News from Nowhere 81 November 2019

In a spin

Revolving doors are old hat in the NHS, which has swapped staff with big Pharma for decades. More doors are turning now, as the NHS recruits from industry and NHS managers move into an expanding commercial health sector. Also NHS senior managers can move from post to post inside the NHS without too many questions being asked about previous performance. 

An example of the first type of revolving door is David Bennett, for five years the head of the competition regulator Monitor, who has been appointed chair of Virgin Care. Virgin Care provides a range of community, public health, primary care and some specialist services for the NHS and local government. During his time at Monitor he suggested that the NHS could take a similar path to the opening up of markets for gas, electricity and telecommunications markets.  After leaving the NHS and before his Virgin post, Mr Bennett was chair of Viapath, a pathology services joint venture between Guy’s and St Thomas’ Foundation Trust, King’s College Hospital FT and Serco. The Health Service Journal described this interesting career, and its (anonymous) commentators were divided between those who thought he was “another toady who did minister’s bidding” and those who remembered him for “protecting Foundation Trusts from lots of crap coming down from Westminster. Add to that he has a brain the size of a planet – it’s no wonder he is recruited to these kinds of roles”.

The internal revolving doors cause the NHS much anxiety. Tom Kark QC made recommendations in his report into the Fit and Proper Person Test, published earlier this year, about introducing mandatory references to make clear the full extent of senior managers’ performance. The HSJ pointed out that these could lead to legal challenges and that the revolving door is not operated by ignorance but often in full knowledge of a individual’s questionable past. It concluded that the club culture for the small minority who should no longer be in director positions “will continue to find ways to operate”.

Sources: Health Service Journal Daily Insight: ‘References available on request’ October 3rd 2019, James Illman, HSJ, ‘Virgin Care hires former NHS regulator boss’ October 4th 2019

 

Roll up, roll up!

Plans for an increase in GP training places, whilst an inevitable response to staff shortages, pose a problem. It is difficult to see where the additional capacity is going to come from. Around 7,400 training places are available in the NHS each year, of which 3,250 are currently for general practice. To create the additional 1,750 we either need more medical students (which will take at least 7 years to have an impact), more medical immigration or a 40% reduction in the number of training places in acute hospitals, mental health trusts, hospices and elsewhere.

Source: Royal College of Physicians Bulletin 20th October 2019

 

Measuring quality

The Health Quality Improvement Partnership (HQIP), a charitable syndicate including the Royal College of Nursing , ‘National Voices’ and the Academy of Medical Royal Colleges, administers and publishes the national audits of NHS clinical processes and outcomes. HQIP “aims to improve health outcomes by enabling those who commission, deliver and receive healthcare to measure and improve our healthcare services”. It has a problem in that most of its money comes from NHS England, with fees paid by provider organisations in addition. There is a resource squeeze as the grant from NHSE has been reduced but the work has not. Within HQIP talk has turned towards accepting sponsorship from and entering partnerships with Big Pharma and medical device companies, prompting worries about commercial influences compromising the independence of HQIP. Let’s hope they think again.

Source cannot be disclosed.

 

A straw in the wind

The commercial sector has long been criticized for benefiting from the education the NHS provides for its professional staff, without contributing anything to it. This may be changing. Cygnet Health Care has started the first ever private sector-led Nursing Associate Apprenticeships (with the University of Wolverhampton, via the Apprenticeship Levy). Cygnet Health Care is a commercial provider of mental health services and operates over 150 centres with more than 1,000 beds across the UK. It is a subsidiary of Universal Health Services.

Source: Cygnet Health Care 20/8/19 (https://www.cygnethealth.co.uk

 

Social determinants of ill-health

Those suspicious about so-called ‘lifestyle factors’ driving the growth in chronic disease will find much to think about in PwC’s report “Action required: The urgency of addressing social determinants of health”.  PwC says social determinants of health – the social, economic and environmental factors of where we live and work – make people more prone to a slew of chronic health problems like obesity. This, in turn, can cause diabetes, cardiovascular diseases and some cancers.

So, 68% of citizens in OECD countries are forecast to be obese by 2025, while chronic diseases have risen steadily despite OECD health spend doubling. One-in-five UK citizens say they can’t afford a healthy lifestyle and a similar number said they just weren’t motivated to adopt more healthy behaviour. 79% of UK survey respondents say government is responsible for addressing social determinants of their personal health. Governments should adopt a long-term approach to reducing social determinants of ill-health, and the PwC reports suggests how short-term thinkers (politicians) can do this.

Source: the ‘Action required’ report  http://pwc.com/sdoh.

 

The Biosimilar Saga

Those who saw the Channel 4 Dispatches programme Trump’s Plan for the NHS on October 28th may have found the comments about ‘biologics’ confusing. The story is simple.  Several blockbuster biologic pharmaceuticals are going off-patent over the next five to ten years, creating opportunities for growth in the ‘biosimilar’ market. Biologics are products that are produced from living organisms or contain components of living organisms. They improve health in many complex conditions, including Crohn’s disease, ulcerative colitis, diabetes, rheumatoid arthritis, cancer, osteoporosis, psoriasis, HIV, multiple sclerosis, and growth deficiencies. The biologics include hormones, blood products, growth factors, vaccines, gene and cellular therapies, fusion proteins, insulin, interferon, and monoclonal antibody (mAb) products. Patients receive biologics by injection under the skin or by intravenous infusion and cannot take them orally, since digestion breaks down the biologic, making it ineffective. Biologics have complex molecular structures. They are produced by living cells, from highly specialized ingredients, using a complex biotechnology process. It is impossible to produce an exact copy even when using the exact same ingredients, the same living cell lines, and identical manufacturing conditions. They are expensive and tax the NHS’ medication budget.

A biosimilar is a drug that has been demonstrated to be highly similar to a particular biologic drug with no clinically meaningful differences in safety and efficacy between them. It is not an identical copy, unlike a generic drug. Approval of biosimilars for use as treatments depends on educated assumptions about extrapolating scientific evidence gathered in the licensing of the original biologic. So a biosimilar might be deemed suitable to treat a specific disease without the manufacturer testing it in that disease. Biosimilars can therefore be 15 -20% cheaper than biologics, because trials are not need to prove their effectiveness, and in effect they extend the shelf-life of the original biologic beyond the expiry of its patent. Manufacturers of biologics are therefore in favour of them. 

The global biosimilars market was valued at over $ 7million in 2018, and is expected to reach a value of $ 30,000 million by 2024. The market is expected to register a Compound Annual Growth Rate of 27.3%, during the forecast period. Several factors may be associated with the growth of the biosimilars market, but their cost effectiveness must be a major one. 

Sources: Canadian Society of Intestinal research    https://badgut.org/information-centre/a-z-digestive-topics/biosimilars-pamphlet/  and Biosimilars Market – Growth, Trends, and Forecast (2019 – 2024) 

 

Market warming

The commercial health care sector is warming up, with an increase in mergers and acquisitions since the dip in 2016. According to Alantra, a global mid-market investment banking firm, there were 88 deals (excluding pharma and medical devices) completing in the first half of 2019 compared with 98 deals completed in the whole of 2016.

 Demand for fertility services is rising significantly as fertility rates continue to fall. Businesses that offer personalised, transparent, effective and flexible treatment plans using the latest scientific and technological advancements will attract investors’ attention.

Dentistry is evolving through the actions of active trade buyers (such as Bupa). Private equity has also been active in this space with recent deals such as G Square Healthcare Private Equity’s acquisition of the UK-based Dental Care Group.

The social care market is facing inescapable pressure from evolving demographics. Commissioners are continually looking for new solutions, with the optimum situation being able to care for patients effectively in the home. Businesses offering personalised, affordable and clinically-led care solutions in the home are strongly placed to become the partner of choice for local authorities, the NHS and self-paying individuals desiring greater independence. No surprise, then, that Sodexo, the international facilities management group, recently acquired The Good Care Group to expand its live-in care operations in the UK and to offer home care solutions to consumers with complex care needs.

The already-lucrative veterinary market is also changing. Pet owners increasingly want a one-stop supplier of products, solutions and personalised medicines that will meet the specific needs of their pets. This consumer demand is filtering into the market, as is exemplified by private equity investor EQT’s recent partnership with Nestle’s expertise in animal health and nutrition.

Source: Alantra (www.alantra.com)

 

Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/

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