Julia Manning is Chief Executive of 2020health.org,
a web-based, centre-right think tank for Health and Social Care which
uniquely focuses on bottom-up policy development by front line
professionals. Pav Kahlon is a researcher at 2020health.org.
Last week's conference on the Post-Bureaucratic Age (PBA) highlighted the growing need for transparency as a key to reform – in an age where speed of access and choice have revolutionised the services we receive, and attitudes regarding what is normal, what is an essential and what we are rightfully entitled to have inevitably changed.
People expect more and have increasingly become more aggressive in their attitudes towards entitlement. Whether it’s electricity, food or medicine, as a nation we are demanding more of the commodities around us. What once were considered luxuries, greater access has turned into the basics in life and we’ve forgotten the price that has to be paid even for these. Gratitude has lost its cachet and familiarity has led to huge wastage. Yet the evidence is there from the high street that the more conscious people are of how much they are paying for ‘an item’ then the less likely it is to be wasted.
Evidence from other sectors
The mere knowledge that electricity consumption levels were being monitored in houses alongside unit prices was found to highly effective in inducing positive behavioural change by The Centre for Sustainable Energy. The experience of viewing numbers change on the energy display when an electrical appliance was switched on was described as being far more powerful than an educational experience of discussing domestic energy saving measures in a focus group. The idea of transparency and awareness continues to achieve success with other commodities. A report by the Environment Agency suggests that in order to reduce water consumption and help lower UK carbon emissions, households need to invest in water meters. Those who did were made more conscious of how much they were using and in affect typically used at least10% less water than those without the device.
Current wastage of medicines is shocking – but most people don’t have any idea of the figures. £800million worth is the estimate – and we’re told the Department of Health is sitting on more data about wastage that it hasn’t released. The PBA themes neatly tie in with one of 2020health’s ideas of transparency, first floated in our January report, Responsibility in healthcare: changing the culture, helping to reduce waste in health by making people aware of the cost of individual medicines.
Our idea is to have the price of the medicine clearly printed onto its label by the pharmacist when the medicine is being dispensed. The impact of publicising this data is several. When people know what their care costs, they are reminded of the essential worth of the service or treatment they are receiving. By having the price visually communicated in black and white, seeing the cost of medicine bold and clear, the abstract reality of value becomes a hard concept. The ability for a patient to truly appreciate both its worth in financial terms and its value as a treatment is enhanced.
And an awareness of cost will help significantly towards addressing the issue of waste. Knowing that your medicine, for which you handed over no money at the time of the transaction, is worth (say) £48 will be a huge incentive to valuing it, taking it and finishing the course. It will also serve inevitably as a discussion point for the patient and practitioner relationship, thus stimulating debate, interest and focus on understanding.
The real practicalities of taking this idea forward were discussed with various stakeholders of the pharmaceutical industry. These included front line pharmacists, pharmacy managers and representative bodies.
Action – The mechanism for printing labels is already in all pharmacies, and prices can be added manually alongside dosage instructions. It would only take simple software to automate this. The only requirement for both price and instructions are that the font size is readable.
Direct consequences – We anticipate this measure will stimulate much greater discussion over medication, which we see as a good outcome. There will always be patients sitting at either ends of the spectrum, with some who believe they are not worthy of their medication on viewing the price and others who believe that they should be getting a more expensive product. A more inquisitive patient, wanting to know more about their care is a more involved and informed patient, which is precisely what we need to engender.
One London borough NHS organisation we spoke to said last year alone they spent £1m simply disposing of unused medicines. Replicated across the country this is a monumental waste that we are sure can be reduced by greater public knowledge of the data!
Indirect consequences – There was a strong consensus among all representatives we spoke to acknowledging a need for patients to change their attitudes and behaviour towards medical use. Enabling people to understand the benefits of taking their medicines is a key driver to reducing waste, and a conversation on cost would also help facilitate comprehension of purpose.
It is estimated that 50% of medicines (for long term conditions such as for blood pressure) prescribed are discontinued within 14 days. Other ideas were raised with us as to how to combat this waste as a result of our suggestion at having the price published to the public. We anticipate that there will be more opportunities to improve transparency in this domain.
This is a small idea for delivering what could be significant savings in the health budget by enabling the public through published data to understand ‘value’ in a holistic way. The current fiscal situation calls for transparency to encourage responsibility in healthcare where cost of care to the NHS is openly communicated and therefore more widely appreciated.