• Stephen Whitehead

    Posted in category News by Stephen Whitehead on 26/04/2013

    Speech by ABPI Chief Executive Stephen Whitehead at the ABPI's Annual Conference 2013 (abridged version)

I’m delighted to be here today and I want to thank you for attending what I know will be an exceptional day.

 

Every one of us in this room is confronting more or less the same challenges that I would summarise in the following way…

The NHS in the UK is undergoing dramatic change, the English system more so than that of Wales, Northern Ireland or Scotland.

We, the R&D based industry, are struggling to understand the nature of that change, the emerging influencers, the appropriate business model to adopt to ensure we are commercially successful, the right tone to ensure our innovations are a cornerstone of healthcare delivery.

We are looking at our emergent pipelines and our existing portfolios alike to see how they can best be positioned in an increasingly complicated and diffuse operating environment.

What I hope today offers are some crucial clues as to how best to respond.

I want to provide an introduction for today by asking four fundamental questions.

  1. What are the challenges that the NHS is seeking to meet? Let’s understand our customer.
  2. What are the current details of the policy environment we are operating in, and how do we interpret so many diverse indicators?
  3. How does the NHS want to work with us and how should we be looking to work with them? What are the rules of the game?
  4. What is our role and are we best positioned as an industry? I cannot answer what is your role and how you are positioned as a company – but I can seek to give you an industry view.

So ... what are the challenges facing the NHS?

I know of and at times I share your frustration with the NHS. It is a difficult, political and at times mystical beast that consumes 9% of our GDP and seems immune to both our products’ potential and our endless charm offensive.

But to understand it we need to look at the immense scale of the challenges facing it. Let’s look at this from the customer’s perspective.

Demography provides a major challenge…

…we know that the UK’s population is ageing. To make sense of this, 538 people go over the age of 60 per day. 176 people go over the age of 70, and 165 people go over the age of 80…

Among other things this means an increase in co-morbidities. 58% of those aged 60 and over report having a long term condition, with 25% of over 60s having 2 or more. 70 pence of every pound spent in the NHS is now on long-term conditions.

Helping to meet that challenge, there are many scientific opportunities as a result of the huge changes we are seeing in R&D. Greater collaboration, improved productivity, open data, more flexibility are all transforming the picture faster than the authorities and regulators can keep pace.

And many motivated patients are already there, they are clamouring for earlier access to new treatments, greater choice and better care centred around their needs.

There is a real groundswell of empowered patients with high expectations.

How is the NHS going to respond? How will it deliver on greater patient expectations? 

Traditionally, increased investment in the NHS has not always been channelled towards significantly improving patient care and the patient experience. Excluding GPs, spend on NHS staff increased by nearly £11 billion between 2003/04 and 2011/12.

To give you just one example of what this means, many of our expensive healthcare facilities are underused on weekends, because staff largely work Monday to Friday – and so patients experience poorer access to care and poorer quality of care on weekends.

Witness the reaction from the BMA to the rather modest proposal from Sir Bruce Keogh suggesting that the NHS really be a seven day a week service.

But funding is not the only issue, perhaps more fundamental are culture and incentives.

Does the NHS respond to the needs of the patient or to the provider?

Culturally, whilst much of the NHS provides excellent care, as the Francis Report showed it can be slow to listen to the voice of the patient, and doesn’t always treat people with the dignity and respect that they deserve.

Beyond the need to treat people safely and with decency, the NHS is frequently told it needs to have a culture of excellence.

In fact, moves towards centres of excellence have been limping on for many years, the issue is too political it seems…

…but we are now seeing signs of change under the new system in England.

The recent agreement of seven London hospitals to start specialising among themselves and referring patients to the other sites for surgery is a significant move.

It is a recognition that not everything can be excellent…

Addressing unwarranted variation in treatment and in outcomes is a good thing for patients. But it must mean levelling up, not levelling down, if the NHS’ pursuit of excellence is to be meaningful.

So…

Demands are rising, expectations are high, technology is advancing, outcomes lag behind the rest of Europe – but funding is barely keeping level and that won’t change for some years to come.

I am a huge fan of the NHS, it does an amazing job of looking after our nation on a relatively small budget…only 9% of our GDP compared to say 12% in France

But in facing the immense challenges that I’ve described, we need to recognise the prioritisation decisions that will be made and the difficult choices that will need to be made to ensure the survival of our national health service.

The recent comments by the new Chair of NHS England, Malcolm Grant, about exploring potential further charges for patients are an early indication of a debate that is yet to come. Our politicians are not yet ready to hear it, but as I say, in my view, there is an inevitability about this…

That is the big picture. Looking at my second question, at some of the policy responses to these challenges and the details of what that looks like, it becomes even more complex.

Some policies aim at improving care and patient outcomes…others address the need to save money in the NHS … others are about spreading best practice and innovation throughout the NHS … others are aimed at connecting innovation to wealth.

There are several key initiatives underway of which the ABPI is the recognised partner.

While we struggle to get to grips with what these policies mean, the NHS has the unenviable job of reconciling them in practice.

In England, we have had the QIPP programme, responding to the famous Nicholson challenge, which has delivered efficiencies…

You may not know this but medicines have delivered the second largest contribution to the QIPP efficiencies, according to NHS figures, totalling £1.4 billion …on top of which price adjustments have delivered over £2 billion…and the often spoken about savings of LOE have delivered £3.4 billion over six years.

Right now the NHS spends just 7 pence per person per day on medicines launched in the last five years ... to put that in perspective, Germany, Spain and France all spend 21 pence per person per day, three times as much.

These results sit somewhat uncomfortably at times with policies aimed at improving treatment and outcomes for patients, from improved access to cancer medicines via the Cancer Drugs Fund, to national strategies for priority disease areas including cancer and dementia.

And they sometimes directly mitigate against the innovation agenda of spreading new treatments, new technology, at pace and scale through the health service through innovation, health and wealth in England and more recently similar efforts in Scotland.

There is much further to go to really prepare the NHS to meet its challenges. In England this has seen major structural reform which it is hoped will herald a new way of working for the NHS.

In Scotland, Northern Ireland and Wales while there are the same big picture challenges, we have not seen the same structural response. We have a session today looking at the devolved nations.

No single part of the UK has all the answers.

It doesn’t help in all this that the NHS remains a political football, meaning some topics are no-go areas…while others suffer from a consensus on a status quo that isn’t fit for the future...

So…

…this is what the NHS has to contend with. It is surely much harder to be on the inside, than on the outside trying to understand it.

Nonetheless on the outside, trying to forge a relationship with the NHS, we get mixed signals and it is hard to get a grip on my answering my third question...

Imagine if the NHS were a date – you would be seriously confused by its contradictory nature...

One minute they love us, the next they hate us...

One minute we are engaged with, part of the solution, the next we are the only problem...

We have IHW then we have double dipping on prices through tendering, we have a Scorecard then we have...

The ABPI works at the policy coalface through all these initiatives…

We have wins, then we have losses...

I don’t know if this relationship is dysfunctional or co-dependent ...do we belong in Relate? Maybe the divorce courts? Or perhaps it’s normal and I have the wrong expectations from a relationship!

As in any relationship the first question is what do we both want...

The solution of course is partnership – possibly the most overused word in our industry, so let’s try to understand it further…

In the future I don’t see us in big companies with our own R&D blocks, I see us sitting in NHS hospital labs...with academics, with NHS statisticians, with other healthcare organisations...

…less bricks and mortar and more externalisation and collaboration with key stakeholders that requires new approaches…

…this can be translated into the commercial environment by thinking of a seamless provision of service, information and product and an understanding on the NHS side...

This is about re-establishing the social contract we have with the NHS ... industry providing great value and the NHS using the innovative medicines that we develop at great expense and risk...

So finally, are we best positioned for the future NHS?

My answer is yes and no.

Yes – because we are already strong partners on IHW – witness the progress on formularies – on medicines optimisation and on clinical research.

No – because the NHS still sees medicines as expenditure to cut and uptake of innovative medicines remains a problem, with usage much lower than comparable countries.

I fundamentally believe that we are heading in the right direction and the ABPI is working across all these areas to ensure that we provide the optimal policy framework to create more YESes than NOs.

Of course trust is an issue.

We spent a lot of time in the last year addressing the criticisms raised by Ben Goldacre…

…much of this was not new and we already had programmes underway on payments to healthcare professionals and trial transparency…

…we got ahead of the argument but are yet to win true reputational merits…

The next stage of ABPI’s approach is to propel good pharma into the limelight…

…we have a strong story to tell about how the innovations over recent decades have improved the lives of patients in the UK more than any other part of the value chain.

Thank you.

 
Print this page icon Print this page
 
Please choose the subject of your enquiry from the list below:
 
Code to enter for submitting the form
Enter the above code here:
Can't read? Try different words.