“The future of health”: Ross Carroll

12 December 2014

Quality and value in a cost constrained NHS: making the “sustainability equation” work

The debate around how to improve quality and value within the NHS whilst ensuring its sustainability has never been more pressing or acute as it is today. As Simon Stevens recently set out in his Five Year Forward View, if things don’t change, the healthcare system we all value will find itself with a funding gap of £30 billion by 2020/2021.1 Mr Stevens argues that more funding is required from politicians to partially close this gap, but states that this in itself is not enough to achieve healthcare sustainability.2 Neither is a simple equation of more funding and greater efficiencies – vitally important elements though they are.

For a truly sustainable healthcare system, “innovation” needs to be embraced, adopted and exploited, people living with illness need to be empowered to self-manage in the home and in the community, new models of care must be adopted and allowed to flourish, prevention must be a central objective, and integration of services to enhance patients’ experience of care must be the norm.

Achieving progress against all of these variables is no easy task. For the quality, value and sustainability equation to add up, I believe a culture of partnership working – a whole system approach – is required from every organisation and practitioner that plays a role in the improvement of health outcomes and experiences of care for people using the NHS. And I strongly believe that the pharmaceutical industry must be central to this solution-oriented approach. As an individual passionate about healthcare, I truly believe that companies such as AbbVie – and my industry more broadly – have a vital role to play in delivering quality and value to people living with illness, as well as their carers, within the context of a sustainable NHS.

Let me provide a few examples. Quality – as enshrined in law – means safety, clinical effectiveness and patient experience. Few would disagree with this. And to deliver quality will require a value based approach, given that value is often defined as quality divided by cost. In a cost-constrained environment it is tempting to consider only cost, but to do this will undermine the necessary focus on quality. In May 2013, the Royal Pharmaceutical Society led a publication called Medicines Optimisation: Helping patients make the most of medicines which was endorsed by numerous organisations, including the Association of British Pharmaceutical Industry (ABPI), NHS England, the Royal College of Nursing, the Royal College of GPs and the Academy of Medical Royal Colleges – whole system endorsement.3 The principles underpinning medicines optimisation – perhaps unsurprisingly – are patient experience, the evidence-based use of medicines, safety and making medicines optimisation routine practice. The broad principles of quality in other words. The challenge is for those organisations that came together to create and endorse the principles of medicines optimisation to work in partnership again to ensure that it becomes part of routine practice in the NHS to deliver quality and value for the people living with illness who we all serve.

But what about speed of adoption across the healthcare system? When medicines optimisation does become part of routine practice, will people living with illness be receiving quality care quickly enough? There is extensive evidence which shows that, in a number of therapy areas, people in the UK receive slower access to innovative therapies than many other countries such as France, Germany, Italy or the Scandinavian countries.4 So are we really able to deliver true quality, and serve our people living with illness optimally, if their ability to access innovative medicines they would benefit from is routinely delayed? I believe not. However,

I am encouraged by Mr Stevens’ commitment in the 5YFV to accelerate the adoption of cost-effective medicines and to improve testing of innovation using “test bed sites” through organisations such as the Academic Health and Science Networks (AHSNs), whilst committing to expand the Early Access to Medicine Scheme that has the potential to enable people suffering from conditions of “high unmet need” – in other words limited treatment options – to access promising new medicines quicker.5,6 This will also require reform of NICE, to ensure that its processes and methodologies evolve and remain “fit for purpose” in a changing world. The result should be swifter approvals for newer, cost-effective medicines that deliver downstream savings to the NHS. NHS England needs to ensure these medicines are made available to people who need them as swiftly as possible, once NICE deems them to be cost-effective. Working out the details of these policies is more complicated and will require what is my core theme in this article – partnership working and a whole system approach.

Can this be done sustainably? From a medicines perspective the answer is very definitely “yes”. The PPRS scheme – the system that regulates pharmaceutical pricing – ensures that the growth of the medicines bill is capped until 1 January 2019 and expenditure above this cap is paid for by the industry.7 This is projected to result in payments of around £4 billion back to the NHS from industry during the five-year duration of the scheme.8 This provides a mechanism to deliver quality and value in a sustainable way, but requires a whole system approach to ensure that the complexities of successfully implementing this deal – to benefit patients – can be overcome.

But in my view, industry’s role in supporting sustainability goes beyond the PPRS. What more can industry do to deliver quality and value to a sustainable NHS? Properly generating clinical and real world data, capturing patient experience and responding to the challenge of an ageing population, with multi-comorbidity, will be critical in demonstrating value and quality improvements. As an organisation, AbbVie is now looking “beyond the medicine” to provide care solutions to support people taking their medicines to ensure medicines optimisation occurs, and that their health outcomes through the use of medicine are maximised. As an example, AbbVie partnered with the College of Medicine to produce a report on sustainable healthcare in June 2014, and we are now actively engaged in funding and working in partnership to deliver a number of the report’s recommendations through pilot programmes to demonstrate that the concepts work in a cost effective way.9 Yet there is much more that AbbVie and our industry can do, but it all starts with a spirit of collaboration and partnership working.

So in summary, it is clear that delivering quality and value in a sustainable way is not easy. But I truly believe that if all stakeholders embrace working in partnership through a whole system approach to deliver for patients, the quality, value and sustainability equation will add up. AbbVie is certainly ready to play its part in dealing with the critical healthcare challenges of our time.

Ross Carroll MRPharmS MBA, Corporate Policy Lead, AbbVie UK

This article is written as part of AbbVie’s co-sponsorship of the “Future of health” conference, hosted by Reform.

This blog was taken from an article written for the brochure that accompanied Reform’s major health conference on the 2 December 2014.

Notes

1 NHS England (2014), Five Year Forward View.

2 Ibid.

3 Royal Pharmaceutical Society (2013), Medicines Optimisation: Helping patients to make the most of medicines. Good practice guidance for healthcare professionals in England.

4 Richards, M. (2010), Extent and causes of international variations in drug usage.

5 NHS England (2014), Five Year Forward View.

6 Ibid.

7 Department of Health (2013), Pharmaceutical Price Regulation Scheme 2014.

8 ABPI (2014), Update from the ABPI Procurement and Distribution Interest Group.

9 Sustainable Healthcare Steering Group (2014), Patient, manager, expert: individual. Improving the sustainability of the healthcare system by removing barriers for people with long-term conditions.

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