March 2023 • PharmaTimes Magazine • 18-19
// NHS //
NHS: Back to the future
We must look after an entire nation’s health – regardless of wealth
The UK’s National Health Service “was founded out of the ideal that good healthcare should be available to all, regardless of wealth”. Factors such as geography, demographic and socio-economic status, however – together with the fact that our healthcare system has long been stretched beyond capacity – have resulted in vast health inequalities across the country.
The pandemic has arguably exacerbated the matter. People living in the most deprived areas in the UK were twice as likely to die after contracting COVID-19, and we are yet to see the full picture of the impact that the pandemic has had on access to healthcare.
Current NHS challenges – workforce shortfalls, waiting lists, long ambulance stacks and delays in patient handover at the hospital front door, to name a few – raise the stark prospect of the country’s health inequality issues being made even worse.
No one left behind
A primary focus of health inequalities is to address the underlying social determinants of health. Just like the COVID-19 statistic, people living in the most deprived regions are much more likely to contract or die from preventable, chronic diseases, such as respiratory conditions – like chronic obstructive pulmonary disease (COPD) – chronic kidney disease, cardiovascular disease and some cancers.
A 2020 report found that over 20,000 additional cases of cancer in the UK each year can be attributed to socio-economic disparities, and survival is worse for the most deprived groups.
Beyond social determinants, it is vital we tackle variation in healthcare provision. The NHS Long Term Plan set the reduction of unwarranted variation as a key test for the System. These variations can be substantial, including in diseases where the burden is closely linked to deprivation. In 2019, only three in five hospitals made rehabilitation available within four weeks for people with COPD despite it being a clear, evidence-based priority.
In heart failure, only half of people are discharged from hospital with the treatments recommended by the National Institute for Health and Care Excellence (NICE) guidelines according to NICE’s latest impact report.
High quality, up-to-date clinical guidelines can play a critical role in addressing such variation. NICE, in its current strategy, sets a strong ambition to deliver these and drive implementation. The ambition is needed as, too often, guidelines are slow to update and/or are not followed locally. In type 2 diabetes, for example, US/EU clinical consensus changed significantly in 2018.
The NICE guideline was subsequently updated and launched in 2021 with significant changes to reflect clinical consensus – this was the first update since the guideline was released in 2015. Local guidelines still aren’t necessarily being implemented, and there are large variations in the prescribing of recommended diabetes medicines across the country.
NHS’s Core20PLUS5 strategy has also been developed to address health inequalities, including, for example, targets for earlier diagnosis of cancer (75% of cases diagnosed at stage 1 or 2 by 2028).
It’s recognition that health inequalities are broad and there is no ‘one-size-fits-all’ solution to tackling them, but that a framework for leaders to adopt with their local communities is key.
The success of Core20PLUS5 relies on stakeholders working in partnership, with clear purpose and urgency, to achieve prioritised goals. This way of working is one of my key takeaways of the success of the Vaccines Taskforce during the pandemic – when people have unanimity of purpose, and a laser-like focus on solving a huge societal issue, collectively, we can achieve great things and in record time.
The NHS has delivered more than 143 million COVID-19 vaccinations since the programme began just over two years ago.
Tomorrow people
This experience has led AstraZeneca UK to accelerate our strategy, fostering ambitious, purpose-led partnerships with the NHS, academia, government and industry to scale solutions towards a fairer and more sustainable NHS.
As we transition out of COVID-19, we are challenging the status quo and striving to address some of the major healthcare challenges in the UK, fostering and investing in proactive care models focused on early prevention of disease progression.
For example, asthma causes over one million severe attacks and 1,400 deaths per year in the UK two-thirds of which are thought to be preventable. People living with asthma in more disadvantaged areas, however, often find their condition to be managed poorly, with prescriptions of blue ‘rescue’ inhalers being much higher than recommended.
This results in an over-reliance on the blue inhalers for quick relief prior to an attack, and underuse of preventative measures, laddering up to the asthma progression and patient deterioration.
In response to these variations in respiratory care, AstraZeneca UK collaborated on the SENTINEL project with the NHS in Hull, where people with asthma were some of the highest users of rescue inhalers in the country.
Ultimately, the programme aimed to optimise the use of anti-inflammatory ‘preventer’ inhalers, which treat the underlying inflammation of asthma, while reducing the reliance on and prescribing of the blue ‘rescue’ inhalers.
At the programme’s core was the implementation of local asthma guidelines, delivery of targeted patient reviews and provision of education to clinicians and patients. Thanks to SENTINEL, clinical practice in Hull has now changed and rates of rescue inhalers use are reducing.
SENTINEL was launched with the intention of transforming respiratory care across the UK, helping AstraZeneca UK to aid and launch asthma policies within the NHS Long Term Plan. Following a successful pilot, AstraZeneca UK is supporting escalation to over 230 Primary Care Networks, health boards and federations across the UK, via a donated goods and service through the SENTINEL Plus initiative.
Altogether now
We continue working in tandem with national bodies such as the Academic Health Science Network and NHS Confederation to spread awareness. Through this partnership, we hope to continue the success of SENTINEL so that, in the near future, this type of healthcare practice will become far less of a rarity and a standard method in this nation’s healthcare system.
Asthma isn’t the only therapy area where we’re demonstrating how cross-functional, scalable partnerships can significantly benefit patients. Heart failure is another preventable yet highly prevalent chronic disease in the UK, with approximately 920,000 people living with this condition across the country.
Shockingly, around 80% of heart failure diagnoses are made in hospital — despite 40% of patients having symptoms that should have prompted earlier assessment — by which time, the patient’s condition has progressed to irreparable lengths.16
To help change the course for heart failure patients, AstraZeneca UK and the NHS in Glasgow established Project OPERA, a partnership programme designed to accelerate heart failure diagnosis and adherence to effective and timely patient management. The initiative uses handheld devices in addition to smart patient management and has reduced waiting lists for echocardiograms (which are required for the diagnosis of heart failure) from 12 months to four weeks.
At a time when health inequality is a prevalent issue in this country, early intervention and equitable access to the most effective treatments is critical to combatting the challenges the NHS is facing. Smart patient management enables the NHS to identify disease prior to progression, helping reduce inappropriate referrals, avoid unnecessary hospitalisations and excessive waiting lists, as well as bed days — a valuable resource when treating preventable chronic disease.
The reduction in delayed diagnoses through Project OPERA is astounding and proves that purpose-led partnerships across the healthcare industry can have a profound impact on the health and well-being of our country.
Peak practice
Everybody deserves rapid, equitable access to patient-centred healthcare, with the most effective diagnostics, the most effective medicines and high-quality evidence-based care wherever they are in the UK.
Patients should be diagnosed and treated early, daring to use scalable resources such as tests and medicines more to reduce pressure on constrained resources such as hospital beds and healthcare professional hours.
No patients should be left behind, especially not because of their socio-economic status, geography or because of organisational inconsistencies in the update and implementation of healthcare guidelines. Collaboration will be key to a fairer and more sustainable NHS.
The pandemic that has worsened health inequalities so greatly could actually show us such a solution. A vaccine taskforce-like partnership for national transformation and implementation, linking what works, industry support and local needs/deprived areas could be a great legacy from two years of crisis.
Much more will be needed to truly deliver the moonshot of health regardless of wealth, but I firmly believe that such a step, possibly a small step for NHS-kind, would get us off the launchpad. Let’s fire up the rockets.
Tom Keith-Roach is President at AstraZeneca UK. Go to astrazeneca.co.uk
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