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Posts Tagged ‘NHS England’

The State of Integrated Care Systems: Finances

Ahead of the now delayed publication of the NHS operating framework and as integrated care systems (ICSs) mark their first full year running as key NHS statutory bodies in 2023/24, WA Communications has undertaken a first of its kind in-depth analysis of all 42 ICBs annual accounts.

This analysis, the second in our ‘the state of ICSs’ series, following our ICB five-year forward plans data map, has been created to foster a mutual understanding of the challenges and opportunities that exist within the NHS, supporting strong collaboration between the private, third sector and ICBs.

We have taken the published accounts and produced an interactive ICB Spending Map that enables comparisons of financial performance – not just of total spend, but more valuable analysis of category spend against the budget set and as a percentage of each ICB’s total budget. In this way comparisons can be made within and across ICBs around the spend upon key categories such as acute hospital care, mental health services and primary care prescribing.

We launch our analysis at a time where ICBs are being asked to take on increasing amounts of responsibility while being scrutinised over finances and impact more than ever:

Methodology

The interactive map uses colour-coded visuals to highlight performance against stated budget, ranking ICBs from significantly overspent through to significantly underspent.

By comparing average figures by 100,000 patient populations we have been able to more accurately compare ICBs. This is important given that ICBs vary so much in gross population with the largest being more than five times larger in population than the smallest.

ICB budgets are set upon a set of formulas that are based upon the number of people registered as patients at their host GP practices. A complex set of weighted capitation indexes then set their baseline budgets through detailed assessment of relative health need against primary care, secondary care and specialised services variables. This produces a highly varied per capita baseline position that needs to be take into account to understand spend performance.

Data map

Our five key takeaways

  • There are emerging patterns of comparisons that indicate a polarising trend across the ICBs linked to factors such as ICB inheritance of historic local trends, presence of major tertiary centres and performance of local acute hospitals.
  • The impact of the weighted capitation formulas is pivotal and provides a clear pattern of correlations with overall financial status.
  • However, there are notable exceptions to the above as Greater Manchester ICB, for example, is both highly capitated and significantly overspent.
  • Therefore, the percentage spend by an ICB on acute hospital services and the level of under/over spend of this category is a key differentiator in overall ICB performance, which reflects a fundamental tension in the NHS structural relationship of ICB to NHS FT/trust control.
  • Primary care prescribing costs are the greatest true variable cost to an ICB and a consistent category of overspending.

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 comparable financial performance, contact Lloyd Tingley at lloydtingley@wacomms.co.uk.

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What does the future of healthcare look like under a Labour Government

Last month we were delighted to host a panel session exploring how Labour’s priorities for the NHS are translating to on-the-ground action. To tackle this question, we were joined by an expert panel including David Thorne, Transformation Director of Well Up North Primary Care Network (PCN), Mike Bell, Chair of South West London Integrated Care Board (ICB), and Ellen Rule, Deputy CEO of Gloucestershire ICB.

Guided by WA’s Head of Health, Dean Sowman, the discussion dived into the key challenges and opportunities in shaping the NHS 10-Year Plan, offering a thought-provoking vision for the road ahead.

Since the Labour Government took office, healthcare has been placed firmly in the spotlight. Health Secretary Wes Streeting’s description of the NHS as ‘broken’ and in need of repair has ignited a bold wave of review and reform. From the influential Lord Darzi review and the subsequent three transformative shifts in healthcare – from hospitals to community care, analogue to digital, and treatment to prevention – to the recent launch of ‘name and praise’ league tables and the upcoming NHS 10-Year Plan, the stage is set for significant change.

As decision-making shifts from NHS England to the Department of Health and Social Care, the UK is entering a new era in healthcare. In the short term, the focus is on decentralisation with ICBs gaining more autonomy and greater control over budgets, sparking tensions between national oversight and local autonomy.

Below we outline five key insights from the panel discussion, shining a light on what these changes could mean for the future of healthcare.

  1. A Budget Focused on Stability, not Growth

The latest budget promises no return to austerity, but still falls short of the investment needed to rebuild public services that have been significantly reduced and strained. While the NHS welcomes a projected funding growth of 3.6–3.7% over the next two years, the system continues to grapple with the lingering consequences of underfunding.

On a positive note, this funding boost provides an opportunity to invest in NHS digital infrastructure, a vital step towards stabilising operations and creating a foundation for transformative change.

Productivity remains a key challenge, with NHS staff expected to improve efficiency despite limited increases in resources. The legacy of austerity continues to hold back progress, while the funds allocated for the elective recovery programme have fallen short of delivering anticipated improvements.

Panellists described the budget as a ‘stand still’ measure – enough to maintain current services but offering little scope for meaningful progress. They concluded that while the resolution of GP pay disputes is a step forward, critical issues such as GP contracts and National Insurance rises  remain unresolved.

  1. Building the Digital Foundation for NHS Innovation

Before AI can revolutionise healthcare, the NHS must first build a solid digital foundation by tackling basic issues, such as interoperability and shared patient records. Currently, fundamental issues concerning digital skills and infrastructure are apparent, for example healthcare professionals requiring keyboard skills training or multiple landlines needing to be installed.

The shift from analogue to digital is essential, but it’s about more than just adopting new technology. The NHS still lacks an integrated system of care and addressing the fragmentation and “tribalism” between NHS departments is critical to achieving any real progress.

To unlock the potential of AI, ICBs must first strengthen their collaborative efforts, with Chairpersons meeting regularly to align on strategy. AI could help triage patients more efficiently, ease pressure on ambulance services, and optimise primary care across regions.

Meanwhile, investing in ambient technology could boost GP productivity by up to 20%. By automating notetaking and coding during consultations, GPs could see a reduction in administrative burden andincreased capacity, while also preventing burnout. In turn, this could lead the way to a more sustainable workforce, with less bureaucracy, and ultimately improved patient care.

  1. Rethinking Prevention and Productivity

Healthcare transformation should extend beyond focusing solely on economic metrics, incorporating prevention models that prioritise social value and patient outcomes.

Traditionally focused on hospitals and waiting times, the NHS must shift its focus to prevention and address the root causes of hospitalisations. However, the current emphasis on productivity often overlooks acuity – the complexity of modern patients – and fails to address the underlying causes of ill health.

A major challenge is the workforce imbalance. The NHS Long Term Workforce Plan calls for a 40% increase in hospital staff, but only a 5% increase in GPs, this disparity is unsustainable under Labour’s three healthcare reforms. To support the shift from hospital to community care, a fundamental reallocation of both funding and workforce planning is urgently needed.

PCNs are already preparing for this shift by planning further investment into preventative and primary care services and reducing investment in acute hospital care over the coming years. This means redirecting resources from hospitals to community care and integrating services across both sectors within single NHS trusts. By doing so, hospital admissions will be reduced and NHS pressures alleviated, while the focus will shift from output-driven metrics to quality patient care.

  1. Integrating Responsibility: ICBs and the Future of Resource Management

ICBs already have significant autonomy, but the challenge lies in making collective responsibility for resources a reality and ensuring accountability. While some ICBs are integrating services effectively, there is a need for stability during this transformation period, with limited capacity to test new ways of working.

ICBs are already shifting their resources to integrate services at the neighbourhood level, which is key to managing the hospital-to-community shift within existing budgets. Meanwhile, PCN’s have the potential to better manage vulnerable patients through enhanced GP roles and personalised care plans, reducing pressures on ambulance services and hospital waiting lists.

The partnership model in general practice is crucial, and more local integration is vital to managing complex patient needs. There is also an opportunity to empower NHS trust providers to act as direct commissioners, easing the burden on ICBs and facilitating smoother transitions from hospital to community care.

  1. The Opportunity of Specialised Commissioning Delegation

To truly transform healthcare, specialist care must be viewed within the context of the entire patient pathway leading into specialised services, which will ensure a more integrated healthcare system. This requires stronger collaboration between neighbouring ICBs to ensure seamless care.

As ICBs review specialised commissioning budgets, there is an opportunity to better integrate local authority and public health services. Since a single ICB’s footprint is too small for effective delegation, a pathway approach is essential.

The focus must be shifted from costly end-of-pathway interventions to prioritising the full patient journey, and shifting care from acute settings into community and primary care.

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A guide on how the pre-election period impacts DHSC, the NHS, health regulators and what that means for Life Sciences companies

Following the dissolution of Parliament last week, we have officially entered the pre-election period. The impact of this period on Parliamentary activity, and the ramifications for MPs, is well understood, but there are wider implications that impact the machinery of Government and how Governmental bodies operate.    

For companies within the health and life sciences landscape, this is particularly pertinent as organisations impacted by the pre-election period, such as the Department of Health and Social Care, NHS England, and NICE play a key role in the medicines access process and wider health policy to support this.  

We have taken the time to analyse the pre-election period impact, as well as what may happen to ongoing policy developments to support Life Sciences companies during this period and beyond.   

Department of Health and Social Care  

In line with official Civil Service guidance, the activity of the Department of Health and Social Care (DHSC) will be reduced during the election, putting into question ongoing policy activity.  

Perhaps the most awaited piece of policy activity is the Major Conditions Strategy that was touted to be published this summer, with work well underway to develop it. As it was not published before Parliament, it will now be a matter for the next Government as to whether they wish to progress with this policy initiative. 

NHS England  

NHS England (NHSE) have published their guidance for the pre-election guidance for NHS organisations, which places NHSE under strict requirements not to make any announcements on policy, strategy, procurement, or business development during this period.  

NHSE are not permitted to launch consultations during the pre-election period unless they are considered essential. Ongoing consultations should continue but should not be promoted and existing consultations can be extended if deemed appropriate.  

This puts into question the timing of the consultation on the updated Commercial Framework for New Medicines that was originally due to be published in June.  

As for medicines access and approval, NHSE will continue to operate as normal, but the pre-election period may impact public facing activity following agreements.  

Regulators  

The Medicines and Healthcare product Regulatory Agency (MHRA) will conduct activity in line with civil service guidelines for the pre-election period, so do not expect any policy activity over this period.  

Communications referring to items such as licensing announcements, marketing authorisations, and manufacturing licensing will continue as normal through their customer service team. 

The National Institute for Health and Care Excellence (NICE) adhere to the same guidelines which means during the pre-election period they will avoid posting news on updates to NICE methods, changes to NICE policy, or consultation results during this time. 

However, the pre-election period does not prevent NICE from operating as usual in terms of publishing guidance or HTA recommendations. This work will continue to the same timeframe and cannot be influenced during the pre-election period by NHS England or Government. 

This means that during this time, NICE will continue to progress key policy areas such as highly specialised technology criteria and the severity modifier internally, but wider consultation and public engagement with industry on these issues may not occur until after the election.  

In Scotland, Government business will continue as normal as the Scottish Parliament is still in session. That said, Scottish Government civil servants, including those working with Government agencies such as the Scottish Medicines Consortium (SMC), are to conduct themselves in line with the Civil Service Code and exercise caution when conducting public activity that could have a bearing on the UK General Election. 

For the SMC, this means business will continue as normal but activity with reserved or cross-border implications, such as activity with NICE, may be postponed until after the election.  

If you would like further information on the impact of the pre-election period and to discuss opportunities to engage with relevant stakeholders during this time, please do get in touch – [Health@wacomms.co.uk].  

WA have also prepared a guide on how best to hit the ground running, assessing the first 100 days post-election. This can be accessed here: https://wacomms.co.uk/hitting-the-ground-running-the-first-100-days/.  

 

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In Conversation with NHS England’s Medicines Value and Access Team

WA Communications hosted an insightful roundtable discussion with NHS England’s Medicines Value and Access (MVA) leadership team, led by Fiona Bride alongside Jack Turner, and were joined by Mike Bell, Chair of South West London Integrated Care Board (ICB) and Senior Adviser to WA Communications.

This roundtable offered representatives from the pharmaceutical industry an opportunity to delve into MVA strategic priorities and explore collaborative opportunities at ICS level to deliver patient access to innovative medicines.

Setting the Stage: Priorities for the Future

The session kicked off with a clear outline of MVA focus areas:

  1. Driving Efficiencies: Streamlining processes to optimise medicines use and secure taxpayer value.
  2. Horizon Scanning: Preparing the system for future innovations.
  3. Addressing Inequities: Ensuring fair access to medicines across diverse populations.

Key Takeaways: A Vision for Progress

From this dynamic discussion, the WA team captured four critical takeaways, highlighting the pathway to a more responsive and innovative healthcare system.

  1. The Commercial Framework for New Medicines – firm or flexible?

The imminent Commercial Framework review aims to clarify its flexibilities, focusing on commercial arrangements including indication-based pricing (IBP) and combination therapies. The consultation presents a pivotal opportunity for the industry to shape long-term policy.

Industry input is vital to determine how explicitly these commercial flexibilities should be defined. While detailed criteria might prove limiting, broader guidelines could lead to ambiguity. It’s confirmed that eligibility considerations will remain case-specific, but NHS England’s move away from viewing indication-based pricing as “exceptional” is a welcome shift. There is also recognition that the changes can’t be strictly held to cost neutral parameters.

A second consultation on the Framework in 2025 will aim to take a more holistic view of the system. This includes how, through working with partners, regulatory, health technology appraisal (HTA) and uptake pathways could be streamlined to facilitate faster access. A consultation on increasing the threshold of the Budget Impact Test (BIT) to £40m from £20m will also be launched imminently.

  1. Earlier Engagement – how and when

NHS England underscored the importance of early engagement from the pharmaceutical industry. Proactive involvement in strategic pipeline discussions, facilitated through channels like NHS commercial surgeries or the Innovative Licensing and Access Pathway (to be refreshed in ILAP 2.0), is crucial. This early alignment ensures the health system is well-prepared for new medicines, ultimately accelerating patient access. The key question NHS England seeks to address: What does a new medicine launch mean for workforce, patient pathways, outcomes, and system interactions? Early dialogue on data requirements for indication-based pricing agreements is particularly beneficial, speeding up implementation when systems are in place.

  1. Strategic Long-term Thinking on the Horizon

The looming General Election and the NHS’s ongoing productivity efforts have temporarily shifted focus to necessary short-term financial objectives. However, there is optimism that post-election, the NHS will have the bandwidth to embrace bold, multi-annual strategies essential for integrating groundbreaking pharmaceutical and technological advancements. Should political tides turn in favour of a Labour government, their systemic reforms will necessitate close collaboration between the NHS and the pharmaceutical and med-tech sectors to realise ambitious strategic goals.

  1. Focus on Community-Based Care

The roundtable discussion recognised the need to enhance the uptake of products and initiatives suited for community settings, given the prioritisation of preventative and anticipatory care. NHSE is keen to understand the unique requirements for effective implementation in these settings and is open to industry insights. While immediate efforts are directed towards community care, addressing long-term issues in primary care prescribing remains on the agenda. The industry is encouraged to share experiences and solutions ahead of formal consultations, noting that this broader challenge is earmarked for the second consultation in 2025.

WA Communications: Bridging the Gap

WA Communications, with its expertise in strategic communications and public affairs, is dedicated to supporting clients at the intersection of policy, government affairs, and healthcare communications. Our health practice is adept at navigating complex landscapes to help clients achieve their strategic objectives.

For a deeper discussion on partnering with the NHS and navigating this evolving landscape, reach out to us at HelloHealth@wacomms.co.uk. Together, we can drive forward innovative solutions for a healthier future.

 

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What are the learnings so far at Integrated Care System (ICS) level to reduce health inequalities?

In conversation with NHS Gloucestershire Integrated Care Board (ICB)

The need for local community action to address health inequalities has never been greater. Over the last few months, we’ve seen a disbanding of the Office of Health Inequalities and Disparities (OHID), the government department set up to drive a meaningful step change in health inequalities.

However, with disappointment comes opportunity.

In a year of political change, many are looking to ICSs who have a statutory duty to reduce health inequalities, as the engines of meaningful progress. Now almost two years on since their formal legislation, each ICS is taking a different approach in response to addressing health inequalities, with great success.

We sat down with Becca Smith, Associate Director Clinical Programmes, Frances Beavis, Senior Project Manager and Natalia Bartolome Diez, Insights Manager EDI to talk about their tailored approach to working with people and communities, and why they are confident it is already working.

What are you doing differently to understand the nuances of the diverse community you work with?

Everything starts with building trust. Whilst national health campaigns over the years have had great results in shifting behaviour, it is the underserved populations that are often forgotten. There are multiple reasons for this, too many to get into today, but one of the most important factors is a lack of trust in the health system. We decided to create a new role, an ‘Insights Manager’ to act as the point of reference for many different religious, ethnic and social-economic communities into the NHS to work out how to overcome this. Our Insights Manager’s main role is to listen and to truly hear the needs of seldom heard communities. Doing this allows us to truly understand what we need to do differently, what are the simple fixes and what are the longer-term changes that will get the results these groups deserve. All good plans start without assumption, and we are seeing the benefits of this first hand.

And more broadly, how does addressing health inequalities fit within your wider organisation?

Often within an ICB, there is a dedicated health inequalities team. However, responsibility for health inequalities is also shared by team members across the organisation, including team members in specific disease areas −transformation roles as well as clinical leads may share responsibility.

If you are interested in collaborating with an ICB on a health inequality initiative, we would recommend mapping stakeholders via desk research. You should also be prepared to speak with several people within the ICB to identify the right person with responsibility for your area of interest.

Is it time to stop categorising ‘ethnic minorities’ into a catch all definition?

We have seen that there is real benefit in developing engagement strategies that are tailored to specific ethnic groups. There are different social and cultural norms between different groups and with this, different barriers and drivers. There can be a tendency to develop health engagement strategies for all ethnic minority communities but increasingly as a sector, we are understanding that engagement needs to be more specific. What might work for one community may not work for another.

Do you have any projects that show this new approach is succeeding?

There are a few examples that we are incredibly proud of.

Our collaboration with the Gloucester Health and Care Community Cancer team to host an early diagnosis in prostate cancer event for Black men demonstrated how local community events are starting to inform local policymaking.

Firstly, we made sure that the prostate cancer event was hosted in a local, familiar space that Black men attended regularly – in this case the local community centre. We also invited a range of people including doctors, clinical nurse specialists, support workers and a Black man with lived experience to provide information on the symptoms of prostate cancer, treatment options and support options.

During the event, attendees suggested some helpful screening recommendations, including offering a drop-in clinic at the community centre for prostate-specific antigen (PSA) testing. This will be discussed with Gloucester ICB’s Cancer Patient Reference Group, a group of people affected by cancer that inform the strategy and activity of the ICB.

We also worked with the Gloucester South Asian local community centre over the course of a year to explore barriers to NHS England’s digital diabetes platform, which sets out to help people manage their diabetes. We managed to identify specific language barriers and develop solutions to inform a national pilot programme.

It’s great to see these new approaches achieving high engagement from communities and now feeding in to how we shape our services in long-term chronic conditions.

If you are interested in further examples of local best practice or how to work collaboratively with an ICB, contact Rose Brade at rosebrade@wacomms.co.uk or Clara McDermott Simarro at claramcdermottsimarro@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 at  lloydtingley@wacomms.co.uk. 

 

 

 

 

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The State of 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 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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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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