News from Nowhere 72 Nov. 9th 2018

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Big Pharma bounces back?

The UK economy may be sluggish after the 2008 recession but Big Pharma continues to grow, worldwide, with overall R&D spending in the pharmaceutical / biotechnology sector growing from around $128 billion in 2008 to $158 billion in 2017. The industry is seeking to mitigate the risks associated with novel drug discovery programs, to avoid costly failure. Over the years, the predictive power of computer-aided drug discovery (CADD) has proven to be extremely advantageous, allowing researchers to bypass the random screening of billions of molecules across hundreds of biological targets.

Driven by the rising number of drugs in the discovery stage across various therapeutic areas, the market is expected to continue on its growth trajectory for the foreseeable future. The CADD market is expected to grow at an annualized rate of ~12.4% between 2018 and 2030. The therapeutic areas expected to capture a significant fraction of the market by 2030 are:  oncological disorders (46%), neurological disorders (13%), immunological disorders (7%) and infectious diseases (6%).

Source:  Biotechnology Update 6/11/18

Trolley waits

The BMA has produced a report on waiting times in A&E departments, claiming that there is now an all-year round crisis. The analysis is based on an examination of data released each month by NHS England that shows the level of pressure on emergency care services. The BMA examined three key measures: emergency admissions; trolley waits of more than four hours (i.e. the time spent between the decision to admit and admission); and the percentage of A&E attendances which were completed within four hours.

The main points of the BMA report are:

  1. The current crisis
  • In a snapshot of three summer months of 2018 (July to September), 125,215 patients were left waiting on a trolley for more than four hours after the decision to admit, a figure that was greater than every winter (defined as January to March) between 2011 and 2015.
  • The figures were not far behind the last three winters, which registered increasing numbers of patients stranded on trolleys at 155,277 in 2016, 177,012 in 2017 and a record 226,176 in 2018.
  • Compliance with the waiting targets for patients to be seen in A&E, also set at four hours, were lower in the summer of 2018 than the winters of 2011 to 2015, with new lows recorded in the last three winters.
  1. Comparing winter 2011 and winter 2018 (January to March)
  • Compliance with the four-hour waiting time to be seen, admitted or discharged from A&E reduced from 96.6 per cent to 85.0 per cent.
  • Total trolley waits of longer than four hours increased from just 29,636 to 226,176, a seven-fold increase.
  • Total emergency admissions increased from 1,290,056 to 1,529,087, a rise of 19 per cent.
  1. Comparing summer 2011 and summer 2018 (July to September)
  • Average A&E four hour wait compliance reduced from 97.3 per cent to 89.3 per cent.
  • Total trolley waits of longer than four hours increased from 18,095 to 125,215, a six-fold increase.
  • Total emergency admissions increased from 1,247,113 to 1,558,691, a rise of 25 per cent.

Ominously, the NHS Confederation, speaking for senior management across the service, endorses the BMA view and hints at tough choices, saying:

“Patients rightly expect shorter waiting lists but the NHS cannot keep pace with the demands on it and before long the extra money which has been promised for the NHS will be spent many times over.  The truth is we face some tough choices and this is a service that cannot do everything. Our biggest threat at the moment is raised expectations…the biggest challenge is to develop new types of care which will help support patients in their own homes and in the community, and so relieve overstretched hospitals and, more importantly, relieve suffering. It seems likely we are about to face yet another difficult winter and the reality is come winter, spring, summer, or autumn, the NHS has not been able to meet key performance targets since 2015. We welcome the Secretary of State’s commitment to investing in primary and community care but the immediate funding for social care on which so much depends remains grossly inadequate. And we need to start this debate with some realism about what the NHS can and cannot do.”

Source: A full list of NHS Confederation press releases and statements can be accessed at its media centre


Fire service rescues NHS Trust

Worcestershire Acute Hospitals Trust is planning an enhanced hospital to home service, seven days a week, using Hereford and Worcester Fire and Rescue Service to support safe early discharge of patients who may need additional help to settle them back home but not require any in-home care. The fire service has already agreed to provide this support for six months free of charge, to identify the exact requirements of such a service in the future. News from Nowhere’ s moles will watch this pilot with interest. How many patients will fit the category of needing additional help, but only through the discharge process?

Source: Ben Heather HSJ  8th November 2018


Mind the gap!

Bidwells, a property consultancy and management company, argue that despite growing student enrolments in fields like computer science and technology, new jobs in these high-growth sectors still outweigh the number of skilled workers to fill them. The size of the gap for health and social work (see the chart below) sums up the NHS’s current dilemma.

Source: (sector vacancies outstrip student enrolments). Sources for the statistics mentioned are from ONS, Tech Nation, Open University Businesses, British Chambers of Commerce, The London Datastore and Bidwells.


Brexit and the health & social care workforce

A new report commissioned by a coalition of 36 health and social care organisations (The Cavendish Coalition), suggests that the NHS could be short of 51,000 nurses – enough to staff 45 hospitals – by the end of the Brexit transition period. The report ‘Brexit and the Health and Social Care Workforce in the UK’  by the National Institute of Economic and Social Research (NIESR) also highlights the increasingly important role European Economic Area nationals are playing in UK social care services. 

The NIESR report – commissioned by the Cavendish Coalition – forecasts a potential shortfall of around 5,000 to 10,000 nurses in the NHS in England by 2021. That is on top of existing vacancies, which stood at 41,722 (11.8% of all positions) at the end of June, the latest period for which NHS Improvement figures are available.

Meanwhile, between 2011 and 2016, the number of EEA nationals employed in social care grew by 68 per cent, or 30,600 people. There were 42,000 registered nurses working in adult social care in England in 2017, with almost a third of registered nurses (32.4%) estimated to have left their role within the past 12 months. It meant a vacancy rate of 12.3%, equivalent to around 5,000 vacancies at any given time.

While it is anticipated there will be provision for doctors and nurses coming to the UK after Brexit, if the government follows the guidance of this autumn’s Migration Advisory Committee report, there could be significant implications for the social care workforce in particular. Health and social care relies heavily on staff from the EEA and the rest of the world. The Cavendish Coalition is warning that the future immigration system must enable the health and social care system to continue to attract the brightest and best from the EU and the rest of the world if health and social care services are to be appropriately staffed after Brexit.

Source: A full breakdown and explanation of the recommendations in the NIESR report can be found here. The executive summary can be found here.


Convergence in a crisis

The Academic Health Economists’ Blog ( is always worth a look. It picked up an interesting study which combined OECD data for 34 countries from 1970-2016 with the Database of Political Institutions, allowing an analysis of government ideology and health service spending. The more left-wing the government the higher public spending on health care was, but only in the period before the crisis of 2007/8. Before the crisis coalition governments spent more, while governments with more years in office spent less. These effects also disappeared after 2007/8. Throughout the whole period, governing parties with a stronger majority tended to spend less on health care. Proximity to elections did not appear to influence spending. Why did left-wing parties and right-wing parties converge? The authors suggest that it’s because adverse economic circumstances restrict the extent to which governments can make decisions on the basis of ideology.

(Bellido H, Olmos L, Román-Aso JA. Do political factors influence public health expenditures? Evidence pre- and post-great recession. Eur J Health Econ. 2018 Oct 24.

doi: 10.1007/s10198-018-1010-2.)

Source: Chris Sampson’s journal round-up for 5th November 2018


It is an ill wind that blows nobody any good

Lots of GPs seem to be surviving by employing sessional and locum doctors. It is a seller’s market. For example, Primary Care Medical Chambers has excellent ‘off-market’ opportunities available for locum GPs who like or are willing to travel, to fill empty posts in general practice. The exclusive packages available to travelling doctors start from ‘1 week taster bookings’ paying the locum £4,000 per week to 12 month long term bookings paying locums over £200,000 a year. Further incentives include accommodation being fully paid by the Chambers, along with expenses and monthly cash bonuses.

Source: Primary Care Medical Chambers 27/10/18


Baling out?

Medic Footprints is a social impact business that helps doctors leave conventional medicine and find new opportunities within the wellbeing industry. It was founded by dissatisfied NHS doctor Abeyna Jones, an Occupational Medicine Physician. Abeyna and her team have since helped doctors find new opportunities with companies such as ITV, Virgin and Deloitte. Medic Footprints points out that:

 The suicide rate for doctors has been estimated at up to five times that of the general population.

  • Royal College of GP’s survey in 2017 found that 39% of GP’s think they’re unlikely to be working for the NHS in 5 years’ time..
  • Despite doctors leaving the NHS in numbers, the government has focused on increasing medical school places by 25%, rather than on retention.

Source: Rae Rose Communications 22/10/18


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