Health Secretary Jeremy Hunt answers the questions you weren’t afraid to ask.

After the clinical waste left by Andrew Lansley, Secretary of State for Health, Jeremy Hunt, is keen to restore public confidence, establish clarity and, generally, galvanise a flagging NHS reform bill. In a Pf exclusive he takes his place on our imitation-leather hot seat, as readers (and writers) don ominous white outfits for a bit of ‘ultra-questioning’.

Since you took over the role as the ‘guardian’ of people’s health in the UK, what has surprised you most about the functionality of the NHS? – Iain Bate (Writer)
I’m very proud to be the Secretary of State for Health, and I know that a lot of people are incredibly passionate about our health service. The NHS is one of our greatest assets; it is admired around the world and has a reputation for excellence, but I want it to be even better.

The coming year will be an important one for the health service and my priorities are to improve care and nursing in the NHS; promote technology to make care more straightforward; and help people to feel in control of their health, supporting them to lead longer, healthier lives.

Given the rapidly expanding role of the private sector in the NHS, how will transparency in contracting be achieved? After all, business to business transactions are confidential. – Joel Lane (Writer)
We have always been clear that, whenever services are procured in the NHS, it should be through a fair and transparent process, judged on the quality of the care. This helps improve healthcare and enables patients to access the best possible services.

The Health and Social Care Act was the first piece of legislation to create rules and regulations around this process, making it more straightforward. It prevents discrimination in favour of private health companies over the NHS, and helps protect patients’ interests.

But it is worth remembering that charities, social enterprises and independent providers have played an important part in providing NHS care for some time. They offer patients more choice about how they are treated by the health service, and every year, a significant number of patients choose to be treated in independent hospitals, ‘on the NHS’.

The NHS is moving into an era whereby it will need to make decommissioning decisions which are unpopular, such as delivering services that patients will have to pay for. How do you aim to integrate this into the wider healthcare bill implementation? – Omar Ali (Pharmacist)
Let me be absolutely clear on this – the NHS will always be free at the point of delivery and no one will be asked to pay for its services. Yes, in the future, services will be provided differently – public health services will be organised by local authorities, for example – but the founding principle of those NHS services being free, for those who need it, will never change.

To some extent, the NHS remains a 1950s animal trying to survive in 2013. What are the challenges when it comes to changing an institution’s post war philosophies and encouraging it to embrace modern practices, without altering the fundamental concept? – John Pinching (Writer)
Of course the NHS has evolved over its 64 year history, and it continues to improve the lives of people up and down the country, but we have to guarantee that the founding principles of the NHS are protected.
I would like to see the NHS using technology more, while continuing to improve care and experiences for patients. That would mean people being able to book their GP appointments online, or those with long-term conditions managing their situation from home, digitally; saving time for both them and their doctor. Technology in the NHS is rapidly developing, and I would urge local doctors and nurses to embrace it.

Recently the Government announced that it will cap individual payments for social care at twice the Dilnot-recommended level, i.e. at about £70k rather than £35k. Will NHS funding for the less wealthy be increased, or will their suffering and avoidable death be allowed to escalate? – Susan Ranch (Key Account Manager)
This is incorrect. The Government has not said this and no decision has been made. I want this country to become one of the best places in Europe to grow old and make sure people can live independent and healthier lives into old age. As part of the care reforms, we committed to taking action: ensuring people do not have to sell their homes to pay for care. While we have also agreed that Andrew Dilnot’s model of the cap on care costs is the right basis for any new funding model. Given the current economic situation, we need to look carefully at how we can pay for this. 

You have acknowledged the differences within the UK of cancer survival rates and compared to other European countries. How can the pharmaceutical industry work with the NHS to help address these inequities? – Leigh Saunders (Key Account Manager)
The pharmaceutical industry already plays a vital role in improving the health of people with cancer. I want to improve mortality rates, where the targeting and development of medicines is becoming ever more important. I am sure the pharmaceutical industry will want to build on its work in this area and help improve cancer care.

Are you still encouraging British hospitals to sell their services abroad and, if so, what future plans do you have to support this? – Valerie Nolan (Clinical Nurse Specialist)
The NHS has many valuable assets, including products, technologies and knowledge. It makes absolute sense that the NHS should be able to use those assets to earn money, which it can reinvest back into patient care at home.

Through Healthcare UK – a UK government initiative in collaboration with UK Trade and Investment and the Department of Health – we are working on several very promising commercial opportunities to support those parts of the health service that can earn income abroad. Any investment generated will be put back into the NHS for the benefit of patients. Importantly, no part of the NHS will be forced to do this, and NHS patients will always come first.

At the current time, David Nicholson is praising the NHS for achieving a major reduction in referral rates, Diabetes UK, however, has noted that reducing referral rates has led to an increase in premature deaths and amputations in people with type 1 diabetes. Is this a case of cost saving targets being achieved at the cost of human lives?  – Nick Dawes (Sales Manager)
Patients should always get the care they need from the health service, and rationing services on the basis of cost alone is wrong and compromises that patient care. Decisions on treatments, including suitability for surgery, should be made by clinical experts taking the needs of each individual into account. We have already written to the NHS to set out clearly, that access to services should not be restricted on the basis of cost.

Should there be incentives in place for the private healthcare sector to expand and take on some of the load from the NHS, such as removing income tax on insurance payments? – Barry Rose (Independent Market Consultant)
The most important thing is ensuring everyone has access to the very best NHS care available and that those services are designed and provided to best meet the needs of the people who use them. This is why we are giving doctors, nurses and other health professionals more power to make decisions. They are the ones who know their patients best and will make sure that services meet the needs of their local communities.

Under this Government the NHS is performing well: waiting times are down, mixed sex accommodation has nearly been eliminated, we have the best ever record on hospital infections and access to dentistry has increased.

A new telehealth scheme has been launched by the DH to help an initial 100,000 patients with long-term conditions gain control over their own care.

Patients will get access to the use of electronic information and technology to help manage their health independently reducing the need to visit primary or secondary care facilities.

The scheme complements the NHS Mandate, which aims to provide telehealth access to three million people by 2017.

Health Secretary Jeremy Hunt said it was “logical” that the NHS should use technology to help patients “manage their condition at home, free up a lot of time and save the NHS money.”

The initial roll out of the project will see seven NHS ‘pathfinders’ across the country agreeing contracts with telehealth suppliers. The project is like no other witnessed in the UK before and is the largest outside the US.

The DH aims to make England the world leader in telehealth in coming years.

“In a world where technology increasingly helps us manage our social and professional lives, it seems logical that it should also help people manage their health,” said Jeremy Hunt. “With our industry partners, we will make England a world leader on telehealth.

“Getting another 100,000 people to benefit from this technology is a very important step and I congratulate all involved on their hard work. I hope it will be the first of many steps towards our overall goal of getting three million people to benefit in the years to come.”

David Nicholson, Chief Executive of the NHS Commissioning Board, said the introduction of the scheme had the potential to transform the lives of people with long-term conditions. “Telehealth not only saves lives, it transforms them, so that people with a long-term condition can feel in control of their life,” he said.

“The seven pathfinders that are offering this new technology to patients will give the NHS Commissioning Board important insight into how best to extend this option to any patient managing prolonged ill health or a chronic condition. 

“Working closely with the local commissioners involved and informed by their experience, we plan to promote vigorously the use of telehealth across England from next April.”

An extra £100m for purchase of new IT resources to aid frontline NHS patient care has been promised by Prime Minister David Cameron.

The funding will be used for electronic data handling, recording and communication systems – enabling nurses and midwives to spend “more time at the bedside”, he said.

Hospitals will access the funding in the form of loans, repayment of which will be reduced depending on patient endorsement through the new ‘friends and family’ feedback system.

A further £40m is promised to develop the clinical leadership skills of 10,000 ward sisters and community nursing team leaders over the next two years.

The PM also announced a £15m cancer radiotherapy innovation fund, starting from April 2013.

New Health Secretary Jeremy Hunt commented: “Most nurses and midwives chose their profession because they wanted to spend time caring for patients, not filling out paperwork. New technology can make that happen.”

Guidance for foundation trusts on the ‘friends and families’ NHS patient endorsement system was published by the DH on 1 October, and the system will be operative from April 2013.

Patients will be asked whether they would recommend a particular hospital ward or department to their friends and family. The results will highlight local priorities for the trusts.

Pf Editor Chris Ross says that delivering the government’s patient-centric mantra of “no decision about me, without me” will require the collaboration of all healthcare stakeholders.

The rise and rise of ‘patient empowerment’ has been an ongoing theme for healthcare both at home and abroad for many years. The UK pharmaceutical industry is obviously restricted in the kind of information it can communicate to patients due to the strict European regulations on direct to consumer promotion – but the need to develop informed and empowered patients is a growing requirement for public health globally.

Back in 2005, the ABPI published a report investigating information access for patients with cancer. The report highlighted the need for a more effective provision of appropriate information for patients all along the treatment pathway – in recognition of the shift towards developing more informed patients. The document said: “The government is moving towards full involvement for people with cancer in the decision-making process, but for this to happen, they will need to be empowered to understand and make the choices that will lead to the best possible outcome for their individual circumstances and condition.”

Fast forward six years and, while access to information has significantly increased with the proliferation of new media channels, the rhetoric from government remains the same: empowerment for patients across all conditions is important – but more must be done to deliver it. The NHS IT Plan has been widely condemned as an expensive failure from a previous administration. But the commitment to ensure NHS decision-making moves ‘as close as possible to the patient’ massively raises the stakes in the provision of relevant and accessible information for patients. “No decision about me, without me” is a catchy sound-bite that may play out well to an information-thirsty patient population, but delivering the promise remains an enormous challenge.

Tackling it requires a collaborative effort and continued dialogue among stakeholders across the health spectrum; clinicians, policy-makers, technology and informatics experts, suppliers, industry and, of course, patients. Pharma can and must have a voice in this important dialogue – but, within a justifiably tight regulatory environment (where failure to comply is actually considered criminal law), the question remains when, where and how can the industry contribute to the realisation of an environment where UK patients are empowered not just on paper, but in reality?

Chris Ross

The NHS Technology Adoption Centre (NTAC) has launched a new online system to help NHS and private health providers adopt proven medical technologies more quickly and effectively.

The new Generic Adoption Process (GAP) provides a detailed roadmap of the adoption process and access to the tools and resources needed.

GAP builds on the experience of NTAC’s Technology Implementation Projects over the past four years in improving the diffusion of proven medical technologies across the NHS.

Users of the GAP website are encouraged to navigate through each of its sections in order, thereby building relevant knowledge – however, they are free to navigate between sections as they wish.

The site is designed for use by health providers at all stages of the technology implementation process.

Sally Chisholm, CEO of NTAC, commented: “GAP has been tested by a number of key stakeholders from the NHS and industry. We believe this is a vital tool which will help drive widespread adoption of proven technologies, as GAP can provide unrivalled knowledge and information to those who do not choose to directly engage with NTAC on an implementation project, for example.

“The idea for GAP came from our recognition that there is a clear need for something which can equip clinicians, managers and other key stakeholders crucial to service development with the tools and resources they need to be able to drive change and innovation throughout the NHS.”

NTAC takes the view that the NHS often fails to adopt innovative medical technologies whose clinical and economic value is proven due to a lack of well-resourced and coordinated adoption pathways.

GAP is available at http://www.ntac.nhs.uk/GAP/GAP_Home.aspx

The FDA has approved Cordis Corporation’s Empira and Empira NC RX PTCA dilatation catheters for the treatment of coronary artery disease.

Both balloon catheters are designed to allow cardiologists to open patients’ narrowed coronary arteries during angioplasty procedures.

Dr Campbell Rogers, Chief Scientific Officer and Global Head of R&D at Cordis, said that the company “worked closely with physician-customers and incorporated their feedback into the design of these next generation devices. We believe the unique design of the Empira Balloon Catheters will meet physicians' needs and has the potential to improve patient outcomes”.

The two medical devices bring several design and technology alterations to Cordis’ portfolio of Empira balloon catheters. They feature the company’s next generation Duralyn Flex balloon material, which is 50% more flexible than the material used in the current Fire Star and Dura Star RX PTCA dilatation catheters, to improve crossability and recrossability, the ability to pass through a lesion.

Cordis Corporation is a Johnson & Johnson company, and develops and manufactures interventional vascular technology. The company works with interventional cardiologists, radiologists and vascular surgeons to treat patients with vascular disease.

The products are expected to be launched for sale in early 2012.

A new technology for point of care diagnosis of carpal tunnel syndrome (CTS) is about to be become available to GPs through leading UK healthcare distributor Williams Medical Supplies.

Williams has an exclusive agreement with Finnish company Mediracer to make this groundbreaking diagnostic tool available to UK primary care.

CTS, often linked to typing or driving, is a pressure on the median nerve in the wrist that can lead to numbness, tingling, weakness or muscle damage in the hand.

The use of Mediracer’s NCS test is claimed to reduce the CTS screening cost per patient from £270 in secondary care to £67 in primary care.

The Mediracer NCS technology identifies nerve entrapments in the hand using disposable surface electrodes. The results can be used to diagnose CTS and grade its severity.

Steve Dunn, CEO of Williams Medical Supplies, said: “We have a strong presence in the primary care market, but we want to strengthen our position to help suppliers and manufacturers – like Mediracer – to win more business.

“By offering exclusivity on key products to Williams, these companies will benefit from our unparalleled market penetration and business support.”

“CTS is a high-incidence condition and our tool provides consultant interpretation within minutes, allowing GPs to do work which is normally confined to hospitals and which saves the NHS money,” commented Pasi Karsikas, Mediracer’s Sales Director.

“We chose to partner with Williams for a number of reasons – they are the UK’s leading GP supplier, with excellent customer support and unrivalled market penetration – so we are looking forward to a bright future in this marketplace.”

Based in Gwent, Williams Medical Supplies is the UK’s leading provider of medical supplies and services, used by around 9,000 of the 10,500 GP surgeries.

Final NICE diagnostic guidance on the EOS 2D/3D X-ray imaging system calls for the system’s health benefits to be further investigated in clinical research settings.

The new system (pictured) from US company EOS Imaging uses low-dose radiation imaging to produce 2D X-ray images and 3D reconstructions for bones.

Its innovative slot-scan technology, scanning a line at a time rather than taking the entire image at once, enables it to produce upright and weight-bearing whole-body images.

By showing relationships between the spine, hip, pelvis and knees, the EOS system could particularly benefit the monitoring and treatment of patients with spinal deformities or alignment problems.

The system’s reduced dose also offers potential safety advantages in the repeated imaging of patients with spinal deformities, especially children.

The new guidance encourages the use of the 2D/3D imaging system in specialist research settings to collect evidence about clinical benefits associated with weight-bearing whole-body imaging and 3D reconstruction.

Professor Carole Longson, Director of the NICE Health Technology Evaluation Centre, said: “The EOS 2D/3D imaging system was identified by the Diagnostics Advisory Committee as an important emerging technology. There is evidence showing comparable or better images and radiation dose reduction associated with using the EOS system to image patients with spinal deformities.”

However, she said, there is currently no evidence that compares the diagnostic accuracy of the EOS system with that of conventional radiological examinations. “NICE will follow up the Diagnostics Advisory Committee’s research recommendations on the EOS 2D/3D system and will assess the feasibility of this research with a view to facilitating the development of further relevant evidence.”

Full data sets evaluating the system’s benefits will trace the outcome of its use from planning through to complex surgeries such as hip replacements.

Marie Meynadier, CEO of EOS Imaging, said: “The EOS 2D/3D imaging system is subject to an extensive programme of research associating radiologists and orthopaedic surgeons. We will provide data to NICE as they are established to determine when a cost-effectiveness review based on this evidence would be appropriate.”

The new external assessment centres recently announced by NICE will help to develop and facilitate research products to assist suppliers when NICE medical technology or diagnostics guidance recommends it.

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.

The FDA has approved Abbott’s next-generation Xience Prime drug eluting stent to treat patients with complex coronary artery disease.

The Xience Prime Everolimus Eluting Coronary Stent System is based on the company’s cobalt-chromium stent technology and is designed to enhance deliverability, flexibility, and more accurate stent placement in patients with symptomatic heart disease due to de novo native coronary artery lesions.

The approval was based on results from the SPIRIT PRIME clinical trial, a prospective, multi-centre, open-label trial involving 500 patients with coronary artery disease at more than 60 centres in the US and Australia. Clinical results show that the trial met its primary endpoint of low rates of target lesion failure (TLF) at one year.

Dr Marco Costa, principal investigator of the SPIRIT PRIME trial, said: “Drug-eluting stent technology continues to advance, leading to improved outcomes for patients with coronary artery disease.”

He said that the medical device “will improve our ability to access challenging, complex lesions, and thereby improve care for our patients”.

Robert Hance, Senior Vice President at Abbott Vascular, said that the FDA’s approval “expands the range of treatment options that we can offer physicians for the benefit of their patients with coronary artery disease”.

Xience Prime received CE Mark Approval in 2009.

Abbott recently split into two companies, one concentrating on research-based pharmaceuticals and the other (Abbott) on medical products.