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An open door

The Conservatives' health policy, which is based on outcomes rather than targets, presents opportunities to industry

A door opening to bright, blue skiesConservative health policy is taking shape. Recent speeches from David Cameron and Andrew Lansley have laid out some key future NHS directions, were they to form the next government.

Practice-based commissioning would accelerate, as would the formation of Foundation Trusts. Spending would continue to increase year-on-year, but central bureaucracy would be cut by a third. Prevention would get major focus, with the Department of Health becoming the Department of Public Health. 'Connecting for Health' would be replaced by transportable, patient-owned health records.

More controversial still, there would be a moratorium on district general hospital closures – controversial, because many observers see these as an inevitable consequence of moving care into the community, closer to patients. But patient choice itself will be re-emphasised, with this choice embracing a larger range of providers – public, private and third sector. Competition will be unleashed in new ways, with the GPs holding the ring.

But central to all this will be management by health outcomes, not process targets. Focus on outcomes is a direction that the ABPI has urged, our stance supported by last year's Office of Health Economics Commission, which demonstrated that outcomes can, and should, be the right measures of the performance and productivity of the NHS. Targets are out, outcomes are in.

What does this era of outcomes spell for the industry? Both challenge and opportunity. The challenge has been clearly signalled. Medicines pricing would reflect outcomes demonstrated, and company control over the reimbursed price would be no more. Many have called this approach value-based pricing; I prefer to call it value-based reimbursement. But, whatever it is called, much careful design is needed before we would have a workable alternative to the currently structured PPRS.

However, at this point, I want to focus on the opportunity that an outcomes-focused NHS could bring. A key element of our case that innovative medicines should be an increasingly important tool for the NHS is that they achieve outcomes that are better for patients, and for the system. Medicines are a primary tool in the prevention of chronic diseases when used in early community-based interventions. They are also a major weapon in the war on cancer and in addressing the gap in cancer survival that the Conservatives rightly highlight.

Yet it should not be just a matter of our asserting the 'outcomes' case for what we do. I believe that, were these outcomes-focused policies to be rolled out, new types of engagement with the NHS would be possible.

The ABPI has pioneered 'joint working' with the Office for Life Sciences to ensure industry is seen as a major business partner to the NHS, achieving outcomes quality with improved productivity. The first phase of this process was the 'outreach' programme, which provided entry into Primary Care Trusts that had been resistant to industry dialogue, let alone industry collaboration, previously. The second phase established concrete collaborative projects across the country, with improved outcomes at lower costs.

I call the next phase 'close encounters of the third kind': business-to-business partnerships that are focused on outcomes productivity and that bring benefit and risk-sharing to the table. I will explore ideas on this third phase in the future. Meanwhile, the ABPI is ready to engage with the NHS, under a government of any colour, to make outcome-based productivity, not line item costs, the focus of NHS management. We'll rise to the opportunities that a Conservative health policy could bring, as well as its challenges.

Dr Richard Barker


The Author
Dr Richard Barker is director general of The Association of the British Pharmaceutical Industry

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16th December 2009


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