The dawn of the digital revolution
The drive to achieve a digital revolution within the NHS has been ignited, with new schemes and opportunities for industry being announced across the UK. At the same time, cross party parliamentary groups have called for faster access to medicines and Labour have announced that, if called into power, they will create a publicly owned drugs manufacturer to supply cheaper medicines to the NHS.
Igniting innovation across the NHS
As the healthcare system continues to struggle under increasing pressures, there is a clear need for more to be done to manage demand, speed up diagnosis, improve treatments and empower people to take control of their health.
Digital innovations such as artificial intelligence (AI), big data, deep learning and analytics, could be the answer to helping reduce the strain on the NHS, by transforming healthcare delivery.
This week saw the publication of a study that found AI was as equally successful as humans when using images to diagnose a condition. This demonstrates how AI could help to ease the strain on resources, by speeding up diagnosis, freeing up time for doctor-patient interactions and aiding the development of tailored treatments.
However, the report cautions that the findings are based on a small number of studies as “the field is littered with poor-quality research”.
Nevertheless, while the application of digital technologies remains speculative, across the NHS a growing number of organisations are adopting bold initiatives to transform patient care through digital innovations which could represent opportunities for industry representatives looking to bring innovative products to market.
Data hubs launched across UK sites
Next month will see seven new data hubs rolled out across the UK, which aim to give patients faster access to pioneering treatments by making health data more accessible for innovative research to be carried out.
The hubs have been announced as part of a four-year £37m investment from the UK Government Industrial Strategy Challenge Fund (announced in November 2017). They will explore the effectiveness of the latest advances in technology using health data in partnership with the NHS.
The hubs are focused around key areas, which include cancer, eye health, inflammatory bowel disease, acute care, clinical trials, respiratory and real-world data.
Follow this link to see whether the seven hubs relate to the area you work, as they represent key stakeholders for industry.
ABPI and providers collaborate to improve healthcare delivery in Birmingham
In Birmingham, the Association of the British Pharmaceutical Industry (ABPI) and Birmingham Health Partners (BHP) have formed a collaboration which aims to “tackle the biggest health challenges” for the area’s 6m people.
As part of the West Midlands Local Industrial Strategy, the collaboration have formed Birmingham Health Partners and Industry Steering Group (BHPISG), which will use real-time clinical trials and health data to speed up research, improve cancer care, maternity services, child health, obesity and dementia.
BHPISG said it aims to make Birmingham a world leader in the development of precision medicines, which are tailored to patients based on genetic, environmental and lifestyle factors.
Industry should find out what projects are taking place in their local territory in relation to the industrial strategy.
Opportunities announced for Manchester healthcare technology companies
In Manchester 15 technology companies have been selected to take part in the Greater Manchester Future of Health Challenge, which is a new accelerator programme that aims to drive healthcare innovation in the North West of England by supporting companies launch products that can support people with long-term health conditions such as dementia and diabetes.
The Health Innovation Manchester Momentum Fund has also been launched, where companies with digital healthcare products or services can apply for up to £75,000, as part of a £300,000 funding call to support the introduction and adoption of healthcare innovations within Greater Manchester.
Plans to fast-track medtech innovations in Devon
Royal Devon and Exeter NHS Foundation Trust has partnered up with Health Enterprise East (HEE) to develop, commercialise and fast-track medtech innovations.
HEE will review the trust’s current portfolio of innovations and help them identify those with the potential to improve both the quality and efficiency of care provided.
NHS England’s digital procurement platform due for development
NHS England has announced plans to develop its Health Systems Support Framework (HSSF), so that trusts can use the procurement platform to purchase “tried and tested innovations for patients, populations and NHS staff”.
The HSSF was developed as a “one-stop shop” for sustainability and transformation partnerships and integrated care systems, to access “pre-approved” industry suppliers that can provide technologies to support integrated care delivery, such as electronic patient records, health analytics, system modelling, clinical decision support, assistive technologies, remote consultations and medicines management support.
Since the framework launched, 15 contracts have been awarded and a further 11 procurements are underway, totalling £54m.
NHSE is currently gathering feedback on the proposed changes.
APPG calls for faster access to cutting-edge medicines
A cross-party APPG report has urged the life science community to work together “to speed up access to cutting-edge medicines in the UK”.
The new APPG report provides a series of recommendations aimed at feeding into the upcoming National Institute for Health and Care Excellence (NICE) methods review, as well as suggestions for future research and work in the wider medicines access landscape.
Among the key recommendations are for:
- a fairer representation of patient groups on NICE appraisal committees
- the Government to review the medicines budget with a view to increasing it so patients can continue to receive world leading treatment
- the pharmaceutical industry to work harder to ensure it brings the best price to the table at the earliest opportunity and to be more transparent on prices
Industry should take note of these recommendations as they may represent a sign of things to come.
Currently less than 50% of orphan medicines are routinely funded in England, Scotland and Wales, compared to over 80% in France and Germany.
Labour announces plans to create a publicly owned generic drugs manufacturer
Labour has pledged to create a publicly owned generic drugs manufacturer to supply cheaper medicines to the NHS.
Speaking at the Labour Party Conference in Brighton, Corbyn launched its new policy document Medicines for the many, public health before private profit, which scrutinises the current system of drug patents and promotes making cheap generic versions of medicines that are deemed prohibitively expensive.
“We’ll tell the drugs companies that if they want public research funding, then they’ll have to make their drugs affordable for all,” said Corbyn.
Labour also announced plans to introduce free personal care for all older people at the conference. The proposed change would be paid for through general taxation, although detail on the proposal is sparse.
Post Brexit medicines access information published
NHS Improvement has published updated information for patients and clinicians to explain the government’s approach to ensuring medicines continue to be available in the event of a no-deal EU exit.
The measures include:
- building buffer stocks of prescription-only and pharmacy medicines
- procuring extra warehouse space for stockpiled medicines
- amending regulations to suppliers to ensure that medicines, devices and clinical trials licensed or tested in the EU can continue to be recognised in the UK in the event of a ‘no deal’ EU exit
Industry should have a strategy in place to ensure continued access to their products, whilst addressing the concerns of healthcare practitioners.
A new report from NHS Digital has found that there were 23.8m attendances to A&E departments in England during 2017-18, which is an increase of 22 per cent since 2008/9.
New data from NHS Digital has shown that A&E attendances are twice as high for people in the most deprived areas of England than the least deprived – could this provide joint working opportunities for industry?
Inspectors have found 28 privately run mental health units to be “inadequate” in the past three years, prompting fears that vulnerable patients are receiving poor and unsafe care.
The Government has announced the UK will invest £18m as part of the effort to tackle global antimicrobial resistance research.
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A drop in the ocean
More funding for the NHS has been announced in the government’s spending round, however, the NHS efficiency agenda is not going away any time soon. The NHS remains under pressure to switch to cheaper medicine alternatives and the scrutiny over prescribing seems likely to increase with the publication of a report that has revealed one in four adults were prescribed addictive medicines between 2017 and 2018.
Industry can play an important role in Improving patient adherence to medicines and so the review may provide important joint working opportunities for industry. In perfect timing, the Association of British Pharmaceutical Industry (ABPI) has published new guidance on joint working initiatives which may provide useful insights on how to proceed.
In other news, the role of pharmacists is increasing, public health strategy and statistics have been released, and stark warnings have been issued over Brexit.
Spending round reveals extra funding for the NHS
After much anticipation, the first week of September saw publication of the spending round, which sets out the NHS’ budget for 2020/21.
Headline figures reveal that an extra £6.2bn will be afforded to the NHS, while £1.5bn will be given to social care. NHS leaders have described the extra funding as a “drop in the ocean” of what is really required, or a “step in the right direction” at best.
For those of you that would like to gain a detailed understanding of what the spending round means for the NHS, the most comprehensive review has been published by the King’s Fund. It breaks down the figures to outline what is “new” funding that has not been previously announced, which it outlines as:
- £1bn for adult social care for councils in 2020/21
- £210m for NHS workforce development
- £7.0bn for NHS capital for investment in buildings, facilities and technology
- More money for public health although no figures were provided
There will be a 2.9 per cent growth for the Department of Health and Social Care. This settlement will see NHS England’s mandate spending rise by £33.9bn in cash terms from £114.6 bn in 2018/19 to £148.5bn in 2023/24. When adjusted for inflation, this equates to the £20.5bn increase that was more commonly referred to when the NHS five-year settlement was revealed.
Chief executive Niall Dickson argued that: “These are sticking plaster solutions and do not provide the long-term certainty the NHS needs. Funding still falls short in key areas, including capital investment, social care and public health.”
This means that you can expect the efficiency agenda to continue.
Quest to move to move to cheaper medicine alternatives saves £700m for the NHS
In the quest to make savings, NHS England has reported that an NHS campaign that aimed to maximise the use of generic and best value biologic treatments has saved more than £700m for the NHS.
According to the report, “the uptake of best value medicines lowered costs to taxpayers by £294m last year”, with a single drug, Adalimumab (a treatment for arthritis and other diseases) saving £110m alone after the drug came off patent at the end of 2018. Previously Adalimumab was the individual medicine that hospitals spent the most money on, at a cost of more than £400m a year.
A total of £413m was also saved from the annual medicines bill in the two years prior to 2018 and a further savings target of £400m has been set for 2021.
This means industry can expect the pressure to reduce costs to remain steadfast.
Some of the main savings that have been achieved so far are outlined in the chart below:
Increased role of pharmacists could include prescribing statins
The Long term plan (LTP) also advocated for an increase in the role of pharmacists to reduce the pressures faced by primary care and hospital practitioners, whilst making efficiencies.
In support of this, NHS England Chief Executive Simon Stevens has announced that high dose statins may soon be made directly available from high street pharmacies as part of the LTP to cut heart disease and stroke.
Pharmacists play an important role in ensuring the safe and effective use of medicines and so it seems to make sense that they will have advice providing advice and provision of statins, which are classified as a safe class of medicine (although not everyone is happy about this).
The findings of a review by NHS England and Improvement will be presented to manufacturers and the Medicines and Healthcare products Regulatory Agency which will have the final say on the proposed changes.
Speaking at the Expo health and care innovation conference in Manchester NHS England Chief Executive Simon Stevens, said: “It makes sense to consider whether there are a broader range of medicines that patients could access conveniently and locally on the high street.” Perhaps this signals that statins are simply a sign of things to come?
As part of a new £13bn five-year contract, from October 31st heart check-ups will also be offered by community pharmacies as part of a programme that seeks to prevent tens of thousands of heart attacks and strokes over the next decade.
This highlights that big changes are on the horizon when it comes to the delivery of healthcare and pharmacists are going to become increasingly important stakeholders for industry to engage with.
ABPI joint working guidance
The ABPI has launched new guidance to support joint working initiatives between patients, the NHS and industry, such as the:
- Identification of undiagnosed patients
- Improving patient adherence to medicines
- Contributions to nurse services
- Increasing NHS system capacity to treat patients
Launching the guidance, ABPI Chief Executive Mike Thompson said: “The benefits of joint working are significant for all concerned – higher quality care, lower hospital admissions and more appropriate use of medicines.”
A landmark report into prescription drugs has found that over 11m adults in England were prescribed addictive drugs between 2017 and 2018, which equates to one in four adults.
The British Medical Journal states that more high-quality research and training is required on withdrawal effects, the harms of dependence and withdrawal and how to avoid them, which may provide joint working opportunities with industry.
Developments within public health
Public Health England (PHE) has published its strategy for 2020-2025, which advocates for an increased role in technology such as data and artificial intelligence to develop targeted advice and interventions and support personalised public health and care.
According to the strategy, PHE will work with NHSX to develop its predictive prevention programme, as well as engaging with the health tech industry and academia to promote innovation across the system.
A new national science campus with state-of-the-art facilities is also due to be developed at PHE Harlow, which could also signify an opportunity for industry.
England’s health profile released
The Health profile for England 2019 has been published, which is a useful source of information for industry representatives that are looking to target their products to areas of need.
Stark warnings have also been issued on the impact a no deal Brexit will have on health and social care, with TechUK stating that the full power of innovative technologies going forward ‘will not be achieved’ in a no-deal Brexit.
A sign of things to come
The news articles published over the past fortnight signify some of the key themes that will govern the NHS over the coming years. Publication of the NHS Oversight Framework has set out the metrics that will govern commissioners and providers, a report published by Age UK could signify that a crackdown on polypharmacy could be imminent, the government review of NHS Health Checks supports a wider move towards personalised healthcare delivery and a campaign has been launched within the NHS to push the care closer to home delivery agenda. Brexit and social care also continue to be problematic.
Regulatory framework for CCGs and providers released
NHS England and NHS Improvement have published the NHS Oversight Framework for 2019/20, which outlines how providers and commissioners will be regulated over the next year. This makes it an extremely important document for industry to be aware of.
The regulatory programme replaces the provider Single Oversight Framework and the clinical commissioning group Improvement and Assessment Framework. Changes taking place include:
- NHS England and NHS Improvement will work together to set the expectations of the system
- there will be a greater emphasis on the performance of the system as a whole, although the contribution of individual healthcare providers and commissioners will also be closely monitored (could this lead to further mergers?)
- regulators will work closely with system leaders to take problems and lead improvements
- greater autonomy will be given to organisations that demonstrate collective working and successful delivery of the NHS’s priorities
Regional teams will lead on system oversight, although the report states that integrated care systems are set to play an increasingly important role in regulation as they develop.
Industry representatives should ensure that they take a look at the list of oversight metrics that organisations will be monitored on going forward, as these will form important joint working opportunities. Metrics that may be of particular interest to industry include:
- reducing the rate of low priority prescribing
- monitoring expenditure in areas where there has been identified scope for improvement
- quality of care metrics to identify any emerging quality concerns at acute, mental health, ambulance and community trusts
Existing failure mechanism tools (which include licence breach, powers of direction, special measures) will continue to be used where performance does not meet certain standards of quality.
The level of support, or autonomy, organisations will be afforded in light of their ratings are outlined in chart below, which was been taken from the report.
Over prescribing within the NHS faces greater scrutiny
Age UK has called for the Government to take into account the harmful effects of inappropriate polypharmacy on older people, as part of its review of overprescribing in the NHS.
The report states that while access to medicine is often vital to older people’s health and wellbeing, as many as one in five prescriptions for older people living at home may be inappropriate and could have serious health consequences.
According to More harm than good:
- almost two million people over 65 are likely to be taking at least seven prescribed medicines
- four million people over 65 take at least five medicines
- in England overall more than one in 10 people aged over 65 takes at least eight different prescribed medications weekly, and this increases to one in four among people who are aged over 85
With the amount the NHS spends on prescriptions increasing by 40 percent since 2010/11, the report calls for more regular medicine reviews to be implemented and could signify that a clampdown on spending on medicines in elderly care settings is imminent.
A personalised approach to healthcare delivery
The Government has announced plans to review the NHS Health Check Service, so that it can explore whether analytics and data-driven technologies can deliver personalised health advice to patients in order to improve outcomes.
Health checks are currently offered to everyone aged between 40 and 74 to spot the early signs of major conditions that cause early death, including stroke, kidney disease, heart disease and type 2 diabetes. However, they do not take into consideration individual risks or needs.
The review will focus on offering personalised interventions that take into consideration factors such as age, lifestyle, location and DNA. This represents a move away from blanket approaches to healthcare and could represent opportunities for companies that offer personalised treatments.
The drive for delivery of care closer to home continues
A campaign has been launched within the NHS that aims to help improve the number of patients that are discharged from hospital.
‘Where Best Next?’ aims to encourage NHS staff to consider whether care could be delivered to patients out of the hospital setting, for example, when patients receive care when recovering from an operation or illness.
The campaign could represent opportunities for industry representatives that have products that can aid safer, speedier discharges and community care.
Social care faces further scrutiny
Adult social care services in London have delivered almost half a billion pounds of efficiencies since 2015 and saved the NHS around £4.6 million a year through avoiding unnecessary hospital stays, according to a report published by London Councils.
However, the report also warns that the sector faces a funding gap of £540 million by 2025 unless the national shortfall in adult social care finances is addressed.
This week also saw more than 150,000 people sign a petition which called on Prime Minister Boris Johnson to take action to address the escalating ‘crisis in social care’.
According to the petition, around 1.4 million older people in England unable to access the care and support they need. This highlights that the pressure to squeeze budgets in social care settings will continue for the foreseeable future.
Brexit looms closer
The Department of Health and Social Care has also set up a £25 million service to deliver urgent medicines and medical products into the UK within 1 to 4 days as part of Brexit preparations. Could patients struggle to access your products?
A North West London CCG has said that there is currently no evidence that online consultations save time, Sir Andrew Dillion is due to step down as chief executive of the National Institute for Health and Care Excellence and the Government has announced £3.3 million in funding for 23 local projects supporting children and young people’s mental health.
The funding will go towards counselling, mentoring and arts programmes in the local communities.
The reign of Boris begins…
Boris Johnson has caused quite a storm in his first few weeks of Prime Minister, while many of his pledges have been viewed with caution, new funding opportunities could represent opportunities for industry.
Nearly new funding announced
The new Prime Minister, Boris Johnson, has announced an extra £1.8bn funding for the NHS.
The funding will go towards new equipment and upgrades to 20 hospitals, primary care services and a £6m backlog of maintenance projects.
Johnson said the funding will mean “more beds, new wards, and extra life-saving equipment”, which may represent opportunities for industry. You can view the 20 areas that have been cited as receiving extra funding by following this link.
Sceptics were quick to point out that the funding is not “new money” but is largely being funded by last month’s request from NHS England that trusts cut their capital spending plans by 20 per cent.
This, as senior policy analyst at Nuffield Trust Sally Gainsbury explained, is: “The equivalent of giving someone cash then banning them from spending it, only to expect cheers of jubilation when you later decide they can spend it after all.”
A sticking plaster for social care
The Prime Minister’s promise to “fix the crisis in social care once and for all” has also been met with criticism.
Cynics voiced that, although focus on the problem is welcome, publishing a white paper “within weeks” without proper research, analysis and reasoning, is likely to mean that the policy is destined to fail.
The Guardian highlighted that just to get back to the levels of access to help that existed in 2009-10 would cost at least £8bn a year in England alone. It will be interesting to see the government’s fresh approach to resolve the problem.
Investing in artificial intelligence
Johnson also pledged to provide £250m of funding for the NHS to set up a national artificial intelligence (AI) lab to enhance care and research.
The lab will use capabilities in AI to improve the detection of diseases, automate admin tasks to free up staff to care for patients and provide a more personalised service to patients.
The lab will sit within NHSX, a relatively new organisation that has been trusted with overseeing the digitisation of the health and care service. This makes it an extremely important organisation for industry to engage with.
Bracing for Brexit
In the wake of comments from the Royal Society and other science groups that a no deal would be the “worst option” for UK science, Johnson has also announced plans to introduce a fast-track visa scheme to make it easier for top scientists to work in the UK, amid reports that Brexit is already discouraging researchers from coming to the country.
Plans to invest £434m in medicine stockpiling and freight capacity in order to prevent drugs shortages in the event of a no-deal Brexit were also announced.
In other news…
Care Quality Commission quality ratings
The Care Quality Commission’s (CQC) annual reports and accounts demonstrated that almost a fifth of practices in England previously rated as ‘good’ have deteriorated to a lower rating.
Find out which category the practices in your area fall into – can improvements or failures be linked to the work you are undertaking in the area?
Primary care networks
The Health Foundation and Community Network have produced useful guides that explain the role and responsibilities of primary care networks (PCNs).
From July 2019, all patients in England should be covered by a PCN. They will be in charge of structured medicines review and optimisation (as outlined in the briefing by the health foundation), which makes them extremely important organisations for industry. (Follow the links to learn more about them).
The Department of Health and Social Care has also published purchasing point information for pharmaceutical buying groups in the NHS that have access to Commercial Medicines Unit (CMU) contracts.
NHS Medicines Procurement in England is coordinated through a structure headed by the CMU, which sits within the Specialised Commissioning Directorate of NHS England. The CMU is responsible for awarding and managing frameworks for licensed medicines for the regional purchasing groups in compliance with public procurement regulations.
Four in 10 emergency admissions to hospital from care homes could be avoided with better provision of preventive primary care, community support, or NHS care on site says a study by the Health Foundation.
Public and mental health
Detail on the updated Public Health Outcomes Framework indicators have also been published following a government consultation and a five year plan to improve mental health services has been released.
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