A Stitch in Time – Consequences of Inaction

This week at Hume Brophy, we have been mostly pondering why many effective technologies and medicines that should be considered by the NHS on benefit terms are not being taken up as (we believe) they should. The answer to why there is an apparent lack of uptake across the multilayered mosaic of organisations of the NHS is that many decision-makers know little and care less about exploring the increasing complexities involved in demonstrating additional benefit to existing care.

That is not to say the many noble professionals who hold up the NHS are not committed to helping patients in all that they do, it’s just that they are overburdened and bombarded with a constant stream of sales-driven literature to highlight the new-fangled bells-on patient-centric whiz bits that are being blanket marketed with increasing regularity.

What clearly resonates, however, are the consequences of inaction that irrefutably cause harm as a result – a fundamental contradiction to the role of healthcare practitioners. For example, when diseases such as cardiovascular disease or diabetes, conditions that have huge commercial focus by many of the global pharma giants, are not treated effectively, the costs to both the patient and the health system are exponentially greater than they are when managed optimally, even when treated with premium cost medicines.

So what does treat effectively cover? Well, there is no point in prescribing the newest high-performing insulin combination to a person with diabetes when they are not encouraged to improve diet and exercise rates, and when the tools they are being given to monitor their blood glucose levels are not accurate.

The long-term consequences of neglecting any aspect of the full care pathway can be anything between loss of pancreatic functions, vascular deterioration, limb loss, kidney failure, blindness and even death. The cost to the person with diabetes is clear and the cost to the health system is huge in terms of unnecessary workload, burden to the healthcare professionals and huge financial implications to an already creaking NHS.

The point is that when making a clear case for a new or existing technology or medicine, it is far better to demonstrate the consequences of not making it available to the patient. This may seem counterintuitive but unfortunately the best way to address inaction is to understand the bias that will effect change – and those who can do no harm will react accordingly.

 

Ensuring that companies manufacturing essential health management tools adhere to standards laid out by regulators is not too much to ask.

 

Look at medical device regulations, particularly blood glucose monitors. Wolfson Laboratories in Birmingham was a centre of excellence that produced a ‘blue report’ on blood glucose meters used in the UK, certifying them for use. This function was discontinued in the advent of PCTs, and with continual change in commissioning arrangements, decision-making at what is now CCG-level has devolved further, moving away from hospital-led, lab-based decisions and towards Formulary Boards with less technical understanding.

This resulted in the blood glucose monitoring market being flooded with sub-standard devices which should be adhering to strict ISO accuracy standards, but in practice have been left to self-regulate and stagnate. Recent academic papers have shown various devices sold in the UK to be below the standards currently set by regulators.

There is a clear problem in this area that needs to be addressed. Ensuring that companies manufacturing such essential health management tools adhere to standards laid out by regulators is not too much to ask. After all, there are people who are dependent on these devices to stay healthy. Would you drive a car if the speedometer told you that you were going ‘somewhere’ between 25 and 35 mph? I wouldn’t. So why allow a medical device to do the equivalent? It would be an easy win for an overstretched system dealing with the consequences.