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Political Notebook

April 2011

  1. Reshuffle or not to reshuffle?

    Posted by Jamie Holyer on 13 April 2011  |  Government

    With almost one year since the General Election and a Health Bill that has hit stormy seas a whole lot faster than Ministers expected, the rumour mill in Westminster is now getting into swing over a possible reshuffle.  Rumour and gossip of an impending reshuffle can be damaging for Prime Ministers as the more talk there is of one the more indecisive a PM looks if they don’t act despite not actually needing one.

    A reshuffle of Ministers after they have been in the job less than a year may also seem a little unfair as they have had little chance to turn around the supertanker of a government department before being moved on.  In the real world it would take a CEO of especially poor calibre to last less than a year in the job. However, politics being politics and the need to be seen to be doing something outweighing common sense, a reshuffle is likely sooner rather than later. 

    The seemingly obvious fall guy is Andrew Lansley MP who has managed to split the coalition, fall out with Downing Street and ignite significant public opposition to a policy all at the same time.  However, moving Lansley at this time would be a clear sign that the PM does not support the health reforms and nothing less than a complete re-working of the NHS reform programme would do to satisfy a blooded opposition.   For a PM who said that the ‘NHS is safe in our hands’ it would be a humiliating public acceptance of a policy gone wrong. 

    The answer is therefore to tweak the Bill through the ‘listen, learn and engage’ exercise whilst simultaneously trying to convince interest groups that the reform programme really is the right thing to do.  First up was former nurse and Health Minister Anne Milton MP who addressed the Royal College of Nursing (RCN) annual conference today (12 April).  A brave and bold move indeed.  Even Labour Ministers were jeered by the RCN conference during the years when they were trebling the NHS budget.

  2. The Budget and Industry

    Posted by Nick Hoile on 1 April 2011  |  Government, Health

    George Osborne’s statement on the Budget last week made just one reference to the NHS, but there was good news for the life-sciences industry buried deep in the accompanying documents. 

     The Government’s “Plan for Growth” made 16 policy commitments aimed at rejuvenating the industry, building on the pro-industry policies introduced by the Office of Life Sciences under the previous administration, with an emphasis on cutting red tape and increasing transparency.  The aim, in the Chancellors’ words, is to “radically reduce the time it takes to get approval for clinical trials”.

     The industry is not alone in welcoming these proposals.  Many patient groups, particularly those representing patients with rare or very rare diseases, are consistently frustrated by how long it takes new medicines to be available in the UK.  They will welcome any new policies that will enable them to access medicines earlier, either through a clinical trial or on an unlicensed basis while the medicine is still in the trials stage. 

     If the reforms are to succeed the Minister responsible for the life-sciences industry (David Willetts MP) will need to be tough with his civil servants, who the Prime Minister recently attacked as “enemies of enterprise”.  He might want to start by spurring the MHRA into action over its plans to improve the regulation of unlicensed medicines and introduce an earlier access scheme, which have lain dormant since mid-2010 despite calls for action by backbench MPs. 

     Backbench MPs and Peers will have a key role to play in ensuring that the coalition’s policies are not lost in the civil service quagmire and monitor the extent of their impact on the industry.  Policy and public affairs agencies can play a vital role in supporting clients to work with parliamentarians to ensure the policies yield the best result for the industry, most importantly, to patients.

February 2011

  1. Value-based pricing: what will it mean for orphan medicines?

    Posted by Jamie Holyer on 25 February 2011  |  Government

     NICE has always classified its oldest problem as appraising orphan and ultra-orphan medicines.  This is not really surprising given that health economics analysis is intrinsically designed to test cost effectiveness for large patient populations.  

    Nevertheless, in 2006 the Citizens Council of NICE produced a paper on how NICE could tackle orphan medicines which subsequently went to the Minister with a request for the green light for further development.  The project was however quietly shelved when advice coming down the line suggested that trying to put a square peg in a round hole would be difficult and that energies would be better spent on renegotiating the PPRS and creating an Office of Life Sciences amongst other initiatives.  

    The recent White Paper has however proposed a new solution of value-based pricing (VBP) with government setting a range of thresholds to reflect the value of a medicine.  Thresholds would take into account benefits displaced elsewhere in the NHS when funds are allocated to new medicines, if the medicine tackles an area of unmet need or burden is particularly severe, if products demonstrate greater therapeutic innovation and where there are wider societal benefits.  

     Whether this will mean that NICE will pick up the baton again remains to be seen.  Whilst Ministers favour a single system for appraising all medicines the new National Commissioning Board will take on responsibility for rare diseases services and pilot programmes are underway by existing Department of Health bodies to assess how orphan and ultra-orphan medicines will be appraised.

January 2011

  1. Health and Social Care Bill – what will it mean for healthcare public affairs?

    Posted by Jamie Holyer on 19 January 2011  |  Government

    In theory at least,  the devolvement of budget responsibility to GPs should make no difference to public affairs campaigns as the funding and accountability flow is very clear: GP consortia answer to the NHS Commissioning Board who answer to the Department of Health Ministers who are responsible to Parliament.  Furthermore, for all the good intention of devolvement of power to clinicians, at the end of the day, it will be the Secretary of State who will be answering questions on the Today programme if services become patchy and patients start to fall between the cracks. 

    The reality will of course be more complex.  GP consortia will create a new tier of decision-makers in the NHS with potentially with many different local systems for managing medicines.  Political and policy solutions to client objectives that rely on a command and control model from central government will no longer be credible.  Their implementation will be reliant upon wide stakeholder support throughout the NHS. 

     However, as much as the rise of GP consortia creates difficulties it will also create opportunities.  Effective political leveraging of GPs at a grassroots level to influence the development of policy could swing the opinion of Ministers as they consider how to proceed in key areas of interest for industry such as patient choice, changing function of NICE and introduction of value-based pricing.

November 2010

  1. Decision by committee

    Posted by Jamie Holyer on 17 November 2010  |  Government

    The Health Select Committee of the 2010 Parliament has now been in situ for four months during which time it has launched five inquiries and we are beginning to get a feel for how its Chair, Stephen Dorrell MP (a former Secretary of State for Health himself), would like the Committee to function.

    With MPs not quite expecting the scale of the NHS reforms when the Select Committee elections were taking place, Stephen Dorrell MP is getting more profile than he can have anticipated. He is however proving more than capable and appears affable, good-humoured and respected.

    His Committee is made up of four other Conservative MPs, five Labour MPs and one Liberal Democrat MP. The smaller Coalition partner is therefore only represented by Andrew George MP and the Labour contingent includes Rosie Cooper MP and Valerie Vaz MP, both of whom voice their Labourite opinions very openly.

    The Committee as a whole appears to be providing robust questioning of witnesses, although the reports and forthcoming recommendations are yet to be seen. Certainly its role as a scrutinising body of health policy during the largest-scale reforms of the NHS since its inception is not one to be understated. However, Ministers have only recently been elected, have a mandate to change policy and can to some extent take any criticism from the Committee in their stride while the momentum of the Coalition is maintained. Any recommendations the Committee makes, like the most influential Committees, have to be sensible, workable and going with the grain of policy.

    The recent session on commissioning on Tuesday 16 November focused mainly around the question of whether the evidence base for the proposed reforms is sufficient, a point that divided many of the witnesses. Professor Le Grand (former advisor to the Tony Blair administration, now at LSE) argued not only that it is sufficient, but that Tony Blair would have attempted a similar feat himself: to quote his recent letter to the Financial Times ‘They [the reforms] are evolutionary, not revolutionary’. Professor Chris Ham (Chief Executive of the King’s Fund) directly reversed these terms later in the session, proving the spectrum of opinion amongst thought-leaders.

    The question we are left with is does the Government need an evidence base for its reforms or is good old fashioned ideology enough? Whilst there were some very obvious failings in the NHS under the previous Labour administration, the Coalition response has clearly not been based on evidence alone.

  2. A national strategy for rare diseases?

    Posted by Jamie Holyer on 8 November 2010  |  Government

    For the 3.5 million people in the UK who suffer from a rare disease the EU Council recommendation last year for Member States to develop national strategies for treatment by 2014 was very welcome and the end of a successful campaign for EURODIS.

    Rare Disease UK (RDUK) has now taken the baton on in the UK and the large number of patient groups getting behind it is demonstrative of the groundswell of support for this much over-looked policy area.  Whilst coalition Ministers, notably Earl Howe and Anne Milton MP,  are not saying too much at the moment, some well timed briefing prior to the election meant that they are up to speed on the issues and know that pressure will expedite quickly if nothing is done (and seen to be done).  

    The problem they have however is that rare diseases will be the preserve of the National Commissioning Board and how this will work in practice still needs to be worked out.  There is some major question marks over whether it will be the ‘lean and expert body’ that Ministers want it to be given the amount of responsibilities being loaded upon it and if it will be truly independent as politicians will have to carry the can in Parliament if specialised commissioning runs into problems. 

    Another major flashpoint could be the price of medicines.  Health economic analysis as a concept is not designed to appraise orphan and ultra-orphan medicines but investment in these types of drugs is what value based pricing is designed to encourage.  

    The early signs are however promising and RDUK have put a lot of work into what a national strategy may look like.  Their report will be launched in Parliament on Rare Disease Day next year.

October 2010

  1. Nick Hoile on the CSR and NHS

    Posted by Nick Hoile on 22 October 2010  |  Government

    There were few surprises for the NHS in George Osborne’s statement on the Comprehensive Spending Review yesterday.

    The Conservative Party’s manifesto commitment to year-on-year real-terms increases in the NHS budget was included in the Coalition Agreement, and is one of the key policies supporting the Government’s claims that the public spending cuts will not disproportionately affect the poorest in society.

    Given the predictability of the announcement of increased NHS funding, the only key announcement yesterday was that this real-teams increase would amount to an additional 0.4% of the budget by 2015-15.  Compared to other spending areas this is a good settlement for the NHS, though clearly it will not cover the ballooning costs incurred by an increasing unproductive NHS.

    The real political issue for healthcare yesterday was not the funding but the NHS but the announcement of the real-terms protection of the medical research budget.  Protests from the scientific community secured the commitment to protect expenditure on the Medical Research Council will be maintained in cash terms, as will the science budget more broadly.  Spending will be targeted towards translating research into practical applications, including developing new medicines.

    When coupled with the re-announcement of the Cancer Drugs Fund to reimburse medicines not approved by NICE, this decision on research funding reveals the Chancellor’s intention to grow the life sciences industry as part his strategy for a private sector recovery.  The political challenge for industry will now be to demonstrate that support for the industry delivers patient outcomes that are more cost-effective for the NHS than direct investment in NHS services.  

  2. The politics of change…

    Posted by Jamie Holyer on 14 October 2010  |  Government

    Politicians may be regarded, perhaps unfairly so, for their U-turns but there is something distinctly strange going on in Parliament at the moment. 

    Despite the Liberal Democrat party courting the student vote vehemently during the General Election with a range of over-sized posters and earnest smiles, Vince Cable MP did not bat an eyelid when he stood up in Parliament earlier in the week to endorse higher charges for students.  To the howls, whistles and general abuse of the opposition party he proclaimed that his hands were tied because “we are not in an ideal world”. 

    The situation for the Liberal Democrats was not unlike what the Conservative Party suffered the week before when despite claiming the ownership of fairness as a political philosophy George Osborne MP bodged an announcement on child benefit that didn’t seem fair at all.  Not least their core constituency of middle-England who let rip just unfair it really is through the established channels of the Daily Mail and Mumsnet. 

    Perhaps the greatest political contradiction of all will be the forthcoming referendum on AV which will see Conservative Ministers propose the idea but actually campaign against it and the Liberal Democrat campaign for it when actually they regard it as a complete sell-out to Proportional Representation.  The Labour Party is the only party that actually supports AV but voted against a referendum and may well campaign against it a defeat for the coalition government in the referendum would go a long way to upset the applecart regardless of the Conservative Party position.  

    The Labour Party has also done its fair share changing direction with the political winds as its new leader sought to move the party from the shadow of Blair claiming that Iraq and the company it kept were all wrong.  Never have so many senior MPs clapped through clenched teeth since David Cameron MP declared there would be a coalition to the 1922 Committee.  

    In healthcare policy, with the notable exception of the pre-election pledge from Lansley of “no more top down reorganisation in the NHS”, the biggest reforms of the NHS in the last 60 years have to date not led to any further tricky policy situations.   There is however still plenty of time as the consultation responses to the White Paper are only just in and Health Ministers have been keeping their heads well below the parapet.