Client zone

Why the NHS needs interim managers to drive change

Hunt announces investment

It was recently reported that up to 86 senior executives in the NHS who are paid through off-payroll in limited companies face investigation by HM Revenue and Customs for failing to provide assurance they are paying the correct income tax and national insurance.

A closer look at the situation reveals that many are being taken on by the NHS in interim management roles, where it is usual practice to work through a limited company rather than be on the payroll and so pay the right amount of taxes.

Interims are not the same as long-term contractors. They operate through their own limited companies and pay fair taxes. On average they work for 166 days and deliver specific results immediately and effectively, which is often critical in the public sector.

They tend to be recruited for short term projects and can be highly cost-effective as they are a resource that can be turned on or off according to needs. They are paid a daily rate and as they are independent, don’t receive any employee benefits including holiday pay, sick pay or pensions.

The NHS is currently undergoing a period of intensive change – technological, social and economic and there is a real need for managers to facilitate this change within their organisations and the wider NHS environment.

Change management and transformation experts don’t tend to be permanent employees so these skills are scarce. For this reason, the NHS is increasing turning to interim managers who offer a high degree of expertise and knowledge and experience in leading major transformation programmes or restructure organisations.

Much has been made about how unfair it is that individuals can pay less tax and national insurance by invoicing from a limited company, rather than paying it at source.  In truth, the savings are often small, but there is a much bigger picture. Interim managers are top level executives that have made a career choice to become independent consultants, and they accept the risks and rewards of doing such.

If departments bring anyone on to the payroll, they will also have to take into account the additional costs of offering holidays, pensions and other benefits associated with full-time employment. They will also lose the ability to turn on and off a flexible high level resource without liability.

Let’s not forget that interim managers are independent. As such, they bring fresh ideas and their own objective views to a situation. This enables them to make unemotional decisions that benefit the departments they work in. If interim managers become part of the workforce you take away that independence and make it more difficult for them to make tough, but necessary, decisions.

Furthermore, if departments turn to the more expensive alternative of using management consulting firms, the cost to the taxpayer will be even higher. Interim managers offer the NHS cost-effective access to high level performers with a track record of quantifiable achievement and this is a truly vital resource for helping to deliver the changes needed.

Pfizer receives new axial spondyloarthritis approval for Enbrel

Pfizer has announced that its rheumatic disease therapy Enbrel has been approved for a new indication in Europe.

The European Commission has ratified a label extension for the drug that will allow it to be used in the treatment of adult patients with severe non-radiographic axial spondyloarthritis, a painful and progressive condition that often develops into the more serious ankylosing spondylitis.

Data from a pivotal trial called Study 1031 showed that 32.4 per cent of patients experienced significant improvements when treated with the drug, compared to 15.7 per cent of those receiving a placebo.

Enbrel is a member of a class of drugs known as anti-TNFs and was the third top-selling medicine in the world last year.

Dr Berkeley Phillips, Pfizer’s UK medical director, said: “This licence extension reflects Pfizer’s continuing commitment to enhancing the scientific community’s understanding of rheumatic diseases and providing treatment options for patients.”

This comes after Eliquis, the anticoagulant therapy it co-markets with Bristol-Myers Squibb, was approved for the treatment of deep vein thrombosis and pulmonary embolism last week.ADNFCR-8000103-ID-801740516-ADNFCR


Siemens to sell health information technology business to Cerner for $1.3 billion

Siemens and Cerner Corporation signed a definitive agreement under which the latter will acquire the assets of Siemens’ health information technology business unit, Siemens Health Services, for $1.3 billion in cash, the companies announced Tuesday.

“We realised that business success of our hospital information systems could not always keep pace with our competition,” noted Siemens Healthcare CEO Hermann Requardt, who also cited “an increasing number of country-specific requirements, such as resulting from US healthcare reform.” He added that looking ahead, the company “will focus on the development of information systems that support our businesses in laboratory diagnostics, as well as imaging and therapy.” The acquisition, which has been approved by the companies’ boards, is expected to close in the first quarter of 2015.

As part of the agreement, the companies will also form a strategic alliance, investing up to $50 million each in new projects that integrate health IT with medical technologies. The project, which has a three-year initial term, will first focus on advanced workflows along with medical images and their role in diagnostic and therapeutic decision-making. Cerner noted that the alliance “will drive the next generation of innovations that embed information from the [electronic medical record] inside advanced diagnostic and therapeutic technologies.”

The transaction is expected to be more than $0.15 accretive to Cerner’s 2015 earnings per share, and more than $0.25 accretive in 2016.

Last month, Danaher subsidiary Beckman Coulter entered into a definitive agreement to purchase Siemens Healthcare Diagnostics’ clinical microbiology business. The transaction, of which financial terms were not disclosed, is expected to close in the first quarter of 2015.

Blood diagnosis app ‘can detect diseases’

A team has developed an app and small lens add-on that allows blood-cell analysis via a smartphone

The app, called Athelas, won a prize at a coding event held by the prestigious start-up hub Y Combinator.

The team says it can detect diseases such as malaria and cancers in seconds, through so-called predictive cell counting.

But experts warned of the difficulty of reproducing the quality of medical labs results using just a smartphone.

Users take a picture of their blood using the lens attachment, which is then sent to the app’s servers, and the results are then sent back to them.

Team leader Tanay Tandon said in his submission: “For more than two centuries, cell morphology – or the practice of viewing/analysing a person’s blood in order to diagnose conditions – has been the primary way to approach medicine.

“Yet, despite the critical nature of blood analysis to the medical industry – the process has hardly changed from its long, expensive form for 150 years.”

Mr Tandon added that in “rural areas, the tech will really shine, providing previously unavailable diagnostic skills through the power of artificial intelligence and computer vision”.

‘Create more confusion’

But experts in the field are not so convinced by the reality of using a smartphone to detect and diagnose.

“This app will create more confusion then alleviate anxiety,” Dr Amar Safdar, the director of transplant medical diseases at New York University’s Langone Medical Center, told the BBC.

“The major limitation for this approach is that most viruses require electron microscopic exams to see them.”

Using the example of the current outbreak of Ebola – which has killed more than 800 people in western Africa and is spreading partly through air travel – Dr Safdar said that patients in the early stages of illness might not have large enough quantities of the Ebola virus in their peripheral blood to be diagnosed.

Lab tests have a lot of regulation to ensure the correct results are delivered

The threat of false positives, or incorrect results, was another concern.

“I’ve no problem with it in principle – but in reality, these need to be carefully calibrated around the right type of diseases,” Dr Mike Chapman, of the University of Cambridge’s Department of Haematology, told the BBC, adding that some diseases were easier to detect than others.

“In a laboratory diagnosis, there is a lot of regulation that goes on behind the scenes to make sure that your results are meaningful.”

Dr Chapman added that he was aware of instances where people took a smartphone picture of a microscopic image of their blood and sent it to an expert.

The Athelas app won a prize as Y Combinator held its first “hackathon” last weekend, where teams come together and are invited to create software together in a limited amount of time.

Mr Tandon won an interview with YC to be in its next batch of start-ups. The California-based accelerator counts billion-dollar start-ups such as Airbnb, Reddit, and Dropbox among its alumni.

Apple files for HealthKit trademarks w/ classifications for watches, fitness sensors, & medical devices

Apple has just filed for HealthKit trademarks in both the US and Europe ahead of iOS 8’s launch this fall and in at least one filing includes watches in a list of goods that could take advantage of the health-tracking software.

While the filing in the US (filed July 31) only includes classifications for computer software and covers the HealthKit text, a filing in Europe (published yesterday) extends classifications to include health, fitness, and exercise sensors, medical devices, and watches:

Of course that would lead to speculation over Apple’s much rumoured iWatch, the one that we reported it has recently assembled a team of health, fitness, and fashion experts to develop. The latest rumors claim Apple could be readying its iWatch for production and a release as early as this fall, but we’ve yet to see any part leaks or other evidence that Apple is getting close to releasing the product.

While the HealthKit app arriving this fall is expected to be the heart of an iWatch product from Apple, the company has also already trademarked the word iWatch in several countries around the globe, including Japan, Mexico, and Turkey. Those trademarks, as well as recently updated trademarks for the company name “Apple”, also include classifications for watches and jewelry like the HealthKit trademark filing published yesterday.

Call for rethink of ‘flawed’ NHS plan to cut inappropriate learning disability placements

An NHS England-commissioned steering group tasked with cutting inappropriate learning disability hospital placements will fail unless it rethinks its priorities, experts have warned.

The Ideas Collective, an informal network of learning disability experts including carers and professionals (see box), said that the NHS group’s plan to develop a ‘closure’ programme for assessment and treatment units and related hospital settings placed insufficient focus on tackling the factors underpinning demand for beds, particularly poor support from community health and social care services. The collective was also critical of the fact the steering group membership only includes one person with a learning disability and one carer.

The NHS England group, chaired by Sir Stephen Bubb, chief executive of ACEVO, was set up in light of the failure to meet the government’s target to end inappropriate placements by 1 June, made in response to the Winterbourne View abuse scandal. About 2,500 people with learning disabilities or autism and additional mental health needs remain in hospitals in England, with just one-third of these due to move out within the next year.

NHS England published terms of reference for the group this week and revealed that it will be advised by a service user and carer reference group. At a meeting with members of the Ideas Collective, Bubb reportedly said that his steering group had four ‘core objectives’: the inpatient unit closure programme; the development of a ‘sensible commissioning framework’; a workforce development programme and a social capital programme for investment in community services.

In a letter to Bubb, the Ideas Collective said that the inpatient unit closure programme and social capital programme plans were “flawed”, particularly givenprevious statements that suggested the social capital programme would be used to fund “group homes and long-term provider contracts.” The collective also questioned how the commissioning framework could be effective if the NHS group “have been given no authority” over local authority commissioning.

In its letter, the collective told Bubb that his group had the “potential to achieve real change” if it revised its plans but warned: “If your group continues with the focus and priorities previously stated, then we fear that another opportunity will have been wasted and any change will merely be superficial and short-term – leaving other people with learning disabilities and families to bear the consequences in the years to come.”

On the ‘closure programme’ the collective said that the focus on closing units should be replaced by a wider project aimed at significantly reducing the number of assessment and treatment beds while recognising a small number will be needed in each area. This should involve ‘hands-on’ support for local authority and NHS commissioners, person centred design for all people currently in placements, and the creation of levers to require commissioners to follow best practice, the letter said.

“Demand has to be addressed and simply closing beds and moving people elsewhere will create a bottled up problem elsewhere in the system….If people are simply moved out of them without action to also reduce demand, the places will be immediately filled by new people who are being failed by local services,” the letter said.

Dame Philippa Russell, one of the letter’s signatories and parent of a son with a learning disability, said a comprehensive demand prevention programme was needed.

“Importantly we must find a better way of transferring resources currently locked into regional specialist commissioning back into the local authorities who will have the main responsibility for reintegration into families and communities,” she said.

“I see a real opportunity in the introduction of independent personalised commissioning, integrating both health and social care budgets and designing care and support around and with people. Without individualised and integrated care planning, families will again fail and people with learning disabilities will continue to be at risk of ‘exile’ to distant emergency services from which a constructive return will be difficult, if not impossible.”

The NHS England steering group, which will report its findings by the end of October, has triggered fierce debate since it was first announced last month. Learning disability activists expressed anger after a blog post by Bubb announcing the group suggested that plans had been drawn up by sector leaders behind closed doors without the involvement of users and carers. NHS England has moved to quell those concerns and insist families and users will be involved in the group.

An NHS England spokesperson said: “NHS England thanks the Ideas Collective for their letter and ideas, many of which we are already working on and we will be considering all the issues raised. We are working closely with people with Learning Disabilities, partners and stakeholders and will be publishing the steering group’s terms of reference, agendas and minutes on the NHS England website.”


UCB offers further expanded access to clinical study data

UCB has taken a new step to make its clinical data more freely accessible to medical researchers.

It has become the first midcap biopharma company to join the new Multi-Sponsor Environment, which allows scientists to request access to anonymised patient-level data and supporting documents from clinical studies to conduct further research.

UCB will be accepting requests relating to pivotal clinical studies that were used in the regulatory approval processes of its core medicines. Requests for access to additional clinical study data will be considered on a case-by-case basis.

The firm’s policy on data sharing aligns with principles laid down by the European Federation of Pharmaceutical Industries and Associations and the Pharmaceutical Research and Manufacturers of America.

Professor Dr Iris Loew-Friedrich, chief medical officer and executive vice-president of UCB, said: “We have committed to sharing data from our clinical studies in a responsible way. We hope this will enhance disease understanding, generate new insights and help develop new treatments.”

During the first half of 2014, the company experienced a year-on-year revenue increase of six percent, thanks to improved sales of its core products Cimzia, Vimpat and Neupro.ADNFCR-8000103-ID-801740255-ADNFCR

How big is Novartis’ LCZ696 heart drug? Experts bet on a key number

In the pharma business, you’re only as good as your next big blockbuster. And in Novartis’ ($NVS) case, the next big cardio blockbuster–LCZ696–looks very good, indeed.

The key number on the heart drug’s ability to reduce mortality risks for patients, though, is still under lock and key for the next few weeks. But Reuters‘ Ben Hirschler has been tracking the betting among groups of physician experts polled by some high-profile analysts. Heart experts polled by Cowen came up with a bet on a 23% reduction in the risk of cardio death for the patients in the study, which was stopped early on stellar but unspecified results. And at Deutsche Bank the poll of cardiologists concluded that 15% or better would be “highly relevant,” according to Hirschler, with a number north of 20% expanding the potential patient pool for Novartis.

Analysts at Leerink said back in April that the number had to be more than 20% to hit the p value laid out in the study, which should be good enough to win a market worth billions of dollars in annual sales. And Reuters notes that Morgan Stanley has taken the bear position with a risk reduction of about 30% needed to persuade physicians to widely prescribe a drug likely to cost around $2,000 to $2,500 a year.

Once considered a marginal, high-risk program, LCZ696–an angiotensin receptor neprilysin inhibitor (ARNi) bidding for first-in-class status–almost overnight became one of the top late-stage drugs in the industry’s pipeline. Up until a few months ago, the company’s cardio spotlight was reserved for serelaxin, a top prospect that has since dwindled to a side show as the data soured and regulators turned cold. Generic competition for the Diovan franchise, meanwhile, has arrived with a vengeance, roiling the numbers at the pharma giant as it restructures in a major asset swap with GlaxoSmithKline ($GSK). And with serelaxin out of the running, LCZ696 has assumed an outsized role at Novartis as analysts assess its potential for a quick recovery.

And that potential is now all about the number. Without a solid figure to rely on, projections on peak sales tend to run the gamut, from the company’s own bullish $2 billion to $5 billion to Deutsche’s awestruck $10 billion top. EvaluatePharma pegged nearer-term 2020 sales at a much more modest $1.3 billion.

The drug itself is a combination of two hypertension therapies, valsartan and AHU-377. Valsartan spurs vasodilation to flush sodium and water through the kidneys while AHU-377 is designed to block an enzyme that threatens a pair of blood-pressure lowering peptides. The FDA has a very high standard for heart drugs intended for a mass market. The question now is just how big Novartis’ market-defining number may be.

Daily aspirin ‘cuts bowel and stomach cancer deaths’

Picture of aspirin pills

Aspirin seems to offer most protection against cancers of the digestive system

Taking aspirin every day can reduce the chance of developing or dying from bowel and stomach cancers, a review of all available evidence suggests.

And scientists predict if everyone aged 50 and above in the UK took the drug for 10 years, some 122,000 deaths could be prevented over two decades.

But they warn aspirin can cause internal bleeding and say medical advice must be sought before using it.

The Queen Mary University of London report is in the Annals of Oncology.

Continue reading the main story

“Start Quote

Taking aspirin daily looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity”

Prof Jack CuzikQueen Mary University of London

Weighing up benefits

Scientists examined some 200 studies investigating the benefits and harms of taking aspirin – an area of continuing medical debate.

They found the drug reduced the number of cases and deaths from bowel, stomach and oesophageal cancer by some 30-40%.

There was weaker and more variable evidence that the drug reduced deaths from breast, prostate and lung cancer too.

And the study found people needed to take the drug for at least five years to see any benefits.

Prof Jack Cuzick, at Queen Mary University of London, who led the research, urged all healthy people aged 50 and above to consider taking a small dose (75mg) of the drug every day for a decade.

Researchers predicted if 1,000 individuals aged 60 took the drug for 10 years, a further decade later there would be:

  • 16 fewer deaths from cancer
  • One fewer death from heart attack
  • Two extra deaths from bleeding

Prof Cuzick, who has been taking aspirin for four years, said: “Whilst there are some serious side-effects that can’t be ignored, taking aspirin daily looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement.

Professor Jack Cuzick: ”The benefits substantially outweigh any side-effects”

Individual risks

They found benefits continued even when people stopped taking the drug, but say it is unclear exactly how long people should use it for.

As the risk of internal bleeding rises as an individual gets older, they suggest a cut-off point of 10 years.

There is still uncertainty whether other doses of the drug could offer more protection.

Picture of aspirin pills
The benefits of aspirin must be weighed against individual risks, experts warn

Aspirin’s well known possible side-effects include bleeding in the stomach and the brain.

And while the study suggests 122,000 lives could be saved if everyone in the UK aged 50-64 took the drug, this is balanced against the estimated 18,000 deaths from side-effects.

Experts warn anyone at high risk of bleeding, including people with blood disorders who take blood thinning medication, or are frequent smokers or drinkers, are more likely to suffer these side-effects.

They recommend anyone considering daily medication should speak to their doctors to discuss individual risks.

Dr Julie Sharp, at Cancer Research UK, said: “Aspirin is showing promise in preventing certain types of cancer, but it’s vital that we balance this with the complications it can cause.

“Before aspirin can be recommended for cancer prevention, some important questions need to be answered and tests need to be developed to predict who is likely to have side-effects.”

Exactly how aspirin protects against cancer is unknown. Scientists suggest it may reduce inflammation or act on blood cells that would otherwise encourage the spread of the disease.

Cerner to acquire Siemens health IT division for $1.3B

Dive Brief:

  • Fulfilling some ongoing industry rumors, EHR giant Cerner will acquire the IT division of German corporation Siemens in a deal worth $1.3B.
  • Combined with the Siemens business, Cerner will now have 20,000 associates in over 30 countries, and 18,000 facilities as clients.
  • The acquisition will increase Cerner’s annual revenue from about $3 billion last year to more than $4.5 billion in annual revenue this year. This makes Cerner the number-one vendor in revenue, over a billion dollars larger than previous industry leader McKesson, according to Vince Ciotti on HIStalk. Epic is now in third place, with $1.7B in revenue.

Dive Insight:

According to Cerner founder Neal Patterson, scale was an important consideration in the deal. “This gets us a bigger, better business platform,” Patterson said. “We’ll have a combined $650 million [in R&D] spend and we think the future of healthcare computing is driven around the ability to innovate. This preserves our ability to spend heavily in innovation and IT certainly for the rest of this decade.”

Moreover, says Patterson, the secret to securing a future in the healthcare industry is being able to manage and interpret huge streams of data to determine population health. “The next [thing] … is through big data to be able [to] identify and manage health conditions before people present themselves to hospitals and emergency rooms,” Patterson said.

When Healthcare Dive reported on the rumors of a Siemens acquisition last month, we noted that the purchase would help Cerner battle for market share against fellow EMR titan Epic Systems. Siemens’ EMR may not have a huge market share, but it does have large customers, and Siemens Healthcare has an extremely strong brand in other critical areas of healthcare technology investment, such as medical devices.

Referral Scheme

Candidate Tools

Join our Mailing list

G2 Academy

Contact Us

We offer a national recruitment service from our Surrey head office, please see contact details below.

Head Office

PM House,
Riverway Estate
Old Portsmouth Rd

T: 01483 910 940

  • 16
  • Aug 2021

Gates & Soros buy UK-based Mologic: A social enterprise to improve global healthcare

Read More

for Us

Find out More