Working Towards a Sustainable Future for the NHS

insights from industryJennifer LeeDirector of Market Access and AdvocacyJanssen UK

An interview with Jennifer Lee, Director of Market Access and Advocacy at Janssen UK, the pharmaceutical company of Johnson & Johnson, discussing the importance of innovation in the private sector and making new technologies available to the NHS.

How are Janssen working to ensure the future of the NHS? Do you think the current system is sustainable?

The current healthcare system is not sustainable, and I think most people would agree with that. You only need to look at the rising cost of healthcare globally and the aging population in the western world to understand that the current system isn’t sustainable long-term.

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Traditionally, companies like Janssen were seen only as suppliers of the healthcare system, but that’s starting to change. We’re seeing more and more joint working initiatives and partnerships between industry, academia, patient groups, and the clinical community.

We’re interested in partnering with the NHS because they are our main customer, so if the NHS isn’t sustainable, we as a business are not sustainable – and this will prevent us from getting our medicines to the patients who need them.

One of the ways we at Janssen are helping is by making sure our medicines fit into new models of care. We’re also trying to revolutionize the medicines we develop for the NHS.

Traditionally, pharmaceutical companies looked to develop medicines that target the most severe stages of a disease, because it is easier to prove that the drug has a significant effect in these patients.

We can no longer treat diseases when a patient becomes severely ill. It’s expensive and is the reason that the NHS can no longer afford to provide the same level of service as it once could. That’s why we’re now investing in drugs that act prophylactically. We need to start thinking about living with disease, rather than dying of it.

Prophylaxis is not a new concept, just look at how long we’ve been vaccinating against infectious disease! We now need to take this approach with non-communicable diseases.

The NHS is currently facing extreme economic hardship. What steps are Janssen taking to reduce this?

For the NHS to become sustainable, we need to deliver healthcare in a completely different way. For us, this means moving away from just being a provider of pills and moving towards personalized care and prevention.

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Before the human genome project, for example, all blockbuster drugs such as statin were developed to give to the entire eligible patient population.

At Janssen, we are now looking to develop highly targeted, specific, personalized medicines that are much more sophisticated and used in a much smaller population of patients – to ultimately help improve outcomes.

This is only part of the solution. The amount of data collated in the UK’s health system is enormous and we’re working on initiatives that will harness this data to provide key insights.

For instance, by analyzing all of the interactions a patient has had with the healthcare system could allow doctors to tailor their treatment plan and decide which interventions to use based on other patients with a similar medical history.

This could allow clinicians within the NHS to develop more of an understanding of which drugs work in which patients, based on their genotype and phenotype. It could also save money and allows the NHS to become more efficient. They would be paying for patient outcomes, rather than the treatment itself.

We want our medicines to do what they say on the tin. We want the NHS to be able to identify cases where what we observe in clinical trials differs from real-life. It’s as simple as not charging the NHS if the treatment isn’t effective in the patient cohorts that it’s designed for.

This is called an outcomes-based guarantee, and it’s already in place for some of our most well-established medicines. I think this is the main way that we can help loosen the economic burden on the NHS.

When it comes to worldwide access to medication, there are a lot of disparities between different countries. What is the pharmaceutical industry doing to tackle this?

We use a tiered pricing model which ensures that if you live in one of the poorest countries in the world and there’s a medicine available that you could benefit from and your country has the healthcare infrastructure to deliver that treatment, you will be given access to it.

I can’t speak on behalf of other pharmaceutical companies, but I wouldn’t be surprised if we weren’t the only ones doing this. Our global pricing model is something that we are profoundly proud of, and something that is here to stay.

Dr. Janssen was the founder of Janssen. How is the work that Janssen are doing today contributing to his legacy?

Dr. Paul Janssen lived by the following words: “Patients are waiting”. I think that everyone working at Janssen believes in this. Patients are at the heart of everything we do and that’s his legacy.

Dr. Janssen was a founding father in medicines for mental health, and he believed that those patients deserved treatments that work. Mental health disorders are notoriously difficult to treat, and yet we are still in this disease area because if it was important for Dr. Janssen, it’s important to us.

Patients have always come first at Janssen - this ethos is reflected in the Johnson & Johnson Credo and is evidenced in our company each day.

For every business decision we make, we ask, is this the right thing to be doing for our patients? If the answer is no, or I’m not sure, then there's a much deeper discussion to be had.

Over the next 100 years, how do you think patient care and the role of the clinician will change?

I think everything will change. From the way that healthcare is delivered to the way we view health and disease in general, all of it will change.

At the moment, the older population are most in need of healthcare resources. However, broadly speaking, they aren’t very comfortable with technology.

This means we aren’t there yet with making technologies such as healthcare apps a part of the NHS, and we won’t be for a while. But, as the millennial generation grows up, their ability to use technology will allow a fundamental shift in the way we deliver care.

The NHS will need to go beyond handing out pills to keep the population healthy and start moving towards technologies that can help you manage your overall health and wellbeing. This could be an app, or a wearable, for example.

The way you think about it today will be fundamentally different to the way we will think about it 10 years, 20 years, 50 years and 70 years’ time.

Clinicians are used to delivering medical care a certain way. They look for specific symptoms and treat the underlying condition whilst doing no harm. In the future, clinicians will need to develop a more holistic approach to care that takes into account the wellbeing of the patient from many different standpoints.

This all contributes to the linking together of the health and social care systems by the UK government. It’s about caring for a patient throughout their entire life. The technology is already there in some ways, but there needs to be a cultural shift in clinicians, patients, all of us. This will be the biggest barrier but could also be the biggest enabler.

A major step towards this will be patient empowerment. People are tracking the number of likes they get on pictures they upload to social media all the time. If they were given the technology to track their own health too, they would be more informed and more empowered to make lifestyle changes that will improve their overall health.

We’re already seeing this with FitBits and health apps, so it’s already happening on some level.

Patients who are informed and empowered have less interaction with the healthcare system. Treating patients who have multiple co-morbidities and who are incredibly ill is costly and often it is too late to reverse most of the damage. By monitoring the health of patients early on, physicians and patients themselves can intervene before it gets serious.

I think the future has the potential to be really exciting for healthcare in the UK, however, I am concerned about the required cultural shift.

We shouldn’t underestimate the significant changes that must take place - from how people think about themselves and their health to the shift needed in the health system, technology, and medicine – everything will eventually need to evolve.

About Jennifer Lee

“Having joined the company back in 2012, Jennifer Lee is the Director of Health Economics, Market Access, Reimbursement & Advocacy at Janssen UK, the pharmaceutical company of Johnson & Johnson. As part of her role, she has been working in partnership with healthcare systems, continually seeking to improve the way products are delivered in collaboration with regulators and governments.”

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