“Our 10 Year Health Plan will deliver the three big shifts our NHS needs to be fit for the future – from hospital to community, from analogue to digital and from treatment to prevention.”

So said the Health Secretary at the launch of this year’s planning guidance in mid-February.

If this government successfully executes the last of Wes Streeting’s three critical shifts – from treatment to prevention – you might conclude this is bad news for pharma, being as it is in the business of… well, treatment.

You might picture a future idyll where ‘the patient’ is a thing of the past, is perfectly nourished, is rigorously exercised, is free of damaging intoxicants of all kinds, breathing purified air. This patient has genes tested, any risks warned of in real time by smart devices and digital monitoring.

In this dimension sickness is, effectively, no longer an issue. As soon as something goes wrong, something gets done, before major medical intervention – pharmaceutical or otherwise – is necessary.

But you’d need to take population health controls to a wild extreme. You’d also assume that the wider population would have great housing, transport, digital literacy, knowledge of aetiology and epidemiology, enthusiasm about regular health checks, and responsible indulgence. Only then would you completely void the need for ‘treatment’.

The government wants to reduce initial risk factors of course; but what’s really important is managing that inevitable part of the population that does come into the system, slowing down the pathway – both literally and metaphorically – between manageable, autonomous wellness and resource-intensive heavy NHS dependency.

This will mean empowered populations. Huge disease awareness. Self-management.  Self-care. Care closer to home. Digital monitoring. Virtual Wards. Community diagnostics centres. Preventive devices. Preventive drugs. Better screening and faster diagnostics.

This article looks at four of the biggest public health and prevention trends in healthcare and asks – what’s in it for Industry?

1. Lifestyle interventions and social prescribing
Lifestyle interventions are the ground zero of preventative medicine. Advice on diet and exercise to pre-diabetic and obese patients, vaping, nicotine replacement therapy and more tax on cigarettes are things this government will continue to support. Improving air quality? The jury is out.

After all, chronic obstructive pulmonary disease (COPD) – mainly caused by smoking - costs the NHS in the UK around £1.9 billion each year. This is part of the £11 billion that all lung conditions cost the NHS annually and prevention is primarily a numbers game.

And in this game, if vaping reduces smoking, vaping is good. Think what you could do with £11bn. Probably build a third runway at Heathrow!

What of social prescribing? The NHS defines this as ‘a key component of Universal Personalised Care… an approach that connects people to activities, groups and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing.’

Social prescribing offers ‘the kind of help that doesn’t come in a tube or a bottle’.
The government will release its latest targets for social prescribing in the Big Plan but last year some 900,000 patients received such prescriptions.

Is this a threat to pharma? Not remotely. It’s in all our interests to have patients in a stable place – not least because grounded patients are more adherent patients that are more likely to conform to their pathway and achieve better outcomes from medicines. Lifestyle and drugs interventions have never been an either/or.

Plus, we are in the business of better disease awareness, screening and diagnostics – all of which will create bigger pools of patients that will benefit from our therapies.

2. Preventive medicines
It costs the NHS about £3,000 a year to give a patient either Mounjaro or Wegovy. And there’re around 3.4m eligible patients. That’s a total market of about £10bn, which sounds like a lot.

Compare that however with this fact. The NHS in England spends around £6.5 billion annually on treating obesity-related illnesses, and around £10 billion a year on diabetes, which is about 10% of its budget. This includes identifying and treating diabetes, 80% of which is on treating complications from the condition.

If it costs less to treat these cohorts with drugs that control a condition in the first place, than to treat with a series of medical interventions across multiple health sectors, then the NHS will be for it. Is this a threat to pharma?

Well, it’s certainly not a threat to Novo Nordisk. Drugs budgets capture products that produce better outcomes across the whole pathway but how much relative investment will the NHS want to put into medicines that extend lives by a few months, compared with medicines that prevent the condition in the first place?

An interesting trend to watch will be how much pharma R&D goes in the future on medicines that limit the need for other health intervention – cancer vaccines will be the area to watch, but neurology and CVD preventive, and lipid management drugs have a big future here too.

3. Preventing hospital admissions
It’s not drugs that Wes Streeting is against. It’s hospitals. According to the Nuffield Trust, around 71% of the NHS England budget is allocated to secondary care, which translates to roughly £70.2 billion in spending based on recent data, representing a significant portion of the overall NHS budget.

The government thinks it can save big by the so-called ‘shift to the left’, bringing services and patients from hospital to community, from community to primary, from primary to pharmacy and from pharmacy to home.

The plan will lean on primary care in particular for elements of care it thinks no longer need to be hospitalised, as it has largely done with therapy areas like diabetes. We’ll see more of this.

Pharma should be all over this – why not market brands explicitly as ‘referral management medicines’ or ‘secondary prevention therapies’, if they allow treatment in more cost-effective, sustainable settings?

4. Preventive Tech
Tech will be key to this movement because it is seen by the NHS as ‘the lever that is easiest to pull’ to streamline pathways, speed up processes and allow savings. And perhaps most importantly, the one that will reduce the need for hospital attendance.

Wearable devices are set to transform healthcare. Smartwatches, fitness trackers and medical-grade devices can monitor vital signs (heart rate, blood pressure, glucose levels) in real time, detecting anomalies before they become critical. Continuous data-gathering allows healthcare providers to tailor treatment and recommendations to an individual’s specific needs, improving outcomes.

Devices that track conditions like diabetes, hypertension and asthma will allow patients to manage these conditions remotely, minimising hospital visits while providing doctors with real-time data to adjust treatment plans.

What’s more, data from wearables can be shared instantly with healthcare professionals during remote consultations. Doctors can monitor patients even from a distance, improving healthcare access, especially for those in rural or underserved areas.

A direct benefit to pharma is medication adherence tech – some wearables will remind patients to take their medication and can even track whether it’s been taken.
 Wearables are going to be big, so the important thing here is to get on board, understand how they are changing patient care for many long-term care patients, align your proposition with this tech, and be prepared to work with the data it will provide.

The prevention agenda is one pharma should align with. Marketed correctly, novel medicines that support it can make waves, especially in so-called secondary prevention.

This can be understood as medicines that help manage patients out of hospital, minimise emergencies and exacerbations, and allow patients to lead independent and productive lives.

Many of our clients at HSJ Market Intelligence are talking to us about these issues and how they should build them into their engagement approach – and we are pointing out that features such as the accessibility of the drug, the delivery system and the monitoring element can all be transformative.

Insights here are important – in local demographics, disease burden, unmet need, inequalities and costs.

Backed by good patient prioritisation data and an understanding of where in the UK and how a medicine can have the biggest impact in referral control, pharma can build a strong offering on prevention.

The need for disease treatment isn’t going away any time soon. There is very much still a place for the pill. And working with the prevention agenda can actually make that treatment far more effective.

Oli Hudson is content director at HSJ. Go to hsjmarketintelligence.co.uk