Writing in The Daily Telegraph earlier this week (‘A single reform that can sustain our NHS’ – 10 September) the Secretary of State for Health Jeremy Hunt raised an important point about just how tough the challenges ahead for the NHS will be.
The rising pressures of long-term conditions are at the heart of many of these challenges. Already, 15 million people in England have long-term conditions, accounting for 70% of health and social care spending. These figures are rising. The pharmaceutical industry knows it has an important part to play in helping the NHS to meet this challenge.
As Mr Hunt writes, a radical transformation of the way we look after people outside hospitals can make a significant positive impact. In many cases, effective use of innovative medicines can support people with long-term conditions to live healthily and independently and avoid the need for them to visit hospital. This is crucial both for patient outcomes and the effective use of NHS resources.
To illustrate this point, I want to focus on one common long-term condition and how the pharmaceutical industry can help the NHS to transform care in the interests of patients.
Atrial fibrillation (AF) is the most common sustained heart arrhythmia. Characterised by an erratic and often rapid heart rhythm, this long-term condition is estimated to affect in excess of one million people in the UK, with 200,000 patients newly diagnosed each year. As the UK’s population ages, the AF population is set to double in the next 40 years. AF is a major cause of stroke and it is estimated that 12,500 strokes are directly attributable to AF each year.
It is estimated that stroke care costs the NHS £2.2 billion per year and costs the wider economy an additional £1.8 billion per year in loss of productivity and disability. Indirect care costs, such as home nursing, are estimated to be £2.4 billion per year. Annually, stroke patients occupy up to a quarter of total hospital bed days.
Managing AF should be an exemplar for the radical transformation which Mr Hunt refers to. However, this has not yet happened in practice.
AF-related stroke can be prevented through appropriate and successful anticoagulation. Historically, the most commonly used anticoagulant has been warfarin. Patients receiving warfarin need to be monitored by their hospital, GP or pharmacy-led clinic every two to four weeks, which can lead to changes in medicines dosage which can be challenging for patients to manage.
Pharmaceutical innovation means that anticoagulation can now be well-managed. Novel Oral AntiCoagulants (NOACs) mean that while patients require some monitoring they require significantly fewer visits to hospitals and their medicines dosage is stable. NOACs have been approved by NICE for the prevention of AF-related stroke as both clinically- and cost-effective for the NHS to provide to patients.
However, evidence suggests that commissioners at the local NHS level are slow to implement the NICE guidance which recommends NOACs for use in the NHS. In some parts of the country patients are simply not receiving these innovative medicines and the NHS is not reaping the potential benefits.
NOACs are an excellent example of the innovative treatments described in 'Innovation, Health and Wealth' (IHW) which recognised the need for the NHS to do things differently. However, our industry’s experience is that even when national policy is favourable, local delivery to patients is blocked. This is not the way to make the NHS sustainable and capable of meeting the challenges of the future.
The NOACs experience is, sadly, just one example. The experience for many patients suggests a focus on short-term cost savings rather than on radical thinking. If the NHS really is to do things differently to meet the future challenges, it needs to place better outcomes for patients at the heart of everything it does.
NHS Partnership Director