NHS faces substantial funding challenges and is looking at ways to bridge the funding gap. Speaking about the scale of the funding challenge facing the NHS, Sir Malcolm Grant, chairman of NHS England shared his thoughts with Indian and UK health care, biotech and life sciences companies attending the bioConclave 2015 - a UK-India Health conference to promote opportunities and develop commercial partnerships between the UK and Indian health and biotechnology sectors, which took place at the Imperial College in London.
“Our pledge within the Five Year Forward View is that we could bring it down with a range of measures and the most extreme version brings it down to £8bn. That is heroic. To get there would involve an extraordinary efficiency and productivity transformation of the NHS. We forecast 2% for the first three years and 3% a year for the three years following that. But it requires much more than that.”
The current NHS budget is £100m and since 1948 the investment in the NHS in real terms has been about 4-5% a year. But Sir Malcolm said:
“Since the global financial crisis of 2008 the country’s ability to sustain that level of financial investment has been lost, so since then our annualized growth rate has been more in the region of 1%, as opposed to 4%.
“This has been a remarkable squeeze on our ability to provide comprehensive health care. The major contribution to it has actually been made by holding down salaries and wages during a period in which the employment market has been depressed. That clearly is not going to be available to us as the economy starts to pick up.
“There is waste throughout the system which is not well wrapped around the needs of patients as they progress through a pathway of care for their particular condition.
“We are now spending 70% of our budget on long-term conditions, not on episodic health care. So we have a huge problem. The first is not to do a top-down re-organisation of the provision of healthcare. These have been a recurrent theme of political parties over the last three decades – it’s visible, it’s clear, it’s something which for the political class can be an attractive way of bringing about change.
“Our belief is that we need to reverse that. We need to create a permissive environment in which local health economies, who know better on the ground what to do than we do, can produce different models of care.”
An invitation to produce different models of care earlier this year had prompted 270 expressions of interest from across all sectors and the NHS was now investing in 30 “vanguards” comprising two principal models – one of which was a multi-speciality community provider (a move away from small General Practices).
Sir Malcolm said, “One of our risks is that in London 20% of General Practices have just one doctor and in the 21stcentury with the complexity of modern medicine and the forensic complexity of people living with multiple conditions to an old age means that the wealth of expertise, diagnostics and treatment you need for patients cannot be found in a practice that has just one practitioner.
“We are anticipating the growth of practices with a list of 80,000, maybe 100,000 or more patients, many more GPs, and an integration between primary and secondary care. For instance, why shouldn’t that practice be hiring in hospital consultants to work either on a full-time or sessional basis? We can treat diabetes now much more effectively in a primary care and community setting.”
Today’s conference brings together the NHS and UK health businesses and investors with 18 of the most innovative Indian health and life science companies.
The conference is being followed by a trade mission to Leeds and Manchester on Tuesday and Wednesday this week. More than 150 UK organisations are involved in the conference or trade mission, and potential partners for Indian companies include Bupa, InterMune (a biotech firm recently acquired by Roche), NHS trusts, Oxford University and the British Medical Association.
On the subject of innovation, Sir Malcolm said:
“We have extended a global invitation to organizations that can come together and focus on particular innovations in particular health care settings.
“The vision we have will be about how we can create models of care that will advance integration, use technology and lay the foundations for boosting economic growth, something that can lead to a wider diffusion of new models of care. We will then co-invest in a small number of test beds across the country.”
Speaking directly after Sir Malcolm, former UK Health Secretary and now Chair of the UK-India Business Council Patricia Hewitt said:
“Innovation is key to achieving the transformation of health systems. It is the only way, whether it’s in India or in Britain or anywhere else in the world to achieve the high quality healthcare for everybody, universally accessible and universally affordable. We can only do that with a level of transformation and innovation way beyond even what we have seen in the NHS over many decades.”
The Indian biotech market was worth US$4.3bn (£2.9bn) in 2013 and is forecast to grow to US$100bn (£68bn) by 2025. India’s pharmaceutical industry is the third largest in the world by volume and the tenth largest by value, with production costs half that of the UK and Europe.
India itself also represents a major investment opportunity for UK firms, as its government has committed to raise health spending from 1.1 per cent to 2.5 per cent of GDP over the next five years, while the private sector spends another 4 per cent of GDP on healthcare.
Yet to date UK companies have nowhere near maximised the potential of India. According to UK government figures, the sector accounts for only £3m worth of potential health sector trade in the coming years – less than 0.03 per cent of the total value of this market – compared to £133m for Brazil, £123m for China and even £5.3bn for smaller countries such as Libya.
That is despite incentives such as foreign direct investments, allowing overseas firms controlling stakes of up to 100 per cent in biotech companies, and Indian states such as Gujarat and Andhra Pradesh offering grants for foreign companies that conduct research.
Indian companies on the trade mission include: