As the Department of Health, the NHS and the pharmaceutical industry clash over what is good and bad news, Maxine Vaccine asks whether there can ever be a consensus of the non-fake variety.
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us… – Charles Dickens
Dickens made some bad choices in the romance, wardrobe and facial hair departments, but despite that he was a shrewd commentator on human affairs. His words precisely capture the uncertainties of a time when different stakeholders are trying to spin not just the news, but the world itself, in opposite directions.
This week, the Office of Health Economics predicted a slight increase in the growth of the annual NHS spend on medicines, from 3.5% to 3.7% per year to 2015. This will be driven mainly by an increase in generic prescribing. Expenditure on new branded medicines will rise by just 1.3%, meaning that their place in the NHS will shrink. Stephen Whitehead, Chief Executive of the ABPI, declared himself “deeply concerned” at these figures. Yet they quite obviously represent the impact of the QIPP agenda.
Last week we had Andrew Lansley telling an audience of GPs that that the current fall in referral rates is a positive achievement. His speech came shortly after a National Audit Office report saying that a lack of GP referrals is increasing the death rate among people with diabetes, and shortly before an All-Party Parliamentary Group report saying that a lack of GP referrals is creating a ‘barrier’ between people with dementia and the treatments they need.
The week before, Sir David Nicholson’s annual NHS report celebrated a “modest reduction in activity levels”. That means the NHS is providing less: fewer drugs, fewer procedures, fewer referrals. It’s called rationing. A “modest reduction” in activity levels is unlikely to be good news on a hospital ward or in a GP surgery, unless you’re an accountant.
So what’s good news for those running the NHS is not good news for clinicians, suppliers or patients. The pharma industry will have to adopt a variety of tactical positions between the conflicting priorities of providers and commissioners, tailoring the message to the local customer. As Bob Dylan said, when there’s not a lot of food on the table but people still have forks and knives, they’ve got to cut something.
The first casualty of the austerity wars will be that most pervasive myth of the pharma industry, the win-win. In business, as in politics, there is always one who gains and one who loses.
Maxine’s views are not necessarily those of Pharmaceutical Field.