EQUAL FOOTING: HOW PHARMA CAN HELP THE NHS TO ACT ON HEALTH INEQUALITIES

The issue of health inequalities looms large over the government’s reform agenda and now features as a golden thread running through all levels of NHS business.

At the highest level, one of the four strategic aims of all Integrated Care Systems (ICSs), according to NHS England’s ICS design framework, is to “tackle inequalities in outcomes, experience and access”. With the Health and Care Bill now achieving Royal Assent last month, this will soon become a statutory duty.

Underpinning this, Integrated Care Boards (ICBs) are required to create a five-year plan, which should set out how they will exercise this duty and will also need to publish an annual report accounting for their progress. Integrated Care Partnerships (ICPs), which represent organisations across local authorities, the NHS and voluntary sector, support this through their integrated care strategies which should “[address] health inequalities and the wider determinants which drive these equalities.

Beneath this, tackling health inequalities persist as a central theme at operational level too. At place level, Provider Collaboratives should “improve equity of access to appropriate and timely health services” including via multi-agency partnerships; while at neighbourhood level, health inequalities are mentioned over a hundred times in the latest NHS England contract specification for Primary Care Networks.

Putting it into practice

What, then, does this all mean in practice? The NHS is interested in several categories of difference: socio-economic (e.g. income), geography (e.g. variation by area), specific characteristics (e.g. disability, ethnicity or sexuality) and social exclusion (e.g. people who are experiencing homelessness).  The specific interventions put in place will obviously vary, but are likely to include:

• improving diagnostics and screening, particularly where there are communities or groups at heightened risk
• providing more equitable access to care, including through outreach activity to support excluded groups;
• delivering a more integrated package of care for people with multiple conditions or complex needs; and
• understanding and acting on variation in outcomes during and after surgery or any other intervention.

Collaborative action across NHS and non-NHS organisations are often key to this. Take, for example, the clinical outreach work commissioned in Rochdale being delivered for homeless people at a long-established soup kitchen.

Technology is another important enabler - as seen along the North West coast, where they are using portable ECG technology to screen for atrial fibrillation (AF) in an attempt to bring down some of the highest AF-related stroke rates in the country.

The opportunity for pharma

Of course, inequalities matter to the NHS for more than just moral reasons. They also tend to carry a significant cost to the system – for example, if certain groups typically present later with more advanced disease, or need more regular hospital care due to challenges in managing their wider health.

Changes to how services are funded reinforce this. The switch to a blended contract, via a single system-level pot of funding means all parts of the NHS should be zeroing in on unwarranted variation, with all organisations sharing collective responsibility for achieving the best possible outcomes for their populations.

This opens up a couple of significant opportunities for pharma. Perhaps the biggest of them is around data. The sort of things industry can do to add value here include:

• providing expertise in understanding specific conditions and patient needs
• helping to identify cohorts of patients who may not be receiving the right treatment
• modelling and segmenting data to advise on how to stratify patients based on risk.

Another important opportunity is around co-production and partnership. This includes working with NHS organisations to:

• support pathway redesign and workforce capability building – this is particularly important where operational pressures and backlogs may be created inequalities
• develop information programmes to help patients manage their own condition more effectively or tackle myths and misinformation about an illness
• provide direct support to improve patient adherence, or reduce unplanned episodes of care, so that resources are used more effectively.

Starting the conversation

NHS customers will be particularly interested in ideas that boost population-level outcomes and reduce the long-term strain on services by zeroing in on untreated or under-served cohorts. But it is important that any approach:

1. Is rooted in a strong understanding of the particular ICS’s strategy for dealing with health inequalities. This should be reflected in its five-year plan and, to some extent, the one-year service delivery plans that ICSs are expected to publish every April. Make sure you are fully across what these documents say and can frame your proposition within this strategic context.
2. Is directed at the right people and groups within the system. Most ICSs will also have a population health “champion” who is leading the charge – often identifiable from board reports relating to population health management. These are typically a transformation lead or partnerships director, or the medical or clinical director, and are crucial stakeholders. Find out what is on their agenda and think about how your proposition connects with it. But remember too that the cast list of influencers will range far beyond the traditional Key Opinion Leader in a hospital setting.
3. Is supported by a highly practical and well-evidenced for how the proposition can be operationalised and scaled appropriately within an integrated provider environment. It is important to consider how proposals resonate with the strategic needs of local communities as set out in Integrated Care Strategy from the ICP. Similarly, how straightforward is it to operationalise? Do you have case studies that demonstrate the proof of concept? And how do you ensure all delivery partners are engaged and onboard?

In short, there is much that Industry can do to help the NHS to reduce health inequalities in a way that benefits all parties, not least the patient themselves.

Basing propositions around an informed and intelligent view of the priorities facing the NHS at system, place and neighbourhood – and, of course, having a clear and costed account of the value you can bring – will give you the best chance of success.

Wilmington Healthcare’s unrivalled data allows you to access intelligent insight at a national or local level on health inequalities. To talk to us about generating reliable real-word evidence to connect and collaborate more effectively with your NHS customers visit wilmingtonhealth.com.