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At a seminar in London this week, Jonathan Fielden, NHS England’s National Director for Specialised Commissioning, stated that given specialised services account for approximately 14% of the NHS budget, it is ‘’vitally important’’ that the NHS gets the best possible value from that ‘’considerable spend’’.

We know, not least from the National Audit’s Office’s recently published report, that there are a number of factors creating financial pressures for specialised services and contributing to this considerable spend. As well as rising demand (more so than for non-specialised services) and new services being added to the specialised services portfolio, the ‘increasing volume of effective expensive new drugs’ were specifically cited by the report. This includes the growing use of high- cost drugs and devices to treat previously untreatable conditions or new, more effective products to replace older ones. In 2015-16 for example, an estimated £2.6 billion was spent on high-cost drugs for specialised services.

So then, where exactly does value fit in this context? Fielden describes value in specialised services broadly as spending money on ‘’things that work, and things that patient’s need’’…… a consideration of what outcomes are trying to be achieved versus what can be afforded with current resources. He explicitly mentioned drugs, and with reference to the increasing pipeline of new products to treat specialised diseases, he cautioned that the funding pot is fixed and that with no extra money, funding for new drugs must come from within this existing pot.

The pharmaceutical industry has always known that the effective communication of value, tailored to local population health needs, is key to ensuring patients are ensured access to effective treatment in an NHS of ‘no new money’. There has however been recent debate, and some uncertainty, regarding how this important notion of value fits within the national centralised model of specialised services, or indeed whether it is still the right approach when there is no local-based decision-making.

Considering the comments from Fielden, and indeed the slow but sure move towards collaborative commissioning, it seems that the picture is clear. That the articulation and communication of value remains a central tenet in ensuring that healthcare decision-makers, both commissioners and providers of care, can see exactly what they get for their pound, and that they are convinced, as Fielden puts it, that it is something that works and that it is something that is right for the patient. Specialised commissioning has come a long way in recent years, much has improved, but as many will agree, there is still much to do – the requirement to achieve the best possible outcomes however with existing resources will remain a key feature, and the concept of value, therefore, never more apparent or important.

By working in collaboration with the NHS, the focus must continue to be on identifying and then communicating the true value of your product across the specialised services system, in a way that resonates and is meaningful, with a clear focus on patient outcomes and at a justifiable cost. This will be the best way of ensuring that the industry’s biggest innovations to treat some of the world’s most severe and rarest diseases reach the patients that need them most, and that their lives are transformed as a result.

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