Transformative change is coming to the NHS and is set to radically alter how the UK’s health service cares for people at a population level.
The NHS Long Term Plan signposted this change, with its emphasis on preventative health, and the forthcoming expansion of the Integrated Care Systems programme continues this direction of travel on a path towards the long-cherished hope of joining up health and social care.
As new approaches to healthcare attainment take hold there will be some degree of uncertainty among pharmaceutical companies about where they fit into the new structures and the holistic care they seek to provide.
But they’re not the only stakeholders working to map out how to enable new models of care and what their role should be.
Lee Outhwaite is finance lead for the Derbyshire Sustainability and Transformation Partnership (STP), as well as serving as director of finance for the Chesterfield Royal Hospital NHS Foundation Trust.
“Traditional approaches to partnership need to be innovated,” he says. “There’s a growing realisation that there are boundaries between some of the silos we’ve had that were not serving the interests of patients particularly well.
“The NHS currently is agonising over how to make its own partnership working better and I don’t think we’ve got a monopoly on the truth of good partnership working in the NHS.”
Meanwhile, new ideas are emerging about how to help more of the population to reach a place of ‘good health’, and these are being led by a desire for more person-centred and value-based models of healthcare.
This sees the sector “transcending the concepts of primary and secondary care” and “creating a more porous boundary for information sharing between healthcare and social care for local governments”, as Outhwaite notes.
In the NHS’ Integrated Care Systems, for example, NHS organisations, in partnership with local councils, charities, community groups and others, take collective responsibility for managing resources, delivering NHS standards and improving the health of the population they serve. So far there are 18 such systems, but more are on the way as the NHS aims to have every area of England covered by an Integrated Care System by April 2021.
Through collaborations like this, Outhwaite says, NHS Trusts can optimise the resources they already have at their disposal and make the flow of patients into healthcare settings as efficient as it can be.
They also allow systems to make more nuanced decisions at a local level, taking into account variations in different regions, towns, or even neighbourhoods – all of which can have a level of autonomy and self-sufficiency with how they are able to care for populations.
One reason for this is that health outcomes can often vary greatly between different parts of a region due to factors like socio-economic groups.
He says that some of the traditional NHS access pathways might look quite different if care could be considered in a much more granular way – which would in turn bring systems much closer to offering truly personalised care.
Of course, this will also require a rethink of how healthcare is financed – and Stephen Jowett, IQVIA’s UK director of applied insights, explains that as integrated care becomes more commonplace, it could shift in traditional division between those that commission services and those that deliver them.
“Within the world of integrated care, you have to look at pooling the pot of money and spending it in a way that is best suited for the specific population you serve – not just giving a set amount to healthcare and a set amount to social care, etc.
“That allows you to harness the autonomy these organisations can have to care specifically for the needs of their local populations.”
These changes in approaches to healthcare provision will have important implications for the kinds of partnerships that pharmaceutical companies will need to bring to the table, and these may well be outside their usual ways of thinking.
“Integrated care systems have a responsibility to look at how they’re caring for their population through a different lens, and that means the component parts of a patient’s care journey don’t necessarily sit just within a healthcare setting – they will venture into areas like social care and education,” says Jowett.
“Pharma will need to start looking at collaborations in those areas if it wants to help holistically develop new systems that act at a subpopulation level to enable better outcomes.”
Jowett says there is also a broader role for pharma in helping the NHS make all these new processes work smoothly.
“The NHS is typically very focused on the big challenges it faces day-in, day-out. Even before COVID-19, for example, the backlog of elective work was already an issue, and there’s always going to be an element of prioritisation within the health service as it considers what it can justifiably focus on with the resources it has at its disposal.
“There is also the potential here for the NHS to look at innovations from pharma that it might not have considered before under a traditional care system, but are better suited to achieving more holistic goals – such as using information to address care inequalities by enabling wider and faster access to clinical research and innovative treatments, or optimising the diagnostic pathway.
“Historically the siloed care settings have created barriers to rapidly scaling innovative ideas or adopting the new ways of working needed for them to succeed. This can make it hard going when trying to bring the right people together who can help push things forward. Hopefully as care management becomes more integrated the case for change can be made from a perspective of commonly shared goals too, and as a result transforming the opportunity for partnerships that are intended from the start to enable change to take place at pace and scale.”
A key connective tissue that will help these new types of partnerships to thrive and create more granular, personalised care will be smart uses of technology, analytics and data science. With the right tech and safeguards to protect individual privacy, systems can encourage and enable patients to better manage their own health, lowering the burden on healthcare resources and allowing for a more seamless journey through healthcare systems, as well as bringing us closer to truly person-centred care.
“We always talk about clinical decision support being something that clinicians use, but today we’re almost moving towards ‘citizen decision support’ as we enrich data that helps us understand ourselves better via technologies such as wearables and smart devices so we can make small changes that can in the long run have a big impact on our health and wellbeing,” says Jowett. “Technology could soon guide patients in an active way.”
He notes technologies like AI powered chatbots are already helping people manage their symptoms without needing to interact with healthcare professionals. “That makes them more engaged and activated in their own care, which can lead to better adherence and ultimately better outcomes.”
As technological engagement increases it provides vital opportunities for improving patient care, as Roche UK’s partnerships lead Jessica O’Neill explains.
This was particularly in evidence, Jessica says, during COVID-19’s acute phase. “During the pandemic the NHS has been able to collate, analyse and visualise large volumes of data. This has helped better understand how the virus is progressing and target local strategies that are important in combating it. This acceleration in the use of health data may provide further opportunity for industry and health system partnership.”
Having worked on enabling and leading healthcare partnerships at IQVIA, Jowett has seen that by bringing together data from different settings, systems can start to be more focused on which elements of the pathway will have the biggest impact for the largest part of the population.
“The parts of the country that have invested time, effort and resources into bringing together integrated data to support integrated care objectives have the foundations to see more success sooner,” he says.
“If we can bring technology and data together and see which actions will drive the best improvement, we can make sure we provide those services in a format that can truly engage patients.”
“Such partnerships are about helping the NHS have more informed choices in an evidenced way,” adds Outhwaite. “In fact, I think in the future the value pharma can bring to the NHS will be less in the products it sells and more in the information it can provide.”
Although Jowett and Outhwaite say that the NHS’ reorganisation around systems to care for populations is “well under way”, there are many important steps that still need to be taken.
“It’s going to be interesting to see what integrated care actually comes to mean in practice,” Jowett says. “Even among people who work within this realm there’s often a misconception that these are actually integrated commissioning systems that are being set up to manage financial elements of the NHS in a different way.”
He says that IQVIA is actively working to help facilitate innovative partnership approaches, bolstering them with a focus on reducing confusion about the torrent of changes that are happening across the NHS.
“We need to make sure people are aware of what these changes are actually aiming to deliver,” Jowett says. “Once we improve people’s understanding and show them what these systems are going to enable, they’ll be better able to work towards achieving greater population care.”
Meanwhile, Outhwaite notes that to provide “legitimacy” to these new structures there needs to be legislation to back them up.
Nevertheless, he says there is a “genuine belief” from the sector that this new level of partnership working is “here to stay”.
“We know it will be more clinically cost-effective, and we have the evidence to show that working in an integrated way leads to better outcomes both in terms of the quality-of-service delivery and the cost of delivery.”
With the right partnerships between healthcare, social care and industry, the entire sector will be able to support patients across their healthcare journey – from better diagnosis and greater access to innovative medicines, to improved treatment pathways and, ultimately, better outcomes.
Stephen Jowett, director, Applied Insights UK & Ireland, IQVIA
Stephen leads IQVIA’s Applied Insights business in the UK&I. These teams are dedicated to helping pharma and NHS clients to understand the practical barriers that exist to improving treatment access and patient outcomes via experts in market access strategy, advanced analytics and service transformation. Since the turn of the century Stephen has been immersed in technologically enabled change aligned to continuous improvement at the front-line of care, firstly within the NHS itself, the services division of Dell Technologies through to the Expert Practices team at Unipart.
Lee Outhwaite, director of financing and contracting, Chesterfield Royal Hospital NHS Foundation Trust
Lee joined Chesterfield Royal Hospital in August 2017. His role covers Finance, Procurement, Estates and Facilities, ICT and the Chesterfield Royal Hospital Charity. He also is the director of Finance for Joined Up Care Derbyshire (the Derbyshire STP). Lee has worked in the NHS since 1993, in a number of finance roles. He sits on the Council of the Chartered Institute of Public Finance and Accountancy and is Vice Chair of their Health and Social Care Faculty Board.
Lee is a Trustee of the Healthcare Financial Management Association (HFMA) and sits on the awarding body of HFMA’s qualification Policy and Research committee. In addition, he is also currently pursuing a Professional Doctorate at Keele University, in their Public Policy and Management faculty.
Dr Jessica O’Neill, partnerships and personalised health lead, Roche in the UK
Jess leads the Partnerships team for Roche UK, focused on working together with stakeholders across the UK healthcare system with a common aim to improve patient outcomes. Jess holds a PhD in translational neuropharmacology from University College London, and previously worked in strategy consulting supporting collaboration between industry and global health systems to ensure innovative technologies are utilised to their full potential.
Dominic Tyer is a journalist and editor specialising in the pharmaceutical and healthcare industries. He is currently pharmaphorum’s interim managing editor and is also creative and editorial director at the company’s specialist healthcare content consultancy pharmaphorum connect.
IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. Powered by the IQVIA CORE™, IQVIA delivers unique and actionable insights at the intersection of large-scale analytics, transformative technology and extensive domain expertise, as well as execution capabilities. Formed through the merger of IMS Health and Quintiles, IQVIA has approximately 68,000 employees worldwide.
Learn more at www.iqvia.com.