When I reflect on the 75th anniversary of the NHS, my family are upper most in my thoughts. Looking back, I am thankful that, since its origin in 1948, four generations of my family have now benefited from such a vital service, free at the point of access. From childhood, I distinctly remember my local community pharmacist and my GP, and the important role they played in our family’s health. I also recall poignant, personal moments - both happy and sad. I am grateful to the midwives who supported me at the birth of my daughters and the doctors and palliative care nurses who helped care for my father as he fought cancer. But looking forward, it is clear that the NHS is struggling to meet patients’ needs and to cope with ever-increasing demands and expectations. For the generations to come, it is vital that the NHS not only survives but thrives if it is to help people maintain their health and lead active, fulfilling lives.
As the Chief Pharmaceutical Officer for Northern Ireland, I am a huge advocate for the appropriate use of prescribed medicines and their role in helping to prevent, treat, and cure disease. Medicines are the most common medical intervention, and in all their forms, they play a vital role in health and wellbeing throughout our lives.
Global advances in pharmaceutical science, research and clinical trials have created a pipeline of medicines for the NHS that has the potential to transform health outcomes for many patients. Last year the Department of Health, through its relationship with the National Institute for Health and Care Excellence (NICE), endorsed 73 Technical Appraisals enabling access to the most up to date, evidence-based treatments for people in Northern Ireland. This included 30 new recommendations for cancer. The rate of innovation in medicines is continuous and, so far in 2023, we have already seen an average of 6 new recommendations a month, many relating to cancer, but also rare diseases and common chronic conditions.
We are also starting to see major advances in personalised medicine. This is an approach to healthcare where the choice of medication and treatment is informed by combining and analysing information about your genome (DNA) with other clinical and diagnostic information. Only last month, NICE issued a consultation on the use of a pharmacogenomic test for clopidogrel, a drug commonly used to prevent heart attacks and strokes. In some people, genetic factors mean that clopidogrel does not work as well as in others and pharmacogenomic testing can help to identify those who would benefit more from alternative treatments, so optimising patient outcomes. Pharmacogenomics testing is already part of the patient pathway for some cancer patients in Northern Ireland, who are benefiting from a service that alerts the clinician or pharmacist to potential toxicity to therapies. To date, over 3,400 patients have been genotyped, with treatment adjustments required in around 200 patients. In time, the ability to treat illness on an individual, personalised basis, will provide improved health outcomes for many patients and, as evidence develops, we expect to see advances in pharmacogenomics embedded into services in both primary and secondary care.
However, advances in therapies and medicines are expensive. Some new medicines can be hugely costly with many examples of treatments costing tens or hundreds of thousands of pounds per patient. In a service that is free at the point of access, this is why we need to start thinking and talking more about our approach to medicines going forward.
As we reach the 75th anniversary of the NHS, medicines costs in Northern Ireland are exceeding £800m per year and are the second largest single investment we make in the health service, after staff. The average number of prescription items a year is 21 per person, at a cost of £227. This cost is the highest in the UK and the volume of prescription items is still rising each year.
There are a range of factors contributing to this situation, including our ageing population with more complex needs and deprivation levels. The underlying issues are multi-factorial. Recent research conducted by the Community Development & Health Network (CDHN) ‘Our Lives, Our Meds, Our Health: Exploring Medication Safety through a Social Lens’ found a clear link between the social determinants of health and health literacy, and the ability for people to take their medicines safely. The evidence in this research provides the opportunity to learn about how people’s everyday lives and social circumstances can impact on their ability to take medication as prescribed and inspire us to drive improvements in medication safety.”
We need a variety of solutions but in terms of prescribing, work has been undertaken to promote improved clinical and cost-effectiveness. Some progress has been made. We have an efficient and cost-effective approach to the procurement of medicines in our hospitals, good compliance with the Northern Ireland Drug Formulary and a generic prescribing rate of over 80% in primary care.
However, more needs to be done. Our use of medicines and associated costs remains too high. There is an uncomfortable truth that manifests in the prescribing data for medicines. In Northern Ireland, we continue to use more of almost every type of medicine than other parts of the UK. That includes more antibiotics, more painkillers, more baby milks, more nutritional supplements, even more oxygen.
This demand for medicines creates a huge burden on our services, with pharmacies and general practices struggling to meet patient expectations. Our community pharmacies currently dispense over 43 million prescription items a year. This involves handling paper prescriptions, individually signed by the prescriber, collected from general practices by pharmacy staff, dispensed and then supplied. In 2023 this reliance on such a manual process is incredible, especially if you consider that 97% of prescriptions in England are now transmitted electronically from GP to pharmacy.
Considering environmental impact, medicines account for about 25% of carbon emissions within the NHS. This is understandable if we consider the life cycle of a medicine, from assembly of ingredients, production, packaging, prescription, dispensing and consumption and finally waste disposal. There is a need for more sustainable use of medicines and to decrease the carbon footprint and environmental risk that medicines currently create.
So where do we start? You may remember the old ad campaign ‘You don’t need a pill for every ill’. That is still very true today. A proportion of GP consultations and prescriptions could be avoided by the safe management of common, self-limiting conditions by individuals either at home or, if needed, with advice and/or treatment from a community pharmacy. This is just one small change in behaviour that could start to make a big difference.
My hope for the next 75 years is that we have a sustainable NHS, one that is free at the point of access and one from which all citizens can benefit from advances in medicines and therapies. To achieve this though, we need to make good decisions as well as invest and innovate. We all need to be a part of the solution.
- Publication of the quarterly Northern Ireland outpatient, inpatient and day case, and diagnostic waiting times statistics - position on 30 September 2023 30 November 2023
- New pancreatic cancer partnership announced 30 November 2023
- Health Survey (NI): First Results 2022/23 29 November 2023
- New obesity consultations launched 24 November 2023