The 2019 study tour represented another successful collaboration between core iDSI partners to support knowledge strengthening among key policy makers in China through interaction with representatives from UK government agencies, NHS, academic and private sector colleagues involved in healthcare.

The Chinese participants included seven representatives from the National Health Commission, including representation from the Department of Drug Policy and Essential Medicines Systems, and the Department of Healthcare Reform; a representative from the Department of Social Security, Ministry of Finance; and representatives from provincial health authorities, including the health commissions of Liaoning, Jiangsu and Henan. Researchers and policy advisers from CNHDRC and the Shanghai Health and Development Research Center also joined, in addition to colleagues from the academic sector in China, the latter including representation from Peking University, the Beijing Normal University, and the China Pharmaceutical University. Full details of all the participants can be found listed in the agenda.

As in previous years, all 27 delegates received a detailed introduction into the structure and financing of the NHS, including the role of HTA in supporting resource allocation decisions in the UK. In addition, there was a special focus on primary care, led by the Imperial College WHO Collaborating Centre for Public Health Education and Training, and an afternoon workshop hosted by the Centre for Health Economics at the University of York, which explored specific issues relating to the application of economic techniques to inform discussions on evaluating health system performance and efficiency.

For this year’s tour, we also placed a special emphasis on the UK’s approach to cancer care, specifically in relation to the process adopted by the National Institute for Health and Care Excellence (NICE) when evaluating new oncology products. We also explored the importance of considering the value that new innovations could bring within the context of delivering appropriate and timely pathways of care, including radiology, pathology, surgery, and radiotherapy. The UK’s experience in these issues can potentially provide useful insights for the Chinese setting, given that cancer has become a leading cause of mortality in the country. This is being driven by an ageing population and the prevalence of lifestyle factors such as smoking, with lung, stomach and breast being among the most common cancers. Policy makers in China have recognised the need to strengthen systems for assessing the clinical benefit of new cancer medicines, and this will be the focus of planned further collaboration between the Global Health and Development Group at Imperial and CNHDRC.

We would like to thank everyone who attended and contributed to the two-week study tour, with a special thanks to the British Embassy in Beijing, and Professor Kun Zhao and her team at the CNHDRC.

The 22 delegates, from both clinical and non-clinical backgrounds, visited London and Cambridge to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms.

Along with visits to St Thomas’ Hospital, Boots Pharmacy’s corporate office and AstraZeneca, the group received talks on the role and function of National Institute for Health and Care Excellence and the Medicines and Healthcare Products Regulatory Agency in protecting and improving public health; the pricing of branded and generic pharmaceuticals in the UK; vaccine evaluation; the development of evidence-based clinical pathways and integrated care pathways; and how to best to make use of electronic health record systems.

Members of the delegation from China with iDSI staff in Queen’s Gate

Yu Ou’yang from the Division of Medical Administration within the Hunan Provincial Health Commission in China said: “Over the last two weeks we have had presentations from almost 30 experts, even though the context of the UK and China is very different there has been so much for us to learn here. During the study tour I have realised healthcare management and delivery in the UK is very detailed and precise to ensure all goes as smoothly as possible, the UK also takes into account the balance between cost and effectiveness in healthcare which is extremely important. It has been great to learn more about standardised operations such as Clinical Commissioning Groups and NICE and their responsibilities. I would like to extend my thanks to all the presenters and those that facilitated our practical days.”

Ying Peng, who is based in Beijing but also carrying out a PhD in Health Economics at the University of Sheffield, said: “The range of presentations we received will really help my own PhD studies, I’ve definitely developed my understanding of how new interventions are appraised in the UK and how evidence is the pinnacle of decision-making. It was really important for me to learn more about the UK health system, which organisations underpin it and how this could be adapted for China.”

The group was made up of officials from iDSI core partner the China National Health and Development Research Center (CNHDRC) and the Chinese Ministry of Health (National Health Commission); along with policy makers and academics from Huazong, Beijing and Shanghai universities.

Liu Jianan, from the Division of the Essential Medicines List, within China’s National Health Commission, said: “Our delegation is diverse but between us all we have rich experience and knowledge. Our learning over the last two weeks has been delivered in such a systematic way; there is still much more we can learn from the UK healthcare system however for now I am pleased we will all be able to bring back our experiences from this trip, especially for matters such as pricing for medicines, which is of broad and current interest in China.”

Chen Bo, a PhD student from Peking University’s School of Public Health, said: “I feel very lucky to be here. The talks have inspired me a lot, particularly as my current area of study is public hospital reform at county-level in China. For me the most valuable part of the study tour has been expanding my knowledge of the ways in which hospital reforms could be made more efficient; and learning so much about Cost Effective Analysis exercises and ways we could push forward with this in China.”

Francis Ruiz, iDSI Senior Advisor, said: “The Global Health & Development Team at Imperial and iDSI have been delighted to organise study tours to the UK for senior Chinese officials since 2014. The talks from various presenters, including representatives from The Nuffield Trust, NHS England, NHS Benchmarking and feedback on their own workstreams from the delegates themselves has been a fantastic complement to off-site days where the group observed the delivery of health care first-hand and attended a workshop focused on primary care. We hope the visit was valuable and will have positive impact on them as individuals; and help develop the UK-China partnership in Health Technology Assessment.”

1- Dissemination Meeting on Developing Evidence-based Care Pathways for Chronic Disease in China
February 17th – Morning

National Developments showcase & providing means for utilising UK expertise

Following successful launch of this UK supported Prosperity Fund project on July 28th 2016, the dissemination meeting had the key aim of communicating progress in establishing a standardised approach to clinical guidelines development, and in applying them to update existing care pathways in China. The topic areas selected for the pilot were on priority chronic disease areas namely hypertension and diabetes that were currently in use in Xiamen and Qingdao cities.

A representative on the behalf of CNHDRC Director General- Ms Wei Fu gave an opening speech where he provided an overview of the burden of chronic diseases in China. He described China’s aging population as a critical high priority issue, highlighting the estimated 220 million people aged above 60 in China, added to by about 8 million people per year. He emphasized the significance of establishing a ‘tiered healthcare system’ in China utilizing UK NHS expertise and experience to support the local development of standardised care pathways. He concluded by inviting the audience of about 50 in number consisting of senior officials from Xiamen Health and Qingdao Health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians- to share the results of the preliminary version of the guidelines handbook, and encouraged feedback and discussion among attendees.

Ashwini Kirchner, Head of Health and Social Care at the British Embassy in Beijing highlighted the importance of bilateral commitment between the UK and China, to learn from one another. She stated that healthcare is a key point of interest between the two countries. Kirchner highlighted the aims of Prosperity Fund Project in providing cutting edge policy in an area where the UK can offer expertise, and to give way for a real impact on the ground.

Kun Zhao, Division Director in CNHDRC, described the status quo and progress of Chinese guidelines development. She compared UK and Chinese guidelines, and provided recommendations for realizing the project aims. She linked the importance of robust guidelines development with the considerable uncertainty around the effectiveness of most of new technologies in China, and the absence of economic and equity perspective in setting hospital treatment standards in different regions in China.

The preliminary version of the Chinese guidelines handbook received strong positive feedback from the audience. Changqin Liu, Vice President of the first affiliated hospital of Xiamen University noted the professionalism underpinning the handbook and described it as a first of its kind to be developed in China.

“This guidelines handbook is very comprehensive…It is first time where we can align with UK Clinical Guidelines principles….I learned a lot”
Fusong Liu- Cardiology department Director of The Third People’s hospital of Qingdao.

Professor Mike Roberts of UCL Partners concluded the meeting by giving a brief presentation on new models of care in the UK, such as ‘Integrated Care Pioneers’ and ‘Vanguard sites’. His presentation can be found here.

2- Leadership & Change Management training
February 17th – Afternoon

Leading Change: New guidelines, new approach..

The afternoon session was dedicated to a training workshop that builds on the introduction of the new guidelines in Xiamen and Qingdao hospitals. According to Mike Roberts, the implementation of new guidelines depends on a number of factors, the most important of which are understanding and managing the change process involved, and developing effective leadership among the interdisciplinary teams adopting the new hypertension and diabetes clinical guidelines.

The training workshop took place over 3 hours and involved presentations on change management by Reetan Patel, effective team leadership by Mike Roberts, combined with an interactive discussion and group work scenarios. The group work emphasised the experience of trying to implement a new set of clinical guidelines and how they may be understood from different perspectives among the stakeholders affected such as management, clinicians and other various implementing teams. The audience were mainly senior officials from Xiamen and Qingdao health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians.

3- iDSI HTA workshop: knowledge sharing event to support newly launched China HTA network
February 20th – 21st

The role of HTA in international development & National Regulatory Authority strengthening

The iDSI HTA workshop in Xiamen builds on the MOU supporting informed implementation framework for HTA between GHD and CNHDRC. The two-day workshop revolved around 6 main themes: standardised methods for economic evaluation, non-budget constraints and health system strengthening, measuring HTA impact and return on investment, HTA and medical devices, economic evaluation modelling and public health, and adapting HTA to the Chinese context.

The workshop commenced with an opening statement by a representative of CNHDRC on the behalf of Deputy Director Hongwei Yang, who emphasized that the current leadership in China is very supportive of HTA capacity building especially in light of major technology transformation in China.

Kalipso Chalkidou gave an overview of the objectives of the HTA workshop including outlining the role of iDSI HTA hubs for supporting national and regional HTA related activities. Kun Zhao introduced the China HTA network, which is a network of 29 institutions and hospitals backed with a great amount of support by the Chinese healthcare authorities (the presentation can be found here). Tony Culyer briefly introduced the iDSI Reference Case, what it is and how it can be adapted to China context (see his presentation here).

Professor Pete Smith of Imperial College London delivered a presentation on developing a framework for evaluating interventions aimed at health system strengthening. Eleanor Grieve of University of Glasgow talked about developing a theoretical framework for assessing the impact of HTA and the return on investment. Professor Klim McPherson of Oxford University provided a presentation on role of epidemiological modelling to support decisions in public health, and Anastasia Chalkidou and Naomi Herz of KiTEC talked about assessing medical devices and the challenge of incorporating economic evaluations in that field (their presentations can be found here).

Chinese academics linked with the new HTA network also spoke about the role of HTA in China in line with the themes of the workshop. There were presentations on: Standards and procedures of HTA in China by Haiyin Wang, Division Director of Shanghai Health Development Research Center, Performance evaluation on public health system in China by Professor Zhachun of Tongji University, Outcome Evaluation of the Tiered healthcare system in China by Rui Zhao of CNHDRC, Rapid HTA on Proton and Heavy Ion radiotherapy by Michelle Li of CNHDRC; Economic Evaluation of hepatitis B management strategy in China by Steven Qiu of CNHDRC; and finally, a talk by Jenny Sui of CNHDRC on using international evidence to assess cellular immunotherapy.

The iDSI HTA workshop provided an opportunity for new collaborations between Chinese HTA specialists, UK researchers, and colleagues from neighbouring countries. During the second day of the workshop, a roundtable discussion involving health officials and academics from Indonesia, Cambodia and China highlighted the interest in engaging in mutual cooperation, and the opportunity offered by the Chinese HTA network in providing regional support. The rise of China’s HTA capacity comes at a pivotal timing given the upcoming BRICS Summit scheduled to take place in Xiamen next September. The five key priority areas for BRICS collaboration are: deepening cooperation, strengthening global governance, making institutional improvements and building broader partnerships. Within this context, HTA capacity buidling and wider heathcare refirm offers one important route to achieve these aims. The Goa declaration highlights the importance of BRICS cooperation in the area of healthcare regulation.

“We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence”
8^th BRICS Summit- Goa Declaration October 2016.

China’s role in international support has been given added impetus by a number of initiatives including the recent “One Belt One Road” strategy. Such initiatives can provide important opportunities for sustainable development in countries along the Silk Road Economic Belt, and will be crucial in supporting the spread of evidence informed healthcare decision making in LMICs, a key objective of iDSI.