Healthcare has been a key battleground of the 2019 General Election since day one. In their manifestos, both Labour and Conservatives have committed to placing the UK at the forefront of medical innovation, with markedly different approaches. However, both manifestos are fairly timid and uninspiring, failing to set out the vision and progressive action needed to modernise healthcare. This article will analyse what the manifestos say—and crucially, do not say—about access to health technologies. It is not apparent they have considered the central role of technology in driving the NHS forward in the next five years.
Both parties plan to increase the annual health budget—the Tories by 3.2% and Labour by 4.3%—until 2023/4[i][ii]. But, what does this actually mean? NHS Confederation has analysed UK spending on Healthcare in their Securing the Future report. Whereas Labour is above the 4% threshold estimated to be required to maintain status quo, and provide some meaningful change, the Conservatives have fallen short by a considerable amount. Neither satisfy the 5% increase deemed necessary to modernise healthcare.
The Tories will also expand the Cancer Drugs Fund (CDF) into an Innovative Medicines Fund (IMF), a ring-fenced fund of £500 million in the first year – almost double the budget of the CDF. Meanwhile, Labour plans to increase patient access to “unfairly priced” medicines through a state-owned generic drug company and the use of compulsory licensing.
MedicinesNot only is the CDF not being scrapped, it is being widened and deepened. This form of managed access agreements has been controversial in the past. Critics say it is a poor use of scarce NHS resources, and represents “onco-exceptionalism”— ignoring the evidence-based criteria and financial thresholds that non-oncology drugs are subject to for reimbursement. The IMF is a sign of the pressure NICE is under to expedite patient access to new, innovative treatments. It is also a recognition of the need for further flexibility in areas of high unmet need, other than oncology. However, the Tory manifesto does not go into detail; scope, entry criteria and assessment methods will determine the reach and impact of the programme. Further, due to purdah, neither NICE nor NHS England has commented on this proposal. A Tory government would want to convince the respective bodies of the new fund’s benefits, in a time of increasing financial scrutiny.
Meanwhile, Labour focuses on medicines access with a robust challenge to the pharma industry, underpinned by its wholesale questioning of the capitalist approach to life sciences. Unsurprisingly, industry believes that Labour’s commitment to patient access is undermined by its own policies. Mike Thompson, Chief Executive of the Association of the British Pharmaceutical Industry (ABPI) emphasises “overturning patents for breakthrough medicines and phasing out R&D tax credits and the patent box would damage the UK’s research base”. Although problematic, these policies have proved popular in the past. Decideum has previously analysed why this policy may mean that patients will miss out in the long term.
Labour’s underlying scepticism of industry is problematic; it hinders collaboration and the delivery of integrated care, both of which can expedite access to medicines. As Decideum previously highlighted, “nobody wins when patients are unable to access the best that medicine has to offer”. Although the Conservatives’ innovation fund is promising, its reach is too small compared to the task at hand. UK policymakers must re-think healthcare delivery; smarter, disruptive change is needed to meet current, and future demand. Ambiguous budget increases alone will not bring about the change the NHS craves. It is certainly the case that manifestos do not lend themselves well to nuanced discussion about complex issues, yet both parties have failed to set out the kind of big-thinking that will transform healthcare and improve patient outcomes.
MedTechPerhaps one of the most interesting insights from the manifestos is their neglect of medical technology and the failure to consider their truly transformative potential. As in the medicines space, where some reform is underway through the draft Commercial Framework providing some added flexibility, the NICE Methods Review, and now the IMF , some progress is also underway in MedTech.
An ongoing NHS England consultation is examining whether to introduce mandatory funding through the Medical Technologies Evaluation Programme (to be implemented in April 2020). There is one caveat: this would be on a cost minimisation basis, and require devices to meet a variety of fairly stringent financial targets. NHS England estimates only 3 out of 74 medical technologies assessed to date would meet the criteria. This means high-value, high-price innovations would not be eligible for mandatory funding, which ultimately means patients will continue to miss out on clinically superior products because they are not cost-saving.
This plays into a broader narrative of disparity in the value perception of drugs and devices. On the one hand, expensive medicines are considered by NICE for mandatory funding if they have a high value proposition – even some medicines with highly uncertain data can obtain temporary funding while they gather more data. On the other hand, evidence-based medical technologies cannot obtain mandatory funding unless they are cost-saving. Whereas medicines are awarded flexibility based on various criteria (innovation & quality of life), the requirements on medical technology are strictly based on cost-minimisation. This inconsistency must partially be due to the public’s familiarity with medicines; and their contrasting lack of experience or understanding of MedTech.
This is particularly concerning because of MedTech’s potential for beneficial disruption. Data driven technologies can be effective medical interventions, with fewer side effects than medicines. Because of their convenience, they can also result in better PROMs (Patient-Reported Outcome Measures). Digital health technology to support care at home can free up hospital space and improve the quality of life for elderly patients. The UK’s ageing population is only one of the key areas where MedTech must be deployed to release headroom in the system and empower patients to make choices about their care.
The NHS is falling behind the times; healthcare is being delivered in the same way it was a hundred years ago, and failing to take advantage of the technology revolution. For NICE to operate in a 21st century world, expanding the CDF into an IMF seems like negligible, if worthwhile, progress. Bolder, disruptive action is needed. This begins with policy makers and the NHS sharing the same vision, and setting the right goals. Smarter healthcare is the future and its absence from mainstream political discussion is disappointing.
Digitally enabled care and smarter prescribing would result in better patient outcomes, and be more cost effective—that, would be truly transformative. It is in the pharmaceutical industry’s interest to support healthcare through this transformation.
With only days to go until the general election, industry and the general public ought to expect more of policymakers. Ambiguous funding pledges, with no real detail behind them, will not bring about the change the NHS so desperately needs. Technologically advanced thinking coupled with appropriate funding and smarter healthcare is the only way the NHS can rise to meet the challenges of the future, and ensure the best patient care possible.
Cristina Ruiz de Villa