NHS ‘must not cut back on technology’

A new NHS Confederation paper recently gave a sober assessment of a future of tightening funding and difficult spending decisions for the NHS. Dealing with the downturn states that, in just under two years, the NHS will face the most severe constriction ever in its finances, with an £8-10 billion real terms cut likely in the three years from 2011. Steve Barnett, chief executive of the NHS Confederation, commented: “The levels of growth seen over recent years are at an end and, despite the relatively strong budget settlement for 2009/10, there are tough times ahead. If the NHS is to continue to deliver high quality care, in an environment with little or no growth and rapidly rising demand, even more significant efficiencies will be needed.” According to Health Minister and pioneering surgeon, Professor Lord Darzi of Denham, creating a culture of innovation will play an essential role in helping the NHS to meet the current economic challenges. Commenting at the Department of Health’s Innovation Expo, held at Docklands, London, he said that leaders must be more sympathetic to risk takers who want to use innovation. Achieving this “mindset change” will be one of the biggest challenges facing the NHS, in his view. Nevertheless, central investment in developing innovation is at an all time high, he claimed, commenting: “We have never seen such levels of investment in R&D. Nearly £1 bn has been invested by the National Institute of Health Research, while £700 m is being spent by the research councils.” Lord Darzi also called for more “intelligent commissioning” based on healthcare outcome data. “We are witnessing the best commissioning for innovation that healthcare has ever seen in infection control,” he stated, adding that those who take risks should be rewarded for changing their practices. He highlighted the fact that the Department of Health has introduced a £220 m Innovation Fund, but pointed out that the entire £100 bn spent on healthcare in the NHS annually should be viewed as the “fund for innovation”. “I am not going to tell you what to do, but I will tell what not to do in relation to innovation and the recession,” he continued. “The advice is the same for all public sector services: in times of recession, do not lose your talent and do not cut back on technology. “In times of recession, do take risks, but take managed risks; encourage innovation and service developments; do not retreat to the command and control section; and do not retreat from collaboration.”

 Taking cost out of healthcare

 Dr Stephen Oesterle, senior vice president for medicine and technology at Medtronic, also addressed the theme of economic challenges throughout his presentation, discussing how medical device innovation could take cost out of healthcare – both now and in the future. “The biggest threat to healthcare systems around the world is the onset of an ageing population with chronic degenerative diseases. Our bodies were not designed to last to 80-90 years of age. In addition to spine and vascular degeneration, neurological degeneration is going to be one of the greatest issues faced by the NHS in the next 20 years. The cost of delivering healthcare must decrease or we will face bankruptcy,” he commented. “There is expected to be a doubling of the population of people over 60 in G8 countries over the next 30 years. To put this into perspective, by 2030, nearly half of all Americans will have a chronic condition requiring therapy – from coronary artery disease and kidney disease, to obesity and diabetes. “Chronic conditions account for around 83% of healthcare spending. The level of spending required to deal with rising demand is not sustainable, presenting a huge challenge,” he continued. Dr Stephen Oesterle raised a number of questions: “How can we prepare for this ageing population?”, “Where will the money come from?” and “Should we wait for patients to develop chronic disease before we treat them?” Addressing these issues, he warned: “We cannot just keep ‘adding on’ new technologies and therapies. We should be looking at prevention and restoration of tissues.” In his opinion, understanding the genetic basis for chronic degenerative diseases will be key. One of the themes for the decade will be “personalised” medicine, which will replace “population” medicine in his view. In the future, genomics and proteomics will have an important role in taking cost out of the healthcare system. Biologics and gene therapy could be used to pre-empt and prevent cardiovascular disease, for example, enabling clinicians to make accurate decisions on exactly who should receive therapy. “Rather than treating a thousand people with the view that this will save three lives, it will be possible to decide exactly who would benefit and who would not,” he explained. Statins were cited as one example where treatment is widely administered despite the fact that many patients do not benefit. In the future, targeting individuals who would actually benefit from therapy, using genomics, would be more cost effective. “One of biggest opportunities in healthcare is to replace much of what we do with biotechnology. There is no question that biologics will replace pharmaceuticals in the next 20-30 years and the UK and the US are currently leading the way,” he continued. Delivery devices, such as catheters for example, will have a major role, in his view. He added that, in the future, restoration will replace palliation. At present, implantable devices, such as stents and valves, lessen the symptoms of chronic degenerative conditions but do not offer a cure. Biologics, on the other hand, offer the promise of a cure or restoration.