Board strategy meeting 14 December 2016: confirmed minutes 1 of 6

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

Minutes of the Board Strategy Meeting held on 14 December 2016 in the Derwent meeting room, NICE London Office

These notes are a summary record of the main points discussed at the meeting and the decisions made. They are not intended to provide a verbatim record of the Board’s discussion. Present Chair Professor David Haslam Non-Executive Directors Professor Sheena Asthana Dr Rosie Benneyworth Professor Angela Coulter Professor Martin Cowie Elaine Inglesby-Burke Tim Irish Andy McKeon Jonathan Tross Tom Wright

Executive Directors Sir Andrew Dillon Professor Gillian Leng (item 8 onwards) Ben Bennett Professor Carole Longson Directors in attendance Professor Mark Baker Jane Gizbert Alexia Tonnel In attendance Mike Burdon Dr Peter Groves

Dr Peter Jackson

Professor Susan Jebb

Professor Danny Keenan

Professor Adrian Newland

Norma O’Flynn

Professor Andrew Stevens

Professor Martin Underwood

David Coombs (minutes)

Apologies (Board and Senior Management Team)

1 Apologies were received from Dr Rima Makarem.

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Conflicts of interest 2 With reference to item 8, Martin Underwood declared that he is

undertaking research on antimicrobial resistance, funded by the National Institute for Health Research (NIHR). David Haslam confirmed this did not present a conflict of interest in relation to the matters for discussion at the meeting.

Minutes of 20 October 2016 Board Strategy Meeting 3 The minutes of the Board Strategy meeting on 20 October 2016 were

agreed as a correct record.

Matters Arising

4 Carole Longson confirmed that the Department of Health have approved the proposal for NICE to commission external support to deliver significant organisational change in the Centre for Health Technology Evaluation (CHTE). The business case now awaits approval from the Cabinet Office.

Chief Executive’s update

5 Andrew Dillon briefed the Board on the proposed timetable for

developing NICE’s 2017-18 business plan. The broad financial plan is already in place as part of the strategic savings programme, and the Board will be able to review the proposed business objectives at the morning session of the January Board meeting. The draft business plan will then be presented to the February Board Strategy meeting, with the aim of seeking Board approval of the plan at the March Public Board meeting. Andrew also outlined the proposed strategic objectives for 2017-18.

6 The Board discussed and supported the strategic objectives, subject to

refinement to give greater external focus, including referencing healthcare professionals, patients and service users. It was noted that the business objectives will reflect NICE’s shared leadership role in the health and social care system alongside the other national agencies.

ACTION: Andrew Dillon

7 Andrew highlighted key themes that he believes will affect NICE in 2017

and set the context for the business plan. He noted that NICE must continue to promote excellence, whilst taking account of the resources available to the health and care system. The Government’s approach to the life sciences industry will influence a number of strategic issues facing NICE, including the next steps following the recent joint

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consultation with NHS England on changes to the technology appraisal and highly specialised technologies programmes.

8 The Board discussed these strategic themes, in particular how NICE can ensure its resources most effectively assist the health and care system respond to the significant financial pressures currently faced. Andrew Dillon noted NICE’s role in promoting standards of care, and that if consistently implemented, quality standards can help reduce variations in quality. It was highlighted that NICE is well placed to support the Government’s ambitions towards the life sciences industry whilst also helping the health and care system respond to the financial challenges.

Government life sciences strategy 9 Andrew Dillon stated that as discussed at the last Board meeting, he has

met with Carole Longson and Tim Irish to consider how NICE could contribute to the Government’s life sciences industrial strategy. Andrew outlined how NICE’s work currently supports the life sciences industry, including through its appraisal and guidance development programmes, and advice to industry via the Office for Market Advice (OMA) and NICE Scientific Advice (NSA). He then set out proposals to further enhance this support to the life sciences industry.

10 Firstly, NICE could potentially help reduce the risk for those seeking to introduce their products to the UK market by helping companies focus their value proposition on the most compelling data. Secondly, NICE could further work with companies and the NHS to design and manage novel evidence generation processes and new data-driven funding models for fast-track approval and reimbursement. Thirdly, building on the international benefit of a positive NICE appraisal, there could be scope to establish a US-based OMA and NSA. The final strand of the proposed support relates to how NICE could support the UK have a world-leading approach to using data to track outcomes and manage early access to new technologies.

11 The Board discussed and supported the proposals as the basis for further engagement with the development of the industrial strategy. In addition, it was agreed that further consideration should be given to how NICE could support the broad spectrum of the life sciences industry, in particular med-tech and small and medium sized enterprises.

ACTION: Andrew Dillon

Committee chair update 12 Professor Adrian Newland, chair of Diagnostics Advisory Committee,

gave a presentation on the committee’s work. Established in 2009-10 the committee evaluates the clinical and cost-effectiveness of

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pathological tests, imaging, endoscopy, algorithms or test combinations, and physiological measurement. Professor Newland outlined how the committee evaluates products and topics following notification by companies or clinicians, and subsequent selection by the Medical Technologies Advisory Committee.

13 Professor Newland highlighted that the diagnostic technology and price may change during the committee’s evaluation process. Also, for both regulatory and economic reasons, the evidence base for diagnostic technologies is different compared with pharmaceuticals. The programme’s methods take account of these challenges. Professor Newland concluded by highlighting the programme’s reputation and impact nationally and internationally, and the potential opportunities arising from the Accelerated Access Review.

14 On behalf of the Board, David Haslam thanked Professor Newland for the work of the committee.

Antimicrobial resistance 15 Gill Leng presented the report that outlined NICE’s current and planned

work to address antimicrobial resistance to antibiotics. Nick Crabb, programme director in CHTE, is coordinating these activities which span a number of programmes at NICE.

16 Gill Leng noted that a Public Health Advisory Committee has been re-established as a specialist committee to develop a series of syndrome specific short clinical guidelines that will provide recommendations for managing common infections in primary and secondary care. She explained there will be two different approaches to evaluate new antimicrobials, depending on their potential impact. NICE will produce a new product, Antimicrobial Prescribing Advice, for new antimicrobials that offer incremental benefits compared to existing agents. Whereas technology appraisal guidance will be produced for new antimicrobials that have high potential to address unmet need. Capturing the full value of these new transformative antimicrobials will be complex, given the intention to ‘de-link’ payment and usage. This will require changes to the technology appraisal process.

17 The Board discussed the importance of communicating NICE’s guidance on this topic, and using a range of media in addition to the British National Formulary (BNF) to disseminate it to clinicians. It was noted that the proposals further diversify the types of guidance produced by NICE, and therefore the terminology around the different guidance will need to be explained. Public engagement and shared decision making will also be key in reducing inappropriate prescribing of antibiotics. Jane Gizbert confirmed that a communications plan is being developed, and she would brief the Board on this accordingly.

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ACTION: Jane Gizbert

18 The Board noted the report and supported NICE’s activities in this area. NICE support for a digitally enhanced IAPT 19 Gill Leng briefed the Board on a proposal for NICE to facilitate the use

of therapist assisted internet treatments within the improving access to psychological therapies (IAPT) programme.

20 Under the proposal, NICE will evaluate selected, digitally enhanced therapies for depression and anxiety using ongoing data collection to determine whether there are improvements in service efficiency, and whether patient outcomes are at least as good as those achieved by NICE recommended, non-digital therapy. Products will be reviewed each quarter, and at the end of the two year period, suitable products would receive final approval for wider roll-out.

21 There is government support for the proposal, and subject to provision of funding to NICE, and agreement from the NICE Board, the aim is to issue provisional approval to implement and evaluate the first technology in the summer 2017.

22 Martin Underwood commented from his background in a clinical trials unit on the challenges of ensuring an accurate review of the effectiveness of the digital therapies. Carole Longson agreed with the importance of clarity over the purpose of the study and the outcomes being evaluated. She noted though NICE’s experience in using real life data in the commissioning through evaluation programme.

23 The Board endorsed NICE’s proposed involvement, subject to the provision of the required funding. It was noted that this is an example of NICE’s innovation in methods and processes to evaluate technology through new mechanisms. The Board noted that the approach of assessing products through ongoing data collection could potentially be adapted and rolled out to other technologies and interventions.

24 The Board confirmed the importance of a robust and transparent process to select products for evaluation. Also, the introduction of digitally assisted services should be managed in a way that does not marginalise service users without access to such technology.

Any other business

25 David Haslam highlighted this was Jonathan Tross’ last Board meeting.

On behalf of the Board, David paid tribute to Jonathan’s outstanding contribution over the last nine years as a non-executive director.

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The Board then held a short part 2 meeting, attended by the Board and Senior Management Team.

Date of the next meeting

26 The next Board strategy meeting will be on Wednesday 15 February 2017 in the Derwent room at the NICE London office.