Guest editor: Stuart Carroll
Snr Visiting Research Fellow & former Senior Expert Policy & Strategy Adviser
of the UK Vaccines Taskforce, Antivirals Taskforce and Therapeutic Taskforce
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As the world is rightly focused on Ukraine, and my deepest thoughts and prayers are with Ukraine and all those affected, the Coronavirus pandemic has not gone away despite the Government announcing the end to legal restrictions last month as part of the “learning to live with COVID-19 strategy”. Although there are strong arguments to limit restrictions due to their direct and indirect costs, there are clear risks to such a strategy particularly if the public health message of caution does not land across the population. We are not through this pandemic yet, with cases persisting, deaths still occurring, and hospitals still busy dealing with and catching up due to
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COVID-19 hospitalisations.There can be no doubt that the vaccination campaign is working, but there is still work to be done: more than a quarter of the UK population and almost half of the world population are not fully vaccinated. Eligible people should still be encouraged to get vaccinated, and booster doses are advised in the future. And whilst vaccination, supported by an impressive arsenal of antivirals and therapeutics, are the primary weapons for tackling COVID-19, exercising personal caution and risk-based decision-making will become more important. Therefore, even though we are transitioning to a new stage of the pandemic – adapting to living with it – we must not forget that it is still capable of causing significant harm on both health and our economies.
Another important but much less well publicised topic is the UK Government’s proposed adult social care reforms. The Prime Minister has reaffirmed the commitment to the Health and Social Care levy, a measure that provides for a temporary 1.25 percentage point increase to National Insurance contributions for the 2022-23 tax year of which the revenues will directly support the NHS and equivalent bodies across the UK. Yet social care will receive only a relatively small slice (£5.4bn) of the £30.3bn the levy is expected to raise over 3 years. Moreover, most of this small slice is being directed at the headline reforms – the introduction of a lifetime cap – meaning that there is very little funding being made available for the reforms identified in the White Paper. The King’s Fund estimate as little as £1bn which spread over three years and 150 Local Authorities is only £2.2m each per annum. Nothing has been done to address concerns about the issue of self-funders hitting local authority balance sheets and potentially bankrupting local councils. Similarly, there is little detail regarding the vision for truly integrating health and social care, how these reforms will impact young adults with long-term disabilities and learning difficulties, how these reforms will improve the quality of care, and most importantly, how the Government plans to tackle the workforce crisis. Questions remain as to whether adult social care’s share of the Health and Social Care levy is sufficient to deliver the ambition the Government claims to have for the reforms. And taken in the round, this feels like a wasted opportunity for real reform and integration for a system that is close to collapse.
*Disclaimer: Views expressed in a guest editorial belong solely to the author, not necessarily to OHE.
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MY TOP READS OF THE MONTH
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As part of my ongoing PhD research which is focusing on the public health and social sciences perspectives of the pandemic and vaccination procurement, the following books have been intriguing to read and digest.
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A Critical Introduction to the Risk Society, Ulrich Beck (2004)
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The world has arguably never been so risky, or certainly for a very long time, and Beck helpfully provides us with a range of concepts, perspectives and frameworks to understand risk and moreover define, calibrate and interpret it. Risk, which is an inherent concept and reality, in matters of healthcare is a well used notion particularly through the mathematical prism of relative risk. We often conflate risk with probabilities and in doing misframe the decisions or calculations before us. A worthwhile read and thought-provoking material.
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Cunning of Uncertainty, Helga Nowotny (2016)
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A brother or sister to risk is arguably uncertainty. Just like risk, it feels like the world has never been more uncertain with a raging pandemic and horrid war erupting in Ukraine. Uncertainty is a function of many thinks and Nowotny helpfully brings a taxonomy of thoughts and definition. Uncertainty is intrinsic to many aspects of health policy and not least health technology appraisal as totemically exemplified by sensitivity analysis and probabilistic treatments of uncertainty. Although a function of mathematical consideration, uncertainty is also a bigger conceptual reality to decisions, which in turn touches upon the issue of information and preferences. A strong read even if tough in places and worthy of consideration.
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The Melancholy Science: An Introduction to the Thought of Theodor W Adorno, Gillian Rose (2014)
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A far more bohemian and iconoclastic read relating to the works of the supremely left-wing and rather eccentric Theodor Adorno; the Morrissey of modern philosophy and a glass not just halve empty but well and truly evaporated. I have next to nothing politically in common with Adorno, but do find his theories around the role and use of media (in his case, serious roast beef against Walt Disney!) rather apposite and pertinent not least in the context of social media and big news corporations. The now well-slammed phrase “fake news” was really something Adorno hypothesised and postulated on. It has big consequences for health and use of health technology. For the more philosophical mind, a sobering read.
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This is the first action plan that aims to set out the Department of Health and Social Care and delivery partners will implement the UK Rare Diseases Framework in England. The framework has outlined four key national priorities:
1. helping patients get a final -diagnosis faster
2. increasing awareness among healthcare professionals
3. better co-ordination of care
4. improving access to specialist care, treatment and drugs.
There is a need for further detail on how this vision shall be lived and breathed. Each of the 4 UK nations has committed to developing nation-specific action plans detailing how these priorities will be addressed. The Government has pledged that the 2nd England Rare Diseases Action Plan will be published at the start of 2023 and will report on progress against the actions set out here, as well as proposing updated and new actions. Action plans will be published annually during the lifetime of the UK Rare Diseases Framework. This is a significant policy area and has critical interdependencies with the National Institute for Health and Care Excellence and the ongoing performance of the Highly Specialised Technology Appraisal system.
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The UKHSA has performed a rapid evidence review, including 15 UK and international studies, which has examined the impact of vaccination on Long COVID-19 or post-COVID symptoms.
It is an estimated that 2% of the UK population have reported Long COVID-19 or post-COVID-19 symptoms. Most of the studies suggest that vaccinated people (1or 2 doses) were less likely to develop symptoms of long COVID following infection compared with unvaccinated people – in the short term and long term (4 weeks up until 6 months after infection).
The evidence base is still growing, but it is compelling supporting data to show the critical importance of vaccination and the value of vaccination in terms of reducing associated complications from COVID-19.
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Sajid Javid set out his priorities for health care by harnessing the power of technology at the Health Service Journal Digital Transformation Summit. The harsh reality is that the NHS has not exactly been an apotheosis of IT and digital with many infrastructure failures and shortcomings over recent decades. The strategy pledges that electronic patient records will be rolled out to 90% of trusts by December 2023 so NHS staff can access all relevant patient information quickly. It sets an ambition of 75% of adults in England to be using the NHS App by March 2024 and commitment to publish digital health plan later this year.
There can be little doubt that the NHS remains behind the curve when it comes to use of technology and digital. Tracking the efficacy and success of this plan will be important to understand how the NHS is advancing, but also the extent to which the population assimilates to the NHS App and the idea of electronic healthcare. The pandemic has arguably and perversely proven the positive, within clear limitations and constraints, and so proof of concept to proof of reality is the next phase to watch and monitor.
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A new journal publication co-authored by OHE's Dimitrios Kourouklis, investigates the impact of pharmaceutical spending on domestic early-stage pharmaceutical innovation in Europe. The paper finds that European spending does impact the number of patent applications and that European pharmaceutical spending has an impact on European countries attracting early-stage development.
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OHE's new blog series provides critical discussion around the NICE new health technology evaluation manual.
The first blog in the series summarises some of the more notable changes put forward in new NICE methods guideline; which changes OHE welcome; and the aspects that we believe were not fully or satisfactorily addressed during the review.
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In the second blog in our series Chris Sampson says to hell with the 3L!
In sticking with the EQ-5D-3L, NICE has missed an opportunity to upgrade its approach to valuing health outcomes. The guidance provided in the new manual is confusing and may lead to NICE making decisions that are not in line with the public's preferences.
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10 March | Economic analysis has been central to human health and health care decision-making for decades. The same cannot be said for animal health. There is a long-standing interest in the interaction of animal and human health; see our 1969 paper on antibiotics in animal husbandry, for example. However, few have explored the potential for broader application of health economics thinking to animal health.
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Join us as we explore the question ‘do we need animal health economics?’
Each of our panellists will present their views on this question, exploring a range of health economics topics as they may relate to animals, from market failures to measuring wellbeing. The panel will identify the complexities of answering this question across agriculture, wildlife, and companion animal settings, and acknowledge the challenge of navigating conflicting ethical principles.
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The panellists:
Hareth Al-Janabi, Professor of Health Economics, University of Birmingham
Werner Brouwer, Professor of Health Economics, Erasmus University Rotterdam
Stefan Lipman, Assistant Professor, Erasmus University Rotterdam
Louise Proud, PhD student, University of Bristol
Chris Sampson, Principal Economist, Office of Health Economics
Register your free ticket
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