21 July 2015
The Department of Health (DH) annual report for 2014-15 has just been released. This sets out the all-important financial data alongside an overview of performance against three themes:
Living and ageing well
Priorities within the ‘living and ageing well’ theme are said to have been helping people to live healthier lives, achieving better integration of health and care (including care outside hospitals), reforming social care and improving care for the elderly and improving care for those with dementia. Achievements highlighted include efforts to tackle antimicrobial resistance, combat smoking and increase provision of vaccination and screening.
The ‘caring better’ theme priorities are said to have been’ improving the quality of care and the use of technology’, rebalancing ‘parity of esteem’ between physical and mental health, and encouraging greater openness. Highlights include the work of the Care Quality Commission, the introduction of the new NHS Friends and Family Test to improve patient experience, and the ‘Technology Revolution’ - using technology and information more effectively across the health and care system, including supporting people to manage their own healthcare.
Preparing for the future
Preparing for the future is the theme that seeks to ensure that the health system remains able to meet future demands whilst maintaining quality of and access to care. Not surprisingly given the 2014 creation of the post of Minister for Life Sciences sitting across the Department for Health and the Department for Business, Innovation and Skills, contribution to economic growth is a significant feature. Highlights include new investments in life sciences and the review of how medicines and medical technology are developed, as well as provision of ‘a world-class research infrastructure in the NHS and partner universities’.
Specifically, the report claims that the DH has ‘increased the pace of translating leading-edge research into patient benefits’, citing the creation of the National Institute Health Research (NIHR) Bio Resource and Rare Diseases Translational Research Collaboration.
The report of the Secretary of State for Health concludes (perhaps inevitably?) that the DH has performed well overall, with life expectancy rates rising to 88.3 years and 86.5 years for women and men, respectively and an improving picture of patient safety. However, it identifies health inequalities as a ‘long-standing challenge’ and promises closer alignment between the three current outcomes frameworks for the NHS, public health and adult social care. A variable picture is also reported in terms of care quality, patient experience and quality of life.
A dangerous disconnect?
The Department of Health appears to be generally well aware of the challenges it faces, not least the apparently inexorable rise in demand for services. However, the report shows no apparent shift in the long-standing belief that investment in research necessarily produces concomitant patient benefits. Good quality translational research is, of course, essential, but the danger remains in the belief that a good ‘proof of concept’ trial equates with successful clinical implementation. This may arise in part from the traditional process of drug development, whereby the clinical trial is a crucial staging post on a well signposted (albeit arduous) journey to drug approval and uptake. Fortunately, there is growing recognition that medical technology has rapidly outpaced the medicines and devices model to include digital devices and apps and new forms of diagnostics.
However, a potentially dangerous disconnect remains between the work of innovators and pioneers, and the providers of everyday health services across the country. The champions of new treatments, diagnostics and medical technologies rightly receive funding to develop and test their innovations. There is increasing awareness of the importance of the NHS working with academia and industry in this respect, and a welcome new focus on regulatory drivers and barriers, increasing the chances that medical innovations will succeed.
Nevertheless, too little money or attention has been given to efforts to make innovations available in everyday clinical practice throughout the NHS. This is actually another form of health inequality, since it results in patients in selected areas having access to expertise and tools significantly ahead of those in other areas.
Ensuring access for all
Much will depend on the outcomes of the current Accelerated Access Review, due to be complete within the next few months; the scope for this review includes, encouragingly, issues of uptake, but will this look at ensuring uptake by health commissioners and professionals nationwide, or only by selected enthusiasts? Plans for review of issues relating to adoption and diffusion of transformative technologies by decision-makers are promising signs. Meanwhile, perhaps another rebrand to the Accelerated Access for All Review would help to keep this in mind.
The PHG Foundation is contributing to the Accelerated Access Review as part of its Health Innovation Manifesto infrastructure goals.