By James Hollaway
2018 promises to be another fascinating year for the healthcare world with undoubtedly lots of surprises which will keep healthcare communicators on our toes. However, after dusting down our crystal ball, there are a few ‘big-ticket’ items that that we are expecting to influence a number of our UK campaigns, including the continued development of Sustainability & Transformation Partnership (STPs), the government’s stance on medicines pricing, and the continued financial strain on NHS provider finances. Looming over all of this, is the uncertainty of Britain’s future relationship with the European Union.
2018 will see the continued evolution of STPs to Accountable Care Systems (ACSs), with greater responsibility for the planning and management of services set to be granted to distinct health geographies. Ultimately, the government has been explicit in its desire for some ACSs to have the ability to “effectively abolish” the purchaser/provider negotiations within their area, and move beyond current payment systems locally. Ironically, the abandonment of the NHS internal market may provoke cries of privatisation from some quarters, and potentially be subject to legal challenge without primary legislation to pave their way. Even if STPs don’t advance to ACS status in 2018, the regionalisation of planning and commissioning functions will likely continue, resulting in CCG roles and responsibilities being diminished through mergers and collaboration with fellow commissioning bodies.
Medicines Value Programme
With the NHS under unprecedented financial strain, the Government’s stance towards medicines pricing (rightly or wrongly) has notably hardened, most prominently through the introduction of a number of ‘affordability’ measures. Negotiations on the next iteration of the Pharmaceutical Price Regulation Scheme (PPRS) are set to commence in 2018, overseen by Steve Oldfield (ex-Sanofi and Teva GM) as the new Chief Commercial Officer at the Department of Health (DH). If the DH commercial teams are busy negotiating a new PPRS, NHS England is expected to continue work on the Medicines Value Programme (MVP), which will be overseen by Noel Gordon (Chair, Specialised Services Commissioning Committee). The MVP is set to examine the policy framework that governs access to and pricing of medicines, along with NHS England’s commercial arrangements, with a view to taking ‘targeted action’ on the highest cost treatments. New gene therapies and high-cost oncology products are likely to be high on the list of Mr Gordon’s priorities.
Despite a firmer stance shown on provider finances in 2017/18, it is unlikely that the NHS will come close to achieving financial balance in 2017/18, with trusts set to record a deficit of between £500m and £600m. Uplifts in system funding should be used to transform the system, but will almost certainly be diverted to prop up struggling front-line services. As a result, the NHS is stuck between a rock and a hard place, and it is difficult to see how it extracts itself from this quandary without a significant funding uplift.
And finally, Brexit
Looming over the NHS in 2018 will be the ongoing uncertainty of Britain’s negotiations, and future relationship, with the European Union. As the year progresses, NHS policy will be increasingly shaped by the realities of the economy post-Brexit, potentially strengthening the hand of industry in key PPRS negotiations. With a minority government likely to continue throughout 2018, the prospect of health-related primary legislation being introduced before Britain’s departure from the EU seems incredibly small, potentially preventing NHS England from surmounting the legal hurdles to system reorganisation.
There are clearly going to be a number of challenges for the NHS in 2018 – those identified above and no doubt a number of others – and with no obvious fixes. Those working in and with the NHS are going to need to ensure they stay abreast of these challenges, understand their full implications, and find a way of successfully working with the reality of the system.