Cost-cutting not the way to drive value for the NHS, finds independent committee

An independent steering committee has compiled a report looking at how more can be delivered from the NHS budget, without necessitating cuts to funding within the system. The initiative, named Decisions with Value, suggests that achieving ‘value’ through the system should not be managed through cutting resources or budget, due to the worsening health outcomes that result.

The initiative comes at a time that the NHS is now at the forefront of public discussion into both cost-cutting measures and how to fund a social institution that is a source of pride for many within the UK. The topic became a major wrangling point during the general election, as the Conservatives, Labour and the Lib Dems all outlined their own plans to boost funding.

The problem that each were met by is the suggestion that none would be sufficient to ensure NHS operations could continue unhindered. The parties offered boosts to funding by 1.2%, 2.2% and 1.8% respectively yet even Labour’s figure, as the highest, was not deemed enough by experts.

The challenges were addressed by opening speeches from various angles. Sir Kevin Barron MP, Labour, referenced how one of the difficulties the NHS faces is that continual medical innovations does mean more treatments for patients but at a higher cost:

"The NHS faces very complex challenges, including changing demographics, greater demand on services and new innovations, so constraints on finances and other resources are not going to help. People ask, ‘Where is money going in the NHS?’…In part, the answer is medical science – more people can be treated for more conditions now. We need to look at where the value of this is and it is important that the NHS is confident it is achieving the best possible value it can from the resources it has. Some decisions that people will take will upset patients."

It was an interesting point to be made at an event sponsored by AbbVie. Pharmaceutical companies rely on continued developments in all medical areas to ensure that they are able to achieve continual revenue. To suggest that the NHS would have to make difficult decisions on which innovations and patient groups to support was a contentious point but a necessary one within the wider discussion of how to achieve sustainability within the system.

Stephen Chapman, Professor of Prescribing Studies and Head of Medicines Optimisation at Keele University, who spoke as part of opening statements, countered this particular point by identifying where new innovations can prove useful to patients:

"Medicines have always been a significant portion of the NHS bill, it was 15% last year at £16.8 billion…However, great strides have been made in cost awareness by prescribers – the use of generics, once patents expire, is now the norm and significant savings are now usually routinely achieved on former blockbuster drugs, such as statins. Pharmaceutical manufacturers acknowledge this, hence the drive for innovation in which new medicines benefit both NHS patients and the companies’ shareholders. That’s not to be sniffed at or apologised for."

The two viewpoints serve to elaborate how complicated the issue of value is for the NHS. There are many competing interests that do not always successfully align. Norman Warner, a member of the House of Lords, painted a picture where the overall future of the NHS is also caught up within a political system not currently promoting long-term planning:

"The NHS has a serious disease called ‘short-termism’ – totally fixated on ‘this week’, ‘this month’. The first person who has really thought about ‘five years’ is Simon Stevens, of NHS England and that seems to be a radical idea to the Department of Health. If you think, up in Richmond House, that they have a cunning long-term plan, they do not."

Warner’s point highlights the difficulty that the NHS has in managing to live within its means as successive political parties come into power, with differing views and ministers passing through the system.

The Decisions with Value initiative itself struggled to define value, itself, in simple terms; it chose to break it down into three constitutive elements: Personal Value (for the individual), Technical Value (for the system) and Allocative Value (for the population).

The report provided particular examples of this, one being the allocative value in lowering the rates of smoking in the UK – a result which would lower healthcare costs in the long-term. Another example provided was the personal value of informing patients of the risks of surgical procedure on benign prostate disease – reducing the number of those opting for surgery by 40% and therefore lowering costs.

As mentioned, the event and the independent steering committee were funded by AbbVie. The question arises of why they should be involved in the direction of the NHS? It referenced during the presentations that the medicine budget is often the one that is earmarked for cuts when finances are tight. If the discussion can be shifted away from specific areas and to broader systematic changes to the system, the medicines budget would be protected by association.

The discussions that arose during the meeting showed how fine the balancing act of the NHS budget is. The fact that there are competing interests is not a new one nor particularly surprising, but the message throughout discussions were one of increased communication. Being better able to share the problems that are faced by all parties may lead to better solutions for all.

However, one of the primary messages was that local authorities need to take more control and those working with or for the NHS must be proactive in their own measures to increase value-for-money, as opposed to relying on the government to be able to apply a consistent, top-down structured approach.

Ben Hargreaves