Ed Clifton spent 10 years working as a Health Economist looking at the cost effectiveness of technology, treatments and medicines across a variety of roles within NHS Ayrshire & Arran and Healthcare Improvement Scotland before taking on the role of Unit Head for the Scottish Health Technologies Group (SHTG) 3 years ago.

What motivates you at work?

My motivation is that our work helps to ensure that the best health and care interventions are available to people when they need them, taking into account the benefits, risk, and costs. As a society we all want to make the most of our valuable health and care resources, and HTA can help determine the most appropriate use of health technologies within the system.

Stakeholders ask for our help across many key areas of health such as diabetes, heart disease, cancer – to name a few recent examples. It’s great to know that our work has an impact. Impact won’t always mean a direct change in service provision, it could be as simple as a commissioning group, policy makers or clinical colleagues who say ‘thanks for the work –  it’s helped us to decide what we think should happen next’. 

Why did you want this job?

Coming from a background in health economics I had always been enthusiastic about the application of robust analyses and evidence to inform decision making. When I first started working in the NHS, one thing I was incredibly (and pleasantly!) surprised by was the value placed on economic evaluation – even in a local context.

Economics is one important component of HTA. Other aspects of HTA include clinical effectiveness, safety, and patient and clinical views, and these are equally important to consider when determining the value of a health technology. My wish when taking on my role was to develop and champion this wider role of HTA to inform decision making around health technologies in Scotland – excluding medicines for which the Scottish Medicines Consortium (SMC) already do a great job!

What new opportunities did you see at SHTG?

The opportunities were twofold. The first is specific to our own approach, whilst the second relates to how we consider health technologies more generally across Scotland.

In my health economist roles one of the key challenges had always been access to data, and then how best to use the available evidence to inform the analyses. Often I drew upon a range of evidence sources (published studies, local data, expert opinion etc.) to inform my work.

For SHTG, there tended to be a reliance on published literature to inform the group’s work. As much as we should always strive to utilise the best study methodologies, and generate the highest quality evidence, the reality is that in the field of health technologies it’s often difficult to give  very clear advice based solely on published evidence.

My view is that a range of evidence is required, with HTA capturing the most relevant and up to date information for the ‘real’ or ‘on the ground’ decision we’re faced with.  This may often involve our own analysis, or working more closely with key partners, to bring in these different perspectives.

If we can ensure our work is inclusive and transparent, and we engage with stakeholders during the HTA process, we stand a much better chance of reaching robust, directive and informative conclusions.

All this is built on my confidence in our great team of experts – our SHTG project team, our researchers, economists, patient/public involvement colleagues – who give us that opportunity to think differently about how we gather and present the evidence in a more up to date, relevant and meaningful format.

At the wider system level, I still see a great opportunity to develop our collective consideration of health technologies. We have a robust HTA process for all new medicines, so why not other health technologies –  which are equally important for our health and care? Yes there may be a number of valid reasons why we cannot analyse all new health technologies in the same way we do for medicines, but we should all be interested in improving the robustness of our decision making around the introduction and use of health technologies. There’s an opportunity for SHTG to drive this change. 

Do you have any favourite projects you’ve worked on?

For me, projects which involve working collaboratively with lots of different groups of people are the most rewarding.

For example, when we looked at new technologies to be used in diabetes care we worked with clinical colleagues, national and local procurement, industry and patient groups.

It was amazing to have so many people involved and these assessments usually result in a more successful outcome because not only are you are tapping into so much knowledge and expertise to inform our SHTG recommendations, the collaborative approach helps raise awareness of the work across Scotland.

What’s your end goal?

I should probably start by referencing our SHTG vision, which is for the use of all technologies in Scotland to be informed by evidence and SHTG advice.

For me, I’ll be happy knowing that SHTG is recognised as providing robust and trusted advice, and that people come to us when indeed they need evidence-informed advice to support their decision making on health technologies.

It’s important to remember that we are all part of the one health and care system and that our work forms part of that care journey for patients. Sometimes in the day-to-day work it can feel like an academic or ‘desk-top’ exercise distant from the overall care system. However, what we’re doing – helping to ensure that our finite health and care resources are targeted towards the most valuable interventions – can and does improve the care system and make a real, tangible difference to people’s quality of care.

We so often talk about positive recommendations whereby health technologies are recommended for use, but we shouldn’t ignore the importance of not recommending ineffective or unsafe use of health technologies. Health and care systems have limited resources and they have to make some very difficult decisions about technologies and treatments they can provide, so when we find that something is not effective, or is not good value for money we need to be very clear about that. It’s our job to help make sure that people are getting the best value from their health service, and that’s how I’d like us to be recognised.

What would you like to achieve in the next year?

I’m loathed to make too many predictions given the year we’ve just had! Over the next year, I’d like our work to have contributed to decision making relevant to the COVID-19 recovery – including the increasing focus on digital technologies and innovation. The pandemic has sparked new ways of working, much of which has been vital towards ensuring continuity of service. However, we need to think carefully about how our future health and care system should be configured: what are the most beneficial and efficient ways of providing a service? Where should we target resources? How will the introduction of a health technology affect a patient and system outcomes and cost. These are all important questions that we should be asking…and I want to make sure SHTG is contributing to finding the answers.