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Here's the plan

ABPI President Nigel Brooksby has a problem with things he feels aren't fair - hence his new manifesto outlining the plan to adjust spending on medicines in the UK. Rob Skelding reports

So, the ABPI has published a manifesto. A gruelling, gnashing tome that aims to set the record straight fundamentally on the value of new medicines, bringing the government to its senses and delivering a few nifty blows to the ventricular of its detractors. Well, no actually; not that in fact. This manifesto is an easy-to-read, six-page, nutshell-sized Polaroid of the Association's desires to partner the government in making the national health service more efficient, stretching further the funds available and, consequently, freeing up purchasing capacity enabling it to accept more innovation into the marketplace.

In this document the Department of Health's (DoH) gizzard remains intact and in good shape, which is, after all, what ABPI President Nigel Brooksby wants. He needs his key prospective business partner to be healthier than the patients coming to it for help, and this is indeed how the ABPI views the government today: a key prospective partner. Then again, there's not too much that is `prospective' about it when you consider that the pharmaceutical industry has been one of the central-most peas since the inception of the NHS pod.

There is, though, a definite anticipation at the ABPI of soon-to-be joint working arrangements with MPs through which, Brooksby foretells, spending on healthcare in the UK may be corrected slightly.

We do need to correct things - not a lot, but we do need to put certain things back in balance. We use generics appropriately in the UK, but we need to use more of our own innovations. You could say that, to some extent, we discover it in the UK but we don't use it here, and to me that's not fair.

This is about patients, not the pharma industry and not politics. I'm apolitical. I've only voted once in my life and that was when I was 22, living in Nigeria. And I only voted then because there was a party I wanted to be more involved with. He lets escape an inkling that this particular party was of the drinking, eating and talking variety, and not the political sort.

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Sufficient reserves
With the benefits to UK healthcare of the pharmaceutical industry and the NHS working more as partners than suppliers and customers spelled out clearly in the ABPI's manifesto booklet, might it provide a useful coil with which to spring a few requests upon the government to assign more money to the pot marked `new and innovative medicines'? Given the 7 per cent price cut imposed through the PPRS in 2005, plus the keen generics prescribing targets in this country, surely the case is strong to ask for more money to be put aside for new medicines?

Actually, we're not having a go at the government. I want to work with the government towards a solution, rather than making a problem even bigger. If you look at the UK, almost half of the medicines we prescribe and use are the cheapest in Europe because they're largely generics. We have some very prudent prescribers here and a government that's been very good at directing that spending. I applaud and appreciate that, though what we want to do, along with the government, is ask how we can make the funds go further, how we can deliver more, Brooksby says.

There are two issues here: the first is that the funds made available for medicines by the government will stretch further than they do at present. The money's there, it's just about spending it slightly differently, he notes. Quite recently the government admitted that we can save ?2bn a year - he repeats this slowly, emphasising each syllable - two billion pounds every year, if we adopt the best practices from the top 25 hospitals and spread those practices around to all of the other hospitals. That frees up a huge amount of headroom for innovative new medicines; two billion pounds I would take.

The second issue relates to ministers' understanding, or limitations therein, of how far current funds already reach. People say too much of the UK's healthcare budget is spent on medicines, but it is only 11 per cent of the overall bill, and it is still declining. Even now when I talk to our government ministers, and also the opposition, they don't realise this fact. We reduced prices of medicines by 7 per cent last year and I think the medicines bill has fallen by 3 per cent over the past 12 months, but when we talk to ministers they don't know this; they still assume it must be much higher, even at 30 per cent or more.

If there are such people in government who have not yet taken the opportunity to examine precisely the level of spending on medicines today, then it would seem that Brooksby's freshly stated mission is imperative. If they have that perception, they are perhaps denying patients the very medicines they need to either improve their lives or even save their lives. If people think that the bill is going up rather than down, they won't spend the money on it. If I thought that my own personal expenditure on something was increasing to 30 or 40 per cent then I'd perhaps stop spending my money too; in this way, governments are no different from you and I.

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The stretchable fund
Of course, the DoH is spending more on healthcare now than at certain times in its history, and so if ever there was a time to make sure the money gets spent in the right way, now is it.

We are spending more on health, which is good, but that is something we should be doing and I think pharma firms can work as partners in that network. We've got a good relationship with the government and with Andy Burnham MP [Minister of State for Delivery and Quality at the DoH, appointed in May 2006], who supports our manifesto. Pharma can help to make money in the NHS go further, and we can work together as partners. Joint working will work for the UK.

The ABPI's manifesto is, in essence, the Association's way of letting the government, its pharmaceutical company members, the press and, crucially, the patients in the UK know that a) it cares about and is tackling the problems in medicines provision in this country, including access to innovation, the passport lottery and post-code lottery; and b) that the ABPI is taking a cooperative stance in order to be able to play a part in shaping the NHS of the future (including the near-term future), striving fervently to do away with the recent buzz about the poor reputation of the pharma industry and going beyond highlighting the problems of providing access to new medicines by proffering workable solutions.

Part of the solution
It was a just a few months prior to Brooksby taking over as ABPI President (April 2006) that the Right Honourable Patricia Hewitt MP, Secretary of State for Health, said something interesting. As Brooksby recalls, she commented along the lines that 'the next 24 months [to December 2007] will determine what kind of NHS we will have for the next 20 years'.

Brooksby's pledge to be in the middle of all this is not, like some of the stuff that can spew out from industry associations, easy-for-you-to-say tittle-tattle. Spend a few minutes in the man's company to see that he believes, 100 per cent, in the joint working plans with government for the future of pharma.

A legitimate desire for rectitude, balance and a keen sense of `right' also strike you. He speaks easily and it's not down, entirely, to media training. He's open to challenges about his plans because he believes himself to be doing the right things, and while this observation may come across as a bout of ingratiation, it is not. Whether he's talking about rugby, becoming quickly animated in his chair every time this crops up, or pharma, it's clear early on that Brooksby is one of those people who is evidently ill at ease with the matter of unfairness in general.

NICE's failure to curb the post-code prescribing issue, the lay media's doggedness in holding a knife to pharma's throat and access to more innovative medicines for patients in this country are some of the areas where he feels things should be fairer; not that it should be all his own way, just that the core arguments, upon which key decisions in the NHS are often made, should be better balanced.

That's not fair is one of my major slogans, as you can imagine, he says. For example, it seems easy to think that the UK pharma industry has a terrible reputation, but while it can be improved - and it can always be improved - in fact it has been shown that we've got quite a good reputation.

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He's not the first association president or general manager in pharma to say this and, even as you read such a statement here, it's very easy to be cynical, or at least to not bother deploying more brain power in order to carve out an opinion based on the absolute truth. How much does it really matter anyway? So what if the public doesn't see past some of the Guardian's headlines, does it make much of a difference?

Well, you do hear about our awful reputation in the media, and that message gets through; even I thought it was true, until recently. He refers to the results from an independent Ipsos-MORI survey, commissioned by the Association, which revealed that the British public, by a count of nearly four to one (n = 1,997), is `favourable rather than unfavourable' towards the industry.

The wording may be mildly woolly, but the point to recognise is that it's not the other way around. Favourable mostly, not vice-versa. Add to this that two-thirds of MPs (of 108 questioned) now also hold a favourable view, and it seems that, in spite of the power of juicy headlines in the national papers, most people believe pharma to be doing some good.

Brooksby puts this down, in part, to the ABPI having shone the light on pharma companies which have breached the Code of Practice throughout this year, whether they did so wittingly or unwittingly, as is always a possibility, he notes.

This is being open with people about what the industry does, that overall it is part of the solution and not part of the problem. And part of the solution I think is to shift the way we spend money, with more on innovation for this country's patients. This manifesto, which by the way is a living document and will evolve as time goes by, is all about patients. If anyone should read it, I want it to be the patients, it's really all about them; it's about putting the patients first. I'd like to make sure that this is not a one-hit-wonder, that the message gets through, because it's very important to me and to all of us living in the UK that we live in a fair society where patients are treated appropriately. That's what I want for me, my family and friends - and, he adds, looking very ardent in the eye suddenly, I think that's fair.

The Right Medicine, The Right Patient, The Right Time is available to download from www.abpi.org.uk, or as a hard copy in mauve from its publications department.

2nd September 2008

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