Written evidence submitted by Roche Products Ltd (CBP0061)

 

Roche is one of the world’s largest biotechnology companies, with a focus on transforming patients’ lives through the development of cutting- edge pharmaceuticals and diagnostics. We are at the forefront of research and development of innovation in a wide range of disease areas, including cancer, neuroscience, infectious disease, immunology, cardiovascular, ophthalmology and respiratory.

 

We welcome the opportunity to respond to the Health and Social Care Committee’s inquiry. We work in close partnership with the NHS to support access to medicines and diagnostics, providing us with clear insights into challenges in service delivery as well as opportunities to support improved patient outcomes.

 

The scale of the backlog is significant and it is vital that steps are taken to address bottlenecks in access to care. However, while the pandemic has exacerbated existing issues with timely access to services, it has also led to a huge step forward in the use of technology to enable new ways of working. As the NHS recovers from the peak of the pandemic, it is important that emerging innovative best practice is widely adopted and that steps are taken to lock in best practice in the use of innovation to support improved care. 

 

Our submission to the Committee’s inquiry focuses on the questions in the call for evidence that align with Roche’s expertise and draw on our understanding of the state of play in our clinical areas of focus.

 

What is the anticipated size of the backlog and pent-up demand from patients for different healthcare services including, for example, elective surgery; mental health services; cancer services; GP services; and more widely across the healthcare system?

 

There is a significant backlog in care, contributing to the record high waiting list of 5.45 million people waiting to start treatment in June 2021.[1] The rising waiting list has in part been driven by pent up demand, with the peak of the pandemic leading to a huge fall in the number of patients both seeking and receiving care. For example, the BMA has estimated that between April 2020 and June 2021, there were 3.66 million fewer elective procedures and 28.35 million fewer outpatient attendances.[2]

 

The overall challenge is mirrored in specific specialties – the impact of the pandemic on levels of activity in cancer care was stark:[3]

 

        82% drop in patients receiving treatment referred from screening

        70% drop in 2-week-wait (2ww) referrals

        28% reduction in CT activity

        76% drop in endoscopy activity

        31% drop in radiotherapy attendances

 

As a result of the fall in activity, nearly 44,000 fewer patients started treatment for cancer between April 2020 and January 2021, compared to the same period the year before.[4]

Services have started to recover, with the number of urgent cancer referrals up by 18.6% in June compared to the year before the pandemic.[5] However, while performance is improving, the scale of the backlog means that it will take a long time to restore waiting times to pre-pandemic levels. A recent survey carried out by the Royal College of Physicians found that the majority of doctors think the NHS will take at least 18 months to recover, while a third said that it would take two years to clear the backlog.[6]

 

It is important to highlight that the recovery has been asymmetric, with extensive variations in the restoration of waiting times. For example, 2ww referrals for breast and colorectal cancers recovered to within 2% of baseline levels by August 2020 while at the end of February 2021, referrals for urological and lung cancers were still 11% and 17% down respectively.[7] Given that 2ww referrals increase on average by 10% year on year,[8] it would be expected that even services that have recovered close to pre-pandemic baseline levels are still building a backlog of patients that will need to be addressed. The imbalance in the restoration of waiting times indicates that there is a need for more intensive support to restore services in specific cancer care pathways.

 

Beyond cancer, the pandemic has also led to service delivery challenges and backlogs in many other areas, including:

 

        Ophthalmology – already one of the busiest NHS specialties in the NHS,[9] the pandemic significantly disrupted services, leading to the highest proportional increase of any specialty in patients waiting over a year for treatment.[10] This led to the Royal College of Ophthalmologists raising concerns that the surgery backlog could take more than two years to clear[11]

        Neurology – there was a considerable slowdown in referrals for some neurology specialties, with centres for motor neurone disease experiencing a 30-50% drop during the pandemic.[12] The National Neurosciences Advisory Group estimated that this led to a total backlog of more than 225,000 neurology appointments and 58,000 neurosurgery at the end of 2020, with the winter COVID surge likely to have increased waiting times further[13]

        Genomic testing – the pandemic led to workforce challenges in the Genomic Medicine Service, resulting in steps being taken to focus on high priority genomic testing during the peak.[14] The scale of the current backlog is not clear, due to the absence of routine publication of genomic testing data, but likely means that patients are missing out on opportunities to be tested, and therefore access potential targeted treatments

 

How might the organisation and work of the NHS and care services be reformed in order to effectively deal with the backlog, in the short-term, medium-term, and long-term?

 

The pandemic has resulted in changes to the delivery of services in a wide range of areas. We have identified several positive lessons that should be used to tackle the backlog and inform the redesign of services in the new NHS, in the following areas:

 

        Cancer services

        Ophthalmology services

        Genomics

 

Cancer services

 

The health sector and its staff have responded to the challenges posed by COVID-19 with unprecedented agility and determination, with the pandemic catalysing innovation to service delivery at a pace hitherto unseen. The key shifts in cancer services expedited by the pandemic are as follows:[15]

 

        Wider adoption of tele and virtual medicine, contactless care and infection control

        Data-driven decision making, leading to the re-sequencing of the pathway

        Enhanced system and community working

Moving forward, there is an opportunity to build on the lessons from these shifts to embed new ways of working that will help both address the backlog in care and improve outcomes for patients. Roche believes that the following steps should be prioritised:

        Utilising technology to support earlier diagnosis – new pathways should be established, promoting the use of virtual consultations and community diagnostics to support the established rapid diagnostics pathways that exist for lung (National Optimal Lung Cancer Pathway) colorectal, prostate and upper GI cancers

        Embracing the shift of cancer care into the community – an international panel of experts from cancer centres should be established to explore the role of community diagnostics and service delivery. From this network and data gathering, a medicine and funding model-agnostic report encompassing good practice, pathway innovations and team composition etc. (to allow reproducibility across countries) should be developed

        Learning from and sharing data – informal and formal networks of information sharing amongst senior clinicians and cancer service managers should be mapped. Their experiences can then be used to develop a long list of anecdotes and innovations to investigate (e.g. increased volume of delayed presentation or persistent reduction of 2WW referrals by older age)

 

 

 

 

Ophthalmology services

 

Prior to the pandemic, in ophthalmology services there was already a strong desire to use digital tools for patient record keeping, referrals, appointment management and digital diagnostics.[16] The pandemic has accelerated this trend and also introduced a growing focus on remote appointments. For example, NHSX is promoting digital platforms with the potential to reduce duplication in appointments, shorten the time between referrals and treatment and, where possible, avoid unnecessary referrals.

 

Roche welcomes the growing use of digital tools and believes that the following steps should be taken to maximise the opportunity for service transformation presented by the greater use of technology:

 

        Improving data flows - The Department of Health and Social Care should ensure that the NHS has the infrastructure in place to routinely capture meaningful data in ophthalmology and analyse how this can improve services. This should include mandating streamlined data sharing between high street optometrists and hospital eye services

        Reviewing best practice - NHS England should work with patient groups to track the success of digital tools in terms of treatment adherence and patient experience, capacity saved and health outcomes, ensuring that patient choice is embedded into clinical practice

        Auditing services – NHS England should work with the Royal College of Ophthalmologists to expand the scope of the National Ophthalmology Database Audit to cover all ophthalmology services and eye conditions in England

        Delivering workforce efficiencies – Health Education England should support nurse and healthcare professional development to take on aspects of care currently performed by ophthalmologists, such as diagnosis, monitoring and injection, to save capacity in hospital eye services

        Supporting remote consultations – NHS England should oversee the national roll out of NHSX’s remote consultations service, currently being piloted at Moorfields Eye Hospital, to avoid hospital and primary care visits across the country where appropriate

 

 

 


[1] BMA, Pressure points in the NHS, August 2021. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressure-points-in-the-nhs

[2] BMA, Pressure points in the NHS, August 2021. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressure-points-in-the-nhs

[3] Carnall Farrar, COVID-19 and cancer recovery, 2021. Available at: https://www.carnallfarrar.com/media/1669/covid-19-and-cancer-recovery_vf.pdf

[4] Cancer Research UK, Written evidence submitted by Cancer Research UK. Available at: https://committees.parliament.uk/writtenevidence/24993/pdf/

[5] NHS Providers,  NHS Activity Tracker, August 2021. Available at: https://nhsproviders.org/nhs-activity-tracker/august-2021

[6] Rimmer, A.,  Covid-19: NHS will take at least a year and a half to recover, doctors warn, BMJ 2021;373:n999

[7] Carnall Farrar, COVID-19 and cancer recovery, 2021. Available at: https://www.carnallfarrar.com/media/1669/covid-19-and-cancer-recovery_vf.pdf

[8] Round, T. et al., Cancer detection via primary care urgent referral in England 2009/10 to 2018/19 and the association with practice characteristics, BJGP.2020.1030

[9] GIRFT, Ophthalmology, December 2019. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2019/12/OphthalmologyReportGIRFT19P-FINAL.pdf

[10] HSJ, NHS may ‘never catch up’ with surgery backlog caused by covid, 2021. Available at: https://www.hsj.co.uk/quality-and-performance/nhs-may-never-catch-up-with-surgery-backlog-caused-by-covid/7029559.article

[11] HSJ, NHS may ‘never catch up’ with surgery backlog caused by covid, 2021. Available at: https://www.hsj.co.uk/quality-and-performance/nhs-may-never-catch-up-with-surgery-backlog-caused-by-covid/7029559.article

[12] House of Lords Library, Neurological conditions and COVID-19, 2021. Available at: https://lordslibrary.parliament.uk/neurological-conditions-and-covid-19/

[13] House of Lords Library, Neurological conditions and COVID-19, 2021. Available at: https://lordslibrary.parliament.uk/neurological-conditions-and-covid-19/

[14] Genetic Alliance, Community Check-in Notes, September 2020. Available at: https://covid-19.geneticalliance.org.uk/wp-content/uploads/2020/10/Genetic-Alliance-UK-Community-Check-In-29-September-2020.pdf

[15] Carnall Farrar, COVID-19 and cancer recovery, 2021. Available at: https://www.carnallfarrar.com/media/1669/covid-19-and-cancer-recovery_vf.pdf

[16] NHSX, Transforming eye services through better connectivity, 2021. Available at: https://www.nhsx.nhs.uk/blogs/transforming-eye-care-services-through-better-connectivity/

 

 

Sept 2021