Technology has revolutionised healthcare – even in the last ten years the diagnosis, treatment and management of health conditions has changed beyond recognition to be more personalised than ever before. I believe we may have now achieved all that technology can do alone and will only unlock the next level of potential when industry works in true partnership with health systems at every step of the way.
I moved to the UK in January, having previously had the privilege of undertaking varied industry roles in my native Germany, northern Europe and most recently in Latin America. When I arrived in the UK, everyone told me how special the National Health Service is, and also that outcomes in diabetes are good; these are two positive things to hear as incoming leader of a diabetes care business! I do agree that the NHS is special, the ethos of those I have met at every level of the the health service demonstrates a can-do attitude and determination to always achieve more.
What I have quickly learned in my short time in the UK so far is that the health system is made up of far more than the NHS alone, and indeed that the NHS itself is far from one entity! The National Institute for Health and Care Excellence (NICE), Academic Health Science Networks (AHSNs), Public Health England (PHE), the Medicines and Healthcare products Regulatory Agency (MHRA) and local authorities all play a fundamental role. I hope before too long that the integral role of industry as a part of the fabric of the health system will readily spring to mind whenever anyone prepares a similar list. The health system at large, including industry, has a responsibility to operate in a way that enables us to provide life-changing care for those who need it – so does collaboration hold the key?
The diabetes care sector is crowded, this competition has fostered innovation and also led to established players withdrawing in recent times. In this area, Roche is currently transitioning from being solely a manufacturer/distributor of medical devices, to become a service provider. In some countries we are further ahead on this journey and deliver what we call ‘integrated, personalised diabetes management’. The breadth of our own portfolio gives us a good starting point but this is not enough if we are to deliver as simply as the NHS wishes. On the industry side, we must partner to offer a full suite of products and services; this partnership between industry players will demonstrate a maturity in our approach and readiness to work constructively with the NHS. At the same time, the NHS should celebrate successful partnerships and encourage replication elsewhere for if it works, it works.
I am coming to understand that whilst the ‘National’ in National Health Service is a little misleading, the NHS does in fact work best when one area is learning from another by adapting a solution for another population. The AHSNs are key to this success, it is especially welcome that they have such a welcoming approach to industry and also to ideas that work well overseas. In any transaction, especially when piloting a new service, there is a risk for all parties; it is now time for industry to share a greater share of that risk and the way to achieve this is through outcome based payment models.
There are lessons to be learned from the insurance-led health economies that have pioneered new models for risk and reward sharing. Upon pausing to think about it, it is a no-brainer that industry, like clinicians, wants those who will gain most from a treatment, technology or service to be prioritised in access to it which leads naturally to the co-creation of pathways. Diabetes care is a fantastic starting point for this approach because there is a wealth of available data. Indeed we are making steps in the right direction with an industry group having partnered with patient organisations and NHS England to produce a ‘type I diabetes technology pathway’. Here I should emphasise that whilst relationships with industry should be built upon trust, clinical leadership is essential to ensure that there is no degradation of the core principle that every patient deserves the right technology at the right time.
Although digital solutions, and big data, now sit at the very core of the care delivered to people across the UK and the rest of the world, unlike many other sectors, healthcare is still one that is slow to adapt to the changing world around us. We must all challenge ourselves to not only gather data but to learn from the information provided to us and if benefit can be found beyond the traditional medical arena, we must demonstrate this. It is very welcome that following a commitment in the Long Term Plan, NICE will have a greater role to play in the appraisal of medical devices and perhaps also digital interventions. As health economists become involved, sometimes for the first time, in assessing these technologies, their expertise should be used to capture long-term value including days in work and changes in the emotional burden of living with a condition. The transactional relationship of the past will not provide the answers for the future; only partnerships where common goals are recognised and success is encouraged will be sustainable.
We must engage with people working at every level of the NHS to achieve this, because it must be a shared effort with government, policymakers and patient advocates.
As a sector, we need to showcase our capability and credentials to drive innovation where there is clear unmet patient or clinical need. We must consider how and where we are able to add value, by supporting the NHS to modify its data infrastructure and value appraisal methodology. In parallel, an expedited development timeline must generate evidence that goes beyond the medical and provides insight into the wider benefit of our interventions. All of this should be rooted in a clear understanding of the people who live with the conditions we seek to support.
As an entire industry, across all partners and collaborators, from public to private to third sector, now, more than ever, we need to work together to co-create solutions that enable us to bring innovative solutions to patients more quickly.
It is time to collaborate.
Michael Goetzl is managing director of Roche Diabetes Care
