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MORE MONEY FOR THE NHS – BUT IS THIS THE ANSWER?

Paul Mannu of Cello Health Insight says that politicians opening their pre-election cheque books can’t put the NHS where it needs to be – but pharma can play a major role in doing so.
With an election looming, the NHS is once again poised to be a key battleground amongst politicians vying for power.  We have already seen this happening: from George Osborne’s announcement of £2 billion extra cash for the NHS in his autumn statement, to Ed Balls’ retaliation with a promise of £2.5 billion of extra spending over and above the Chancellor’s promised funds.  

Of course, the NHS can always use extra money – that much is not in doubt.  But will all these promised extra riches solve its inherent problems?  Or are we just throwing hard-won taxpayer billions into a system which is not fit for purpose?  

Of course, promising cash is an easily-digested electoral message, as is talking about reform or leadership; however, attitudinal change is a more difficult pill for voters to swallow.  Yet no matter how big an election windfall comes the NHS’s way, without a fundamental change in attitude within the health service, and in particular a refocusing of how it reflects health and well-being in the 21st century, the same problems will remain.  

Intellectual think tanks such as the Kings Fund make clear that the days of the heroic single-handed doctor remain, but are disappearing in favour of expert teams -  including the empowered patient.  These views are echoed by NHS England’s ‘The NHS belongs to the people’, where patients are given greater control and personalised healthcare planning: ‘No decision about me, without me’.  

Much like spending pledges, controversial statements will always find page-space in our newspapers.  When Prof Sir Bruce Keogh, Medical Director of NHS England, suggested that hospitals could learn from Tesco, he was met with predictable howls of protest from physicians.  Yet he makes a valid point that the NHS is stuck in the past when it comes to being a purveyor of modern services.   

Nowhere does attitudinal change need to happen more than in the area of using technology.  56% of us now use online banking - unthinkable a few years ago.  Yet a similar change has not materialised within the NHS.  Fortunately, this is an area where pharma can play a part, but only if pharma itself accepts that its role in the NHS also needs to change.  

Changing the NHS is never easy.  Partly, that is because of the esteem in which it is held in the UK: as a British institution, it is second only to the Queen - there is a sense that you can’t knock it.  It is so fundamentally ingrained in our cultural identity, that challenging it becomes very difficult.
 

Into this environment has come rapid technological change which has, to a very great extent, passed the NHS by when it comes to physician-patient interaction.  Certainly, it hasn’t been embraced to the extent it has by the general population: 84% of us use email, and yet a recent survey by doctors.net showed that less than 4% of GPs use this communication channel with patients.  Yet those that have note efficiency improvements.  

The traditional face-to-face interaction model of the NHS simply isn’t working and cannot be sustained.  Patients are waiting weeks for appointments, and doctors constantly complain of not having the time to do their job.  Yet still there is a reluctance to embrace changes which would directly ameliorate that situation.  

Signs of hope exist.  In the Airdale region in West Yorkshire, a Telehealth hub was recently introduced that included 24 hour video consultations to cover 150 nursing homes.  The result?  Between April 2012 and March 2013 there was a 35% drop in hospital admissions and a 53% drop in A&E visits among patients from within the nursing homes.  The advent of ‘homes as hubs of care’ using technology is not far off the horizon.  

Why isn’t telemedicine already ingrained into the system?  Why are we not Skyping or teleconferencing with our physicians?  Why are we not using these services more for triaging?  Why, if the doctor needs to monitor my blood pressure, can they not use a monitoring device attached to my existing smartphone and transfer the data?  Cello Health’s’ 2014 European survey of healthcare digital uptake showed that 65% of GPs over the age of 55 in the UK would welcome an app that would help compliance.  

One significant barrier is that we still do not have integration of medical health records or patient access to medical records, and the reason for this once again comes back to politics – people don’t trust Government with their data.  But perhaps an attitudinal change in the NHS – which as we have seen, is highly trusted – might bring about a similar attitudinal change amongst the general public, particularly if the advantage is more efficient management of their disease, rather than believing their data will be used to exploit them.  

The public is open to embracing change.  Just look at the extent to which they are trusting the internet, even if physicians are reluctant for them to do so (although doctors themselves use it more and more).  The European Commission recently conducted a flash Euro-barometer that showed that 60% of the European population used the internet for health-related information.  

Why are doctors bemoaning the fact that they have to readdress the information that patients are finding on the web, rather than steering them towards the most appropriate sources of online information?  Partly because HCPs are reluctant to admit that they no longer have a monopoly on medical information, something which is changing the power relationship that exists between them and patients.  

So the big question is this: what developments would result from such change in the NHS, and, crucially, what part does pharma need to play in facilitating these changes towards technology?  

One of the key roles for pharma is as much an attitudinal change as a technological one: the industry needs to be taking a lead in thinking about how technologies and approaches can be integrated to support the patient across the whole of the disease journey.  This is particularly true for chronic diseases and those rarer disease states that involve life-long, expensive therapies.  

That role cannot simply be about providing the tools to make it easy for physicians; pharma also needs to play a role in changing physician attitudes themselves and to be seen to involving itself across the whole disease.  

Currently, if you suggest to a doctor that, alongside the actual treatment, they should be providing the social, psychological, emotional and financial support that people actually need in their disease, to increase the quality of life for the individual and reduce the burden on the doctors themselves, the answer would be: ‘We haven’t got time to do that.’  Even if they know it is the right thing to do and improves health outcomes.  

So for it to happen, pharma has to play a major role in delivering such support.  That means moving away from the ‘I will support you in your treatment’ paradigm to an ‘I will support you in your chronic disease’ paradigm.  

You cannot call yourself a patient support service if all you are focussed on is the treatment.  That makes you a drug support service – you are supporting your product, not the patient.  But if pharma is seen to be caring for the disease, it will win the physician’s trust, opening up the door to a change in attitudes.  

This is where pharma can add resource into the NHS over and above that extra money which is being promised by the politicians - resource which is not just going to be directed towards the politically expedient quick fixes.  

Given the relatively low cost of creating, for example, virtual consultation platforms for patients and doctors, the return could be very high, not least in becoming a starting point for persuading them of the potential for improvement through technological change as well as raising the collaborative profile of the industry.  

Alongside this carrot needs to come a stick.  Extra financial resource into the health service can only come at the cost of something else.  So to ensure value, future cash injections should be conditional upon change, upon acceptance of new, more efficient and more patient-friendly ways of doing things.  Pharma can lead the way in delivering such methods, which are endorsed by intellectual think tanks such as the Kings Fund.  

Pharma can drive the understanding of what is potentially available.  If future funding becomes dependent on a change in the way the NHS operates (and make no mistake, the politicians will not be so generous with taxpayers’ money once they are safely elected), then pharma will have the opportunity to integrate itself more into the system, as long as it takes the truly patient-centric view that we are dealing with solutions to problems, rather than simply marketing treatments.  

Pharma must not see pre-election financial sweeteners for the NHS as an opportunity to sell more product; instead, it should be concentrating on helping the NHS understand that money is not the solution to all its problems.  Pharma acting as an agent for – and facilitator of - change within the NHS will ensure the industry plays a central role in healthcare, whatever the voters have to say on 7th May.
 

The Author Paul Mannu is behavioural insights director at Cello Health Insight.  He can be contacted at pmannu@cellohealth.com. Twitter: @pmannu

27th April 2015

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