NHS England Commissioning Work

Pilot investigation of IDEAL as a decision tool for Specialised Commissioning by NHS England

Following a Policy Workshop to which we invited senior leadership from several governmental organisations which need to make evidence-based decisions about novel therapies including complex interventions, we were asked by the Medical Director of NHS England, Stephen Powis, to work with Dr Anthony Kessel, head of Policy or Specialised Commissioning, to trial the use of IDEAL in their decision-making process.

In the UK system, the commissioners decide how government funding is distributed within the NHS.  Most funding for routinely provided treatment is decided regionally, but novel, costly and controversial treatments are considered at a national forum.  We have worked with this group for over a year to identify proposals for funding treatments which are suitable for analysis using IDEAL (mainly therapeutic devices).

The NHS England team is responsible for collecting and evaluating published evidence on the device and has had an IDEAL analysis of Stage added to their workflow for these cases.  The panel members who make the decisions have received brief training on IDEAL and how to use it, and a clear explanation of the meaning of the IDEAL  Stage of the evidence for a treatment.  Our proposal to NHS England is that an evidence base containing at least one study equivalent to an IDEAL 2b study (a large prospective collaborative cohort study) should be the threshold for consideration at the Clinical Panel that makes purchasing decisions.  If there are no such studies the treatment should be considered experimental, disqualifying it from receiving routine funding.

We are hopeful that this addition will both simplify the decision-making process and make it more standardised, fairer and more evidence-based.  The pilot is due to continue during 2023 and a decision will then be made about whether IDEAL will be adopted as part of the process.