1. NHS finances – Demands and Challenges! Or Cause and Effect In Hospital Pharmacy Procurement Ian Bourns Director of Medicines Management and Pharmacy East Sussex Healthcare NHS Trust

2. Presentation What is Causing Change What Effects are Happening The Healthcare Impact The Pharmacy and Medicines Impact The Medicines Procurement Impact Summary

3. Causes Lower Funding Growth & Inflationary Pressures Demographics Social & Political Demands Technological Developments Information Developments

4. Lower Funding Growth and Inflationary Pressures – WHY ?

5. Lower Funding Growth and Inflationary Pressures

6. Causes - Demographics Ageing population Approx 15% Approx 24%

7. Causes – Social and Political Demands Access to Treatment 18 week RTT A&E 4 Hr Max waits Care closer to home Patient Experience Safety Respect Convenience Involvement UK PLC Income and R&D Spend from Pharma

8. Causes – Social and Political Demands UK PLC income from Pharma

9. Causes – Social and Political Demands UK PLC income from Pharma

10. Causes – Social and Political Demands UK PLC R&D Spend from Pharma

11. Causes – Social and Political Demands UK PLC - R&D Spend from Pharma (Reuters – 2 nd Feb 2011) Pfizer to shut major Sandwich site, home of Viagra Pfizer Inc is to close its research and development centre in Sandwich, southern England, which employs 2,400 people, dealing a major blow to Britain's scientific jobs base (Telegraph – 3 rd Feb 2011) David Cameron blasted over closure of Pfizer Viagra site Labour have accused David Cameron of having “no strategy for growth”, following this week’s surprise decision by US group Pfizer to close a major research and development base at Sandwich in Kent. (Pharmaceutical Field – Nov 2011) More jobs saved at Pfizer Sandwich site About 650 jobs will be saved at Pfizer’s R&D plant in Sandwich, Kent – 300 more than previously announced in June

12. Causes – Technological Developments New Medicine Gene therapies New Administration Technologies Biofeedback Technologies Automation Will provide improved care outcomes All breed higher patient expectation and demand

13. Causes – Information Developments Detailed Costing Service Line reporting Patient Line reporting Ability to assess if income and costs balance Linking Data Sources Outcome Analysis Potential ability to see if promised benefits are gained

14. Demographics Technological Developments Social / Political Demands Information Developments What Effect Follows ? Financial Pressures Nicholson Challenge £20B & QIPP Lower Funding and Inflationary Pressures

15. Nicholson “4 Year” Challenge NHS faces 'decade-long savings drive' BY NICK TRIGGLE HEALTH CORRESPONDENT, BBC NEWS 21 st March 2012 THE NHS FACES A DECADE-LONG SAVINGS DRIVE, MANAGERS BELIEVE. THE WARNING FROM THE NHS CONFEDERATION CAME ON THE DAY OFFICIAL WORKFORCE FIGURES SHOWED NURSING POSTS HAD FALLEN BY 1% IN THE PAST YEAR. IT COMES DESPITE PROMISES BY MINISTERS THAT THE FRONTLINE WOULD BE PROTECTED DURING THE EFFICIENCY DRIVE.

16. Demographics Technological Developments Social / Political Demands Information Developments What Effect Follows ? Need For Cultural Change NHS Constitution & CQC Focus on Patient Dignity and Experience

17. Demographics Technological Developments Social / Political Demands Information Developments What Effect Follows ? Safety & Experience Improvements Clinical Guideline Development, Professional Obligations & Regulatory Force

18. Demographics Technological Developments Social / Political Demands Information Developments What Effect Follows ? Need To Prove Value For Money Outcomes Analysis & Value Based Pricing Lower Funding and Inflationary Pressures

19. POLICY EFFECTS

20. EFFICIENCY SAVINGS cutting “back office” management, limiting staff pay and pensions, selling assets, rationalising procurement and drugs purchasing, and re-aligning the NHS IT programme. POLICY EFFECTS

21. PREVENTION AND PRIMARY CARE Arguments for early intervention and care “closer to home” often highlight the savings from avoiding hospital admissions, as well as the benefits for patient care If the NHS provides more care in community settings and reduces the use of hospital services, then there will need to be substantial reconfiguration of services, POLICY EFFECTS

22. IMPROVING CLINICAL EFFICIENCY As NHS funding tightens, another option is to try to target resources on clinical interventions that optimise health outcomes The King’s Fund has suggested money could be saved by reducing the length of stay in hospitals and using lower cost drugs. POLICY EFFECTS

23. Healthcare Impact Redesign Smaller acute hospitals Planning by Pathways Long term condition management Community led Clinical networks across health economies Increased focus on outcomes and value for money

24. Pharmacy and Medicines Impact Hospital, Community Health and Community Pharmacies working in a networked way to: Access scarce expertise Reduce clinical risks and hospital admissions More focus on cost benefit analysis of new medicines Outcomes of medicine use assessed in the real world after licensing: Assess clinical benefit against drug cost Assess healthcare resource use against drug cost Confirm continued or expanded use

25. Hospital Pharmacy and Medicines Impact Homecare Expansion Reduced costs Patient convenience and experience ?? How do we gain assurance about safety, optimum outcomes and service quality ??

26. Medicines Procurement Impact Hospital Reduce stock holding and process costs Greater use of ICT in purchasing Greater use of automation Even more joint working between Trusts Divestment / subcontracting of services Increased risk assessments of all processes

27. Medicines Procurement Impact Schizophrenic role for Chief Pharmacists Support introduction of new high cost drugs to support Pharma and UK PLC ? Reduce drug spend ?

28. Medicines Procurement Impact Manufacturers / Suppliers Performance management & KPIs Improved supply chain failure management Joint planning about options for supply chain restructuring Clinical trials that assess impact on NHS resource use as well as clinical effectiveness Joint work to assess the outcomes of use of a drug in the “real world” along a whole care pathway

29. Summary Change factors affecting the NHS will impact on hospital pharmacy and medicines procurement but some appear to be in conflict The pressures for change affect both the NHS and Pharma To manage that The supply chain needs to be optimised We need to be able to demonstrate clinical and resource use value for money from buying medicines We can only do that by working together