The MedTech funding mandate

The NHS Long Term Plan committed to accelerate the uptake of selected innovative medical devices, diagnostics and digital products to patients faster, by developing the MedTech Funding Mandate policy.

The proposal for this policy was consulted on in December 2019 with patient representatives, NHS providers, commissioners, charities, academics, delivery partners, consultants, independent health providers and industry. The consultation report is available here.

The MedTech Funding Mandate policy received strong support with clear recommendations on the criteria for inclusion of technologies.

Technologies covered by the MedTech Funding Mandate policy are funded by commissioners from their existing allocations. This is because the technologies supported meet the criteria to save costs and resources and make a return on investment within three years.

The MedTech Funding Mandate policy launched on the 1 April 2021. The guidance for 2022/23 is published here.

Together with technology suppliers we work with patients and our delivery partners, the Academic Health Science Networks (AHSNs) to support NHS organisations to implement the existing innovations, to understand local and regional issues and to share learning from NHS organisations who have already implemented the innovations. This helps to identify barriers to their uptake, such as duplicative procurement processes.

We expect hospitals and commissioning organisations to comply with the policy guidance where appropriate. We ask our AHSN delivery partners to work closely with commissioners, providers, clinicians, patient groups and others, to understand the impact of the policy and support its development.

Providers wishing to implement any of the supported technologies should contact their regional AHSN. Alternatively, for more information contact the MedTech Funding Mandate team (see contacts at the foot of the page).

In addition you can watch Matt Whitty, Director of Innovation, Research and Life Sciences and Chief Executive of AAC, and other policy leaders, discussing the MedTech Funding Mandate policy’s introduction. The videos provide an overview of the policy and the financial flow between NHS England and NHS Improvement, healthcare providers and commissioners, as well as an introduction to the first four products supported.

Technologies covered by the MedTech Funding Mandate in 2022/23

The MedTech Funding Mandate (MTFM) launched on 1 April 2021 and in its first year, 2021/22, supported four NICE-approved, cost saving technologies. Support for these technologies is continued in 2022/23 (supported technologies are reviewed annually to ensure that they meet the policy criteria).

To be considered for the MTFM 2022/23 policy, technologies needed to be:

  • Effective: demonstrated through positive NICE Medical Technology Guidance (MTG) or Diagnostic Guidance (DG), published by 30 June 2021.
  • Cost-saving within three years of implementation: as demonstrated by NICE modelling and published in a NICE resource impact template.
  • Affordable to the NHS: the NICE budget impact analysis total costs should not exceed £20 million in any of the first three years.

With NICE, the Innovation, Research and Life Sciences (IRLS) team assessed all available MTG and DG guidance to understand which technologies met the criteria.

The technologies included in the MTFM 2022/23 policy are categorised into the following two themes:

  • Benign prostatic hyperplasia (BPH) is a common condition in ageing men and others with a prostate (trans women, some non-binary and some intersex people). It is currently treated with the surgical procedure, transurethral resection of the prostate (TURP) which usually requires the patient to stay in hospital for 1 to 3 days. Four less invasive innovations allow patients with BPH to be treated as day cases. Providers will not be expected to implement all four technologies, instead, each would be expected to work with its AHSN and the Getting It Right First Time (GIRFT) Urology Area Networks to understand its technology needs and the potential uptake locally.
  • Improving the patient experience during procedures technologies are innovative alternatives to otherwise more invasive and costly procedures. Thopaz and Spectra Optia use digital technology to increase efficiency and improve outcomes compared to current procedures and Xpress is a minimally invasive alternative to invasive sinus surgery, thus reducing the risk of complications and improving patient recovery, outcomes and experience.

Benign prostatic hyperplasia

  • UroLift: The UroLift system lifts and holds the enlarged prostate tissue away from the urethra, relieving the compression of this organ. It can be performed under local anaesthesia in an outpatient setting or ambulatory care centre, and the patient can return home the same day without a catheter. NICE guidance MTG58.
  • GreenLight XPS: The GreenLight XPS vaporises prostatic tissue with a laser. The laser fibre is passed through a cystoscope to photoselectively vaporise the enlarged prostate tissue, leaving a clear urethral channel. GreenLight XPS can be done as a day case procedure, reduces the risk of complications, and allows a quicker return to normal activity. NICE guidance MTG29.
  • Rezum: Rezum is a minimally invasive procedure that uses water vapour (steam) to treat BPH. The technology delivers targeted, controlled doses of stored thermal energy in water vapour directly to the region of the prostate gland with the obstructive tissue causing lower urinary tract symptoms (LUTS). Rezum effectively alleviates BPH and patients can be treated as outpatients. NICE guidance MTG49.
  • PLASMA system: PLASMA is a bipolar electrosurgery system for transurethral resection and haemostasis of the prostate. The system uses electrodes to cut out (resect) prostate tissue and stop any local bleeding afterwards (haemostasis), which avoids the risk of transurethral resection syndrome and reduces the need for blood transfusion. This procedure can be done as a day case. NICE guidance MTG53.

Improving the patient experience during procedures

  • XprESS multi-sinus dilation system: The XprESS multi-sinus dilation system is a sterile, single-use device for treating chronic sinusitis. Dilation of the XprESS balloon remodels the bony sinus outflow tract by displacing adjacent bone and paranasal sinus structures. This has the potential to reduce the tissue lost compared to traditional functional endoscopic sinus surgery (FESS) procedures. NICE guidance MTG30.
  • Thopaz+ portable digital system: Thopaz+ is a portable digital chest drain system that provides regulated negative pressure close to the patient’s chest and continuously monitors and records air leak and fluid drainage. The system comprises an inbuilt, regulated suction pump with a digital display, rechargeable battery, tubing that connects to any standard chest drain catheter and a Thopaz+ disposable fluid collection canister. Sensors in the system turn the pump on and off to ensure the pressure level set by the healthcare professional is precisely maintained. NICE guidance MTG37.
  • Spectra Optia: The Spectra Optia Apheresis System is an apheresis and cell collection platform for the treatment of sickle cell disease. In a typical exchange procedure, Spectra Optia separates and removes sickle red blood cells from the patient’s blood using continuous flow and centrifugation. These are replaced with healthy red blood cells according to the user-defined software protocol. NICE guidance MTG28.  This will be supported by NHS England Specialist Commissioning who fund the treatment of sickle cell disease patients.

We will continue to work with wider NHS England and NHS Improvement colleagues and the Academic Health Science Networks (AHSNs) to develop the policy mechanisms.

The preferred procurement route for the MTFM technologies is through NHS Supply Chain (NHSSC), who already have most of the technologies in place on their catalogues. We are working with NHSSC to strengthen this process to ensure providers are reimbursed by commissioners and NHS England has supporting information for decision making.

The technologies receiving continued support from the 2021/22 policy are:

  • placental growth factor-based testing: Placental growth factor based-testing are blood tests (PLGF) for ruling out pre-eclampsia in pregnant women. PlGF-based tests are intended to be used with clinical judgement and other diagnostic tests, to help rule out suspected pre-eclampsia. This assessment focuses on ruling out pre-eclampsia in the second and third trimesters of pregnancy. NICE guidance DG23.
  • SecurAcath: SecurAcath is a device for securing percutaneous catheters. SecurAcath is used to secure peripherally inserted central catheters (PICCs) and should be considered for any PICC with an anticipated medium to long-term dwell time (15 days or more). NICE guidance MTG34.
  • HeartFlow: Heartflow creates a 3D model of a patient’s coronary arteries and assesses the extent and location of blockages. HeartFlow FFRCT estimates fractional flow reserve from coronary CT angiography (CCTA) for patients with stable, recent-onset chest pain, therefore avoiding invasive investigation and treatment. NICE guidance MTG32.
  • gammaCore: gammaCore is a handheld and non-invasive device which stimulates the vagus nerve and is used to treat and prevent the symptoms of severe cluster headaches. It is self-administered by the person or their carer. NICE guidance MTG46.

For reference you can find last year’s guidance here.

For any queries, please contact england.medtechfundingmandate@nhs.net. In addition, our FutureNHS collaboration platform will continue to be updated with information and helpful resources on the MedTech Funding Mandate policy; please email the team to request access.