A bill so big you can see it from space. Bigger than the decades-old bill that created the system the current bill is intended to replace. Two descriptions of the Health and Social Care Bill, a controversial set of proposals designed to overhaul the UK’s unwieldy and overly-bureaucratic NHS. After a rocky few months, the bill is at committee review stage in the House of Lords. Reformers hope it will reach royal assent in spring 2012 and become law soon after. This raises two questions. Once all the necessary amendments are made, what bill can we expect to emerge in a few months’ time? And what can the pharmaceutical industry do to prepare for it?
Companies can do little to influence the answer to the first question; the passage of the reforms is now in the hands of the peers. But the recent
Wellards Annual Conference, held in London on 9 November, showed that there are plenty of experts willing to have a stab at answering the second. A day of presentations and discussions, aimed primarily at pharmaceutical marketing and other customer-facing professionals, underlined two new strategic priorities: the need for proactive engagement with an enlarged group of stakeholders and a shift from selling drugs to providing broad healthcare solutions.
The first priority is to recognise the stakeholders. The few constants in the new system will be patients, health providers and the Department of Health; virtually every other component of the UK healthcare landscape will change. Some 250 clinical commissioning groups (CCGs), member organisations led by GPs, will take over work currently carried out by primary care trusts and regional strategic health authorities.
Monitor, the independent body that regulates NHS foundation trusts, will become an economic regulator responsible for overseeing access and competition in the NHS. Health and wellbeing boards (HWBs) will co-ordinate and integrate services and develop strategic-needs assessments. And there will be a shift from centralisation to localism. Come 2013, local governments will take on a long list of public health responsibilities, including dealing with key disease areas such as mental health.
Some companies have seen these changes coming and been quick to adapt. David Rogers, chair of the
Local Government Association Community Wellbeing Programme Board, said he had been approached by firms asking how best to work with local government. A recent pharma roundtable discussion, organised by the
HFMA, an association representing NHS accountants and finance directors, showed that drugs companies are willing to share ideas with influential new stakeholder groups. A few years back, pharmaceutical sales and marketing teams were already talking about key account management as an effective way of working with NICE and other payer groups. It would not be much of a leap to do the same in their interactions with local governments and HWBs.
The second strategy, rethinking traditional sales approaches, may have more of an impact. Senior NHS managers are tired of seeing sales reps trying to sell pills and fancy gadgets. They are frustrated that a health service that claims to be primary care-led ends up dealing with so many patients admitted to hospitals as emergencies. They are crying out for solutions so that patients stop using A&E departments as their first port of call. How to achieve this? NHS officials argue for the creation of holistic disease-management pathways, integrating diagnostics that can be used at home, the most appropriate pharmaceuticals, self-monitoring and management by patients, and better use of smart telemedicine tools.
These ideas are gaining currency among policymakers the world over. Barack Obama’s health reforms in the US have placed a premium on the ability to deliver cost-effective health solutions across the entire treatment spectrum. In its two most recent Progressions thought-leadership reports, Ernst & Young has promoted guiding principles that it calls
“Pharma 3.0”. These include the need for pharma companies to focus on health outcomes, for example by forming non-traditional partnerships with firms outside the life sciences space.
Delegates at the Wellards conference also heard some frank admissions about where the NHS needs to change. One area is cultural: the rules of the NHS have created a culture of risk-aversion rather than risk-taking. This will hold back a system that desperately needs to get into better shape. Jim Easton, national director for improvement and efficiency at the Department of Health, admitted the NHS is often scared to back new ideas and timid when it comes to disseminating or adopting innovation.
Other reforms will be structural. Senior NHS officials are already speaking the corporate lingo of the pharmaceutical CEO. Dr Gordon Coutts, chief executive of Colchester NHS Foundation Trust Hospital (himself a former Lilly and Schering-Plough man), talked about weighing up market penetration versus market expansion, competition or collaboration, and vertical or horizontal integration. Dr Coutts is on a quest for efficiency that will lead to a shortening of patients’ length of stay in hospital. He also wants to implement just-in-time principles (used to superb effect in the car-making industry) in his hospital’s supply chain.
Under intense pressure to adapt, most big pharma companies have spent the past few years re-engineering their organisational structures. They could be a fount of knowledge for an NHS undergoing upheaval. In addition, the drugs industry is shy of neither risk nor failure; the two have always been integral to the pharmaceutical R&D model.
Conference chair Alan Jones was probably only half joking when he told a room full of pharmaceutical professionals: “The NHS is full of people who don’t like you.” If companies were to share with NHS managers their expertise in re-engineering large bureaucratic organisations and innovation through smart risk-taking, they could go a long way towards overturning such ingrained negative attitudes.
Authored by Pete Chan