LOOKING BACK, LOOKING LOOKING BACK, LOOKING FORWARD:FORWARD:

The view from Health BoardsThe view from Health Boards

Tom Divers,Tom Divers,

SMC Member andSMC Member and

CE, NHS Greater Glasgow & ClydeCE, NHS Greater Glasgow & Clyde

LOOKING BACK, LOOKING FORWARD:LOOKING BACK, LOOKING FORWARD:Budget Impact AnalysisBudget Impact Analysis

Peripheral to SMC decision … butPeripheral to SMC decision … but Central to NHS PlanningCentral to NHS Planning SMC ‘Intelligence’SMC ‘Intelligence’

SubmissionSubmission Expert CommentsExpert Comments

Support for SMC User Group Review Support for SMC User Group Review Consistent & transparent structureConsistent & transparent structure Gross & net costsGross & net costs Adaptable to local circumstancesAdaptable to local circumstances

Public Petitions CommitteePublic Petitions Committee Availability of and access to new medicinesAvailability of and access to new medicines Openness, clarity, transparency … FlowchartOpenness, clarity, transparency … Flowchart

Respective roles of national and local processes?Respective roles of national and local processes? Distinctive contributionDistinctive contribution Continuum for managed introduction of new medicinesContinuum for managed introduction of new medicines

Joint challenge for SMC & NHS BoardsJoint challenge for SMC & NHS Boards Public perception of NHS prescribing?Public perception of NHS prescribing? ExamplesExamples

Cancer medicinesCancer medicines Antimicrobial therapyAntimicrobial therapy

LOOKING BACK, LOOKING FORWARD:LOOKING BACK, LOOKING FORWARD:Patient and Public InvolvementPatient and Public Involvement

LOOKING BACK, LOOKING FORWARDLOOKING BACK, LOOKING FORWARDOrphan Drugs - A Wicked Issue?Orphan Drugs - A Wicked Issue?

Often areas of greatest debate at SMCOften areas of greatest debate at SMC - less confident touch in decisions- less confident touch in decisions

Cost-effectiveness is generally challengingCost-effectiveness is generally challenging

Is it inevitable that decision-making is pushed down to Is it inevitable that decision-making is pushed down to NHS Board and individual patient level?NHS Board and individual patient level?

Boards’ ‘risk-sharing’ arrangement is pragmatic Boards’ ‘risk-sharing’ arrangement is pragmatic ‘ ‘holding’ positionholding’ position

LOOKING BACK, LOOKING FORWARDLOOKING BACK, LOOKING FORWARD “Accepted for use” – Too broad a church?“Accepted for use” – Too broad a church?

Force of SMC decisions not well understood by some Force of SMC decisions not well understood by some politicians and mediapoliticians and media

- local ADTC now determines formulary status- local ADTC now determines formulary status ‘‘Unique’ status is rare attributionUnique’ status is rare attribution ‘‘Accepted for use’: from elements of ‘unique’ to ‘me too’Accepted for use’: from elements of ‘unique’ to ‘me too’ Is any finer gradation reasonable or possible?Is any finer gradation reasonable or possible? Can we rely on maturity of ADTCs to ensure that Can we rely on maturity of ADTCs to ensure that

important advances are implemented consistently?important advances are implemented consistently?

Evaluation successEvaluation success Comprehensive horizon scanningComprehensive horizon scanning Timely ADTC adviceTimely ADTC advice Effective communication networksEffective communication networks

ChallengesChallenges Orphan medicinesOrphan medicines Accepted for use …Accepted for use … Budget impact analysisBudget impact analysis Public involvementPublic involvement

FutureFuture Development of SMC / NHS B partnershipDevelopment of SMC / NHS B partnership

LOOKING BACK, LOOKING FORWARD:LOOKING BACK, LOOKING FORWARD:View from Health BoardsView from Health Boards