Spending on anti depressants soars as the Pandemic's effect on NHS prescribing patterns is revealed

WILMINGTON Healthcare's State of the Nation prescribing report shows that spending on sertraline, commonly used to treat depression and anxiety, increased by 305.5% between 2019/20 and 2020/21 while overall spend on mental health drugs rose 66.1%. The spending value of GP prescribed laxatives, heart burn medication and statins also increased as the Pandemic took its toll on people's physical and mental health.

The report, based on analysis of NHS Primary and Secondary care data, also shows significant falls in spending on drugs for certain eye conditions, which is likely to be the result of interruptions in Hospital based ophthalmology services during the Pandemic, as well as sharp rises in spending on innovative treatments for haemophilia, cystic fibrosis and other rare diseases.

The emotional strain of the Pandemic; combined with difficulties in maintaining access to face to face counselling and other forms of non-medical support during lockdown; is likely to have contributed to a massive rise in NHS spending on anti-depressants, a new report from Wilmington Healthcare suggests.

Its State of the Nation report draws on comprehensive review of primary and secondary data from:- 2019 to 2021 to reveal the full impact of the Pandemic on activity and prescribing habits across health services during an unprecedented period.

In primary care, the prescribing data shows that:-

Annual spend on the anti depressant drug sertraline in primary care rose by more than 300% in 2020/21 compared to the previous year, while overall spending on anti depressants in primary care increased by two-thirds to £371 million, as GPs dealt with increasing numbers of patients experiencing depression and anxiety during the Pandemic.

Statins such as atorvastatin (up 24.8%), and the heartburn and indigestion drug omeprazole (up 49.6%) also saw significant gains over this period. Overall spending on statins and other lipid regulating drugs (up 17%) and laxatives (up 14.9%) in primary care also rose significantly, reflecting the impact of the Pandemic on people's diet and lifestyle.

The largest area of expenditure in primary care remained diabetes drugs, which accounted for £1.2 billion of prescribing costs in 2020/21, rising by just over 3% year on year. This was followed by anti coagulant medication (£740 million), where there were notable increases in spending on drugs such as apixaban (up 16%), rivaroxaban (up 5.1%) and edoxaban (up 73.3%).

In secondary care, the prescribing data shows:-

Spend on ophthalmic preparations fell by 14.6% as reductions in routine eye appointments in Hospitals during the Pandemic affected patient access to high value treatments for wet AMD. Antibacterial drugs spending also fell sharply (down 8.9%) as prescribing rates for antibiotics continue to drop; a trend potentially exacerbated by the reduction of inpatient admissions (which led to fewer, non-COVID-related Hospital-acquired infections).

Several innovative therapies meanwhile recorded over 3 fold increases in the amount spent on them, as the NHS invested heavily in new treatments for rare diseases. These include the cystic fibrosis treatment ivacaftor (up 225.5%), emicizumab for haemophilia patients (up 247.3%) and asfotase alfa for the genetic disorder hypophosphatasia (up 201.3%)

Areas associated with oncology and immunology provided the largest source of prescribing expenditure in secondary care, with cytotoxic drug costs increasing by 9.0% to £1.8 billion in 2020/21. Mucolytics saw the sharpest percentage increase in costs (up 242.7% to £388 million), partly as a result of increased prescribing of the cystic fibrosis drug ivacaftor, as mentioned above.

The report also reveals stark and largely unexplained Regional disparities in per patient healthcare costs:-

Integrated Care Systems (ICSs) in the south and south-east spent up to 23% more on secondary care costs per patient than in other parts of the country in 2020/21, despite these areas often having lower Hospital admissions rates. Cost per patient were highest in Surrey Heartlands Health and Care Partnership (£3,200), where there were comparatively low Hospital admissions, but lowest in areas such as Coventry and Warwickshire ICS (£2,605), Our Dorset (£2,610) and Greater Manchester Health and Social Care Partnership (£2,640), where Hospital admissions were comparatively high.

Regional variation is also seen in per capita spend on prescribing, where the highest spending systems have more than double the rate of expenditure on patient drugs than the lowest. Highest per capita spend on prescribing is in North London Partners in Health and Care ICS (£469.90), Birmingham and Solihull ICS (£413.30) and Cambridge and Peterborough ICS (GBP £405.50), while the lowest per capita prescribing spend is seen in Hertfordshire and West Essex ICS (£215.70), Bedfordshire, Luton and Milton Keynes ICS (GBP 218.20) and Frimley Health and Care (£228.90).

Finally, Wilmington's analysis of Hospital Episode Statistics data shows the impact of COVID on patient volumes and the spend on different therapy areas within the NHS:

Inpatient spells collapsed from 17.3 million in 2019/20 to 12.8 million in 2020/21, as the NHS took dramatic steps to minimise patient footfall. Outpatient care saw a similarly stark redrawing of activity, with a 39% drop in in-person appointments and over a 5-fold increase in telemedicine appointments.

With the exception of infectious disease; which saw an increase during this period largely as a result of Covid19 admissions; all therapy areas saw annual declines in admissions in 2020/21. Overall, the NHS spent between 12 and 51% less across all therapy areas in 2020/21 compared to the previous year.

Oli Hudson, Policy and Communications Director at Wilmington Healthcare, said:- "Prescribing data reveals the many challenges faced by health professionals during the Pandemic. Our report finds that COVID exposed and aggravated a whole range of lifestyle related conditions in primary care; from high blood cholesterol to digestive complaints; as well as contributing to a dramatic rise in anti-depressant prescribing. It also created major problems in prescribing across secondary care, where we saw sharp falls in the amount spent on advanced treatments for Wet AMD as a result of Hospital outpatient services being restricted. More positive was the significant increase in spending on novel drugs for cystic fibrosis and other rare diseases, which offered some hope for patients amidst the many hard realities of the Pandemic."

Saffon Cordery, interim chief executive of NHS Providers, said:- "Covid19 laid bare the extent of health inequalities in this country, and unwarranted variations in prescribing is an important part of that story. This report shows there is more work to do to ensure fair and equitable access to medicines across the NHS. Any attempt to improve health outcomes needs to start with a healthy respect for the evidence. By bringing together a series of different data sources into a single place, this report provides a valuable overview of where the NHS, and the wider health and care system, needs to focus."

Wilmington Healthcare provides data, insight and intelligence for pharma and medtech companies, healthcare charities and other NHS suppliers. Its State of the Nation report draws on a wide range of data sources, including the English Hospital Episodes Statistics (HES) collected by NHS Digital*, RTT waiting times data published by NHS England, and prescribing data provided by the NHS Business Services Authority. The full report can be downloaded here:- WilmingtonHealthcare.Com.

* Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by NHS Digital. Copyright © 2022, NHS Digital. Re-used with the permission of NHS Digital. All rights reserved.

New data strategy to drive innovation and improve efficiency

MILLIONS of patients will benefit from faster, more innovative treatment and diagnosis following publication of a new data strategy for health and social care. New data in health strategy; Data Saves Lives; Reshaping Health and Social Care with Data, that was published on Monday, 13 June 2022, focuses on seven principles to harness the data driven power and innovation seen during the Pandemic to drive transformation in health and care, creating a secure and privacy preserving system which delivers for both patients and professionals.

The strategy sets out ambitious reforms for the health and care sector, transforming the way data is used to drive breakthroughs and efficiencies, helping to tackle the Covid backlog and create a system fit for the future.

Launching the strategy at London Tech Week's HealthTech Summit Health and Social Care Secretary Sajid Javid is expected to say:- "We are embarking on a radical programme of reform that will make sure the NHS is set up to meet the challenges of 2048; not 1948, when it was 1st established. Earlier this year I set out a range of stretching targets for digital transformation in health and care, and we're making great progress […] This landmark document will look at how we can build on this momentum and apply the lessons challenges ahead of us, including tackling the Covid backlog and making the reforms that are vital to the future of health and care. It shows how we will use the power of data to bring benefits to all parts of health and social care."

The principles set out in the data strategy are:-

► Improving trust in the health and care systems use of data.

► Giving health and care professionals the information they need to provide the best care.

► Improving data for adult social care.

► Supporting local decision makers with data.

► Empowering researchers with the data they need to develop life changing treatments and diagnostics.

► Working with partners to develop innovations that improve health and care.

► Developing the right technical infrastructure

To give patients greater confidence than ever that their personal information is safe, Secure Data Environments will be made the default for NHS and adult social care organisations to provide access to de-identified data for research. This means data linked to an individual will never leave a secure server, and can only be used for agreed research purposes.

Following a £200 million investment, Trusted Research Environments (TREs); a form of Secure Data Environments; will be established to better enable researchers to securely access linked NHS data while maintaining the highest levels of privacy and security.

This will enable the NHS to deliver cutting edge life saving treatments and diagnosis to patients faster through clinical trials and facilitate more diverse and inclusive research to tackle entrenched health inequalities, which will in turn allow the NHS to work through the Covid backlog at a faster pace.

Speaking at the HealthTech summit, Health and Social Care Secretary Sajid Javid is expected to say:- "We will make sure researchers and innovators are able to access data safely and efficiently. In this country we have some of the world's best research institutes and Universities, a powerhouse life sciences sector, and a thriving HealthTech industry. When this ingenuity meets the insight of health and care data, the opportunities are incredible."

The data strategy also contains key commitments to give patients greater access to and control over their data including by simplifying the opt out processes for data sharing and improving access to GP records in the NHS App by giving patients access to their latest health information by November 2022. Further improvements, including being able to more easily request historic information including diagnosis, blood test results and immunisations will be made available by December 2023.

The public will also be consulted on a new "data pact" which will set out how the healthcare system will use patient data, and what the public has the right to expect.

Use of the NHS App has boomed throughout the Pandemic. 28 million users already have ability to access their data and services and statistics show in April alone, the NHS App enabled 1.7 million patients to order repeat prescriptions, 150,000 primary care appointments were managed and 5 million people viewed their GP record, saving vital clinician time.

With an ambition for the NHS App to be a one stop shop for health needs, the strategy commits to a target of 75% of the adult population to be registered to use the NHS App by March 2024.

Speaking at the HealthTech summit, Health and Social Care Secretary Sajid Javid is also expected to say:- "We will improve trust in data, which is the currency that data-driven technologies need to function. We will work with the public, including people working in health and care, to develop a new pact on data, which will set out how we will use health and care data, and what the public has the right to expect. This will include the ability to opt out of sharing data. Because although we know that most people want their data to be used for good, we will make the opt out system simpler and more transparent."

Better use of data is central to the Government's mission to integrate health and social care. Following a £150 million funding commitment to drive rapid digitisation in the adult social care sector, the strategy outlines how integrated care records will enable smoother transitions between NHS services and social care, including quicker discharge from Hospital freeing up valuable space.

Currently only 45% of social care providers use a digital social care record, and 23% of care home staff can not access the internet consistently at work. The data strategy reinforces the ambition for at least 80% of social care providers to have a digitised care record in place by March 2024.

To support this, £25 million will be made available in 2022/23 to scale up the investment and implementation of digital social care technology across England with integrated care systems including adopting Digital Social Care Records (DSCR) to ensure data is captured at the point of care and can be shared between care settings.

Technologies like remote monitoring tools are already being used successfully to provide more targeted care. The Government's digital home care projects have used remote monitoring to support over 740,000 people with care at home, including care homes residents, improving their health outcomes and reducing the burden on the NHS, supporting clinicians as they focus on tackling Covid.

Speaking at the HealthTech summit, Health and Social Care Secretary Sajid Javid is also expected to say:- "We must be open and honest about the fact that social care lags behind the NHS when it comes to digital transformation. Our social care system is home to some of our most vulnerable in our society, and so the opportunities on offer are even greater. This Strategy shows our determination to close the digital divide that exists between the NHS and social care."

The data strategy will be followed by the publication of the digital health and care plan shortly which brings together Government's aspirations for digital transformation for health and social care with an ambitious delivery plan.