Chatting with our Chair: evidence, healthcare recovery and innovation

Chatting with our Chair: evidence, healthcare recovery and innovation

Neil Smart was appointed as Chair of the Scottish Healthcare Technologies Group (SHTG) Council in January 2021. We talked to him about what attracted him to the role, including what he means by ‘useful’ evidence.


What attracted you to the role of SHTG Chair?

I wanted to become chair of SHTG because it’s a role that can make a difference.

...and where can it make a difference?

In answering, let me start by describing the Medtech environment in which we work.  It is highly dynamic and innovative, with over 500, 000 devices on the UK market and a ‘fast fail’ culture in which product lifespans are relatively short. When considering the adoption of any particular technology, decision makers are often faced with enormous choice, persuasive advocates and finite budgets. SHTG undertakes health technology assessment (HTA) to identify the underlying value of technologies, and across the world, investment in similar assessments processes is growing, even attracting funding from the Bill and Melinda Gates Foundation. Underpinning this trend is a recognition that there is a pressing need not only to identify technologies which can improve or transform health outcomes, but also at the same time to take appropriate account of what is of value to patients and to society and balance that with the efficient use of resources..  But most importantly in health care if you don’t act with evidence, or attempt a full understanding of the uncertainties faced, it is possible to do great harm even when acting with the best of intentions.

I’ve heard you talk about evidence needing to be ‘useful’? What do you mean by useful evidence?

Now while I think the use of evidence in policy and decision making is crucial, perhaps even more so in service recovery and redesign post COVID-19, that evidence has to be useful. In other words, it should be sufficient for the task in hand, relevant, timely, reliably of high quality, and easily understood by a wide audience.

Bearing these many facets in mind, SHTG provides evidence tailored to the underlying question and context.

At one end of the spectrum, we make comprehensive recommendations which health boards are required to consider. But we also provide evidence in various other formats including assessments which can be delivered at speed, and adaptations of other HTA agencies’ work to a Scottish context. 

To further improve the usefulness of our work, which ultimately is planted in the analysis of clinical effectiveness, cost effectiveness, safety, and an understanding of the patient perspective derived from working with patient groups, we have been widening our evidence net to consider real-world evidence and equalities issues, evolving our stakeholder engagement processes, and expanding into new areas.

What sort of new areas?

One such area is digital. The use of digital technologies in healthcare is evolving at speed and these will come to play a huge role in patient care.  Of course, digital carries a wide range of complexity, from smartphone apps that provide advice such as how to protect yourself against infection travelling abroad, or that calculate insulin doses based on your blood glucose levels, to the more sophisticated such as computer-aided detection artificial intelligence software that performs image post-processing to help detect cancers. Increasingly, devices are implanted into people and use software to monitor health and determine treatment. By developing an assessment framework which enables us to tease out the evidence around digital technologies,  we can help ensure that such devices are clinically safe, technically effective and that patient privacy is protected.  

Where do we fit into the innovation landscape?

Innovation is another exciting area which has the potential not only to benefit patients but also to deliver gain to the Scottish economy. To further assist innovators, we are developing our scientific advice service which will help them better navigate barriers to development and adoption of their technologies in NHS Scotland and further afield.

Patients, health boards, and Governments will always face opportunities and challenges when it comes to the consideration of innovation: some are great, but not all deliver the expected benefits or are a good use of money. In this increasingly complex web of new technologies and healthcare decision making, I'm pleased that SHTG is playing a crucial role in identifying the value of innovations through the . The challenge is to make our evidence increasingly useful to our many stakeholders and thereby further grow our contribution to a high quality, equitable and sustainable health care system in Scotland. Perhaps more than anything, that’s what attracted me to the role of chair. 


Neil studied medicine at Glasgow University, also completing an intercalated degree in Pharmacology. He trained in Glasgow, Adelaide and Sheffield and is now a consultant anaesthetist at NHS Greater Glasgow and Clyde, based at the Queen Elizabeth University Hospital, Govan. He has a wide range of interests in health technology assessment, quality improvement and the use and purchasing of medical devices.  

Neil was formerly vice-chair of SHTG, was a European Commission Advisor for Medical Devices and in vitro diagnostic devices and currently also chairs a Clinical Procurement Steering Group with NHSGG+C.  


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