Party conference season gives valuable airtime and oxygen for new ideas to be debated, disputed, and digested, and in a year where many day-to-day realities have been turned upside down for politicians and businesses in the UK, I had a welcome opportunity to join a Health Fringe event and make the case for innovation as a driver for change, hosted at this year’s Conservative Party Conference.
There's no doubt that the NHS like most healthcare systems faces challenging times. Resources are tight but demands continue to increase. Public expectations quite rightly grow as they hear of the relentless advances in diagnostics and treatment. Standing still is not a sustainable option, which is why innovation has an important role to play in sustaining healthcare systems.
In reality, this means innovation in the way that healthcare is structured and delivered, as well as the readiness of healthcare systems to adopt innovative products and services.
However, for many healthcare managers the over-riding priority is to manage within the one year budget and innovation is often regarded as a cost, or a threat. Somehow we have to break out of this paradigm and demonstrate that innovation in all its forms can be part of the solution for modern healthcare systems. For this to happen, there are four areas of focus.
Firstly, the patient, and in particular the achievement of measurable patient outcomes, has to be at the heart of the healthcare system. A focus on outcomes enables a conversation about value not just cost and activity. Value is about improving the outcomes to cost ratio. Ultimately it enables payment systems to shift from volume to results. It enables comparison between organisations in order to identify best practice and innovation which works and disseminate it throughout the system. A focus on outcomes also helps bridge organisational silos and the establishment of integrated care teams around the patient.
There is a lot of work ongoing globally in this area. One organisation in particular, The International Consortium for Health Outcome Measurement aims to have published standard outcome sets covering more than 50% of the global disease burden by the end of 2017. So this is an achievable vision.
The second area of focus is information systems. There's a general consensus that integrated information systems which collect data such as activities, costs and outcomes along the patient's care pathway, rather than in organisational silos, are critical to the successful management of modern healthcare systems. The NHS as a single payer system should be world leading in this respect. These data provide deep insight into the performance of the healthcare system and how it can be improved. They also drive the measurement system.
NHS Right Care's 'Commissioning for Value' approach is an exciting development in this area, alongside its 'NHS Atlas of Variation' which serves up data from across traditional healthcare silos to provide insights that are readily accessible, allowing targeted improvements and innovations to be brought forward. What's vital though is that the focus of this work is balanced between improving important patient outcomes and managing the NHS budget.
The third area of focus is partnership. Partners can provide different perspectives and insights on the same problem. In our industry we have quite rapidly moved away from a model where we work in isolation in our laboratories in the search for innovation to one where we work with a whole array of partners (academia, healthcare professionals, patients and other corporations) to identify important and actionable insights which can spawn innovation. The same is true for healthcare systems like our NHS. Driving a more innovative approach will require closer partnership with patients, our industry and others.
Although it is early days, there are encouraging signs that our NHS is open to such partnerships with industry and we are being increasingly invited to come forward with our ideas about how care can be organised better using new medicines and technology to improve patient and financial outcomes.
This brings me to my final area of focus, rapid adoption of proven innovations. It should go without saying that proven innovation, particularly innovation which has passed the test of cost-effectiveness, should be adopted rapidly, replacing outdated approaches and technologies. This is an area where we can do a lot better in the UK. If we take innovative medicines as an example, medicines which have been approved by NICE, for every 100 patients who receive such a medicine in the first year from launch in France, Germany or Spain, only 15 British patients receive it. Even after 5 years uptake in the UK is only three-quarters the level in other developed countries.
Many commentators believe that we are at the dawn of a new era of innovation in our industry – from personalised medicine to blockbuster immunotherapies. But how can we ensure that the promise of these advances is harnessed to the benefit of patients here in the UK? Some rethinking is needed.
Medicines face more rigorous cost effectiveness assessments than any other area of healthcare spending, yet medicines are not currently the major driver of increasing costs in healthcare. The OECD Indicators Report (2015) shows that growth in drug spending is significantly slower than growth in healthcare costs overall.
On top of this, the 2014 PPRS is an innovation in itself in which the pharmaceutical industry has underwritten the growth in the branded medicines bill for our nation during these recent years of public funding challenge. This gave the NHS the opportunity to accelerate the adoption of innovative cost effective medicines whilst providing reassurance on the size of the branded medicines bill. Unfortunately this has been an opportunity missed – and industry eagerly awaits the outcome of the Accelerated Access Review that we believe must seek to redress this legacy.
So how do we truly embed innovation in our healthcare system? 'More of the same' is not a recipe for success – and we must all work together to ensure innovation in all its forms is recognised and adopted as a solution and a driver of real change.
For our part, the life sciences industry stands ready to work together with all partners to realise a new and exciting future for the delivery of healthcare here in the UK; where the NHS is at the forefront of medical science, where innovation is rapidly and readily available, where the treatment of every single patient is forward-looking, and where outcomes are measured, evaluated and improved.