Ian Addie is head of market access and external affairs with pharmaceutical company Novartis. Previously with VHI Healthcare, he now leads a dynamic team specialising in areas such as health economics and outcomes research, strategic access and reimbursement policy. He will speak on "Access – what's the ambition?" at the Future Health Summit 2022
As the pandemic nears its close, where does the Irish health service find itself?
In Ireland we had one of the longest and most restrictive lockdowns and it was for good reason, to protect our health system. Post-pandemic we are in a new age where the problems in our healthcare systems, not only in Ireland but globally, have been highlighted. The question now is, what should the future look like? We see the focus on the crisis in health all the time – we have long waiting lists and shortage of beds to name a few. When we look at pharmaceuticals, patients are experiencing long waits when it comes to reimbursing new medicines, compared with the rest of Europe. Ireland ranks 19th out of 29 European countries for speed of access to new medicines. We need to incorporate long-term thinking alongside the immediate need. Unless we address the root cause of the current crisis, and not just the symptoms, we will be in a perpetual crisis.
What are the challenges Ireland faces as we look to the future in health?
One of the main challenges is our ageing population. While we have one of the youngest populations in Europe, we are ageing rapidly and living longer – the number of over-65s is going to double in the next 20 years. Right now, everything in our health service is primarily focused around secondary care. There are calls for more hospital beds, and it is true that we need more beds. However, the solution isn’t to just keep building more hospitals and adding more beds, because it is mainly driven by ageing and chronic diseases.
There are currently about a million people in Ireland with a chronic condition and about 65 per cent of our over-65s have co-morbidities meaning they have two or more chronic illnesses. This results in more hospital visits, more inpatient stays and longer average lengths of stay. We have to realise that we are simply driving people into hospitals because we haven’t done enough to address the chronic illness issue in the community.
The Department of Health and the Health Service Executive have set up the chronic disease management programme but this needs to be expanded to everyone, not just those on the GMS or public medical card scheme. Health inequality is an issue, but chronic diseases and their impact on the health system is a problem for the whole population.
What role can the pharmaceutical industry play in this future proofing of the health service?
We want to move away from the traditional model, where we are seen as suppliers by the healthcare system, to a model where we really understand the needs and issues of our healthcare system. By doing so, we can bring not just medicines, but collaborative solutions that are effective and can have a positive impact on the health system and the health of the population. Ireland is perfectly set up for this kind of multi-stakeholder collaboration as it has the richest health ecosystem of any country in Europe, between tech, the MedTech industry, the pharmaceutical industry, public healthcare and private healthcare. With all of these collaborating together, we could achieve so much, just as we saw with Covid.
During the pandemic, we stepped away from the traditional fragmented approach to tackling healthcare issues, and it became clear that the disease was the villain and the public sector and private sector collaborated to defeat it. There was a collective ambition and that is the model we should move towards.
Is the pharmaceutical industry ready to play that collaborative role?
I believe that the pharma industry is ready and willing to collaborate. However, this will require a mindset shift for both pharma and healthcare systems. We need to look now to that longer-term view and this is a bigger problem than simply access to medicines. Our model has always been to focus on specific disease areas isolated from the issues and needs of the health system.
We want to collaborate differently with healthcare systems, to understand fully the system needs and to have a collective ambition to improve access and outcomes in health at a population level. For example, Novartis is working closely with the National Health Service in the UK to provide solutions for cardiovascular disease at primary care level in a bid to reduce the burden of cardiovascular disease on society and health systems. There is no reason why we couldn’t achieve something similar in Ireland.