New medicines – who decides and how

Access to new medicines is a hot topic. Whether it’s the newest treatment for Chronic Obstructive Pulmonary Disease or psoriatic arthritis, to name but two recent introductions, the latest invention is usually welcomed by patient groups – and all too often resisted by the NHS. At least that is the conventional wisdom.

But research by the Welsh Institute for Health and Social Care, discussed at a meeting of the Assembly’s Medicines Knowledge Base group yesterday, suggests that the reality is more complex.

Crucially, while new medicines are widely seen as an additional cost burden, their potential contribution to cost savings – for example because patients do not need in-patient treatment or need to see a consultant less – is less often recognised or realised.  Yet some new treatments could in fact help in the redesign of services. As is so often the case, the enemy of change is silos – Department A bears the cost of a new drug while Department B gets the saving.

NICE or the All Wales Medicines Strategy Group – the sources of approval for new medicines – were seen as part of the problem. The research found that guidance that “X can be used to treat condition Z” didn’t go far enough.  It doesn’t say at what point in someone’s treatment that it should be used e.g. as a first resort or last resort, whether it worked with certain co-morbidities, or whether once X is introduced, use of medicine Y should stop.  NICE guidance also refers to individuals, whereas health boards are making decisions about populations.

So what to do?

The research concluded that the problem is essentially one of implementation. Although it is too polite to say it,  approving a medicine for use in the NHS simply isn’t enough. There’s a long and rocky road between approval and Mr Jones getting the new medicine for his COPD – or not.  Requiring health boards to be open about the availability of new medicines is one idea (about which we were reminded that, in NICE-speak, when a treatment should be an ‘option’ that doesn’t mean one option is ‘not available here’).  Holding health care providers to account for predicated savings is another.

More effective working between managers, clinicians, the pharmaceutical industry and patients is also important.  The research found that while the NHS is pretty good at horizon-scanning, it was, bizarrely, less good at the more immediate task of planning the introduction of a new medicine. This seems extraordinary to me – and surely something on which Welsh Government could lead.

If it really is the case that some new medicines have the potential not only to treat a condition affecting an individual more effectively but also save money, then surely Welsh Government should be championing their introduction.  This is not to say that all  new medicines should be shouted from the roof tops – it’s probably only a fraction that have the ability to transform how health services are delivered. For most, the gains are probably relatively small (if at all), but that’s not to say there are no gains.

What’s clear to me from this research is that introducing new medicines effectively is not just about better management techniques in each health board. It requires a whole new approach, in which new medicines are not seen as a cost to be controlled but a potential solution to both health and budget problems. It requires greater collaboration between pharmaceutical companies, clinicians and managers to plan the “what, when, where and how” of introducing a new medicine.

With scarcely a day passing without a warning about an ‘epidemic’ of a chronic condition – diabetes and dementia are the current favourites – the Welsh NHS can ill-afford to leave the use of new medicines to local chance.

Victoria Winckler is Director of the Bevan Foundation.

The research was commissioned from the Wales Institute for Health and Social Care by the Association of British Pharmaceutical Industries Cymru Wales, who also covered the costs of Victoria chairing the Medicines Knowledge Base meeting.