GHP April 2016

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April 2016

www.ghp-magazine.com

Research, Translation, Commercialisation

Support for Mental Health Welsh hospitals, Health and Social Services Minister Mark Drakeford has announced that new dedicated teams of staff will provide hands-on support for people with mental health needs.

Using Technology as a Solution to GPs’ Growing Workload

Brother UK’s Greig Millar lifts the lid on the company’s report, ‘GP Workload: Statistics & Solutions for a More Productive Practice’, the Infographic of which highlights some of the activities that take up the most time for GPs. It also illustrates how technology is being used to alleviate some of that pressure.

Research Funders join Forces to Tackle Zika virus with £3.2m

The MRC, the Newton Fund and the Wellcome Trust have joined forces to tackle the global threat posed by the Zika virus.

The Forces Shaping the Pharma ‘Lab of the Future’

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Research, Translation, Commercialisation

editor’s note

this month’s feature

inside this issue

Welcome to the April 2016 edition of global health & pharma magazine, we begin the edition with a round up of news from the central government in the UK and also from Northern Ireland, Scotland and Wales.

Health Minister Simon Hamilton for example recently announced a 15% increase in the annual number of pre-registration nurse training places commissioned in Northern Ireland and the establishment of a new task group on nursing.

04 News

Clare Periton is the CEO of Helen & Douglas House, the world’s first children’s hospice based in Oxford, writes about running a hospice and her thoughts on the importance of having a coordinated health and social care system.

Brother UK’s Greig Millar lifts the lid on the company’s report, ‘GP Workload: Statistics & Solutions for a More Productive Practice’, the Infographic of which highlights some of the activities that take up the most time for GPs and how technology is being used to alleviate some of that pressure.

Elsewhere, a recent report by the International Longevity Centre – UK (ILC-UK) argues that our ageing society offers significant social and economic opportunities but only if policymakers plan better for the long term.

In another piece, Leading NHS cardiologist, Dr Aseem Malhotra, in late February highlights a complete healthcare “system failure”, that is resulting in the unnecessary deaths of tens of thousands of people globally every year.

Artificial intelligence and wearables thrive across healthcare sectors, says Frost & Sullivan in an insightful article. Jyoti Nagrani, Consulting Analyst from the same company argues that the total healthcare expenditure as a percentage of gross domestic product (GDP) is expected to increase to 4.3 percent to reach $50.8 billion in 2020.

I hope you enjoy reading this compelling edition.

We hope you enjoy this issue.

New Teams to Support People with Mental Health Needs in Welsh Hospitals.

New dedicated teams of staff to provide hands-on support for people with mental health needs will be set up in Welsh hospitals, Health and Social Services Minister Mark Drakeford announced on 31 March 2016. Page 32

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Clare Periton: The Privilege of Running a World Class Children’s Hospice

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Using Technology as a Solution to GPs’ Growing Workload

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NHS Flu Fighter Awards

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Saving Two Lives: Unravelling the Burden of Thyroid and Influenza During Pregnancy

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Future of Ageing Bleak Without Better Planning

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Smoking Ban

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Majority of UK Healthcare Property Values Experience Growth

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Healthcare Expenditure Across All Sources to Rise in Indonesia in 2020

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Community Resuscitation Across Northern Ireland

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IBIS Capital Launches Global Healthtech Investment Review

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Value Based Healthcare Transformation Spurs Innovative Opportunities for Industry Participants

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AAIPharma Services Corp./ Cambridge Major Laboratories, Inc. Expands IDBS’ E-WorkBook Platform Across Global Analytical Sites

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The Forces Shaping the Pharma ‘Lab of the Future’

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New Drug Shows Promise Against Muscle Wasting Disease

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SIMPONI® (golimumab) shows higher treatment persistence rates in patients with immune -mediated rheumatic diseases compared with other subcutaneous TNF-alpha inhibitors in Sweden

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Healthcare Corruption Results in Deaths of tens of Thousands of People each year, Leading NHS Doctor Warns

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Research Funders join Forces to Tackle Zika virus with £3.2m

“This government’s decision to invest in science and innovation and protect science spending means we are able to react to emerging global threats like the Zika virus and allow the world class scientists we have here in the UK to conduct ground breaking and potentially life-saving research.”

Universities and Science Minister Jo Johnson

Global Health & Pharma, 39A Birmingham Road, Blakedown, Worcestershire, DY10 3JW Tel: +44 (0) 1234 567 890 | Email: info@ghp-magazine.com | Web: www.ghp-magazine.com

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Health Matters Promotes Midlife Approaches to Reduce Dementia risk Following the recent launch of Public Health England’s (PHE) One You, a ground-breaking campaign to help adults across the country make simple changes to improve their health on 22nd March and in the future, PHE has launched the fourth edition of Health matters: midlife approaches to reduce dementia risk.

Alzheimer’s and other forms of dementia affect some 850,000 Britons and cost the economy £26 billion a year. If things continue as they are the number affected will rise to 1 million by 2025 and 2 million by 2050.

“In 2016, 1 person every 3 minutes will develop dementia but, recent statistics from Alzheimer’s Research UK show only a quarter of the British public believe it’s possible to reduce dementia risk.

This latest edition of Health matters, a resource for health professionals and local government which aims to support commissioning and the delivery of local services, shows that dementia is not an inevitable part of ageing.

“Research has shown that dementia is caused by a complex mix of genetic and lifestyle factors but by maintaining a balanced diet, exercising regularly, not smoking or drinking to excess, keeping blood pressure and cholesterol in check the risk of dementia can be lowered in some cases.

What is good for the heart is also good for the brain.

Modifying cardiovascular risk factors has contributed to a large decline in deaths from heart disease and stroke over the past 50 years. The same could be the case for dementia.

Health matters brings together in one easily accessible package local and national level data, as well as infographics, slide sets, case studies and blogs – that will help make the case for investing in dementia risk reduction.

Using PHE’s Dementia Profile tool, for example, can help to identify local risk factors for dementia such as smoking prevalence or physical inactivity. This will help to prioritise efforts to reduce such risk factors.

Launching Health matters, PHE Chief Executive Duncan Selbie commented: “Dementia is a critical public health concern. In the absence of a treatment or cure, it is important that we take action to reduce the numbers of people getting dementia.

“It’s important to be aware that age is still the biggest risk factor for dementia, and as there is not yet a surefire way to prevent the condition it’s vital we continue to invest in research into preventions, as well as better treatments for those cases that cannot be prevented.”

George McNamara, Head of Policy at Alzheimer’s Society added: “In recent years, awareness and understanding of dementia has drastically increased - and so too has the evidence base indicating that a person can make simple lifestyle changes from midlife onwards to reduce their risk of developing the condition.

“This useful resource has compiled the available evidence and helpfully identified local risk factors for dementia to support commissioners to make evidence-based decisions on what services are needed and where. Prevention is always better than cure so we commend this proactive approach to improving health across the population.”

“Protecting and promoting brain health has been relatively neglected. This edition of Health matters makes the case for action that will help reduce the risk of dementia in later life.

Dr Matthew Norton, Head of Policy at Alzheimer’s Research UK, said: “Alzheimer’s Research UK welcomes the new Health Matters resource from Public Health England, which will help healthcare professionals raise awareness of ways the public may be able to reduce their risk of developing dementia.

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Lexacom and Docman Announce new Partnership to Drive ‘paperless National Health Service’ Forward Lexacom, the leading supplier of digital dictation solutions for NHS Primary Care, were delighted to announce in March 2016 a new, exclusive partnership with Docman. This partnership will see the deployment throughout England of a fully integrated document creation, workflow and management system.

Working closely with Docman the number one supplier of advanced electronic document management software enabling the transfer of care for 40,000,000 patients between 120 NHS Trusts and 6,000 GP Practices.

Users will now benefit from a seamless document creation and workflow platform driving greater levels of efficiency and productivity. Through the tightly integrated solution, healthcare providers can significantly improve the management of their patients’ care.

Dr Andrew Whiteley, Lexacom’s Managing Director commented: “We are delighted to be able to formally announce our key strategic partnership with Docman.

This announcement is testament that both companies are dedicated to improving the efficiency and safety of the NHS through the use of technology. Together, we are able to offer a much broader solution to our clients throughout the NHS. The partnership of our two organisations is extremely well timed, as the Health Secretary, Jeremy Hunt, announced recently the NHS’s paperless aspirations and how technology is critical in achieving these goals.”

Ric Thompson, Managing Director, Docman added: “Working with Lexacom will provide our customers with one seamless solution for the creation, management and workflow of patient’s transfer of care between healthcare settings. Docman are committed to interoperability to ensure clinicians get the right information at the right time supporting the NHS Five Year Forward View.”

Lexacom, who are based in Banbury, Oxfordshire, have been providing digital dictation solutions to the NHS for almost 20 years. Lexacom 3 and its mobile apps fully integrate with the Docman software and provides the number one solution for healthcare providers.

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Funding for Carers’ Groups in Scotland Carers organisations are to benefit from more than £700,000 of Scottish Government funding over the next year the Scottish Government announced on 23rd March.

The funding will be used to help them deliver a wide range of programmes and projects to support Scotland’s carers.

The package will be shared between Carers Scotland, Carers Trust Scotland, Coalition of Carers in Scotland, Crossroads Caring Scotland, Minority Ethnic Carers of Older People Project (MECOPP) and Shared Care Scotland.

It includes a contribution towards the Young Carers Festival, which gives young carers the chance to come together, meet other people in the same position, and take a break from their caring responsibilities.

In addition, there will be £3 million to Shared Care Scotland and the Family Fund for voluntary-run short breaks.

Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, said: “These organisations provide a huge level of help and support to Scotland’s carers, and the commitment of their staff is beyond doubt. I believe that this funding package provides good value for money because these groups, and the projects they run, are a crucial part of the Scottish Government’s efforts to improve the lives of carers.

“Earlier this year the Scottish Parliament unanimously passed the Carers Bill, which strengthens the rights of carers. As we move to implementation of the Carers Act, these national carers organisations will have an important role to play.

“I am particularly pleased that we have been able to continue funding the Young Carers Festival. When I attended the festival last year it was clear that the event was valued by the young carers present. It gives them a chance to make friends with other young people in their position.”

Simon Hodgson, Director of Carers Scotland, commented: “Carers Scotland is delighted to receive this continued support from the Scottish Government. The next two years are going to bring significant changes to the way carers are supported in Scotland and we share the Scottish Government’s understanding that it is vitally important that carers, and the professionals they come into contact with, understand what all the changes mean. We are also acutely aware of the importance of supporting working carers and carers trying to get back into the workplace and are confident that the Carer Positive initiative will continue to help make this a reality.”

Pete Richardson, Carers Trust Scotland, added: “On behalf of Carers Trust, I am delighted that the Scottish Government continues to support our work to improve support, services and recognition for carers in communities across Scotland. Anyone can become a carer at any time in their lives, and Carers Trust Scotland will continue to work with network partners to help provide services to support a carer’s individual and changing needs throughout their caring journey.”

Claire Cairns, Coalition of Carers in Scotland, said: “We are delighted to have our funding confirmed for 2016-17. This is an important time for the carers movement as preparations begin for the introduction of the Carers Bill in 2017.

It is our aim to support these development by ensuring that carers have a strong voice and are able to participate through local partnerships and in developments at a national level.”

Margaret McCarthy, Chief Executive of Crossroads Caring Scotland said: “We are delighted to receive an award from the Scottish Government.

“Carers now make up 17 per cent of our population.

This figure is set to rise over coming years and we need to find innovative ways in which we can support carers. As well as helping us sustain existing services, this funding will help us work to create caring communities where social isolation is reduced, carers feel connected and the wider community benefits.

“Legislation is also changing to support the growing caring population. This funding will enable us to create local resources and opportunities so that carers can participate in consultation and play a role in shaping their collective future.”

Don Williamson, Shared Care Scotland, said: “We are grateful to the Scottish Government for this funding which will help Shared Care to continue our work in 2016-17 to support the development of short breaks for the benefit of Scotland’s carers and cared-for people.

“These are undoubtedly challenging times for our sector but we are beginning to see new opportunities emerge with the progress of self-directed support, health and social care integration and of course new carers legislation. We look forward to working with our partners and government to ensure these developments deliver the best possible outcomes.”

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Proton Partners will Transform Cancer Care in the UK On 1st March 2016 Proton Partners International announced they aim to “revolutionise” the UK’s cancer landscape, its Chief Executive Officer Mike Moran said.

Speaking at the BioWales flagship event for the life sciences sector in Wales, Mr Moran discussed Proton Partners’ progress in bringing proton beam therapy to the UK.

“The spirt of our centres is to beat cancer. This therapy is not a panacea but it does make a real difference for patients and will help to revolutionise the level of care that is currently available.”

There are currently no operational proton beam therapy facilities in the UK and therefore Wales-based company Proton Partners are in the process of developing three new centres – in Newport, Northumberland and London.

Also taking part in the event was Proton Partners International Non-Executive Chairman, Professor McVie.

Work has already begun on the first centre, located in Newport, which will provide chemotherapy and radiotherapy later this year, and proton beam therapy in 2017. Proton Partners has also just received formal planning permission for the second centre in Northumberland.

Mr Moran said: “There is a growing demand for proton beam therapy in the UK. Currently patients have to travel abroad to receive treatment and therefore Proton Partners aim to fill the void that has developed in the UK’s cancer landscape.

“Each of our three centres will have the capacity to treat 500 unique patients a year. Our plan is to network our centres together into an eco-system to help advance proton beam therapy technology from a patient perspective, rather than a manufacturers perspective, and develop greater outcomes for patients.

He added: “By 2020, one third of the world’s population will be affected by cancer and therefore our plans mark the most strategic healthcare project for decades.

“We will provide an all-encompassing cancer service for patients, delivering world class imaging, chemotherapy, radiotherapy and proton beam therapy treatment.

“Every patient deserves the best possible care without needing to leave the country or spend huge amounts of money.”

The theme of this year’s BioWales event is Connect and Collaborate, building on Wales’ collaborative strength, bringing together industry experts, life science investors and international networks to focus on the interaction between business, academia and healthcare.

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Northern Ireland Health Minister Announces 100 Extra Nurse Training Places Health Minister Simon Hamilton, MLA, at the end of March announced a 15% increase in the annual number of pre-registration nurse training places commissioned in Northern Ireland and the establishment of a new task group on nursing.

The Minister stated: “I am delighted to be able to announce an increase of 100 pre-registration nurse training places to be available in Northern Ireland from autumn 2016. This increase will take my Department’s annual commission of training places to 745.

Nurses are central to the delivery of safe, effective and compassionate care. Even though we have increased the number of front-line nurses and midwives in the HSC by 1,200 over the past four and a half years, I recognise that the demand for nurses across our health system continues to rise.”

The Minister added: “I am deeply impressed by the quality of care provided by our nurses, and of the pre-registration training provided by our partner universities. The close collaborative approach to training adopted by the HSC and the universities consistently produces nurses which, I believe, are among the best in the world. With this in mind I am also announcing the commissioning of a Task Group under the direction of the CNO to which I will appoint a lay chair.

This Group will make clear recommendations about the future delivery of nursing and midwifery over the next 10 – 15 years. It will inform the development of new and exciting roles, building on the existing skills of our graduate workforce to lead the transformational changes required to deliver the world class health service to which we all aspire.”

contribution of Nurses and Nursing to the delivery of health and social care in Northern Ireland and that despite significant financial challenges his Department continues to financially support Nurse Education in Northern Ireland. His announcement that the number of nursing students is to be increased will be widely welcomed by the profession.

RCN Northern Ireland Director Janice Smyth said: “We welcome the Minister’s announcement that he is commissioning a “Task Group” for Nursing and Midwifery under the direction of the CNO. The nursing profession is facing unprecedented pressure and the Royal College of Nursing believes that an independently chaired review group is urgently required.

This provides an opportunity to ensure an approach that promotes health and wellbeing, identifies and embraces innovative practice and work already undertaken in Northern Ireland and is informed by evidence of best practice here, across the UK and further afield. In response to this announcement the RCN have warmly welcomed the Minister’s ongoing commitments to our health and social care system.”

In conclusion, the Minister noted: “This significant investment, funded from the Transformation Fund which I have established, demonstrates my commitment to providing the highest standards of care to our population. This increase in training places, which will take commissions over the 700 mark for the first time since 2009, will be warmly welcomed by the many individuals who I know wish to pursue a career in nursing.”

In a statement the Royal College of Nursing said they were pleased that the Minister recognises the

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SalaryFinance Partners with My Trust Benefits to roll out Financial Benefit to NHS Employees • SalaryFinance allows employees to repay their personal debts as quickly as possible through a low-cost, fixed-rate loan • Through My Trust Benefits, the service could reach over 120,000 NHS Trust staff • SalaryFinance will also be available through My Trust Benefits’ sister company, Groupschemes, to over 100,000 employees in the private sector • Savings made from the service equate to a 3%5% pay rise SalaryFinance, the financial employee benefit, is today announcing a partnership with benefits provider My Trust Benefits to make its service available to over 120,000 NHS Trust staff in England.

This company offers businesses and public sector institutions a free financial employee benefit that allows their staff to consolidate their personal debts into a low-cost, fixed-rate loan. The repayments are taken directly from their salary payment, keeping the interest rate low (7.9% APR), saving each employee an average of £900 pounds.

The service is free for employers and staff, and an applicant’s eligibility is unaffected by their credit score or income level. The partnership with My Trust Benefits means that thousands of NHS Trust staff may be able to drastically reduce their personal debts, and improve their financial health.

Alongside this, SalaryFinance is also partnering with My Trust Benefits’ sister company, Groupschemes, to extend the benefit to a further 100,000 private sector employees.

Asesh Sarkar, CEO of SalaryFinance commented: “Public sector pay has been a contentious issue in recent months, particularly in the NHS. Through this partnership, we hope to help tens of thousands of NHS Trust staff to pay off their debt quicker and get on the road to financial wellbeing. Every year, NHS Trust staff help millions of people improve their physical and emotional wellbeing.

We are very excited by the potential to help these terrific people improve their own financial wellbeing”.

Peter Jenkinson, MD of My Trust Benefits added: “This partnership with SalaryFinance will allow us to add to our list of innovative employee benefits that we can offer to staff across the UK. With its unique offering, SalaryFinance will undoubtedly help many NHS Trust staff and other UK businesses to improve their personal finances and reduce their stress”.

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Clare Periton: The Privilege of Running a World Class Children’s Hospice 10 | ghp April 2016

Health & Social Care Clare Periton is the CEO of Helen & Douglas House, the world’s first children’s hospice based in Oxford. Previously Director of Clinical Services, Clare was made Chief Executive in 2015 after ten years at the Hospice. Clare currently lives in Oxford with her two daughters.

On running a hospice It is a huge privilege and I feel immense pride to be part of a sector that is frequently heralded for the essential services that it provides. I am equally proud that the UK has been acclaimed as the world’s best provider of palliative care. The hospice is an incredibly positive and happy place to be, which many people don’t expect. Of course we have our sad days, but we endeavour to create an atmosphere for the children and young adults, and their families, where they can be happy, live their lives and help them when they want to talk about death.

Remarkably many of them do want to know what is going to happen and do not want to shy away from it.

Running a hospice is also a huge challenge and it is essential to have a team that works well together in order for us to deliver our high standard of care. Within the hospice we all have many different roles, whether it is in finance, retail, human resources or care that people work, they all contribute to the service that we provide. To all be able to do our jobs as best as we can, it is advantageous to have a team where everybody gets on and respects each other. It is in this kind of environment that people can flourish and excellence can be aimed for and often achieved.

On the challenges of maintaining a work/life balance Being a single mother of two, it is crucial that I make sure I have balance in both sides of my life, both with my family at home and at the hospice. Professionally, I have tried to learn as much as I can over the years, both academically and from experiences, and not to beat myself up when things go wrong (whilst of course taking accountability appropriately). It is a skill that is so important in this sector, in both the business and the care aspects and one that I have managed to practice through my nursing and management career.

When a relatively junior nurse I learnt about the concept of ‘reflective practice’ and I commend it to anyone. Nurses can spend a lot of time dwelling over patient’s cases and thinking what we could have done differently, but reflective practice helps to make sense of the situation and to reflect on what happened and what they could change next time in order to improve care or the management of a situation.

I am extremely lucky to have an amazing and strong team around me and I have always made a point of employing people that have complementary skills to me and who ‘get’ what we are trying to do. It is empowering to work around people who are aiming to be the best they can be, so that we can provide a high quality of care for all the children and young adults who use the services of Helen & Douglas House.

On the importance of having a coordinated health and social care system In the past Helen House (one of the two houses which forms the hospice) used to be slightly insular and I wanted to challenge this when I joined ten years ago.

I am naturally a very collaborative person and see great advantages in this style of practice. Working as a District Nurse and Health Visitor, I have experience of working in a community team and being part of the team around the child. On joining Helen & Douglas I realised that it can be easy, when we have the luxury of working one to one with a child, to forget that there are other nurses or professionals working with this child and family. Not only do they bring different t skills, but they are often having to juggle other priorities and challenges; it is therefore crucial that we all acknowledge the different roles that we play.

We always strive for better coordination of a person’s care. This often includes meeting face-to-face and encouraging people to pick up the phone rather than emailing, in addition to thinking pragmatically and using skills appropriately. We try to recognise that everybody has different skills and how to utilise these to their best potential. It is hugely beneficial for the right people from all the different teams to be involved in a child or young adults care, as this provides the best outcomes and the best quality of care.

It is also essential for us to be able to identify when we are not the right place for a child or young adult and this needs excellent working with the family and the other health care and social care professional whether they be in the community, or other hospices or hospital units.

When it comes to my family life, I try to let my children understand what I do and give time back to them as much as I can. I ensure I pick them up at normal time from school at least once a week and we also try to do something special together each week, like a film night or a sleepover night where the kids invite their friends round and I cook with them. It is amazing how having children gives one a sense of perspective and makes you more organised with your time. No matter what, unless I have made other plans in advance, I need to pick up my children by 6pm each day and this really puts things into order and makes me plan my day efficiently and switch off from the day job.

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Nathan Best with Jackie HH

Using Technology as a Solution to GPs’ Growing Workload A summary of how GP’s currently spend their time & how technology might help improve efficiency.

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Health & Social Care According to the Chair of the Royal College of General Royal College of General Practitioners, many of Britain’s GPs’ are extremely tired and overworked. Not only is this something we see reported in the news, it’s become a widely-discussed topic for society at large. There are a number of innovations that could be adopted to help healthcare professionals, with things such as their ever-growing amount of paperwork.

Brother UK’s Greig Millar lifts the lid on the company’s report, ‘GP Workload: Statistics & Solutions for a More Productive Practice’, the Infographic of which highlights some of the activities that take up the most time for GPs. It also illustrates how technology is being used to alleviate some of that pressure.

For many it’s surprising to learn that there are now more GPs in the UK than ever before, however this doesn’t appear to be an effective solution to the growing problem. An investigation conducted by the Citizen’s Advice Bureau reported how much time GPs spend on issues other than health. It was found that 19% of GP consultations are spent addressing social issues. Within a month, GPs identified some shocking figures about the issues that patients discussed during consultation time: • 92% discussed relationship issues; • 77% raised housing issues; • 77% talked about work related issues.

Making the changes The Government plans to improve the quality of patient care with the use of technology and innovation.

Their focus will be to introduce hospital-led vertical integration of acute and primary care, as well as GP practice-led integration of out-of-hospital services.

An investigation undertaken by the Primary Care Workforce Commission discussed the ways technology could be incorporated into such services. Suggestions included email correspondence, electronic messaging between healthcare professionals and readily available digital medical records. The outline highlights how real time data would be readily available to nurses, paramedic and doctors, to ensure that patients receive the best possible information at the point of care.

Improving patient experience with the right innovation Implementing the right kind of innovation could not only improve patient care, but can also the make life easier for GPs and practice staff alike. http://www.brother.co.uk/gp-doctor-workload-infographic#sthash.aXdyfHEn.dpuf

Working beyond designated hours There is massive strain on the care that GPs provide, which means that they regularly work beyond the hours they are assigned. Some practices have reported that for just one GP the average working day can see up to 62 patient visits, often resulting in a 13-14 hour working day.

Managing a demanding workload A GPs workload is not made up of consultations alone, it is in fact administrative tasks that have a significant bearing on the problems that we see in contemporary society. A report by The Primary Care Workforce Commission found that keeping up with administrative tasks accounted for 11% of their time. If these types of tasks were handled by designated admin staff, it would equate to the equivalent of 1,400 additional full-time GPs. The quality of care provided to patients According to 93% of GPs, the care that they provide to their patients has been negatively affected by their growing workloads. GPs have their patients’ best interests at heart, however the growing demand and unmanageable workloads, means that there isn’t enough time to meet the required standards of patient care.

How technology can be used to alleviate the pressure Using innovative methods to help alleviate workload pressures can help to ensure that patient care remains the main focus for GPs. Some dynamic GP practices have already seen the benefits of integrating technology into their day-to-day practises.

A GP practice in Lancashire saved over seven hours a day using paperless technology and a GP practice in London saved more than 600 appointments each year by using a text messaging service to communicate with patients.

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NHS Flu Fighter Awards A ‘Get me out of here’ themed campaign and targeting ‘carers in the community’ were two of seven campaigns that scooped awards at the NHS flu fighter awards on 23 March.

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Health & Social Care ‘Get me out of here’ and ‘carers’ in the community’ win at this year’s NHS flu fighter awards The awards are part of the NHS flu fighter campaign run by NHS Employers, which has helped increase the number of frontline NHS staff having flu vaccinations.

Danny Mortimer, Chief Executive, NHS Employers, who co-presented the awards, said: “These teams have done fantastic work to help make the NHS an even safer place for staff and patients. More than a million people use the NHS every 36 hours and many can be very vulnerable to flu. It’s great that over half a million NHS staff now find time in their busy days to seek out these voluntary vaccinations The dedication shown by flu teams has been inspirational and deserves both celebration and recognition.”

At the end of the last winter 490,000 (50%) of frontline NHS staff were choosing to be vaccinated, compared with 359,000 (34.7 per cent) in 2010/11the winter before the national campaign began.

The vaccinations are not mandatory but help to protect staff, their friends, family and patients from flu. Flu fighter provides information and resources to help the NHS promote vaccinations locally and make them more convenient to have. More details are at www.nhsemployers.org/flufighter, #flufighter and www.facebook.com/ nhsflufighter and the winners of all seven categories can be seen at www.nhsemployers.org/flufighter Winner of flu fighter champion: Liz Grady of Alder Hay Hospital. Alongside her role as Health and Wellbeing lead, Liz has led the flu fighter team for the past three flu seasons. In this time Liz has improved flu uptake from a baseline of 68 per cent to a fantastic 78 per cent this year. She has spent many hours working tirelessly to make sure the campaign is delivered to a high standard and that all staff have access to the vaccine in a fun, friendly and accessible manner.

Through Liz’s infectious enthusiasm and dedication the trust had a very successful campaign. Liz often worked late into the night collating flu data and even going so far as ironing flu logos onto T-shirts.

Winner of #flufighter award for digital and social media: Sandwell and West Birmingham Hospitals NHS Trust. The Sandwell and West Birmingham Hospitals (SWBH) Occupational Health and Wellbeing Service has embraced digital and social media as an integral part of the flu campaign. Feedback showed that staff struggle to be released from training, so the team developed an online training package for vaccinators.

They can take part in training at a suitable time for them, with no disruption to their patient services.

Winner of most improved flu fighter campaign: Central London Community Healthcare NHS Trust In the 2014/15 flu season, Central London. In the 2014/15 flu season Community Healthcare had a 26.5 per cent uptake, which was the lowest for a community trust in the country. Now, the trust has been ranked highest community trust in London with a 46 per cent uptake.

The Trust took a simple approach – make it available and make it visible. With 3,000 staff in nearly 200 sites across London and Hertfordshire it was essential to take the vaccine to teams. The team took on board findings in its internal review of the 2014/15 programme and started its campaign early in the season.

Winner of Best flu fighter team: Northumberland Tyne and Wear NHS Foundation Trust. This campaign

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Flu Fighter Champion

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Health & Social Care bought together staff from infection prevention control (IPC), IT, communications, estates, pharmacy, nursing, occupational health, operational and managerial services and, for the first time, the systems development team. Each department contributed a unique and valuable skills set. Pharmacy in supply, estates resolved issues with storage fridges and the mobile clinics. IPC matrons worked to recruit more community vaccinators. IT designed a recording system to improve reporting accuracy. Increasing the numbers of community vaccinators enabled staff to offer support to GPs who vaccinate patients with learning disabilities in their own homes, and previously found this procedure daunting.

Vaccinators offered vaccination to all partner agency staff including social workers, teachers, agency nurses and frontline police officers, totalling 365 staff being vaccinated and achieving uptake of 63.4 per cent.

Winner of Innovative flu fighter campaign: Dorset County Hospitals NHS Foundation Trust. The HR Department at Dorset County Hospital led its flu fighter campaign this year, with the theme of ‘get me out of here’. The team used a number of initiatives including free giveaways, a flu week, a bush tucker trial and I’m a celebrity flu information boards. Due to the new fun, competitive nature of the campaign, junior doctors took part as vaccinators for the first time. A fortnightly flu real-time uptake dashboard was created for each division. This really encouraged management at divisional level to get involved and take ownership for uptake in all departments, especially high risk ones.

The campaign created a real buzz around the trust for several weeks and maintained a positive uptake result.

Best Team

Carers Award

Winner of flu fighter carers award: Cray Hill Pharmacy.

Cray Hill successfully targeted those who identified themselves as a carer within the local community by designing specific leaflets informing them of their eligibility. Staff were also encouraged to engage in conversations to identify carers, which was a huge success as a large number of carers visited the pharmacy.

Many patients were not aware that people at home were eligible for the vaccine. Once this was communicated, the pharmacy saw a rise from 60 vaccines in 2015/15 to 600 vaccines given in 2015/16 Winner of flu fighter residential care award: East Cheshire Hospice, Macclesfield. East Cheshire Hospice has worked in partnership with Cheshire Occupational Health Service, to deliver its annual flu fighter campaign. The hospice communicated with its 120 staff members through a variety of channels and used a range of mythbusting techniques. The team gained support from senior management and directors, who championed the campaign by having their vaccines and encouraged others to do the same.

The hospice achieved over 70 per cent staff uptake of the flu vaccine, a fantastic achievement.

NHS Employers is part of the NHS Confederation charity and supports employers to put patients first.

It provides a voice for employers on national policy decisions, produces up-to-date guidance for leaders and managers and leads on national pay negotiations.

The NHS Confederation represents 85 per cent of NHS providers and commissioners. The organisation has nearly 500 members across health and social care, including hospitals, community and mental health providers, ambulance trusts and independent sector organisations providing NHS care. It is the only membership body to bring together and speak on behalf of the whole NHS.

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Health & Social Care

Saving Two Lives: Unravelling the Burden of Thyroid and Influenza During Pregnancy The Federation of Indian Chambers of Commerce and Industry (FICCI) — an apex business organization, in association with Frost & Sullivan, a leading strategy consulting firm, announced earlier this year the launch of two whitepapers at an event titled “Roundtable on Addressing the Impact of Thyroid Disorders and Influenza: An Initiative towards a ‘Healthy Mother, Healthy Child’ Vision”.

The whitepapers were launched in association with the Ministry of Health & Family Welfare and the Ministry of Women & Child Development, and are titled: • Impact and Assessment of Thyroid Disorders on Mother and Child Health: Possible Policy Interventions; • Impact and Assessment of Influenza on Mother and Child Health: Possible Policy Interventions.

The whitepapers are endorsed and supported by various clinical associations namely, the Federation of Obstetric and Gynaecological Societies of India, the Indian Academy of Pediatrics, the National Association for Reproductive & Child Health of India, Indian Thyroid Society, Influenza Foundation of India, Endocrine Society of India, Indian Virological Society, Vaccine Advocacy Forum India, Gynaecological Endocrine Society of India, and International Medical Sciences Academy.

These whitepapers touch upon some of the most relevant issues impacting pregnancy and its outcome, chief among them being thyroid disorders and influenza.

Speaking about the event, Mrs. Shobha Mishra Ghosh, Senior Director, FICCI, said, “FICCI has always been at the forefront of highlighting the most relevant issues impacting the mother and child health scenario in India.” This event intended, “to provide a forum for initiating a debate on the issues of thyroid disorders and Influenza during pregnancy and its impact on the maternal and child health” she added.

Frost & Sullivan, the leading growth and strategy consultancy firm, prepared these whitepapers post exhaustive research and consultation with a variety of clinical and non-clinical stakeholders along with inputs

from FICCI. Commenting on the event, Ms. Ankita Kothari, Industry Analyst, Healthcare Practice, Frost & Sullivan, said: “There are approximately 2.6 crore pregnancies in India annually. Latest clinical data suggests that the burden of thyroid disorders during pregnancy is as high as 11-16 percent in India, which is abnormally high when compared to other countries.

She added that “For effective clinical interventions, all women should be screened for thyroid disorders in order to pick up the suspected cases”. She also said that “high prevalence of hypothyroidism is not only a clinical problem, but also has severe economic impact. The annual spend of managing the complications arising out of thyroid disorders during pregnancy in India ranges between INR 700-1000 crore, which is on account of managing complications like pre-term delivery, miscarriages and preeclampsia”.

The objective of these white papers is to sensitise the policy makers and clinical stakeholders which will improve the maternal and infant health scenario in India and also reduce the economic and social consequences with respect to the productivity index, arising from the impact of thyroid disorders and influenza on the mother and the infant.

Frost & Sullivan, a Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants.

Established in 1927, the Federation of Indian Chambers of Commerce and Industry (FICCI) is the largest and oldest apex business organization in India. Its history is closely interwoven with India’s struggle for independence, its industrialization, and its emergence as one of the most rapidly growing global economies.

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Health & Social Care

Future of Ageing Bleak Without Better Planning A recent report by the International Longevity Centre – UK (ILCUK) argues that our ageing society offers significant social and economic opportunities but only if policymakers plan better for the long term.

The report, ‘Tomorrow’s World: The Future of Ageing in the UK’ describes the future challenges and opportunities posed by an ageing population.

The ILC-UK argues that our society is not adequately responding to ageing today: • The social care system is crumbling and health care is failing to incentivise the prevention of ill health; • The housing and planning system is failing to respond to ageing resulting in people living in housing which does not meet their needs; • Individuals are currently underestimating their life expectancy and risking running out of money in retirement.

ILC-UK point out that without action today, the picture in 10 years’ time could be much worse. The report predicts that average pensioner incomes will start falling as more people retire with a less generous state pension and without the benefit of final salary pensions.

If urgent action is not taken to address the challenges posed by population ageing, ILC-UK presents a future in which health expenditure has increased debt as a proportion of GDP to 180%; more than 1 million additional care workers are required to meet the demand for social care; and millions have failed to save enough ahead of retirement.

ILC-UK predicts that: • Without action to better support more disadvantaged social groups and communities, the gap in life expectancy between the wealthy and the poor will continue to increase; • Without action to address the current funding and workforce shortages in health and social care, the future needs of our ageing population are unlikely to be met;

• Without action to better highlight how long people are likely to live, and the measures that they need to take to ensure financial security later in old age, even wealthier older adults may experience financial difficulties in later life; • Without action to encourage and facilitate longer working lives we will see a future drop in the UK’s employment rate and reductions in overall productivity; • Without action to build more houses, and houses which are adapted to the needs of older people, the housing shortage will continue.

The report proposes 10 long-term indicators of progress. ILC-UK plan to report against these indicators at their next Future of Ageing Conference on November 9th 2016.

1. Health must find a way to be more responsive and preventative; 2. Government must make progress in delivering a long term settlement to pay for social care; 3. Savings levels for working age adults must increase; 4. Average age of exit from the workforce should rise; 5. The number and type of homes built should be increasingly appropriate for our ageing society; 6. Government should make progress in facilitating greater risk sharing in accumulation and decumulation of retirement income; 7. We must have a more informed older consumer; 8. Our aspirations for retirement must be about much more than us spending more hours watching television; 9. Businesses should better respond to ageing; 10. We must strengthen the social contract between young and old

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Health & Social Care The report incorporates expert testimony from contributors at ILC-UK’s first Future of Ageing Conference which took place on Tuesday 24th November 2015.

ILC-UK’s second Future of Ageing Conference will take place on Wednesday 9th November 2016: www. futureofageing.org.uk Baroness Sally Greengross OBE, Chief Executive of ILC-UK said: “If we want future generations of older people to age well policymakers must act now. The UK’s demography is slow to change and we can make some reasonable predictions and forecasts on how this may influence UK society over the next ten years.

This gives us an opportunity to plan for the change we will witness. We can’t wait and hope ageing goes away.

It won’t’”.

Dr Michael Hutton, Chief Scientific Officer, Neurodegenerative Disease at Eli Lilly and Company Ltd commented: “An ageing population is placing pressure on finite NHS resources whilst there are also important concerns about the quality of care, particularly for our elderly population in health and social care settings.

The total cost of conditions such as dementia is huge.

When assessing the scale of the problem, we must have a holistic understanding of the disease to ensure patients and their families are adequately supported and also to prevent a knock on effect to our economy, as this caring role prevents ‘carers’ from accessing other forms of employment”.

‘Innovation offers the NHS a real opportunity to meet the challenge of increasing demand on resources and squeezed budgets. Lilly was delighted to support this event and help develop ideas, to make the UK the best possible environment for supporting an ageing population’.

Lord Filkin, Chair of the Centre for Ageing Better added: “If we don’t build the social care workforce by some mechanism both in volume and skill we are in trouble. It is hard to overstate what a bad place we are in. The system is crumbling now. Social care needs to have increased investment: the increase in long term conditions in the older population will drive big increases in demand and cost”.

Professor Ian Philp CBE, Deputy Medical Director for Older People, Heart of England Foundation Trust said: “I think we can turn a concern about the costs of an ageing population into an opportunity to see growth, partly because so much wealth, asset wealth and disposable income sits with older people in our society.

That wealth can be mobilised, for example to pay for major infrastructure projects through investment and return. We could turn it on its head from the apocalyptic tales of ‘we can’t afford an ageing population” to “my goodness what an asset”.

Emma McWilliam, Hymans Robertson LLP said: “Grey hair is definitely something to be celebrated.

That’s easier to do when governments have applied wisdom to setting policies that encourage generations to save enough to enjoy retirement, as well as leaving a fair and sustainable legacy for future generations that we can be proud of. There is more that Government can do, both to safeguard future generations and to support people in retirement.

“The Government’s role in retirement should be to provide certainty through the flat rate state pension and act as an insurer of last resort for long-term care needs. To ensure those roles can be performed in a sustainable way, it’s vital that individuals are clear about how much money they will have in retirement, how far off track they might be and what they need to do to get back on track. Talking about the ‘savings gap’ in general terms doesn’t resonate with individuals.

“They need to know how they will personally be affected. Technology is making that easier, and the government should pave the way to make that technology more readily available to greater numbers of people.

Enabling a smoother transition into retirement through part-time working will also help address individuals’ savings shortfalls, as well as deal with a potential future fall in UK productivity as we see greater swathes of the population ‘retired’”.

Gary Day, Land & Planning Director from McCarthy & Stone, added: “The population is ageing rapidly but the UK’s housing stock is not coping with this change.

There is a lack of choice when older people come to move to properties suitable for them in later life.

This impacts negatively on a range of areas – poorer well-being, higher public spending on health and care, and blocked housing chains. We need to raise our focus beyond starter homes and encourage the building of more specialist housing suitable for older people across all tenures”.

ILC-UK’s first Future of Ageing Conference took place in November 2015. Representatives from Government, business, academia and civil society gathered for the first annual Future of Ageing conference, hosted by the International Longevity Centre – UK ILC-UK. Speakers included Baroness Altmann (Pensions Minister), Lord Willetts (Executive Chair, the Resolution Foundation), Professor Sir Mark Walport (Government Chief Scientific Officer), Lord Filkin (Chair, Centre for Better Ageing and former Labour Minister with responsibility for Sure Start, Early Years and Childcare), Paul Johnson (Director, Institute for Fiscal Studies), and Professor Jane Elliott (Chief Executive, The Economic and Social Research Council).

ILC-UK’s second Future of Ageing Conference will take place on Wednesday 9th November 2016 www. futureofageing.org.uk. The International Longevity Centre – UK (ILC-UK) is a futures organisation focussed on some of the biggest challenges facing Government and society in the context of demographic change.

Much of ILC-UK’s work is directed at the highest levels of Government and the civil service, both in London and Brussels. We have a reputation as a respected think tank which works, often with key partners, to inform important decision-making processes.

ILC-UK’s policy remit is broad, and covers everything from pensions and financial planning, to health and social care, housing design, and age discrimination.

We work primarily with central government, but also actively build relationships with local government, the private sector and relevant professional and academic associations.

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Smoking Ban

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Health & Social Care Ahead of its tenth anniversary, Scotland’s Public Health Minister Maureen Watt reflects on the impact of the smoking ban.

“We know in Scotland we have some really deep rooted public health challenges to deal with. But we also have a proud record of taking brave and innovative steps to make our country a healthier place.

“There is no doubt the ban on smoking in public places ranks highly amongst the steps that, as a country, we have taken together. As we approach the tenth anniversary of the smoking ban, it is clear that this was, without doubt, the right thing to do. The positive impact on our health and our future health is without question. Things have had to change. But few would argue they haven’t changed for the better.

“Scotland was the first country in the UK to ban smoking in public places. Since then, evidence shows that the smoking ban has contributed to a 39 per cent reduction in second-hand smoke exposure in adults and 11-year old children, a 17 per cent reduction in hospital admissions for acute coronary syndrome and improvements in the respiratory health of bar workers.

“Nearly nine out of ten Scottish adults – and almost two thirds of smokers – support the smoking ban.

“It has increased awareness of the risks associated with second-hand smoke and there is some evidence of changing social norms around exposing others to second-hand smoke. There was also a 15 per cent reduction in the number of children with asthma being admitted to hospital in the three years after the ban came into force. And just last month, a study suggested that the ban may have helped reduce the number of teenagers taking up smoking by a fifth.

“But we know there is much more to do, and we remain firmly committed to creating a tobacco-free generation by 2034.

“We’ve taken further action to reduce the harm caused by tobacco: banning the display of tobacco products in shops, banning cigarette vending machines, creating a new tobacco retail register, supporting plain packaging and making it illegal to smoke in cars where children are present. Most recently we passed legislation to restrict the sale and availability of e-cigarettes to under-18s and make it an offence to smoke near buildings on hospital grounds.

“Since the ban came into place, Scotland has continued to pursue a bold and innovative approach towards public health. We remain committed to minimum unit pricing, which we know is the most effective pricing measure to tackle Scotland’s harmful relationship with alcohol.

“And we are taking advice on how Scotland could fortify flour with folic acid, which we believe can help to save many families from the heartbreak of being told their baby has Spina Bifida. Together, and with the public’s support, all of these steps take us closer to our goal of a healthier Scotland.”

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Marbury / Shutterstock.com

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Funding & Investment

Majority of UK Healthcare Property Values Experience Growth MSCI Inc. (NYSE: MSCI), a leading provider of investment decision support tools worldwide, released the results of the IPD UK Annual Healthcare Property Index on 7th March. The results show a 10.4% return for healthcare property in the UK in the year to end 2015.

MSCI Index reveals 10.4% return Sponsored by Aitchison Raffety, the index measures 1,030 healthcare properties worth GBP 4.3 billion.

The returns are calculated from a mix of primary care properties, leased principally to GP Practices and the NHS, as well as secondary care assets including care homes, specialist treatment centres and hospitals.

Zeinab Azadi, Vice President, MSCI commented, “The index data shows that healthcare has outperformed other asset classes, including bonds, equities, all property and real estate equities, on a risk adjusted returns basis since the launch of the IPD UK Annual Healthcare Property Index in 2007.”

Total returns across all UK healthcare property have increased over the last 12 months from 8.9% at the end of 2014 to 10.4% in 2015. This is the fourth year of consecutive steady growth in total returns for the index. The return of 10.4% for the year to 2015 comfortably outperformed the three, five and nine year average annualised returns of 9.9%, 8.6% and 7.6% respectively.

Azadi continued: “In 2008 almost 90% of assets were seeing capital value falls with the reverse of that in 2015, with almost 90% of properties seeing values grow year on year. Indeed only 8% of properties saw falls in 2015, which is the lowest we’ve tracked over the history of the index”.

The secondary healthcare market returns have improved from 6.3% in 2014 to 10.2% in 2015. Whilst the total returns are very similar in the primary and secondary markets, only 30bps difference over the

year, the components are very different. Secondary healthcare’s lower capital growth of 2.8% in 2015 is topped up by its strong income return of 7.2%.

Rental growth is modestly positive in all sectors with all healthcare adding 0.5% to average open market rental values.

The largest rise in capital growth over 2015 was experienced in the secondary market, which rose from -1.5% to 2.8%. However, the best performing sector was London primary healthcare which had a total return of 11.6% in 2015. The South East, South West and Eastern primary healthcare marginally underperformed due to a lower capital growth of 3.7% in 2015.

John Hearle, Chairman and Head of Healthcare, Aitchison Raffety commented: “The 10.4% growth in the sector with a steady rise over the last four years reflects the consistency that we have come to expect in the healthcare investment market. Looking ahead there continues to be a huge need for more purpose built properties both in respect of care homes with proper modern facilities and primary care centres, where with funding, we could really start to see more new multi-use centres attending to not just healthcare but incorporating community and social care as well. Whilst the NHS remain slow in completing their estate and service plans the launch of the GBP 1.0 billion Primary Care Transformation Fund shows that they realise the need for more funding, albeit that the amount is small when compared to the need and the guidance for its use still uncertain”. www.msci.com

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Funding & Investment

Healthcare Expenditure Across All Sources to Rise in Indonesia in 2020 Frost & Sullivan is forecasting the healthcare expenditure across all sources to rise in Indonesia in 2020. Jyoti Nagrani, Consulting Analyst, Frost & Sullivan Asia Pacific said the total healthcare expenditure as a percentage of gross domestic product (GDP) is expected to increase to 4.3 percent to reach $50.8 billion in 2020.

Jyoti Nagrani said that Indonesia is gearing up for a rapidly urbanized population. Jyoti predicts 68 percent of Indonesians will live in urban areas by 2025. Jyoti said over 80 percent of Indonesians could potentially belong to the middle class by 2025. The spending power will generate an huge spill-over effect for both domestic and ASEAN economics, creating enormous business opportunitiesincluding Healthcare.

Jyoti also said that urbanization and rise in middle class, with its rather unhealthy lifestyle will drive the increase in lifestyle-related diseases, leading to an increase in demand for faster disease screening, advanced medical technologies for early diagnosis, and low cost, high quality efficacious medicines for treatment.

She said that more and more multi-national company manufacturers will jump onto the e-catalogue bandwagon alongside government’s effort to accelerate the development of the e-catalogue system for e-procurement.

Jyoti also said that private hospitals will continue to expand and increasingly accept Badan Penyelenggara Jaminan Sosial (BPJS) patient. Further, she said that aged care private investment will begin to surge as the population above the age of 65 years is expected to reach 5.4 percent of total population in 2017.

Asia Pacific Healthcare Industry Predictions Dr. Milind Sabnis, Director, Transformational Health, Frost & Sullivan Asia Pacific predicted the total global healthcare industry to grow by 6.9 percent to $ 1.68 trillion USD in 2016, with Asia Pacific showing double digit growth. Dr. Milind highlighted that Asia Pacific will emerge as the epicenter for regenerative medicine and biosimilars.

He said, “Asia Pacific Stem Cell therapy market was valued at $9.04 billion in 2015 and is projected to double to $18.71 billion by 2018 and innovative Asia Pacific companies will drive the global bio-similars market,” he added. “About USD 80 billion worth of

biologics will lose patent exclusivity in the next five years and a number of new Asian companies and established companies such as Celltrion and Samsung Bioepis are expected to launch biosimilar version for majority of top ten biologics in 5-10 years,” Dr. Milind said.

Other predictions included: introduction of new imaging systems (MRI, CT scans, etc) with options to upgrade to higher versions and new business models, in clinical pathology, that aim to increase efficiency and improve cost-effectiveness.

Megatrends Impact on Functional Food and Beverages in Asia Frost & Sullivan forecasting the global nutraceutical market to grow to 6.0 percent to $ 225 billion in 2020. Dr. Satish Lele, Senior Vice President, Visionary Science Practice, Frost & Sullivan Asia Pacific said that global nutraceutical market moving to Asia due to Asia Pacific is driving global health food demand as emerging economies and growing lifestyle disease incidence drive consumption.

Dr. Satish Lele also said that globalisation driving exposure to western food habits and non-ethnic functional food options and influencing demand for convenient health foods. “As demand for naturally healthy ingredients starts to rise consumers are moving towards “superfoods” such as quinoa, chia, blueberries. One such example is the coconut water industry which is now a 1 billion USD market”, he added.

Urbanisation also has impact on the APAC nutraceutical industry, Dr. Satish said that urbanisation increases working hours, longer commutes and women in the workforce and is driving demand for convenient yet nutritious food options where traceability is key. Dr. Satish said that beverages are no longer expected to serve as adjuncts to meals but provide as much nutrition as the meal itself especially in the breakfast sector. http://ww2.frost.com/

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Funding & Investment

Community Resuscitation Across Northern Ireland The Health Minister announced an investment of £250k per year to promote community resuscitation across Northern Ireland at the end of march. The new money from the Transformation Fund will be used to set up a regional team of Community Resuscitation Development Officers.

Commenting on the new investment the Minister said “CPR and early defibrillation are the two critical interventions to enable a person to survive an out-of-hospital cardiac arrest. Carrying out early CPR can double a casualty’s chances of survival.

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• “My department’s Community Resuscitation Strategy, the first in the UK, is designed to promote collaboration between Health and Social Care and the voluntary and private sectors to improve survival rates.”

Each year in Northern Ireland about 1,400 people suffer an out-of-hospital cardiac arrest and only 10% of them survive. The key is swift action by bystanders: recognising that a cardiac arrest is happening; performing cardiopulmonary resuscitation - CPR; using a defibrillator and keeping the person alive until an ambulance gets there.

The Minister continued saying; “We need to raise awareness, increase the number of people with CPR training and encourage members of the public to intervene in the event of a cardiac arrest.

“I would encourage everyone to take the time to learn CPR. It’s surprising how straightforward it is, and you never know when someone will need you to have those skills.”

Survival rates are highest in places like Seattle where more people are trained to intervene. In 2014 the Health Minister launched the Community Resuscitation Strategy. The Community Resuscitation Development Officers will play a key role in increasing the number of people who are trained to intervene and who will be prepared to step in.

CPR: Top Tips • if you see someone who you think has had a cardiac arrest call 999 immediately shout for help

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and send someone for a defibrillator (AED), if there is one available; don’t panic - you can help. If you’re on the phone with the 999 operator, they will also be able to guide you; immediately begin CPR if the person is unresponsive and not breathing normally; if you haven’t been trained in CPR, you should perform hands-only compressions: rest one hand on top of the other and interlock your fingers, ‘Push hard and fast’ on the centre of the victim’s chest with the heel of your hand; compress the chest at least 2 inches/5 cm (adults) or 1/3 depth of chest (children and infants); provide 100 compressions per minute counting out loud to maintain a rhythm – like this; one and two and three and four; keep the rhythm going until the ambulance arrives. If someone else is there and is able to, they can take over if you get tired;

The biggest tip: get trained! Skills deteriorate. Refresh your CPR training at least once every two years.

• CPR training courses may vary depending on their overall duration but in general a course will cover; • How to recognise that someone may be having a cardiac arrest; • Calling for help & asking if a defibrillator machine is available; • The basics of CPR training; • Practical session, rehearsing learned techniques on a training mannequin; • Questions and answers.

CPR is an important link in the chain of survival which has 4 stages: • Early recognition and call for help; • Early CPR; • Early Defibrillation; • Post resuscitation care;

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New Teams to Support People with Mental Health Needs in Welsh Hospitals

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Funding & Investment New dedicated teams of staff to provide hands-on support for people with mental health needs will be set up in Welsh hospitals, Health and Social Services Minister Mark Drakeford announced on 31 March 2016.

As part of £30m for mental health and older people in 2016-17, the Welsh Government will invest £2.3m to create new teams who will provide extra support, especially in the evening and at night, for people with mental health needs, including dementia.

An extra £1.5m is being made available to local primary care mental health support services to further support the Mental Health (Wales) Measure. This will provide more capacity to respond to people’s mental health needs locally. £1.15m is being allocated for psychological therapies for inpatient older person and adult mental health services. This will support the additional investment of £1.9m in adult psychological therapy provision which was announced earlier this year.

The Minister also announced: • £1m non-recurrent funding to reduce waiting times for local memory clinics and initial assessment for dementia • £325,000 for transitional/recovery support workers, who will be based in early intervention psychosis teams to promote active recovery for young people who have developed severe mental illnesses – evidence suggests this greatly improves long-term outcomes • £329,000 of non-recurrent funding to promote and protect the rights of people without capacity • £100,000 for a dementia campaign focusing on health promotion and prevention.

Professor Drakeford said: “Mental health is the foundation of all health. One in every four of us can expect to suffer mental ill health and some point in our lives. That’s why we are investing more than ever before in mental health services in Wales – a clear demonstration of this government’s commitment to improving the health and mental wellbeing of people across the country. This will provide support for, among other groups, people with dementia and their families in the community.”

The £30m for mental health and older people for 2016-17 is in addition to the £15m-plus of recurrent funding announced in June 2015.

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IBIS Capital Launches Global Healthtech Investment Review

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Innovation & Technology Media and tech investment and advisory firm IBIS Capital in March released its forecast for the biggest trends set to impact the HealthTech industry in 2016 and beyond. With a greater emphasis on digital transformation and spend, HealthTech acceleration in emerging markets will present some of the greatest growth opportunities for the coming year.

Leading investment bank boutique makes HealthTech predictions for 2016 and beyond in Global Investment Review The report from IBIS Capital predicts that healthcare sector spending will accelerate, rising over the next 3 years to $9.6tn. However, despite this, the industry faces enormous structural issues, due to pressures from an increasing global population and life expectancy. The report predicts that as demand rises, the pressure to reduce costs and demonstrate value will start to intensify. As such, digital transformation will be crucial – and within the healthcare sector, this expands beyond the health service, and in recent years’ services, now into the information dimension too – helping to dramatically improve diagnosis, wellness and disease prevention.

In line with many industries, smartphone penetration and increased access to internet and wireless technologies were found to be creating the greatest growth opportunities within the market. In fact, the report predicts that global healthtech expenditure will grow nearly four times, to $233.3bn by 2020, with the telehealth sector (+48%) expected to show the greatest individual growth rate, followed by mHealth (+36%) and wireless health (+23%).

“Smartphones and devices have revolutionised the way we consume, manage and share information – that applies to every industry, and healthcare is no exception,” said Charles McIntyre, CEO, IBIS Capital.

“For example, companies have seen downloads of health apps more than double (+197%) in a single 12-month period, as consumers look for new and easier ways to integrate healthcare into their everyday lives. We understand smartphone technology, and now we want everything translated through it – that’s especially true of healthcare advice and information which can often be dense and complex. This is opening up huge opportunities for tech growth and investment within the healthcare space” The report indicates that global markets with the greatest opportunities for growth run parallel with the penetration of smartphone and wireless technologies.

As such, emerging markets APAC and LATAM are showing the greatest numbers of users, and so also healthtech growth potential. The report highlights that emerging economies often with weaker healthcare infrastructures, rural areas and less doctors per inhabitant, have a greater need for tech innovation and disruption. Furthermore, emerging countries are better prepared to embrace new technology, leapfrogging older legacy infrastructure.

The use of social media for healthcare research and delivery is emerging as an important trend the report finds, growing 25% since 2012. Largely, groups were found to be using social channels to review healthcare providers, treatments and products (42%) and a quarter are accessing health-related videos. The penetration of social media in healthcare was also found to be being used by health professionals themselves, with LinkedIn seeing the greatest share of users (32%), as well as consumer facing sites such as Facebook. Millennials were found to be having the greatest impact on this trend, due to a strong correlation between this generation and the use of technology.

With the adoption and implementation of new technologies, the review noted an increasing consumer acceptance to wear health and fitness trackers, with the wearables market predicted to increase 7.7 times to $23bn by 2020. Revenue from global wearable devices will be primarily driven by smart watches with 94m units sold in 2020 followed by transformables.

Key reasons for wearables adoption were noted as, to exercise smarter (77%), collect and track medical info (75%) and eat better (67%).

With cost savings ever paramount, the continued digitisation of health records is predicted to save the health sector billions, with almost $1.5m potentially saved from duplicate or lost records, $20bn from duplicate radiology tests and increased efficiencies from consolidated information and accurate transcripts.

Finding ways to harness big data and analytics will create big opportunities for better patient care in the future.

“Technological disruption within healthcare has advanced significantly over the last 5 years but there is still a long way to go and huge opportunities to be had,” said Charles McIntyre, CEO, IBIS Capital.

“Developments in the market in 2015, such as a partnership to print human skin between L’Oreal and Organovo, and a similar research partnership between P&G and Agency for Science, Technology and Research, demonstrate the exciting innovation coming out of the industry. As new technologies penetrate the market, such as 3D printers, advanced prosthetics, and increased mobile and internet access, the market opportunities for growth will accelerate.”

To see the full report from IBIS Capital, as well as investment reviews from the Gaming and Advertising technology sectors, visit http://ibiscap.com/index.php/ insights-research/

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Bloomua / Shutterstock.com

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Innovation & Technology

Value Based Healthcare Transformation Spurs Innovative Opportunities for Industry Participants With Artificial Intelligence (AI) enabling a vast array of applications, healthcare companies have been eager to layer their existing lines of business with AI-based services. While pharma companies have been seeking tools for tracking the effectiveness of therapeutics, imaging companies have been augmenting the interpretability of scans through cognitive pattern interpretation.

Artificial intelligence and wearables thrive across healthcare sectors, says Frost & Sullivan Recent analysis from Frost & Sullivan, 2016 Global Outlook for the Healthcare Industry (http://frost.ly/1l), finds the industry was worth $1.58 billion in 2015 and estimates this to reach $1.68 billion in 2016, growing at a rate of 6.9 percent. For complimentary access to more information on this research, please visit: http:// frost.ly/2b Approximately 24 percent of consumers currently use mobile apps to track health and wellness, 16 percent use wearable sensors and 29 percent use electronic personal health records. Significantly, 47 percent of consumers reported they would consider using wearables in the near future, prompting technology developers to design wearables with advanced sensing, capture and analytical functionalities. The collected data from wearables are gaining relevancy through AI facilitated patient guidance and coaching.

Meanwhile, the healthcare industry has become more consumer-oriented and transparent with rating systems, incentives, penalties as well as online reviews for providers and physicians.

“There had been considerable excitement surrounding consumerization in healthcare for many years, now it has begun to acquire new dimensions,” said Frost & Sullivan Transformational Health Research Analyst Siddharth Shah. “There are more options for wellness and fitness technologies, virtual care and tools for disease management. Furthermore, there is greater flexibility in pricing and a higher degree of customization.”

However, in spite of these developments, the slowing top line growth and narrowing margins have given companies for a reason to worry. Start-up companies are more optimistic than established organizations and are expecting quicker time to market, return on investment (ROI) and pace of market evolution due to the Internet of Things (IoT) as well as additional industry convergence trends.

“In 2015, retailers made sizeable investments in expanding their clinical footprint, acquiring new tools and forming unique partnerships with healthcare companies,” observed Shah. “These investments are expected to bring great returns in 2016 and help companies execute their strategies of becoming the front line of primary care services.”

2016 Global Outlook for the Healthcare Industry is part of the Visionary Health (http://ww2.frost.com/ research/industry/healthcare/advanced-medical-technologies) Growth Partnership Service program. Frost & Sullivan’s related studies include: 2016 prediction trends for pharmaceutical biotechnology, medical device, medical imaging equipment, in vitro diagnostics, patient monitoring and healthcare IT. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.

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AAIPharma Services Corp. / Cambridge Major Laboratories, Inc. Expands IDBS’ E-WorkBook Platform Across Global Analytical Sites AAIPharma Services Corp. / Cambridge Major Laboratories, Inc. (AAI/CML), a leading provider of contract manufacturing and development services for the pharmaceutical and biotechnology industries, has expanded its IDBS E-WorkBook platform across analytical laboratories in the United States and will be incorporating its Netherlands facility in the coming months, to support further company growth.

The expansion complements all six of AAI/CML’s US sites which have been using E-WorkBook for three years, moving away from paper-based processes to streamline sample analysis and encourage collaboration.

“E-WorkBook is a critical part of our business operations, enabling us to harmonize documentation practices using electronic, automated and integrated templates, thereby increasing the speed with which we can test samples. We rely on the efficiency the platform delivers to turn around our analyses, and ultimately, deliver results to our clients faster,” explained Ted Dolan, Chief Operating Officer for AAI/CML. “Our previous paper-based approach required analysts to hand off test packages for quality review or ship packages between sites, causing unnecessary delays in review and final data write-up.”

He added, “As we have grown and become an integrated full service custom CDMO, it is in our best interest to capture and store all test results electronically so they can be shared in real-time across the organization, regardless of geographical location. The platform has been a welcome change with our US teams and implementing it in our Netherlands facility will complete the system integration.”

and ensures quick access to data for compliance purposes. Laboratory analysts across the company use a number of validated templates to ensure standardized data input, reducing errors often associated with transcribing paper-based results. When the company was recently audited by the FDA, it was able to easily provide a full audit trail, which is essential in such a highly-regulated industry.

Michael Hampton, Vice President, North American Operations at IDBS commented, “AAIPharma Services Corp. / Cambridge Major Laboratories, Inc. has been through a significant transformation, from a paper-based system to an electronic environment and it is certainly seeing the benefits. Giving laboratory analysts access across global sites ensures data can be shared quickly and efficiently, boosting collaboration opportunities and ensuring compliance in today’s tough regulatory arena. Above all, a reduction in timeline duration enables the organization to complete more projects for clients faster, boosting revenue to better compete in today’s marketplace.”

For more information, please visit www.idbs.com or follow the company on Twitter @IDBSsoftware.

E-WorkBook enables AAI/CML to record and share data from its API custom development, testing and manufacturing, analytical development and testing and drug product development, testing and manufacturing teams, on a single platform across the company’s seven sites. This approach saves time, boosts productivity, streamlines the review process

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The Forces Shaping the Pharma ‘Lab of the Future’ The conclusion of negotiations for the Trans-Pacific Partnership (TPP) trade deal will have brought a chill to a number of biotech players.

While business has broadly supported the deal, which involves 12 Pacific Rim nations accounting for 40% of the global economy, many biotech stakeholders have taken a dim view of the intellectual property implications. Compared to the US’s twelve-year rule on exclusivity for biologics – the time that a drug can be sold exclusively by one company with sole access to the data collected on treatments – the new treaty offers only eight years of exclusivity. According to industry bodies, this could negatively impact investment and the development of new breakthrough treatments.

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Innovation & Technology Clearly, the pharma and biotech industry is under pressure. This latest agreement, among a number of other factors ranging from evolving lab processes and technologies through to M&A activity, are reshaping the R&D ecosystem as we know it. How will these changes impact the lab environment, and what can we expect the ‘lab of the future’ to look like as a result?

Putting a price on innovation The cost of drug development has continued to grow.

Estimates now stand at around £1.7 billion per drug, which highlights the mounting cost pressures faced by research organisations developing new drugs. There has been some debate over that figure, of course – it could be lower or higher, depending on what you read. The elevated costs of developing a breakthrough blockbuster drug to deal with more complex, chronic diseases have combined with the effects of the socalled patent cliff – the expiry of patents on a slew of drugs that has put pressure on the industry over the last few years. This complex scenario has taken a further twist with the development of personalised medicine – which can focus the applicability of a given drug on a subset of the population – and the challenges of protecting the intellectual property of this via the traditional patent system.

The debacle surrounding Turing Pharmaceutical’s recent price hike, and the exclusivity debate heightened by the new TPP deal, underscore the limitations of either relying on patent protection or raising prices to protect the bottom line from the publicised ever-growing drug development costs.

Unsurprisingly, companies have led the charge in finding other ways of creating value for shareholders.

Record-low US interest rates have helped fuel a frenzy of M&A activity in the pharma and biotech industry amounting to £144 billion worth of deals in the first half of 2015. Brent Saunders, CEO and President of Actavis, described his company’s £46 billion takeover of Allergan as creating a leader in a new industry model: ‘Growth Pharma’. While analysts expect this ‘bull run’ to continue through 2015, it’s a short-term fix and the expected rise in US interest rates will make debt loading less attractive to shareholders. Ultimately, pharma and biotech companies will have to look beyond M&A and become even more resourceful in order to create value and turn a profit.

you safeguard data quality? There is a host of other considerations too, including systems integration and interoperability, data archiving, the sample and test logistics and efficient payment systems that all need addressing to make virtualised research work.

Turning challenge into opportunity Growth from M&A has long been the accepted route for pharma and biotech companies to expand and compete quickly. But with a wave of new technologies changing the way we think of the lab, this virtualised approach represents the next stage for R&D – where ‘big pharma’ buy proven new drug candidates and develop them, the smaller players do the research and early development, and the CMOs focus on optimising production. This is a simplified view of the new drug value chain, but it does give an indication of how the market will work.

The advent of the electronic laboratory notebook (ELN), meanwhile, has certainly brought progress in R&D efficiency but even larger, more fundamental shifts are underway. The tools and data management infrastructures that support lab work will be even more critical in the new world order, where greater efficiency and greater levels of innovation require even more intelligent and scientifically aware software, machines and automation.

This increased efficiency won’t replace humans in the lab – it will supplement, speed up and ensure greater accuracy in the work they do. And with the future lab being a more collaborative endeavor, we can also expect to see teams using software that incorporates more ‘social’ features, such as the ability to easily share and comment on others’ findings. This represents a radical departure from the siloed, paper-based way of working of years gone by.

It’s become clear that the convergence of cost and competitive pressures, IP challenges, new technologies and a potential M&A slump are playing a significant role in shaping the way drugs are discovered, developed and brought to market. Above all, industry players that have a robust technology strategy in place to support a collaborative, secure, virtual lab environment will win out in the long run.

Company: VP Strategic Solutions, IDBS Name: Paul Denny-Gouldson

From across the hall to across the globe As the industry strives for ways to make resources go further, many see collaboration as the silver bullet.

For today’s research-oriented organisations, collaboration and outsourcing parts of the R&D process often makes business sense, as well as opening up access to new technologies and skills. It has even been taken up by the previously hesitant pharma sector. The result is a complex ecosystem of stakeholders involved in R&D from contract research organisations (CROs) to contract manufacturing organisations (CMOs) and academic partners.

With collaboration and outsourcing becoming the norm, the research environment has gradually become more like a ‘virtual lab’ with a disparate number of actors working towards a common goal. But this business model brings a new set of challenges. In a virtualised environment, how do you ensure that the right person has the right data on time? How do you secure and protect intellectual property, and how do

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Research & Development The study, published in Science Translational Medicine, found that the new drug Arimoclomol reversed the disease’s effects at the cellular level and improved muscle strength in mice. A safety trial in 24 IBM patients conducted in London and Kansas found that the drug was safe and well-tolerated.

IBM is the most common muscle disease in people over 45. It is incurable and causes progressive muscle degeneration leading to severe disability, paralysis and dependency. The precise cause is unknown and there are currently no effective treatments.

In this study, the research team pursued a new treatment approach based on observations that muscle tissue from IBM patients contains many misfolded proteins. The research team reported results using an integrated investigational plan of the new drug, Arimoclomol, to clear these proteins out by either refolding or eliminating them.

New Drug Shows Promise Against Muscle Wasting Disease A new drug to treat the muscle wasting disease inclusion body myositis (IBM) reverses key symptoms in mice and is safe and well-tolerated in patients, a new study led by the MRC Centre for Neuromuscular Diseases at University College London (UCL) and the University of Kansas Medical Center finds.

The team started by creating cells in a petri dish that mimic the muscle tissue of IBM patients, and successfully tested Arimoclomol on these cells. They then used genetically modified mice whose muscle cells and symptoms closely resembled the human disease.

An Arimoclomol trial in these mice found that it was well-tolerated, reversed key features of the disease, and importantly, improved muscle strength.

Following a successful patient safety trial, has plans to begin a full-scale randomized controlled clinical trial to formally assess if the drug is effective in slowing disease progression in people with IBM. Director of the MRC Centre for Neuromuscular Diseases and the UCL Institute of Neurology Professor Michael Hanna, co-senior author of the paper, said: “This is an excellent example of interdisciplinary collaborative translational research that spans discovery, preclinical science and experimental medicine by a group of academic investigators supported by the MRC Centre. Targeting proteostasis has important potential benefit for patients with this disabling degenerative muscle disease. I want to congratulate the entire team and especially the MRC Centre-supported PhD students Mhoriam Ahmed, Pedro Machado, Adrian Miller and Charlotte Spicer. This work was underpinned by our critical collaboration with Linda Greensmith.”

Lead basic scientist and co-senior author Professor Linda Greensmith, Head of the Sobell Department of Motor Neuroscience and Movement Disorders at the UCL Institute of Neurology, added: “Through this collaboration and the support of the MRC Centre we have been able to take our fundamental observations in cell and animal models right through to a proofof-concept trial in patients. We are actively pursuing this promising approach of manipulation of the heat shock response in IBM as well as other neurodegenerative diseases such as motor neurone disease, in collaboration with the MRC Centre and Danish biotech company Orphazyme ApS.”

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Research & Development

SIMPONI® (golimumab) shows higher treatment persistence rates in patients with immune -mediated rheumatic diseases compared with other subcutaneous TNF-alpha inhibitors in Sweden MSD, (Merck & Co., Inc., Kenilworth, NJ, USA in the United States and Canada), announced in February this year the publication of the results of a retrospective analysis of a large Swedish prescription registry study, which described real-world treatment persistence in patients with immune-mediated rheumatic disease (IMRD) newly treated with different subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi).1 Higher persistence in these patients may be associated with lower healthcare costs A total of 4,903 patients with ankylosing spondylitis, psoriatic arthritis or rheumatoid arthritis (collectively referred to as IMRD) were included in the study.1 The study results show that SC-TNFi-naïve IMRD patients initiating treatment with golimumab in Sweden had significantly higher persistence rates than patients initiating treatment with adalimumab or etanercept at 3 years (unadjusted Kaplan-Meier survival probability estimates, 40% versus 33% and 33% [p=0.042 and p=0.006], respectively).1 The study also indicated that treatment persistence with SC-TNFi may be associated with lower health care resource utilisation (HCRU) costs (~873 Euros [987 US Dollars], p < 0.001), comprising specialised outpatient care, inpatient care and non-disease-modifying antirheumatic drug (DMARD) medications.1 “This real-world study demonstrated that, in SC-TNFinaïve IMRD patients, Simponi had significantly higher persistence rates compared with Humira and Enbrel.

These results support existing long-term Simponi data for persistence,” comments Sumesh Kachroo, Director of Outcomes Research at MSD and Swedish registry publication author.

As persistence rates observed across all treatments in this study were lower than those observed in clinical trials,1 the study authors suggest the need for all-party (provider-patient-payer-drug manufacturer) engagement and development of programmes to increase

persistence rates in clinical practice, to improve clinical outcomes.1 Higher persistence rates with golimumab Persistence was measured in accordance with the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Medication Compliance and Persistence Work Group definition2, from the date of the first filled prescription of an SC-TNFi until the end of the duration of the last prescription.1 Patients were identified through filled prescriptions for adalimumab (n=1,823), etanercept (n=1,704), certolizumab pegol (n=622), and golimumab (n=754) between May 2010 and December 2012, from the Swedish Prescribed Drug Register.1 While persistence was similar for the four agents in the first 12 months’ post-treatment initiation, golimumab consistently demonstrated significantly higher persistence than adalimumab and etanercept between 12 and 36 months.1 Golimumab showed numerically higher persistence than certolizumab pegol from 12 to 36 months, however, the difference was not statistically significant at the 5% level over the full study period (p = 0.075).1 Persistence estimates were derived using nonparametric survival analysis, Kaplan–Meier (“survival”) functions3, and were estimated with treatment discontinuation as the failure event. Unadjusted analyses were carried out on the full study population. Analyses of persistence were also carried out on propensity

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Research & Development score matched (PSM) cohorts, attempting to adjust for potential selection bias.

Effects of non-persistence on healthcare resource utilisation (HCRU) costs A secondary objective of the study was to describe potential effects on HCRU cost from non-persistence.1 The analysis of costs was carried out on a subset of patients with at least 24 months of follow-up (i.e., patients initiating treatment prior to 1st January 2012; n= 3,120) and stratified by persistence status at 12 months’ post-treatment initiation.1 Patients who were persistent at 12 months incurred lower non-DMARD HCRU costs than patients who were not persistent over the same period, with an average of 1,574 Euros (1,780 US Dollars]; p < 0.001) higher costs for non-persistent patients when taking differences in costs prior to treatment initiation into account.1 “This is thought to be the first study in a European setting that shows that persistence in treatment with SC-TNFi may be associated with cost offsets,” explains Sumesh Kachroo. “This provides further evidence for the need of an all-inclusive approach involving provider-patient-payer-drug manufacturer to find ways to increase persistence rates in real-world settings”.

About the Swedish Registry Publication The Swedish Registry Publication reports the findings of a retrospective analysis of data collected in a prescription registry. It evaluates real-world persistence with subcutaneous tumor necrosis factor-alpha inhibitors in SC-TNFi-naïve patients with ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis in Sweden. The secondary objective of the study was to describe potential effects on health care resource utilisation (HCRU) cost from non-persistence.1 A strength of this study is the size and coverage of the data.1 However, the study does have limitations. One is that the data obtained were extracted from administrative databases, which are reliant on the quality of the coding and do not contain clinical measures, such as Health Assessment Questionnaire or Disease Activity Score 28; as a result, reasons for discontinuation with treatment cannot be determined. Another limitation is the register does not include information on dosage or actual consumption of medicine, so the persistence analysis relies on assumptions regarding treatment use.1 Patients included in this study were identified through filled prescriptions for adalimumab, etanercept, certolizumab pegol, and golimumab between 6th May 2010 and 31st December 2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialised outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified and remained in the final study sample (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754).1 Comparisons over 3 years showed that golimumab had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared

to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with golimumab had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden.1 This study was funded by MSD (Merck & Co., Inc., Rahway, NJ, USA), who were involved with the writing, study design, analysis, and interpretation of data.

About Rheumatoid Arthritis Rheumatoid arthritis is a chronic inflammatory disorder that occurs when the immune system attacks the lining of the membranes that surround joints, also known as the synovium. Unlike the wear-andtear damage associated with other types of arthritis, rheumatoid arthritis causes painful swelling and can eventually result in bone erosion and joint deformity.

Rheumatoid arthritis can be difficult to diagnose in its initial stages because the early signs and symptoms mimic those of many other diseases. Currently, there is no single blood test or physical finding to confirm the diagnosis.4 It is estimated that 0.3 to 1 percent of the world’s population are living with rheumatoid arthritis. The disease is most common in women and is more prevalent in developed countries. It tends to strike during the most productive years of adulthood, between the ages of 20 and 40.5 About Psoriatic Arthritis Psoriatic arthritis, a type of inflammation that occurs in about 15 percent of patients who have a skin rash called psoriasis, is a chronic arthritis that can lead to joint damage.6 Psoriatic arthritis can affect any joint in the body, and it may affect just one joint, several joints or multiple joints. It typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis.6 Psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time.6 Both men and women are equally affected by psoriatic arthritis, most commonly between the ages of 30 and 50.6 About Ankylosing Spondylitis Axial spondyloarthritis is a painful and potentially progressive form of inflammatory arthritis that mainly affects the spine and pelvic joints, and most commonly results in chronic lower back pain.7 It typically begins in the late teens and early twenties and in severe cases can result in complete fusion of the spinal vertebrae and cause structural damage to hips and other joints.7 The term axial spondyloarthritis covers both non-radiographic axial spondyloarthritis and ankylosing spondylitis.8 In patients with ankylosing spondylitis x-ray changes are clearly present.8 Axial spondyloarthritis is a systemic inflammatory disease that, in addition to its effect on the spine, can affect other areas such as peripheral joints, eyes, and the bowel.7 About Simponi Simponi (golimumab) is a human monoclonal antibody that targets and neutralises tumor necrosis factor (TNF)-alpha. Simponi is approved for the treatment

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Research & Development of moderate to severe, active rheumatoid arthritis in adults, in combination with methotrexate, when the response to disease-modifying anti-rheumatic drug (DMARD) therapy including methotrexate has been inadequate; severe, active and progressive rheumatoid arthritis, in combination with methotrexate, in adults not previously treated with methotrexate; active and progressive psoriatic arthritis in adult patients, alone or in combination with methotrexate, when the response to previous DMARD therapy has been inadequate; severe, active ankylosing spondylitis in adults who have responded inadequately to conventional therapy; and for the treatment of adults with severe, active non-radiographic axial spondyloarthritis with objective signs of inflammation as indicated by elevated C-reactive protein (CRP) and/or magnetic resonance imaging (MRI) evidence, who have had an inadequate response to, or are intolerant to nonsteroidal anti-inflammatory drugs (NSAIDs).9 Simponi is also the first and only subcutaneous anti-tumor necrosis factor (TNF)-alpha treatment administered as an every-four-week maintenance therapy for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy, including corticosteroids and 6-mercaptopurine or azathioprine, or who are intolerant to or have medical contraindications for such therapies. Simponi is available either through the Simponiâ&#x201E;˘ SmartJect autoinjector or a prefilled syringe as a subcutaneous administered injection.9 Janssen Biotech, Inc. discovered and developed Simponi and markets the product in the United States.

The Janssen Pharmaceutical Companies market Simponi in Canada, Central and South America, the Middle East, Africa and Asia Pacific.

In Japan, Indonesia, and Taiwan, Janssen Biotech, Inc. licenses distribution rights for Simponi to Mitsubishi Tanabe Pharma Corporation. In Europe, Russia and Turkey, Janssen Biotech, Inc. licenses distribution rights for Simponi to Schering-Plough (Ireland) Company, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Important Safety Information Simponi is contraindicated in patients with active tuberculosis, severe infections such as sepsis, opportunistic infections, in patients with moderate or severe heart failure (NYHA Class III/IV), as well as in patients who are hypersensitive to Simponi or any of its excipients. Serious infections, including sepsis, pneumonia, tuberculosis, invasive fungal and other opportunistic infections have been observed with the use of TNF antagonists including Simponi. Some of these infections have been fatal. Simponi should not be given to patients with a clinically important, active infection. Caution should be exercised when considering the use of Simponi in patients with a chronic infection or a history of recurrent infection.

Patients should be monitored for signs and symptoms of infection before, during and for several months after treatment with Simponi. If a patient develops a new serious infection or sepsis, Simponi therapy should be discontinued and appropriate antimicrobial or antifungal therapy should be initiated until the infection is controlled. Patients should be advised of and avoid exposure to potential risk factors for infection as appropriate. For patients who have resided in or trav-

elled to regions where invasive fungal infections such as histoplasmosis, coccidioidomycosis, or blastomycosis are endemic, the benefits and risks of Simponi treatment should be carefully considered before initiation of Simponi therapy. Patients must be evaluated for the risk of tuberculosis (TB), including latent tuberculosis, prior to initiation of Simponi. If active TB is diagnosed, Simponi must not be initiated. If latent TB is suspected or diagnosed, then the benefit/risk balance of Simponi treatment should be considered.

Treatment of latent tuberculosis infection should be initiated prior to therapy with Simponi. Antituberculosis therapy prior to initiating Simponi should also be considered in patients who have several or significant risk factors for tuberculosis infection and have a negative test for latent tuberculosis, or for patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed. Patients receiving Simponi should be monitored closely for signs and symptoms of active tuberculosis during and after treatment, including patients who tested negative for latent tuberculosis infections.9 The use of TNF blocking agents including Simponi has been associated with reactivation of hepatitis B virus in patients who are chronic carriers of the virus.

Some of these cases have been fatal. Chronic carriers of hepatitis B should be appropriately evaluated and monitored prior to the initiation of, during treatment with, and for several months following discontinuation of Simponi. In patients who develop HBV reactivation, SIMPONI should be discontinued.9 Lymphomas have been observed in patients treated with TNF blocking agents, including Simponi. The incidence of non-lymphoma malignancies was similar to controls, and lymphoma is seen more often than in the general population. The potential role of TNF-blocking therapy in the development of malignancies is not known. Based on an exploratory clinical trial in patients with COPD, caution should be exercised when using any TNF-blocking therapy in COPD patients, as well as in patients with an increased risk for malignancy due to heavy smoking.

Rare post-marketing cases of hepatosplenic T-cell lymphoma (HSTCL) have been reported in patients treated with other TNF-blocking agents. This rare type of T-cell lymphoma has a very aggressive disease course and is usually fatal.9 Malignancies, some fatal, have been reported among children, adolescents and young adults (up to 22 years of age) treated with TNF-blocking agents (initiation of therapy â&#x2030;¤ 18 years of age) in the post marketing setting. A risk for the development of malignancies in children and adolescents treated with TNF-blockers cannot be excluded.9 It is not known if Simponi treatment influences the risk for developing dysplasia or colon cancer. All patients with ulcerative colitis who are at increased risk for dysplasia or colon carcinoma, or who had a prior history of dysplasia or colon carcinoma should be screened for dysplasia at regular intervals before therapy and throughout their disease course.9 Melanoma has been reported in patients treated with TNF-blocking agents, including Simponi. Periodic skin examination is recommended, particularly for patients with risk factors for skin cancer.9

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Research & Development Worsening and new onset congestive heart failure (CHF) and increased mortality due to CHF have been reported with another TNF blocker. Simponi has not been studied in patients with CHF. Simponi should be used with caution in patients with mild heart failure and must be discontinued if new or worsening symptoms of heart failure appear.9 TNF-blocking agents, including Simponi, have been associated in rare cases with new onset or exacerbation of demyelinating disorders, including multiple sclerosis. The benefits and risks of anti-TNF treatment should be carefully considered before initiation of Simponi therapy in patients with pre-existing or recent onset of demyelinating disorders.9 There is limited safety experience of Simponi treatment in patients who have undergone surgical procedures, including arthroplasty. A patient who requires surgery while on Simponi should be closely monitored for infections, and appropriate actions should be taken.9 The possibility exists for TNF-blocking agents, including Simponi, to affect host defenses against infections and malignancies. Treatment with Simponi may result in the formation of auto-antibodies and, rarely, in the development of a lupus-like syndrome.9 There have been postmarketing reports of pancytopenia, leukopenia, neutropenia, aplastic anemia, and thrombocytopenia in patients receiving TNF blockers. Cytopenias including pancytopenia, have been infrequently reported with Simponi in clinical trials.

Discontinuation of Simponi should be considered in patients with significant hematologic abnormalities.9 The concurrent administration of TNF-antagonists with anakinra or abatacept is not recommended.

Concurrent administration has been associated with increased infections, including serious infections without increased clinical benefit.9 Patients treated with Simponi may receive concurrent vaccinations, except for live vaccines. Non-serious allergic reactions associated with Simponi occurred in clinical trials, and included urticaria, bronchospasm, and hypersensitivity. In post-marketing experience, serious systemic hypersensitivity reactions (including anaphylactic reaction) have been reported following Simponi administration. Some of these reactions occurred after the first administration of Simponi. If an anaphylactic reaction or other serious allergic reactions occur, administration of Simponi should be discontinued immediately and appropriate therapy initiated.9 The needle cover on the syringe in the pre-filled pen is manufactured from dry natural rubber containing latex, and may cause allergic reactions in individuals sensitive to latex. Simponi also contains sorbitol; patients with rare hereditary problems of fructose intolerance should not take Simponi. All patients should be monitored for anaphylactic or other serious allergic reactions.9 Patients should be given detailed instructions on how to administer Simponi. After proper training, patients may self-inject if their physician determines that this is appropriate. The full amount of Simponi should be administered at all times. Mild injection site reactions

commonly occur. In case of severe reaction(s) Simponi should be discontinued.9 Women of childbearing potential must use adequate contraception to prevent pregnancy and continue its use for at least six months after the last Simponi treatment. Women must not breastfeed during and for at least six months after Simponi treatment.9 The most common adverse reaction reported from the controlled period of pivotal trials was upper respiratory tract infection (12.6 percent of Simponi -treated patients compared with 10.7 percent in control-treated patients). In the controlled period of pivotal trials, 5.1 percent of Simponi treated patients had injection site reactions compared with 2.0 percent in control-treated patients. The majority of the injection site reactions were mild and moderate, and the most frequent manifestation was injection site erythema.9 The Simponi Patient Alert Card provides safety information to the patient. It should be given and explained to all patients before treatment. Patients must show the Alert Card to any doctor involved in his/her treatment, during and up to six months after Simponi treatment.9 For complete EU prescribing information, please visit www.ema.europa.eu References: 1. DalĂŠn J, Svedbom A, Black CM, et al. Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence. Rheumatol Int. Advance online publication. doi: 10.1007/s00296-0163423-5.

2. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health 2008;11:44-47.

3. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481.

4. Mayo Clinic. Rheumatoid arthritis website. Available at: http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/symptoms/con20014868?p=1. Last accessed January 2016.

5. World Health Organisation (WHO). Chronic rheumatic conditions website. Available at: http://www. who.int/chp/topics/rheumatic/en. Last accessed January 2016.

6. American College of Rheumatology (ACR).

Psoriatic arthritis website. Available at: http://www. rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis. Last accessed January 2016.

7. American College of Rheumatology (ACR). Spondylarthritis (Spondylarthropathy) website. Available at: https://www.rheumatology.org/Practice/Clinical/ Patients/Diseases_And_Conditions/Spondylarthritis_(Spondylarthropathy)/. Last accessed January 2016.

8. National Ankylosing Spondylitis society (NASS) website. Available at: http://nass.co.uk/. Last accessed January 2016.

9. SIMPONI. Summary of product characteristics.

Available at: https://www.medicines.org.uk/emc/ medicine/23766. Last accessed January 2016.

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Healthcare Corruption Results in Deaths of tens of Thousands of People each year, Leading NHS Doctor Warns

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Research & Development · Public funding allocated to medical research because it is likely to be profitable, not because it will be beneficial for patients · UK’s leading doctors call for immediate inquiry into safety of medicines · Britain faces “epidemic of misinformed doctors and misinformed patients”, senior NHS cardiologist warns

Leading NHS cardiologist, Dr Aseem Malhotra, in late February highlighted a complete healthcare “system failure” that is resulting in the unnecessary deaths of tens of thousands of people globally every year.

Writing for MailOnline, Dr Malhotra says that biased research funding, biased reporting in medical journals and commercial conflicts of interest are contributing to an “epidemic of misinformed doctors and misinformed patients in the UK and beyond.”

He claims public funding is often allocated to medical research because it is likely to be profitable, not because it will be beneficial for patients. Leading doctors supported Dr Malhotra’s claims and have called on Parliament’s Public Accounts Committee to conduct an independent inquiry into the safety of medicines.

those who call for greater transparency and more independent scrutiny of scientific data.”

In relation to cholesterol lowering statin drugs he calls for a full reassessment of all the statin studies.

“Physicians should be aware that present claims about the efficacy and safety of statins is not evidence based,” he writes, demanding that the Clinical Trials Service Unit at Oxford University release the raw data for independent scrutiny.

Dr Malhotra gives recent examples of where the National Institute of Clinical Excellence (NICE) and the drug regulator (the MHRA) have failed to manage lack of transparency and conflicts of interest over the prescription of several drugs including Tamiflu, Statins and Stroke drug alteplase.

The calls for greater transparency in the prescription of medicines come from the immediate past president of the Royal College of Physicians, Sir Richard Thompson, the Chair of the BMA General Practitioners committee Dr Chaand Nagpaul, the President of the Faculty of Public Health, Professor John Ashton, the Chairman of the British Association of Physicians of Indian origin, Consultant Psychiatrist Dr JS Bamrah and the editor in chief of JAMA Internal Medicine and Professor of Cardiology Rita Redberg.

Gaming the system, manipulation of data and prolific scientific fraud is contributing to the unnecessary deaths of tens of thousands of people and the suffering of millions costing billions to our national economies every year.

Citing recent studies, Dr Malhotra says that prescription drugs are the third most common cause of death after heart disease and cancer, with side effects of antidepressants and dementia drugs responsible for more than half a million deaths per year in the United States and Europe.

“For the sake of our future health and the sustainability of the NHS it’s time for real collective action against ‘too much medicine’ starting with the Public Accounts Committee launching a full independent inquiry into the efficacy and safety of medicines. The underlying scandal that may ensue is likely to dwarf that of Mid Staffs. Medical science has taken a turn towards darkness. Sunlight will be its only disinfectant.”

The elderly are particularly vulnerable to polypharmacy, with one in three hospital admissions in the over 75s a result of an adverse drug reaction.

In addition to a “more medicine is better” culture exacerbated by financial incentives to prescribe more drugs and carry out more operations, Dr Malhotra reveals a more sinister side that is corrupting the information that is being given to doctors and patients when medical decisions are made.

Citing recent examples from Australia and the UK he writes: “Medical journals and the media can be manipulated to serve not only as marketing vehicles for the industry but be unwittingly complicit in silencing

“Without full transparency and accountability no doctor can provide what we slogged through medical school and devote our heart and souls to: providing the best quality care for our patients.

Sir Richard Thompson, immediate past president of the Royal College of Physicians, commented: “DrMalhotra again draws the attention of doctors and the public to the too often weak and sometimes murky basis on which the efficacy and use of drugs, particularly in the elderly, are judged. There needs to be closer scrutiny of the evidence underpinning drugs, and devices, and then better promotion of the evidence, together with more education of the public, doctors and medical students in how to assess the value of prescribing drugs to different groups of patients.

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Research & Development “The time has come for a full and open public enquiry into the way evidence of the efficacy of drugs is obtained and revealed. There is real danger that some current drug treatments are much less effective than had previously been thought.”

Professor John Ashton, President of the Faculty of Public Health, added: ‘Public health relies on a comprehensive, accurate and cost effective evidence base to ensure we make decisions based on the best available research that improve and protect people’s health, as well as prioritise care in the best way for patients. A public enquiry could be a useful tool in ensuring that research is published in a transparent and independent way.”

Dr J S Bamrah, Chairman of the British Association of Physicians of Indian origin, commented: “There has been an alarming increase in prescriptions in the modern world which cannot be simply explained in terms of increasing disease. The context of this in regards to the dangers of over-prescribing cannot be overstated. As Dr Aseem Malhotra rightly points out, there are a number of areas where there are incentives and conflicts that doctors and researchers have either been complicit or complacent, or plainly they have failed to declare their conflicts of interest. In some cases, this will have led others to believe in their authoritative assertions.

“In my own field of psychiatry there are been much abuse and overuse of a number of drugs, and this pattern is destined to repeat unless someone like Dr Malhotra stands up to the establishment. His expose deserves a high level independent enquiry by the government as otherwise patients will continue to rely on medications they need not have been prescribed by trusted doctors.”

Rita Redberg, Professor of Cardiology at the University of California, San Francisco and editor of JAMA Internal Medicine, said: “As a practicing cardiologist for 30 years as well as a journal editor for seven years, I know how important it is to have reliable high quality data in peer-reviewed medical journals. It is crucial for clinicians to be able to trust what they read. We need this trust and transparency to be able to accurately advise our patients on risks and benefits of medical treatments.

“In addition, all conflicts should be disclosed, such as relationships with industry and any other potential biases. Clinical trial registration before trial initiation on publicly available sites such as clinicaltrials.gov and publishing of all results is essential, even if results are negative or show harms of a treatment. We need to know that we have full access to all relevant information. Our current system needs more work and efforts towards achieving these goals.”

Dr Aseem Malhotra is an NHS Consultant Cardiologist.

He writes in a personal capacity but was recently appointed to the board of trustees to the UK Health Think Tank, The King’s Fund and is a member of the Academy of Medical Royal Colleges Choosing wisely Steering Group.

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Research Funders join Forces to Tackle Zika virus with £3.2m The MRC, the Newton Fund and the Wellcome Trust have joined forces to tackle the global threat posed by the Zika virus. Following the Zika Rapid Response Initiative launched by the MRC in February, which saw £1m of funding made available through the Government’s Global Challenges Research Fund, an additional £1m and up to £2m was contributed by the Wellcome Trust and the Newton Fund respectively, totalling up to £4m worth of funding.

This was further aligned with additional support in Brazil provided by the São Paulo Research Foundation FAPESP. The MRC-led Rapid Response received a total of 103 proposals and funding was awarded to 26 high quality projects with a combined value of £3.2m.

To support the rapid allocation of funding, proposals were not subject to the usual external peer-review.

Instead, each submission was carefully assessed directly at a specially convened panel meeting of over 20 international leading scientists whose areas of expertise spanned the breadth of the initiative. The successful projects were deemed able to provide novel, critical and timely insights into the nature of the virus and/or potential avenues for its management or prevention.

investigation of the link between Zika virus infection and neurological disease.

Professor Sir John Savill, the MRC’s chief executive said: “Two very important elements needed to come together in order to respond to the global health threat from the Zika virus – agility and capacity. Our Rapid Response Initiative allowed us to allocate funding to this global research challenge within a very short time frame, and valuable contributions from the Wellcome Trust and the Newton Fund created the capacity to match the remarkably strong response we received from the research community. Working in partnership is vital if we are to successfully tackle the health risks posed by emerging infections such as the Zika virus”.

Since the World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February, substantial new clinical and epidemiological research has strengthened the association between Zika infection and the occurrence of fetal malformations and neurological disorders.

Universities and Science Minister Jo Johnson said: “This government’s decision to invest in science and innovation and protect science spending means we are able to react to emerging global threats like the Zika virus and allow the world class scientists we have here in the UK to conduct ground breaking and potentially life-saving research. By increasing this funding, and with the support of the Wellcome Trust, more of this vital work can now get started.”

In addition, the geographical distribution of the disease is now wider. There are currently 52 countries which have reported local transmission of the Zika virus. Applicants were encouraged to work in conjunction with colleagues in affected countries and the successful funding will go towards a wide range of projects across several countries including Brazil, Columbia, Ecuador, Cape Verde, Kenya and Uganda.

In line with our commitment to sharing data and results relevant to the current Zika crisis and future public health emergencies as rapidly and openly as possible, a full list of projects can be found here: http://www.mrc.ac.uk/documents/pdf/zika-award-list-summaries/

Specific awards include: the development of an online data-sharing platform for images of fetal and newborn heads; improved diagnosis for Zika virus infection through a shared laboratory partnership; and further

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