Steve How, Paul Midgley and Sue Thomas, of Wilmington Healthcare, explore population-based planning in the NHS and what this means for pharma.
Sustainability and Transformation Partnerships (STPs) are being required to tackle the healthcare needs of their local populations in the light of ever increasing financial constraints. Accurate population and pathway data is crucial to this process, and pharma can play an important role in helping the NHS to develop an increasingly tailored approach.
Local population needs and STPs
Achieving required efficiencies has been forcing STPs to look beyond the integration of buildings and services to determine how they can manage the needs of their entire healthcare population. Patient outcomes are the crucial yardstick by which their success will be measured, and they cannot assume that more interventions will generate better results.
STPs need to profile their local population to understand the burden of disease. They must also analyse how their services are performing and where patient pathways could be changed in order to improve outcomes and save money. Promoting the self-care agenda will form part of a more preventative approach to healthcare; while co-production of new pathways with patients involved from the start is now seen as the best way to optimal design.
Moving from STPs to Integrated Care Systems (ICSs)
Eight areas in England have already been chosen to lead the way in forming an Integrated Care System (ICS), originally known as an Accountable Care System (ACS), which will replace STPs in those places.
Following controversy over the term “accountable care”, planning guidance issued for 2018-19 from NHS England and NHS Improvement recently stated that ICS will be the “collective term” for the devolved health and care systems in Greater Manchester and Surrey Heartlands, as well as the eight shadow accountable care systems.
The planning guidance document said that the eight shadow ICSs would not be “considered ready to go fully operational” until they produced a single system operating plan for the coming financial year. These plans should “align key assumptions on income, expenditure, activity and workforce” and system leaders within the ICS are expected to take an “active role in this process”.
The systems will operate under one system control total allowing more flexibility within organisations’ budgets as long as the system produces a zero net financial balance. This allows for the potential decommissioning of some traditionally high PbR earning hospital services to more cost effective integrated pathways. It will also mean that organisational differences in prescribing costs between hospital contract and prescription tariff will now bow to whole system prescribing costs.
How should pharma adapt to the changing NHS landscape?
Pharma needs to understand the local models of care delivery within specific areas and get on board with different care models. It also needs to stress the preventative elements of therapies in business cases.
Data is key to this approach and given the fact that the NHS has historically struggled to capture, procure and analyse its own patient population and pathway data, this is a key area where pharma can assist.
Hospital activity data, such as Hospital Episode Statistics (HES) can provide vital insights into the way local services are performing and the current cost of admissions, which could be offset with more appropriate and preventative service provision.
Interviews with stakeholders, such as STPs, ICSs and patients, can also be invaluable to gather insight on trends, gaps or inefficiencies in patient care in a variety of priority and non-priority disease areas.
These insights can be used to highlight the burden of disease; identify variations in patient outcomes and provide evidence for change in therapeutic areas. They can also help the NHS gain a clear understanding of the impact that pathways have on patients’ experiences and outcomes, and highlight areas of best practice and opportunities for improved efficiencies.
STPs and the newly emerging ICS models will be key to driving change within the NHS by allowing it greater flexibility when responding to challenges in specific localities. So, too will the increased focus on preventative care and self-care.
Pharma needs to keep abreast of the new local care models that are emerging and find ways to support them. Understanding and analysing local population data will be critical to engaging with STPs and ICSs, and enabling pharma to ensure that its products and services will help STPs and ICSs achieve their sustainability and transformation goals.