October 2024 • PharmaTimes Magazine • 18-20
// POLITICS /
How can pharma help rebuild and reinvent an NHS in dire straits?
In my last article for PharmaTimes about the NHS entitled, ahem, ‘Starmer Times’, I scoped out the challenges facing the NHS for the new leader.
It’s depressing as a patient and frustrating as a commentator to have to go through it all, again, but that’s what we have to do to get a grip on where the solutions are.
And that’s precisely what Lord Ara Darzi – consultant surgeon, MedTech pioneer and healthcare system investigator – was asked to do by the new Labour Government. He duly published his first report in early September.
Allow me to sum up the 163-page doc for you – Darzi says the NHS is in trouble, big trouble.
He establishes four great issues – austerity and capital starvation from 2010, the top-down reorganisation of 2013, the lack of staff and patient engagement and voice (all of which he basically blames on the Tories), and the pandemic (not just COVID itself, but how it was handled, and the fact that many patients were excluded from the service during it).
These four drivers have left staff morale and numbers at rock bottom, waiting times and lists ballooning, people unable to see a GP, far too much money spent on hospitals and not enough on primary and community, low productivity, lagging cancer and cardiovascular care and (I quote) A&E “in an awful state”.
However, despite all this, he is reassured of “the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay”.
And he established seven principles that the government could take forward into its 10-year plan – the next big NHS document to look out for.
They are: re-engage staff and re-empower patients; lock in the shift to care closer to home by hardwiring financial flows; simplify and innovate care delivery; drive productivity in hospitals; tilt towards technology; contribute to the nation’s prosperity; and reform to make the structure deliver.
It’s most probably the time of year in the planning cycle when you’re looking to spend budget on the kind of NHS engagement that best looks after your brand.
When you’re doing so, remember Darzi’s findings – this is what the NHS will be working towards now, and using the kind of language and approach decision-makers will respond to will help you align and make partnership working more likely.
Think about how your brand can simplify or innovate care delivery.
What relationship does it have with new tech fixes, virtual care and AI diagnostics?
Can it help move care closer to home? Does it support the re-empowering of patients? And, ultimately, what will be the overall effect of your brand on healthcare and the wider economy?
Darzi frequently uses the phrase “interrogating pathways” and that is what we, as an industry, will have to do too.
It’s challenging, with so many variables, outputs and possibilities, but with the right data, and knowing the right questions to ask of it, persuasive cases for change can be made where the NHS, patients and industry are all winners.
In this section I’ll outline five areas that Pharma can examine using data tools with the aim of improving pathways and re-engaging the NHS.
This issue will run and run, and Darzi mentions it 16 times. The most deprived patients are most likely to present as a cancer emergency. General emergency presentations are 68 per cent higher in the most deprived. The most deprived are more than twice as likely to die of heart failure than the least deprived.
Darzi says: “A strong voice for patients and local communities would promote more responsive services, while making it easier for the NHS to fulfil its promises to promote population health and to narrow health inequalities. The NHS could look to make data more publicly available by local authority area.” What can pharma do here?
Pharma can interrogate variation in system-level utilisation of different interventions in oncology. Who exactly is using what, and what difference does that make?
Morbidity, mortality, quality of life, patient-reported outcomes; these are all factors that can differ depending on whether the medicines, the diagnostics, the pathways and the overall service are working as they should.
There’s a stark difference in survival times between the UK and other countries – are the way pathways are set up contributing to this?
What difference does system-level use of different combinations of therapies make to those metrics Darzi looks at?
Cancer waiting times, too – monitoring performance of cancer referrals across a range of cancer types – is ripe for re-investigation, to be able to highlight need and establish best practice.
Some areas do things better – this is NHS fact. It’s empowering for pharma to be able to help spread this news and to shine a light on how it’s done to those systems that are struggling with your patients and your pathways.
Looking at referral to treatment (RTT) times for your condition, and comparing one system with another, can help to show where blockages are and where the local NHS might need to support to identify and mitigate against them.
You can analyse the changing waiting lists across a wide range of services, determine which services are succeeding and why.
Outpatient KPIs – analysing variation in outpatient services such as DNA rates, referral source, waiting times and first: follow-up ratios, are also worthy of investigation to establish obstacles and drags.
Or you can use commissioning maps and data to track the provision of services across newly formed commissioning boundaries – offering insight on how evidence-based changes in that provision lead to better outcomes.
Everyone knows that the NHS’s biggest problem at the moment is capacity and occupancy, with thousands of patients in hospitals that don’t need to be there, and many millions of patients on waiting lists.
In this climate, looking at the number of patients in your disease area that are ‘A&E Frequent Flyers’ is a reliable way in to concerned commissioners.
You can assess the impact of patients experiencing multiple A&E attendances on A&E performance, and establish how better patient management, faster diagnosis or care closer to home could beneficially affect these numbers.
You might also want to examine Mental Health Service data – to understand the pressures from referrals into the mental health service.
What concomitant costs does your pathway have here, for example from diabetes patients, who, lacking the right management, begin to suffer MH comorbidities?
You can also analyse bed occupancy rates specific to certain diagnoses/ procedures across hospital sites – can these be improved upon with better patient management?
Improved diagnostics are absolutely crucial for a number of areas – to establish patients on pathway at the earliest possible stage, so the chance of treatment working is optimised.
Also, to be able to stratify and prioritise the most pressing diagnoses within the backlog and to have a realistic estimate of the number of patients you’re going to need to treat and establish budget impact and staffing models.
Furthermore, there is a need to understand the nuance between different diagnoses within the same condition, to be able to place patients on the right clinical and pharmacological pathway, to reduce the chance of misdiagnosis and sending patients on the wrong pathway, and to ensure underserved or deprived patients groups are being diagnosed with the right level of timeliness and accuracy.
Absolutely all of these factors are key to success for a new launch or indication, and doubly so if companion diagnostics to biotech are in play.
For many of our clients at HSJ Advisory, working with the NHS to improve diagnostics in their chosen clinical field is a key goal they ask for help with.
Fortunately, these days there are sophisticated tools at your disposal. You can opt for diagnostic imaging data set dashboards, which can benchmark diagnostic service performance for a wide range of imaging and procedures and is extraordinarily useful in pinpointing where blockages are.
You can cross-reference diagnostic performance with outcomes, cost and patient throughput; and you can use all this data to show how important enhanced diagnosis will be to the performance of the overall NHS pathway.
Oli Hudson is Content Director at HSJ. Go to hsjmarketingintelligence.co.uk