The NHS is limiting patient care by reducing access to medicines in order to achieve short-term cost control targets, the ABPI has said.

At its annual conference, the industry association emphasised that France, Spain and Germany spend three times as much per patient on new medicines as the UK.

While it focused on medicines, the ABPI statement echoed comments from the NHS Confederation on the way that ‘salami slicing’ of healthcare is being used as a short-term financial solution.

Both organisations are calling for service redesign to shift healthcare from the hospital to the community, rather than further cutbacks to existing services.

In particular, the ABPI noted, denying patients access to new medicines on grounds of cost is holding back the treatment of long-term conditions within the community, while giving hospitals more work.

Spending on new medicines is set to rise by only 1.3% by 2015 – half the projected increase in total NHS spend, and far below the rate of inflation.

The UK spends 74p per person per day on medicines, compared to over £1 in Spain, Germany and France. It spends only 7p per person per day on new medicines, compared to over 20p per day in those countries.

Stephen Whitehead, Chief Executive of the ABPI, said: “Our healthcare system needs to focus much more on caring for patients in their own homes and much less on treatment in expensive hospitals. Investing in new, innovative medicines will be absolutely key to this.

“By 2015, the new medicines which are being launched now will make up just 2.5% of the entire medicines budget, and yet it is these treatments which are able to transform the way many diseases are treated.”

The NHS will need to start charging for services if economic conditions do not improve, according to Malcolm Grant, Chairman of NHS England.

Grant warned that “a future government” can be expected to introduce “new charging systems” unless “the economy has picked up sufficiently”.

Possibilities include the intensification of the current rationing system and the introduction of a ‘co-payment’ system similar to that applied for NHS dentistry.

He also forecast “a complete rethinking of some of the fundamental tenets of the way in which care is provided,” with hospital services being moved into the community.

NHS providers have been rationing NICE-approved drugs and procedures since 2010, despite the Government’s claim that it does not sanction such measures.

The fact that the £6bn cut from NHS spending last year under the ‘Nicholson challenge’ was reclaimed by the Treasury and not reinvested in the NHS means that the NHS budget is not ‘ring-fenced’.

According to a 2012 report by the Institute for Fiscal Studies and the Nuffield Trust, within the next few years the NHS will need to carry on reducing the number of services it provides.

Ana Nicholls, Healthcare Analyst at The Economist Intelligence Unit, commented: “Malcolm Grant is stating the obvious when he says that unless the economy picks up, the NHS could be forced to impose user fees.” His statement was “bringing the debate out into the open, laying the ground for an eventual change of policy,” she noted.

“User charges, if they are introduced, could take several forms, though all would be controversial. Patients could start paying for services or treatments that are currently free. Alternatively, the NHS could introduce co-payments – small payments towards treatment to stop overuse.”

A vital aim of the NHS reform act is to reduce the amount of time patients spend in hospital beds. Paralympian Bethany Woodward is the perfect example of what can be achieved by getting treatment at home, avoiding unnecessary surgery and reaching personal goals. With three major athletic medals – you can’t argue with the results.

We meet in an upmarket hotel in London, where she is about to attend an awards ceremony. In previous Paralympic years this situation would probably not have happened. In a few short months the world has changed its attitude to disability forever.

It’s been pretty hectic since those halcyon summer days, but Bethy – who is wearing that iconic Stella McCartney tracksuit – has loved every moment. “It feels like a dream now,” she reflects.

Her charm, confidence and winning smile makes her a natural under the spotlight. It all seems so effortless, and yet, getting to this point has been the result of incredible determination.

While still a baby Bethany was diagnosed with cerebral palsy (CP). From the beginning, however, her parents – who are both senior NHS nurses – insisted on positivity. “I wasn’t diagnosed until eighteen months, when I started to crawl round in a circle,” says Bethy. “There were chances to have surgery to stretch my Achilles, but my parents were anti-operations. They didn’t want me to spend years in and out of hospital. Instead I relied on massages and walking.”

Run way
Bethy has always refused to hide behind her condition. “I’ve always tried to look at what is possible rather than what isn’t,” she says. “I was abseiling down the side of a mountain at three. I’ve never looked at my disability as something that will hold me back.”

During a blissful childhood she started to take up running after seeing the Paralympians at Athens 2004. It quickly became obvious that she had something special and, by the age of 17, she left home and headed for London to start a career in professional athletics.

“For me the hardest part was showing people my disability,” she remembers. “I didn’t expose it that much outside my safe circuit of people, but I can’t hide it on the track, where it is laid bare to everyone. Showing people that I’m proud to have CP and love my disability is really important. I wouldn’t change it for anything.”

Fast tracked
Before the Paralympics Bethy had rapidly climbed the rankings and at the World Championships in 2011 had claimed gold in the 400m. As the New Year unfolded, however, it became clear that while her speed was improving, her endurance was suffering.

She made a difficult decision. Rather than continue with 400m, she opted for 200m. Ironically, it is actually because of CP that Bethy has become such a versatile athlete, medalling at three different distances.

“I couldn’t carry on doing 400m,” explains Bethy. “I changed to the shorter distance and within a week I went from not being in the Paralympics to qualifying as a European record holder. I had a goal and I wasn’t going to lose sight of the dream I had for seven years.”

Passing the baton
One of the most gripping moments during the Games came in the aftermath of the women’s 4×100m relay final (T35–38). After receiving the baton smoothly from Olivia Breen, Bethy ran a magnificent second leg, before delivering a masterful changeover to Katrina Hart. The girls were in a glorious position to claim some precious metal, when suddenly Hart and Jenny McLoughlin got in a pickle with their exchange. The nation held its breath while officials checked whether the baton had changed over legally.

“We weren’t aware what was going on, because they were quite far away,” Bethy recalls. “When I passed the baton I thought ‘we’re on to a winner now’. We had no idea that there was a problem and were lapping up the glory. Can you imagine if we were running round and suddenly it came over the public address system that we had been disqualified?”

Fortunately they were inside the zone and Bethy was able to pick up her first Paralympic medal which, she confirms, is “bigger than a Wagon Wheel.” The time had come for the 200m.

One moment
“I was not coming out of the arena without a medal,” she said. “I was ranked number one and I wanted gold.”

On the morning of the race, however, Bethy’s condition meant that she wasn’t quite firing on all cylinders.
“There was a huge gap between the heat and final so I went for a sleep, but the thing about CP is that it is completely unpredictable. When I woke up my legs just weren’t there,” she explains. “You train really hard, but you can’t work out whether it’s going to be a good or bad day. Three races in under 24 hours is hard for anyone, but especially people with CP.”

At this point Bethy transports me back to the Olympic stadium with a dazzling description of her race.
“You couldn’t get complacent. The level of competition was fierce. I went on to that track and everyone was looking at me. This was my race, my stage, my town. I was nervously waiting in the call-up room, but as soon as I was out on the track calmness came over me. My family were there and my two brothers were watching me run for the first time. I ran on pure adrenaline and once I started to kick, pushed on by a mask of noise, I knew I would have a good finish. I loved every second, and took as much as I could, because I’m never going to see anything like that again.”

Para-mazing
Since being inspired by the Paralympians in Greece, eight years before, Bethy has witnessed the astonishing development of the Games, while also taking a great interest in Paralympic history.

“In Atlanta [1996] they were actually taking the Olympic village down when the Paralympics started!” she tells me. “In Athens there was only 15 minutes of coverage. Beijing had a full crowd, but it was free. In London two million tickets were sold, coverage was constant and there was global interest.

“This has resulted in a society-wide shift in perception. It was a real shock to be recognised as elite athletes. I’ve had children coming up to me and saying that they were inspired by me and now want to take up sport. People have changed their opinions and that will be the legacy.”

Bethy then quotes David Cameron: “The disability drifted from view and the sports person appeared.”
I conclude that this is possibly the first time that I have wholeheartedly agreed with the Prime Minister!

Building blocks
In preparation for the World Championships next year Bethy recently relocated to Loughborough with her partner Lee Doran – the javelin thrower who was controversially left out of the GB Olympic team for London 2012.

The pair will now train together at the same facilities, as they start the long journey to Rio 2016. Lee’s disappointment at not qualifying for the Olympics has served as an inspiration to Bethy who was able to rely on his support throughout the Paralympics.

“He’s incredible,” says Bethy. “He had a week when he was upset, but picked himself up and has been the most positive guy in the world. He’s my hero.”

Bethy’s burning ambition now is to break records and take home two golds from Brazil. After that she would like to become a speech therapist for the NHS. “I could go and earn a fortune, but I’d rather use my experience to change people’s lives,” she says.

I think it’s safe to say, she’s already done that.

After taking a couple of photos, we exchange farewells. Reflecting on our meeting I realise that Bethy is actually the epitome of progress: of what can be achieved by people regardless of their circumstances. NHS reform wants to change our attitudes but, as a society, the process of reforming has already begun.

A new report by the FDA highlights weaknesses in medical device quality in the US over the past decade.

The FDA’s report, Understanding Barriers to Medical Device Quality, stated that while revenues in the medical technology industry have grown over the last ten years, “serious adverse events” have outpaced this growth by 8% each year.

Failures in medical device design and manufacturing process control were found to account for more than half of all product recalls.

“While medical device flaws may vary by device, some sources of error are pervasive throughout the field,” the report reads.

“Identifying and addressing systemic barriers may yield improvements in medical device quality on a large scale.”

The report was launched by the FDA’s Center for Devices and Radiological Health in order to understand and improve gaps in device quality, and outlines recommendations for both industry and federal regulators.

The analysis found that “nearly 60% of the adverse event reports” involved cardiovascular, in vitro diagnostics and general hospital/surgical equipment.

“Our efforts revealed that there are systemic gaps within the medical device industry's quality approach that result in these issues,” said the report. “Attempts to improve quality are hindered by challenges within the industry as well as specific aspects of the agency's regulatory approach.”

According to the FDA, medtech manufacturers are facing a series of challenges which are impeding device quality, such as the increasing complexity of devices, time to market competition, and cost pressures.

Identified opportunities for improvement include postproduction monitoring and feedback, creating quality incentives, and improving design and engineering.

The report also cited steps for the FDA to incorporate, such as clarifying Agency requirements and learning from regulators of similar high-tech industries.

A similar initiative is underway in Europe to improve medical device regulatory assessment processes, with support from Eucomed.

Despite huge investments into CRM systems some pharma companies still struggle to get all of their staff to embrace and fully interact with them. Pf’s Iain Bate explores why, and what the future holds for technology in the industry.

There’s no doubt that technological developments have changed the way we live and work from year to year – maybe even from month to month in the 21st Century. But has the world of healthcare been travelling in the slow lane of the intergalactic highway?

The potential that technology offers to pharma, and the general world of healthcare, is enormous. But is the pharmaceutical industry, and its staff in particular, using it to maximise the returns of billion-dollar investments?

It would seem that technology is the ‘buzz word’ on the lips of a few of healthcare’s major players at present. The DH recently invited people to nominate their favourite health-related mobile phone ‘app’ – be it for keeping fit, to locate a hospital or chemist, or helping to manage an illness. Creative minds were also asked to design their own health app with a panel of DH judges deciding on their favourite from the most popular entries.

Health Secretary Andrew Lansley says it’s the Government’s intention to give people better access to information using modern technology and the exercise is a “unique opportunity for the NHS and those who develop apps to not only showcase their work, but to bring to life new ideas and realise true innovation in healthcare”.

As part of the DH’s technology revolution, patients may also soon be offered online consultations with their GPs using programmes such as Skype. Clearly the Government is embracing the convenience technology offers to patients, but are other sectors in healthcare as interested? It would seem there is still some way to go.

 

In two minds

Pf ’s 2010/11 annual Company Perception, Motivation and Satisfaction Survey suggests that not all respondents are completely convinced by the power of technology in the workplace. Although the Survey – which relates to 2010 and the early part of this year – found that nearly 90% of respondents have access to a CRM system, only 43% find time to use it in the field and more than a fifth of people fail to accurately record post-call reports with important clients.

Questions have to be asked as to why, despite multimillion pound investment and training by pharma companies, there remains a percentage of staff that still ignore the power and potential of the technology at their finger tips.

Results from the Survey reveal there’s no difference in uptake by key account managers, primary and secondary care representatives, those in primary care roles only, firstline sales managers and secondline sales managers and the use of CRM technology between differing age groups – although surprisingly 10% of respondents in these positions with less than two years of experience said they did not have a CRM system, compared to just 5% more experienced colleagues.

The launch of the iPad in March 2010 promised to revolutionise the way sales representatives, and those in similar roles, use CRM systems in the field. However, nearly three-quarters (70%) of respondents from the Survey are still presently sent out with laptops containing their customer-relationship systems.

When quizzed on what they’d change about the hardware which houses their system, the majority of respondents said that their CRM was too awkward to carry, with poor running systems an issue and that batteries ran out too quickly. Apple claims its second-generation iPad now enjoys ten hours of use away from a plug socket in the field.

Yet the switch to the latest convenient tablet devices may not necessarily be about high levels of investment, it may be down to maximising value for money as Paul Shawah, Vice President, Multi Channel Strategy, Veeva Systems explains. “I would say the life cycle of devices within the industry is generally about three years, sometimes a little bit longer,” he said. “When a company invests in new technology they typically depreciate that over that period, so they don’t want to replace it in the field for that time to maximise their investment.

“However, with the introduction of game changing technology like the iPad, this has changed. We see a number of our pharmaceutical customers are justifying the business case to move to the iPad even before their tablets are fully depreciated. This speaks to the business benefit that pharma expects to achieve from the iPad and the related applications only available on that device.”

A convenient shield

Despite technology eliminating mundane process in the workplace and offering the potential to assist employees and improve their efficiency at work, it has historically been used as a shield to mask poor performance and abused as a means to waste company time – a recent online survey by AOL found that nearly half of Americans (44.7%) rank surfing the web as their primary activity during the two hours they ‘waste’ each day at work.

But it would seem that a high number of respondents do value the opportunities CRM offers. Almost two-thirds (64%) said they always enter correctly the amount of customer sales they make into their CRM. But 21% admitted they fail to always report face-to-face meetings with clients. More surprisingly, over a fifth of participants said they do not always record the number of products they had sold to clients.

The lack of honest accuracy is surprising considering the amount of time spent using CRM systems each day. A third said they spend between one and two hours a day on their system with a fifth spending three hours or more on their CRM. During their time using the management system, more than half (55%) said that call reporting was the most useful feature.

Although respondents were less impressed with the KAM abilities of their software with only 19% believing it to be the most useful facility. When questioned about what they would change given the chance, 45% said they wanted an improved database, over a quarter (28%) called for their system to be overall more useful, and 18% said they would prefer their CRM to be easier to use.

 

The next level

But what of the future of CRM systems? Will they be easier to use and have improved customer databases? David Round, General Manager, UK, Cegedim Relationship Management, says the regular interaction we now have with technology means we’ve all come to expect the latest developments.

“End users are significantly more ‘technology-savvy’ than their counterparts of even five years ago,” he explained. “If anything, the challenge for companies is to ensure that they provide their end users with the types of technology that they use as consumers. It’s also important to focus on the usability of your software to ensure maximum use. Technology companies – and pharma – must work together to develop a better understanding of the interaction, to ensure it meets users’ needs in the field.”

One main reason that users have become more ‘savvy’ is down to the use and interaction with social media. Whether at home or at work, websites such as Twitter, Facebook, LinkedIn and most recently Google+ have driven an increased use of various forms of technology – especially on devices such as smartphones or tablet devices which reps are calling for in the field.

Pharma companies, both in the US and UK, have flirted with the idea of fully embracing the power social media harnesses, but at present are restricted by the PMCPA’s Code of Practice and by the FDA – who has again delayed the publication of its guidance.

The FDA says it is “difficult to provide a timeframe... due to the extensive work and review process, or ‘Good Guidance Practices’, which ensures that FDA’s stakeholders are provided well vetted guidances articulating FDA’s current thinking on a topic”.

Although the FDA may be unsure on how to direct healthcare companies, David Round believes the introduction, both professionally and personally, of social media has had an impact on staff and their expectations.

“For the modern professional person, much of their everyday life is conducted online – for example on shopping, utilities, insurance or booking a holiday – and many users then want the same level of capability from the tools they use in their job,” he added.

Dan Goldsmith, General Manager, Veeva Europe, agrees there has been a significant shift in the way we operate and interact due to our experiences online through tagged posts or hash-tagged searches. But although the 800 million users on Facebook – more than half which ‘log-on’ every day – and 175 million people on Twitter have no problem saying hello to friends, pharma finds it more difficult reaching out to people.

“Social media create a new avenue for healthcare dialogue and will only continue to pervade our lives,” said Dan. “Consequently, I believe that pharma faces two challenges. The first is to decide how to participate in the online dialogue with stakeholders and then to create those interactions through the channels we’re all familiar with, such as Facebook and Twitter.

“The second is to figure out how to leverage the model of social dialogue internally to support stronger collaboration and more focused communication among employees. Already, we see some companies taking advantage of the latest social business tools to connect employees with one another and to access and share information in real time.”

Clearly CRM solution providers understand the potential modern technology and social media platforms offer to companies. Whether pharma and its workforce get fully up to speed on the intergalactic highway sooner or later remains to be seen.

EKR Therapeutics has appointed Robert Roche Jr as an independent director to its Board.

John Bailye, President and CEO of EKR Therapeutics, said that Mr Roche “brings a wealth of operating and management experience to our company at a time when we are working hard to expand our business”.

Mr. Roche currently works as Independent Director of NuPathe in Conshohocken, Pennsylvania. His previous positions include executive vice president of Worldwide Pharmaceutical Operations at Cephalon as well as various sales and marketing roles at SmithKline Beecham.

EKR Therapeutics is a pharmaceutical company that provides acute care products to the hospital marketplace.

Seven medical devices, diagnostics and healthcare IT have been named in Cleveland Clinic’s Top 10 Medical Innovations for 2012.

The list of medical devices and therapies was chosen by a panel of physicians and scientists at Cleveland Clinic, named one of “America’s Best Hospitals” by the US News & World Report survey.

The annual list recognises new techniques, therapies and approaches to treat medical conditions.

The selection criteria for qualifying in the Top 10 Medical Innovations required nominations to:

• Have significant potential for short-term clinical impact (either a major improvement in patient benefit or an improved function that enhances healthcare delivery)
• Have a high probability of success
• Be on the market or close to being introduced
• Have sufficient data available to support its nomination.

The Top 10 Medical Innovations for 2012 are:

10. Genetically Modified Mosquitoes to Reduce Disease Threat

9. Novel Diabetes Therapy: SGLT2 Inhibitors

8. Harnessing Big Data to Improve Health Care – Health care data requires advanced technologies to efficiently process it. Analytics can be applied to better hospital operations and tracking outcomes for clinical and surgical procedures.

7. Active Bionic Prosthesis: Wearable Robotic Devices

6. Implantable Device to Treat Complex Brain Aneurysms

5. Increasing Discovery with Next-Generation Gene Sequencing

4. Medical Apps for Mobile Devices

3. Concussion Management System for Athletes – Patient management tools can instantly detect brain injuries at the moment of contact.

2. CT Scans for Early Detection of Lung Cancer

1. Catheter-Based Renal Denervation to Control Resistant Hypertension

Cleveland Clinic is a non-profit academic medical centre that integrates clinical and hospital care with research and education.

The Government has faced further opposition to its NHS reforms after campaigners staged a sit-down protest on Westminster Bridge in central London.

Approximately 2,000 health workers and activists attended UK Uncut’s ‘Block the Bridge, Block the Bill’ demonstration ahead of the Health and Social Care Bill’s debate in the House of Lords this week.

UK Uncut said: “If we want to save our NHS we need to shout as loud as we can. No-one voted for this Bill, but together we can stop it.”

The bridge, which links St Thomas’s hospital on the southern bank with the Houses of Parliament, was closed to traffic for the event until late afternoon.

Mark Arnold, a UK Uncut spokesman, said the protest had been effective and there was a “happy, party atmosphere” among those who attended.

The sit-down protest featured many demonstrators wearing hospital scrubs and bandages with fake blood.

Mark Serwotka, General Secretary of the Public and Commercial Services Union, said he hoped the protest would support the healthcare workers who “make our health service the envy of the world”.

The Government said the NHS reforms would give patients and doctors more choice, while encouraging the health service to focus on results, but has come up against various forms of criticism, including from the BMA, who said that the plans “pose an unacceptably high risk to the NHS in England”.

However, Health Secretary Andrew Lansley continues to back the Government’s reforms, claiming them to be “the right thing to do” for a better NHS.

Home healthcare provider Amcare, part of the ConvaTec UK group, has acquired UK company Farnhurst Medical, a specialist in home delivery of stoma and continence care products.

Farnhurst Medical holds three licences in the south of England, and its home delivery business will be integrated with the Amcare network.

Current orders and delivery schedules will not be interrupted during the transition.

ConvaTec is a leading supplier of medical technologies for stoma care, wound therapeutics, continence care, critical care and infusion, spanning hospital and community health settings.

Amcare is a Dispensing Appliance Contractor that specialises in stoma and continence care, providing home delivery and care services. The company also supplies NHS organisations with a wide range of prescription medical devices and appliances to support community care.

Farnhurst Medical specialises in home delivery of stoma and continence care products, offering a comprehensive range of technologies from a number of manufacturers.

A monitoring technology used in hospitals has helped the GB Rowing Team to train for the current World Championships in Bled, Slovenia.

As the team’s High Performance Partner, Siemens Healthcare has provided them with a RAPIDPoint 350 Blood Gas analyser (pictured), which helps to monitor the athletes’ adaption to intense training.

By monitoring their blood gases, the team can identify any imbalance that might lead to loss of breath or development of a stitch.

The RAPIDPoint analyser is small, lightweight (less than 8kg) and easy to use in a wide range of environments. It delivers results in just 2 minutes.

David Tanner CBE, the GB Rowing Team’s International Manager, commented: “The use of the Siemens RAPIDPoint 350 is a very good example of the partnership between Siemens and the GB Rowing Team. There is no question that this has helped the GB Rowing Team to improve performance on the water.”

According to Chief Coach Paul Thompson, “Using this analyser allows coaches and support staff better to monitor, direct and individualise the rowers’ programme to maximise the training effect and their race readiness.”

Helen Glover, World Cup winner 2011, offered a user’s view: “The testing involved with the RAPIDPoint 350 is painless and non-invasive. The results have been very helpful to me in understanding how my body reacts to intense periods of training.”

“Our RAPIDLab300 is a small, low-maintenance and easy-to-use system, making it ideal for hospital critical care environment and a huge range of other testing environments, including sport,” said Afia Boamah, Blood Gas and Stratus CS Product Manager at Siemens Healthcare Diagnostics.