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“Even though we have a state-provided system, individuals should still be able to express some choice about whether or not they want particular treatments,” he says.

By Editor on Oct 9, 2007

Even though we have a state-provided system, individuals should still be able to express some choice about whether or not they want particular treatments, he says. There's a real push on to individualize care, rather than simply making it one-size-fits-all.

Elective treatments, which are where the government has begun its push toward individualization, are relatively easy, Procter says. Selecting a hospital to perform a hip replacement is fairly uncomplicated for consumers based on wait times and quality of care. And because of the financial systems that now work behind the UK's NHS, Procter says there is incentive for hospitals to provide good service, knowing the more patients they attract, the more money they stand to make.

However, as Procter points out, there are some risks of giving people real choice, including some options which have different costs and budget implications. There are inherent risks to a public system getting into choice of treatment, particularly in long-term care, because of its ability to fund and afford the consequences of those choices, Procter says. You can'st say to people we want you to play an active role but only on our terms.

It's a double-edged sword for the NHS, but as Procter says, perhaps the opportunity of getting a better response from patients outweighs the risk.

You want to encourage people to play a more active role in managing their conditions as a way of reducing the burden on healthcare, he says. But to do so, you must empower them and provide the ability to make choices.

By becoming better self-managers, people are likely to rely on the service less. If you make an investment in people, then there is likely to be some savings through the healthcare system in the long-term by putting people in a position where they can take a more active role, he stresses.

Procter says it is an opportunity for healthcare, if they'sre prepared in the UK to see it as such.

But how do you apply such consumer choice goals to long-term disease conditions that include multiple events spread out over a period of time during which a patient's health often deteriorates, requiring different levels of input at different stages? It becomes really challenging to create a system that responds the way an individual wants it to when it comes to the management of long-term disease conditions, Procter says.

Communicating across the system

We know that one of the things the UK's approach to healthcare is not particularly good at is communicating across the system, he points out. So, when you have people going to hospitals, into community care and to social care, the systems aren'st very good at connecting up.

This lack of communication makes introducing consumerism and individualism into long-term healthcare situations much more difficult. It is particularly important, however, for people who still want to work and lead full and rewarding lives and are the most in need of individualized care, Procter says.

Having services that are responsive to their needs and that will develop with them, as their condition develops, are particularly important, but long way off for the NHS. As the choice agenda moves forward, however, patient input into which general practitioner they see, which treatment plans to pursue and eventually which pharmaceutical products best suit their condition and circumstances seems likely, Procter predicts.

Pharma's role

But what role can pharma play in such a scenario?

When you work in an environment where you don'st do any direct marketing to patients, what is the process by which you are going to provide people with information that will enable them to make a more informed choice? Procter asks.

There's going to be a need in the future for good collaboration between central government, local health services and the providers of the whole range of treatment options, Procter says. Where possible, we'sll need to work together to give a consistent and sensible line of information to people, so they can make these choices.

Procter believes the big challenge right now for the pharma industry is proving it can be a trustworthy partner in healthcare beyond the simple provision of medicines. Pfizer's work, he says, centers around being able to turn to policy makers and show it does not just talk about wanting to make a bigger contribution, but is actually doing so.

Procter says: We need to show that we can play an active role and that will only come through by putting our money where our mouth is. If we'sre saying we'sre more than a medicines provider, we'sre a healthcare company we must prove that."

Procter believes the relationship with central government must become more mature and transition to one where government has a greater appreciation for what pharma brings to the UK and its economy, as well as recognizes a more active role in the debate of how its services and products might be used.

Outcomes-based decision making

Procter also hopes the industry can influence the way the NHS makes decisions on commissioning and what services are provided locally, using the outcomes-based measurement and assessment techniques it utilizes in clinical trials.

Getting commissioners to the point where they use meaningful language and measures beyond simple activity is really important. Procter says. If you have a language based on outcomes, then you'sll be much more able to make informed decisions. And until we get to that point, we are going to be stuck in an ill-informed debate that focuses on acquisition costs.

Where should the push for new approaches come from?

Procter believes the public health agenda will drive the debate. With conditions like childhood obesity and diabetes, unless we do something, the burden of long-term care is just going to grow and grow. If we don'st invest in a health's service, rather than a sickness's service, the NHS will eventually go bust.

But it is difficult in a system that is used to 12-month, short-term cycles of decision making, he says, and will require a gradual transition over the next ten to 12 years.

It is a lesson that has value far beyond the specifics of the NHS and UK healthcare, however. And one pharma should be eager to learn and apply.