Catriona Manville

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003–13: a multimethod evaluation

BACKGROUND The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. METHODS Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. RESULTS We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.

Innovative Procurement for Health and Industrial Development

Part II of this book has demonstrated that building synergies between health systems and industrial development is a complex process of reshaping the politics and political economy of the two systems. A key tool for building and sustaining health-industry relationships, as Smita Srinivas observes above and as some Part I chapters also emphasized, is procurement. Yet procurement remains under-researched and over-simplified as a technical, linear, ordering and delivery process (see Chapter 8), rather than an exercise in deepening and strengthening the domestic economy through market and non-market relationships building.

Education: Digital technology's role in enabling skills development for a connected world

This Perspective explores the ways in which the growth of digital technology is impacting education and skills.

Digital Learning: Education and skills in the digital age

The report gives an overview of an expert consultation on the role and future of education and skills in the digital world. It looks at which skills are important and necessary for current and future jobs, and what skills we need to be thinking of developing now and in the future. The report also highlights the important role of government and industry in encouraging the greater use of digital technologies in learning.

Open science: The citizen's role in and contribution to research

O pen science can be thought of as a movement or an evolution in the research process. It relates to how scientists interact with one another and how the public engages with and is engaged in science. It also relates to societal expectations about the imperative to share results – particularly those obtained through publicly funded research. In practical terms, open science can be seen as a systemic change in the way research is conducted, affecting steps throughout the research process, from idea generation, planning and design, through to the outputs and impacts of research further along in the process. Linking these changes towards openness is a shift in our understanding of the role of science in society that, some have argued, is bringing back values that have been overshadowed in modern science, such as a spirit of exploration (Lichten et al. 2014) and an appreciation for sharing knowledge (Könneker & Lugger 2013). Digital technology has enabled radical changes in how we

Digital Currency and the Future of Transacting

D igital technology has not just changed the way that we communicate with one another, it has allowed new platforms and mediums of transaction to emerge which could fundamentally alter the nature of how we organise the exchange of goods and services. Early message services allowed potential buyers and sellers to connect and arrange offline exchanges; improved encryption methods allowed the direct communication of bank account details; the growing numbers of web users facilitated websites and services based entirely on online advertising revenue; and improved payment and messaging systems facilitated the online presence of established businesses, the growth of niche online shops able to access a wider market, and dedicated e-commerce giants such as Amazon and eBay. At the same time, innovations in payment platforms have led to a diminishing role for physical currency, even

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

This study aimed to inform Hepatitis C (HCV) treatment by (1) better understanding the nexus of factors physicians consider when making HCV treatment decisions; (2) investigating the comparative influence and importance of specific factors and the trade-offs implicated in the decisionmaking process; and (3) examining how much thrombocytopenia impacts treatment decisions and how it impacts treatment. To meet this goal, we conducted five analyses, focusing on four European countries characterised by different approaches to healthcare organisation and financing, which alongside cultural differences may have potential implications for treatment pathways for patients with HCV infection. These were: France, Italy, Spain, and the United Kingdom. These analysis included: Review the academic literature and of relevant national and European guidelines;Conduct key informant interviews (KIIs) with national experts to contextualise the data from the literature review and further explore some emerging themes;Map the patient journey in the four countries to identify stages HCV patients pass through once they have entered the healthcare system and map, for each stage, potential points of departure from the typical journey;Design and conduct of Discrete Choice Experiments (DCEs) to quantitatively assess the importance of factors that influence treatment decisions;Conduct expert workshop to help build scenarios identifying challenges to HCV treatment.The five analyses build on one another, with the first three providing evidence that fed into the design of the DCEs and with the DCE results in turn serving as the key inputs into building the scenarios for the expert workshop.