Archive for the ‘Health’ Category

Do White Papers save lives? The potential pros and cons of the new Major Conditions Strategy

Posted on: February 3rd, 2023 by Morgan Arnold

Last week, Steve Barclay, the Secretary of State for Health and Social Care, announced the Government’s plan for a Major Conditions Strategy.  The announcement has caused controversy in the health policy space, as parliamentary questions have seemingly confirmed that long-awaited policy documents like the Health Disparities White Paper and 10-Year Cancer Plan, amongst others, are scrapped.

While a more cynical reason for the move is that the Government needs to deliver on key issues ahead of an election – long-term plans make no political sense – there are some other reasons which suggest this approach is rational.

The benefits of a simpler, joined-up approach

 In some ways, the de facto consolidation of multiple health strategies into a single centralised document makes sense and fits coherently with the future direction of policy.

The vision for the NHS over the next decade is supposed to be one in which relatively autonomous regionally-based systems are in control – driving change and developing services based on local need.

In an environment where health is becoming increasingly devolved, with Integrated Care Systems (ICSs) established in July 2022 and the ongoing Hewitt Review to help these succeed, it may be right that NHS England (NHSE) and the Department of Health and Social Care (DHSC) are relinquishing some top-down control, using the catch-all strategy to guide, rather than direct, NHS systems.  The detail of a 10-Year Cancer Plan could be seen as micromanagement and the Health Disparities White Paper could be redundant if  ICSs work as they should.

A single consolidated strategy also reduces the risk of incoherence between policy areas. In his statement, Barclay alluded to a Major Conditions Strategy, a piece of health policy, aligning to the life science policy.

Policy workstreams like the Life Science Missions and the Life Science Vision, are supposed to be industrial and science policy as well as health policy. In reality, it has often felt like life science policy has been poorly married with current health service policy priorities. This has led to the Government giving full economic policy backing to certain research and investment projects, while the health service fails to take advantage or support such initatives.

Specific policy saves lives

On the other hand, there is evidence that long-term and condition-specific policy plans do drive meaningful change.

The International Cancer Benchmarking Partnership (ICBP) found that countries with appropriately funded, long-lasting cancer policies see the greatest improvements in cancer survival.  With recent reports that nine in 10 cancer survival rates are worse in the UK than Europe, it seemed like the opportune moment to turn the tide on cancer by introducing the 10-Year Cancer Plan.

Now it seems the fate for these bespoke strategies is sealed and the test is whether a catch-all approach can deliver the same impact.

The Whitehall workforce crisis

As well as an upcoming election and the need to deliver on the Public’s immediate priorities, there is a another reason behind the move to a single strategy. Maintaining relevant and dedicated policies may have benefits, as outlined above, but the reality is that creating, renewing and implementing a plethora of policy strategies takes headcount. Yet, NHSE is looking to reduce headcount and the DHSC has had an effective hiring freeze. As all replacement hires require ministerial approval, developing several strategies, plans and workstreams, has become unrealistic.

Additionally, this is allegedly a DHSC-owned strategy, not one owned by NHSE. This is an interesting development of the themes which came out in debates over the Health and Social Care Act 2022, which ministers hoped would rebalance the relationship between the two bodies and give ministers, and therefore DHSC, more power.

Finally, we should acknowledge that such a move may sour the relationship between DHSC and teams in NHSE which have worked to develop these strategies over the past few years.

By James Juster and Noah Froud

What’s coming up in European health policy in 2023? Everything EU need to know

Posted on: January 12th, 2023 by Morgan Arnold

The word of the year is: polycrisis

In March 2020, the rest of Europe was transfixed by images of a healthcare system collapsing as COVID cases piled up in Lombardy, Italy, imminently expecting similar scenes to hit their hospitals. Fast forward nearly three years and European healthcare professionals are watching queues of ambulances outside UK hospitals, predicting the same scenario in their countries soon.

Against crisis backdrop, we know that industry voices have a shopping list of asks for European governments: increased investment in innovation to catch-up with the US; cooperative usage of data; novel approaches to technology evaluation and appraisal. Industry leaders say these amount to a call to target wholesale transformation and move to an ‘ideal’ healthcare system, rather than tinkering at the edges.

The polycrisis European health systems face will make it hard for these voices to get a hearing, even as system collapse tells us we need a more radical approach.

As this newsletter covers, 2023 will see varied responses to these issues. While France is pushing ahead with a renewed focus on prevention, Italy has placed a major primary care reform on hold. As Germany is looking to control its healthcare spending, Spain’s Government is pushing through pioneering changes in reproductive health.

This is our most comprehensive newsletter yet – if you have any questions about the topics raised, do get in touch.

Noah Froud, Charlotte Moss and Isabelle Scali

The biggest voice in European health policy: US Senator Bernie Sanders

Vermont independent and Medicare-for-all proponent Bernie Sanders is set to take over the Senate’s Health, Education, Labor and Pensions Committee next month, giving him oversight over key health policy priorities such as drug pricing. What happens in Washington inevitably influences European politics, and there’s potential for appearances by industry leaders in front of the Committee to be picked up by European media – just as Mark Zuckerberg’s were. POLITICO has chronicled how US lobbyists are preparing for challenges given the Senator’s well-chronicled antagonism towards them.

France:

Social Security Financial Bill to cap health products cost to state

The new  PLFSS (“Social Security Financial Bill”), which entered into law in December 2022, came into effect this month, ushering in multiple changes to the French health system. This act offers little flexibility for interpretation during the implementation process. While CEPS (“Economic Committee of Health Products”) will have some decision-making control over establishing reimbursement costs for certain advanced medicinal therapy treatments (AMTPs), most pricing and social regulations under the PLFSS have already been finalised. Excluding COVID-19 spending, budget growth for reimbursement of health products by insurance has been limited to a conservative 3.5 per cent (€244bn), in keeping with previous ONDAM (“National Goal of Health Insurance Spending”) targets. Projections for 2023 forecast a national social security balance of -€7.1bn, from 2022’s budget deficit of -€18.9bn. However, the restricted drugs budget has been decried by some outlets as a threat to industry innovation and barrier to patient access.

New services including ‘prevention appointments’ and screening for sickle cell

Prevention is a central focus in the French Government’s public health strategy. From 2023, ‘prevention appointments’ will be established for citizens at key age milestones (20-25 years; 40-45 years; and 60-65 years). The National Newborn Screening Programme is expanding its systematic testing of 3-day-olds in France to include 7 additional congenital diseases (including homocystinuria [HCY], leukinosis [MSUD], and tyrosinemia type 1 [TYR-1]). At the recommendation of HAS (“High Authority for Health”), screenings for sickle cell disease will also now be conducted across all newborns, including those in low-risk populations. This expansion we be trialled over the next three years. Free and non-prescription access to emergency contraception will now be made available to all women and non-prescription testing for STIs will be fully reimbursed for under 26s. Tobacco prices will also rise substantially as a continuation of the PLNT (“National Tobacco Control Programme”).

France to introduce reference pricing

HAS has made a concerted effort to improve the transparency of their market access decision-making over the past year. Now CEPS (“Economic Committee for Health Products”) will be expecting the same of industry. First, the PLFSS aims to use discount levers (paid to health insurers) to encourage further claims for reimbursement across all eligible indications, moving away from indication-specific claim strategies. Secondly, under new ATMP financing, payments to the manufacturer will now be spread over time, at key milestones based on real-world evidence of treatment efficacy even after reimbursement approval.

Finally, under the PLFSS, CEPS will introduce reference price groups and additional evidence requirements following market access approval. This aims to guarantee proportional reimbursement for product outcomes and encourage use of comparable cheaper alternatives or generics. This follows a similar approach to other EU systems. However, the impact on generics uptake is uncertain without additional patient or prescriber incentives.

Germany:

Cost-containment measures to be introduced

Long since one of the most attractive EU markets for pharmaceuticals, Germany is adopting cost-containment measures that are set to significantly impact industry revenue and R&D in the country. In light of the statutory health insurance system (GKV) facing financial difficulties, the Bill on the Financial Stabilisation of the Statutory Health Insurance System (‘GKV-Finanzstabilisierungsgesetz’) passed through the Bundestag and the Bundesrat in October 2022.

The Bill aims to distribute financial burden across all healthcare players without reducing patient benefits. Changes in reimbursement pricing mean the period in which a pharmaceutical company is free to set its price for new medicines is reduced from 12 to six months. The German Government has also stated its expectation that future price negotiations will also consider price-volume components. Meanwhile, orphan drugs will be subject to the full AMNOG process (including HTA assessment) if their annual revenue exceeds €30 million – a tightening of the current €50 million bar which has drawn concerns from smaller pharmaceutical companies, particularly in the rare disease space. Reactions to the Bill have been mixed, with some stakeholders voicing concerns that the Bill is a quick fix rather than a long-term solution to stabilising GKV finances.

While the rest of 2023 is likely to reveal further cracks in the running of Germany’s health system, the GKV Bill may well have a broader impact for many years to come. Besides the possible stagnation of R&D and innovation within Germany, the Bill could affect innovative therapy pricing beyond its borders, as German pricing is often used as a reference for both EU countries and others such as Canada, South Korea and Japan.

Alert level red

Amid recent mass resignations in Germany’s hospitals, staff have cited a workload so extreme that some were unable to take even a short break or go to the toilet. In a country that spends more on healthcare than almost any other in the world, this is triggering widespread alarm. The Health Minister, Karl Lauterbach, announced a plan to move nurses and doctors around to match demand that has been dismissed as “absurd” by leading clinicians; the Süddeutsche Zeitung stated that the country was witnessing “what it means when a system implodes”.

What lies ahead for Germany’s coalition?

Cost-containment measures can be viewed as a stress test for the so-called ‘traffic light coalition’, with social democratic Mr Lauterbach (SPD) and the liberal Finance Minister Christian Lindner (FDP) both key players. Mr Lauterbach also featured in the news towards the end of 2022 when German police revealed they had thwarted a far-right terrorist group’s plot to kidnap the Health Minister. The planned attack has been interpreted as an extreme response to Mr Lauterbach’s cautious approach to COVID-19 and follows the rising trend of renewed political extremes in countries generally regarded as stable democracies. Suspicion of vaccines and opposition to lockdowns and mandatory mask-wearing have provided fertile ground for healthcare issues to accelerate extreme political movements since the beginning of the pandemic.

Spain:

Overstretched frontline staff

In December, El Mundo spoke with Professor Verónica Casado, former Minister of Health for the Junta de Castilla y León and internationally renowned family doctor. The discussion centred on the apparent lack of doctors across Spain. Professor Casado, however, dispelled this notion and stated that there have never been so many doctors, but the distribution of specialties is “very chaotic” with 18 specialties being classed as “very deficient”. Looking towards 2023, Professor Casado suggested the introduction of a specific MIR (Resident Medical Intern) for the 18 specialties most at risk might be one resolution, but also noted that this is a multi-causal issue. This takes place against the backdrop of a more widely reported issue of many doctors in southern Spain leaving the area in pursuit of better pay and prospects, as well as numerous planned doctors’ strikes.

Sexual and reproductive health policy

Towards the end of 2022, Spain’s Parliament passed a pioneering sexual and reproductive health law. This law removes a mandatory three-day “reflective” period for women who wish to terminate a pregnancy and removes the need for those aged 16 and 17 to obtain the consent of a parent or guardian to abort, which is a first for a European country. Other changes included amends to maternity pay, menstrual products and surrogate pregnancies. The law was adopted with a 190-154 majority with five abstentions, although those against were resolute in their opposition: Lourdes Mendez from the far-right party Vox believes the law “violates the constitution and has turned Spain’s system of values upside down”. The law is now with the upper house for final approval but – given the far-right party Vox won a 15 per cent vote share in the last election – we expect a hostile response from some of the Spanish public.

Italy:

New Government divided on health

Italy’s recently elected Government of right-wing parties, formed by Giorgia Meloni’s Fratelli D’Italia (Brothers of Italy) (FdI) and its junior partners La Lega (the League) and Forza Italia (Come on Italy) (FI) have differing views on healthcare. FdI favour a more centralised system. Their partners Lega and FI favour regional autonomy and privatisation, in the model of Lombardy, which is publicly funded but also supported by the private sector.

Italy’s governance system allows unelected specialists to serve in Government as “technical” Ministers, meaning they do not have a political background; this has allowed the parties to agree on a compromise Health Minister Orazio Schillacci, who is not affiliated with any of the ruling parties. Schillacci previously served on the Scientific Committee at Italian National Institute of Health as a researcher, appointed by Roberto Speranza, the previous Minister, which fed into PM Mario Draghi’s Government’s public health decisions during the pandemic. This may be an indication that they recognise the scale of the challenges ahead and are choosing to take the health brief seriously. However, it could also signal a lack of political ambition. As the Government was elected in September and had to pass a rapid budget by December, there were no new landmark health projects announced. It is yet to be seen what direction the Government will choose to take, preferring to focus now on the cost-of-living crisis through support for families and tax cuts.

Private-public partnerships under scrutiny

According to the bureaucratic structure in place since 1992, healthcare services are regulated by the Government, but the regions have autonomy over budgets, spending and provision. This has led to a patchwork of local systems that have opted for varying degrees of privatisation. It is now understood that the Lombardian private-public model resulted in one of the worst death rates of all the regions during the pandemic. Silvio Berlusconi’s FI and Matteo Salvini’s LI parties have governed the region since 1995 and allowed private and public systems to compete for funds based on efficiency. Praised as one of the most advanced healthcare systems in Italy, it also meant that private firms invested in areas that would generate more revenue, leading to a reduction in hospital beds and a decreased capacity to combat a sudden emergency. This arguably contributed to the area’s poor outcomes compared to neighbours with higher levels of public funding Veneto and Piemonte.

Health spending frozen in real terms

Spending cuts in the previous decade left the Italian health system weak as the country in the G7 with the lowest healthcare funding since 2008, which may have contributed to its status as a country with one of the highest death rates in the EU. Whilst the recently passed budget law in December increased healthcare spending by €2.15 billion for 2023 and a further €2.3 billion in 2024, €1.4 billion of this funding will be going towards covering high energy costs for hospitals, and the remaining money covers inflation, so will not be enough to properly address some of the outstanding issues.

Workforce shortage expected to worsen

There is a chronic shortage of healthcare workers. The ANAAO (National Association of Hospital Assistants), Italy’s largest doctor’s union, estimates that based on current trends of retirements and layoffs, there will be a total loss of 40,000 medical specialists by 2024. Plagued by long working hours, lack of staff, heavy bureaucracy, poor social and economic recognition, and assaults and accidents at work, more staff might opt to head for the door too.

Educational bottlenecks resulted in fewer doctors being trained than were needed in the system, whilst a large number of doctors have retired in recent years. Measures were introduced by the last Government to expand medical school places and training residencies, but it may be another few years before their impact is felt. Additionally, some residencies are undersubscribed, such as emergency medicine, microbiology and anaesthesiology. The new coalition Government repealed the regulation barring unvaccinated healthcare workers from work in October partly to reverse the departure of 4000 healthcare workers, and throwing their COVID-sceptic base some red meat. As in the UK, this has led to a reliance on locum doctors (called “token” doctors in Italy). Schillacci has acknowledged that to some extent, making certain disciplines more attractive to specialise in and stopping the exodus to the private sector will require better pay and flexibility.

Primary care reforms on pause

Italy’s primary care problem has been exacerbated by the pandemic. We’ve noted previously that the EU Commission’s National Recovery and Resilience Plan (NRRP) included €7 billion of NRRP funding toward local health centres known as “community houses,” in which primary care would be supported by enhanced laboratory facilities for testing and diagnostics, enhancing screening capabilities and reducing pressure on hospitals and long-term costs. Schillacci has signalled that this might not be the solution the Government takes, and this will need to be evaluated. As the NRRP money is still largely unspent, and is the only ‘additional’ money available, what Meloni’s Government chooses to do with this will be significant.

Brussels:

European Commission mental health strategy pencilled in for Q2 2023

The EU’s health chief Stella Kyriakides had previously commented in October that the Commission is supporting member states to reform mental health systems and has allocated more than €28 million to mental health actions under the EU4health programme over the last three years. How the Commission plan to build on this with its mental health strategy is currently unknown, but – based on President Ursula von der Leyen’s State of the EU speech last September – it appears to be a top health priority for the upcoming months.

European Council to decide on medical devices transition timeline

Later this year, health ministers will formally vote on the European Commission’s proposal to extend the deadline for the transition period of medical devices regulation (MDR) from 2024 to 2027, following concerns that delays in the regulation’s implementation are creating shortages of devices used by health services.

Orphan products and pharmaceutical legislation?

In November 2022, the Commission promised MEPs that they expect to adopt the proposal for revising the orphan medicinal products legislation in the coming months – albeit without providing a specific date. The current legislation was introduced in 2000 to better incentivise those developing orphan medicines; the Commission evaluated the legislation revision in 2020 but adoption of the proposal has been continually postponed.

Following a similar path of delays, pharmaceutical legislation revision should have been presented in December 2022 but as yet remains unseen. The Commission says the new legal framework will ensure access to quality and affordable medicine but, in its response to the public consultation on the revision, the European Federation of Pharmaceutical Industries and Associations (EFPIA) argue that ensuring faster, more equitable access “cannot be achieved through the revision of legislation and an incentives framework”, and instead must be addressed through stakeholders understanding the root causes of access barriers and jointly finding solutions to these delays.

Isabelle Scali

Associate Director

Former Global Corporate Communications Director at ViiV Healthcare, Isabelle has 20 years of strategic communications experience.

Noah Froud

Account Director

Noah is the brains behind our newsletter, and previously worked for a Member of the European Parliament.  He’s an unashamed health policy nerd and has his finger on the pulse of UK and European developments.

Charlotte Moss

Account Manager

Charlotte is well versed in European policy, having studied Governance, Economics and Development in The Hague, the heart of European justice and political capital of the Netherlands.

Neil Moscovici

Account Manager

Neil holds an MA in Geopolitics and Grand Strategy, and before joining MHP worked for the European Committee of the Regions in Brussels.

Laurence Childs

Account Manager

Laurence joined MHP from the UN Office of Drugs and Crime in Vienna. He holds an MSc in International Health Policy and has a background in market access.

Matteo Bellani

Account Executive

Matteo joined MHP in 2022 from ViiV Healthcare, where he worked in Pharmacovigilance and Regulatory Affairs.  Matteo is a specialist in HIV advocacy and holds a first class degree in Biochemistry.

Reflections on the Health and Care Act, 2022

Posted on: December 20th, 2022 by Morgan Arnold

For most people, the way the NHS is run at an organisational or structural level is of little interest.  After all, what most people want from their health service is pretty straightforward: easy-to-access GP appointments; timely referrals; good quality care at each step of the pathway and the ability to receive urgent care should the need ever arise, to name but a few.  The how in the delivery of what the NHS does is of secondary importance.

In health policy, advocacy and reporting this is different.  How the NHS organises itself with the resources it is allocated by central government is a never-ending source of intrigue, speculation, and contention in the pursuit of ever-improving outcomes, efficiency and overall health delivery.

It is for this reason that the passage of the Health and Care Act earlier in 2022 – a parliamentary journey monitored each step of the way by MHP Health – was a major source of interest.  This was the first major piece of legislative reform undergone by the health service in a decade, and came in the context 2019’s NHS Long-term Plan setting out a strategic decade-long vision for the NHS, the massive and persistent impact of the COVID-19 pandemic, ongoing crises besetting the social care sector, not to mention the five Health Secretaries running the department since 2012.

Throughout the course of the second half of this year, we spoke with experts representing different parts of the system, all of which would be affected in different ways by the changes, to understand their perspectives and what they would be looking out for as the legislation begins to take effect.  What is actually meant by Integrated Care?  What will accountability look like between NHS England and the Department of Health and Social Care?  And what does this all mean for the patient?  We were delighted to talk to the following people to find out:

Paul Howard, Chief Executive Officer, Lupus UK

 

Laura Donnelly, Health Editor, The Daily Telegraph

Shaun Lintern, Health Editor, The Sunday Times

Victoria Macdonald, Health and Social Care Editor, Channel 4 News

 

By Miles Watson, Sophie Vandenbroucke, Noah Froud, Jaber Mohamed

Related Content:

                                                               Bill Watch: The Health and Care Bill becomes law

                                              Bill Watch: a review of the Health and Care Bill’s passage through The Lords

                                                     Bill Watch: Who will be scrutinising the Health and Care Bill?

Halfway to 2030: Equalising the Global HIV Response

Posted on: December 1st, 2022 by Morgan Arnold

World AIDS Day 2022 marks the halfway point of the UN’s SDGs 2030, which set the aims to end all AIDS-related deaths by 2030. The central strategy towards achieving this were the 90-90-90 goals but few countries managed to achieve this by 2020. Infection rates have increased in some parts of the world, and between 2021 to 2022, the number of infections only dropped 3.6%. There is a sense that the Global HIV response is slowing, and that the shift from acute to chronic infection has pushed HIV and AIDS down the policymaker agenda in favour of COVID-19 or other domestic challenges.

MHP’s ‘Networked Age’ research shows that identity and obligation are the primary reason individuals advocate for issues and the two drivers that cut across demographics. Over the years the HIV response has become a less polarising issue that is strongly tied to identity or relatability, and risks being lost in a lengthy list of global issues. Communication and messaging about HIV should seek to ensure the audience feels a personal commitment to care about HIV. Without this there could be a risk of limiting progress to reaching the SDGs.

Four decades since the start of the epidemic, 38.4 million people globally have HIV, and 40 million have died from AIDS-related causes. However, the brunt of the crisis is largely being felt in lower-income countries (LICs), with two thirds of people living with HIV (PLHIV) being in the WHO Africa region. Due to persistent issues of marginalisation, the global response should continue prioritising intersectionality and target populations most at-risk of contracting HIV: young women and girls, LGBTQIA+ people, sex workers and injecting drug users.

The COVID-19 pandemic has disrupted the response towards eliminating AIDS-related deaths and risks undoing much of the progress of the last decade. Beyond experiencing worse outcomes, PLHIV have seen access to screening services, check-ups and treatment disrupted globally. Disparities have widened and health services are stretched in LICs, meaning they are unable to deliver the appropriate care needed at this critical time. This major health crisis, coupled with other significant events such as the war in Ukraine, have shocked the global economy, leading to a reduction in funding for international aid projects, including the HIV response.

That the response depends so heavily on higher-income country (HIC) funding highlights that progress is fragile, and there is a need to ‘shockproof’ it. Continuing to strengthen and expand multilateral partnerships, debt relief in LICs, and reinforcing healthcare systems through sustainable community investments is needed to maintain equal access to resources and end the inequalities that drive AIDS. There is a large gap in all regions between the resources needed and the amounts available for prevention and societal enabler programmes.

15% of PLHIV still do not know their status, meaning 5.9 million are not being provided prompt treatment and may be unknowingly transmitting to others. Stigma makes it harder to bring patients into the treatment pathway. It prevents undiagnosed PLHIV engaging with testing, fearing they could face discrimination and abuse from their peers, family, and employers, despite the potential for serious illness. There is additional hesitancy to access services in marginalised populations, such as LGBTQIA+ people and sex workers, especially where they are criminalised or viewed negatively. Girls and young women —a group that saw one person globally acquire HIV every two minutes in 2021 – have an increased risk of infection from gender-based violence and in some areas are stigmatised for using sexual health services.

HIV-specific laws, such as those criminalizing HIV non-disclosure, exposure, and transmission, further entrench stigma and discrimination. Restrictive laws and policies, such as the requirement for parental consent for adolescents and young people to access services, discourage help seeking. Therefore, without tackling stigma in healthcare, educational, legal, and social settings, then those unknowingly living with HIV may not seek the help they need. Others who know their status but hesitate to attend check-ups and to pick up their medication, may also be impacted.

There needs to be a compassionate approach, increasing awareness of U=U (Undetectable=Untransmissible; PLHIV with an undetectable viral load cannot infect others) tackling misinformation and strengthening human rights legislation. Industry has been playing a valuable role in this, for example ViiV Healthcare’s campaign ‘HIV in View’, shows PLHIV leading normal, happy, and healthy lives, which is possible with access to diagnostic services and effective treatment. Positive examples in the media would reduce PLHIV’s fears of their futures, whilst tackling stigma. Compelling campaigns reflect the needs of the whole patient community, positioning patients as equal partners in their own care to drive and shape healthcare change.

LICs struggle to train and retain researchers and practitioners to address local and regional challenges. This leads to a reliance on external solutions, and an inability to develop their own approaches taking their contexts into account. There is limited access to research funding, and localised challenges or knowledge are generally not focussed on, meaning methods, theories, and insights from HICs are used more often. This ‘trickle-down science’ effect perpetuates the cycle of lack of advancement in LICs scientific capabilities and skews research to HIC priorities.

Voices in these communities are excluded in favour of HIC scientists; for example 96% of all global health conferences in the last 20 years have been held in those countries. MHP’s advocacy principles emphasise the need for community voices and representation. Effective advocacy focuses on compassion, patient-centrism, connection, and identity. Top-down advocacy from large organisations risks depersonalising messaging if the science and voices on the forefront of the HIV pandemic are not front and centre.

Ending the AIDS pandemic is both an ethical imperative and an urgent health and economic priority. Yet, in the age of polarisation in public debate, HIV no longer inspires the strong feelings it once used to, the kind which motivate more vocal advocacy. To compete with other priorities and capture attention, the HIV response needs to reframe itself as a fight against the structural and personal inequalities, grounded in intersectionality, that would build a broader coalition to continue the fight to 2030.

Top Tips For Speaking To Health Journalists

Posted on: October 20th, 2022 by Tomas White

Here are my top tips:

Focus on what it means for the patient

Health journalists are very consumer focused.  What they care about most is what does the story mean for real people. How many lives will your product save? Or how will it make them happier, healthier and live longer? You should always focus on the people you are helping, never the product when trying to sell in a health story.

For example, when the government was planning for a No Deal Brexit, there were concerns over the practice known as ‘parallel exporting’ – when companies buy medicines meant for UK patients and sell them on for a higher price in another country.  The government was forced to take the unprecedented step of banning this practice on certain drugs deemed to be in short supply.  There were fears it would cause panic buying amongst the public.  We put the focus on the patient and portrayed the export ban as an attempt to protect to UK supplies of Hormone Replacement Therapies (there were a number of HRT drugs on the list). The government was widely praised for taking such decisive action.

 

Always have a story – don’t let them pick the angle

When I first started in PR my Head of News gave me some sage advice about engagement with the media, he said: “If you don’t give them something to write about – they will find something to write about”

This means never agree to an interview unless you have a positive story to tell. If the story is negative, issue a reactive statement. If you agree to interviews without a story, the journalist will find a story and it may not be one that you like. The NHS’ former Chief Executive Simon Stevens would rigidly adhere to this principle and his team would never let him make any media, parliamentary or public appearances without a positive story to tell.

 

Use the data to your advantage

The best stories are about people but they should always be supported by evidence – facts and figures can go a long way towards winning an argument or illustrating a point. The pandemic saw the proliferation of data-based health stories on topics such as the efficacy of COVID-19 vaccines or the number of infections, hospitalisations and deaths. A good stat can make an entire story.

 

Don’t deal in misinformation

This one should hopefully go without saying but lying to journalists is always a bad idea. While not knowing the answer to a question is embarrassing, misleading the public can have far more serious consequences.  If you don’t know the answer, say you don’t know or that you’ll get back to them.

Sir John Bell, Regius professor at Oxford University, a man at the heart of the team that got the Oxford vaccine out of the lab and into the arms of millions was highly critical of the misinformation spread by decision-makers in the EU about that vaccine.

He said: “They have damaged the reputation of the vaccine in a way that echoes around the rest of the world. I think bad behaviour from scientists and from politicians has probably killed hundreds of thousands of people – and that they cannot be proud of.”  Sir John was referring to the decision by Germany not to give the AZ/Oxford jab to those over 65 and comments by French President Emmanuel Macron, calling the vaccine “quasi-ineffective” in the elderly. But just hours later, the European Medicines Agency approved the jab for adults of all ages.

 

This is a sobering example of why you should always stick to the facts when working with health stories.

For more insights contact the MHP Media Network media@mhpc.com

Has understanding of suicide been left behind in the societal progress made on mental health?

Posted on: August 1st, 2022 by Tomas White

Prior to 1946, technical references to mental health as an explicit field or discipline are rare, although mentions of mental hygiene exist.  Over the subsequent 75 years, understanding of mental health has progressed rapidly, going from an unknown, stigmatised phenomenon to a much better-understood subject.  It is now often considered to be of equal importance to physical health – with ‘parity of esteem’, a term which describes the need to value mental health equally to physical health, being noted by institutions including the Royal College of Nursing, NHS England, and the House of Commons.

In spite of this progress, suicide has remained riddled with misconceptions, poor understanding and taboos, resulting in a limited ability to recognise and support those at risk.  Suicide accounts for 10 in every 100,000 deaths in the UK and increases to as high as 20 in every 100,000 for males aged 45-65.    It is rightly considered an incredibly sensitive subject.  For both those at risk of suicide and their friends and family, it is a complex, personal, and difficult topic to approach.  However, unfortunately, a reluctance to talk about suicide on a personal level has resulted in a wider issue of poor public understanding.

The Campaign Against Living Miserably’s recent ‘the Last Photo’ exhibition served to highlight some of the misconceptions around suicide by displaying photos of people taken within 50 days of them taking their own life – often happy, laughing, or with loved ones.  The exhibition was complemented by a YouGov poll which found that only 24 per cent and 22 per cent of people respectively think that someone experiencing suicidal thoughts would smile and joke, or would share happy photos on social media.  Whilst there can be signs or situations to look out for, these do not apply to all who are struggling.  Sensitively opening dialogue can therefore often be the only way to gain a true understanding of what someone is going through.

The same YouGov poll found that over half of people said they would not feel confident helping someone who is at risk.  In a representative poll conducted in Australia, 31 per cent of people believed that ‘asking about suicide might start them thinking about it’.  This view is associated with a reduction in the intention to ask risk assessment questions.  However, evidence shows that asking someone if they are suicidal enables the person to feel listened to, validates their feelings and helps let them know someone cares.  Talking to someone, whether that be a loved one or a healthcare professional, can often be the first step to getting help (more information can be found on Samaritans’ website As illustrated by Samaritans here, many myths surrounding suicide have been debunked yet continue to contribute to a reluctance to discuss the topic – when in reality, talking about the subject is a crucial first step in helping those at risk.

The portrayal of suicide in the media also complicates the discourse.   Online searches for the corresponding method increased sixfold on the day when details of Caroline Flack’s death were released, highlighting the impact that reporting can have, and also shining a light on the ease with which anyone can access information about suicide online.  This impact can be even more substantial when the media sensationalise the story and give a detailed account of the method.  This issue has led for calls to formally regulate how the media represent suicide. The Samaritans provide clear guidelines on how to best portray suicide in the media and, whilst open dialogue is encouraged, it must be done in a sensitive and constructive manner.  One of the more common examples, not just in the media but in society as a whole, is to move away from the use of the phrase ‘committed suicide’ which harks back to an era in which suicide was a sin or crime.

On the other hand, media can be used as a productive tool in suicide prevention.  One example is the song “1-800-273-8255” by American rapper Logic in collaboration with the US National Suicide Prevention Lifeline (NSPL).  The song details the beneficial role of crisis counselling from personal experience and the three weeks following the release of the song saw a reported rise of 27 per cent in calls to the NSPL.  Charities across the UK are similarly seeking to open the dialogue about suicide in a sensitive manner, and campaigns such as the annual Talk to Us by Samaritans remind people that, should they need it, there is always someone there to listen.

Mental health has undergone a seismic shift in recent decades – from highly stigmatised to slowly becoming embedded in mainstream health services.  However, it is vital that the issue of suicide is not left behind.  Reducing misconceptions, encouraging wider discussion, and handling the topic in a sensitive manner will hopefully empower people to recognise, understand and support those at risk, overcoming the final taboo.

Photo by Aarón Blanco Tejedor on Unsplash

A formidable in-tray – from Covid response, to driving cross-NHS cultural change

Posted on: June 28th, 2022 by Tomas White

The pandemic is far from over, unlocking the lockdown is proving a game of snakes and ladders. Javid has already been warned that his first priority needs to be the continued success of the vaccination programme if we are ever to see our lives return to normal.

Ensuring the NHS has the resilience necessary to face any future waves of new Covid variants is also pressing. Tackling burgeoning waiting lists will be a very visible litmus test for Javid. More than 5.1 million patients in England are waiting for treatment, the highest since modern records began, and the number is likely to keep on going up as Covid admissions continue to disrupt the recovery of other services like cancer care and routine surgery.

The list of operational challenges is growing. The coming winter could be as challenging as the last though in different ways.

Flu was effectively suppressed last winter thanks to social distancing. That means less residual population immunity and medical experts have warned that the coming winter could see a nasty resurgence of flu.

The last bad flu season was in 2018 and then – even before Covid existed – there were widespread suspensions of routine operations and procedures.

The rollout of booster Covid jabs in the autumn and linking that to the flu campaign could be even more complex than what’s been run up until now.

These challenges are compounded because NHS and social care staff and leaders are exhausted from dealing with the pandemic. But there is no quick relief in sight with multi-year training required for new doctors and nurses. There is also a very tricky decision to make on pay soon following an outcry after an earlier 1% pay offer to many health workers.

And the list of strategic challenges is daunting.

The reform of social care has been left in the ‘too difficult to do’ drawer by successive Governments. Yet landing the integration agenda requires a Long Term Plan for social care. Javid’s Treasury experience could stand him in good stead when he sits down with the PM and Chancellor to agree a plan.

Within days Javid will have to kick off the Parliamentary scrutiny of the Health Bill. Any delay will spell trouble for an ambitious timetable that sees Integrated Care Systems (ICS) formally established from 1st April 2022.

Unlike the 2012 reforms the move to integrated, place based care and population health has NHS backing. But Javid will have to decide whether he sticks with Hancock’s plans to take new powers to direct NHS England. There were already rumblings on the Conservative backbenches about the plan, is this a fight Javid wants to have?

And with Sir Simon due to step down as NHS England CEO this summer Javid and his boss the PM will have to decide what sort of ‘guiding mind’ they want at the top of the NHS. How long will the leash be?

All this while the UK Health Security Agency is being set up and absorbing some of the work of key agencies involved in the pandemic response, such as NHS Test and Trace and Public Health England.

Steering the Health Bill through Parliament won’t be without its challenges, especially in the Lords. But it will be its implementation and impact that the public will judge.

The centre always has to resist a strong temptation to micro-manage the NHS, both from the Department and from NHS England. But the ICS project is predicated on a very different model of place-based collaboration and system leadership to deliver more person-centred care, make a reality of prevention and tackle inequalities of access and outcome.

Without the culture change the new structures will fall short of the ambition looking up for direction rather than out to the communities they serve. Appointing an NHS CEO who can foster that culture, manage political expectations and let the ICS reforms mature and deliver may be the most important NHS legacy of Javid’s tenure.

Are we going back to the “bad old days” with the most innovative NHS services?

Posted on: March 30th, 2022 by Tomas White

The measures embodied in the Health and Care Bill are seen as the reversal of Andrew Lansley’s 2012 reforms.  It’s therefore unsurprising that Lord Lansley has had much to say about the Bill, making over twenty speeches on the legislation since it arrived in the Lords.

On the topic of specialised services, he has raised the spectre of the “bad old days” where there were “considerable disparities and consistencies” between services. As Lansley put it, his approach in 2012 aimed to “level-up” services in this area by making sure standards were consistent. Whether or not this was achieved, a number of Lords have joined Lansley in making their concerns known, making this a major subject of debate over the past few months of the Bill’s passage.

But to start with, what actually are specialised services and why do they matter? The term ‘specialised services’ hides the fact that actually, some of the diseases, conditions and treatments covered by this style of commissioning are far from rare, or that this part of the NHS is somehow small.

Specialised Commissioning covers 146 services, from conditions as diverse as blood borne viruses like hepatitis C and HIV, which affect hundreds of thousands of people, to treatment for liver and pancreatic cancers which together kill 15,000 people each year in the UK.  When you run through the list of conditions, you realise how important these services are for the people under their care and why finding the perfect formula to structure these services is both so important, and such a challenge.

On the issue of size, it’s worth noting that specialised services now make up a sixth of the NHS’s budget. In the five years to 2020, its budget rose by an average of 8 per cent per year.

Whilst it is the case that the 2012 reforms helped reduce disparities in the care patients received and their access to specialised expertise, they still clearly exist. For example, the recent GIRFT Rheumatology report said that while the current model for commissioning specialised rheumatology services “is working well in some areas” in others, there has been little change to the informal model which existed before. These services are meant to cover rare and complex diseases like systemic vasculitis which have “a much higher risk of mortality and morbidity than more common conditions”.

Meanwhile, on specialised asthma services, the GIRFT Respiratory report said there is “confusion” with some specialised centres not meeting the required criteria.  Again, getting commissioning right here is vital, given large numbers of asthma deaths are preventable.

Now though, a portion of the budget for specialised services is set to be delegated to Integrated Care Boards (ICBs), the NHS bodies which will commission services for areas covering about 1-2 million people, and it’s envisaged that ICBs will either organise provision as an individual ICB, or with other ICBs.  However, NHS England has said that while ICBs will take on the commissioning of some specialised services, “national standards and access policies” will remain. Other services, such as highly specialised services will remain directly commissioned by NHS England. Still, the changes raise a number of questions: Which services will be delegated?  If keeping national policies in place looks to be the strategy to prevent disparities, what happens when, inevitably, services in one area do not meet the national standards, or the standards in other areas?

Specialised services were subject to a National Audit Office report in 2016. The current reforms seek to address some of the wider concerns in that report. For example, the NAO highlighted that patients felt their care was becoming disjointed between specialised and non-specialised services. In addition, over 70 per cent of Clinical Commissioning Groups surveyed by the NAO supported a more joined up approached to services.

Disjointed care is not just an inconvenience. Research in the US, for example, showed that lupus patients with more fragmented care are more likely to develop serious infections and kidney damage. The barriers uncoordinated care creates can exacerbate inequalities as patients have to fight the system to get the care they need. Giving responsibility for specialised services to ICBs, could ensure more coordination, with a ‘bottom-up’ commissioning structure meaning specialised services are more integrated into secondary care and commissioning decisions are made more precisely on local need.

Another of the NAO’s recommendations was for NHS England to develop an overarching strategy and “communicate this clearly to stakeholders”. The number of Lords raising concerns about specialised services in recent weeks is a sign it has not yet succeeded in doing this. For example, Baroness Neuberger, who is also chair of University College London Hospitals Foundation Trust – a major specialised provider (and therefore a major stakeholder) – warned that delegating responsibility “where there is no evidence base for joining up pathways” will lead to more fragmentation and increased costs.

The diseases covered by specialised services include conditions where outcomes have historically failed to improve, like pancreatic cancer, or where current standard treatments remain inadequate. Wonkish discussion of ‘specialised commissioning’, hides the very real consequences that getting this aspect of NHS reforms wrong would have for some of those patients in the most need.

Reporting the pandemic and beyond – dispatches from MHP Mischief’s Health Media Roundtable

Posted on: September 23rd, 2021 by Tomas White

Never has the role of the health journalist been so important in deciphering, interpreting, conveying, and interrogating the news. The past 18 months has seen a raft of seismic events in health news: a global pandemic; a health service in crisis; the development and rollout of a vaccine; sweeping reforms to health policy…and health journalists have been integral in explaining what it all means to the average person on the street.

It was in this context that the MHP Mischief Health team was thrilled to convene a panel of the country’s leading journalists, spanning print, online and broadcast.  Hugh Pym (BBC News), Ashish Joshi (Sky News), Kat Lay (The Times) and Stephen Adams (Mail on Sunday) provided open and insightful commentary of their experiences of pandemic reporting and their broader predictions for future health media trends, in a conversation chaired by MHP Mischief Health Associate Director and former press officer at the Department of Health and Social Care, Jaber Mohamed.

Catch up on highlights from the discussion below:

Striking the balance – reporting during a pandemic

The panel candidly admitted that the enormity of COVID-19 could not have been predicted when murmurings of a novel coronavirus in the Far East were first being mentioned in early 2020.  Indeed, in the initial days when the crisis reached the UK, the panellists said that the general sense of ‘chaos’ was exacerbated by difficulties around access to sites and officials and the sourcing of robust data.

A persistent challenge media faced in telling the story(ies) of the pandemic was how to strike the right balance of reporting fact, holding truth to power, and interpreting vast quantities of data, all whilst recognising the human grief that was sitting at the heart.  Not to mention the very real personal health risk they ran in seeking the story, for themselves and the people they lived with.  This balancing act continues, with panellists explaining the need to constantly find fresh angles and satiate the public’s appetite to be informed about the pandemic as it lurches from phase to phase.

Doing more with science, data and research

A positive that emerged from pandemic reporting for our panellists has been how data – always essential in the craft of a health reporter, but often a difficult ‘sell’ to an editor – is now in demand and integral to the telling of any story.  This transformation mirrors Government communications during the pandemic, with the appearance of graphs, dashboards and infographics becoming commonplace on television screens and newsprint on a daily, if not hourly basis, presented by scientists previously unknown to the public but are now trusted household names.  People now ‘get’ and want to be told about science and the researchers and innovators who are behind it.  The previous assumption that audiences would somehow be ‘turned off’ by intimidating stats and dry research has proven not to always be the case.  In a piece of advice to the gathered communications professionals in the audience, if the story can be pitched blending the right use of data plus what it means on a human level, it’ll have a higher chance of success.

Pharma’s halo – is it beginning to fade?

It was recognised that the pharmaceutical industry’s reputation received a huge boost in how it handled the pandemic, from its repurposing of existing medicines to treat COVID-19 symptoms, to its role in bringing a suite of vaccines to the public, and many elements of support and innovation in between.  Underpinning these efforts was the industry’s outstanding collaborative work with partners like Government, NHS, small biotechs and universities.  The panel noted, however, a risk that this ‘halo effect’ could be beginning to fade, as perceptions grow that commercial imperatives might be taking over, in addition to a lack of transparency around dealings with governments and medicines regulators across the world.  MHP Health’s Maddy Farnworth recently blogged about this subject in more detail.

What’s on the news agenda?

Our panel agreed that, despite occasional moments when the pandemic news cycle seems to abate, the story will continue to dominate their agenda for the foreseeable future.  The persistent threat of COVID-19, what health system recovery looks like, health inequalities and the mental health consequences of lockdown are all story permutations which look likely to come to the fore.

COVID-19, and its subsequent impact on other conditions, such as drops in diagnosis rates for cancer,may dominate, but other health stories need to be told, not least the major organisational changes that the NHS will undergo as part of the Government’s NHS Health and Social Care Bill.  The panel was honest in explaining that their willingness to cover something ‘other’ than the pandemic will go in peaks and troughs.  A piece of practical advice was to try and get a sense of the mood of the newsroom – either through assessing the wider context of the news cycle or picking up the phone to media contacts – to see whether a story was likely to land amidst the swirl of pandemic stories, or whether it could provide ‘relief’ from COVID-19 news.  Despite the turbulence caused by the pandemic, the panel stressed that a good story – whether COVID-19 related or otherwise – which had the core elements of novelty, a sense of scale, robust evidence and a human element would always be of interest.

For our panel and their peers, the COVID-19 pandemic has been an all-consuming challenge like no other.  The interest and scrutiny in health stories and the demands placed on how they are told has increased exponentially, and with no end in sight, it has never been a more interesting time to be part of it.