Community medicines cut counter-productivity

Rick Greville says Wales should not ignore the benefits of using innovative, cost effective treatments

Rick Greville is Director of the Association of the British Pharmaceutical Industry in Wales. The report, Health and the Use of Medicines in Primary Care in Wales, is available here

Innovation has delivered some life-changing as well as life-saving medicines. Take statins – estimated to save around 112,000 bed days over five years and almost 3,000 lives. The economic benefit of such a large reduction in mortality is in excess of £3.5 billion.

Statins have helped to reduce the consequences of heart disease such as angioplasty, hospitalisation from stroke and heart bypass operations. These and other similar innovations in medicines such as anti-epileptics and bone density regulators have been shown to bring substantial benefits to patients. Thanks to the successes of both incremental and breakthrough innovation in therapy, cancer is also no longer a death sentence.

From the discovery of penicillin and the smallpox vaccine, to modern day treatments for dementia and arthritis, pharmaceutical innovations are constantly challenging boundaries in healthcare, bringing with them long term health and cost benefits.

More than ever, the NHS needs to embrace what innovation has to offer. One fifth of the population of Wales is aged 65 and over – and 65 per cent of all medicines are prescribed to people over 65. The proportion of elderly people is growing faster in Wales than anywhere else in the UK and in the coming years the reliance on and expectation of the NHS will be greater than ever. This poses serious questions for the way in which we provide healthcare, especially in an environment with significantly fewer resources.

A recent report by the Office for Health Economics, commissioned by the Association of the British Pharmaceutical Industry (ABPI) in Wales, says the drive is for more efficient and effective ways of delivering better health for the people of Wales.

It also says that medicines recognised by the All Wales Medicines Strategy Group or the National Institute for Health and Clinical Excellence (NICE), which have a proven cost effective and clinical evidence base, should be viewed as part of the solution to the financial challenges facing the NHS in Wales. However, innovative new medicines approved by NICE are not being prescribed quickly or consistently enough in Wales.

The incremental benefits these medicines offer, such as reduced side effects, increased effectiveness and allowing more patients to manage long term conditions closer to home rather than in a hospital setting cannot be ignored – especially in the current financial climate.

The NHS in England and Wales is supposedly duty bound to fund new medicines approved by NICE, within three months of its final guidance being published. But the Office for Health Economics report found that, three years after licensing, the use per person in Wales of new medicines recommended without restriction is less than half that in England.

While affordability is often given as a reason for not investing in the latest treatments, Welsh Health Boards have consistently under-spent their medicines budgets for several years. As a consequence the share of total NHS expenditure on medicines has been declining.

Recent figures compiled for the ABPI show that the health service in Wales under-spent its medicines allocation from the Welsh Government by over £70 million in 2009-10. It remains unclear how these resources were spent and reflects a trend over the last decade.

The slow rate of growth in primary care medicines expenditure in Wales has been in the context of fast growth in total NHS spending in recent years, and the difference is now greater here than in any other country in the UK. Although the number of prescriptions dispensed has been increasing faster in Wales, reflecting poor health demographics and perhaps even Government policy, this growth has been more than off-set by decreases in average cost per prescription which have fallen at a greater rate than other UK countries.

The overall impact has been that the rate of growth in the primary care medicines bill is much slower in Wales. In fact, the proportion of the NHS budget spent on medicines prescribed in the community has fallen steadily since the establishment of the National Assembly in 1999 – down from 13 per cent to under 10 per cent.

The need to find efficiency savings is likely to compound the low and slow uptake of innovative new medicines in the NHS but now more than ever, we need to develop an NHS environment that is receptive to and values innovation.

As the recent Bevan Commission report warned, current circumstances “will not allow the status quo to be maintained in NHS Wales”. “Long-term demographic change and the immediacy of financial pressures could both force that change,” it said.

Announcing her five year vision for the health service last month Health Minister Lesley Griffiths also acknowledged the urgent need to do things differently. Together for Health pledges to put primary and community services at the centre of healthcare delivery, but a shift away from hospital based settings will depend on having the tools to treat people successfully closer to home.

We now need an evidence-based approach to tackling chronic disease including the use of new and established medicines which are fundamental to reducing hospital admissions and improving health outcomes. As the needs of an increasing elderly population grow, the routine use of medicines that have a proven cost and clinical evidence base could play an important role in keeping more people well – and out of expensive hospitals.

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