September 2024 • PharmaTimes Magazine • 10-13
// POLITICS //
Starmer times
What can the son of a toolmaker do for the crumbling NHS?
The constantly regiving gift of a PM that rhymes with ‘pharma’, not only produces headlines, but provides a new chapter of the enduring industry/NHS soap opera.
Kier Starmer inherits an NHS with manifold challenges – deficit finance, demoralised and striking staff, overloaded capacity, insufficient activity, rampant inefficiency, swelling demand, mental health and diabetes epidemics, erratic access, sharp inequalities, poor estate management, strangulated capital investment – and a long list of local issues.
Thus, in the NHS commentary zone, think tanks, academics, politicians – even the odd ex-PM – are weighing on the exam question – ‘How do we fix the NHS’?
We have some clues: the Labour Manifesto; interviews Wes Streeting has given, including to HSJ; and actions the new government has taken already, including commissioning a new 10-year NHS Plan. The last time Labour did one of these, it was big news.
There’s also the appointment of Lord Ara Darzi, surgeon and NHS investigator, to carry out a comprehensive review.
Finance is the uber-issue, and most accept that nothing much will change without a huge cash injection.
My sources say this won’t happen in the first year of parliament, but it may in the second, that the government knows how much this will cost, and is prepared to pay it – particularly in the long-neglected area of primary and community care funding.
But in the meantime, expect ‘efficiency’ to be the watchword here: more cost-improvement plans; more ways Trusts must find to save – and smart pharma companies are already building efficiency gains into their VPs.
Money isn’t everything though. Below, I’ll take a look at the six broad areas that are providing answers to that exam question – staffing, private sector Involvement, AI, prevention and primary care, localism and health-tech.
1. Will a new staff deal fix the NHS?
Recruitment and perhaps even more, retention have been affecting patient care. It’s not an especially nice time to be an NHS worker.
Various groups of NHS staff – nurses, GPs, junior doctors, consultants, allied health professionals and others – have been in some kind of industrial dispute with governments for over five years now.
Labour will probably have slightly better industrial relations with the BMA and the nursing unions than the Tories – and an offer of 22% pay rises for junior doctors is now on the table for the next two years. While that might be a goer, the NHS managers, the nurses, the GPs and the dentists are not so delighted with their 5.5% uplift – so we are definitely not out of the woods yet.
‘In the NHS commentary zone, think tanks, academics, politicians – even the odd ex-PM – are weighing on the exam question – How do we fix the NHS?’
When HSJ looks at vacancy data in the NHS, one of the most acute gaps we see is in specialist positions – it’s these kinds of HCPs that are really lacking, and difficult and expensive to find cover for.
In the meantime, it’s important to know the nuances of workforce gaps and how pathways are staffed, both in terms of stakeholder mapping and helping to address access and patient flow issues for your therapy area.
2. Will the private sector fix the NHS?
Here the issue is capacity, which the private sector has some of, and Wes Streeting intends to buy off to fix the biggest problem in the NHS – giant, record-breaking waiting lists.
Around the edges, we’re hearing Old Blairite Health Secretary Alan Milburn (author of the original NHS plan) has turned up to advise the government, saying there should be a return to some kind of competition and a reform of payment and incentive regimes.
This could be controversial, as we’ve just spent eight years getting the NHS integrated and not competing with itself.
But keep an eye on the private sector – depending on your therapy area it could change where your patients flow to, and it could expand your stakeholder map.
3. Will AI save the NHS?
Meanwhile, Tony Blair has stepped in to say that AI is what will fix the NHS.
The combination of the giant NHS federated data platform and AI will not only have huge implications for the future of healthcare, essentially by allowing the treatment of exactly the right patient with exactly the right medicine or intervention at exactly the right time but could also signal a huge payday for UK PLC and turn us into a biotech tiger.
It’s likely that Streeting – no stranger to Blairism himself – will absorb at least some of this message, and AI-mediated solutions are going to be huge in the next decade of the NHS.
Big news for pharma of course, who will need to be part of the process building its patient group data and knowledge, medicines and companion diagnostics into the next-gen healthcare infrastructure.
4. Will prevention and primary care fix the NHS?
Back to the appointment of Lord Ara Darzi, who reviewed the NHS in 2008 and found the need to reform prevention and primary care.
Strangely enough the need has not gone away and we have had it from the health secretary himself that primary care investment will be coming.
Darzi initially reports back in September ’24 before the final review later in the year, and if primary care reform isn’t in it, I’ll eat my hat.
The big phrase of the moment in NHS management is ‘the shift to the left’ in terms of care closer to home, which means – what is being done in specialist centres that could be done in local hospitals?
Also, what is being done in local hospitals that could be done in community; what is being done in community that could be done in GP surgeries and what is being there that could be done by pharmacists, at home, or by the patients themselves?
Ultimately this means patients having lifestyles that prevent ill-health in the first place. Awareness campaigns are going to be huge, and pharma should definitely build all aspects of this into its VP, and deal with the shift to the left ethos in the way it views future pathways.
5. Will localism save the NHS?
There will be in all probability a tussle between the 42 integrated care systems, the standard operating units of the NHS, and the centre, represented by NHS England and the DHSC, over power and control.
The direction of travel has hitherto involved giving more and more autonomy and budget, now including the specialised commissioning budget, to ICSs, plus fewer and fewer targets, since the Hewitt review a few months ago (Patricia Hewitt, another Blairite).
But at the same time, the government needs results fast and if these aren’t forthcoming, expect more national target stick to match the increased funding carrot.
This could be a shame, as at HSJ we believe localism – finding local solutions to healthcare challenges, working with the talent and services that you have, within local capabilities and parameters – can be very successful in the NHS; that not all areas are the same and need different, locally appropriate fixes.
Indeed, partnering on local projects with ICSs and PCNs – streamlining pathways, improving diagnosis, patient identification and patient access to therapies – should be one of the main ways pharma interacts with the NHS itself.
6. Will health-tech save the NHS?
We are on the precipice of a new healthcare revolution – not just in AI and digital support to therapies but in the next generation of medicines, vaccines, devices and techniques themselves.
We’ve seen how pharma came to the rescue of all of us in the pandemic and we know it can offer so much more.
There are many areas where the judicious use of clinical and cost-effective medicines can rapidly improve patient management, demand and long-term outcomes.
Labour is pursuing ending all HIV cases by 2030; it can only do this because the medical technology is there to support it.
So, at a deep level the government knows how vitally important new health-tech is to its NHS plans. It has also published a life sciences action plan and understands that supporting industry is a UK business-critical end in itself to boost growth.
It’s talked a good talk about improving regulation, HTA and market access for new products – let’s hope they walk the walk.
Oli Hudson is Content Director at HSJ. Go to hsjmarketingintelligence.co.uk
A note on Starmer-vision by Editor, John Pinching
Like some kind of modern prophet, Keir Starmer has preached without relent about his calling and his origins as ‘the son of a toolmaker’. Only Dusty Springfield has reminded us more about the original occupation of the father of a specific male offspring.
But, lo, was there something more at play when Starmer green-ticked his working-class credentials – was there something more than the conjuring up of a tired worker, slumped over the unforgiving lathe?
Put ‘I was the son of a toolmaker’ under the figurative microscope, while pipetting the public health situation into the same Petri dish and the result is a spectacular visual cacophony of metaphors about identifying tools, creating tools and – most profoundly – incorporating those tools as a force for good (and to repel the influence of bad).
One of the most interesting aspects of Starmer’s first few weeks in office is, what appears to be, a refreshing lack of ego – we have forgotten that serious politicians with a focus on serious politics should come as standard, to the extent that when it happens, we are both bewildered and impressed!
As it is, he has gone even further by making things happen – with unusual haste. Whereas previous regimes – not least Sunak’s – constantly spoke of ‘process’ as a reasonable excuse for unending delay.
In contrast, Starmer has used his encyclopaedic knowledge of the legal system in the UK to imprison violent rioters within days of crimes being committed, while also providing guarantees regarding compensation to the victims of the contaminated blood scandal.
It seems it was a self-fulfilling prophecy all along – Keir Starmer is nothing if not the son of a toolmaker. But, his greatest challenge, for which no tool has ever been made, is the careful deconstructing, reconstructing and reimagining of the NHS.
Whether he can handle that quest will be the ultimate forging of his legacy.
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