According to recent data, supported self-management can result in fewer GP appointments and fewer A&E attendances.
Supported self-management helps patients play a greater role in managing their own health and reduces their need for GP or hospital care, and there are financial implications that are clearly positive for the NHS budget. But it’s not only about cost savings, it’s also about enabling people to live better and healthier lives. NHS data shows that shared decision- making reduces the uptake of high-risk and high-cost interventions by 20%, and supported self-management results in 19% fewer GP appointments and 38% fewer A&E attendances.
While there is mounting evidence of the positive impact of personalised healthcare initiatives (particularly in mental health and learning disabilities) in primary care, personalised healthcare has not yet become systematically embedded in secondary care. This is why Merck has made a commitment to build shared decision- making and supported self-management into our ways of working, including the creation of tools to support patients, carers and clinicians. We want to accelerate the implementation of shared decision- making and supported self-management initiatives which can support the NHS COVID-19 recovery plan. We have now published a set of case studies on our website from the Greater Preston, Chorley and South Ribble CCGs, and the Buckinghamshire Healthcare NHS Trust and Oxfordshire Mental Health Trust long COVID clinic. These case studies demonstrate how other organisatons outside Merck are embedding the principles of supported self-management and shared decision- making to meet the needs of local populations.
Implementing personalised healthcare
When we dug deeper and read more about the direction of travel and the NHS commitment to personalised healthcare, we found that there was no clarity on which organisation would
be accountable for ensuring that there is a systematic approach to planning and delivering services, particularly in secondary care.
Given the compelling data that supports the need for better personalised healthcare, Merck is driven to understand how to make shared decision-making and supported self- management a reality within planned care patient pathways initiated in secondary care. The NHS Long-Term Plan outlines the aim that 2.5 million people are receiving personalised healthcare by 2024. The NHS concluded that personalised healthcare is critical in helping to reduce health inequalities and support the future sustainability of our healthcare system.
The case for implementing personalised healthcare is compelling and more important than ever before, given rising costs, demand and inequalities. For the last two years, integrated care systems have been created in England. These integrated care systems and NHS organisations, in partnership with local councils and others, have collective responsibility for managing resources, delivering NHS care and improving the health of the population they serve.
Integrated care systems allow organisations to work collaboratively to make real practical improvements to patients’ lives. They are natural and optimal healthcare settings that deliver personalised healthcare as place- based strategic plans and are operationalised based on local population needs.
Highlighting unmet needs
The COVID-19 pandemic has been a catalyst for change. The requirement to change the way care was delivered during lockdowns demonstrated what is achievable when collaboration and shared decision-making are implemented flexibly across health and social care, and when new technology is adopted that focuses on the needs of the patient. However, the pandemic has also widened the existing health inequalities gap, which has resulted in operational challenges, including the need to tackle backlogs and waiting lists.
Framework of accountability
We have created a personalised healthcare framework of accountability, supported by a set of guiding principles that will be embedded within our businesses, and all future personalised healthcare activity we initiate or support will be evaluated against them. The framework and the principles were based on insights collected from a multistakeholder survey, which was completed by over 100 individuals working within the NHS, in pharma, in patient organisations and in academia. We then took a deep dive into the survey findings with multidisciplinary experts and explored how Merck could support the implementation of the personalised healthcare agenda, with a particular focus on shared decision- making and supported self-management.
If we take multiple sclerosis (MS) as a living example, we know that patient outcomes are better when patients have a key role to play in their ongoing treatment. And yet, depending on where patients live, their ability to be a part of their healthcare decisions will vary. We want to support clinicians to make shared decision- making and supported self-management an embedded part of MS patient care, and we are working on some exciting plans with an independent body to facilitate that. We are also exploring initiatives in oncology and fertility that could be used for pilots to inform the personalised healthcare agenda in these areas.
Future collaboration
When we shared our thinking with NHS leaders, the response was really positive. There is an appreciation that pharma has a key role to play. Pharma has skills and capabilities such as R&D and access to big data that can help to enhance health and close the gap in health inequalities. We hope to be able to play a pivotal role in driving additional initiatives forward in partnership with the NHS.
To find out more, visit: https://www.merckgroup.com/uk-en/expertise/news.html
Doina Ionescu is General Manager at Merck, UK & Ireland