The cutting edge - and why the NHS is falling behind it

This week, the government finally published its latest review on innovation in the NHS.

Entitled the Accelerated Access Review (AAR), the review finds that patients could get new life saving drugs four years earlier than they do at the moment, through a range of sensible measures, including the creation of a new fast track process for the most promising new medications.

This would be a welcome development. According to PricewaterhouseCoopers, patients in the UK regularly fail to get access to new drugs before their counterparts in other European countries

However, a consultation document, published earlier this month by NHS England and the National Institute for Health and Care Excellence (with much less fanfare) tells a very different story.

Focusing on ways in which the NHS can control its spiralling drugs bill, it suggests that NICE, who are currently responsible for testing the cost effectiveness of new medications, may also get a remit to determine their affordability.

According to PricewaterhouseCoopers, patients in the UK regularly fail to get access to new drugs before their counterparts in other European countries

This will be done by measuring all new drugs against a new ‘affordability’ threshold.

These two documents tell very different stories about the future of innovation in the NHS. The first sets a laudable ambition for the UK to be at the forefront of health and care innovation in the coming years - with British patients getting the best available treatments at the earliest possible point - whilst the second suggests that the reality may be much harsher, with the NHS unable to afford the best new medications.

If the latter becomes a reality we will see both the NHS and the UK life sciences industry lag behind the global scientific and technological frontier, whilst patients wait longer for access to life-saving drugs.

We are already getting a sense of what this might look like. The BMJ recently found that the NHS has systematically attempted to limit access to some Hepatitis C drugs, whilst the service is also in the process of appealing a High Court ruling which would require them to make ground breaking HIV treatments such as PrEP available across the UK.

As it stands, battles like these are relatively rare, however as new and innovative medicines come on stream in the coming years, it is possible that they will become the part of the NHS’s day-to-day reality.

Painful reality

Whilst these documents make passing reference to each other, it is clear that little effort has been made to address the contradiction between the call for improved processes and investment in access to treatments on the one hand, and a proposal to establish restrictions on the other.

This is a telling omission which reveals that, whilst the AAR could and should address some of the existing barriers to getting new treatments into the NHS, it will ultimately be undermined by the lack of a sustainable long term funding settlement for the health service.

Despite this painful reality, there seems little chance that the NHS will get more money in the coming months.

Despite efforts such as those outlined in the AAR, the NHS will continue to lag behind the cutting edge of medicine and new technologies

Simon Stevens, Chief Executive of the NHS, and others may have been hoping that the Chancellor of the Exchequer, Philip Hammond, might use his upcoming Autumn Statement to loosen the fiscal targets set by his predecessor and channel more money into the NHS, however, the signs so far are not positive.

In a recent meeting with Stevens, Theresa May purportedly made it clear that it was down to him and NHS leaders to make the necessary efficiency savings to close the funding gap.

If this stance is maintained, it seems inevitable that, despite efforts such as those outlined in the AAR, the NHS will continue to lag behind the cutting edge of medicine and new technologies.

Becca Antink works on health and social care policy at the Institute for Public Policy Research (IPPR)