Background
In December 2011, the Department of Health and Social Care (DHSC) set out plans to support the development, adoption and spread of innovation in the NHS. It published a report titled "Innovation, Health and Wealth, accelerating adoption and diffusion in the NHS", referred to as IHW. IHW is part of the Government’s Plan for Growth and the Life Sciences Strategy.
One of the actions identified in the IHW aims to drive implementation of National Institute for Health and Care Excellence (NICE) Technology Appraisals (TA). It also aims to reduce variation by publishing information that relates to levels of variation and compliance with NICE TAs locally. It stated:
"Working with industry, the Department of Health, NICE, the NHS and the Health and Social Care Information Centre, we will develop and publish a straightforward Innovation Scorecard, designed to track adoption of NICE Technology Appraisals at a local level."
IHW committed the NHS to establish a NICE compliance regime to ensure the rapid and consistent implementation of NICE TAs throughout the NHS. This regime was introduced in January 2012 and includes a new requirement in the Operating Framework, binding the NHS to comply with NICE TAs. The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE TAs where clinically appropriate.
The Accelerated Access Review (AAR) commissioned by the government in November 2014 sets out recommendations to speed up access to innovative healthcare and technologies. The final report released in October 2016 makes recommendations to make it easier for NHS patients to access innovative medicines, medical technologies, diagnostics and digital products, to improve efficiency and patient outcomes.
The AAR makes several references to the development of the Scorecard, in particular its role in measuring the uptake of medicines and potential to measure other technologies. It also makes a specific recommendation: “5.7. There should be a single, accessible source of information on the uptake of technologies for the NHS, patients and industry”.
The AAR proposes that the Innovation Scorecard should be the single source of information on the use of innovation in the NHS. It should be owned by NICE and used by the rest of the Accelerated Access Partnership, particularly NHS England, to hold the system to account and assess the progress of local areas.
The Innovation Scorecard is currently published every 6 months by the NHS Business Services Authority (NHSBSA) on behalf of the Office for Life Sciences. The NHSBSA onboarded the publication from April 2024, and it was previously published by NHS England with the first publication in January 2013.
This work is informed by collaborative working with colleagues from the Association of the British Healthcare Industries (ABHI), Cabinet Office, DHSC, the NHS, NHS England, NICE, Office for Life Sciences, and the pharmaceutical industry.
Introduction
The Innovation Scorecard aims to improve transparency within the NHS of what treatments recommended by NICE are available at a local level. The local level can be within trusts and ICBs as well as national and NHS England region levels. The Innovation Scorecard has been published with the intention of assisting the NHS in the identification of variation which, through discussion, can be explained, challenged, or acted upon. It is not intended to be used for performance management.
Information on compliance with NICE guidance by NHS organisations is not centrally collected. Due to limitations in the data available, and to improve transparency, the Innovation Scorecard reports on variation based on a range of different data sets. The data sets currently used in the publication include:
- English Prescribing Dataset (EPD) published by the NHSBSA
- Secondary Care Medicines Data (SCMD) supplied by Rx-Info and published by the NHSBSA
- Hospital Episode Statistics (HES) data from NHS England
- population data from the Office for National Statistics
- Defined Daily Doses (DDDs) from World Health Organisation Collaborating Centre for Drug Statistics Methodology
The resources available for this publication include this report with associated background quality report, estimate values with methodology, csv data files, guidance documents, a key facts infographic, and an online web platform.
Due to the provisional nature of some data included in the innovation scorecard, some figures may be revised from publication to publication as issues are uncovered and resolved. Users should always use the figures in the latest publication to ensure they are the most up-to-date figures available.
- The latest data is available up to December 2023.
Main findings
The Innovation Scorecard measures use of 190 medicines.
For the 12 months from January 2023 to December 2023, compared to the previous 12 months:
- 73.1% of medicines were prescribed more (125 of the 171 medicines with data for all 8 previous quarters)
- 15 of 17 medicine groupings were used more
The Innovation Scorecard includes 17 medicine groupings:
- direct oral anticoagulants (DOACs) for the prevention of stroke in primary care
- DOACs for the prevention of stroke in secondary care
- multiple sclerosis
- cystic fibrosis
- smoking cessation
- severe asthma
- acute coronary syndrome
- hepatitis C
- metastatic prostate cancer
- migraine
- epidermal growth factor receptor (EGFR) non-small-cell lung cancer
- hypercholesterolaemia
- COVID-19
- hereditary transthyretin amyloidosis (hATTR) polyneuropathy
- obesity
- sodium-glucose cotransporter-2 (SGLT-2) inhibitors
- icosapent ethyl
When interpreting the data there are a number of considerations:
- medicines can be used to treat multiple conditions
- a condition can be treated with various medicines
- one medicine may displace another, for example, an older class of medicine will show a large decrease in contrast to a newer class of medicine that has increased in use
- for a typical uptake curve the rate of increase is rapid in the early years but eases off over time
- year on year comparisons of the volume of medicine use may have been impacted by the effects of COVID
Medicines with an increase in use:
For the 12 months from January 2023 to December 2023, compared to the previous 12 months:
- there were 125 individual medicines which recorded an increase in prescribing, this is based on the 171 out of 190 individual medicines that had data for all 8 previous quarters
- year on year comparisons of the volume of medicine use may have been impacted by the effects of COVID
Medicines with a decrease in use:
For the 12 months from January 2023 to December 2023, compared to the previous 12 months:
- there were 46 individual medicines which recorded a decrease in prescribing, this is based on the 171 out of 190 individual medicines that had data in every quarter of the most recent 24 months
- year on year comparisons of the volume of medicine use may have been impacted by the effects of COVID
Medicine groupings
Medicine groupings were introduced to the Innovation Scorecard in January 2016 and have been developed by analysts and pharmacists at NHS England, the Association of the British Pharmaceutical Industry (ABPI), the Office of Health Economics (OHE), NICE, and the Office for Life Sciences (OLS).
These medicine groupings have been designed to show the combined use of medicines where:
- there are a number of medicines as options for treatment of a specific condition
- one TA covers more than one medicine for the same indication
- two or more TAs cover the same specific condition
It is more informative to compare uptake of combined options for treatment than only showing uptake of the individual medicines in isolation.
Estimates of medicine uptake require the medicines to be included in a grouping. There may also therefore be groupings based on a single medicine where an estimate of uptake is produced.
The published medicine groupings will only include those medicines with a positive TA. All other treatment options that may be available will not be reported in the Innovation Scorecard unless agreed by the Technical Working Group as an exception. Medicines with discontinuing use that have been replaced by newer medicines may also be excluded from the group.
There are 17 medicine groupings published in this release of the Innovation Scorecard with 11 estimates.
The use of medicines to prevent stroke (DOACs) is reported separately for primary care and secondary care due to the specific conditions they are being used for. All other medicine groupings report use in the NHS as a whole covering both primary and secondary care.
For the 12 months from January 2023 to December 2023:
- 15 of 17 medicine groupings were used more, compared to the previous 12 months