Does drug company bribing hospitals improve outcomes and at what cost

Does drug company bribing hospitals improve outcomes and at what cost

Drug companies providing services to the NHS

This is happening a lot

Is it a good thing
I have mixed views but am mostly against
The question that was pt to me by Deb Cohen was one of “Should the NHS turn to drug companies to run clinical services related to their drugs?”

 
 

My immediate response was one of

yes interesting idea

 

We know this sort of stuff happens, difficult to quantify either in financial terms or in terms of direct & unanticipated impact.
two types of involvement
1. investment in capital and or services

egs below in area of opthalmology…. but I’d be pretty sure general principles hold true….

 

a)

eg Eye Care Liaison Officer funded by the RNIB who in turn got the money from Novartis

(of note local RNIB office seem to niether know nor understand the wider context, nor does local commissioner)

Often these kind of arrangements are for a time limited period.

as a colleague if mind said – The modus seems to be to provide a gift and monitor response for reciprocation – nothing in writing

I know this type of arrangfement exists in a number of locations. I’ll keep quiet about where.

(Ps Eye Care Liaison Officer types are a good thing, if a little tricky to evaluate)

 

b)

man with van type of scheme to do mobile monitoring and OCTs for their AMD patient 

 

c)

Direct investment in kit in the opth clinic – OCT machines etc

This happens a lot

Pharma subsidising what the NHS should buy

To curry favour to a certain way of thinking, push prescribing in a certain way….or in medical retina prevent it moving in a certain way (ie towards avastin) by shaping opinions even if there are no contractual clauses (which there probably ARE)

 

2)

planning and “support functions”

Im aware that many companies have invested quite heavily in data sources and analytics and are only too keen to help the NHS do long term capacity planning, short term patient flow planning and the like

 

to be fair, they are often pretty good at this (better than NHS is)
its, obviously, always directly related to the business interest …and they will never stray from this…. so whilst Novartis were keen to help with long term capacity planning in medical retina they had no interest in a broader question of glaucoma or cataract etc……

 

 

 

 

Issues

gain for hospital

fixes capacity problem by buying more staff (esp nurses) or capital (building space, man with van to do do outreach etc)

risk – none really. Id hazard much gets done properly wihtin a proper procurement framework but only trust knows

 

 

the service is a much needed service and many of these services – especially what happening in medical retina have really changed outcomes.

similar thing happening around Eye Care Liaison type services

 

 

long term downside

trust becomes indebted to pharma company who are funding what NHS should fund,
And thus institutionally less likely to support moving away from those shiny licenced medicines …. towards what we can really afford… yes of course theyll hidebehind regulatory, legal, safety arguments and the like…. but….
In theory PBR tariff supposed to cover long term investments so as trust can put some aside for infrastructure and capital projects and the like….but in practice…..so this it’s easy to become reliant on financially attractive external investments.

 

 

its an interesting area

Deserves more air time

And more examples than the v narrow view stated here.

And a proper two sided debate
I’d be more confrontaitonal – but for now I’ll not be

 

But the debate might be best framed as “does drug company bribing hospitals improve outcomes and at what cost……….”

 
Greg

 

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