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Archive for the ‘WA Health’ Category

Addressing England’s cardiovascular disease emergency – learnings from the new ICS five-year plans

England’s Integrated Care Systems (ICSs) have published their five-year joint forward plans, setting out Integrated Care Boards (ICB)-led priorities to tackle physical and mental health challenges being faced in their populations. We are summarising the key priorities of ICS’s in a series of articles, based on data revealed in our interactive map. This map is free to use, supporting better engagement and collaboration with all stakeholders in the healthcare community – industry, patient organisations, and the NHS.

Here, we focus on ICS five-year plans tackling cardiovascular disease (CVD).

Cardiovascular disease continues to be a top priority

Cardiovascular disease (CVD) is the top priority in almost two-thirds of ICS plans, second only to cancer, and every ICS has identified it as one of their top priority clinical areas. And rightly so. CVD affects around 7.6 million people in the UK and is a significant cause of disability and death. Since the beginning of the COVID-19 pandemic, CVD-related excess deaths have spiralled and although we are seeing signs of recovery year on year – the number of deaths involving CVD has remained higher than expected.

So, what are the key approaches being taken to tackle CVD across the nation for the next 5 years? Prevention, targeting inequalities, moving care into the community, identifying risk, and using digital technologies.

Prevention. Every ICS emphasised the importance of CVD prevention. Most plans pledge to tackle modifiable risk factors such as smoking, alcohol, and inactivity. Case example: The Humber and Yorkshire ICB CVD Prevention and Detection Plan 2022-24 covers primary, secondary, and tertiary prevention tactics for CVD, in addition to proposed methods for risk stratification and early identification.

Targeting inequalities. People living in England’s most deprived areas are almost four times more likely to die prematurely of CVD than those in the least deprived areas. So it’s reassuring to see Core20PLUS5 features in every plan and that many ICS plans are tailoring community interventions to help those most deprived. Case example: Dudley is launching a mobile Healthy Hearts Hub to empower residents to manage their own CVD health and will be moving throughout the area to reach the most deprived communities.

Community services. Many ICSs propose to increase care in the community for people with CVD, reducing demand on hospitals and reaching more patients. Some plan to achieve this through Community Pharmacies and Neighbourhood teams, others through digital engagement. Case example: Black Country is expanding community pharmacy blood pressure services and further embedding personalised care at that level through Health and Wellbeing Coaches as part of the Healthy Hearts Project.

Identifying risk. Optimal management of cross-cutting risk factors like high blood pressure and high lipids, to prevent CVD, or diagnose and treat people earlier. In many ICBs, cardiac pathway reforms are being proposed to enable this shift. Case example: Suffolk and Northeast Essex is encouraging the use of Accelerated Access Collaborative pathways to simplify lipid management and encourage adherence to national guidance for optimal management of patients at high risk of CVD.

Digital technologies. Many plans emphasise the monitoring, treatment, and detection of patients with CVD-related conditions, tying into the imperative around community care. This is tied to a much broader drive to scale tech innovation in the NHS whereby each ICB has laid out an extensive digital strategy. Case example: Mid and South Essex is continuing with the successful national pilot BP@home, where residents are self-monitoring blood pressure; they are also rolling out mobile heart monitors allowing people to detect, monitor and manage heart arrhythmias.

What does this mean for industry?

We hope you found this useful – if you would like to discuss in more detail, please get in touch.

Further reading:

Five key takeaways: Engaging with ICS priorities panel session https://wacomms.co.uk/five-key-takeaways-engaging-with-ics-priorities-panel-session/

Engaging with Integrated Care Systems priorities https://wacomms.co.uk/engaging-with-integrated-care-systems-priorities/

What the new integrated care model means for specialised services https://wacomms.co.uk/what-the-new-integrated-care-model-means-for-specialised-services/

 

About WA Communications

WA Communications is an integrated strategic communications and public affairs consultancy. Our specialist health practice supports clients across a diverse range of diseases at the intersection of policy, government affairs and communications, to achieve their strategic objectives.

If you would like to discuss how to best work in partnership with Integrated Care Systems, and our analysis of their key areas of focus, contact Lloyd Tingley at  lloydtingley@wacomms.co.uk.

 

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Five key takeaways: Engaging with ICS priorities panel session

WA was delighted to host a panel session with Dr Layla McCay, Director of Policy and NHS Confederation and Mike Bell, Chair of NHS South West London integrated care board (ICB) and WA Health Senior Adviser.  

At the session, WA’s Head of Health, Dean Sowman, explored Layla and Mike’s perspectives on how the life sciences industry can meaningfully engage with, and play a role in delivering integrated care systems (ICS) priorities. 

In light of a 30% cut to operating budgets and industrial action absorbing the bandwidth of executive teams, ICSs are currently heavily focused on short-term operational priorities. We have outlined five key factors to engage effectively against this backdrop:   

1. ICSs are delaying some action until the general election 

Whilst both the Labour and Conservative parties have communicated support and optimism for ICSs, the reality is that political uncertainty and operational pressures mean that many ICBs have little bandwidth to implement their ICB led five-year joint forward plan.  

Instead, ICSs are increasingly deferring important decisions until there is a stable administration which can ensure the preservation of essential funding and objectives. The overarching concern is that the exact vision of ICS working to respond to local population needs will be overshadowed by national pressures.    

Whilst this is a considerable challenge, the take home message for organisations looking to engage is the importance of timing the hope is that following the winter period, which is a particularly politically sensitive time, ICSs will have greater bandwidth to begin to implement their strategies.  

2. There’s no shortcut to engaging with all ICSs, and no one-size fits all approach 

When looking to secure policy changes, there is currently no shortcut to speaking to all 42 ICSs. We are starting to see some ICSs coalescing or developing strategic multi-ICB structures where some ICBs lead on certain workstreams on behalf of others. This trend is likely to become more commonplace – so engagement may become more streamlined in the future.  

For now, the best route to engage with multiple ICSs comes through existing forums, including NHS Confederation’s ICS network and NHSE’s Academic Health Science Networks (AHSN) 

3. Medicines optimisation and management is a priority with positive examples needed  

One key barrier to ensuring medicines optimisation is that current financial models are created to show benefits to local service providers – some of which are not covered by ICS budgets. There needs to be an overhaul of where the service is delivered, where the money flows and where the savings are realised. While there is clarity on this being a problem – at present there is no solution.  

NHS Confederation would welcome examples of impactful collaborations between ICSs and industry as there is currently a shortfall of tangible examples.  

4. New evidence and ideas to support the delegation of specialised commissioning are welcomed  

The delegation of specialised commissioning to ICSs remains a concern. Prescribing budgets will remain with NHS England, but services deemed ready for integration will be delivered locally. There are outstanding questions as to whether individual ICSs are equipped with the right workforce and expertise, and what multi-ICB structures could be formed.  

This is especially pertinent in the case of rare diseases. Given their low prevalence in local areas, rare diseases are unlikely to be a core focus for ICSs, as evidenced by WA’s analysis which found that just five of the ICB five-year plans featured rare diseases.  

However, there is optimism that the transfer of specialised commissioning responsibilities offers the opportunity for a reset. If done right, it could ensure the repurposing of specialised commissioning budgets across the whole pathway, challenging local systems to reduce spend on tertiary services, and instead finding new ways to act earlier.  

5. Understanding where each ICS is placing strategic emphasis is critical 

Each ICS is at a different stage of maturity and there is distinct variation in size, scale and local characteristics, meaning a one-size fits all approach to engagement will not work. As a first step, understanding where you may wish to begin engagement and how to frame this in line with local priorities is essential. 

At the end of June 2023, 40 of the 42 ICBs had published their five-year joint forward plans setting out their strategic vision to tackle the health issues faced by their local population.  

To support industry, WA has undertaken an in-depth analysis of the plans to create an interactive map showing the level of priority each ICB is placing across 27 themes. Understanding the ICBs that are prioritising your areas of interest, can support you in identifying meaningful collaborations and partnerships aligned to an ICB goals. 

About WA Communications 

WA Communications is an integrated strategic communications and public affairs consultancy. Our specialist health practice supports clients across a diverse range of diseases at the intersection of policy, government affairs and communications, to achieve their strategic objectives. 

If you would like to discuss how to best work in partnership with Integrated Care Systems, and our analysis of their key areas of focus, contact Lloyd Tingley atlloydtingley@wacomms.co.uk. 

 

 

 

 

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Engaging with Integrated Care Systems’ priorities

At the end of June 2023, 40 of England’s 42 Integrated Care Systems (ICSs) published their Integrated Care Board (ICB) led, five-year joint forward plans.  

The long-awaited plans set out each ICBs strategic vision to tackle the health challenges their population faces. They have been developed by examining local need, taking into account an array of local health stakeholders priorities. 

To ensure the plans are impactful NHS England issued three core principles that they must all follow:  

  1. The plan being fully aligned with the wider system partnership’s ambitions. 
  2. The plan building on existing local strategies and reflect universal NHS commitments, for example, reducing health inequalities. 
  3. The plan being delivery focused, including specific objectives, trajectories and milestones as appropriate.  

With only loose guidance, and in line with the ambitions of integrated care, ICBs delivered plans in a range of formats, with a range of different priorities and approaches to improve healthcare locally. 

Now that their priorities are set, industry, patient advocacy groups and other key stakeholders need to now be engaging with these evolving bodies. However, this is challenging given the great divergence in their approaches, making it harder to have an in depth understanding of local priorities and initiatives they can support ICBs to achieve.  

To help improve this understanding and support strong collaboration between the private, third sector and ICBs, WA Communications has undertaken an in-depth analysis of all 40 ICB five-year joint forward plans. 

Methodology 

Our data, displayed in a brand-new interactive map, has been created following a deep-dive analysis of all 40 ICB plans, and any standalone documents published to alongside the plan.  

To do so, we prepared a four-point scale (0 to 3). On the scale: 

In total WA Communications have analysed 27 areas of focus in ICBs five-year joint forward plans, including specific conditions, performance objectives and cross-cutting health themes. Full data can be viewed via our new interactive platform.  

Data map 

Our five key takeaways 

About WA Communications 

WA Communications is an integrated strategic communications and public affairs consultancy. Our specialist health practice supports clients across a diverse range of diseases at the intersection of policy, government affairs and communications, to achieve their strategic objectives. 

If you would like to discuss how to best work in partnership with Integrated Care Systems, and our analysis of their key areas of focus, contact Lloyd Tingley at lloydtingley@wacomms.co.uk.

 

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NHS England’s medicines optimisation guidance: What are the opportunities to improve uptake of medicines at ICS level?

The NHS has been plagued by difficulty when it comes to variation in the uptake of NICE approved medicines. With the establishment of ICSs, there has been an attempt to position medicines as strategic enablers of improved patient outcomes and NHS productivity and efficiencies rather than just a clinical intervention for patients. The publication of NHS England’s medicines optimisation guidance 2023/24 last week signals a shift to create a national framework around this ambition, which NHS England (NHSE) has linked to integrated care board (ICB) priorities. Reading the guidance, the financial imperative is clear the broader goals of medicines optimisation e.g., reduced wastage, improved outcomes, and improved safety, are consistently correlated to helping systems ‘deliver financial balance’. 

However, with financial constraints placed on ICBs and the ongoing operational pressures facing staff, the root perception that medicines optimisation equates to doing more with less must be tackled first.  

NHS England’s new guidance sets out 16 national medicines optimisation opportunities for 2023/24, and signposts to best practice resources to support implementation. NHS England recommends that ICBs choose at least five medicines optimisation opportunities.  

What does Industry need to know and do following publication of this guidance?  

Here are a few of our thoughts: 

As we look to implementation, many questions remain. Will we see ICSs prioritise the same five ‘opportunities’ and what does it mean for progress in the opportunities that are not selected? How should system partners tailor their approach to targeted interventions in each ICS, each with differing local barriers? Finally, what additional strategies can help ensure that healthcare inequalities are not exacerbated? The ambition is high and must be matched by collaborative action at national, regional and local levels.  

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WA Communications wins prestigious Public Affairs and Policy Consultancy at the 2023 Communiqué Awards

The health practice of WA Communications is delighted to have been recognised for its industry leading team after another outstanding year. This year’s win marks a significant milestone for the agency’s health team. Having won the Small Consultancy Award in 2022, it has now claimed the highly coveted title of Public Affairs and Policy Consultancy of the Year.

The prestigious Communiqué Awards was celebrating its 25th year of recognsing excellence and innovation in the healthcare communications industry.

Commenting on this achievement, Head of Health at WA Communications, Caroline Gordon, said:

“Winning the Public Affairs and Policy Consultancy of the Year is a testament to our team’s commitment to delivering exceptional service and strategic counsel to our clients. It underscores our industry-leading position and serves as a testament to the trust placed in us by our clients. We couldn’t be more delighted.”

WA Health Partner Dean Sowman said:

“We are really pleased that the judges recognised our strengths, highlighting our focus on impact and dedication to developing our team. It’s what we’re most proud of and what stands us out in such a strong market.”

2022 was another standout year for the agency. Highlights include expanding our roster of clients to include GambleAware, Janssen and AbbVie; growing the team to 17 healthcare communications specialists, and broadening our offer increasingly into communications and digital.

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NHS Leader Joins WA Communications Advisory Board

We are pleased to announce the appointment of NHS leader Mike Bell to our growing advisory board. Mike Bell brings a wealth of experience and expertise in the healthcare sector, having served in various senior roles within the NHS.

Mike is currently Chair of NHS South West London Integrated Care Board and Chair of Lewisham & Greenwich NHS Trust.

With over 25 years of NHS board level experience, including more than a decade on strategic health authority boards, including as vice-chair of NHS London, Mike brings a deep understanding of the healthcare landscape to his advisory role. Previously, he served as the Chair of Croydon Health Services NHS Trust, playing a pivotal role in improving healthcare services in the Croydon area.

Our specialist health practice offers integrated services in public affairs, corporate communications, digital, research, and creative services. Current clients include life sciences companies including Sanofi, AbbVie and Roche, as well as charities and patient groups including Guide Dogs and Muscular Dystrophy UK.

Mike Bell’s appointment to the advisory board further strengthens our commitment to providing strategic counsel in the healthcare sector.

WA’s advisory board is chaired by Sir Philip Rutnam – former Permanent Secretary at the Home Office and Department of Transport, and founding Partner of Ofcom. It also draws together senior figures from the communications industry, Westminster, the media, and the health sector, including former CEO of Grayling UK Alison Clarke, and broadcaster & journalist Steve Richards.

Commenting on the appointment, Caroline Gordon, Partner and Head of WA Communications’ health team said,

“I am delighted to welcome Mike to our team. His extensive experience and strategic insight in the NHS and medtech sectors will be invaluable in delivering senior counsel to our clients in health and life sciences. WA is now even better equipped to navigate the complex and changing landscape of healthcare delivery and drive meaningful outcomes for our clients.”

Mike Bell added,

“I am delighted to be joining WA Communications at this exciting time. As a member of WA Communications’ advisory board, I look forward to using my experience from two decades in the healthcare sector to provide strategic guidance that helps clients partner effectively with the NHS.”

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In conversation with Matthew Taylor — Chief Executive, NHS Confederation

This week, WA was delighted to host NHS Confederation Chief Executive Matthew Taylor. WA’s Head of Health Caroline Gordon led a discussion exploring Matthew’s perspective on how to tackle the big challenges facing the NHS, and how partners can work together to support the system.

Bringing decades of experience from both inside and outside government, Matthew expanded on his agenda-setting NHS Confed Expo speech which outlined five key ways to improve the UK’s health.

A few things we learnt:

Big change is possible, but it needs a big political vision

Matthew’s ambition for the UK to have a cross-cutting ‘health strategy’ – not just a set of policies for the NHS – is a hefty aspiration, particularly when government departments tend to work in vertical silos. Getting health policy into housing, criminal justice and levelling up policy is challenging.

But it can be achieved if the Prime Minister owns it from the centre, owns the mission, and insists on a cross-government structure that is focused on delivery. A clear vision is key.

Show the savings

The argument for investing in prevention and out of hospital care – often described as upstreaming – is well established and widely shared. However, persuading those holding the purse strings, whether centrally in the Treasury or locally in Trusts, is challenging. Too often ‘invest to save’ arguments are rejected, because in the past, new investment has not always led to the promised savings.

Two possible solutions: First: make the case by modelling the long-term savings. The NHS Confederation has been working hard to demonstrate the cost effectiveness and productivity benefits of investing in smarter healthcare. Second: know how the savings will be realised – ideally within a reasonable timeframe. Reassure the budget holder that you have real evidence that investment will pay off.

Integrated Care Systems (ICSs) – one year on

As the dust settles on the Hewitt Review, the emerging ICSs continue to evolve. There is significant variation in their size, approach, and progress (not necessarily a bad thing if we want to experiment with different models) and the system is learning together all the time.

It was recognised that it can be challenging for stakeholders to engage with the new structures, even when they want to share ideas that could help ICSs achieve their ambitions.

Some ideas for reaching new local decision makers:

The discussion was practical, realistic, and thought provoking, providing lots of new ideas for engagement with the NHS as it changes.

To find out more, or to discuss how WA can support your engagement with the NHS, please contact Caroline Gordon at carolinegordon@wacomms.co.uk.

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Mission Impossible? Labour’s plan to tackle health and social care

What’s the substance of Labour’s health mission?

Labour’s recent ‘health mission’ unveiling is their most comprehensive offering on health policy yet. Labour would look to shift care out of the hospital and into the community, placing more attention on preventing rather than treating ill health. They would look to modernise the NHS, embracing digital and technological innovation to improve efficiency in the NHS. Their proposals also focus on making the NHS a more attractive place to work, to improve recruitment, training, and retention. And, aligning with current priorities in the health service, Labour would commit to tackling three of the country’s biggest killers: cancer, heart disease and suicide.

On the surface, the health mission lacks depth. However, it landed well, securing positive headlines on this most politically salient of issues.

Beyond the headlines, WA’s engagement with senior figures in the Labour Party and across British politics are reassuring, suggesting that far more detailed policies are in development. Health system leaders we have spoken to are optimistic about the proposals they have been consulted on. We also know that there is more opportunity ahead: Starmer is willing to grant freedom to those he trusts on policy development, tasking them to ‘think bold’.

Are Labour’s health ambitions achievable?

Prioritising community care, prevention and tackling health inequalities over the delivery of acute and elective care aligns with what the NHS needs. But Labour might find it difficult to achieve if they triumph at the next General Election. Waiting lists are at an all-time high, ambulance services are under considerable pressure and the NHS is under extreme financial scrutiny.

The urgent demands on the health agenda may limit Labour’s ability to deliver radical improvements in the NHS. Despite the positive reception of their policy offer among health system leaders, Labour have already discovered how difficult it can be to take everyone with them when proposing more radical change; Wes Streeting’s early announcements on primary care reform generated significant pushback from doctors’ unions.

In this crucial period for manifesto shaping, Labour will need to balance Starmer’s call for bold thinking with solutions that are politically palatable. Labour will need to develop policy solutions that combine quick wins with long-term innovative thinking. Health stakeholders will need to share policy proposals that align with short and long-term ambitions and show awareness of the balancing act required from Labour.

Is Labour’s mission-led approach likely to succeed?

When New Labour revived a crisis-ridden NHS it was transformative. However, it took a considerable amount of time and relied on heavy investment; neither are a luxury available to Starmer in the current political and financial climate.

The scale of the challenge lying ahead of Labour means they won’t be able to fix the NHS in one electoral term. Solving the health and social care crisis isn’t all about money and if Labour wants to follow through on their mission-led approach to health policy, they will need to invest the right money in the right areas.

Despite the challenges ahead, Starmer is convinced that bold thinking is the key to successful and progressive policy development. Working in partnership and embracing innovation from all sectors could be pivotal in this approach.

More information about Labour’s policy-making process, the battlegrounds for business, and how organisations can get heard can be found in WA’s Guide to Engaging with the Labour Party.

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A life sciences package the Government hopes will take the sting out of VPAS

Today’s comprehensive life sciences package is a vote of confidence in a sector whose consistent real terms growth over the last decade is something the Government is keen to sustain. 

And it’s hardly a surprise – negotiations on the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS) began just three weeks ago, following months of comment in the media about the rebate disincentivising research, and about the NHS needing to ensure value for money at a time of significant resource stretch.  

But are today’s measures sufficient, or are they just tokens to soften the difficult conversations around VPAS and medicines access? They include: 

Announcements have been cautiously welcomed as a means to deliver the UK’s ambition to be a science superpower. But Lord O’Shaughnessy himself has said that the proof of the pudding will be in the eating: rapid implementation will be key to driving maximum impact.  

And while these measures will help to address sector concerns about system delays and limitations to research routes, VPAS is still the big priority. These announcements won’t shift that focus. As the ABPI said in their quote for the Government’s press release: “Improving research is only one part of the equation. To get innovative medicines to patients and fully capture the growth opportunity, we must also fix the commercial environment”. 

Many of today’s announcements are also not new. The regulatory recognition routes were announced in the Spring Budget, as was a plan to expedite approvals of clinical trials. CTANs had been leaked to the media some weeks ago as ‘clinical trial pop-ups’. Reiterating these measures as part of a wider package of life sciences policies is designed not only to butter up the industry but also to position the Conservatives as the party of science and innovation with voters as eyes start to turn to next year’s election. 

How successful these measures will be in making the UK a life sciences superpower, and overcoming the system and regulatory barriers to investment, remains to be seen. But with Sir Keir Starmer stating in his speech to launch Labour’s health mission this week that “science and technology are game changers”, the Government can be sure that they won’t be the only ones trying to woo the life sciences sector. 

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‘Stopping the 8am rush’ – Is the plan for recovering access to primary care an oversimplification?

The primary care access plan is finally here. A comprehensive plan to mull over but difficult to have a full view in the absence of the workforce plan. It is coined by DHSC as “the first step to address the access challenge ahead of longer-term reforms”, but this is not to undersell its transformative potential. Primary Care Networks (PCNs) are now fully focused on delivering this plan which spans the introduction of better phone and online systems, pharmacies supplying medicines for more conditions, and more staff and more appointments – anything else will be deprioritised.  

The plan has been widely praised as championing innovation. However, there is a feeling that the plan doesn’t duly assess the risks and benefits of what has been put forward and is perhaps an oversimplification from DHSC and NHSE.  

On a micro level, in this blog we explore the potential impact on access of changes to the role of pharmacy, the Investment and Impact Fund (IIF) and Quality and Outcomes Framework (QOF).  

Broadening the role of pharmacists presents both opportunities and risks

Pharmacy First has arguably elicited the strongest discourse and feelings both good and bad. Outwardly, a number of high-profile pharmacy leads are supportive of the initiative but there is cautiousness amongst the health sector. In conversation with David Thorne, Transformation Director at Well Up North PCN, he noted the following challenges:

1. Interoperability: It is vital that GP and pharmacy systems speak to each other, and we avoid the fragmentation that has bedevilled GP systems to date. Currently, robust systems are not in place to inform pharmacists of what medication someone is on to support their prescribing decisions ─ apart from placing faith in very early use of the NHS App. We need consistency and safe links, especially when looking to enable people to use a pharmacy distant from their GP practice.

2. Pharmacy closures:  In theory, the enhanced role of pharmacists could make primary care more accessible. However, data reports that pharmacy closures have disproportionally been in the most deprived areas of England ─ so there is a risk that positive changes to the role of pharmacists’ conflict with national priorities around health inequalities. One of the main drivers of the shortages of community pharmacists is the PCN recruitment of pharmacists to work in primary care roles.

3. Right Place, Right Role: Community Pharmacies may not be able to develop responsive clinical governance systems that adequately respond to case mix escalation, for example when superficially routine consultations escalate to issues of drug/alcohol misuse, mental health and safeguarding. How can we support pharmacists to develop the skill, time and governance systems to manage the types of conversations that GPs have?  Extensive training and public awareness will need to accompany these changes.

This is far from a done deal with negotiations on the £645 million supportive investment ongoing. Further, there will be a consultation on upholding patient safety considering greater prescribing powers for pharmacists.

Polling results conducted by WA communications in March 2023 of 1,000 members of the UK public highlight that whilst there is public support for a greater role for pharmacists, there is some way to go to building public awareness of the services pharmacists can provide.

A word of caution surrounding progressive changes to the IIF and QOF

Further details of the streamlining of IIF and QOF were announced within the plan. Redirecting £246 million of IIF funds represents a major shift with 30% to be awarded by ICBs (integrated care board), conditional on PCNs achieving agreed improvement in access and patient experience. DHSC/NHSE guidance is that access improvement plans should prioritise supporting those with the lowest patient satisfaction scores.

Local flexibility must be at the heart of the re-design of incentives, without arbitrary access quotas for certain groups such as ethnic minorities or LGBTQ+, which could lead to under-funding and deepening inequalities. It seems that DHSC/NHSE are cognisant of this, explaining that the plan is designed to move towards a “more equitable approach that will benefit all patients” and “does not call out specific cohort of patients” for that reason. This must be pulled through at an incentive level to ensure certain PCNs such as rural PCNs who may have small numbers of certain communities, are not caught out.

NHSE further announced that, through a consultation this summer, they will explore how to link QOF to key strategies such as the upcoming Major Conditions Strategy. Ultimately, ICBs new commissioning powers will mean ICBs very closely performance manage PCNs. This goes against the ‘neighbourhood’ aspect of integrated care reforms, which will only seek to become more complex as preventative care models are adopted.

As always, implementation will be the true test. The plan comes with no standardisation frameworks or action plans attached. This passes the buck to PCNs and/or ICBs to operationalise, which risks fragmentation in the absence of nationally led advice.

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The policy platform that will shape Labour’s manifesto

Last week, details of the Labour policy handbook that serves as the initial blueprint for the party’s next manifesto was circulated, ahead of the next meeting of Labour’s National Policy Forum (NPF).

The full summary of policy positions was revealed online by LabourList.

The policies included will be subject to scrutiny and debate by members involved in the NPF, with amendments able to be filed until June. The National Policy Forum will meet in July to discuss its contents ahead of the Labour Party Conference in October, where voting will take place on the programme presented. Following this, once the official timeline for the next General Election has been called, Labour will hold a Clause V meeting to decide which policies make it to the manifesto.

Further detail of this process can be seen in WA’s Guide to Engaging with the Labour Party:

Following months of accusations levied against Keir Starmer that his leadership lacks ideological rigour – and whilst it remains far from a completed manifesto – the leaked documents give us an idea of what the policy direction for the UK could look like under his stewardship. Labour have signalled that their next manifesto will ‘under-promise and over-deliver’.

As such, with vital discussions and developments in the policy-making process still to take place in the coming months, NEC members will be fighting for space on what Labour will choose to fight the next election on.

Businesses should follow the next few months of the policy development process closely in anticipation for party conference – a key milestone in the policy-making process, with the shadow cabinet told to present a credible alternative plan for government at the gathering.

Reaction from those involved at the ground level of Labour policy towards the leaked document has been generally positive, but there are still disagreements in the direction of some critical areas.

Below WA’s sector specialists have set out what the initial policy handbook means for each key policy area:

Energy

Energy is set to take a leading role in Labour’s offering at the next General Election, with the Policy Forum recommending ambitious targets on energy infrastructure, building to the ultimate goal of delivering clean electricity by 2030.

Specific targets include doubling onshore wind capacity, quadrupling offshore, and tripling that of solar. Given these technologies currently have around 14GW of installed capacity each, hitting these targets would involve commissioning over 20GW of wind and solar every year from 2024 to 2030, no mean feat, given the current speed of planning and Grid approvals.

In addition to renewables, there is strong support for nuclear and hydrogen, and a recognition that the likes of floating offshore wind, CCS and marine energy will require Government assistance in their developments.

As for the other side, it’s clear the forum doesn’t want to see any expansion in the use of fossil fuels, pushing for no more oil and gas licenses, maintaining the ban on fracking, and avoiding using coal, and no mention of biomass.

There is no clear message on decarbonising tougher sectors, such as energy-intensive industries or aviation, meaning there is still opportunity to influence in these areas.

Financial Services

The party has shown significant commitment to partnering with the financial services sector and protecting the UK’s reputation as a global financial leader. Central to this is its headline economic ambition to secure the highest growth in the G7, delivered through the Green Prosperity Plan and driven by inward investment aligned to the Paris-agreement targets.

They have also outlined plans to introduce long-term policies relating to consumer protection in emerging markets, including in the buy-now-pay-later sector which has been a bedrock issue for the party whilst in Opposition. Businesses should anticipate a review of regulatory barriers and potential risks.

Health & Life Sciences

Nothing in the proposals will come as a surprise for those following Labour’s core offering during the Starmer and Streeting administration. Detail is light and centred primarily around the issues that currently drive the debate in health: tackling the workforce crisis and cutting waiting lists.

Notably absent from the proposals is a focus on reducing health inequalities, despite both the Conservatives and numerous think tanks sympathetic to Labour correctly identifying it as one of the health challenges holding back growth across areas of the country. Critically for Labour, these inequalities are often most prevalent in areas they will need to win at the next General Election. Streeting is expected to set out Labour’s position on this in due course.

A strict focus on addressing only the major systemic health challenges is typical for a party in opposition, but Labour will at some point need to set out its plan to address the knottier challenges that require targeted action: cancer; obesity; the ageing population; and cardiovascular disease to name a few. This next phase of the manifesto development will look to examine these areas in more detail, and businesses should be alert and on-hand to offer potential solutions in these spaces.

Addressing these critical challenges will not be quick, and Labour’s success in delivering against its objectives will be measured in years, not months. As the manifesto develops, Labour must look to balance its top-level agenda for reform against ‘oven-ready’ wins early into their potential Governance to ensure they are seen to be progressing against their own objectives in the minds of an electorate increasingly losing faith in the health service.

Transport

As anticipated, Labour’s flagship transport policy is the renationalisation of rail. Labour intend to bring the railways back into public ownership as contracts with existing operators expire. The scale of ambition for rail does not stop there, with the document setting out intentions to deliver Northern Powerhouse Rail and High Speed 2 in full. This will be underpinned by a long-term strategy for rail that’s consistent with Labour’s fiscal panning and gives communities more of a say on their local rail services.

With GB Railways still in formative stages ahead of a potential Transport Bill in the King’s Speech and no guarantee of it completing its parliamentary stages before a general elations, there remains significant uncertainty and a range of potential outcomes for the rail sector. For commercial interests in the sector now is the time to carefully set out a vision for how they’d align with Labour’s agenda and rebuild trust in the network.

Devolved governments and local authorities can also expect more responsibility over what Labour calls “the broken bus system”. Communities will be granted powers to franchise local bus services, lifting the ban on municipal bus ownership. With franchising still in its infancy in the northern metro areas, the next few years will be essential to assess how local control is working and define a model that will work in rural, semi-rural and other non-metro areas.

In addition to public transport, Labour are also seeking to turbocharge the just transition to more affordable EVs by helping households to manage the higher upfront cost of vehicles. To ensure EV infrastructure is able to keep up pace, Labour are planning a programme of electrification, including accelerating the rollout of charging points in left behind areas. A package of incentives may well be needed to help address an emerging challenge around access inequality.

Childcare, Education & Skills

Shadow Education Secretary Bridget Phillipson is determined to ensure that education is at the heart of Labour’s programme for Government, as it was when the party last came to power in 1997.

Labour recognise that one of the most significant challenges facing the country today is the need to rebuild the economy and ensure that workers have the right skills required to support the jobs of the future. This cuts across different departments and policy areas, but remains a core ambition of the Shadow Education Team, who want to deliver a “landmark shift in skills provision”.

Where Labour differ from the Government in this regard, they have linked future skills needs closely to their ambitions for the green agenda, they want to devolve adult education and skills budgets to metro mayors and combined authorities, and they want to give businesses more flexibility to use skills funding to meet specific employer needs.

Another key priority of Labour’s is to reform childcare, right from the end of parental leave to the end of primary school. These plans are still light on detail – perhaps because of the need to work around the announcements made by the Government in March’s Budget, and perhaps because of the funding implications required to meet their ambitions for a so-called ‘childcare revolution’.

Looking ahead, Keir Starmer is set to launch his opportunities mission ahead of the summer recess in July – we look forward to seeing the detail then.

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WA Health named Small Consultancy of the Year at the Communiqué Awards

Following a brilliant 2021, we are thrilled to have been named Small Consultancy of the Year at the 2022 Communiqué Awards. 

The award comes as WA Health achieved 128% growth and expanded the team from nine to 16 last year. 

We were proud to accomplish this growth while maintaining a fantastic team spirit. Onboarding almost half a new team during a pandemic was challenging, but our deep shared commitment to creating a collaborative, supportive and fun working environment gave us real collective strength.  

The Communiqué Awards judges said: 

“WA clearly demonstrated the impact of their communication programmes, which combine research, strategy and creativity to tackle life-changing issues and deliver outstanding results for their clients.”   

We look forward to continuing to deliver thought-provoking, evidence-based work, providing robust challenge and getting to the heart of our clients’ most pressing needs.  

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The Hewitt Review unpacked

In July 2022, Integrated Care Systems (ICSs) were formally established with the intention of delivering joined-up services along a place-based approach, improve outcomes in population health and tackle health inequalities across the country. 

Yet, just six months into their formation, Chancellor Jeremy Hunt announced a review to be undertaken by Patricia Hewitt, former Secretary of State for Health and current chair of Norfolk and Waveney Integrated Care Board.  

The review sought to consider the oversight and governance of ICSs, examining the balance between greater autonomy and accountability for these emerging structures.  

Hewitt’s paper, published yesterday, reiterates the significant potential of the new NHS structures to deliver more strategic and sustainable healthcare – albeit with refinements. However, with a muted response from the DHSC and NHS England on timelines for responding to the review’s findings, there are questions over whether core recommendations will be taken onboard with any sense of urgency. 

What stood out? 

Prevention and population health 

The review reiterates the big opportunity of prevention and proactive population health as key to sustainable solutions to immediate performance pressures in the NHS. This is a well-trodden message – but one that continues to be easier to write about than deliver.  

To address this gap, Hewitt argues for a change in how the health and care system operates. This includes a shift in resources, to which she recommends a 1% increase in the NHS budgets going towards prevention. She also calls for a Government-led national mission on health improvement, with prevention, the reduction of health inequalities and the social determinants of health as musts, rather than ‘nice to haves.’ 

This sentiment is in keeping with other recent policy reports on prevention and early intervention, such as the recent Health and Social Care Committee inquiry into prevention which received over 600 stakeholder responses.  

Largely missing was any focus on industry partnership beyond high level commentary on evolving pathways and vendor management. This suggests that treatments are still not seen as a key part of the approach towards better population health.  

The potential of delivering on placed-based priority and need 

A big theme in the review is the need for a shift from a top-down, centralised system of managing the NHS to a bottom-up system, responsive and responsible to local communities.  

To facilitate this, Hewitt recommends a reduction in national targets with no more than 10 national priorities and the development of ‘High Accountability and Responsibility Partnerships’ (HARPs). These are additional mechanisms aimed at incentivising integration across all partners of a local system.  

However, integration and true place-based care cannot be fully achieved without local government and social care involvement. This has already been somewhat muted with the decision to create two local bodies – healthcare-led Integrated Care Boards and wider community involvement through the Integrated Care Partnerships. And there is an irony that on the same day as Hewitt review was published calling for better integration of health and social care, a £250m of budget committed to support social care innovation and training was withdrawn. Without a genuine joined-up approach, the opportunity for integration is unlikely to be truly realised.  

Decisions on accountability and governance  

Fundamentally, the review was commissioned to consider the oversight and governance of ICSs. However, it is not immediately clear whether this question has been answered and the critical question of whether ICBs or NHS England manages Trusts has been fudged.  

The review recommends that any intervention from NHS England direct to Trusts should come through the ICB structures. However, it then peddles back on that ambition by stating that it needs to be proportionate to the strength of the relationships, leadership and challenges facing a local system. 

Therefore, there is still considerable room for NHS England to be involved in the performance of local care providers. This takes away from the intended freedoms and flexibility at the forefront of the ICS model. 

Better funding flows 

The review does not call for any additional funding for NHS services but rather scratches beneath the surface to offer a remedy for how operationally government spending on health can achieve value for money.  

Hewitt identifies “over-complex, uncoordinated funding systems” as an impediment to achieving this principle. She calls for ICS funding to “be largely multi-year and recurrent” and for budgets across health and local government to be better aligned.  

Greater financial autonomy as well as simplified and coordinated funding behind ICSs has been welcomed as a recommendation. However, the varying degree of maturity of ICSs across the country, as recognised in the review, risks investors needing to adopt a more cumbersome and tailored approach depending on the ICS. 

What’s next? 

As yet, next steps remain unclear. The Government will respond to the central recommendations, but not immediately. Clarity around responsibility and accountability between NHS bodies may take more time. Many other key points may be chalked up as ‘requiring further consideration’. 

Jeremy Hunt – who commissioned the review – retains his interest in health improvement and is keen to drive better outcomes and efficiencies for patients and the public purse. How far he is prepared to loosen the grip on NHS budgets remains to be seen.  

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Scottish National Priority: how the SNP leadership contest could shape the NHS

This SNP leadership election will, for the first time in almost a decade put a new face at the forefront of Scottish politics.

While independence is unsurprisingly at the top of the agenda for the candidates, healthcare is a key battleground: a recent Ipsos poll found the NHS is the issue of greatest concern for Scottish voters.

Scotland is facing a healthcare crisis. The gap in life expectancy between the least and most deprived areas now stands at 13.3 years for men and 9.8 years for women, A&E waiting times are increasing, and the Government is set to miss key targets this year in NHS recruitment and tackling elective waiting lists.

How do the leadership candidates plan to address the healthcare crisis?

Humza Yousaf

With almost two years of health and social care experience under his belt, Humza Yousaf expectedly has the most developed set of healthcare policy goals, stating that he will make the NHS a priority as First Minister. As such, his ability to follow through on campaign commitments will be closely scrutinised if he is selected at the end of March.

Kate Forbes

Kate Forbes has also leant on her experience as Finance Secretary for the policy basis of her campaign.

Uniting both Forbes and Yousaf is their commitment to delivering the controversial National Care Service, an NHS-style centrally managed care service pitched as a solution to social care. Scottish Labour has framed the plans as a ‘power grab’ from local authorities; however, given the state of the social care sector across the rest of the UK, the SNP’s ‘top two’ are eager to promote Scotland’s solution.

Ash Regan

Despite being the clear underdog in the contest, the third and final leadership candidate, Ash Regan, proposes solutions that demonstrate the political breadth of the SNP.

While Ash Regan is unlikely to triumph in the contest, she represents the scale of the challenge that Kate Forbes or Humza Yousaf will have in uniting the Party to tackle the issue of greatest concern to Scottish voters, and the broad spectrum of policy ideas that lie within it.

Regardless of who is voted in as Party leader, the Health and Social Care in-tray will be busier than every other department. Before the next General Election, the incoming First Minister, and their new Health and Social Care Minister will need to drive significant improvements in healthcare if they want to have any chance of matching the flawless electoral performance of their predecessor.

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Spring Budget: warm words, limited progress for the life sciences industry

It is no surprise that the Chancellor called out the importance of the life sciences industry to the UK in today’s Spring Budget. Intensive industry engagement over recent months made its inclusion as a critical industry inevitable.

During his lengthy speech, he gave a few positive signals on the Government’s intent to boost the sector. He went out of his way to praise industry, particularly for its role during the pandemic, before making two new headline announcements.

First, Hunt announced an enhanced tax credit scheme for small and medium sized R&D businesses.

20,000 companies will receive £27 for every £100 they spend. This has already been celebrated by the UK BioIndustry Association (BIA), and is clear recognition of the need to do more to support biotech companies to develop breakthrough treatments in the UK.

Second, he announced new reforms to regulatory approvals in an attempt to speed up access to innovative treatments.

From 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) will allow for fast-track approval of medicines and technologies already approved by trusted international regulators, such as the US, Europe and Japan.

The intention is to support companies to bring innovative treatments to patients faster, while encouraging further investment and priority launches in the UK.

This announcement comes as industry has become increasingly vocal over their concerns that the UK is losing ground as a launch market. In 2023 alone, AstraZeneca cited a sub-optimal business climate as the main reason for building a new $400m plant in Ireland, instead of the UK, and AbbVie and Eli Lilly exited the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS).

This pressure has clearly cut-through, and industry should be pleased their voice is being heard.

But, will this new MHRA process actually make the difference the Government hopes and change the direction of travel? Potentially not.

As heralded by Hunt in his speech, the MHRA was the first in the world to approve a vaccine for COVID-19. The regulator is already efficient and new schemes to speed up regulatory approval, such as Project Orbis and the Innovative Licensing and Access Pathway (ILAP), are already in place.

The biggest barrier to providing swift access to innovative treatments is NICE’s capacity to swiftly appraise the increasing volume of company submissions, and the subsequent potential for protracted negotiations with NHS England. Quicker licensing will do nothing if the resource and full system alignment are not in place.

There are also questions around how the process will be implemented. It could easily become a perverse incentive, with companies prioritising regulators with more appealing launch markets, such as the FDA, in the knowledge that the MHRA will fall in behind any license anyway.

It would also be naïve to view any announcement of this kind outside of challenging VPAS negotiations, kicking off in earnest this month as the ABPI set out their proposal of a 6.88% fixed rebate rate, which was swiftly, and strongly rebuffed by both the Department of Health and Social Care and NHS England. Ultimately, companies remain deeply concerned about the attractiveness of the UK.

Labour could steal a march if they take a bolder, whole medicines pathway approach to access. Because while it is a good sign that the Government still acknowledges the critical importance of the life sciences sector, whether the bigger issues are addressed any time soon remains to be seen.

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The challenges that remain for tackling variation in CVD prevention in England

Cardiovascular disease (CVD) is one of the leading causes of morbidity, disability and health inequalities, affecting approximately 6% of the adult population in England.  

To provide greater understanding on the state of CVD prevention services across England, the NHS Benchmarking Network publishes an annual CVDPrevent audit report. The latest iteration is much more oriented to looking through the lens of health inequalities and regional variation in care, highlighting the significant issue of a postcode lottery in cardiovascular care across the country. This new angle of focus of putting inequalities in the spotlight in the CVDPrevent report rightfully signals that this is where the focus should be for both health system leaders and industry working in this space alike.  

The report indicates some positive highlights for example with the prescription of anticoagulation drug therapy for those with atrial fibrillation at high-risk of stroke rising to 88.9% – only 1.1 percentage point below the national ambition to reach 90% by 2029.  

However, there remains some distance to go on the road to recovery from the pandemic with hypertension services particularly lagging behind others and health inequalities and variation remaining prevalent. Notably, individuals from a Black, Asian or Minority Ethnic background were identified as being the least likely to be prescribed an appropriate drug therapy, receive monitoring, or be treated to target with similar issues present across sex, age and deprivation level.   

Alongside variation in treatment and management, there is also significant variation in local approaches to CVD prevention. Our research and analysis of ICS strategies, planning documents and data relating to CVD-prevention, has found that there is a significant level of variation present in the level of planning for CVD prevention services, as well in care and outcomes.  

It is therefore particularly welcome to see the recent prioritisation of CVD services on the national policy agenda through the intention to publish a Major Conditions Strategy later this year and more recently through the appointment of Professor John Deanfield as the first ever Government Champion for Personalised Prevention. Both developments recognise the issue of inequality and unwarranted variation in the absence of a dedicated Health Disparities White Paper.   

However, the test of any such policy is whether it can be implemented uniformly to impact change across the country and not exacerbate variation as well as whether it can truly trickle down and impact at the local place-based level. To do so these policies will need to balance national direction with a sufficient amount of autonomy to allow for population-based CVD prevention strategies, an ambition of newly formed integrated care systems.  

Although the report demonstrates that progress is being made in this hugely important disease area, it is clear to see that much work remains to be done. Promising policies with high potential are a welcome sight to see and only time will tell if they can truly make the impact they set out to achieve.  

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Major ambitions in a new Major Conditions Strategy

A new health strategy is coming – finally! And it threatens to be a whopper.  

A Major Conditions Strategy will be consulted on – and potentially published – in 2023. After months of firefighting on day-to-day NHS operational performance the Government is looking to get back on the front foot and show the world it still has ambitions to improve the long term health of this nation. 

2022’s political turbulence put the 10-year cancer, dementia and mental health plans on ice, saw off the health disparities white paper, delayed the workforce plan, stalled the implementation of the Life Sciences Vision, and neutered the joint DHSC and NHS England Long-Term Plan refresh. Pressure on NHS services across the country and at every point in the system made long term strategising – however urgently needed – impossible. 

Steve Barclay’s ministerial statement today is an attempt to correct this perception, while streamlining the numerous strategies his predecessors committed the Department to.  

In short, the Government and NHS England will be developing a new strategy for ‘major conditions’ including cancers, cardiovascular disease – including stroke and diabetes, dementia, mental ill health and musculoskeletal disorders.  

The ambition is to develop a ‘strong and coherent policy agenda’ building on the progress of the NHS Long Term Plan to deliver the Government’s manifesto commitment of gaining five extra years of Healthy Life Expectancy by 2035.  

The statement makes for dizzying reading as it sweeps across healthcare hot topics: 

Given the breadth of the scope, it will likely generate cynicism as well as hope. There is no doubt that there are many big challenges that need addressing – conditions like diabetes and dementia have a huge impact on society and individual lives, and have consistently not received the attention they need to drive meaningful improvements in care.  

However, there is also a very real risk that this new attempt at a sweeping strategy is seen primarily as a move to kick action into the long grass, while giving ministers an answer to the persistent questions about progress on long awaited strategies in cancer, dementia and mental health. As healthcare has become increasingly political, today’s announcement is primarily about providing a degree of political cover.  

The consultation will need to address how any new strategy aligns with the wider approach to delivery. A major national review across multiple disease areas doesn’t naturally lend itself to the agenda of greater delegation of powers to ICSs through Hewitt Review or the removal of centrally imposed targets. It is also unlikely that significant funding will accompany reforms when all signals point to the expectation of efficiency and restraint.  

The health community will inevitably, and rightly, want to engage again: sharing evidence, policies, and best practice examples to try and shape this latest attempt at a vision for the future of care.  

But how many times can stakeholders and patients be walked up the hill without seeing any tangible change? 

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WA Communications roundtable with Rob Kettell

On Thursday 6 October, WA Communications convened a roundtable discussion between Rob Kettell, Director of Commercial Medicines Negotiation and Complex Transactions at NHS England, and representatives from leading pharmaceutical companies.

The session explored NHS England’s Commercial Medicines Directorate (CMD) priorities, and how companies can work in partnership with the NHS to ensure timely access to medicines for patients.

The session was timely, given the recent and further pending changes in the leadership team within the CMD, the recent launch of the innovative medicines fund (IMF), and ahead of discussions about a successor to the voluntary scheme for branded medicines pricing and access (VPAS) that runs to the end of 2023.

To start, Rob outlined his three priorities:

  1. Access: Continuing to secure rapid patient access to new treatments
  2. Uptake: Ensuring there is consistency in the use of innovative treatments that are provided on the NHS across the country.
  3. Value: Delivering value for taxpayers by striking commercial deals for new medicines that are clinically led and commercially driven, at cost effective prices

A wide-ranging discussion followed. We outline five key takeaways below:

  1. Better, earlier dialogue between the NHS, NICE and companies has helped ensure expanded and accelerated access to innovative treatments, and this can continue to develop in the future

The growth of the commercial medicines team and with it the evolution of the commercial capabilities within NHS England has allowed for earlier and greater engagement with industry. Whereas previously, dialogue between NHS England, NICE and companies could be inconsistent and limited, there are now clear and established routes for early and ongoing communication – including a formal triage function in the CMD. This has benefited both sides, and is an approach that NHS England is keen to continue to develop.

As well as supporting new approaches to individual negotiations, it has also led to more effective horizon scanning which, in turn, has helped the CMD to work with NHS colleagues to better plan for new types of medicines, or medicines in specific disease areas, which may be ready to be appraised at the same time. For example, Advanced therapy medicinal products (ATMPs) have been earmarked as a potential priority area for the coming years, building on the NHS’ track record as a leader in Europe for cell and gene therapies

It was acknowledged that this stronger approach to partnership working has been essential in overcoming some of the more difficult recent access challenges. Securing patient access to immuno-oncology treatments and combination therapies are clear examples of cracking ‘unsolvable’ challenges when all parties work together in partnership to ensure rapid access.

NHS England is now keen to work with companies to explore how to signal areas where there is demand for innovation from the system. This can give further clarity to industry on where focus may lie in the future.

  1. A focus on primary care to meet population health needs

Rapid innovation in drug development over the last ten years has led to huge breakthroughs for conditions with high unmet need like cystic fibrosis and spinal muscular atrophy. However, the focus on innovations like gene therapies and precision medicines, which are prescribed and administered in hospital settings, has not been matched by the same focus on innovation in the primary care setting, which is needed to achieve the population health ambitions of the NHS Long Term Plan.

There is now a real appetite to explore how innovative treatments that have an impact on a wider, population-based level, in areas like as cardiovascular disease, can be brought into the system.

This may require new approaches to align value and affordability among very large patient populations. There is appetite for further exploration of how industry and NHS England can work together to find access routes for more to patients in primary care – to have the most significant impact.

  1. The CMD is keen to partner with companies to boost uptake, but must be selective

It was acknowledged that progress on boosting the uptake of new medicines has been mixed.  There have been some big successes, particularly on treatments that have benefited from funding through the Cancer Drugs Fund, but also areas where potential uptake has not been realised, or has been slower than it could have been.

NHS England – including the CMD – has finite resource, and current fiscal pressures mean there is more focus than ever on achieving value. It must therefore focus this resource towards areas which are likely to have the biggest impact. This will inevitably require a degree of prioritisation on where to focus attention.

As an example, this might include working more closely with companies on targeted uptake strategies whose treatments address longstanding health inequalities, for example, as aligned with the NHS’ health inequalities CORE20PLUS5 strategy.

  1. The CMD is driven by the need to provide value to the taxpayer across all activity

There is recognition that the pricing and revenue environment in the UK is tighter than some other countries. From an NHS perspective, this provides value to the taxpayer and supports the sustainability of the NHS – while companies benefit from the NHS model where access to more than 55 million people can follow a single successful negotiation.

The NHS commercial framework for new medicines points to the complex problems that the CMD is often trying to solve by agreeing ground-breaking and world-first deals, for example the recently announced antimicrobial subscription model.

There is clearly risk involved in facilitating complex deals that go beyond a simple discount to reach a cost effective price with NICE. Therefore, more value needs to be derived from them, ideally creating a ‘win-win’ for companies, the NHS and the taxpayer.

Value is always expected to be at the cornerstone of all decisions made and can often be generated by treatments sitting at, or below, the bottom end of the NICE QALY cost-effective range. This is the value NHS England expects going into a complex negotiation.

  1. Making the UK an attractive place to launch medicines and bring in research and development investment is a continued area of focus

In recent years, the Life Sciences Vision and the UK’s Industrial Strategy have set-out ambitions to make the UK an attractive location for global pharmaceutical companies to invest in.

Maintaining and building on the opportunities of the UK’s strong skills and science base, regulatory regime, single payer system and high levels of clinical trial activity remain key features in the government’s ambitions for global life sciences leadership.

There is clearly appetite on all sides for the pharmaceutical sector to be a key industry to help deliver the government’s economic agenda. However, industry representatives expressed their views that life sciences investment in the UK could be limited due to the rigorous focus on securing value as outlined above.

While recognising the need for value, a more holistic approach to the life sciences operating environment is becoming increasingly important for industry. There are risks to these growth ambitions if industry feels squeezed on all sides. An elevated – more unified recognition of industry’s contribution would enable UK leadership teams to make a stronger case internally for further investment in the future.

In summary:

  1. Utilise NHS England’s CMD triage function and the Office for Market Access to support with early dialogue and horizon scanning
  2. NHS England would welcome ideas and support to more effectively signal demand to the sector in specific disease areas
  3. Ensure resources are used effectively by providing detailed information and positions to NICE at pre-committee stage
  4. The NHS is looking to tackle the population health challenges set out in the NHS Long Term Plan, including by utilising greater innovation in primary care
  5. Medicines that offer holistic benefits, such as addressing longstanding health inequalities, are more likely to be considered for a bespoke NHS arrangement to drive faster and comprehensive uptake

About WA Communications

WA Communications is an integrated strategic communications and public affairs consultancy. Our specialist health practice supports clients across a diverse range of diseases at the intersection of policy, government affairs and communications, to achieve their strategic objectives.

If you would like to discuss how to best work in partnership with the NHS, contact Lloyd Tingley at lloydtingley@wacomms.co.uk.

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The future of HIV/AIDs in the UK – ending HIV transmission for everyone, everywhere.

Undoubtedly, progress toward ending HIV is a major twentieth-century success story. Within our lifetimes, HIV has gone from a life-ending condition to being completely treatable and non-transmissible. It is a fact that a person living with HIV today who is on effective treatment can’t pass it on.

These significant advances in treatment mean that the vision of ending HIV transmission has become tangible. The UK has an opportunity to be a world leader in this space, and the government is committed to being the first country in the world to achieve zero new HIV infections, AIDS and HIV-related deaths in England by 2030. The current political turmoil and the new cabinet’s lack of appetite for prevention do not seem to have tainted a commitment to the effective implementation of the HIV Action Plan.

So where are we now?

HIV prevention is working. For the second year in a row, England met its 95:95:95 HIV treatment targets. The number of people diagnosed has fallen by 35% from 2014 – 2019, particularly among gay and bisexual men. In 2019 an estimated 94% of people living with HIV had been diagnosed, 98% of those diagnosed were on treatment, and 97% of those on treatment had an undetectable viral load – meaning they cannot pass on the infection.

Few countries can show this level of success but as we approach eliminating HIV transmission, we need to ensure that the most vulnerable do not fall through the gaps.

Last week I attended the 5th biannual National HIV Prevention conference. It was the first time so many health professionals, community experts, and researchers working in HIV prevention in the UK have met face to face since the pandemic.

There was palpable enthusiasm to maintain momentum and go further, faster and harder than ever before. And rightly so. Lives depend on this work. Professor Kevin Fenton asked attendees to ‘celebrate and recommit’ and stated that progress on the HIV Action Plan has been necessary but insufficient to end HIV transmissions in a UK context.

As the epidemiology of the virus evolves, what is the future of the fight against HIV?

Solely focusing on diagnosis as a measure of progress does not tell the whole story. Retention of people in care is key to managing HIV transmission. UKHSA estimates that between 15,000 and 20,000 people are living with transmissible levels of the virus in England. Delving into this a bit further reveals that only 24% of these people are undiagnosed, and over 7,000 people living with HIV in the UK have not been retained in care (lost to follow-up).

This problem, it seems, is much larger than was previously recognised. Lost to follow-up is now replacing those still undiagnosed in driving HIV morbidity and mortality.

Patients lost to follow-up are critically immunosuppressed, resulting in immense human tragedy. Speakers at the conference shared first-hand accounts of people presenting at Kings College Hospital with advanced AIDS, despite being aware of their status. This issue disproportionately affects women of black ethnicity from areas of social deprivation. As such, it represents a significant health inequality.

But in a country with universal health coverage free at the point of access, the question surely must be – why?

Reasons will differ on a case by case basis but can be broadly broken down into three key areas:

  1. Stigma kills. It prevents people from getting tested and accessing treatment because they are afraid. It interacts with homophobia, racism and transphobia and prevents people from meeting their need to thrive. It means that patients are treated differently by health care providers once their HIV status becomes known. All of these factors prevent access to care.
  2. The current cost of living crisis means that for some, attending appointments is simply unaffordable. Rocketing childcare and transport costs and the rise of zero-hours contracts coinciding with a huge NHS backlog has meant that logistically retention in care is becoming more difficult to manage.
  3. Some patients are more complex than others. People are individuals with chaotic lives and can experience mental health, mobility or drug and alcohol issues further complicating the matter. There is no baseline measure in place for treating complex HIV patients. The care you receive depends on the training of your physician.

So what can be done?

It’s about people and partnerships. Putting patients at the centre and working together to adopt a proactive approach to prevent people from falling out of care. Every part of the system has a responsibility to find solutions that work. Innovations in diagnosis (oral swabs) and treatment (long-acting injectables), or personalized care, such as offering flexible appointments at alternative venues and providing food and travel vouchers all have a role to play. The voluntary sector are well placed to provide comprehensive support in order ot allow clinicians to focus on the clinical aspects of care.

One thing is certain – offering patients a full range of choices is central to success.

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What the new integrated care model means for specialised services

In July this year, the Government passed the long-awaited Health and Care Act 2022. A major part of the legislation was designed to drive integration of local services with the aim of enabling areas to adopt a preventative approach that focuses on population health.

After many years of movement in this direction, 42 Integrated Care Systems (ICSs) were formalised and tasked with bringing local health services together to provide more joined up care. Unlike unpopular health system reforms of the past, the broad consensus is that this reform is both important and progressive. Indeed, this was a reform that NHS England itself had called for.

However, major changes to specialised commissioning have raised concerns. In particular, patient groups have many questions around the impact these changes may have on the day-to-day care of people living with complex conditions.

Previously, NHS England commissioned many specialised services. As a result of the Act, the majority will now be commissioned locally by Integrated Care Boards (ICBs).

But complex conditions need complex care. The move to local commissioning is risky, mainly because a population management approach is not suitable for rare and complex conditions and commissioner expertise may be lost in the transfer.

Against this backdrop, WA Communications has been working with Muscular Dystrophy UK, the charity for the 110,000 people living with muscle-wasting conditions in the UK to understand the situation better.

Together, we’ve been exploring how ICSs should approach their new commissioning responsibilities to ensure people with muscle-wasting conditions receive best-practice care from 2023.

It’s vital that ICSs get this right, so that patients with muscle-wasting conditions experience at least a maintenance, or at best an improvement, in their care.

Our work culminated in a report, based on insights gained through workshops with clinicians and an APPG on Muscular Dystrophy meeting. The report can be accessed here. We identified three key areas that ICSs need to focus on:

  1. Building understanding: Inevitably, ICS commissioners and community clinicians may be less familiar with muscle-wasting conditions than specialist commissioners. However, it is fundamental to the commissioning and provision of good care that there is appropriate understanding of the condition and the level of care required. Finding ways to rapidly boost knowledge must be a priority.
  2. Holistic approach: There is a real opportunity for ICSs to improve care due to their in-built, joined-up approach. This means moving away from a sole focus on medical care to one that includes social care, education, physical activity, all of which takes place closer to home.
  3. Data: High quality and regularly updated data are vital for oversight of the quality of care, service planning and improvements. NHS England could support effective local commissioning through the creation of a data dashboard across ICS regions. This could outline key datasets for muscle-wasting conditions, such as condition prevalence, time and route to diagnosis, mortality, admissions and treatment.

You can download the full report here:

The new integrated care model and muscle-wasting conditions: How Integrated Care Systems can implement best-practice

Change of this nature is never easy, especially in a period of financial constraint and workforce pressures. However, focusing on the opportunities for better, more joint-up care – ideally backed up by robust data – could deliver important outcomes for people with muscle wasting conditions. Because ensuring the best possible integrated care for patients with all complex conditions can only be achieved through collaboration, communication and consistency.

We have been proud to support Muscular Dystrophy UK in this important pro bono project. You can read the full Muscular Dystrophy UK report on The new integrated care model and muscle-wasting conditions: How Integrated Care Systems can implement best practice here. If you are interested in learning more about how we can help you, please get in touch with carolinegordon@wacomms.co.uk

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Like pulling teeth: has the government finally got to grips with dental contract reform?

More than a decade after the coalition government announced its intention to reform the dental contract in England, action may finally be on the horizon. The new Health Secretary Therese Coffey has announced her focus will be on “ABCD: Ambulances, Backlogs of routine treatment, Care, Doctors and Dentistry.” It is no secret that NHS dentistry has been facing a growing crisis, with patients across the country struggling to access treatment due to the number of dentists moving to the private sector. Coffey’s challenge is significant – stabilizing the system and restoring public and professional trust in a system that has seen a number of false starts in the quest for a new dental contract.

The current dental contract has long been criticized by dentists for its sole focus on activity, which reimburses dentists for the volume of activity ‘units’ they complete. Dentists argue that this process is overly simplistic, and prevents them from focusing on preventative treatment, as they are financially incentivized to carry out more invasive work.

To remedy this, in 2015 the coalition government announced the launch of two new prototype contracts, with the aim of reducing dependency on activity as the only means of measuring activity and allocating funding. After the timetable for reform was pushed back repeatedly for a number of years, the government announced it would abandon the protypes in March 2022 and would work to find an alternative means of reform.

Against this backdrop of long term uncertainty, NHS dentistry has struggled to recover from the disruption caused by Covid-19, and is now suffering from an accessibility crisis. Since the pandemic, many practices have been operating at full capacity with patients waiting months for an appointment. At the same time, dentists are leaving the NHS, with over 2,000 ending their NHS contracts in 2021 alone. This leaves those remaining struggling to keep pace with demand. Currently, 90% of dental practices in England are unable to take on new patients, driving patients to the private sector (where they can afford it).

In July 2022 the Johnson government announced some significant revisions to the contract, with the aim of stabilizing NHS dentistry. These changes included establishing a new minimum UDA value, which increases the amount dentists will receive for their work, funding practices to deliver more work where possible and removing some of the barriers preventing dental therapists from carrying out treatment.

The reforms have been largely well received, but some sector leaders have warned that they lack the ambition to truly solve the issues the sector faces. Nigel Edwards, Chief Executive of the Nuffield Trust has argued that ”a lack of investment and misalignment between costs and funding have made it increasingly unattractive to be an NHS dentist. The resulting exodus of dentists has fuelled growing waiting times. While more money to help high-performing dental surgeries see more NHS patients is helpful, it does not address the problem that many areas in England have little or no access to an NHS dentist.” This view is shared by the British Dental Association, which has warned that the changes will not stop the ongoing exodus of staff from NHS dentistry, or solve patient access issues.

We may have already seen some preliminary reform to the dental contract, but Coffey’s very public focus on dentistry as an issue indicates that further reform is on the horizon for the NHS dental sector, an admission of how much change is needed. It also potentially signals that dentistry, long seen as a Cinderella service in comparison to other parts of the health system, may finally be getting the recognition and attention it needs to be able to secure real and lasting change.

In the meantime, however, more dentists are likely to switch their focus to private practice, in turn driving those who can pay for dental treatment to do so. The government is unlikely to seek to alter this dynamic and is likely to instead focus on addressing the lack of NHS dentists taking on new patients to attempt to stem the accessibility crisis.

Solving the issues facing the dental sector is no mean feat, but in putting the issue so high on the political agenda, Therese Coffey has indicated that there is now a feeling of greater urgency in finding a solution to long running issues affecting the sector. Regardless of what this change looks like, demand for affordable, accessible dental care will remain extremely high, particularly for patients who are unwilling and unable to pay high prices for treatment in light of the growing cost of living crisis.

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Stamping out “waste and wokery” – the task at hand for the new NHS Chair

Stamping out “waste and wokery” – the task at hand for the new NHS Chair.

Richard Meddings, a former banker with over 40 years of experience in the financial sector in both public and private sector roles has recently taken over as the new Chair of NHS England. Meddings has been brought in to be watchful over “any waste and wokery” of NHS resources and help deliver the Government’s ambitious agenda of reform for NHS England. The ongoing pressures on the NHS were well documented prior to the pandemic, and concerns over the sustainability of its funding are seldom absent from political discourse. So, is Meddings’ appointment in keeping with Sajid Javid’s ambitions for the NHS in the coming years, who is he, and what can we expect from him?

Who is Richard Meddings?

Those who have worked with him report that he is forensic, exceptionally detailed and pragmatic in his approach to his work. Whilst serving as a Chair at TSB, Meddings was known for navigating them through a turbulent year of crises and restoring public confidence in the bank significantly. It is no surprise these qualities endeared him to Sajid Javid, who sought a skilled operator with experience of reforming and influencing change at the highest levels of business as his ministers have taken a harder stance on holding managers to account for improving services within the NHS.

Others have expressed concern over his lack of experience in the health sector, and the Health and Social Care Select Committee were not unanimous in their decision to appoint him. Meddings countered critics by stating that there was ample sectoral experience in the board already, and his merits would be to bring “to bring fresh insights, strong experience of board governance, digital and financial skills, and courage in adversity and strategic leadership”.

What can we expect from him?

Meddings enters his role with a challenging brief already in front of him. He will quickly have to showcase his understanding of NHS England’s DNA to win over any sceptics in the organisation. Whilst his appointment was unashamedly based on his experience in finance, he will among other things, have to adequately manage the redirection of an expanded workforce back to the day-to-day delivery of services, as well as ensuring NHS boards align with the Government’s wider integrated care ambition.

Overseeing the change from CCGs to ICSs in July will be a significant stress test of his Chairmanship. Across the country several clinicians will end their roles as CCG Chairs, thus creating a large exodus of clinical experience. Without his own established network throughout NHS England, Meddings will have to quickly understand what life is like at the coal face to get an acute sense of the pressures at a local leadership level. Clinicians are typically not engaged in managing systems and overseeing budgets, so in order for Meddings to achieve his ambitions of better managing NHS finances and reducing waiting lists he must ensure that under the new ICS structure they are engaged at all levels of decision-making.

The Government has stated £800m needs to be made in savings across its health departments this calendar year and as such funding for several programmes has been pulled back already. Whilst it seems unlikely that this ambitious target will be met, a more accurate metric of Meddings’ success will be whether he can balance cost savings whilst also producing tangible results for patients.

What does his appointment tell us?

The Government is eager to demonstrate how the NHS can be run cost-effectively, and how it can be reformed to improve the way it works in addressing the significant backlog it continues to face. It is no coincidence that Meddings’ appointment is one of three recent major Government appointments of officials with backgrounds in finance, with Samantha Roberts (formerly at Legal and General) appointed as the Chief Executive of NICE, and Ian Dilks (formerly at PwC) as Chair of the Care Quality Commission. Given the Secretary of State’s previous experience both in finance and in his previous role as Chancellor, it is unsurprising he is looking to those with a history in the financial sector to support the delivery of his ambitious reforms.

His appointment also reminds us that Javid will need to demonstrate to the Chancellor that Meddings is the man who will deliver tangible improvements to NHS England’s efficiency and value for money to substantiate the controversial health and social care levy introduced in April this year.

Measuring success

Meddings’ first year will be critical in defining whether Javid’s gamble to appoint a rank outsider has paid off. Javid’s optimism in the new Chair’s previous experience to address any “waste and wokery” and see through his reforms may be well placed, but Meddings must be careful to ensure that ruthless focus on finances does not come at the expense of patient outcomes and quality of care.

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Are women finally being heard?

Women in the UK are becoming increasingly vocal about the challenges they face in their healthcare and the unjust variation in access to services. When the Government opened their consultation to inform a Women’s Health Strategy in Spring 2021, over 110,000 respondents took the opportunity to make it known that the system does not work for them. Following years of campaigning, it comes as no surprise to women and those in the women’s health community that an overwhelming 84% of people felt their voices are simply not being heard when they seek health care.

By demonstrating an interest in women’s voices and their experiences, recognising failures in the system, and committing to developing a Women’s Health strategy, the Government has taken a positive initial step, albeit an ambitious one. There is no disease-specific focus and no target patient population, unlike other policy areas. This challenge affects 51% of our population and includes natural, life course events that women have, for many years, been told to just live with. With publication of the strategy imminent, the Government now need to demonstrate that they are willing to not only listen to women’s voices but to implement action based on what they are saying.

Women continue to face challenges when it comes to choices about their own bodies. Ongoing variation in access to abortion care, a full range of contraceptive choice, and a holistic range of menopause treatment options, all impact on women’s freedom to choose the treatments that work best for them. The Government’s commitment to prioritising the menopause in the upcoming strategy and cutting prescription costs for Hormone Replacement Therapies (HRT) in response to the Menopause Revolution campaign is hopeful. However, the Government’s initial attempt to reverse progress made in at-home abortion during the pandemic despite women citing a clear preference for this to continue, suggests more need to be done to prioritise women’s voices, choices and rights in practice.

In addition to not being heard, a fragmented system and the pandemic backlog have resulted in services that are increasingly difficult to navigate, leading to the most vulnerable falling through the cracks. Upcoming system reforms focusing on the integration of care offer opportunities to take a patient centered approach and reduce inequalities in outcomes. The Government is also expected to advocate for the establishment of ‘women’s health hubs’, which aim to enable access to all required care in a one-stop shop, in line with calls from advocates including the Primary Care Women’s Health Forum and Royal College of Obstetricians and Gynaecologists. Despite the promise of better integration locally, fragmentation is continuing at a national level. Abortion has been removed from the Women’s Health Strategy and is expected to feature in the upcoming Sexual Health Strategy. With a wider interest in health inequalities, the Government must recognise the connection between these elements of healthcare and align planning nationally to support local areas to integrate care.

Committing to a women’s health strategy is a promising step in the right direction for this Government and has offered women long overdue hope. Action in response to prominent campaigns, such as the Menopause Revolution, to change the way women can interact with the system allow us to believe that the challenges women have faced for far too long could be overcome within their lifetime.

The Government have a real opportunity to ensure women have their voices heard. To do this, they must recognise the challenges they face, capitalise on system reforms to integrate care, collaborate with the women’s health community, and most importantly, commit to funding appropriate and immediate action. In a health system and economy designed by and for men, the time for meaningful, impactful change, is now.

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Battle stations: reflections on the Government’s War on Cancer announcement

When the Conservatives were re-elected in 2019, it was on a manifesto that mentioned cancer in only two specific commitments: the expansion of the Cancer Drugs Fund and the rollout of cancer diagnostic machines across 78 hospital trusts. And yet, at the beginning of February, the Government used World Cancer Day to declare war on cancer, announcing a sweeping consultation for a new 10 Year Cancer Plan for England, designed to “radically improve” outcomes for cancer patients.

There is no doubt that the COVID-19 pandemic has had a significant impact on cancer diagnosis and care, so, despite the surprise nature of the announcement, it’s hard to oppose the Government’s decision to intervene. What isn’t clear yet is the extent to which this will be a wholesale reform backed by serious funding commitments, or a rehash of existing policies in the 2019 NHS Long Term Plan and the 2015 Cancer Strategy for England.

The announcement shows the Government’s intention of taking the reins on cancer policy, and making it political. Following months of political unrest and serious concerns about the elective care backlog, this allows the Government to set its long-term intentions. By making cancer a political priority, the Government and NHS can be held to account on the impact of reform, ensuring delivery against commitments. This is likely to be central to the purpose of the Cancer Plan and will help to give momentum to a programme of change.

It is essential that funding is adequate to achieve targets at an extremely challenging time. Patient groups, who have witnessed years of rhetoric yet insufficient progress, are cautiously optimistic, rightly concerned that years of underinvestment and understaffing will mean that however great the commitments are, the resource to achieve them will not match.

We have also witnessed this week The Treasury being more muscular on making stipulations attached to funding commitments. The tense stand-off with Department of Health and Social Care (DHSC) over the Elective Recovery Plan may indicate what’s to come with the Cancer Plan, with the Treasury not keen to loosen the purse strings for wooly ambitions.

Whether the Plan, when published, is a total reset or momentum for existing policy in a new format, the potential for real change in the diagnosis, management and treatment of cancers is certainly closer.

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Time for a NICE change

Insights from the conclusions of the NICE methods review.

The conclusions of the NICE methods review, approved by its board last week, mark the end of an extended process looking at overhauling the methods and processes by which the organisation evaluates new health technologies. The review, which spanned a period of two years, is likely going to be the last one of its magnitude for some time. It was positioned as an important step towards achieving the UK’s ambitions to cement itself as a world leader in the faster access and uptake of innovative medicines; a vision it has been pushing since the UK detached itself from the European Union’s regulatory orbit.

Industry’s initial response has been largely welcoming to the changes, although it has also been quickly acknowledged that some of the review’s original ambitions have been diluted or, as the BioIndustry Association recently wrote, ‘failed to match the ambitions set out at the start of the review’.

The changes present a shift in approach to NICE’s reviews as processes, to one that is more focused on ‘living’ guidelines. However, despite NICE positioning itself as helping to support the healthcare and life sciences ecosystem through flexible, agile, robust, future proof and rapid access intentions, there are several areas that still lack detail, or fail to provide the clarity many had hoped for.

Highly specialised technology criteria

The first is that the gap between single technology appraisals (STAs) and highly specialised technology appraisals (HST) has likely increased. Much of the criticism of the old HST methods was centered around the restrictive criteria for which a technology was considered highly specialised. The inconsistency in how these criteria were applied also meant only a smaller number of orphan products were ever considered as suitable for very rare diseases.

The new criteria has sought to provide clarity to this definition. However, in doing so, they may have further restricted the application of the programme. Those medicines falling between the very rare and common therapy areas spectrum still have no clear pathway. NICE has sought to rectify this with the introduction of a ‘severity modifier.’ The severity modifier will be used to decide whether to recommend a technology with an incremental cost effectiveness ratio above the normal QALY threshold depending on the severity of the disease. But it is likely that those medicines that are for rare diseases, but not ultra-rare diseases, remain at a disadvantage; and subsequently, those patients that they cater to.

Evolving complex healthcare needs

The second is around how health technology appraisals overlap with wider social policies, such as health inequalities, comorbidities and the impact of the life sciences sector on the environment. There had been hopes that NICE would provide a steer on how, like the severity modifier, these factors could be considered when evaluating technology.

Although it is arguably not in the remit of NICE to spearhead the sustainability agenda, these other broad stroke areas are increasingly topical challenges for the future of health policy and will need to be taken into account going forward if the organisation strives to remain forward looking and flexible to real world realities.

NICE has now committed to review the way in which these areas can be accounted for within appraisals to better reflect the real value of medicines. The conclusions of the review make no provisions for these areas yet. However, they do make the commitment to review this in the future, although the process and timeline beyond public consultations, remains unknown.

We can therefore expect significant focus over the course of the next few years on assessing what modifying for these considerations might mean. Views from industry are likely to be wide ranging and the onus will be on NICE to understand society’s willingness to make tradeoffs in recommendations and pricing based on these factors.

NICE has clearly recognised that this review is a chance to remove anomalies and bring in some consistent processes across the programmes. The message to industry also remains clear – the organisation remains the authority for driving the appraisals process and they will ultimately still have full control over determining whether an evaluation is progressed or not.

Despite the strive to consider the full spectrum of uncertainty that comes with the evaluation of new health technologies, implementation of modifiers, or future commitments to review more advantageous discount rates, the organisation’s ultimate objective to drive better value for money remains unchanged.

 

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What can we learn from the proposed NHS Standard Contract for 2021/22?

What can we learn from the proposed NHS Standard Contract for 2021/22?

NHS England has published a consultation on its proposed changes to the NHS Standard Contract for the financial year ahead. The final document will be used by Clinical Commissioning Groups and NHS England to contract for all healthcare services bar primary care. The focus of any changes often provides important insight into system priorities for the coming year and the strength of conviction behind them.

With 2021/22 set to be another uniquely testing year for the NHS, one might expect measures to mitigate the impact of COVID-19 to dominate the contract. Instead, there is a sense of defiant ambition, with clear signals for providers to push on with other key NHS and government priorities.

With this year’s consultation now live, here are four key takeaways for the year ahead:

 

1. Don’t get left behind as the NHS pushes on with system transformation

The Contract for 2021/22 shows that NHS England is not letting up in its push for system transformation. It includes several steps to establish more collaborative relationships between commissioners and providers, the most symbolic of which is the removal of financial sanctions for providers that fail to achieve national standards.

This is a significant step towards reversing the transactional, almost adversarial relationship that has proliferated between commissioners and providers over recent years, instead encouraging more collaborative system-level action to identify and address the causes of poor provider performance.

The cogs of system transformation are well and truly turning again so engagement with NHS leaders will need to focus on how to support the achievement of their newly framed outcomes in the most direct way. Additionally, the prospect of major health legislation is looming large for the first time in almost a decade, providing an important opportunity to think bigger picture.

 

2. Get serious about delivering ‘Net Zero’

In October, NHS England published its report on Delivering a ‘Net Zero’ National Health Service, which set out the interventions required to achieve just that, ‘Net Zero’. Yet, the report itself had no legal standing on which to enforce its recommendations or incentivise action.

The inclusion of stronger targets on the reduction of harmful greenhouses gases and air pollution in the proposed Standard Contract for 2021/22, and a requirement for providers to identify board-level officers accountable for delivering ‘Net Zero’ commitments, is a clear indication that NHS England is serious about driving this agenda forwards.

The NHS will increasingly expect everyone who works alongside it to demonstrate that they are also serious about reducing their environmental impact. Medicines, medical devices, services and care pathways can all be made more sustainable. Clearly communicating what you are doing in this space could start to deliver a commercial advantage as pressure builds on providers and health systems to make rapid progress.

 

3. Offer a helping hand on health inequalities

Commitments to reducing health inequalities have been somewhat of a stalwart in NHS policy over recent years. The delivery of coordinated programmes at a local level that actually move the needle have not been so common. This was brought into stark relief by the disproportionate impact of COVID-19 on people of Black, Asian and Minority Ethnic backgrounds.

To create greater accountability at a local level, it is proposed that the Contract include a requirement for each provider to identify a board-level executive responsible for overseeing their actions to address and reduce health inequalities. With broader government and public focus on health inequalities brought on by COVID-19, the pressure on these individuals to demonstrate progress will be palpable.

Those working alongside the NHS should place increasing focus on how they support providers and health systems to address health inequalities. At a time when resources are stretched, we may find that some are actually more open to industry support in delivering staff training programmes, new capacity or improvements to patient pathways, but they’ll have to be able to justify the time investment. Demonstrating how you can contribute to reducing health inequalities could help to secure support for your joint working projects.

 

4. Communicate the benefits of remote consultations and management

Following the rapid up take of video and telephone outpatient appointments during COVID-19, the NHS is now trying to cement their use into everyday clinical practice by requiring all providers to offer patients (where appropriate) a choice between remote and face-to-face consultations. The hope is that this choice will be maintained in primary care too, where uptake of remote consultations has also rocketed.

However, to truly support clinicians and patients to select remote consultations in the long-term, the NHS will need to place additional value on health technologies that support effective remote monitoring and management.

Before some slip back into old habits, the wider health sector can play a role in crystallising broad clinical support for this new way of working. Arming your field force and spokespeople with clear, real-world evidence of how your technology is reducing the need for labour intensive, face-to-face clinical interventions could provide clinicians with the confidence to continue their transformation.

 

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Balancing the health of the nation with the health of the economy – 10 key takeaways

On 15th October WA hosted an event exploring the difficult decisions facing government in balancing the health of the nation with the health of the economy.

With a second wave of Covid-19 upon the UK and much of Europe, political, media and public pressure is building, and a difficult winter is approaching.

We brought together an expert panel to consider the issues, hosted by WA Director Caroline Gordon. The speakers included Tom Newton Dunn (Chief Political Commentator and Presenter at Times Radio), Poppy Trowbridge (former Special Adviser to the Chancellor and WA Advisory Board Member) and Dr Jonathan Pearson-Stuttard (Epidemiologist at Imperial College London).

It was a wide-ranging debate (watch here if you missed it), but what were the key takeaways?

Here are our top 10 points made during the discussion:

 

1) The prosperity of a nation is inextricably linked to the health of a nation:

The pandemic has taught us the value of public health cannot be underestimated. A legacy of Covid-19 must be a proper review of how we approach public health and what we ask of the NHS.

 

2) Devolved and regional politics has grown in power:

With healthcare devolved to national governments and Metro Mayors exercising influence over local lockdowns, leadership over the pandemic has often come from politicians not based in Westminster. What will this mean for the Government’s agenda beyond Covid-19?

 

3) Government is still stuck in campaign mode and not thinking long term

It’s no great surprise that a government of campaigners would think in campaign terms, but their focus has been too short term and the messaging too ambitious. With the pandemic creating complicated and long-term challenges they need to find a more nuanced way of communicating.

 

4) The libertarian principles of the Government are holding it back from decisive action

The restrictions being introduced to manage the spread of the virus are unprecedented for any democratic government, but they particularly jar with the PM’s brand of libertarianism. That conflict, manifested in hesitation and delays about enacting measures, has surfaced repeatedly through the crisis.

 

5) No 10 and No 11 have been closely aligned, but that could be fraying

There has often been tensions between the inhabitants of No 10 and No 11 Downing Street, but in Boris Johnson and Rishi Sunak there has been unusual harmony up to now. That consensus, however, is coming under strain with the Treasury keen to focus on keeping the economy moving and resistant to overly restrictive measures. How this relationship plays out could come to define the rest of this government’s term, particularly with the Chancellor being tipped as the most likely successor to the PM.

 

6) Internally government realise ‘Test & Trace’ is not working

With no clear vaccine timetable or even the promise that one will work, NHS Test and Trace is the only route back to a degree of normality. A fully functional test and trace system was the only reason SAGE agreed to the unlock over the Summer, but the Government’s centralised approach has been beset by problems. Whilst they have not publicly admitted it, quietly they are beginning to shift people and resources towards local test and trace approach which has been much more effective.

 

7) The government could do a lot more to help businesses navigate the crisis

Government offloaded too much responsibility onto businesses and were not clear about how long restrictions were likely to be in place. This uncertainty has meant businesses can’t plan effectively and many have taken an understandably cautious approach because of this. With unemployment rising, the Government needs to find a way to give business the confidence to invest and create jobs.

 

8) The public consensus is fragile compared to the first wave

People feel ‘cheated’ by being ask to lockdown again – they were willing to trust the process first time around, but a lack of faith in the government a second time around (not helped by the Dominic Cummings affair) could undermine the effectiveness of measures for the second wave.

 

9) England and Wales has one of the worst excess death tolls in Europe

Dr Jonathan Pearson-Stuttard’s research has shown that excess deaths in England and Wales were 37% above normal, second only to Spain’s 38% as the worst performance in Europe. When the public inquiry into the handling of Covid-19 finally comes, there will surely be questions to answer.

 

10) The Government’s long-term ambitions are on hold

It may not feel like it, but we are still in the early days of this Government. Elected back in December 2019 with a strong majority, the crisis has put the brakes on the broader policy agenda as they battle to tackle the virus and shore up an unstable party. The Government is a long way from making strides on its domestic agenda, businesses need to try to understand what each Department is trying to achieve despite the virus and bring solutions and opportunities for good news.

 

These are just a handful of takeaways from a wide-ranging and fascinating discussion, you call watch the full video exploring how to balance the health of the nation with the health of the economy here.

 

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Webinar – Balancing the health of the nation with the health of the economy

On Thursday 15th October 2020, WA Communications Director, Caroline Gordon, hosted a webinar exploring how the Government can balance the health of the nation with the health of the economy.

We are living through unprecedented times in which a devastating public health crisis is creating a global economic slowdown.

The Government has to make daily decisions that balance the health of the nation against the health of our economy. Political, media and public pressure is building and a difficult winter is approaching. There are no easy answers – just more questions facing every business and organisation in the UK as to how to respond, plan and communicate.

Panellists included:

 

Watch a recording of the webinar:

 

 

 

 

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Webinar – In conversation with the Rt Hon Andrea Leadsom MP

On Tuesday 18h November 2020, WA Communications Director, Lisa Townsend, sat down with the Rt Hon Andrea Leadsom MP to discuss her Early Years Healthy Development Review, the first phase of which will report to the government in January.

The first 1,000 days of children’s lives are critical for their development, and hugely impact their physical health, mental health and opportunity throughout their lives. The potential for the ‘levelling up’ agenda to support the early years is vast, and something we know is on the government’s agenda.

 

The webinar covered a huge range of issues, providing insight on subjects such as:

 

Watch a recording of the webinar:

 

 

 

 

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Novo Nordisk chooses WA Communications for diabetes brief

WA Communications’ growing health team has been chosen by leading diabetes company Novo Nordisk to drive government affairs in their diabetes business, making the first half of 2020 WA Health’s most successful period to date.

WA Health won a competitive pitch to secure the retained account with Novo Nordisk, supporting the company with their innovative type 2 diabetes portfolio. Head of Health Caroline Gordon will lead the account alongside Associate Director Dean Sowman, working to Dan Beety, Director of Corporate Affairs at Novo Nordisk.

Dan Beety of Novo Nordisk said:

‘‘We put in place a rigorous selection process and were impressed by Caroline and her team. WA’s insight, commitment and enthusiasm shone through. Their approach brought creative ideas that showed a deep understanding of what we’re trying to achieve.”

The wins cap off a strong first half of 2020 for WA’s health team, who also recently won a five way competitive pitch to work with Sanofi’s rare disease franchise.

Earlier this month, WA Communications also won the coveted CIPR Consultancy of the Year award.

To talk to Caroline about your business needs, please get in touch via carolinegordon@wacomms.co.uk.

 

 

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After COVID-19, what next for cancer services?

Thousands of cancer patients are missing. Many patients are having appointments delayed or cancelled, others simply aren’t seeking help. There is growing unease over the implications.

And so the direction from the centre is clear – getting cancer services back up to pre-pandemic levels is a top priority for the health service.

How this will be achieved remains to be seen, with many remaining unknowns around how, when and which services and standards will be brought back.

As the health system starts to piece together a path towards the new normal, we provide a recap of the key decisions made during the pandemic and some of the remaining questions that will be playing on the minds of those tasked with delivering the cancer recovery.

A pause on the 28-day faster diagnosis standard (FDS)

Due to be rolled out fully from April 1st, NHS England and Improvement cancer leads confirmed that implementation of the FDS would be put on hold indefinitely. While providers have been asked to continue sending data, they will not be expected to meet the 75% threshold and no data will be published until at least July.

Cancer providers will be anxious for further guidance over expectations when the NHS formally enters the “recovery” phase. With the need to maintain surge capacity alongside an anticipated backlog of pent-up demand for cancer services, there will be tough decisions to be made over how much leeway can be allowed for services that will undoubtedly continue to be stretched thin over the foreseeable future.

Maintaining impetus on early cancer diagnosis in primary care

The re-worked primary care network (PCN) contract for 2020/21 pushed back the start date for the Early Cancer Diagnosis service specification from 1 April to 1 October, while urging PCNs to “make every possible effort” to begin work earlier if possible.

This plaintive request from the centre was no doubt made against concern over the impact of the suspension of all cancer screening programmes. Together with screening, the service specification is integral for achieving the Long-Term Plan ambition to diagnose most cancers at an early stage.

It includes considerable administrative asks of PCNs, including a rigorous review of their referral practice and targeted action to improve the uptake of cancer screening services. Whether this can feasibly be done amidst the current situation remains to be seen. With no further signals on the resumption of the cancer screening programmes, much depends on PCNs’ ability to drive progress on this front.

Accelerating the roll-out of Rapid Diagnostic Centres (RDCs)

Many RDCs across the country have continued to operate during the pandemic, and NHS England has recognised their potential to support the COVID-19 response with guaranteed funding flows as required. The pandemic has accelerated the introductions of innovative approaches to manage referrals to RDCs and avoid hospital attendances, which may well continue well beyond the current crisis. At the same time however the submission of RDC management information has been paused, as has the planned national RDC evaluation exercise.

As services begin the task of bringing referral and diagnostic activity back to pre-pandemic levels, the expectations of RDCs will be high – the challenge will be to ensure that their learnings and good practice can be shared effectively across the system.

Continuing uncertainty over shielding

Little has been said officially over whether individuals who have been advised to shield during the pandemic, many of whom are cancer patients, will be asked to continue isolating in the coming weeks and months. Reports of recent communication by text message with those on the shielding list has indicated that some individuals are being removed from the list, although nothing has been announced on the rationale behind this decision or which groups will be affected.

Cancer Alliances have reported significant falls in 2WW referrals for suspected cancer, with anecdotal reports of some patients refusing to attend for fear of infection. Any continued ambiguity in the official advice will only exacerbate the concerns of vulnerable patients and will need careful management in order to ensure that cancer patients are receiving appropriate treatment and support.

Responding to the pandemic required rapid changes to cancer services and the necessary suspension of initiatives that were just gathering momentum before the crisis hit. What’s clear is that the task of piecing cancer services back up to pre-pandemic levels is just as complex, and there is a lot of remaining uncertainty as to where and how priorities should lie.

 

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WA promotions as WA Health expands the team

WA Health continues to grow as it welcomes Account Manager Ben Latimer to the team.

His hire comes off the back of several recent high-profile health client wins for WA Health, including the Sanofi Genzyme’s UK rare diseases brief and work with Senzer, an innovative UK-based pharmaceutical company manufacturing respiratory devices.

Ben joins WA from another consultancy where he worked with leading global pharmaceutical brands on high level market access issues and across several portfolios including immuno-oncology, cardiovascular disease and osteoperosis. He also specialised in joint working groups between industry and patient groups, and worked with independent healthcare providers to develop best practise in patient-centred care for NHS services.

Caroline Gordon, Director of WA Health said: “It’s an absolute pleasure to have Ben join our growing team. He will be a great addition across a number of our health accounts, bringing his strong and diverse healthcare experience to the table.”

Ben Latimer added: “WA’s reputation has grown in the sector as they’ve delivered outstanding work for clients and continued to win interesting and large briefs. I’m excited to work with Caroline and be part of this this independent agency which clearly takes great pride in the work they do.”

WA has also promoted three of its Senior Account Executives to Account Managers this month across its Public Affairs and Investor Services teams.

Caitlin Fordham, Cameron Wall and Lizzy Cryar have all been promoted in recognition of the effective work and timely advice they consistently deliver for their clients.

Dominic Church, WA’s Managing Director congratulated all three on their promotions: “Despite the extraordinary circumstances we currently find ourselves in, we still believe it is essential to recognise and thank staff for outstanding performance. Lizzy, Caitlin and Cameron are all integral parts of their client teams and I am really delighted to announce their well-deserved promotions”.

 

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Mental Health MPs’ top priority according to new poll for WA

Research from WA Communications on the health priorities of the new parliament has found that 62 per cent of MPs see mental health as the top priority for health spending over the next five years.

The research, informed by a cross-party YouGov poll of 100 parliamentarians, finds that more MPs selected mental health spending as a top three priority than any other condition, coming ahead of cancer care (selected by 35 per cent), cardiovascular (14 per cent) and diabetes (8 per cent).

The findings reflect the political prominence of mental health over the past few years with all major parties placing it core to their health plans. Yet a significant gap between the parties exists, with 80% of Labour MPs placing it as their top priority, in contrast to 47% of Conservative MPs.

Cancer care, traditionally a key political health issue, falls behind mental health overall, but is still viewed by more than a third of MPs as one of the top three priority areas for NHS funding. Conservative MPs identified cancer care as the area they would most like to see money spent on, with almost half (46%) selecting this.

This is despite Conservative Party plans to broaden the scope of the Cancer Drugs Fund into an Innovative Medicines Fund to support other areas such as autoimmune and rare diseases.

Prevention agenda

Matt Hancock’s ambition of an NHS shifting the NHS’s resources from treatment to prevention also appears to be backed by parliamentarians. 69 per cent of MPs believe the NHS should “direct more resources towards prevention, rather than increasing funding for new treatments.” This is 5% higher than when this question was asked a year previously, suggesting growing support for the prevention agenda.

Medicines access

MPs also believe that patients in the UK get good access to the medicines that can treat them best.

More than two thirds (67%) of MPs agreed with this statement, particularly Conservative MPs, with 79% stating this is the case. And just 25% of MPs believe improving the availability of new medicines on the NHS is a top funding priority.

This is despite a steady drumbeat of medicines access issues being raised throughout the last parliament, such as that of Orkambi.

Labour’s high-profile General Election focus on medicines pricing and life sciences companies being part of Brexit trade talks isn’t reflected by the Parliamentary Labour Party, with more than half (52%) of Labour MPs stating that patients get good access to medicines.

 

To discuss the wider findings and what they mean for your business in more detail, please contact Caroline Gordon, WA’s Director and Head of Health, at carolinegordon@wacomms.co.uk.

 

The polling was conducted by YouGov between 8th and 23rd January 2020. 101 MPs were polled, including 40 from the Conservative Party and 40 from the Labour Party.

 

 

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Bayer appoints WA Health to lead government affairs for cardiovascular disease

WA Health, the specialist health practice of WA Communications, has been appointed by Bayer to lead the government affairs brief for their blockbuster cardiovascular brand.

WA was brought in following a competitive pitch and will focus on supporting market access preparations for their expansion into coronary or peripheral arterial disease (CAD / PAD) as well as Bayer’s traditional stronghold in anticoagulation for stroke prevention.

The account is being led by WA Health’s director Caroline Gordon, who joined the company last summer from Incisive Health, reporting to Bayer’s Government and Industry Affairs Manager, Andrew Brown.

Andrew Brown, Bayer’s Government and Industry Affairs Manager said:‘We’re very happy to be working with the team at WA on our cardiovascular disease government affairs brief. WA’s ideas really stood out to us during the pitch process and we’re excited to be working with them during this critical phase. We’re confident it’s going to be a strong partnership.’

Caroline Gordon, Director at WA said: ‘This is a flagship win for WA Health and exactly the kind of work we thrive on. We’re delighted to add Bayer to our growing client list. It’s been a really strong few months for the WA team across our specialisms in health and wellbeing and we’re all hugely looking forward to building on this success in 2019.’

This win comes off the back of a successful period for WA Health, having recently secured projects across Sanofi’s oncology portfolio, corporate communications for Takeda and retained work supporting the UK launch of Camurus’ opioid replacement therapy treatment.

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A year in WA Health

It’s a year since I joined WA’s Health Team – and I’m a firm believer of using anniversaries to look back and take stock. I joined as an account executive into what was a fairly new, but clearly ambitious health team. It was a daunting but exciting move.

Every company sells itself as a great company to work at. ‘Growing’. ‘Ambitious’. ‘Fun’. The usual selling points. For some companies, this is either wishful thinking or shrewd marketing.

It can be difficult in interviews to get the true sense of a workplace. All the same, I felt confident when I started working at WA that I had made the right choice and found a workplace where I could not only develop professionally – but also enjoy doing so.

And so, a year in, I can comfortably and confidently say that the gut instinct was right.

WA has a knack for attracting talented people who get along well and can work hard together but also genuinely enjoy going for drinks at the end of the week.

My background isn’t in healthcare. I’m a politics geek at heart. And the last year has pushed me to learn a huge amount. But working in this fast-paced environment has fast-tracked my learning and experiences.

I look back and can tick off my key ask of this job, which was to work on genuinely interesting and intellectually stimulating work every day; writing insightful reports and patient booklets, holding exacting but ultimately rewarding roundtables and events both in our office and in parliament, and advising them on strategic challenges. Just this week we supported a parliamentary event where Parliamentarians had their faces scanned to see skin damage.

Winning pitches and being nominated for awards have been particular highlights for me as well – and are the start of a trend I think we’re definitely going to continue.

Its genuinely impressive to watch how quickly my colleagues can get up to speed – and help me to as well – with the terminology and details of incredibly complex challenges. It’s always been important for me to be in a job where I can develop my knowledge and expertise – and though it sounds cliché I really do feel lucky to be in a position to learn so much from my colleagues every day.

I’m looking forward to the start of my second year at WA, and taking into consideration how the team has developed since I joined –  I’m confident that it’ll be even better than the first.

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