Health and Prosperity: charting a path forward for the NHS

In recent weeks there has been a surge of attention on the state of the NHS and UK life sciences. Policy-makers and think-tanks have scrutinised these critical sectors for opportunities to improve health outcomes, health equity and work productivity, firmly recognising health as an engine for economic growth. Reflecting on Lord Darzi’s?report,?the Prime Minister candidly echoed the first announcement from his new Secretary of State for Health, Wes Streeting, and described the NHS as “broken”; it must “reform”. Wes Streeting has added that “too many parts of the NHS are paid for effort rather than outcomes” and, in the face of?criticism from NHS leaders?has stressed that not acknowledging the problems in the NHS would result in “killing it with kindness”.

Lord Darzi’s report spotlights all too familiar issues: late diagnoses, long waiting times, reduced routine care, and a surge in waiting lists for mental health services, among other pressing challenges. The startling fact that 1.75 million people are waiting between 6 and 12 months for a hospital procedure demonstrates how accustomed we’ve become to delaying or waiting for care. The report also underscores the need for improved productivity in hospitals, a shift towards data & technology and reform to strengthen the structure of the NHS. It also emphasises the necessity of empowering staff and patients, simplifying care delivery, and driving productivity in hospitals to address the challenges faced by the health service.

All of our families are users of the NHS so it’s something we hold very close to our hearts and, when it’s threatened, our overriding sentiment is one of concern. Media outlets and commentators will pour over the challenges highlighted by Lord Darzi’s report but the question on everyone's mind will be "OK, so, how do we fix it?". The system is extremely complex, what we call “the NHS” is made up of over 20,000 different organisations in England alone, and reform is tough to achieve, particularly without new money and when there can be no interruption to routine care.

Hot on the heels of the Darzi report we were offered glimpses of potential solutions in the final report of the IPPR Commission on Health and Prosperity, work that we were delighted to support and also Chaired by Lord Darzi. On the day of its launch he?said?“My report on the NHS diagnosed its dire condition. Now here’s the cure”.

I’d encourage you to read the report in full. The IPPR emphasises the necessary shift from sickness to health creation structured as five imperatives:?

1. From work that harms health to work that creates it
2. From tolerating health harms to an active industrial strategy for health
3. From waiting for sickness to health creation at the start of life
4. From places that make us sick to empowered, healthy communities
5. From reactive services to preventative, primary care-led healthcare

?The inspiring ambition is to add 10 years to healthy life expectancy by 2055. It’s acknowledged as requiring investment but shows too that the savings, and potential impact on growth will by far outweigh the costs. It also underscores the potential for health to be the clearest and most direct route we have towards prosperity for all, the most significant opportunity we have to overcome the challenges we face. Health creation will require a national effort and so, as a Lifesciences leader, I’ve been thinking about how our industry can best make a contribution. In summary, I believe we need to focus on four areas

1.?Invest in R&D; accelerate new innovation:?

My company is proud to invest more than ￡2.5 billion in the UK in R&D each year as the largest private sector investor in the country. The UK remains highly competitive in drug discovery and early development and it’s essential that we make the most of this strength. Last year’s Lord O’Shaughnessy review set out the goal to regain the UK’s leading position in clinical research, developing novel medicines that can treat unmet needs and improve the quality of people’s lives has long been at the heart of what the NHS and the life sciences industry can achieve together. Last year I was proud to be part of the team that put together an industry-funded ￡300 million investment fund specifically to support commercial clinical trial recovery in the NHS. It’s critical we now deliver against the target to “double, then double again” clinical trial activity. It’s of course also vital that UK patients can actually access these innovations! At a minimum this should be in line with the access that patients enjoy in other comparable countries, reversing the sad trend we see in Section 2 of the Government’s Life Sciences Competitiveness Indicators.

?Action: Work together to ensure the UK has a clear picture of future clinical trials, deploy investment fund to the right places in the NHS, ensure UK patients have rapid and equitable access to innovation.

?2.?Get existing medicines to the patients who need them most:?

In many areas, certainly for our most prevalent chronic diseases, we already have highly effective treatments in hand, but few people understand the full extent of the mechanisms in place in the NHS which have the effect of slowing down and rationing patient access. In practice, particularly in Primary Care, patients often need to be well-informed and sharp-elbowed to get access to the medicines recommended for them. Work by?UCL Partners Health Innovation?shows the negative impact of COVID on management of blood pressure, but also the significant pre-COVID and enduring gap between Guideline Defined Medical Therapy and actual practice. If 10% more patients already diagnosed with high blood pressure were on optimal treatment around 11,000 heart attacks and strokes would be prevented in three years with savings to the NHS of ￡126 million. Failure to prioritise proactive, preventative treatment of chronic disease is a false economy. A recent PwC report, looking at 4 classes of medicine, concluded that if all eligible patients were to be given immediate access to the treatments recommended for them it would create ￡18bn of productivity gains for the UK economy over five years.

?Action: Work together to make early diagnosis and intervention in our most prevalent chronic diseases a defining and central national mission for productivity, growth and a more sustainable NHS. The new Long Term Plan is a key opportunity for a bold, multi-condition ambition that challenges an engrained, unwarranted culture of cost containment

?3.?Partnering with the system to manage affordability:

Most people are unaware that total branded medicines spend in the NHS has been capped since 2014. Under a series of 5 year agreements, industry volunteers to pays back 100% of all NHS spending above a pre-agreed cap, the rebate being paid in advance of anticipated spending so it can be immediately ploughed back into front-line care. Despite demand for branded medicines rising sharply, driven by clinical decisions and patient need, the money spent on them has declined by 14% and has also declined significantly as a percentage of total NHS spending. This is lowest-in-the-world territory and the commentaries we hear suggesting branded medicines spending is a key driver of NHS cost inflation are just wrong. With a new 5-year cap in place from 2024, there are no other health interventions I’m aware of which are immediately available to the Chancellor and Secretary of State and which can be rapidly scaled at zero short- or medium-term cost. This could be viewed as a unique opportunity to kick-start growth and trigger life sciences investment, paid for by the industry, available immediately, and within our fiscal constraints.

Action: A reinvigorated Life Sciences Council could be an excellent forum to fully explain the current system, it’s financial flows and trade-offs and to rapidly crystalise an integrated medicines policy across DoH, NICE, and NHSE with the objective of improving health outcomes, kick-starting growth, and accelerating life sciences investment.

4. Systematic approach to innovation and scale-up, in partnership:?

The industry has an important role to play, working with the NHS, to invest in, test, and prove the effectiveness of new models of care. This has never been more urgent. An excellent roadmap for partnership is NHS Confed’s recently published guide:?Accelerating Transformation: How to Develop Effective NHS-Industry Partnerships”. In my own experience at AstraZeneca partnership working has proved highly effective from supporting new tools to identify patients in need of proactive review and increasing efficiency in primary care to ensure patients are receiving optimal treatment, to working in secondary care using AI to speed up cancer diagnosis times, or increasing the number of patients that can be screened for heart failure by nearly tenfold.

Action: The newly established Health Mission Board should rediscover the “can do”, “must do by date”, and “in partnership with” mindset of the Vaccines Taskforce. We need NHS England, the Integrated Care Systems and equivalents in the Devolved Nations partnering and mobilising rapidly to test and prove new models of care and a systematic approach to scaling what works led by the Health Innovation Networks in England and ANIA in Scotland.

Now more than ever we need optimism, partnership, and a shared agenda to support the NHS and mobilise as ‘One UK’ behind our shared national missions for health, health equity, investment, and growth. The UK has a profoundly strong life sciences sector and in these areas we look forward to leaning in and partnering with the new Government to maximise the positive contribution we can make.

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AstraZeneca has provided funding, through a sponsorship agreement, to the IPPR Commission on Health and Prosperity which conducted the work referenced in this article. IPPR Retained full editorial control”