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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

Innovation with Earl Howe and George Freeman MP

Feb 08. till Dec 08.

2020health Expert Breakfast Roundtable on Innovation with Earl Howe and George Freeman

2020health roundtable discussion on Innovation with Earl Howe and George Freeman.

Date
February 8, 20112011-02-08T08:30:00 - December 8, 2010 2010-12-08T10:00:00
Time
8:30 AM 2011-02-08T08:30:00 - 10:00 AM 2010-12-08T10:00:00
Location
Westminster, London

Attendees

1. Earl Howe, Parliamentary Under-Secretary of State
2. George Freeman MP
3. Mark Lloyd Davies, Head of Government Affairs & Communications, Janssen
4. Nick Bruce, Customer Access Director, Pfizer
5. Miles Ayling, Director of Innovation and Service Improvement, Department of Health
6. Kate Eden, Director of Market Access and Public Affairs, Shire
7. Judy Britton, Deputy Director, Government Office for Science
8. Steve Bates, Senior Director of Government Affairs & Market Access, Genzyme
9. Mark Wilkinson, Director of Life Sciences Innovation, NHS North West SHA
10. Dr Panos Kanavos, Senior Lecturer in International Health Policy and Head, Medical Technology Research Group, LSE
11. Professor David Taylor, Professor of Pharmaceutical and Public Health Policy, London School of Pharmacy
12. Katy Peters, Head of Pricing, Prescription and Supply Team, Department of Health
13. Michael Garrison, Head of Business Development, Health Enterprise East
14. Julia Manning, Chief Executive, 2020health
 

Introduction

Good innovation background

  • The NHS has a worldwide reputation for innovation and R&D
  • Advances in technology have driven improvements in patient care
  • There is no shortage of intelligent people with good ideas
  • Example of Royal Brompton Hospital which is collaborating with PCTs to develop a pathway for children dependent on ventilation, to get them out of the intensive care unit and back home

Improve communication of ideas and best practice across the NHS

  • Innovation needs to be both invention and adoption of good practice, new technologies and new medicines
  • Need to find new ways of spreading new ideas at scale

Significant challenge ahead

  • Challenges of rising demand, ageing society, rising public expectations
  • Without significant innovation we will see the costs rising faster in the NHS than in the rest of society

 

New NHS landscape and government localism agenda

  • As the landscape shifts, so too will the role of the Department of Health
  • The uptake of innovation will be less about mandating from the centre, and more about creating a culture of innovation and empowering people to innovate
  • The Big Society gives us the opportunity to enhance innovation at the front line
  • The conditions need to be propitious to allow research and innovation to take place

Government encouragement of innovation

  • £20m available through regional innovation funds, with high interest - 10x more applications than funding available
  • £2m prize money available to reward ideas that tackle challenging areas of healthcare
  • Legal duty for innovation – currently residing with SHAs, but will move with new landscape
  • NHS Innovation Expo – the largest event of its type in Europe.  Opportunity for those working within the health services to see innovations that are deliverable now, and hopefully to copy these ideas!

Life Sciences

  • Life sciences research makes a large contribution to both our economy and to our health services
  • The Academy of Medical Sciences states that the current regulation is too complex.  The Government agree with the need to streamline and coordinate regulation and governance, and are considering recommendations from the report
  • Patient access to drugs – Mike Richards’ review looked at international variations in medicines usage.  Showed that in the UK we have a mixed usage – high usage includes lipid regulation drugs, but low usage on the newer cancer drugs

VBP

  • Intended to give clinicians the confidence that the medicines they are prescribing provide value for money, so that prescribing decisions can be based on clinical need alone
  • NICE to be expanded into social care, and with increased focus on developing quality standards
  • In relation to medical devices and diagnostics, support iTAPP, which is repositioned to the heart of QIPP

Discussion

 

Changing the culture

  • It isn’t possible to legislate for a culture of innovation. Innovation is people under pressure trying to solve problems. People have to feel responsible for innovation and able to realise the benefits – this doesn’t work currently in the NHS
  • Many of those in the NHS do not like thinking in terms of markets, there is a need to encourage a shift in mindset
  • We need a stronger culture of entrepreneurialism in the NHS
  • Factors which should help change the culture: outcomes framework, financial incentives, patient power, holding the health service to account
  • Need to get the macroeconomic rules right, and let the clinicians who are enthusiastic go ahead with innovation

Spreading current technologies

  • Not everyone is an innovator, but need to get other trusts to take up good ideas
  • Need uptake of technologies which are already available
  • Want uptake of innovations to happen quickly, not everyone reinventing processes
  • Benchmarking should increase the pressure to encourage trusts to take things up quickly

Levers for change

  • We are losing some of the current levers for change e.g. targets and some additional money for QUOF.
  • To replace these we will need new levers – benchmarking, with comparable information on performance should be one
  • Need to improve on current benchmarking e.g. current benchmarking reports do not name individual PCTs
  • Need to free up capacity of clinicians to innovate – many currently don’t have time or energy
  • Need incentives and rewards for the individual to encourage innovation

Nationalism vs. Localism

  • Currently in the NHS, have to sell to the top before a product is used locally
  • In other countries can make deals more locally
  • Worry for pharmaceutical companies that new scheme will have no obvious incentive for drug uptake – NICE will no longer be able to decree that a medicine should be offered country-wide

Balancing economic policy and health policy

  • NHS has not historically seen itself as a driver of economic growth, but it should be
  • The private patient income cap has previously discouraged the NHS from behaving economically
  • We need to exploit the resource in terms of expertise which we have in the NHS – many developing countries would like to partner with us and benefit from our expertise
  • GPs as small businesses are already entrepreneurial
  • The old PPRS was explicitly about balancing health and industry policies, and any new system needs to do this better

Current DH innovation agenda

  • Moving from Research Assessment Exercise to Research Excellence Framework
  • Patent box
  • R&D tax credits
  • NHS as a showcase for British industry
  • Skills needed for companies – lab skills as well as business skills for small companies
  • Small Business Innovation Research programmes – providing capital for early stage innovative thinking

The pharmaceutical industry in the UK

  • UK has a well structured healthcare system
  • NICE assessments are useful for pharma companies, to study the value proposition of drug
  • Whether technology works in the NHS is a good test for how it will do elsewhere
  • An additional benefit is that the UK government very approachable to industry
  • Worry of changes causing loss of speed for drug uptake
  • There are benefits to UK economy of being a launch market for pharmaceuticals
  • Message that UK is a good place to launch drugs not getting back to home headquarters of multinational companies.

Benefits and drawbacks of Value-based pricing 

  • NICE will have a role in evaluating drugs
  • Different philosophy from PPRS 
  • Want to move to a system that is much more predictable 
  • There is current need for better incentives for innovative medicines
  • There is a case for paying higher prices for medicines if there is a breakthrough 
  • VBP must still bring together health policy and industrial policy 
  • Need to be careful of making generalisations about different types of drug or different sectors of the population

Definition of Value

  • NICE is currently very focussed on maximising health gain
  • We also need to consider value to society – tackling health inequalities, supporting lower ends of society.  These additional values could be incorporated into the ICER and the QALY

Additional questions to consider in relation to VBP

  • How strong is the evidence that prices set for medicines determine pharmaceutical investment in a country?
  • If we change how we price medicines, will we be referenced on price as widely? – is it because we have free pricing?

 

 

Earl Howe

Earl Howe has been Parliamentary Under-Secretary of State in the Department of Health since May 2010.

Between 1997 and 2010 he was opposition spokesman for Health and Social Services in the House of Lords. He is an elected hereditary peer under the provisions of the House of Lords Act 1999. Apart from his frontbench responsibilities, Earl Howe has previously been a member of the all-party groups on penal affairs, abuse investigations, pharmaceuticals, adoption, mental health and epilepsy.