Two weeks ago now the UK government launched the concept of an NHS constitution as one of its new ‘big ideas’. Jon Chandler comments that this could restore the ‘fairness’ lost from the NHS.
Jon Chandler 
15 Jul, 2008
Counter reformation in the NHS
The UK healthcare system has been a focus of international interest because of its focus on cost containment. The NHS constitution appears to be a radical departure from this focus.
In a Third Tuesday feature in July last year we looked at the World Health Organization year 2000 league table of the worlds 192 national healthcare systems. The UK came in 18th place, ahead of the US, but behind some of our other European partners... France, Spain and Italy were all in the top 10.
Closer
examination of the WHO’s evaluation criteria revealed that the egalitarianism
of healthcare in the UK was one of the major reasons for occupying this no.18
position. ‘Fairness’, or equality of access to healthcare, was one of the WHO’s
5 key evaluative criteria. As we pointed out then, ‘fairness’ does not equate
to best delivery of overall healthcare, France, Italy and Spain all had significantly
larger private healthcare systems and overall they performed better. It was
clear that without ‘fairness’ as a key evaluative criterion the UK would have
fallen backwards in this particular league table. ‘Fairness’ is something that
has been increasingly legislated out of UK healthcare in the past 10 years.
As a consequence of this UK pharma has been increasingly legislated out as
well.
Many of the NHS reforms of the last 10 years have improved the overall health of the nation. Incentives to GPs to achieve targets have resulted in some fat bonuses paid out precisely because some GPs have hit those targets and improved the standing of the nations health along the way. Ironically other reforms have had less positive impacts, most notably they have impacted ‘fairness’ or equality of access to healthcare. Effectively some of these recent reforms have abolished ‘fairness’ within the NHS, equality of access has been de-listed.
Much of the focus at this years BHBIA conference was upon the way that differences in funding policy applied at the local level really have resulted in a ‘postcode lottery’. Services and treatments readily available in one area are off limits in another. Differences in local policy and funding have come to mean that the launch of new therapies is pointless in over half the PCTs within the UK.
From an industry point of view this means that new launches and ongoing marketing need to be targeted specifically at those areas where there is a possibility that Doctors will be allowed to prescribe. Alternatively it means that the UK is not worth the effort... some recent new introductions have simply not been launched in the UK.
From the patients point of view this is simply iniquitous. Most people have bought into and paid for the concept of ‘fairness’ in the NHS. However, ‘fairness’ can have different interpretations. The mantra of ‘free at the point of delivery’ is one interpretation. This piece of political cant looks tired and worthless in a situation where delivery is poor, or where there is no delivery at all or where there is delivery in one place but not in another.
One of the headline features of the new NHS constitution is the proposed right
of patient access to therapies. This could restore some of the lost ‘fairness’.
If the NHS constitutions actually delivers to this then this will restore the
equality of access that citizens certainly expect and arguably have a right
to. Beyond this ‘access to therapy’ should also mean access to excellence,
the upgrading of service provision and Doctors prescribing best options rather
looking for the cheapest option first.
For UK pharma a key promise appears to be ‘equal access for all, and it enshrines patient rights to choice and to NICE-approved drugs recommended by clinicians’.
If reform lives up to this promise then the days of PCTs controlling what drugs are or are not prescribed are over, the power to prescribe is returned to the Doctor. In turn this should mean an end to ‘post code lotteries’ and a real shift in who or what influences what is prescribed in any instance. This should mean that influence shifts away from those that we currently call ‘payers’ and more towards the real payers... the British people who own and fund the NHS and the Doctors who are their servants. In turn this should mean that the economic success of therapies will have more to do with what they really offer and the way that they are presented. In all of this Sales and Marketing will have a more genuine role.
The UK has seen reforms that have put the choke on prescribing of best therapies. Prescribing parsimony has been the policy not because drugs are the biggest item of expenditure in the NHS, but because it does not challenge or upset the sacred cow. The value of the NHS constitution could be that it will provide a counter reformation... ironically brought to us by the same people who brought reform in the first place. Plus ca change!
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