NICE's Deputy Chief Executive Prof Gillian Leng: 5 Questions

Peter Russell

Disclosures

August 13, 2018

Professor Gillian Leng is the deputy chief executive at the National Institute for Health and Care Excellence (NICE), the director of health and social care, and a visiting professor at King's College London.

After training in medicine at Leeds, she spent several years researching the epidemiology of peripheral vascular disease at Edinburgh University.

Prof Leng specialised in public health medicine and worked as a consultant before moving to NICE in 2001.

At NICE, she was responsible for the initial set up and running of the clinical guidelines programme and for establishing the NICE implementation function.

She also established NHS Evidence, a source of information and best practice guidance for health, social care and public health that emerged in the wake of Lord Darzi's 2008 strategy for improving patient care.

   

Prof Gillian Leng

More recently she has been responsible for the transfer of the National Prescribing Centre into NICE, for establishing the NICE accreditation programme, and for new work on quality standards across health and social care.

Q&A

Medscape UK: What do you think have been the major milestones since NICE was established?

Prof Gillian Leng: There are several major milestones relating to points when we've taken on significant areas of work. The first one would have been when we merged with the Health Development Agency. That gave us a public health function and we became the National Institute for Health and Clinical Excellence.

There was quite a big expansion in NICE's remit following the Darzi report, including the setup of NHS Evidence.  At that point we took over the National Library for Health, which gave NICE a significant role in the information world.

Shortly after that we also absorbed the National Prescribing Centre and we took on responsibility for the BNF [British National Formulary], which gave NICE a significant remit with prescribers. And after that we took on the National Technology Adoption Centre to support the work that we do around adopting new technologies.

Most recently of course the Health and Social Care Act of 2012 gave us a social care remit and expanded what we do right across public health and social care. Also set out in the Act were the quality standards that NICE now develops right across the system.

Medscape UK: You have figured prominently through much of NICE's history. You're frequently seen as the person behind new ideas, such as the NHS Evidence web portal, what would you say has been your biggest achievement and what has that contributed to health and social care?

Prof Leng: I think NHS Evidence was a significant achievement. At the time, it was really quite a challenge to get it together in the timeframe that we’d been given. Of course it was underpinned by IT, and IT projects are never easy. So, I was quite pleased that we'd managed to deliver an IT project to time and to budget.

But perhaps underpinning all of that, most of my time at NICE has been focussed on putting in place mechanisms to support the uptake of NICE's recommendations.  This has been an ongoing piece of work, including providing practical support, understanding what the system needs by engaging with others, and thinking about the levers for change, such as the inspection mechanism. Adoption is an ongoing requirement and something I'm proud of leading, as getting change to happen is a challenge – we all know that – even when it's going from worse to better. It's a challenge to make change happen and it requires commitment to work with a system that reforms itself quite regularly – new people, new organisations, [and] new structures.

Medscape UK: We live in a time when the population is ageing, pharmaceutical costs are high and the NHS budget is squeezed. What might this mean for NICE's funding guidelines in the future?

Prof Leng: It's always been a challenge to get anything new funded in the system, and as you say particularly challenging now as money is tight.

There are a number of things to point out. One is that we are very sensitive to cost when we actually develop guidelines, so we look for what's cost effective practice to identify what should be promoted as a new, important intervention for the system. But we also look for things that can be stopped and disinvested. So, we actively promote areas of disinvestment where we can to support the system to make savings.

However, it may still be that there is an added cost from putting a guideline into place, so once the guideline is finalised there's a team that calculates the resource impact of putting that guideline into place.

Calculating resource impact is an ongoing piece of work with a RAG-rated table [RAG is an acronym that stands for Red, Amber, Green and relates to project status] that tells us where we think there will be significant costs in putting a guideline into place. And to help manage that in the future, we recently set up a new panel called the Guidelines Resource Impact Panel, which I chair.  It has members from key arm's- length bodies – NHS England, NHS Improvement, Health Education England, Public Health England – and the aim of that is to help manage the introduction to the healthcare system of anything with an added cost. So, instead of us just issuing a recommendation that we know will require more resources, we produce a statement of support from other arm's-length bodies and perhaps some advice on implementation.

Medscape UK:  There have been widespread fears that Brexit, and particularly a no- deal Brexit, will put enormous stress on the healthcare system. How do you see the future of NICE, and of healthcare, after we leave the EU?

Prof Leng: In terms of what it means for NICE specifically, there are probably three things: one is what it might mean in terms of access to research funding. At the moment we do quite a bit of research as part of the European networks of health technology assessment, and we have access to funding from the EU, as of course do universities in the UK.

The second issue is interest in how the new licensing process will work. It's not directly affecting NICE as it does the MHRA [Medicines and Healthcare products Regulatory Agency], but a new licensing process may have implications for NICE, including access to trial data.

The third area is a general one that others across the health service are particularly concerned about, which is staff. I would say that is the biggest issue for the NHS as a whole in ensuring that we don't lose important staff from the EU, but it’s probably less of an issue for NICE.

Medscape UK: Do you see the UK at the back of the queue for medicines and medical technologies in a post-Brexit world, with patients having longer waits for novel treatments and fewer treatments for rare diseases? Or is that too pessimistic a scenario?

Prof Leng: I hope that it's over-pessimistic, and I think that the arrangements that are being put in place around the licensing of new drugs, including close links with the European Medicines Agency, will mean that isn't the case.  We want to make sure patients in the UK continue to be able to access new medicines, such as cancer drugs, as rapidly as possible. So, we really don't want to be in the back of the queue, and I'm pretty sure the Government sees that as a priority.

What we need to do at NICE is to make sure that we have an efficient, effective method for assessing new technologies, following on from the licensing process, that is seen as helpful and supportive in the UK but also more globally.

To support this, NICE has been setting up a number of schemes to help med tech companies to understand how their new products will fit into the health landscape. This includes an online tool called META [Medtech Early Technical Assessment], which helps companies see how their product might fit into the healthcare system.

We also run a scientific advice programme to inform companies what they might need to do to collect data that will demonstrate their product is effective. And we're shortly going to be launching something called Health Tech Connect.   This is an online system for companies to register information about their new devices and technologies in a central resource that will help those who want to evaluate or potentially purchase those products.

We have done a lot in the UK to support the evaluation and uptake of new technologies. We need to continue to lead the field, and to carry on doing that after we leave the EU.

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