often a perception amongst commissioning and procurement staff that similar-seeming urology products are interchangeable or fully substitutable. However, while products may look superficially similar to non-experts or non-users, in actual fact such products have significant differences which can have a major impact on a user of such a medical device, if they are prescribed an inappropriate device. Indeed, it can take several attempts before an individual is fully satisfied with such a device.
- By way of example, leg bags may have different straps and valves which are designed to meet the needs of a patient. The condition of the patient may lead to them preferring more securely attached leg bags, or attachments with more flexibility. Mobility issues may lead to greater difficulty in emptying a bag which may require difference in design.
- Inappropriate devices can cause a range of difficulties ranging from mild discomfort to infection, and consequential increased dependence on the health service. Inappropriate catheterisation and urinary tract infections is a significant burden on the health service and despite usually being easily treatable are usually avoidable.
- Thus, the UTA argues that it is essential that staff responsible for commissioning and procuring continence-related care and medical devices must be fully trained to understand both the differences in medical devices and the need of patients to be able to access a range of devices to ensure they can choose one which best meets their needs.
- Such staff should also consider the long- term impact of failure to provide suitable devices to individuals, including as mentioned above the potential for increased urinary tract infections.
- The UTA also believes that it is important that continence services are of high quality, as access to innovative products would be best-preserved by ensuring that healthcare professionals and patients have access to information and support. We are aware of particular issues faced by users and patients, such as insufficient specialist advisers, difficult-to-access services, and inconsistency in referral processes. Additionally, sometimes health professionals themselves are not fully aware of particular conditions which cause continence problems, leading to incorrect advice being given.
- There are a range of expert continence advisers across Wales and we would suggest that the Committee investigate the value of developing a partnership programme between continence advisers and procurement/commissioning teams, to ensure that commissioning staff always have access to expert advice.
Financial barriers to adoption of new medical technologies
- The UTA wishes to raise concern that the increased pressure on public finances may have in leading to short term decision making across the Welsh NHS. While the UTA understands the difficult economic situation that the Welsh health service finds itself in, we feel that this should mean even more emphasis is placed on robust assessments of value over the medium and long term.
- Through the national Drug Tariff commissioners of health services can be reassured that the products listed have been assessed for both clinical and cost effectiveness. The UTA feels that any attempt at circumventing the Drug Tariff, such as through formularies established by local Health Boards, which restrict the range of products that GPs or other healthcare professionals are able to prescribe. While an organisation establishing a formulary may not restrict access to off-formulary products, in practice access to off-formulary products is very difficult due to a lack of information and added bureaucracy.
- The UTA feels that the Committee should make a strong recommendation that in times of more limited public resources it is even more important that patient choice is preserved and access to appropriate urological medical devices is maintained. This will ensure that patients can remain independent and dignified and that the health service does not have to deal with the consequences of short term decision making that leads to increased costs.