Supporting the NHS - Q4 2020

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Q4 / 2020

Supporting the NHS

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~ Lord Victor Adebowale, Chair, NHS Confederation

~ Lou Patten, CEO, NHS Clinical Commissioners

~ Warwick Smith, Director General, British Generic Manufacturers Association (BGMA)

“The NHS has adapted and developed at an incredible pace so that it could treat COVID-19 patients while still providing care to millions of non-COVID-19 patients.”

“New relationships have been established as well as strengthening existing ones, data sharing has improved to ensure patients received better care.”

“Partnership and collaboration were critical elements of how the UK medicines supply chain has supported the NHS so far during COVID-19.”

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IN THIS ISSUE

04 “The increased use of virtual platforms is certainly one that will endure beyond COVID-19.”

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Crisis is a once-in-a-lifetime opportunity to make real change The COVID-19 crisis has been a challenge the like of which the NHS – and indeed, the rest of the population – has never witnessed in its more than 70-year history. But the health service and its staff have stepped up to the plate with fortitude, resilience and dedication beyond measure.

Andrew Davies, Digital Health Lead, Association of British HealthTech Industries (ABHI)

08 “Partnerships are key to unlocking better patient outcomes for those at risk of developing CVD.”

Jonty Heaversedge (Clinical Director) and Amanda Lucas (Information Director), Imperial College Health Partners

10 “The pandemic has really demonstrated what can be achieved when all parts of the health service work together.”

David Hare, Chief Executive, Independent Healthcare Provider Network (IHPN)

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T WRITTEN BY

Lord Victor Adebowale Chair, NHS Confederation

he dire predictions at the beginning of the year that the health service would not be able to cope have not come true.

Instead, the NHS has adapted and developed at an incredible pace so that it could treat COVID-19 patients while still providing care to millions of non-COVID-19 patients.

Beyond the claps and platitudes, we owe every member of the NHS workforce an incalculable debt of gratitude, especially as their work is far from over. The pandemic has not been defeated yet, and the COVID-19 vaccination programme – which represents both an unprecedented scientific success and a mammoth logistical task – is on the horizon.

in funding; workforce shortages – but in doing so it has given the NHS a historic opportunity not to “return to normal”, but to reset.

Accelerating meaningful change in the NHS There have also been some unexpected benefits.

There has been less scrutiny and bureaucracy, allowing innovation and decision-making to happen much more rapidly. There has been greater collaboration across organisations, pushing forward the integration of health and social care.

Changes that might have taken years have been delivered in weeks.

Now is the time to take action to hold on to these improvements and lessons, so that this crisis does not become merely a page in the history books.

Deep-rooted and longstanding issues such as health inequalities have been brought into the spotlight like never before, presenting potentially a once-in-a-lifetime opportunity to make real and lasting change, to improve the health and quality of life of generations to come.

The road to recovery will be long and fraught, especially as a second wave is now upon us. But the NHS has learned a great deal. As we begin to glimpse the light at the end of the tunnel, we cannot allow the lessons learned and the huge transformation that was made possible by these strange and harrowing times to slip away.

We owe every member of the NHS workforce an incalculable debt of gratitude, especially as their work is far from over.

We must support our greatest asset As we said in our report on the workforce during our NHS Reset campaign, our people are our greatest asset. They will need ongoing support as they continue to care for our communities, while also recovering from the trauma of working during a pandemic.

NHS organisations have done great work in focusing on staff wellbeing in response to these circumstances, and we look forward to seeing that continue.

Of course, the pandemic has exposed the cracks in the foundations of the health service – the disproportionate impact on BAME people; gaps

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Helping restart clinical trials and access to data Industry is well placed to help the NHS recover from the pandemic for the benefit of all patients.

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he coronavirus pandemic has changed all of our personal and working lives, but the good news on vaccines recently gives a sense of cautious optimism that science will win in the end.

Although there’s a lot more work to do, in the meantime, we also need to think broadly about how, together as a health and care system, we navigate the long road to COVID-19 recovery.

One of the first challenges we face is getting non-COVID-19 work back up and running again for the benefit of patients.

Planning and coordinating together as health and care systems has been key; collaborating, breaking silos and boundaries between local government, voluntary sector groups, and other parts of the NHS to deliver the best support possible to people.

The crisis has shown true NHS innovation that we must treasure The pandemic has tested the mettle of NHS England in so many ways. Clinical commissioners across the country are working to help support the effort and implement new ways of working as part oft the NHS and care for their communities.

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t is testament to the monumental efforts made by staff that even now, with the continued fight against COVID-19, there are new-found ways of working that have changed the NHS for the better. This is as true for clinical commissioners as for any other part of the system.

WRITTEN BY

Lou Patten CEO, NHS Clinical Commissioners

Commissioning evolution In the NHS, clinical commissioners working in CCGs (Clinical Commissioning Groups) are the glue that holds the system together. They bring stewardship, resource allocation and planning for the long-term improvement of a population’s health; they set outcomes, manage the all too challenging fixed financial budgets and are accountable to their populations for service changes.

The pandemic saw procurement functions pulled into NHS England to achieve at scale purchasing and provider contracts were moved to blocked payments. This freed up valuable time for commissioners to concentrate on what their systems and populations needed.

Helping to support the COVID-19 effort Commissioners have been involved in a wide range of activity during the pandemic; some very visible, such as supporting the new Nightingale hospitals, establishing quarantine care homes for patients discharged from hospital and delivery of a digital-first primary care within three months. Other areas of support include

distribution of PPE and computer hardware and establishing system-wide governance to co-ordinate individual organisations’ COVID-19 responses.

There have been few silver linings, but one CCG Chair described the targeted support they were able to give rough sleepers, that were put into accommodation, as a ‘once in a lifetime opportunity’. Rough sleepers on average die thirty years earlier than the average person.

Collaboration and partnerships are key Planning and coordinating together as health and care systems has been key; collaborating, breaking silos and boundaries between local government, voluntary sector groups, and other parts of the NHS to deliver the best support possible to people. New relationships have been established as well as strengthening existing ones, data sharing has improved to ensure patients received better care.

Looking into the future, commissioners must work closely with their systems to plan how they collectively respond to the emerging picture of the disproportionate impact COVID-19 has on specific communities.

As the NHS faces potential legislative change into an Integrated Care System model, we will support our CCG members to ensure that the innovations and gains made during the pandemic coupled with their clinical expertise continue to shape the future NHS.

Helping restart clinical trial research Restarting clinical trials for conditions like cancer is a priority and progress is being made by both industry and the NHS. According to latest figures from the NIHR, around half of studies are now open once again. But recovery isn’t just about clinical trials, it’s also about wider care for patients.

Companies are well placed to support the reintroduction of services and the evaluation of innovative changes in practice.

One thing that COVID-19 has taught us is that we have to make better use of diagnostics and data to improve healthcare.

Industry can help with data analysis to improve health outcomes for the people who need it most - a process known as ‘risk stratification’. A study of almost 17,000 people hospitalised with COVID-19 found more than half had at least one comorbidity, the most common of which were chronic cardiac disease (29%), non-asthmatic chronic pulmonary disease (19%) and asthma (14%).

This kind of insight is essential to be able to treat people effectively for all sorts of conditions and industry is keen to work with the NHS to make sure we have the best data available.

Improved use of high-quality, costeffective healthcare data presents an opportunity to make the UK the home of data-driven life sciences research, innovation, and development – and in so doing improve outcomes for patients and the NHS. The pandemic has shown us the important role that the pharmaceutical industry has to play in global healthcare.

Industry can also support across cancer services, diabetes, mental health, vaccinations, and every other area of the NHS Long Term Plan.

But it’s vital that we all work together.

We are one, interconnected ecosystem.

We were all impacted by this pandemic and we will recover, together.

WRITTEN BY

Haseeb Ahmad President, ABPI (The Association of British Pharmaceutical Industry)

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Utilising technology to avoid hospitals

Medicines policy needs to learn from the pandemic

The COVID-19 pandemic has accelerated the use of remote monitoring technologies and online tools to help support patients whilst helping free up healthcare capacity.

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Generic medicines, which make up three quarters of all prescription drugs in the UK, were central to treating patients in intensive care during the peak of the first wave of the COVID-19 pandemic.

he move to better use of technology to liberate acute capacity was always embedded in the NHS Long Term Plan.

This was built on in the Wachter Review which had, as one of its key principles, that digitalisation is a means to an end, to deliver better health, better healthcare, and lower cost.

Remote monitoring and remote consultations are enabling easier and more equitable access to services for patients and helping health systems effectively deploy their, often limited, clinical resources.

G WRITTEN BY

Warwick Smith Director General, British Generic Manufacturers Association (BGMA)

A change in culture It is also supporting a shift in culture, empowering patients with information and choices. Prior to the COVID-19 pandemic we had seen a steady rise in A&E admissions, something that was putting severe strain on the system.

One factor in this was the constrained capacity in primary care and patients by-passing the GP and going straight to the hospital.

Technology is addressing this in a multi-pronged approach, through NHS online, NHS 111, which is now the “first line of defence for the Urgent and Emergency Care” and via online GP consultations either by phone or video call. It has enabled easier access and more productive use of the GP workforce, as well as being ‘COVID-Secure’.

Coping with soaring demand However, this objective was severely challenged

by COVID-19 as demand soared in the early months of the pandemic. In some cases, products typically produced in relatively small volumes, suddenly saw demand rise by five or even 10 times.

This coupled with transport disruption across the globe meant manufacturers had to work extremely hard not only to fulfil orders but ensure they made it to the UK. Stockpiles already prepared for a possible non-negotiated exit from the European Union were run down.

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Sophisticated monitoring to intervene early The use of technology is in monitoring patients with long term conditions has also arisen. The creation of platforms that support remote video consultations, with multi-disciplinary teams if required, virtual tools, and all linked through to the patients record and data. Increasingly sophisticated, these platforms can integrate vital sign monitoring devices and highlight any decline in patients’ status, enabling clinicians to intervene early and remotely, before a need for admission.

Further measures are needed to protect future As the pandemic continues, the challenges within the UK are far from over. Complacency cannot be afforded, further measures must be considered from a medicines supply perspective, to mitigate what might lie ahead either from COVID-19 or other crises.

For example, currently around 25% of medicines prescribed in the UK are made here, and supply chains can stretch across the globe.

Safeguarding the future patient interests There is a range of actions and policy changes that government and our stakeholder partners should examine in more detail to ensure medicines supply resilience can continue in the face of future issues.

These changes would cover strategic buffer stocks; changes to the intellectual property regime; procurement which focuses on resilience as well as cost; regulation which encourages diversity of supply; and targeted investment into the UK manufacturing base.

These areas should be brought together under a specific industrial strategy for the generic and biosimilar medicines industries.

Partnership and collaboration were critical elements of how the UK medicines supply chain has supported the NHS so far during COVID-19.

It is vital now that lessons are learned and acted upon with tangible measures put in place which safeguard the future interests of patients by strengthening the supply chain.

The industry provides more than a billion items a year to patients, saving the NHS £13 billion in the process.

A “virtual first” future The increased use of virtual platforms is certainly one that will endure beyond COVID-19. By providing access to care outside of the hospital, and empowering patients to better self-care through access to their own results, the move will lead to fewer unnecessary A&E visits, an improved patient experience and a reduction in the overall cost to the health system.

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WRITTEN BY

Andrew Davies Digital Health Lead, ABHI (The Association of British HealthTech Industries)

eneric medicines have been at the forefront of treating hospitalised COVID-19 patients which has led to extraordinary demand for intensive care medicines. Manufacturers have had to go to great lengths to maintain provision of critical medicines. Lessons need to be learned to ensure supply chains remain robust both now and in the face of future pandemics.

Ensuring wherever possible that high quality, low cost medicines get to patients in the right place at the right time is the guiding ethos of the UK’s generic medicines industry. The industry provides more than a billion items a year to patients, saving the NHS £13 billion in the process.

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How to balance the supply and demand of critical medicines The NHS’ medication needs changed overnight when the pandemic hit earlier this year. With the end of 2020 bringing hope of new vaccines, we cannot overstate the impact that off-patent generic medicines have had in the fight against COVID-19 and the role they will play in the future.

INTERVIEW WITH

Paul Burden Chief Commercial Officer for Strategic Growth, Advanz Pharma

Written by: Amanda Barrell

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eneric drugs, which contain the same chemical make-up as products that were once patent protected, have been the quiet workhorses of modern healthcare systems for years.

They provide the same quality and efficacy as the original medicine at a fraction of the price, but that isn’t their only benefit. Four out of five prescription medicines in the UK are generics which demonstrates the vital role they play in enabling the NHS to deliver cost-effective care to millions of people, every day.

Generics are often seen as the poor cousin to innovative medicines. The reality is that generic medicines underpin the NHS. If these were not readily available, accessible and costeffective, the NHS couldn’t afford to operate the way it does. So, for the health and wellbeing of the nation, they are essential.

The impact of generics on COVID-19 “This has been heightened during 2020, as the need for generic medicines has been instrumental in the fight against COVID-19, particularly in the area of intensive care,” says Paul Burden, Chief Commercial Officer for Strategic Growth at specialty pharmaceutical company Advanz Pharma.

Many generic medicines were used to treat symptoms of COVID-19 and care for critically ill patients in intensive care units (ICU). As the NHS mobilised to increase bed capacity, the generic industry mobilised to ensure each bed could be supplied with the critical medicines they need.

Paul Burden says: “Back in March, no one knew how this would work out, how long it would go on for, or how many people would be affected.

We didn’t know how much of each product we could bring into the country, or what the supply chains were able to produce. It placed a lot of question marks around manufacturing and logistics.”

“Ensuring continuity of supply has always been our number one priority.

We were aware more than ever that patient’s lives were dependent on our ability to do our jobs well. Working in partnership with the NHS and Dept of Health and Social Care, providing transparency on our stockholding and future manufacturing quantities,

proved critical in ensuring that no patient went without the medicines they needed,” says Burden.

Securing supply and maintaining stability As well as securing supply, ensuring manufacturing facilities were able to work effectively to sustain production became a priority – no easy task as many factories were affected by the same lockdowns and staff shortages as other sectors.

He adds, “Whilst the world faces unprecedented challenges today, we will most certainly overcome COVID-19 and come out the other side stronger with greater collaboration between all parts of the medicine supply chain, and greater appreciation and awareness of the value of all parts of the pharmaceutical industry, both innovator and generic.

“It is critical that beyond COVID-19 the generic industry continues to deliver medicines into the NHS, in a way that balances robustness and predictability of supply with cost effectiveness.

“The UK Generics industry delivers medicines to the NHS today at some of the lowest prices in Europe with on average generic selling prices being between 70–90% lower vs the originator.

“Open, continuous dialogue between NHS procurement teams and suppliers is a key component to managing this complex challenge. Beyond this, we need to ensure the UK market remains an attractive market for pharmaceutical investment. We have to look at how we hold buffer stocks for the most critical medicines. As well as how we avoid the unpredictability of global supply chains, by incentivising local manufacture of certain product types.”

The UK generic pharmaceutical industry has been one of the most robust and cost-effective systems in the world, that is critical to the success of the NHS. It’s vital that industry, the NHS and government departments work together to ensure a sustainable and better future.

Four out of five prescription medicines in the UK are generics which demonstrates the vital role they play in enabling the NHS to deliver costeffective care to millions of people, every day.

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Rethinking the value placed on generic drugs Thanks to generic drugs, the NHS saves enough each year to fund half a million nurses, but that’s just one of the many benefits that come when patents expire. to ensure there were fewer potential points of failure in the supply chain.”

In an effort to increase production and ensure continued access, there was increased collaboration between the generic drug developers, the UK regulator MHRA and the NHS. While swift action served to ensure medicine cabinets were well stocked, the pandemic has highlighted a vulnerability which Kelly hopes will be addressed.

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Value not price Our obsession with cost has left a potential blind spot when it comes to manufacturing and distribution.

If we’re going to learn lessons from COVID-19, then we need to recognise that value doesn’t mean taking the cheapest option.

Within the healthcare system there’s a concept known as an ‘most economically advantageous tender.’

This essentially means looking at the

SPREAD INTERVIEW WITH

Peter Kelly Managing Director, Accord UK

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n average, it takes 10 years for a drug to come through the discovery stages and onto the market. But the journey doesn’t stop there.

When drugs come off patent, stringent procedures are in place to ensure the continuity of quality.

However, with a patent expiry also comes the scope to adapt and modify treatments to further support patients. Patient populations change over time, and generic drug companies play an important role in making the incremental adaptations required to ensure maximum benefit for the patients.

“It’s not always a direct replica of what’s been on the market, value added generic medicines can be something that’s better either for healthcare professionals or for patients,” explains Peter Kelly, Managing Director of Accord UK - the largest supplier of generic drugs in the UK. Increasing options Three quarters of all drugs used in hospitals in the UK are generic and the UK actually writes more prescriptions for generic drugs than any country in Europe. They underpin pretty much everything the NHS does and enable a greater number of individuals to access gold standard options.

“If you look at statins, the ones that came off patent first are now

not always the physician preferred treatments in their category” explains Kelly. “We often focus so much on price that we forget that it’s not just about that - it’s a combination of value and getting access to high-quality treatments.”

We want to build on that shifting perception to make sure more complex generics and biosimilars get a seat at the table, so there’s also some incentives for incremental innovation.

Ensuring access Access has been in the forefront of people’s minds throughout the COVID-19 pandemic. Concerns over drug shortages loomed large amid global travel bans and disruption in supply chains. This was a concern shared by the drug companies themselves.

“Very early in the pandemic we built a forecasting model based on what we thought would happen to the demand, particularly intensive care medicines,” says Kelly. “We worked hard to fulfil the extra demand from hospitals and community pharmacies

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In an effort to increase production and ensure continued access, there was increased collaboration between the generic drug developers, the UK regulator MHRA and the NHS. overall value of a product, including supply chain resilience, and not just price. It’s something Kelly believes should be standard.

Alongside this, Kelly reports that the government is also investigating how buffer stocks of emergency medicines and reserves of active pharmaceutical ingredients can be built up to ensure medication doesn’t run out.

Shifting perceptions around generic medicine It is still very uncertain what 2021 will look like, but Kelly is hopeful that the spirit of innovation which has been prevalent through the pandemic will become the ‘new norm’.

“This year has created a real shift in terms of the perception and the understanding of the value of generics in the UK,” he says “We want to build on that shifting perception to make sure more complex generics and biosimilars get a seat at the table, so there’s also some incentives for incremental innovation.”

It’s essential that collaboration between industry, government and regulators continues to allow generic drugs to be developed at speed to ensure maximum benefit for patients and healthcare workers alike.

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Q&A

Innovation in generic drugs needs to continue Peter Kelly, Managing Director of generic drugs supplier Accord UK, gives an insight into how the industry is adapting to changing needs of patients and the NHS. are generic drugs Q.Why so important in the UK?

Around three quarters of all medicines in the UK now are generic. The UK writes the most generic prescriptions across Europe and research shows the UK has the lowest generic prices across Europe when compared to five or six of the largest mature generic markets. The NHS would not be sustainable without generics for sure.

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Can you put the cost savings into context?

According to the BGMA [British Generics Manufacturers Association], generic drugs save the UK £13 billion each year, but it’s easy to lose sight of what that means. If you imagine that that would pay for half a million nurses, it puts the savings into context.

has COVID-19 changed perspectives Q.How toward generic drugs?

This year has created a real shift in terms of the perception and the understanding of the value of generics in the UK. Generic medicines have played a vital role in supporting patients during the pandemic. It was predominantly generic medicines that were used in intensive care settings.

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How are generic drugs helping to improve patient outcomes?

When a particular product gets delivered for a lower cost

then more patients can get access to a treatment that might have previously been difficult to access. Generic drugs also create headroom for more innovation. This means when companies bring future products to market, we won’t just produce a direct replica, we can make incremental innovations so it’s better either for health care professionals or patients.

do we ensure supply Q.How chains can meet demand?

I think that resilience is going to be key in the future.

When you just focus on price at the expense of supply chain resilience that’s when you can see shortages appearing in markets. We need a sustainable model where we look at the overall value for that medicine rather than just the price. We manufacture over half of our current volume in the UK and are keen to keep investing in, and supporting that from a UK resilience perspective.

does the future of the generic Q.What drug industry look like in the UK?

I think some of the things we’ve seen in terms of closer collaboration between industry and government and regulators will be here to stay. We’ve shown we can be more flexible and act quicker and perhaps there’s some more we can do to continue to extract benefits.

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What is high cholesterol?

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Cholesterol is a type of blood fat (lipid). We all need some cholesterol in our blood to stay healthy, but too much can lead to serious health problems in the future, including heart attacks and strokes.

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nyone can have high cholesterol – even if you are young, slim, eat well and exercise. That’s because high cholesterol can be caused by different things. It can be caused by an unhealthy lifestyle, but it can be genetic too.

High cholesterol is very common, but most people don’t know they have it because it doesn’t usually have any symptoms. That’s why everyone should have a cholesterol check.

Another type of blood fat called triglycerides can also become raised and lead to health problems, you can have these checked too.

If your cholesterol is raised, there are treatments available if you need them. But it’s usually possible to lower cholesterol naturally with healthy lifestyle changes.

Why get a cholesterol check?

We recommend that all adults should get a cholesterol check – no matter what your age or how healthy you feel.

High cholesterol doesn’t usually have any signs or symptoms, so the only way to know your cholesterol levels is to get a check.

It’s possible to have raised cholesterol even if you’re young, fit, and feel healthy – because your cholesterol levels depend on your genes as well as your lifestyle.

A cholesterol check involves a simple blood test. Your doctor should also check your levels of another fat called triglycerides, as these also affect your heart health.

High cholesterol can lead to heart attacks and strokes. A cholesterol test can be used along with other simple tests to give a good idea of your heart health and if you’re at risk of health problems. These include a blood pressure test and finding out your BMI and waist measurement.

The results will show you if you need to make any lifestyle changes or need treatment.

Data at the core of efforts to streamline care of cardiovascular disease INTERVIEW WITH

Jonty Heaversedge Clinical Director, Imperial College Health Partners

Amanda Lucas Information Director, Imperial College Health Partners

Data collaborations are set to re-shape the way care for diseases like cardiovascular disease (CVD) are planned and personalised in the future.

Real-world evidence: The key to the future of disease prevention and research?

It’s by no means a revolutionary idea that any research looking into the effectiveness and efficiency of NHS treatments should be based on healthcare data collected in reliable and joined up ways.

Historically, this has been a challenge with data often being captured in many different places and not being joined together, leading to a confusing picture of how best to treat patients and plan care.

Discover-Now, led by Imperial College Health Partners (ICHP), is one of seven health data research UK hubs and specialises in real-world evidence data. Real-world evidence means data that is collected in real-world settings, in health for example this can mean during a GP or hospital appointment, visit to A&E or home visit by a nurse. The potential of real-world evidence is realised when it is linked together to help give a whole joined up view of a patient’s journey.

Written by: James Alder

HEART UK is the UK’s only Cholesterol Charity. Our website has a wealth of information that offers scientifically backed information in a practical and everyday way to help people manage their cholesterol.

Having access to scaled up, depersonalised healthcare data, gives a clearer picture with how patients interact with healthcare in the real-world.

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WRITTEN BY

Simon Williams Head of Communications and Policy, HEART UKThe Cholesterol Charity Read more at healthawareness.co.uk

The UK’s leading health data access service Discover-NOW supports access to one of the largest real-world evidence depersonalised linked health data sets in Europe. Through their combination of data access, tools, technologies and expertise, the hope of ICHP’s Information Director, Amanda Lucas, is that health data research will become the norm in how treatments are evaluated and improved.

“Having access to scaled up, depersonalised healthcare data, gives a clearer picture with how patients interact with healthcare in the real-world.”

“What this does is link together a patient’s journey through health, social, mental health care to provide a broader picture.

Understanding that whole pathway was historically a real challenge, which is where our hub comes in.”

The power of data to improve future patient outcomes Access to real-world evidence is one thing, but the ability to use it to tangibly improve treatments across the NHS is another altogether.

Collaborating is vital in addressing this challenge which is why Discover-NOW is bringing together NHS organisations, academic, industry, technology, research and charity partners as well as patients and the public according to ICHP’s Clinical Director and practising GP, Jonty Heaversedge.

He believes that these kinds of partnerships are key to unlocking better patient outcomes for those at risk of developing CVD, whilst also ensuring greater efficiency for the NHS. “What we’re trying to do jointly with Amgen (ICHP’s industry collaborator in this instance) is to turn that real-world data into tools that people responsible for planning and delivering care can use to better identify patients and cohorts of society whose CVD treatment could be optimised further.”

“Are there any gaps in care for patients identified as being high risk? What are the opportunities for improvements? This data and these tools enable us to see where those gaps are and plan our interventions in a more targeted personalised way to ultimately improve patient lives.”

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This year, as the world adapted to the unprecedented impact of the COVID-19 pandemic, one thing was clear at every step: the incredible role the NHS plays in society.

With roughly 30% of all coronavirus hospitalisations being in individuals with CVD,3 now is the time to focus on developing and introducing innovative solutions that reduce risk and improve health outcomes for this vulnerable group of patients.

Paid for by Amgen

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nnovative collaboration between the NHS, academia, and industry will enable the health system to navigate acute challenges like COVID-19, but also to support delivery of its Long Term Plan,1 a vision for continuous development so the NHS remains fit for purpose, even as the health needs of society change.

Tackling a silent risk: cardiovascular disease Heart and circulatory disease, also known as cardiovascular disease (CVD), is one of six priority health conditions in the NHS Long Term Plan and singled out as the biggest area where lives can be saved over the next 10 years.1 With roughly 30% of all coronavirus hospitalisations being in individuals with CVD,2 now is the time to focus on developing and introducing innovative solutions that reduce risk and improve health outcomes for this vulnerable group of patients.

Alongside atrial fibrillation and blood pressure, cholesterol is a major risk factor for CVD, yet it is often overlooked in assessment and treatment.3 If we are to help predict and prevent illnesses before they occur – and achieve the aim of the NHS Long Term Plan to reduce CVD events by 150,000 over the next 10 years – all three risk factors need to be addressed.

Amgen is partnering with NHS organisations to help tackle the ‘silent killer’ of high cholesterol through our Control Cholesterol programme –

a two-year partnership running in areas that are heavily impacted by heart attacks, strokes, and premature deaths due to cardiovascular disease.

The COVID-19 pandemic has acted as a catalyst for accelerating change, with the NHS rapidly adopting new ways to treat patients and keep people healthy. Control Cholesterol is an opportunity to harness this innovation and provide patient-centred care in ways that move more services out of hospital and closer to patients.

With the patient at the heart of everything we do, Amgen focuses on creating innovative solutions to tackle some of society’s biggest health challenges. We are partnering with the NHS, collaborating to create solutions which demonstrate meaningful change. We are currently working with the NHS across six regions in England4 covering over 20 million people – a third of England’s population5 – to help reduce the risk of heart attacks or stroke for people with cardiovascular disease.

WRITTEN BY

Dr Tony Patrikios Executive Medical Director, Amgen UK & Ireland

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References 1. NHS Long Term Plan https://www.longtermplan.nhs.uk [accessed November 2020] 2. Features of 20,133 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Docherty et al, 2020 3. https://www.heartuk.org.uk/downloads/healthprofessionals/heart-uk-cvd-prevention-policy-paper--july-2019.pdf Last accessed Decemeber 2020 4. https://www.amgen.co.uk/en-gb/about/partnershipsand-support/disclosures/joint-working-initiatives/ Last accessed August 2020 5. https://www.ons.gov.uk/ peoplepopulationandcommunity/ populationandmigration/populationestimates/bulletins/ annualmidyearpopulationestimates/mid2019estimates Last accessed December 2020

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How innovative collaboration is accelerating important change in the NHS

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Read more at amgen.co.uk GB-NP-1220-00008 Date of preparation: December 2020

Amgen is partnering with Imperial College Health Partners (ICHP) to develop a High Impact Intervention Tool (HIIT) which aims to quantify the current care gaps in terms of detection, treatment and management of patients with high cholesterol levels. The gaps in care can be addressed using different high impact interventions, such as lifestyle interventions, reviewing lipid levels and statin prescription doses, etc. The HIIT will use predictive modelling to establish the impact of addressing these gaps on reduction of CVD events and costs.

The tool complements NHS England’s CVDPREVENT, a national primary care audit of GP data which will enable GP practices and primary care networks to understand how many patients with cardiovascular disease are potentially undiagnosed or not treated optimally.

ICHP are world-leaders in harnessing the power of data to create solutions for health challenges. They have previously developed another high impact intervention tool to optimise outcomes for people with atrial fibrillation; using the power of data to support the NHS in realising the NHS Long Term Plan, the ambition is to create a similarly powerful intervention to improve the lives of people with raised cholesterol.

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How independent healthcare is helping the NHS’ fight with COVID-19 NHS and independent healthcare providers have a long history of working together to deliver services to NHS patients free at the point of use. The coronavirus pandemic has accelerated that partnership further.

WRITTEN BY

David Hare Chief Executive, Independent Healthcare Provider Network (IHPN)

T

he sector delivers hundreds of thousands of NHS operations every year. It also provides care to millions more NHS patients through the delivery of diagnostic imaging, primary and community care as well as clinical home healthcare and digital services.

Rapid availability of independent capacity However, with the onset of the coronavirus pandemic, this partnership stepped up to a whole new level. In a bid to avoid the health service being overwhelmed by the virus in the same way that large parts of the world in March, a deal was struck within days between the NHS and independent sector providers.

The deal made virtually the entire independent hospital sector available, including their 20,000 staff, 8,000 beds and over 1,000 ventilators, to help the coronavirus effort. This historic deal is on an “at cost” basis with no profit being made during this time. It was vital in ensuring that the NHS had enough capacity to deal with surges in the virus and that vital NHS treatment,

notably cancer care, could continue.

Since the agreement was reached in the spring, over 1.5 million NHS operations, scans, and chemotherapy sessions have been delivered by the independent sector under the contract. There has been some truly inspirational partnership working taking place.

All across the country there are countless examples of independent providers repurposing their facilities and welcoming whole NHS teams in. They have also undertaken new training and implemented new processes, all within a matter of days to ensure that patient care could continue during this time.

Helping the NHS to stay open Equally, independent healthcare providers delivering diagnostic, primary and community care really stepped up and worked with their local NHS partners to ensure patients could continue to receive treatment in a safe and timely way during lockdown. This includes switching from face-to-face to virtual

consultations, repurposing their services to ensure vital NHS care which ordinarily would take place in hospitals can be carried out in the community. They have continued to provide overarching support as needed by the NHS. With the second wave of COVID-19 upon us and the impact of the virus to be felt for some time to come, no one should be in any doubt about the scale of the challenge that faces the health service.

The coronavirus pandemic has really demonstrated what can be achieved when all parts of the health service work together and when teams from the public and private sectors work as one. Indeed, with NHS waiting lists set to hit record levels and a growing backlog of delayed treatment to work through, the independent sector’s ability to seamlessly work hand in hand with the NHS by adding capital, capacity and capability should be seen as integral to getting the health service back on its feet.

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The coronavirus pandemic has really demonstrated what can be achieved when all parts of the health service work together and when teams from the public and private sectors work as one.

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COVID-19 crisis has demonstrated the value of homecare The COVID-19 pandemic has driven an acceleration in the use of homecare services across the UK – representing a win/win for the NHS and patient care alike.

INTERVIEW WITH

Robyn Busby Business Unit Head Chronic Oncology Ipsen UK

WRITTEN BY

Amanda Barrell

Paid for by Ipsen UK

Content sponsored, shaped and approved

by Ipsen UK

Utilising alternative methods to expand capacity Expanding capacity and keeping people out of healthcare settings to control infection levels go hand in hand, says Busby.

“Healthcare professionals are triaging a lot more through virtual appointments on the phone or online. Services have become more digitally capable.”

“It’s all about making sure we don’t expose people who might be vulnerable to risk,” she says.

For those on ongoing treatment, such as for cancer or long-term conditions, homecare has become key.

Chemotherapy at home and training people to administer their own injections, for example, has significantly reduced pressure on the NHS. Based on the number of referrals to Ipsen’s homecare services over the last 12 months, homecare could save

Although we’ve used homecare for many years, the start of the pandemic saw an immediate demand for more patients on the service. We had to work collaboratively with the homecare providers to ensure they had capacity to take on the increased numbers. As a result, our team has been able to streamline the clinic and increase capacity and the patients are more empowered, feel safer at home and are saving money and time by not coming into the hospital. A win-win for patients, doctors, nurses and pharmacists. ~ Lillian Cortez, GI Cancer Specialist Pharmacist, Royal Marsden Hospital

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C

OVID-19 forced fundamental changes on the NHS. While many were born of necessity and were challenging to implement, they look set to supersede traditional ways of working.

One example is homecare, which has seen an exponential rise in uptake since the start of the pandemic.

Pharmaceutical company Ipsen saw a 25% increase in usage across its homecare services and an increase in the number of people trained to administer their own treatment during the pandemic.

Robyn Busby, Chronic Oncology Business Unit Head at the company, says: “A number of things have kept people away from hospitals this year. Many services shut down, and people were too scared to go to hospital.”

The possible implications are dire. University College London predicts that almost 18,000 people with cancer in England could die due to not accessing care early enough – a 20% increase on previous years.

Healthcare teams across the UK are working hard to address this. The challenge is bringing services back online and dealing with backlogs, while also dealing with the second wave of the pandemic and normal winter pressures.

an estimated 5,500 NHS clinic appointments each year.

The nurse administration service could add another 6,500 to that total.

This approach doesn’t just free up healthcare professional time, though, it can also contribute the more effective selfmanagement of chronic diseases, says Busby.

“It’s a win/win. The NHS is able to deal with capacity in clinics, and people have an enhanced level of independence,” says Busby.

“However, successfully working this way takes true collaboration and partnership between ourselves, the homecare providers and, most importantly, the NHS.” Encouraging partnership collaboration Back in March and April, homecare providers were under increasing pressure across all therapy areas, Busby explains.

“To make it work, we had to work very closely with our partners to see what capacity could be released and how to streamline the way we provided the services: doing certain things digitally, or training patients, for example.”

“Companies like ours were continually working with providers and the NHS to monitor, evaluate and release capacity,” she says, adding that this is ongoing.

Looking to a homely future In the process of meeting the demands of the crisis, home care has experienced an acceleration in adoption that Busby does not see reversing anytime soon.

“Regardless of COVID-19, the NHS is stretched.

But homecare can add value and help ease capacity as we go forward.”

“Also, I think you would struggle to get people to go back now they are managing their conditions more independently and they recognise the freedom that gives them.”

She goes on to say that while it had been a challenging year for everyone, she is proud of what she and her team have achieved.

“I am so proud of the way we have been able to work with the NHS to save them hours, money and burden during such an acute crisis,” says Busby.

CR-UK-000081 Date of prep: December 2020

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The People’s Picture is a photography and design studio from British artist Helen Marshall. Every piece of artwork is made up of thousands of photos yet every single one tells a story. As an artist-led studio practice they create innovative photo mosaic artworks and installations at the leading edge of design and technology.

Beyond the claps and platitudes, we owe every member of the NHS workforce an incalculable debt of gratitude, especially as their work is far from over. The pandemic has not been defeated yet, and the COVID-19 vaccination programme – which represents both an unprecedented scientific success and a mammoth logistical task – is on the horizon. ~ Lord Victor Adebowale, Chair, NHS Confederation