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Patient care is key to a thriving health system

Investment in cutting-edge care will reap long-term benefits for patients and healthcare budgets alike.

The NHS is one of the finest healthcare systems in the world, and an integral part of the United Kingdom’s post-war identity. That is why I am so proud to run the UK operations of BD (Becton, Dickinson and Company), a world leader in patient safety, which is the standard benchmark of modern, high-quality healthcare.

We are a global medical technology company leading the world in innovations to improve health outcomes. Health systems today need a collaborative approach to deliver higher quality care for less. We want to share the responsibility to improve health outcomes – ensuring safer, more efficient care delivered to patients – and to do it sustainably. We work across the continuum, from discovery of new markers for disease to diagnostics to the delivery of care and have end-to-end, interconnected solutions. We have the resources and global network to gather the finest minds to make it happen.

The NHS’s basic formula is built on the Hippocratic Oath of “First, Do No Harm” to patients and maximising patient safety is key to that. In order for the NHS to provide quality affordable care we need to provide joined up solutions and deliver improvements on patient safety.

The crucial patient safety challenge, and one which some NHS leaders across the past few decades have occasionally struggled with, is infection prevention and control. Most people understand this as Healthcare Acquired Infections (HAIs) such as MRSA (methicillin-resistant Staphylococcus aureus), and there have been many examples in the press of the severe effect these infections have on patients.

There is good news. Infection rates have fallen, and improvements have certainly been made. MRSA Action have reported that there has been a 37 per cent drop in the number of MRSA bloodstream infections reported in the primary care setting between 2011 and 2016, with 1,116 cases reported in 2011/12 down to 820 cases in 2015/16. However, the trend in reductions halted in 2014/15 and a 3 per cent increase was seen in 2015/16. Clostridium difficile (C. diff) reduced significantly between 2011 and 2016, with a 48 per cent reduction in hospital cases and 27 per cent reduction in primary care. However, the reducing trend has stalled since then and it is vital we continue to monitor and highlight the importance of managing both MRSA and C. diff, along with other infections.

This is still a problem. In certain areas MRSA and C. diff are too high and sepsis still kills about 14,000 people unnecessarily every year in the UK, even though basic interventions could prevent these complications.

Antimicrobial resistance (AMR) is the new challenge on the horizon, and this problem is potentially more challenging than any in healthcare. Current trends project that AMR could cause up to 10 million deaths annually by 2050, surpassing deaths currently caused by cancer. If we fail to tackle it at the root, surgical and commonplace medical procedures, which are now routine, will come with huge risks to the patient, and antibiotics that have been used for decades will become useless. Preventing this catastrophe will involve rethinking our approach to surveillance, diagnostics and treatment. Diagnostic operations will have to become far more effective, and appropriately targeted antibiotics must only be given out where a set of conditions are met.

Medication errors also present a significant and avoidable burden of harm and cost to patients and the efficient running of health services. There is a 45 per cent chance for error in the medication administration process. Campaigns to reduce errors were launched in 2017 by both the UK Department of Health and the World Health Organization. Through our research, we have shown medication errors can be reduced through the better use of technology, including automated dispensing systems in pharmacies and digital checks at every step of the process.

BD has solutions to some of the key pillars underpinning safer patient care, be it medication errors or HAIs and its related problem, AMR, and we are ready to partner with the NHS to implement these solutions. Industry needs to take shared responsibility for failures in patient safety and must deliver improvements, not just through the technologies we provide but by working alongside healthcare providers to ensure the necessary practices and procedures, supported by the most appropriate proven technologies, are used to ensure we put patient safety at the heart of everything we do.

We work tirelessly to educate clinicians in using these tools effectively. We are here as a resource for clinicians, managers and politicians to draw on in tackling some of the biggest challenges facing the NHS – challenges which needlessly costs thousands of lives and many millions of pounds.

In April, BD announced our intent to acquire C. R. Bard, Inc., a company with similarly international operations and complementary safety platforms that broadens our offering right across this landscape. After the acquisition is completed, it will enable us to provide even more comprehensive solutions.

In an austerity economy, we must find ways to save money and improve outcomes wherever possible. This is easier said than done, of course, but it is possible. Companies such as ours must be realistic about the reality of budgetary pressures and pose solutions to both clinical and economical challenges. But there is no false dichotomy.

By procuring for the longer term, healthcare leaders can improve outcomes and save money. Effective, safe solutions are not always the cheapest but, often, provide efficiencies further down the line and avoid additional cost burdens by reducing errors. For example, by diagnosing the correct pathogen in a case of suspected sepsis, clinicians can halt the systemic infection and avoid life-changing injuries, which will take a patient out of work for decades, and lifelong care, which is costly. By investing in technological solutions, this can be avoided not just in one case, but thousands.

Patient safety is not simply a luxury – it makes complete financial sense to treat it as a long-term investment. BD supported Health First Europe’s Declaration for Patient Safety, which was launched in December, and urged Ministers of Health across Europe to agree a high level of understanding on patient safety practices and standards to make care consistently safe across Europe’s healthcare systems.

My message is this: we are here to help make the NHS the safest healthcare system in the world. Our experts are a resource for healthcare professionals to draw on. We want to contribute in any way we can to the UK’s national objectives of keeping patients safe and, by doing that, lowering the cost of healthcare delivery.

Mike Fairbourn is vice-president general manager at BD UK & Ireland.

REBECCA REID / EYEVINE
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The number cruncher-in-chief: OBR head Robert Chote on the costs of Brexit

The chair of the Office for Budget Responsibility explains why the UK economy is "weak and stable, rather than strong and stable". 

On the top floor of the Ministry of Justice – an imposing brutalist structure just off St James’s Park, Westminster – lies one of the UK’s most powerful economic institutions. Since its creation by the former chancellor George Osborne in 2010, the Office for Budget Responsibility (OBR) has been charged with producing economic forecasts and forensically scrutinising government policy. In the polarised era of austerity and Brexit, its judgements have profound political implications.

The man who has chaired the OBR since its inception is Robert Chote. One recent morning I met Chote, 50 – tall, lean, dark-haired (with a marked resemblance to Serbian tennis star Novak Djokovic) – to discuss his work and the state of the British economy.

“It’s been great fun, there’s a good esprit de corps,” Chote said of his 30-strong team. Until the OBR’s establishment, the Treasury had sole responsibility for producing forecasts, which led to the justified suspicion that the forecasts were made to fit the policy, rather than the policy to fit the forecasts.

Chote spoke with gratitude of how the OBR had been accepted as a “permanent part” of the economic architecture. “Opposition parties tend to want us to do more, rather than less” (Labour has proposed that the body should audit party manifestos).

The politically independent OBR, Chote noted, is part of a “global phenomenon”. “I was in Cape Town in the summer and had an opportunity to meet my Zimbabwean counterpart. If ever I wake up in the morning and think it’s a tough job, that’s a salient reminder that it could be a lot more difficult.”

For eight years until 2010, Chote was director of the much-revered (and feared) Institute for Fiscal Studies. When Gordon Brown was presented by aides with the body’s painful post-Budget findings, he would exclaim with anger: “Chote!”

Before this, as economics editor of the Financial Times and a reporter at the Independent, Chote similarly tormented chancellors (a framed front page from 1992’s Black Wednesday – “Pound goes into freefall” – hangs above his OBR desk). It was while working for the International Monetary Fund in Washington, DC that Chote met his wife, Sharon White, a former Treasury permanent secretary, who is now chief executive of the media regulator Ofcom (the first woman and the first black person to hold the post).

Chote, the son of an Olympic javelin-thrower, studied economics at Cambridge University, where he was also chairman of the Social Democratic Party association (he stood as a county council candidate in 1989 following the Liberal Party merger). “I’m very lucky – I managed to get it all out of my system at the time,” he said of his past activism.

As a former journalist, Chote, unlike some technocrats, has an ear for an arresting phrase. The British economy, he told me, was “weak and stable, rather than strong and stable” (in reference to the Conservatives’ ill-fated 2017 election slogan). He warned: “There’s an evens chance of a recession in any five-year period if you look back at the historical experience. We’ve not abolished boom and bust.”

In its most recent set of forecasts (November 2017), the OBR dramatically revised down anticipated productivity growth. And though the latter has since increased at its fastest rate for six years, Chote cautioned: “These are noisy numbers, they go up and down, and we’ve had false dawns before”.

Chote, who lives in Corbyn’s Islington North constituency (in Tufnell Park), would not tell me how he voted in the EU referendum (“We have a secret ballot and I shall respect it”), he did not refrain from charting Brexit’s harmful economic effects: “In terms of the net effect on GDP, the hits to demand have outweighed the boosts”. (Following the referendum, the OBR forecast that the Leave vote would cost the UK £15.2bn, or nearly £300m a week, by 2020/21.)

Chote cited “most of the work that trade economists have done” as showing that the costs of leaving the single market and the customs union are greater than the benefits. “The reduction in openness likely with the EU is likely to outweigh any increase elsewhere.”

A permanent reduction in immigration, he warned, would increase the national debt. “Net inward migration tends to be a net positive for the public finances because inward migrants are generally more likely to be of working age than the native population.”

The OBR’s dull-sounding fiscal multipliers (which estimate the effects of tax and spending policies on growth) also show that austerity harms growth, while state investment aids it.

“Infrastructure spending has the largest direct effect,” Chote confirmed. “That’s basically because less of the spending leaks out into savings or imports.” He warned that growth would be “weaker” over the next few years as public spending cuts were still “intensifying”.

Even under the government’s fiscal rules, Chote noted, “there is room for spending more, there is some room for fiscal giveaway that would still be consistent with those targets”.

I ended by asking Chote the most important question of all: has he ever actually been mistaken for Djokovic? “No!” Chote insisted. “I think if you ever saw us physically next to each other there would be no doubt who was who, even if the headshots occasionally look slightly discombobulating.” 

George Eaton is political editor of the New Statesman.

This article first appeared in the 26 January 2018 issue of the New Statesman, How women took power