How the NHS is tackling the third phase of its COVID-19 response, and implications for pharma

Coronavirus could see siloed working consigned to the history books; the drive towards integrated systems will accelerate, while traditional distinctions between primary, secondary and tertiary care will become blurred as healthcare care models reorganise around patient groups and adopt a multidisciplinary approach. Sustaining the private and public sector collaboration that has gained momentum in recent months will be a critical success factor.

This is the clear message we’ve been hearing from healthcare leaders across the NHS, academia, health tech, clinical research and pharma, as we seek to understand which of the ‘good bits’ of the health service’s initial response to the COVID-19 pandemic should be captured and taken forward as healthcare systems start to reset.

NHS England chief executive Sir Simon Stevens and chief operating officer Amanda Pritchard penned a letter to the NHS at the end of July which set out the key priorities for the third phase of the NHS Response to COVID-19, but time moves very quickly in 2020. The threat of COVID-19 is again on the rise, social restrictions are coming back, improving access to testing is still firmly on the agenda, and the progress towards vaccine development has momentarily stalled. It feels like we are a fair distance away from a ‘recovery’, and yet attempt to recover we must.

The job has undeniably got more complex than ever as the health system, like the rest of society, attempts to juggle both the short and longer-term consequences.

So what are the priorities for the NHS right now, and what should those working in pharma be paying closest attention to?

As a reminder, the three key areas of focus for Phase Three of the NHS programme are:

* Accelerating the return to near-normal levels of non-COVID-19 health services, which includes addressing the backlog

* Preparing for winter pressures in the context of likely COVID-19 spikes

* Learning from the first wave of COVID-19, specifically in supporting staff, guarding against inequalities and in prevention.

All this against a backdrop of the continuing need to address the funding and structural mechanisms.

Further implementation guidance has since been published, adding more clarity and leading with the need to address inequalities in NHS provision and outcomes. This should be a point of note for pharma. The inequalities and the disproportionate impact of COVID-19 on BAME communities have been deeply wounding to the health service. It is a failure of one of the key pillars of the NHS constitution: namely, equal access to high-quality care for all.

At a recent webinar chaired by ZPB and hosted by the Healthcare Communications Association (HCA), Parker Moss, chief commercial and partnership officer at Genomics England, spoke about the heroic efforts of those working in drug discovery and clinical development in both pharma and academic research overall during the last six months, and also pointed to the progress being made to increase the representation of the BAME community in its current genome sequencing project among COVID-19 patients, which is tracking at over double the representation compared to the national average. As an extension to accelerating inclusivity in the clinical trials arena, therapies and interventions that support more equal access across all patient groups and communities, and reduce the COVID-19 threat, will most certainly find themselves more in demand than before.

At the same webinar, Graham Kendall, director for the Digital Healthcare Council (DHC), addressed the issue of the NHS 18-week waiting list targets and the recovery in the number of GP appointments. Kendall said that whilst there had been some positive news in the latest set of figures published in August, in particular an overall increase in GP appointments compared to the previous month, there is huge variation across the country, with patterns starting to emerge.

This is alongside countless reports being published daily from specific interest groups which highlight the impact COVID-19 has had on non-COVID-19 conditions and services. Everything from breast cancer detection to an increase in non-COVID-19 deaths, notably from heart and circulatory disease.

It highlights another communications consideration for pharma. Whilst lobbying, whether directly or via the media, has a place, and data analysis is imperative, this is arguably not the time to be adding to the pressure that the system is under. Being part of the solution, sharing data and insight and giving careful consideration to selecting the right channel for the right message when it comes to communicating more broadly, will help to move us forward most constructively.

Graham Kendall provides a case in point from his work at the DHC. “It’s striking that many of the areas that have done best in maintaining appointment levels are those that use DHC members to manage and deliver their remote consultations. Increasingly we see patients choosing remote options, and by matching those preferences to clinically appropriate channels, this frees capacity for those patients who need face-to-face consultations. In turn, all patients benefit, including those who are digitally excluded”.

Whilst the panel gave a health warning to avoid shoehorning commercial objectives into the NHS agenda, this serves as good inspiration. During the webinar both panellists and audience exuded confidence and identified specific examples of where collaboration was resulting in real progress. Over 60% of the audience said that they had personally witnessed an increased appetite for collaboration between the NHS and industry since the arrival of COVID-19. As Samuel Hollis, business unit director for the Cardiology and Respiratory Franchises at Novartis UK, says, “Genuine moves to evaluate where pharma can drive value into the system, at local and national level, should and are being welcomed. It’s less push, and more pull that is required around aligned common objectives, and this is what is going to sustain the increasing levels of trust between individuals and organisations”.

As in all crisis situations, speed is paramount and so many of the achievements over the last few months have clearly been driven by a need to crack on with the job at hand, rather than getting tied up in the central chain of command. Though conversely, again common to all crisis situations, the need for tight control by the centre is also in evidence. This points to a second implication for pharma – the need to preserve the progress made in improving internal efficiency whilst still maintaining the required levels of governance and standards, coupled with intimate understanding of the organisational changes in the health and care system as new individuals and groups of decision makers emerge.

The health service transformation to Integrated Care Systems (ICSs) continues at pace regardless of the unforeseen events of the last six months, so partners and suppliers to the NHS will need to quickly understand who the new lead commissioners are, in addition to some of the new groups emerging too. In spite of the move to a simpler healthcare system, it’s going to be essential to understand the differences arising within the seven NHS regions, both in strategy and operational design.

There is still much we don’t know. When will we have access to effective vaccine solutions for COVID-19? How severe will the seasonal flu season be? How will it complicate COVID-19 detection and management? What impact will the delay of the NICE Methods and Process Review have on broader medicines access? How quickly will we see true digital transformation among both the pharma industry and the healthcare system? And what will the impact of Brexit be on top of all this?

What has become clear during this most challenging of years is that the environment has never been more right for all those who care about the UK’s health outcomes to work together to improve them.

Jo Spadaccino is a partner at health communications consultancy ZPB Associates