Steve How and Paul Midgley, of the Wilmington Healthcare Consulting Team, explore what the NHS 10-year plan could mean for medicines budgets
Introduction
The 10-year plan, which is due to be launched this autumn, represents a major new policy drive for the NHS in England. It will support the full integration of health and social care services, and this joined up approach will be key to enabling significant efficiency improvements.
With regards to budgeting, it has been confirmed that NHS England will receive a 3.4 percent per year, real terms increase in funding until 2023/24, to support its roll out, frontloaded to 3.6 percent in 2019/20.
Implications of long-term planning
When it comes to introducing new technology and innovation into the NHS – long-term planning is a real advantage. The 10-Year plan could, therefore, be good news for pharma companies struggling to sell innovative, and often expensive, products to low and middle management and clinicians who are currently constrained by in-year budgets. This is because the 10-year plan is likely to give NHS organisations a set of longer term service level targets, rather than a single, annual financial control target.
Frequently, rebates have been used because they fit well with in-year plans. However, with longer term budgeting, it would be easier to move to shared risk or outcomes-based schemes, since changes in patient management and outcomes could be monitored over periods of between two and five years, rather than one year which is a very short space of time in which to evaluate change.
However, the NHS will still have to meet targets every year, even within a five-year plan, so may seem two-headed in its strategy. Consequently, industry must manage itself within both of those constraints and show, for example, where it can deliver immediate savings – perhaps by reducing associated costs within a pathway – as well as where it can make a longer-term impact.
The NHS RightCare scenarios are a valuable resource for guidance in this area for pharma because they not only show what is happening in one year, but also what happens if you change the way a patient is managed for a particular condition, over a longer time-frame, usually five years. Getting it Right First Time (GIRFT) which looks at in-year efficiencies in the specialist units in hospitals, as well as longer-term efficiencies, is also very useful for pharma’s value proposition demonstration. It covers a range of disease areas including cardiovascular, mental health, diabetes and neurology.
Integrated health and social care budgets
The integration of health and social care budgets, combined with the move towards integrated healthcare systems, is expected to encourage commissioners to take an increasingly holistic view of medicines. It is expected that social care will play a key role in decision-making in the future; hence pharma could find that competition for funding comes from unexpected areas outside the healthcare industry.
A simple, but powerful, example of the impact of this change could potentially be applied to the management of asthma in deprived inner-city areas, where branded generics are currently one of the biggest competitors for many asthma treatments. If the social care budget was combined with the budget for medicines, then one of the biggest competitors for these asthma drugs could come from companies that sell anti-fungal paint and damp proofing; since these products can have a huge impact on asthma prevention and management.
Pharma must become more focussed on ‘appropriate patient care’. This involves looking beyond the cost and efficiency of a treatment at a single point in the care pathway and think instead about the whole care pathway. So, for example, what are the implications of failure rates for a drug? What are the implications of changing the care pathway further down the line due to a reduction in side effects from a medication? What are the implications for the rest of social services if a drug is increasing ambulation for patients?
To work in this way, pharma also needs to engage widely with decision-makers across the NHS – where, for example, STPs now encompass a variety of stakeholders ranging from representatives of Academic Health Science Networks (AHSNs), clinicians and pharmacists to local authority officers, charities and patient groups. Pharma also needs to understand the needs and priorities of individual STPs.
Tracking outcomes is also key and is being assisted by patient technology, such as diabetes monitoring kits, which are vital for concordance and improving outcomes. Another exciting development is genetic ID which can help to identify the right patients for the right personalised treatments.
Conclusion
Long-term planning and integrated care systems that involve both health and social care will be key to the NHS. Pharma needs to understand this direction of travel and future-proof its business by identifying and engaging widely with key stakeholders; understanding the needs and priorities of local healthcare economies, and thinking more holistically about how medicines can add real value to the integrated health and social care mix.