Healthcare will evolve under the new government – but what’s Pharma’s role?

This is my first newsletter since the new government was elected and it’s difficult to reflect on that until we see what the Labour Party will do over the coming weeks. Watch this space for updates on new initiatives and a probable change of course for the country’s healthcare system.?

One area where change is likely is the shift of work from hospitals into the community. For many years, there has been a desire for that process to accelerate, and it will be interesting to see how big a priority the new government will make it.?

The thinking behind such a move is to enhance patient care and reduce hospital pressure. But I actually think there’s a bit more to it than that.?

When the patient gets an early and correct diagnosis, leading to early and correct treatment, and that can be managed in general practice, it relieves the pressure for everybody because there is a better patient outcome.??

That means fewer appointments in general practice and fewer non-elective admissions to hospital because relapses and problems with long term conditions tend to be the workload drivers.??

Read my blog here on how industry can help reduce NHS workloads. ?

But the problem with moving work away from hospitals is that it has been tried numerous times before. And that transition has always faced real challenges and setbacks, which is why it’s never really happened.??

So I thought it might be worth putting together a quick explanation of the hurdles encountered in the past and what the future might potentially look like. And I also want to look at where the Pharma, MedTech and Device companies fit in.?

Why community-based healthcare is a good idea?

The rationale for community-based healthcare is a good one. The NHS has long recognised there’s a need to adapt to changing demographics and healthcare demands that the population brings.?

With an ageing population and an increasing prevalence of chronic disease – more commonly called long-term conditions – the traditional hospital-centric model is becoming unsustainable as well as unaffordable.??

Shifting care into community settings is often viewed as having several advantages. The most obvious one is that it makes life easier for the patient because they receive care closer to home. There’s no travel time and no circling around for half an hour trying to find a parking space.??

Continuity of care obviously improves, it’s what general practice goes on about all the time. The ability to enhance co-ordination across primary care providers – bringing the specialists into the community health service when they need them – really does ensure a much better patient outcome.?

There’s an argument that it’s more cost effective because it is generally less expensive to manage patients in the community than to admit them to hospital. And of course, it frees up hospital and general practice time for the more complex and more critical patient needs.?

There are other advantages in terms of prevention and early intervention - early and correct diagnosis leading to early and correct treatment through good preventative approaches and measures really does reduce the need for hospitalisation and hospital referral.??

We’ve been here before?

So why has it failed in the past? Despite the clear benefits, NHS efforts to move into the community have usually encountered several obstacles. If we’re looking at more up to date attempts, Integrated Care Systems (ICS) were introduced on the basis they were going to foster collaboration between NHS organisations, local authorities and other stakeholders.??

You can read my guide to Integrated Care Systems here.?

But ICSs have struggled with integration issues. There’s lots of reasons for that – different organisational cultures, the inability to share data between different organisations and providers and inconsistent funding being just three.?

Primary Care Networks were introduced in 2019 to enable general practices to work together but they’ve faced challenges from day one. There’s massive staffing shortages, varying levels of engagement among the practices and the networks often lack the infrastructure needed to support any significant shift in services from hospitals into the community.??

As with all things, there are pockets of brilliance. In my work, there are some good examples of consultants working out in the community. We’ve even got hospital subcontracts, some run by GP federations, but these are pockets of brilliance rather than a consistent picture.?

Also relevant here are community health hubs , which were designed to provide a wide range of services under one roof. They have had mixed results, with issues including inadequate funding, logistical problems of co-ordinating care and limited patient awareness that they even exist, leading to real under-utilisation. The money is spent but the outcomes envisaged don’t materialise.?

Digital health initiatives also play a part in this. Whilst we’ve got health tools like telemedicine and remote monitoring, the adoption of virtual wards/Hospital at Home has been really uneven.??

We also have problems with digital literacy. Some people don’t have WiFi at home, others have real fears over data security and all of that limits the impact of digital health initiatives.?

I would say virtual wards have worked well for some and less well for others but it’s a policy area that has been expanded and continues to grow and therefore could provide a route forward.??

Funding will be at the heart of any positive change?

In terms of future strategies, it will be interesting to see what the new government does. If there is a determined shift from hospital to community-based care, the root causes of the past failures must be addressed to build successful initiatives that will scale up and cover the country.?

Adequate and sustained funding is crucial. If we’re going to invest in community health, the foundation is provided by spending on the infrastructure, the workforce development and the technology.??

But to do this properly, ongoing funding is required – and that must start with general practice, which has been grossly underfunded and is currently just about surviving. The last three contracts have been imposed; they haven’t been able to negotiate a proper settlement for general practice. So, money would be top of my list.?

The workforce capacity also must be strengthened. There are huge shortages in the training programmes. It’s all well and good saying more nurses, doctors, and GPs are going to be brought in, but we haven’t got the training spaces for them.?

Better working conditions are also required?

A lot of people talk to me about not having a proper career pathway and not being able to see a way to advance. They join a particular part of the NHS but get stuck and can’t see what the next move is. So, we really need to empower people, let them see they can start in the community but there is a clear pathway in front of them.?

Improved integration and coordination is essential. There must be robust data sharing, that’s the one thing that gets in the way of pretty much everything. If data can’t be shared, we can’t deliver unified care pathways and we can’t deliver collaboration across healthcare providers and sectors.?

If that situation improves, it will absolutely transform the way providers can deliver and then really enhance care coordination.??

Patient and public engagement is an area that needs a lot of work??

Raising awareness of the services that are available and involving patients in their care would boost the utilisation of people accessing the right care at the right time.?

If we’re going to deliver telehealth , remote monitoring and digital health, it can overcome a lot of geographic barriers. But we have to make sure people can actually access these technologies, that they are user friendly, secure and that widespread adoption can be properly facilitated.?

Last but by no means least, we've got to implement rigorous monitoring and evaluation to assess the effectiveness of community-based initiatives. That can provide huge insight and the data we collect can be used to refine and adapt strategies to drive continuous improvement.??

Government can take learnings from the past?

The shift from hospital to community-based care represents a real paradigm shift in healthcare delivery. While it’s been tried and failed several times, the journey has thrown up pockets of brilliance as well as areas where it’s just never got going.??

But we can build on these past experiences, we can adopt strategic, patient-centred approaches and that could lead to success.?

Funding is key, as is strengthening the workforce, improving the integration between different providers, then engaging the patients and leveraging technology. Then, by robustly monitoring and evaluating everything that we do, taking the best and scaling it and expanding, it could and should work.?

The NHS is going to continue to evolve, the new government has already described it as broken, and they’ve made it a top priority to fix it. They’ve given a commitment to providing high quality care and so it will be really interesting to see exactly what they do with this.??

Massive opportunities for industry to help reframe the future?

If there is a transition away from hospital care, there’s a terrific opportunity for Pharma companies to develop community-focused medicine, simplified regimes that can reduce the complexity of medicine changes, making it easier for patients to manage their health outside the hospital.?

Pharma, MedTech and Device companies are all good at supporting learning and education, both from a patient education perspective but also healthcare professional training. I think these are things that we can continue to build on.??

I’d like to see more made of medication management technology, things like digital adherence tools and potentially telepharmacy – they are great routes in for the industry.?

If I was a MedTech company and I had a telehealth solution, that would be one of the things I’d really be looking at developing with the NHS. Enhanced platforms that help patients manage their own healthcare – video consultation, secure messaging, integrated electronic health records – all of those things can really help patients.?

Remote monitoring is also a big area?

Virtual wards and Hospital at Home are great concepts for industry to help continue to build. Point of care testing has been talked about forever, diagnostic tests in general practice and in the community just haven’t taken off. I don’t know why; I get asked about it all the time.?

And wearable health technology – our watches can tell us so much about our health now and that’s another potential way in for industry.?

All of that requires data integration and analytics, interoperable systems and programmes that can predict what’s likely to happen – another entry point for the MedTech companies.?

For the Device firms, the opportunity is in home-based medical equipment, keeping people at home when they otherwise would be in hospital. Innovative treatment solutions, minimally invasive technologies that allow quicker recovery, chronic disease management equipment – they’re all areas that the Pharma, MedTech and Device companies could work in.?

Industry is going to be crucial in enabling the cross-sector collaboration between hospitals, community services, general practice, social care and local authorities needed for any sort of successful transition.?

As the NHS continues to evolve, it will be very interesting to see what the government does next. I think whatever happens, it will be about ensuring patients receive high quality care, wherever they are, to deliver the best possible outcome in the most cost effective way – and industry will be integral to that.??

My online learning packages, designed in conjunction with the Life Science Access Academy and which you can find here give Pharma, MedTech and device firms all the information they need to impress the NHS and get their projects embedded.?

Scott McKenzie helps pharmaceutical, medical technology and appliance firms get their products and services in front of the right NHS decision makers. He helped to land no fewer than 53 new projects with the NHS in 2023 alone and has now developed a 12-month mentorship programme that helps individuals and teams get straight to the heart of the challenges of selling to the NHS. If you want to get your products fully embedded into treatment pathways, Scott can help. Get unprecedented access to key customer insights, proven tools, resources and strategies plus 1-2-1 coaching and decision-maker introductions to finally get your project over the line. Find out more here. ?