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Rick Greville, Director of the ABPI Cymru Wales, reflects on the role that medicines should play in helping the NHS in Wales to face the next 75 years.
In a report released for the NHS’s 75th birthday, the Welsh NHS Confederation called for a national conversation on co-producing a health and care service fit for the future.
The report discusses the need to tackle health inequalities, highlighting a fairly eye-popping stat – that health inequalities cost the Welsh NHS an estimated £322 million each year (Cost of health inequality to the NHS in Wales, 2022).
The NHS alone does not hold all the levers to reduce these inequalities, so we need to consider factors such as poor housing, green spaces, transport, and food quality. The Welsh NHS Confederation argues persuasively that we need to take a wider holistic approach to tackling health inequalities.
Lord Crisp recounted a famous Ugandan message in a keynote address at the Bevan Commission conference: “Health is made at home and only repaired in hospitals when it breaks down.” 1
A truly holistic approach to health must include trying to prevent people from needing the services of the NHS in the first place. The key priority should be to keep people out of hospitals and GP surgeries, while ensuring everyone can lead a healthy life no matter where they live.
Better use of medicines and vaccines must feature strongly in any holistic strategy for keeping people well and helping the NHS meet the challenges of the next 75 years.
When I say better use of medicines – I mean that from two perspectives.
Firstly, helping patients access the medicines they need and should be able to expect.
UK spending on medicines is the lowest among its peers, accounting for just 9% of the UK’s overall healthcare spend. This was the lowest proportion among eight similar countries, including Italy 17%, Germany 17%, and France 15%. (The Kings Fund ‘How does the NHS compare to the health care systems of other countries?’ Figure 18, p57, 202)
Earlier this year, our research with the NHS Confederation (UK) showed that quick adoption of evidence-based, innovative medicines is a strategic opportunity for health systems. While the medicines have clear clinical benefits, they also have an important broader impact on the NHS, society, and the economy.
More equitable use of just thirteen medicines in line with national guidance across four treatment areas – stroke prevention, kidney disease, asthma, and type 2 diabetes – could bring significant economic benefits to the UK, in addition to wider individual and community benefits for patients, carers, and families. (The Kings Fund ‘How does the NHS compare to the health care systems of other countries?’ Figure 28, p81, 2023)
Secondly, helping patients make better use of the medicines they already have.
Before the pandemic, a local campaign called ‘Your Medicines, Your Health’ aimed to ensure people maximise the benefit from their medicines.
The World Health Organisation believes that adherence to treatments for chronic illnesses is about 50% in developed countries. 2
To change this, the campaign developed several strands to encourage people to use their medicines safely and effectively, and we understand it is now gearing up for a national relaunch across Wales soon.
The message of “Take them when you can, tell us when you can’t” empowers people to take more control of their health – and benefit from the prescribed medicines. It can also prevent medicines waste and free up resources.
The NHS Confederation has started a national debate on the elements needed to help the NHS in Wales face the future. Medicines must be part of that conversation.
1 Quoting Prof. Francis Omaswa, Executive Director at the Africa Center for Global Health and Social Transformation (ACHEST)
2 World Health Organisation, Adherence to Long-Term Therapies, Evidence for Action, 2003. Also cited in NICE Quality Standard on Medicines Optimisation, 2016.
