NHS-life sciences partnership: Learning and recovering from COVID-19

In a recent IQVIA webinar, ‘Partnering with the NHS in a crisis’, representative experts from the life sciences industry and the NHS explored why collaboration between the two is more critical now than ever. Key issues mulled over included missed or incomplete care pathways, backlogs and waiting times, and within partnership efforts themselves the access to the right people for facilitating that collaborative process more efficaciously.

Moderated by pharmaphorum founder and Healthware International’s Managing Director, Dr Paul Tunnah, the panellists participating in this discussion included NHS Deputy Chief Operating Officer for Leicester, Leicestershire, and Rutland (LLR ICB) Debra Mitchell, IQVIA’s own Senior Director and Head of Healthcare Consulting Stephen Jowett and IQVIA Senior Director for Strategy and Business Development Jim McArdle, together with Gilead’s UK General Manager and vice president Dr Véronique Walsh.

Partnership for a two-sided issue

Beginning on the question of the optimism or otherwise that such a scenario imbues, Jowett noted that the mere ability of the NHS and life sciences industry to collaborate exhibited just how much had been achieved. Nonetheless, despite investment, waiting lists remain of real concern. Further compounding issues affecting access to care, by looking at the actual state of the crisis – and how that plays through in statistics – what is revealed is a two-sided issue: one of demand, but also one of an incomplete care pathway.

In order to ‘fix’ such a problem, it is, according to Jowett, necessary for life sciences to be involved. After all, there are “6.7 million additional patients that have sat in their care pathway, when you'd have expected them to move through".

McArdle concurs on this point, noting during the discussion that, from 2019 to 2023, there was an 18% increase in GP workload, while, at the same time, fewer GPs are working in primary care, dramatically increasing GP to patient ratio. This has, of course, not lessened the ‘phenomenal effort’ of those working in primary care, but with the new 6th March contract for GPs, access became a central theme (including telephonic solutions), in addition to early cancer diagnosis. The NHS England letter to all GP practices and primary care network (PCN) clinical directors in England set out changes that will take place in 2023/24, with the goal of improving patient experience and satisfaction.

McArdle commented upon the increase in the volume of roles driving this –towards a possible impasse between primary care physicians and government. As he succinctly put it, it is indeed all about access, and driving patient centricity, but the workforce has to be brought along with that progressive impetus.

Transforming the care pathway for patients

A manager within the NHS for 34 years, Debra Mitchell provided personal insight into the crisis, into what it looks like for the patients themselves, and why the NHS is in the situation it is. She described the circle of pressure seen in ambulance handover and in waiting times for an ambulance: there is, she said, nothing scarier than that waiting time, besides the obvious immediate impact on patients, it is a case of what effect such experience has on the system as a whole.

Mitchell continued to explain that hospital demand is increasing with people relying on emergency departments more. Hospital beds are also under pressure and the length of inpatient stay has increased largely due to patients being stuck in a system because of limited capacity in Social Care, driven by workforce shortages and financial cost pressures. Nonetheless, the public still believe that they need to see a GP when unwell and are unaware of the other healthcare professionals that could help e.g. community pharmacists, nurses and of course self-help via online portals. Working on public expectation and education on what is available to match need is key.

Whilst GPs are best placed to manage long-term conditions, due to the critical pressures within the NHS, they are being used more for acute minor illness. Mitchell proposed that patients can be helped to maximise self-care where appropriate and navigated to the appropriate pathway if they do need help. To facilitate this, close working with communities and Health and Wellbeing Boards is needed. This would result in reduced pressure on Emergency Departments and inpatient beds as GPs can concentrate on managing patients with chronic illness, keeping them out of hospital as long as possible. Mitchell added that addressing the additional issue of health inequality relies upon a reliable source of population health management information and public engagement.

Referring back to McArdle’s comments on a tired workforce, Mitchell summarised the problem as being threefold: one of workforce availability, demand, and money, whilst noting that the UK has one of the lowest doctors and nurses per patient ratios in comparison to the EU. Waiting list backlog (as a result of COVID) has contributed to a median waiting time for treatment now being 14.4 weeks compared to 8.3 weeks in 2019. Patients will often deteriorate with longer delays to treatment which adds another strain to the workforce. Although NHS funding has for a long time struggled to keep up with demand, the increased costs of delivering healthcare as a result of higher acuity and lower throughput (due to Infection Prevention measures), alongside social care cuts increasing the healthcare burden, has made the funding gap far worse. What is crucial now is large scale transformation.

NHS Planning guidance cannot be delivered without transformation, Mitchell stated, but the NHS struggles to transform at scale on its own. And so, looking to partnerships with mutual benefit is key.

Working together for better patient outcomes

Meanwhile, Dr Walsh provided an industry perspective on how it can best support the NHS for the overarching goal of better patient outcomes; the essential purpose being to make the world a healthier place for everyone. For this, “transparent and genuine partnership” is needed to make a true difference for the patient, she said. It is critical that the NHS is fully functioning.

Offering support where there is a shared aim – the win-win for the patient, the NHS and the company – Dr Walsh advised looking towards clear governance and rules. Incomplete pathways are a real problem. The voice of the patient has to be much more present – just as in the midst of the pandemic, when everyone was in the same crisis and working toward a common goal.

The lesson of COVID-19: trust and transparency

Learnings from COVID-19 must continue, Dr Walsh emphasised. Gilead has invested resources, focusing on drug treatment services to partner with the NHS to eliminate HCV by 2025, with their patient access to a care team - identifying precise needs and optimising time. With an almost 80% significant change, streamlining patient pathway benefits, it puts the NHS, third party, and peers all together, permitting data that shows identification and diagnosis, and adapted and accelerated support.

From another Gilead prison care group example, Dr Walsh noted that investment in regional leads, as well as in training and implementing localised pathways, had resulted in some 2,500 people being treated. How? Again, trust and transparency. When data is seen in the right way, solutions are much more easily identified. However, the goal must be clear from the beginning. For instance, she said, England’s approval of CAR-T treatment: five years on, and industry is working with the NHS to make sure innovative technology improves patient outcomes. Or, another example, HIV care and improving patient experience. What patients need, she said, is peer support, good data and an aligned agenda within the NHS and the local community.

Equality of care for everyone

Another of those learnings, of course, was telehealth and digitalisation of healthcare during the pandemic. Such virtual consultations have continued, benefitting patients for whom having to return to hospital for treatment is not practical, minimising face-to-face visits to once per year. Besides ameliorating a patient’s experience, it also lightens the NHS pathway and reduces the load on its services. Mitchell highlighted the positive impact of digital on rural communities.

What mustn’t be overlooked, in any case, is the patient voice. In cancer care, as Dr Walsh noted, and for example in in breast cancer care, patients sometimes think along the lines of ‘That’s not in my community’ – there is a lack of awareness, education, often seen in migrant communities, and inequality of care in the failure to address this. Mitchell agreed that a cultural shift is needed, but a latent fear of consulting with the public remains, a fear of not meeting expectations. Together, though, this can be overcome.

The collaborative cost carrot

But what of the challenges of collaboration, given this is a relatively new way of operating? For Jowett, “everyone needs to be on the same page from the start”; McArdle also deems this “paramount”. Certainly, consideration of the exit plan, in addition to actual access to data, is crucial, but important also is the potential for scalability of what is being proposed. Citing the “Scottish example”, McArdle made clear that it is “not about pockets of excellence, but scalability”, while Jowett mentioned the lung health screening programme, set up to diagnose people with lung cancer earlier. What is needed is the ability, Dr Walsh said, to “have timely, accurate, localised data” that permits better diagnosis. On this, however, Jowett would caution that it needs curating.

From primary to secondary care, the holistic perspective of collaboration matters as well: how best things can be done across the entire care journey and as to Mitchell’s point, especially within social care. Mitchell noted that the NHS is keen to meet the need of early diagnosis but currently this is being carried out at the same time as the NHS is treating a “massive backlog” of patients. The NHS is eager to “start new things with partners but is not great at stopping things layering and layering”. What Mitchell meant by this is a resultant financial waste, while partnership – notably, “clever” collaboration – might permit a regeneration of resources, waving a “huge bill”, and such financial incentive can only draw the NHS into the conversations needed.

In conclusion

With the positioning of dialogue on what industry can bring to the NHS critical, Mitchell asserted what is needed is upfront recognition of the pressures the NHS is facing, that industry should pitch to address those first and foremost, and then sequence in a solution. There might yet be a “huge step to climb”, she said, but more conversations can only be beneficial to the health and care system.

As Jowett noted, perseverance is necessary, but, with the NHS in crisis, that step must be climbed. Post-COVID, partnership has never been more possible. That small success should be celebrated and nurtured to expand and to multiply across the collaborative bridge between life sciences and the NHS, thereby benefitting patients and reducing the inequity of care and access that should already have been consigned to history long ago.

About the panellists

Debra Mitchell is deputy chief operating officer - Leicester, Leicestershire and Rutland Integrated Care Board (LLR ICB)
Debra joined LLR ICB last year to lead the development of Rutland as a Place along with a Long Term Conditions Transformation Programme. Having joined the NHS as a National Management Trainee in 1989 straight from Nottingham University, Debra has over 30 years’ experience in NHS Management mainly in the Acute sector and was Acting Chief Operating Officer for Leicester Hospital throughout the 2 years of the COVID Pandemic. During her career, Debra has managed the vast majority of Clinical Services within Acute Hospitals spanning 3 Health Regions. She spent 2 years leading a transformation and Cost Improvement programme and also led the development of an Elective Care Alliance comprising of 3 Provider and 2 Commissioning Organisations.

Stephen Jowett is senior director & head of healthcare consulting IQVIA
Stephen leads IQVIA’s Market Access, Pathway Transformation and Pathway Analytics teams with a focus on enabling successful collaboration between the NHS and the life sciences industry. Stephen has worked extensively within innovation and digital enablement in healthcare, strategy consulting and service re-design for over fifteen years. Early in Stephen’s career, he got to see first-hand how the successful alignment of people, process and technology could drastically improve care quality and patient outcomes via his work on the adoption of electronic medical record technology at the front line of care. Subsequently, at IQVIA Stephen has sought to harness the use of real-world data to inform patient centric service models, making certain that patient’s receive equitable access to the care they deserve.

Dr Véronique Walsh is general manager & vice-president, Gilead – UK & Ireland
Véronique joined Gilead in October 2021 as general manager & VP for the UK & Ireland. Previously she worked at Bristol-Myers Squibb (BMS), where she spent the last two years as General Manager for Benelux, building on 25 years of experience in the pharmaceutical industry. Prior to this experience, Véronique held leadership positions for the UK & Ireland affiliate at BMS, including interim General Manager, and Business Unit Director for the Innovative Medicines franchise and Virology, where she was responsible for their HIV, Hepatitis B, and Hepatitis C portfolio. Before joining BMS, Véronique held commercial roles at Sanofi Pasteur MSD and Aventis Pasteur MSD in the UK and France. Véronique is a Medical Doctor by training.

Jim McArdle is Senior Director, Strategy & Business Development, Interface Clinical Services, IQVIA
After qualifying as a pharmacist, Jim worked across many sectors of pharmacy both in the UK and internationally. In 2006, Jim joined Interface Clinical Services as Commercial Director, responsible for strategy and growth, and was a key factor in the success of the organisation. A passionate proponent of the role of clinical pharmacists, harnessing data to inform clinical and commissioning decisions, and patient centricity, Jim is viewed as a true innovator in healthcare. He has led on many projects designed to improve the lives and wellbeing of patients across primary and secondary care and recognises the value in collaborative working between the NHS and life science sector, to bring innovative solutions to health economies and to patients. Jim has a BSc in Pharmacy from LJMU and a Masters in Business Administration (MBA) from the University of Liverpool

Dr Paul Tunnah is managing director Healthware International (moderator)
Alongside his work as a recognised author, speaker, moderator and industry advisor, he founded the industry-leading publication pharmaphorum in 2009. Dr Tunnah also holds a BA in Biochemistry and DPhil in Biological Sciences from Oxford University, where his work focused on identification of novel anticancer therapies.