Why did you get in touch with SHTG and what was this like? 

The idea initially came from the British Society for Antimicrobial Chemotherapy OPAT initiative, which I co-lead with Mark Gilchrist a consultant antimicrobial pharmacists in London, and dove-tailed with our ongoing SAPG OPAT development work in Scotland. We wanted to explore the health economics of OPAT and specifically a comparison of relative healthcare associated costs between OPAT and traditional hospital inpatient treatment. It was the initial interactions with SHTG colleagues which developed from “just” a health economics assessment to a full health technology assessment and potential recommendations for NHS Scotland

What were the key OPAT implementation barriers that you hoped to overcome by speaking with SHTG? 

The main issues have been funding (hence the economic assessment), visibility of clinical activity (OPAT data is not routinely reported in Health boards) and recognition of its potential utility amongst policy makers.  

What is the attractiveness of combining SHTG and SAPG forces? 

Working in the same organisation and knowing the key SHTG personnel has really helped communication and collaboration. The willingness of SHTG to not just tackle the question asked but to consider how else they could help was really appreciated.  

I think working alongside SHTG and SIGN particularly gives SAPG that opportunity to always consider and further explore the evidence that underpins our quality improvement and broader antimicrobial stewardship work. 

How has SHTG’s work contributed to service delivery across Scotland?  

The SHTG OPAT report published in February 2021 has been fundamental to OPAT development across Scotland. It has been well received by Health boards and by OPAT teams and is informing and widely supporting service development.  

The report has been used and referenced within the Scottish Government Interface Care programme including within the OPAT Target Operating model. This group is looking at multiple different health delivery models that can provide alternatives to hospitalisation and OPAT has been recognised as an exemplar service supported by the SHTG report. 

 Since January 2022 NHS Grampian have secured significant funding to develop a substantial OPAT service. NHS Greater Glasgow and Clyde have also received additional funds to improve reach and equity of the existing service. Other boards have also made important inroads in service development.  

Through the interface care group and SAPG we have developed OPAT collaborations across Scotland including the Island boards who are developing services within Hospital at Home (or in Orkney Hospital without walls). 

What are the expected future service changes, including reference to COVID-19 recovery and resilience? 

It is anticipated there will be significant OPAT development over the next 1-2 years with optimisation of staffing to achieve shorter hospitalisation for key patient groups and avoided admission with complete care delivered in the community for other groups.  

Assuming that recruitment goes to plan it is estimated that the number of inpatient bed days that will be avoided as a consequence of OPAT service development will at least double over the next 1-2 years with potentially more than 100,000 avoided bed days per year allowing for better use of the existing bed use including contribution towards COVID-19 recovery and resilience.     

What role do you feel SHTG has to play in informing decision making on the use of technologies and service provision as part of future health and care resilience?  

Following the OPAT work, SHTG has been supporting the SG interface care group with objective, comprehensive evidence for other health technologies and services that aim to promote admission avoidance and improve longer term healthcare resilience. There are also further opportunities for collaboration between SAPG and SHTG in the antimicrobial stewardship field which I would be very keen to pursue.   

Would you encourage other services to speak with SHTG about how HTA can help drive objective and value-based decision making? 

I would strongly recommend other healthcare services to consider how their practice can be supported by SHTG and a full HTA. Decision making in health care must as far as possible be objective and value based.   

Better understanding of the HTA process and its value and potential for other aspects of healthcare, not just in my area of infectious diseases. I’ve been encouraging others to think how their clinical services can be better supported and informed by an HTA. We were also able to collaborate and publish the health economic analysis in a peer reviewed medical journal.