Partnering with the pharmaceutical industry and bringing together a diverse group of experts is a novel but valuable approach for the NHS to address healthcare challenges, write Robyn Hudson and colleagues.
The NECLES HIEC
Representing a region of social disadvantage and associated poor health outcomes, the north east London, north central London and Essex (NECLES) health innovation education cluster (HIEC) aims to transform the region by identifying new models of delivering care that are empowering and relevant to the needs of the population.
Key areas of focus for the HIEC include improving cardiovascular disease prevention, maternity care and the management of chronic ocular diseases. In addition, due to variation in the provision and quality of services across the region, a HIEC priority is to optimise the patient pathway for chronic obstructive pulmonary disease.
The COPD Challenge
Chronic Obstructive Pulmonary Disease (COPD) represents a significant economic and social burden nationally. While approximately 835,000 people are diagnosed in England, the true prevalence of COPD is likely to be greatly under-estimated, due to considerable under-diagnosis in patients who may not access health services in traditional settings, such as GP surgeries, together with significant local and regional variation in diagnosis rates (Figure 1 - attached right).
- Diagnosis rate in England is 1.6 per cent of population
- Estimated to affect over 3 million people in England
- Causes 25,000 deaths annually in England and Wales
- Second most common cause of emergency hospital admissions
- Annual direct cost to UK healthcare system estimated at £810 - £930 million
In 2010 the Department of Health issued a Consultation on the Strategy for Services for COPD in England which aimed at improving the approach to COPD prevention, diagnosis and treatment; a key objective being to identify people earlier in the disease course and increase rates of early diagnosis. The resulting National Service Strategy will provide a framework of service improvement recommendations to optimise the patient pathway.
The NECLES HIEC recently partnered with Novartis Pharmaceuticals UK to achieve two goals. Firstly, to create a transferrable platform to encourage creative thinking which can be applied to different problems and secondly, to apply this platform to develop innovative solutions to identify and engage with undiagnosed COPD patients in the region.
To meet these goals, in November 2010 the HIEC and Novartis brought together a diverse group of attendees from the NHS (primary, community and secondary care), social marketing, advertising and health entrepreneurs for a creative workshop to “find the missing millions of COPD patients”.
Attendees brainstormed ideas for a seemingly unrelated, abstract scenario before working in groups to translate ideas to the COPD challenge, prioritising solutions and considering steps required for successful implementation.
The broad participant group, which introduced different experiences and insights into the problem by including people with no clinical background, coupled with the alternative meeting approach, generated many varied and new ideas. Peter Baeck of The Innovation Unit commented: “The open-forum approach allowed the sharing of different opinions and viewpoints, resulting in ideas that reflected the diversity of the people taking part – you wouldn’t get that range of ideas with the usual suspects in the room.”
Furthermore, many of the solutions included the involvement or collaboration with other previously unconsidered parties, such as dental clinics, homeless shelters and schools. The numerous ideas fell into three broad categories: those within the HIEC’s immediate reach, those requiring government influence and those utilising local and national partnerships.
This approach mirrors those utilised by other NHS initiatives, such as the Darzi Fellowship programme. Darzi Fellow Asiya Yunus, who is involved in COPD service redesign and attended the workshop, commented: “The Darzi programme has given me an insight into how to lead by getting people involved rather than a top-down approach. The novel approach to the workshop and the ideas generated fit into the way that the Darzi programme tries to create new ways of doing things.”
Outcomes and next steps
The range of solutions proposed and attendee feedback validate the effectiveness of the meeting format, achieving the goal of developing a platform to solve problems by encouraging creative thinking. Furthermore, because the format is transferrable, it may be utilised by the HIEC and Novartis across different NHS bodies to address different problems.
Following the meeting different solutions were, and continue to be, pursued, including the suggestion to conduct spirometry at heart failure clinics to identify potential COPD patients. The NICE guidance for chronic heart failure already recommends the use of spirometry to test for possible alternative diagnoses. Performing spirometry in heart failure clinics was seen as a credible solution as these people are already within the NHS system. This solution has been well received by stakeholders and the HIEC is working to identify possible resources to support this work. Unfortunately, this is challenging in the currently constrained health environment.
The success of the meeting was highlighted by comments from both partners. Reflecting on the day, Professor Mike Roberts, COPD pathway facilitator for NECLES HIEC, said: “Bringing together participants from outside the mainstream of respiratory medicine and particularly from commercial organisations provided perspectives that wouldn’t normally have been discussed. We now have some ideas that as partnerships might go forward.”
Alisha Alaimo from Novartis commented: “I’m confident that the creative approach on the day will result in valuable strategies to uncover COPD patients that can benefit from treatment and we remain committed to working with the HIEC in this area.”
The success of this joint initiative demonstrates that forming effective partnerships and drawing on wider experience outside of the NHS can not only lead to the development of new solutions for a long-standing problem, but also to the creation of a transferable platform that may be replicated and applied to other regions and challenges within the NHS.
Working well with a pharmaceutical partner
Robyn Hudson and Professor Mike Roberts, NECLES HIEC:
- Choose a partner with whom you can work effectively
- Be transparent about your goals
- Agree mutually beneficial objectives
- Agree process steps in advance
- Use strengths from across a commercial partner’s business model to support activities
- Be willing to try different approaches and think outside traditional solutions
- Recognise that everyone has something to contribute