2020health at Conservative Party Conference 2010: A summary of 2020health s Fringe Events Contents

Transcription

1 2020health at Conservative Party Conference 2010: A summary of 2020health s Fringe Events Contents Elderly Care: Are we failing?... 2 Pre-hospital care Why the NHS is not fit for purpose... 4 Combating Stress the hidden injury of mental illness... 7 Why the NHS needs to be transformed by technology... 9 Pricing Medicines Can we deliver value to patients and industry?... 12

2 2020health Event Conservative Party Conference fringe event Elderly Care: Are we failing? Speakers pm Sunday 3 rd October Hall 7, The ICC, Birmingham Chris Skidmore MP (chair) Health Select Committee Julia Manning Chief Executive 2020health Helena Herklots Services Director Age UK Victoria Fletcher Health Correspondent Daily Express Imelda Redmond Chief Executive Carers UK Key points Probable decreases of social care budget are a concern Elderly people should not be sidelined when receiving health care Carers continue to give a lot to the elderly We need to do more as individuals and as organisations to promote the well-being of the elderly 2

3 Summary In this event we discussed how we treat the elderly, both as individuals and as a country, and what we can do to improve that treatment. At first the discussion focussed around the likely cuts in the social care budget. Whilst the NHS budget has been ring-fenced, the social care budget has not. This does not seem to make sense, since the failure of social care will lead to many more people in A&E. It is not clear how health and social care will interact in the future, and how the integration of these disciplines would work. Are we failing in how we care for the elderly? The elderly need the same standard of treatment and care given to the rest of the population. Stories of malnourishment in hospital and elderly people dying from cold and hunger in their homes show how we are failing our elderly. Even in social care, the trend is towards rushed 15-minute visits with no time for the careworker to treat the client as an individual. In some ways the NHS appears to be institutionally ageist however this policy should be publicly debated, rather than quietly introduced. One of the sectors of the population not failing the elderly are the carers. The number of people providing care for more than 50 hours per week is increasing. In general families are not failing their relatives, despite living further away, making visiting more difficult What can we do? - Make time for elderly people including friends and relatives - With 2020health, raise the status and improve the appreciation of the elderly - Benefit from the experience of the elderly, who are coming towards the end of life s adventure - Make use of telecare and telehealth - Become advocates for elderly care at a local level, through Healthwatch - Highlight elderly care issues through the media 3

4 2020health Event Conservative Party Conference fringe event Pre-hospital care - Why the NHS is not fit for purpose Speakers pm Sunday 3 rd October Hall 7, The ICC, Birmingham Gail Beer (chair) Consultant Director 2020health Nadine Dorries MP Health Select Committee Dr Phil Hyde Consultant Paediatric Intensivist Southampton Barry Johns EMS Consultant CranmerLawrence Lois Rogers Specialist health contributor The Sunday Times Key points Pre-hospital critical care is known as an area for improvement The emphasis is on pre-hospital critical care and not just pre-hospital care. The latter term would encompass all that occurs to a patient outside of hospital, whereas the former is provided only to patients who need it (as they are critically ill) and can only be provided by a doctor and skilled assistant. Ensuring the professional transfer of life saving skills that patients need for their journey.london is the only region where good quality pre-hospital care is commissioned and funded by the NHS. Other regions need to put in place provision based on their population.we should address the culture of cover-up within the NHS, acknowledging that it is a complex subject which requires careful and open discussion. Pre-hospital critical care impacts on time taken for rehabilitation There is international evidence supporting reduced intensive care bed stays for patients who have received pre-hosptial critical care. 4

5 We would like to Thank the sponsors of this event, Cranmer Lawrence Summary Pre-hospital critical care is one of the known areas of deficit in the NHS. Outside of London, many critical injuries are not dealt with until the patient arrives in hospital. In March 2010 the department of health produced guidance about how improvements could be made in this area, however this guidance has not been widely implemented. Although the lack of improvement could be due to the major changes occurring in the NHS at this time, this could be a future field of inquiry for the health select committee. International best practice for critical injuries - access to emergency service - quality of response, quality of care taken to patient - Projecting skills of A&E doctor and registered paramedic to incident to deliver care immediately, ensuring that a hospital standard treatment is brought to the patient. - taking patients to centres of excellence - Less rehabilitation and a quicker return to normal life Describing pre-hospital care as taking skills from A and E makes it sound like we are removing doctors from the hospital. Rather it is hospital standard treatment which is brought to the patient. It is projecting the life saving skills that patients need forward in their journey. The military already achieve this very effectively in Afghanistan and consequently their survival figures eclipse those within the NHS. The Clinical Advisory Group on Trauma highlighted the obvious skills overlap between MERIT requirements and provision of accessible pre-hospital critical care. One solution to the current absence of pre-hospital critical care provision may be to combine funding streams for MERIT (Major Emergency Response and Incident Team ) and pre-hospital enhanced care provision to ensure a regional 24/7 pre-hospital critical care support capability. MERIT s stated remit encompasses any incident with critically ill or injured patients whose care requirements exceed the capability of the ambulance service. This would meet day to day ambulance demand while also acting as the first medical component of a response to a disaster. Innovative integration of our national need for pre-hospital critical care and major incident provision could provide the economic efficiency required for development of the pre-hospital enhanced care component of our newly developing trauma systems. There is an inequity of care provision across the country and London is best served, but their model would not suit every region. The principle of improving care is based around the patient and not the region. Critically injured and ill patients deserve life saving care that begins as soon as possible and London has achieved that for their particular social and physical geography. In London, the best served region for pre- 5

6 hospital critical care, a team of a doctor and a paramedic attend the patient by the roadside. In the case of a head injury an anaesthetic can be administered to reduce the metabolic rate, and a tube used to facilitate breathing. These interventions can be done before the patient reaches hospital, thus providing early treatment. Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. There is wide geographical and diurnal variability in availability and utilisation of physician based pre-hospital critical care support. Only London Ambulance Service has access to NHS commissioned 24 hour physician based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability. We should also not forget the costeffectiveness arguments. Since there may be an extended recovery through the delay in care, it could be more cost-effective to provide treatment at the roadside where necessary. The culture of cover-up of malpractice was discussed. To encourage change, we need to complain publically about problems with the health service and have an open dialogue. The media can assist with publicity of adverse events. 6

7 2020health Event Conservative Party Conference fringe event Combating Stress the hidden injury of mental illness Sonata Room, Hyatt Regency, Birmingham am Monday 4 th October Speakers Dr Jonathan Shapiro (chairman) Consultant Director 2020health Andrew Selous MP PPS to Iain Duncan Smith MP John Glen MP Defence Select Committee Lt Col Peter Poole MBE Director Strategy, Policy & Combat Stress Performance James Forsyth Political Editor The Spectator Key points High levels of mental illness in the armed forces. Stigma associated with mental illness means a delay in accessing help. Need to raise awareness of resources available. A better mental health service is needed for the population as a whole and getting the services right for the forces should provide a template for the rest of the population. 7

8 Summary Many points were made which were relevant to mental illness across the population but the discussion centred around the case study of mental illness resulting from time spent in the armed forces. Ex-service personnel are known both for high levels of mental illness, together with a reluctance to seek help. This reluctance may stem from the training received in the services, where self-sufficiency is highly valued. The first main issue discussed was the stigma associated with mental illness. This stigma means that many of those who had been diagnosed with mental illness are reluctant to admit to the difficulties that they experience. In addition, many who might benefit from help of this kind do not visit a doctor and therefore cannot be treated. In many professions, including in the armed forces there is a fear for ones continued reputation and career if one admits to mental health problems. Secondly there is the need for more resources to tackle the problem of mental illness, to support both those affected, and their families. In this area we can learn from the work of the Veteran Affairs in the United States. In the UK, Combat Stress have been tackling mental illness in ex-military personnel for over 90 years, working together with the NHS to deliver mental health services in line with best practice and NICE guidelines. However with the increased deployment of troops, an increased incidence of mental health problems is expected. Peter highlighted the need to raise awareness of the resources available both through the NHS and through organisations such as Combat Stress. On average it takes 14 years for those in need of help to reach Combat Stress. In addition help is often needed for the families of those affected. In the case of a member of the armed forces returning home, the family often have very little understanding of what has gone on. It is not just ex-service men and women who experience mental health problems - a better mental health service is needed for the country as a whole. By initially concentrating on the armed forces, we may be able to begin to improve mental health services across the population. 8

9 2020health Event Conservative Party Conference fringe event Why the NHS needs to be transformed by technology Drawing Room, Hyatt Regency, Birmingham pm, Monday 4 th October Speakers Julia Manning (chair) Chief Executive 2020health Rt Hon Stephen Dorrell MP Chairman Health Select Committee John Cruickshank Consultant Director 2020health Dr Clare Gerada MBE FRCP FRCGP Chair Elect of Council Royal College of General Practitioners John Murray Business Development Manager Public Sector Vodafone Key points - IT and telehealth solutions are needed to improve efficiencies within the NHS and increase capacity for treatment - Despite the reluctance for change there are many benefits to using IT in healthcare - Telehealth needs to be driven forward from pilots to a mainstream approach. Government, NHS and industry need to work together to develop solutions We would like to Thank the sponsors of this event, Vodafone 9

10 Summary This discussion addressed both NHS IT in general and focused more closely on telehealth, a subject on which a report will shortly be published by 2020health. Whilst we need to avoid the pitfalls from the National Programme for IT of assuming that we need a national-only solution to the IT programme, there are many benefits that can be achieved through the use of IT. Benefits of IT that were mentioned include: - Facilitation of measurement and publication of healthcare outcomes - Improving the linkages between different parts of the NHS and with social care - Management of long term conditions through telehealth - Transfer of notes between GP practices - Choose and book speeding up making appointments There is a problem with the reluctance to change to new ways of practice which includes all new technologies such as IT systems and telehealth. Change has never been well accepted and there are still 3 GP practices in the country that still don t use computers. What can we do to drive telehealth forward? - A clear policy commitment and support are needed from government - Removing blocks such as regulation and improving national infrastructure and standards - Central guidelines for commissioning, governance, ethics - Industry need to develop models to reduce cost, such as risk sharing models How should we progress with healthcare IT? - Need to move forward slowly, applying simple solutions. NHS staff need really simple, effective tools that work. 10

11 - Need to be able to plug into the work of the individual in developing their own health information. This may be done through telehealth or online solutions, but these need to be able to be used by the clinician. - Need to reuse what national programme has left us not waste what has already been done. - Need to look at 40-60% solutions, which are not too expensive and not restricted to one technology platform, rather than an optimum solution. The constant development of technology mean that an optimum solution can never be found. 11

12 2020health Event Conservative Party Conference fringe event Pricing medicines: Can we deliver value to patients and industry? Speakers pm, Monday 4 th October Marquee 6, The ICC, Birmingham Julia Manning (chair) Chief Executive 2020health Earl Howe Parliamentary Under Secretary of State for Health Dr Panos Kanavos Senior Lecturer London School of Economics Richard Ascroft Corporate Affairs Director and Lilly UK Senior Director Hilary Tovey Policy Manager Cancer Research UK Key points - Need a clear system which is transparent and fair - Need a broad definition of value to incorporate all societal aspects - Need a system that favours true innovation - Need to recognize that without improved coverage and uptake, future development and trials in the UK are jeopardized We would like to Thank the sponsors of this event, Lilly 12

13 Summary As we move from a PPRS arrangement to a new agreement in 2014 under value-based pricing, it was discussed what we want to achieve from a valuebased pricing agreement. Two main problems with the current PPRS arrangement were highlighted in the discussion. These are around the freedom of pricing of new drugs, which can put the NHS in the difficult position of either having to pay high prices that are not always justified by the benefits of a new drug; or else having to restrict access. Also, the current PPRS system does not promote true innovation; It encourages spend on R&D but not necessarily R&D that is truly innovative. A lot of what are called me-too drugs come out of this rather than breakthrough drugs that address areas of significant unmet need. There are several critical success factors for the new value-based pricing arrangement. We must concentrate on: 1. Patient focus, ensuring best outcomes for patients; 2. Improving access and uptake access to new drugs in the UK is often lower than in many other countries. This also has a crucial knock on effect on clinical trials; 3. Clinical trials which are undertaken against the current gold standard of medication. If that gold standard has not been adopted in the UK, the trials cannot be undertaken here; 4. Value for money - Value must be broadly defined; 5. Ensuring appropriate rewards are in place for industry, given the importance to Britain s economy; 6. Promoting innovation; 7. Transparency of system a system must be agreed between industry and government that is transparent and fair. The way in which value-based pricing is implemented is quite varied across Europe. We need to address the questions around the different methodologies for implementation. We need to ensure that the pricing assessment is predictable so that companies can plan and prioritise work on that basis. In particular we need to be clear what kind of value we mean when we talk about value-based pricing. 13

14 The balance of different factors in creating a value was a key area of discussion. We need to consider the value to patients, value to society, and value that flows from innovation. To understand what is meant by the value for society a discussion will be needed between the departments for employment, health, and business. To a certain extent this is the approach which has been followed in Sweden. We need to ensure that a new system of value-based pricing favours innovation. Assessment of value does not necessarily reward innovation. We need to encourage technology transfer from university research laboratories so that more knowledge can be shared and capitalised upon. Value-based pricing should empower doctors to be able to make treatment decisions and prescribe the appropriate drugs, allowing quick access to drugs for patients. The challenge is for a new pricing mechanism to ensure access for patients (health policy) and reward for innovation (industrial policy)? 14