MISSION CRITICAL: HOW PHARMA CAN HELP THE NHS IMPROVE CARE FOR OLDER PEOPLE

It cannot be stressed enough that the 6.8 million-strong backlog in care is, in no small part, a backlog in elderly care – making this a mission critical area for the NHS.

As our recent State of the Nation report shows, older age groups were disproportionately affected by the withdrawal of health services during pandemic. Adult patients in the 55 and over age bands experienced 2.5 million fewer spells of inpatient care in 2020-21 compared to the previous year, with over 85s seeing over a million fewer episodes alone.

Pathways are also being compromised by severe and long-standing shortages in social care provision – an issue that the Health Secretary is seeking to address through a new £500 million winter fund announced earlier this autumn – as well as the well-recognised workforce shortages and capacity challenges affecting services.

New ways of delivering care

For all of these reasons, older patients have a vital strategic importance for Integrated Care Systems (ICSs), and many are now working with health and care organisations to introduce new ways of caring for them. This includes:

• The introduction of technology-enabled care, such as virtual wards and other remote-monitoring solutions, which can enable more patients to be cared for safely in their own home (or in a care home).
• The expansion of preventative health services, such as frailty clinics or falls assessment services, the presence of social prescribing professionals in GP surgeries, and greater join-up with social services and mental health teams, to help identify and support those at risk.
• Investment in multi-disciplinary community health support, such as improved out-of-hours crisis response services and a more proactive approach to supporting care homes through the Enhanced Health In Care Home programme.
• Changes in the way hospital-based services work, such as the introduction of Same Day Emergency Care services, patient-initiated follow up (PIFUs) for outpatient care, and the continuing expansion of virtual clinics to support patients and primary care teams.

Understanding the practical implications of change

All of these have practical implications for the way pharma works with the NHS.

First and foremost, there will be significant changes to the care pathway, involving different points of entry (e.g., digital or community-based referral) and taking in a much wider range of health and care professionals.

In particular, there will be extended roles for nurses, allied health professionals, pharmacists, and advanced practitioners, as well as more overlap between acute/specialist and community teams – which will need to be factored into brand planning.

Pharma will also need to work closely with NHS organisations to help them manage risks, while also directly supporting older people and their carers to educate and inform them about the changes in their care.

Specific challenges and complexities may emerge when it comes to decisions about how drugs are administered. Oral or sub-cutaneous methods gained currency over hospital-based infusion for practical reasons during the pandemic, but may create issues with adherence among some older patients.

How these risks can be mitigated – either by upskilling frailty teams and community-based health professionals, or by reverting to more traditional hospital-based infusion methods – needs to be part of the conversation pharma has with NHS customers.

Building a credible response

Industry’s response also needs to be weighed up against the headwinds that many health organisations will be facing. Inadequate access to diagnostics, delays in hospital discharge due to lack of social care packages and workforce and skills shortages across the pathway may limit what the NHS can realistically do for its older patients.

So how should pharma build a credible case?

First, it is important to understand local realities. This may include looking at current referral patterns, waiting times and other access issues, workforce capacity challenges and development plans, and what commitment are currently being made to improve service delivery for older patients in ICS five-year plan.  Make sure you leverage all relevant data and evidence to inform your approaches.

Second, it can be helpful to invoke national policy in making the case for change. For example, it is worth looking at the growing collection of Getting It Right First Time (GIRFT) reports, which outline best practice case studies and expose variations in clinical practice across a range of specialties (including Geriatric Medicine). NICE guidelines are also essential reading.

Third, it is important to work with ICSs and the wider clinical community to raise awareness of disease and facilitate best practice. Pharma can draw on a wealth of national and international experiences to influence local decision-makers’ thinking. Developing pertinent, evidence-based case studies can help illustrate the potential difference your offer can make.

Conclusion

In short, nobody doubts that the challenge of supporting increasing numbers of older patients is here to stay – indeed, the number of over-85s living in England is expected to double within the next 25 years.

This is likely to bring huge challenges for NHS customers, but also – by necessity – will present important opportunities to rethink how the health and care system supports us as we get older and frailer.

Pharma needs to be actively involved in this debate. By engaging intelligently with ICSs, it can make a significant difference to many older cohorts of patients today – and play a role in making the health and care system more effective and resilient for the future.

Wilmington Healthcare has unrivalled healthcare knowledge, data and intelligence across the NHS. We can help you to truly engage ICSs by understanding their individual operating models, needs, priorities and objectives. To find out more about how we can support your NHS partnerships, visit wilmingtonhealthcare.com.