To safeguard the NHS’ future and strengthen its resilience we need to think now about the challenges it faces well into the future. Professor Andrew Farmer sets out a future vision for the NIHR’s Health Technology Assessment (HTA) Programme addressing this question, and how the programme needs to evolve into its fourth decade - reflecting on its impact so far.
While working as a GP - most recently in a busy urban practice - I’ve seen first-hand how health and care research play a key role in saving and improving lives.
Working with patients facing serious illnesses and long-term conditions, I’ve come to appreciate the critical importance of having timely access to rigorous, evidence-based research to meet their needs and use it to guide them towards the most appropriate care and support.
These experiences were at the forefront of my mind when I started as HTA Director in 2020. I took on the role back then committed to ensuring the research we fund continues to meet the needs of people in communities across the UK, and that HTA would evolve to meet the changing landscape of healthcare.
Thirty years of building on achievement
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For over 30 years, HTA has been a cornerstone of needs-led research, tackling some of the toughest challenges in health and care. Our work has underpinned NIHR’s mission of improving the health and wealth of the nation. But none of this can be accomplished in isolation. Our success is shared with the wider community. It’s a collective effort including the NHS, NICE, patients and public, and countless other key stakeholders.
HTA has funded 1,709 studies in the last 30 years, with a combined budget of £1.5 billion. Each year, we fund around 70 new studies covering many different types of research - not just Randomised Controlled Trials (RCTs).
More importantly, these studies have had a sustained impact, saving and improving the lives of the UK public. Some of the most notable examples of our funded research includes:
Looking to the future
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Looking ahead, the research community faces new challenges to deliver research that meets the needs of patients and service users. We must build on our strengths whilst embracing new opportunities.
* **Life-changing impact:** Our research must continue addressing crucial questions, particularly in areas impacted by health inequalities like cancer, cardiovascular disease, stroke, and mental health. These remain some of the biggest challenges facing our society and HTA is well-placed to drive forward new discoveries. These trials should be conducted in diverse settings across the UK to ensure resulting evidence is relevant and applicable throughout the NHS and care system.
* **Pioneering:** NIHR must utilise the full spectrum of research methods to address the most critical comparative effectiveness questions in health and care. This includes employing evidence synthesis, randomised trials, adaptive trials, platform trials, and other innovative approaches. This ensures the most efficient study designs and the highest quality evidence.
* **Harnessing innovation:** Research must become more efficient, leveraging cutting-edge technology and new methodologies to pioneer solutions. Our life sciences sector is a critical part of the UK’s competitive advantage. We must continue pushing the boundaries of what’s possible.
* **Economic impact and sustainability:** We need to continue to drive economic returns, inward investment, and economic growth. It is estimated the economic returns to society from investing in NIHR lead to £13 of benefits for every £1 spent.
Novel and efficient trials
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Funders need to collaborate to support large ambitious studies. This includes large platform trials. These trials can efficiently compare multiple treatments, be embedded efficiently within the NHS and be extended to include new treatments. We are already doing this. Examples include a recent study co-funded with Prostate UK, testing [innovative new screening techniques for prostate cancer](https://www.nihr.ac.uk/news/new-screening-trial-save-thousands-mens-lives-prostate-cancer). But more work is needed to deliver the infrastructure for these trials.
Massive investments now being made in electronic health records are transforming our ability to collect and analyse data in real-time. This will change how data is used in research. Alongside this we need to develop frameworks to understand how real-world evidence can complement large-scale clinical trials.
Building the future of research
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The next decade also requires us to invest in people through career development - building skills and expertise. Coordinating efforts with the NIHR Academy allows us to build on our current work to support all those who contribute their skills and expertise to design and deliver our research.
The problems facing the NHS and social care are changing. But I have no doubt HTA’s principles - research driven by need, rigorous science, and a commitment to patient outcomes - will continue to deliver. HTA will remain at the forefront of scientific advancement, shaping the healthcare of tomorrow and addressing the needs of the health and care system, and beyond.
Leading the programme has been both a privilege and a responsibility. HTA and its community will continue to put its energy into being at the forefront of scientific advancement to test new treatments for the next 30 years and beyond. As I transition into new roles, my focus on supporting the generation of high-quality evidence remains strong, continuing to drive scientific advancement that will benefit us all.