2020health at Conservative Party Conference 2010: A summary of 2020health's Fringe Events Contents

2020health at Conservative Party Conference 2010: A summary of 2020health's Fringe Events Contents
2020health at Conservative Party Conference 2010:
A summary of 2020health’s Fringe Events

Elderly Care: Are we failing? ........................................................................ 2
Pre-hospital care – Why the NHS is not fit for purpose ............................... 4
Combating Stress – the hidden injury of mental illness............................... 7
Why the NHS needs to be transformed by technology ............................... 9
Pricing Medicines – Can we deliver value to patients and industry? ......... 12
2020health Event
                              Conservative Party Conference fringe event

                        Elderly Care: Are we failing?
                                   12.30 - 2.30pm Sunday 3rd October
                                      Hall 7, The ICC, Birmingham

 Chris Skidmore MP (chair)         Health Select Committee
 Julia Manning                     Chief Executive                     2020health
 Helena Herklots                   Services Director                   Age UK
 Victoria Fletcher                 Health Correspondent                Daily Express
 Imelda Redmond                    Chief Executive                     Carers UK

Key points

       Probable decreases of social care budget are a concern
       Elderly people should not be sidelined when receiving health care
       Carers continue to give a lot to the elderly
       We need to do more as individuals and as organisations to promote the well-being of the elderly


                                                          In this event we discussed how we treat the
                                                          elderly, both as individuals and as a country, and
                                                          what we can do to improve that treatment.

                                                          At first the discussion focussed around the likely
                                                          cuts in the social care budget. Whilst the NHS
                                                          budget has been ring-fenced, the social care
                                                          budget has not. This does not seem to make
                                                          sense, since the failure of social care will lead to
                                                          many more people in A&E. It is not clear how
                                                          health and social care will interact in the future,
                                                          and how the integration of these disciplines would

Are we failing in how we care for the elderly? The elderly need the same standard of treatment and care
given to the rest of the population. Stories of malnourishment in hospital and elderly people dying from cold
and hunger in their homes show how we are failing our elderly. Even in social care, the trend is towards
rushed 15-minute visits with no time for the care-
worker to treat the client as an individual. In some
ways the NHS appears to be institutionally ageist
– however this policy should be publicly debated,
rather than quietly introduced.

One of the sectors of the population not failing
the elderly are the carers. The number of people
providing care for more than 50 hours per week is
increasing. In general families are not failing their
relatives, despite living further away, making
visiting more difficult

What can we do?

    -   Make time for elderly people including friends and relatives
    -   With 2020health, raise the status and improve the appreciation of the elderly
    -   Benefit from the experience of the elderly, who are coming towards the end of life’s adventure
    -   Make use of telecare and telehealth
    -   Become advocates for elderly care at a local level, through Healthwatch
    -   Highlight elderly care issues through the media

2020health Event
                                Conservative Party Conference fringe event

Pre-hospital care - Why the NHS is not fit for purpose
                                      5.45-7.00pm Sunday 3rd October
                                        Hall 7, The ICC, Birmingham

 Gail Beer (chair)                   Consultant Director                   2020health
 Nadine Dorries MP                   Health Select Committee
 Dr Phil Hyde                        Consultant Paediatric Intensivist     Southampton
 Barry Johns                         EMS Consultant                        CranmerLawrence
 Lois Rogers                         Specialist health contributor         The Sunday Times

Key points

       Pre-hospital critical care is known as an area for improvement
       The emphasis is on pre-hospital critical care and not just pre-hospital care. The latter term would
       encompass all that occurs to a patient outside of hospital, whereas the former is provided only to
       patients who need it (as they are critically ill) and can only be provided by a doctor and skilled
       Ensuring the professional transfer of life saving skills that patients need for their journey.London is
       the only region where good quality pre-hospital care is commissioned and funded by the NHS. Other
       regions need to put in place provision based on their population.We should address the culture of
       cover-up within the NHS, acknowledging that it is a complex subject which requires careful and open
       Pre-hospital critical care impacts on time taken for rehabilitation
       There is international evidence supporting reduced intensive care bed stays for patients who have
       received pre-hosptial critical care.
We would like to Thank the sponsors of this event, Cranmer Lawrence


Pre-hospital critical care is one of the known areas of deficit in the NHS. Outside of London, many critical
                                                            injuries are not dealt with until the patient arrives
                                                            in hospital. In March 2010 the department of
                                                            health produced guidance about how
                                                            improvements could be made in this area, however
                                                            this guidance has not been widely implemented.
                                                            Although the lack of improvement could be due to
                                                            the major changes occurring in the NHS at this
                                                            time, this could be a future field of inquiry for the
                                                            health select committee.

                                                            International best practice for critical injuries

    -       access to emergency service
    -       quality of response, quality of care taken to patient
    -       Projecting skills of A&E doctor and registered paramedic to incident to deliver care immediately,
            ensuring that a hospital standard treatment is brought to the patient.
    -       taking patients to centres of excellence
    -       Less rehabilitation and a quicker return to normal life

Describing pre-hospital care as taking skills from A and E makes it sound like we are removing doctors from
the hospital. Rather it is hospital standard treatment which is brought to the patient. It is projecting the life
saving skills that patients need forward in their journey. The military already achieve this very effectively in
Afghanistan and consequently their survival figures eclipse those within the NHS.

The Clinical Advisory Group on Trauma highlighted the obvious skills overlap between MERIT requirements
and provision of accessible pre-hospital critical care. One solution to the current absence of pre-hospital
critical care provision may be to combine funding streams for MERIT (Major Emergency Response and
Incident Team ) and pre-hospital ‘enhanced care’ provision to ensure a regional 24/7 pre-hospital critical
care support capability. MERIT’s stated remit encompasses any incident with critically ill or injured patients
whose care requirements exceed the capability of the ambulance service. This would meet day to day
ambulance demand while also acting as the first medical component of a response to a disaster. Innovative
integration of our national need for pre-hospital critical care and major incident provision could provide the
economic efficiency required for development of the pre-hospital ‘enhanced care’ component of our newly
developing trauma systems.

There is an inequity of care provision across the country and London is best served, but their model would
not suit every region. The principle of improving care is based around the patient and not the region.
Critically injured and ill patients deserve life saving care that begins as soon as possible and London has
achieved that for their particular social and physical geography. In London, the best served region for pre-

hospital critical care, a team of a doctor and a paramedic attend the patient by the roadside. In the case of a
head injury an anaesthetic can be administered to reduce the metabolic rate, and a tube used to facilitate
breathing. These interventions can be done before the patient reaches hospital, thus providing early

Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured
patients with pre-hospital care. There is wide geographical and diurnal variability in availability and
utilisation of physician based pre-hospital critical care support. Only London Ambulance Service has access
to NHS commissioned 24 hour physician based
pre-hospital critical care support. Throughout
the rest of the UK, extensive use is made of
volunteer doctors and charity sector providers
of varying availability and capability.

We should also not forget the cost-
effectiveness arguments. Since there may be
an extended recovery through the delay in
care, it could be more cost-effective to provide
treatment at the roadside where necessary.

The culture of cover-up of malpractice was discussed. To encourage change, we need to complain publically
about problems with the health service and have an open dialogue. The media can assist with publicity of
adverse events.

2020health Event
                               Conservative Party Conference fringe event

    Combating Stress – the hidden injury of mental illness
                                Sonata Room, Hyatt Regency, Birmingham
                                    8.00-9.30am Monday 4th October


 Dr Jonathan Shapiro (chairman)     Consultant Director                  2020health
 Andrew Selous MP                   PPS to Iain Duncan Smith MP
 John Glen MP                       Defence Select Committee
 Lt Col Peter Poole MBE             Director Strategy, Policy &          Combat Stress
 James Forsyth                      Political Editor                     The Spectator

Key points

       High levels of mental illness in the armed forces.
       Stigma associated with mental illness means a delay in accessing help.
       Need to raise awareness of resources available.
       A better mental health service is needed for the population as a whole and getting the services right
       for the forces should provide a template for the rest of the population.


                                              Many points were made which were relevant to mental illness
                                              across the population but the discussion centred around the
                                              ‘case study’ of mental illness resulting from time spent in the
                                              armed forces. Ex-service personnel are known both for high
                                              levels of mental illness, together with a reluctance to seek
                                              help. This reluctance may stem from the training received in
                                              the services, where self-sufficiency is highly valued.

                                             The first main issue discussed was the stigma associated with
                                             mental illness. This stigma means that many of those who had
                                             been diagnosed with mental illness are reluctant to admit to
                                             the difficulties that they experience. In addition, many who
                                             might benefit from help of this kind do not visit a doctor and
therefore cannot be treated. In many professions, including in the armed forces there is a fear for ones
continued reputation and career if one admits to mental health problems.

Secondly there is the need for more resources to tackle the problem of mental illness, to support both those
affected, and their families. In this area
we can learn from the work of the
Veteran Affairs in the United States. In
the UK, Combat Stress have been
tackling mental illness in ex-military
personnel for over 90 years, working
together with the NHS to deliver
mental health services in line with best
practice and NICE guidelines. However
with the increased deployment of
troops, an increased incidence of
mental health problems is expected.

Peter highlighted the need to raise
awareness of the resources available both through the NHS and through organisations such as Combat
Stress. On average it takes 14 years for those in need of help to reach Combat Stress. In addition help is
often needed for the families of those affected. In the case of a member of the armed forces returning
home, the family often have very little understanding of what has gone on. It is not just ex-service men and
women who experience mental health problems - a better mental health service is needed for the country
as a whole. By initially concentrating on the armed forces, we may be able to begin to improve mental
health services across the population.

2020health Event
                                Conservative Party Conference fringe event

Why the NHS needs to be transformed by technology
                               Drawing Room, Hyatt Regency, Birmingham
                                   12.30 – 2pm, Monday 4th October


 Julia Manning (chair)               Chief Executive                   2020health
 Rt Hon Stephen Dorrell MP           Chairman                          Health Select Committee
 John Cruickshank                    Consultant Director               2020health
 Dr Clare Gerada MBE FRCP FRCGP      Chair Elect of Council            Royal College of General
 John Murray                         Business Development Manager –    Vodafone
                                     Public Sector

Key points

       -     IT and telehealth solutions are needed to improve efficiencies within the NHS and increase
             capacity for treatment
       -     Despite the reluctance for change there are many benefits to using IT in healthcare
       -     Telehealth needs to be driven forward from pilots to a mainstream approach. Government, NHS
             and industry need to work together to develop solutions

                       We would like to Thank the sponsors of this event, Vodafone


This discussion addressed both NHS IT in general and
focused more closely on telehealth, a subject on which
a report will shortly be published by 2020health.
Whilst we need to avoid the pitfalls from the National
Programme for IT of assuming that we need a
national-only solution to the IT programme, there are
many benefits that can be achieved through the use of

Benefits of IT that were mentioned include:
        - Facilitation of measurement and
             publication of healthcare outcomes
        - Improving the linkages between different
             parts of the NHS and with social care
        - Management of long term conditions
             through telehealth
        - Transfer of notes between GP practices
        - Choose and book – speeding up making

There is a problem with the reluctance to change to
new ways of practice which includes all new
technologies such as IT systems and telehealth.
Change has never been well accepted and there are
still 3 GP practices in the country that still don’t use

What can we do to drive telehealth forward?
  - A clear policy commitment and support are
       needed from government
  - Removing blocks such as regulation and
       improving national infrastructure and
  - Central guidelines for commissioning,
       governance, ethics
  - Industry need to develop models to reduce
       cost, such as risk sharing models

How should we progress with healthcare IT?
   - Need to move forward slowly, applying simple solutions. NHS staff need really simple, effective
      tools that work.

-   Need to be able to plug into the work of the individual in developing their own health information.
    This may be done through telehealth or online solutions, but these need to be able to be used by the
-   Need to reuse what national programme has left us – not waste what has already been done.
-   Need to look at 40-60% solutions, which are not too expensive and not restricted to one technology
    platform, rather than an optimum solution. The constant development of technology mean that an
    optimum solution can never be found.

2020health Event
                                 Conservative Party Conference fringe event

                   Pricing medicines:
      Can we deliver value to patients and industry?
                                      7.30-9.00pm, Monday 4th October
                                      Marquee 6, The ICC, Birmingham

 Julia Manning (chair)                Chief Executive                    2020health
 Earl Howe                            Parliamentary Under Secretary of
                                      State for Health
 Dr Panos Kanavos                     Senior Lecturer                    London School of Economics
 Richard Ascroft                      Corporate Affairs Director and     Lilly UK
                                      Senior Director
 Hilary Tovey                         Policy Manager                     Cancer Research UK

Key points

       -     Need a clear system which is transparent and fair
       -     Need a broad definition of ‘value’ to incorporate all societal aspects
       -     Need a system that favours true innovation
       -     Need to recognize that without improved coverage and uptake, future development and trials in
             the UK are jeopardized

             We would like to Thank the sponsors of this event, Lilly


As we move from a PPRS arrangement to a new
agreement in 2014 under value-based pricing, it was
discussed what we want to achieve from a value-
based pricing agreement.

Two main problems with the current PPRS
arrangement were highlighted in the discussion.
These are around the freedom of pricing of new
drugs, which can put the NHS in the difficult position
of either having to pay high prices that are not always
justified by the benefits of a new drug; or else having
to restrict access. Also, the current PPRS system does
not promote true innovation; It encourages spend on
R&D but not necessarily R&D that is truly innovative.
A lot of what are called ‘me-too’ drugs come out of
this rather than breakthrough drugs that address
areas of significant unmet need.

There are several critical success factors for the new
value-based pricing arrangement.

We must concentrate on:

    1. Patient focus, ensuring best outcomes for
    2. Improving access and uptake – access to new
       drugs in the UK is often lower than in many other countries. This also has a crucial knock on effect on
       clinical trials;
    3. Clinical trials which are undertaken against the current gold standard of medication. If that gold
       standard has not been adopted in the UK, the trials cannot be undertaken here;
    4. Value for money - Value must be broadly defined;
    5. Ensuring appropriate rewards are in place for industry, given the importance to Britain’s economy;
    6. Promoting innovation;
    7. Transparency of system – a system must be agreed between industry and government that is
       transparent and fair.
The way in which value-based pricing is implemented is quite varied across Europe. We need to address the
questions around the different methodologies for implementation. We need to ensure that the pricing
assessment is predictable so that companies can plan and prioritise work on that basis. In particular we
need to be clear what kind of value we mean when we talk about value-based pricing.
The balance of different factors in creating a value
                                                       was a key area of discussion. We need to consider
                                                       the value to patients, value to society, and value that
                                                       flows from innovation. To understand what is meant
                                                       by the value for society a discussion will be needed
                                                       between the departments for employment, health,
                                                       and business. To a certain extent this is the approach
                                                       which has been followed in Sweden.

                                                       We need to ensure that a new system of value-based
                                                       pricing favours innovation.

Assessment of value does not necessarily reward innovation. We need to encourage technology transfer
from university research laboratories so that more knowledge can be shared and capitalised upon.

Value-based pricing should empower doctors to be able to make treatment decisions and prescribe the
appropriate drugs, allowing quick access to drugs for patients.

The challenge is for a new pricing mechanism to ensure access for patients (health policy) and reward for
innovation (industrial policy)?

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