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York research has, continuously since the early 1990's, underpinned the methods by which a substantial proportion of the total NHS budget is allocated by the Department of Health to the organisations providing or arranging healthcare. Despite numerous NHS reforms, our research has produced formulae appropriate to each new system. These formulae have driven NHS policy on allocations across geographical areas and health care administrative entities in England, thereby ensuring that the population of approximately 55 million people receives a share of over £90 billion of healthcare resources that is fair and better reflects relative health care needs.
The NHS spends about £11bn annually on pharmaceuticals, of which £8bn is on branded drugs, representing about 13% and 10% respectively of available NHS resources. Research at York has been central to the public and policy debate about how branded pharmaceuticals ought to be priced and has made a material contribution to the development of government policy to introduce a value based pricing (VBP) scheme for all new pharmaceuticals. VBP has significance for the prices that the NHS pays for pharmaceuticals, access to new drugs for NHS patients, and the return that manufacturers can expect from future research and development. There is also an international impact in two respects: UK prices are estimated to influence 25% of the world market and York has contributed to a wider policy debate about international pharmaceutical pricing and the potential role of value based pricing in European, North American, South American and South East Asian health care systems.
A programme of methodological research undertaken by the University of York has shaped the economic evaluation methods used by the National Institute for Health and Care Excellence (NICE) since its inception, to assess the cost-effectiveness of healthcare interventions. Therefore the methods developed by York underpin many of the healthcare decisions by NICE on which new and existing interventions and programmes should be funded and used in the NHS. The methods used by NICE have also had a major influence on the approach taken to technology assessment internationally and so York's underpinning research has had wide impact beyond the UK.
Research by Community and Health Research Unit (CaHRU) broadly impacted on healthcare provision and care received by patients from ambulance services. The research directly informed policy and was a key factor in improving prehospital care for emergencies by directly influencing care systems, regulators, ambulance services, paramedics, and service users, initially in the East Midlands and subsequently throughout England from 2008 onwards.
The research which aimed to improve quality of ambulance care led to: development of new clinical quality indicators for ambulance services in England; benchmarking of service quality; initiatives to address gaps in care; measurable improvements in managing pain, heart attack, stroke, asthma and diabetes across all English ambulance services. Regulators now use these quality indicators to assess ambulance trusts in England.
Research at York has had a direct impact on national guidance about the use of health technologies in the NHS. It provided methods that are used to assess whether a technology is expected to be a cost-effective use of NHS resources, how uncertain this assessment is likely to be and whether additional evidence is sufficiently valuable to recommend further research to support its widespread use. It has had an impact on the technologies available in the NHS and the evidence available to support their use: improving patient outcomes; saving NHS resources and strengthening the evidence base for clinical practice. It gives an explicit signal and incentive to manufacturers; informing development decisions and the type of evidence collected. It has had an international impact on how the adequacy of evidence is judged and research is prioritised; particularly in recent reforms in the United States (US) where the principles of this value of information (VOI) analysis are informing the prioritisation of $3.8bn for `comparative effectiveness research'. It has also informed the methods used in low and middle income countries, especially national agencies in health care systems in South East Asia and South America, as well as global funding bodies.
Acute stroke services in the Belfast Health and Social Care Trust have been reorganised using research on modelling stroke patient pathways through hospital, social and community services carried out in CSRI at Ulster. By suitably administering thrombolysis (clot-busting drugs), a stroke patient's time in hospital, community rehabilitation and nursing homes can be reduced, so that although the treatment costs money up front, it saves in the long-term and also improves quality-of- life. The work has contributed to changing stroke patient policy in the Belfast Trust as well as enhancing patient quality-of-life. It is applicable throughout the UK and beyond.
The research has led to the design of a new clinical pharmacy service model, centred on community pharmacies, to improve the care of patients with palliative care needs living in the community. This resulted in better provision of information for patients (and their carers) and new training resources and staff development opportunities for the multi-disciplinary palliative care team. Funding has been secured to rollout the new service across NHS Greater Glasgow and Clyde Health Board (NHS GGC - 1.2M population) in 2013. The research has also supported a successful bid to explore the service model in a remote and rural Health Board (NHS Highland) and has informed specific programmes of Macmillan Cancer Support UK, pharmacy workforce planning, and the Boots Macmillan Information Pharmacists initiative.
Between 2006 and 2008 an evaluation carried out by the University of Sheffield of the National Infarct Angioplasty Pilot showed that primary angioplasty for ST-elevation myocardial infarction (heart attack) is feasible, cost-effective and acceptable to patients and carers. As a direct result, a new national strategy using primary angioplasty was published in the National Service Framework for Coronary Heart Disease. National audit data has since shown the proportion of patients receiving primary angioplasty increasing from 42% to 73% and mortality falling from 10.6% to 8.7%. An impact assessment based on our economic analysis estimated a £294 million net benefit to the NHS.
National and international policy on the use of competition in health care since 2006 has been strongly influenced by a series of studies conducted at the University of Bristol led by Professor Carol Propper. By providing compelling evidence on how competition affects patient care, these studies have had a major impact on policy design at the highest levels. The research has underpinned a series of political decisions to use competition and choice in the NHS and informed the design of the current regulatory structures to support these policies. Specific decisions influenced by the research relate to the structure of prices, policy on mergers, and policies to promote greater use of choice and competition to benefit patients and taxpayers.