"NHS QIS values contributing to the work of the International Health Technology Assessment (HTA) community, promoting robust, evidence-based advice to improve healthcare decision-making and quality of care"

History and structure
The Health Technology Board for Scotland (HTBS) was established as a special health board in April 2000 to provide a single source of authoritative advice to NHSScotland on new and existing health technologies. In January 2003, HTBS merged with several other organizations to form NHS Quality Improvement Scotland (NHS QIS). Since 1 January 2005, the Scottish Intercollegiate Guidelines Network (SIGN) has been part of NHS QIS. The HTA Programme is one of the key tasks of NHS QIS.

Mission
The role of NHS QIS leads the use of knowledge to promote improvement in the quality of healthcare for the people of Scotland. We achieve this by looking at scientific evidence, listening to the needs and preferences of patients and carers and learning from the experiences of healthcare professionals. In addition, NHS QIS works closely with the Scottish Medicines Consortium (SMC) and the Scottish Health Council (SHC).

NHS QIS informs local and national decisions by providing advice on the clinical and cost effectiveness of new and existing health technologies. HTA consider the medical, social, ethical and economic implications of the development, diffusion and use of health technology. Their theme is making evidence work for a healthier Scotland by providing a bridge between the scientific evidence, the judgment of health professionals, the views of patients and the general public, and the needs of policy-makers. In providing advice about value for money and the resources required for implementing HTA recommendations, NHS QIS is keen to shape HTA to make them rigorous, but also timely and of practical use to decision makers at all levels.

How NHS QIS works
NHS QIS demonstrates its independence by choosing its own work program, reaching its own conclusions based on the best available evidence and publishing its findings. Its processes have been developed in partnership with NHSScotland staff and all aspects of its work involves liaison with healthcare professionals.

To promote openness and transparency and to gain an understanding of the needs and preferences of patients and stakeholders, NHS QIS involves the public in its work.

As part of its work program, NHS QIS also produces Systematic Reviews and Evidence Notes (a rapid review of clinical and cost-effectiveness evidence for health interventions). NHS QIS uses the INAHTA definition of HTA, ie a multi-disciplinary policy analysis that studies the medical, social, ethical and economic implications of development, diffusion and use of health technology. Systematic literature searching is undertaken and manufacturers, patients and professional groups are invited to submit evidence. Focus groups are undertaken where appropriate to ascertain the views of patients.  In order to allow robust economic modeling and detailed budget impact calculations, many discussions are required with health professionals to understand the details of a patient journey and the associated benefits and resources. A multi-disciplinary group of experts (including patient representatives) help to interpret the evidence for the Scottish setting. The process incorporates statistical and economic analysis, peer review, dialogue with those who submit evidence and open consultation.

In addition to this, NHS QIS produces resource and costing reports, to assist Scottish NHS boards to implement evidence based recommendations. The aim of these reports is to support financial planning by providing estimates of the resoutces required, unit and total costs of implementing key recommendations and epidemiology of the condition. The reports are also supported by excel spreadsheets which allow the assumptions to be adapted to suit the user's needs.

Dissemination activities
The NHS QIS website www.nhshealthquality.org is a key tool for disseminating information and capturing ideas and feedback. The site includes the work program, processes, consultation papers and publications. NHS QIS uses a direct mailing list and networks to disseminate its advice. It also participates in educational initiatives and facilitates workshops and seminars on methodological developments.

Current projects
To date NHS QIS has published 11 HTA reports, two Systematic Reviews and 23 Evidence Notes. Recent publications include Systematic Reviews on the clinical and cost effectiveness of hyperbaric oxygen therapy (HBOT) and service delivery organisation for acute low back pain on HTAs the clinical and cost effectiveness of thromboelastography/thromboelastometry and the most clinical and cost effective way of implementing digital mammography services for breast screening in NHSScotland.

Future plans
NHS QIS plans to build on the foundations already put in place to improve the quality of healthcare across Scotland. It will develop initiatives to address specific issues and will endeavor to ensure that care and treatment across Scotland consistently meets NHS QIS standards.