NHS finances – Demands and
Challenges!
Or Cause and Effect In Hospital
Pharmacy Procurement
Ian Bourns
Director of Medicines Management and
Pharmacy
East Sussex Healthcare NHS Trust
Presentation
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What is Causing Change
What Effects are Happening
The Healthcare Impact
The Pharmacy and Medicines Impact
The Medicines Procurement Impact
Summary
Causes
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Lower Funding Growth & Inflationary
Pressures
Demographics
Social & Political Demands
Technological Developments
Information Developments
Lower Funding Growth and
Inflationary Pressures – WHY ?
Lower Funding Growth and
Inflationary Pressures
Causes - Demographics
• Ageing population
Approx 15%
Approx 24%
Causes – Social and Political
Demands
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Access to Treatment
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Patient Experience
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18 week RTT
A&E 4 Hr Max waits
Care closer to home
Safety
Respect
Convenience
Involvement
UK PLC Income and R&D Spend from Pharma
Causes – Social and Political
Demands
• UK PLC income from Pharma
Causes – Social and Political
Demands
• UK PLC income from Pharma
Causes – Social and Political
Demands
• UK PLC R&D Spend from Pharma
Causes – Social and Political
Demands
• UK PLC - R&D Spend from Pharma
(Reuters – 2nd Feb 2011)
Pfizer to shut major Sandwich site,
home of Viagra
Pfizer Inc is to close its research and development
centre in Sandwich, southern England, which
employs 2,400 people, dealing a major blow to
Britain's scientific jobs base
(Pharmaceutical Field – Nov 2011)
More jobs saved at Pfizer Sandwich
site
About 650 jobs will be saved at Pfizer’s R&D
plant in Sandwich, Kent – 300 more than
previously announced in June
(Telegraph – 3rd Feb 2011)
David Cameron blasted over closure
of Pfizer Viagra site
Labour have accused David Cameron of having
“no strategy for growth”, following this week’s
surprise decision by US group Pfizer to close
a major research and development base at
Sandwich in Kent.
Causes – Technological
Developments
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New Medicine
Gene therapies
New Administration Technologies
Biofeedback Technologies
Automation
Will provide improved care outcomes
All breed higher patient expectation and
demand
Causes – Information
Developments
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Detailed Costing
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Service Line reporting
Patient Line reporting
Ability to assess if income and costs
balance
Linking Data Sources
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Outcome Analysis
Potential ability to see if promised benefits
are gained
What Effect Follows ?
Social / Political
Demands
Demographics
Financial
Pressures
Technological
Developments
Nicholson
Challenge £20B
&
QIPP
Information
Developments
Lower Funding and Inflationary Pressures
Nicholson “4 Year” Challenge
NHS faces 'decade-long savings drive'
BY NICK TRIGGLE HEALTH CORRESPONDENT, BBC NEWS
21st March 2012
THE NHS FACES A DECADE-LONG SAVINGS DRIVE,
MANAGERS BELIEVE.
THE WARNING FROM THE NHS CONFEDERATION CAME
ON THE DAY OFFICIAL WORKFORCE FIGURES SHOWED
NURSING POSTS HAD FALLEN BY 1% IN THE PAST YEAR.
IT COMES DESPITE PROMISES BY MINISTERS THAT THE FRONTLINE
WOULD BE PROTECTED DURING THE EFFICIENCY DRIVE.
What Effect Follows ?
Social / Political
Demands
Demographics
Need For
Cultural
Change
Technological
Developments
Information
Developments
NHS Constitution
&
CQC Focus on
Patient Dignity
and Experience
What Effect Follows ?
Social / Political
Demands
Demographics
Safety &
Experience
Improvements
Technological
Developments
Clinical Guideline
Development,
Professional
Obligations
&
Regulatory Force
Information
Developments
What Effect Follows ?
Social / Political
Demands
Demographics
Need To
Prove Value
For Money
Technological
Developments
Outcomes Analysis
&
Value Based Pricing
Information
Developments
Lower Funding and Inflationary Pressures
POLICY EFFECTS
POLICY EFFECTS
EFFICIENCY SAVINGS
cutting “back office” management,
limiting staff pay and pensions,
selling assets,
rationalising procurement
and drugs purchasing,
and re-aligning the NHS IT programme.
POLICY EFFECTS
PREVENTION AND PRIMARY CARE
Arguments for early intervention
and care “closer to home”
often highlight the savings
from avoiding hospital admissions,
as well as the benefits for patient care
If the NHS provides more care in
community settings and reduces
the use of hospital services,
then there will need to be substantial
reconfiguration of services,
POLICY EFFECTS
IMPROVING CLINICAL EFFICIENCY
As NHS funding tightens,
another option is to try to target
resources on clinical interventions
that optimise health outcomes
The King’s Fund has suggested money
could be saved by reducing the
length of stay in hospitals
and using lower cost drugs.
Healthcare Impact
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Redesign
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Smaller acute hospitals
Planning by Pathways
Long term condition management
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Community led
Clinical networks across health economies
Increased focus on outcomes and value
for money
Pharmacy and Medicines Impact
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Hospital, Community Health and Community
Pharmacies working in a networked way to:
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Access scarce expertise
Reduce clinical risks and hospital admissions
More focus on cost benefit analysis of new
medicines
Outcomes of medicine use assessed in the real
world after licensing:
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Assess clinical benefit against drug cost
Assess healthcare resource use against drug cost
Confirm continued or expanded use
Hospital Pharmacy and Medicines
Impact
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Homecare Expansion
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Reduced costs
Patient convenience and experience
?? How do we gain assurance about safety,
optimum outcomes and service quality ??
Medicines Procurement Impact
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Hospital
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Reduce stock holding and process costs
Greater use of ICT in purchasing
Greater use of automation
Even more joint working between Trusts
Divestment / subcontracting of services
Increased risk assessments of all processes
Medicines Procurement Impact
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Schizophrenic role for Chief Pharmacists
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Support introduction of new high cost
drugs to support Pharma and UK PLC ?
Reduce drug spend ?
Medicines Procurement Impact
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Manufacturers / Suppliers
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Performance management & KPIs
Improved supply chain failure management
Joint planning about options for supply
chain restructuring
Clinical trials that assess impact on NHS
resource use as well as clinical
effectiveness
Joint work to assess the outcomes of use
of a drug in the “real world” along a whole
care pathway
Summary
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Change factors affecting the NHS will impact on
hospital pharmacy and medicines procurement
but some appear to be in conflict
The pressures for change affect both the NHS
and Pharma
To manage that
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The supply chain needs to be optimised
We need to be able to demonstrate clinical and
resource use value for money from buying medicines
We can only do that by working together