PM Society NHS Partnerships Interest Group - Carol Blount: Driving NHS/Industry Partnerships Through Innovation

1. Driving Industry/NHS Partnerships
through innovation
PM Society NHS Partnerships Group
Carol Blount - NHS Partnership Director
18th April

2. Role of the ABPI
• The ABPI represents innovative research-based biopharmaceutical companies, large ,
medium and small, leading an exciting new era of biosciences in the UK.
• Our industry, a major contributor to the economy of the UK, brings life-saving and life -
enhancing medicines to patients
• ABPI members supply 90 % of all medicines used by the NHS, and are researching and
developing over two-thirds of the current medicines pipeline
• ABPI is recognised by government as the industry body negotiating on behalf of the
branded pharmaceutical industry, for statutory consultation requirements including the
pricing scheme for medicines in the UK
• We have full, research affiliate and general affiliate membership
• The arms length body of the PMCPA upholds the ABPI Code of Conduct

3. The Nicholson Challenge..
• The NHS needs to make savings of £20 billion by 2015 – this means year-on-year
efficiency gains of 4% for the next four years - the Nicholson Challenge.
• “success in delivering the government’s aspirations for healthcare and growth will depend
on a fundamental cultural change within the NHS, supporting innovation in ways that
increase health benefits while driving out costs across the system” Committee for Science
and Technology (CST) Sept 2011
• “It is an immensely difficult task which requires those responsible to rethink fundamentally
the way that services are provided”. Health Select committee Jan 2012
• “to deliver a change its not just about a change in the management structure, but a change
in the way care is delivered”. Stephen Dorrell Jan 2012

4. “Innovation must become core business
for the NHS”
• ““we need to think about whether we are willing to spend more on a new drug which will
provide better outcomes or keep on going with the cheaper options” Jonathan Mason,
National Clinical Director for Primary Care and Community Pharmacy at the Department of
Health Nov 2012
• Innovation has a vital role to play if we are to continue to improve outcomes for patients and
deliver value for money….. All parts of the NHS will need to take bold, long term measures
in 2012/13 to secure sustainable change”
• “Simply doing more of what we have always done is no longer an option. We need to do
things differently. We need to radically transform the way we deliver services. Innovation is
the way – the only way – we can meet these challenges. Innovation must become core
business for the NHS” Sir David Nicholson, Innovation Health and Wealth Report Dec
2011

5. And the industry has a challenge too….
• Coupled with rising costs of research and development we work within the terms of the
2009 PPRS agreement which has 4 main objectives:
1. Deliver value for money securing the provision of safe and effective medicines at
reasonable prices and efficient development and competitive supply of medicines.
3. Encourage innovation to promote a strong and profitable pharmaceutical industry to
invest in sustained R&D to encourage the future availability of new and improved
medicines
5. Promote access and uptake for new medicines. The Department and the industry are
committed to increasing uptake and patient access to cost effective medicines
7. Provide stability, sustainability and predictability to help the NHS and the industry
develop sustainable financial and investment strategies

6. Medicines life cycle in UK... delivering
efficiencies but out of balance
UK prices are
UK has slow & low UK has very
New medicines uptake
amongst the
use of innovative efficient use of
lowest in
medicines generics
Europe
Cancer therapies: Even after 5
years only achieved 2/3rds • 83% generic prescribing
average usage in appropriate • 66% dispensed as generics
patients • Average price of generics amongst
lowest in Europe
Time
Encourage Maximise value Efficiency
Innovation for patient,
NHS &
Industry
Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data. Market Statistics IMS World Review, OECD GDP
data. PPRS reports to Parliament 6th and 10th IMS world review EGA National Association 2007. EU 15 countries.

7. Appropriate use of Innovative medicines is part of the
solution for improved patient outcomes
Vaccines HIV
In 1992, routine vaccination of babies The development and adoption of
against Haemophilus influenzae type b combination treatment for HIV infection
(Hib) commenced. transformed HIV treatment
Within 3 years, the number of children who The treatment success was clinically driven
contracted Hib before their first birthday owing to a large unmet need
had fallen by 96%.1
Life expectancy for an HIV +ve 20 year old
increased from 36.1 to 49.4 years 2
Between 1996-1999 mortality among
people with HIV was 16.3 deaths per 1000
person years
This declined to 10 deaths per 1000
person years over 2003- 2005
Over the same period potential years of life
lost decreased from 366 to 189 per 1000
person years
Source: NCSI
1. www.immunisation.nhs.uk/FAQs/Werent_childhood_diseases_disappearing_long_before_vaccines_were_introduced
“Coronary Heart Disease”, David Wood, HCNA
2. Antiretroviral Therapy Cohort Collaboration Life expectancy of
individuals on combination antiretroviral therapy in high-income

8. Significant improvements have been
made in reducing mortality in CHD
Cardiology Statins
• The death rate from heart disease • The estimated number of lives
and related diseases among the saved through the use of statins has
under-75s has fallen by 47% tripled & rates of premature death
since 19961 from CHD are now lower than ever
• Medical and surgical treatments before 2
for CHD can together be directly • Around 4 million people are now
credited with saving 28,520 lives receiving statins, saving an
in the year 2000 – roughly estimated 10,000 lives every year 3
equivalent to one life saved every
20 minutes4
“We have seen steep improvements in
cardiac care of uniformly high standards
in mortality rates...better survival rates
for older people undergoing heart
surgery.” • Source: NCSI “Coronary Heart Disease”, David Wood, HCNA
• 'Shaping the future', progress report healthcarerepublic.com, 05 January 2007
Source: NCSI Andrew Lansley • http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096556.pd
“Coronary Heart Disease”, David Wood, HCNA • Unal B, Critchley JA, Capewell S Explaining the decline in coronary heart disease mortality in England
Wales between 1981 and 2000 Circulation 2004;109:1101–7 7.

9. Improvements to reduce mortality in Colorectal
Cancer and reduced rate of childhood disease
Colorectal Cancer
• The increased use of chemotherapy with bowel cancer
patients could, alone, be responsible for saving over
1,600 lives a year by 20201
• The five-year relative survival rates for both male and
female colon and rectal cancer have doubled between
the early 1970s and mid 2000s1-5.
1.
Need to check ref
2.
1. Coleman, M., P. Babb, and P. Damiecki, Cancer Survival Trends in England and Wales, 1971-1995: Deprivation and NHS Region. Vol. 1999: TSO.
3.
2. Rachet, B., et al., Population-based cancer survival trends in England and Wales up to 2007:an assessment of the NHS cancer plan for England The Lancet Oncology
(2009). Standardised figures were provided by the author on request.
4. 3. Office for National Statistics (ONS), Survival Rates in England, patients diagnosed 2001-2006 followed up to 2007
5. 4. Richard, MA., Trends and inequalities in survival for 20 cancers in England and Wales 1986-2001: population-based analyses and clinical commentaries. Foreword. Br
Source: NCSI
Journal Cancer, 2008, Vol. 99, Supplement 1, September
“Coronary Heart Disease”,al., Population-based cancer survival trends in England and Wales up to 2007:an assessment of the NHS cancer plan for England The Lancet Oncology
6. 5. Rachet, B., et David Wood, HCNA
(2009).

10. Appropriate use of medicines can deliver patient
benefits and cost savings to the NHS
• NICE estimates that £446,627 can be saved for every 100,000
patients that are treated in line with the hypertension guidance,
resulting in an overall saving of over £200 million/year.1
• It is estimated that, following the NICE recommendation, for the
prevention of venous thromboembolism, the savings to the NHS
would reach £8,904 per 100,000 of the population - equivalent to
£26.3 million nationally. 2
1. http://www.nice.org.uk/newsroom/features/HowNICECouldSaveTheNHSOver600million.jsp
2. http://www.nice.org.uk/usingguidance/benefitsofimplementation/costsavingguidance.jsp

11. Innovation, Health and Wealth Report
Accelerating adoption and diffusion in the NHS
Patient Outcomes Partnership
Innovation
Health and
Wealth
Access and Usage of Opportunity/Action
Innovative Medicines

12. ABPI input to the Innovation Review
A collaborative approach
• The ABPI Hardwiring Uptake Group co-
ordinated input to the ABPI submission to
the Call for evidence
• ABPI submitted evidence to support ‘low
and slow uptake’ and to illustrate local
barriers to uptake with proposed
solutions to address the issues
• The ABPI submission also included Joint
Working case studies to illustrate what
can be achieved through a partnership
approach
• ABPI Board members attended a dinner
with Sir Ian Carruthers and Miles Ayling

13. Innovation, Health and Wealth report
Accelerating adoption and diffusion in the NHS
• Innovation, Health and Wealth
report was published on 5th
December 2011
• Sir David Nicholson also sent a
letter outlining his expectations for
NHS action
• ABPI warmly welcomed the report
as a significant step forward to
support adoption and diffusion of
innovative medicines

14. ABPI priorities
• Implementation of National Policy at a local level to address ‘low and slow uptake’ in
the UK and improve patient access to innovative medicines
• 3 priority areas in the ABPI submission:
– Removal of local duplication of value assessments
– Mandatory adherence to national guidance and guidelines
– Mandatory adherence underpinned by performance management and metrics
• The final IHW report:
– NICE Compliance Regime
– Automatic inclusion in local formularies
– NICE Implementation Collaborative (NIC) to support prompt implementation of NICE guidance
– Innovation scorecard designed to track compliance with NICE technology appraisals
– Alignment of financial, operational and performance incentives to support adoption and diffusion of
innovation
21/05/12 14

15. Implementation phase – continuing the
collaboration
Stephen Whitehead, ABPI
ABPI Hardwiring Uptake Group
Implementation Board Simon Jose, GSK
IHW Implementation Secondments:
DH Programme Management Rachel Cashman, Andy
office Jones, Sameer Mistry
18 representatives across 12
IHW Task and Finish Groups
Task and Finish Groups
Implementation at pace and communication throughout the NHS

16. ABPI Partnership Vision
• Industry as a partner to the NHS and an integral part of the solution
• Improve the environment for access and uptake
• Align the national policy to local implementation (including IHW Report)
• To create the framework for partnership working
• To be the Industry ‘hub’ for access and uptake of innovative medicines within
guidance/guidelines
• Facilitate dialogue between Industry and NHS
• To support the Joint Working agenda

17. ABPI Partnership Working
IHW Implementation Board and T&F
National groups
Strategic partnership between ABPI,
NHS Confederation and ABHI
ABPI Therapy Area Groups

18. ABPI Partnership Working
• A strategic partnership designed to
Strategic partnership increase the adoption and diffusion of
between ABPI, proven technologies in areas of high
NHS Confederation clinical need to deliver high quality patient
and ABHI outcome and efficiency gains
• The approach is to showcase best
practice Joint Working case studies to
demonstrate outcomes that can be achieved
• Projects are reviewed by an independent
Panel
• Launch event 2nd February. Further
events to follow

19. ABPI Partnership Working
• Within the ABPI we host a number of
disease specific Therapy Groups
ABPI Therapy Groups • ABPI member companies who have an
interest in the disease area.
• The companies come together to work
with and support the NHS
• The groups work on a range of
strategic projects aimed at improving
the quality of care and services for
patients and ensuring all patients have
access to the right medicines at the
right time.

20. ABPI Therapy Groups and examples of
projects
Pharmaceutical • C-PORT, Cancer Commissioning Toolkit, NCEI Equalities
Oncology Initiative project
Pharmaceutical • Diabetes e- learning modules - optimal use of diabetes
Diabetes Initiative products, Atlas of Variation - unwarranted variation in diabetes
Pharmaceutical
• Communication plan for engaging with Primary Care
Hepatology Initiative
Pharmaceutical VTE • VTE education along the patient pathway, study on factors
Initiative impacting outcomes in Primary Care
Pharmaceutical Pain
• Partnership with Pain Summit, stakeholder engagement
Initiative
Pharmaceutical Mental
• Commissioning toolkit for mental health
Health Initiative
Orphan Medicines
• HTA and commissioning requirements for orphan medicines
Industry Group

21. ABPI Therapy Groups
Pharmaceutical
• Recently set up.
Ophthalmology Initiative
Stroke/Atrial Fibrillation • In development
Inflammatory arthritis • In development

22. ABPI continues to support Joint Working
Joint working - What is it?
•Joint working describes situations where, for the benefit of patients, NHS and industry
organisations pool skills, experience and/or resources for the joint development and
implementation of patient centred projects and share a commitment to successful delivery.
Joint working:The Benefits
•"Joint working provides the foundation, for which innovative healthcare solutions can be
born, and grow, to deliver better health outcomes for the patient, the NHS and the industry
alike.”
Deepak Khanna, President of the ABPI and Managing Director of MSD UK, 2012
•Local examples of joint working between the NHS and industry can demonstrate multiple
benefits to patients and the NHS
•There are over 30 Joint Working partnerships with the NHS delivering tangible patient
benefits

23. Joint Working resources
• DH Moving Beyond Sponsorship toolkit
• ABPI Joint Working Guidance notes
• ABPI Joint Working Handbook