When I decided to make the move to NHS England in 2018, I wanted to bring a new perspective, shaped by nearly 25 years working in the pharmaceutical industry and with a clear objective to make a real difference to the lives of NHS patients.

As I leave NHS England for pastures new, I reflect on a period of real challenges to navigate. That adversity, however, has been met head-on by working with remarkable colleagues, patient groups, companies and many more. The result is that I depart incredibly proud of what the NHS has been able to achieve over the last four years.

Scientist and medical pioneer Marie Curie said that “One never notices what has been done; one can only see what remains to be done.”

While it’s true that there remains more work to be done, it is now impossible not to notice what has been achieved when it is so clearly illuminated by the personal stories of NHS patients across the country.

Four years ago, we had intractable issues to resolve, including for cystic fibrosis and spinal muscular atrophy (SMA) treatments and approached a new era of advanced therapy medicinal products (ATMPs) with some trepidation about access and affordability.

Today, we have world-leading uptake of the cystic fibrosis triple therapy – Kaftrio – and can see the fundamental difference it has made to individuals. Whether it was seven-year-old Kate, one of the first young children to benefit from the triple-therapy, who spoke of her hope to fulfil her dream of becoming an Olympic gymnast. Or new mum, Sherry, who three months after beginning treatment with Kaftrio was able to become pregnant, having spent four years trying, and is now a mother to baby Freyja.

Indeed, the latest data shows that the number of women with CF that have become pregnancy has nearly doubled since the latest treatment was made available.
We have also been able to secure three new SMA treatments in less than three years, providing a treatment for people with SMA types 1, 2 and 3 where before there had been significant unmet need.

With the third of those three treatments secured, more children like Melvil will benefit from an oral treatment that can be taken at home. We have also used our commercial capabilities to get cutting-edge gene therapies available on the NHS, providing life-saving interventions for children – including the ‘world’s most expensive drug’, Libmeldy, for children with metachromatic leukodystrophy.

The publication of the NHS commercial framework for new medicines was a big step forward. The commercial framework provides clarity to commercial partners while also setting-out new commercial flexibilities that better enable the NHS to fully utilise the national buying power of the health service. A single deal agreed with the NHS provides access to 55 million people in England.

A great example of how we have utilised this national buying power is with hepatitis C. By working with clinicians and industry we are chasing down an ambition to be the first country in the world to eliminate the virus.

More recently, a new deal to expand access to HIV drugs and treatments will contribute to the goal for England to be the first country in the world to have no new HIV transmissions by 2030. It’s this kind of approach that marks the NHS in England apart from other healthcare systems around the world.

By utilising the commercial flexibilities set out in our commercial framework, new initiatives have accelerated patient access to treatment. It’s now no longer uncommon for the NHS to be the first health system to secure access to an innovative new pharmaceutical.

In the past four years we have concluded a number of world-first and first-in-Europe commercial medicines agreements, including for new lung cancer drugs, peanut allergy treatment and personalised CAR-T therapy for a rare blood cancer.

The reformed Cancer Drugs Fund has continued to deliver substantial patient benefit, enabling more than 80,000 people to benefit from faster access to more than 100 cancer treatments. Building on this success, the new Innovative Medicines Fund will be a key part of the health systems’ readiness for the continued adoption of ATMPs.

Looking to the future, the NHS continues to take a lead on global challenges, such as in antimicrobial resistance which, without action, could have a devastating impact on the delivery of care that we currently take for granted.

In June, the first two products to utilise a new, world-first ‘subscription-style’ payment model were purchased. This new model will incentivise companies to invest in this critical area, to help secure a pipeline of future treatment options for NHS patients.

Our successes demonstrate the vital importance of strong relationships with industry. When I arrived, it sometimes felt like there was an ‘us and them’ mentality. Since working together on countless new drug deals – and accelerated by the unprecedented collaboration through the pandemic – the NHS and industry are now better partners, able to constructively disagree, while not allowing that to undermine our shared commitment to patients.

As I leave, I feel it is important to note that risks to that partnership still exist. With discussions about a successor to the voluntary medicines scheme beginning, it is vital that neither side allows rhetoric to undermine the NHS-industry partnership.

Any suggestion that new treatments will be withheld from the NHS will have a corrosive effect on the public goodwill that the industry rightly garnered through its ingenuity to develop COVID vaccines and continue to produce revolutionary medicines. We must remember what is at the heart of all our work and at the heart of the NHS-industry partnership – our shared commitment to help patients and change lives for the better.

I am incredibly proud of what my team has delivered. Looking to the future, as well as continuing to bring innovative medicines to patients and secure a good deal for taxpayers, it is vital that we also build a secure, resilient and decarbonised medicines supply chain. That work is underway, taking lessons from the national response to the pandemic, and I have no doubt the talented colleagues I leave behind will deliver this objective.

The NHS is unique – there’s no doubt about it. I have never worked with colleagues who are so committed to delivering in a duty of care to others, and so clear-eyed in looking to patients as the focus of everything the NHS should do.

Whether working with colleagues to conclude a commercial medicines’ deal or spending time on the frontline with NHS staff providing those treatments to patients, my time here has been incredibly rewarding and only reaffirms my invincible confidence in our NHS.

Blake Dark was Commercial Medicines Director for NHS England.
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