Shifting influence: the unaccountable millions paid by industry to healthcare organisations
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2330 (Published 24 October 2024) Cite this as: BMJ 2024;387:q2330In moving the NHS from broken to “fixed” (doi:10.1136/bmj.q2309),1 the focus is on three shifts identified in the Darzi review: from treatment to prevention, from hospital to community, and from analogue to digital (doi:10.1136/bmj.q2263).2 These all seem sensible, well established, and widely endorsed. Yet there are other shifts: unspoken ones or givens.
One given, in common with most national policies, is the absolute centrality of public-private partnership. In healthcare this dogma tends to involve the use of private healthcare companies for extra capacity or the rule of management consultants over healthcare staff and resources. When it comes to science, life science strategies can be proxies for better conditions for drug and device industries.
In this rush for capacity, efficiency, and economic growth you might forget that the jury is out on whether any of these public-private partnerships are beneficial. They might even cause net harm. It’s also easy to forget the voice of patients, the public, and staff.
On this front, the UK government’s plan to inform its promised 10 year NHS plan with probably the most extensive public consultation exercise ever is a welcome one (doi:10.1136/bmj.q2315 doi:10.1136/bmj.q2344).34 One view is that we know enough already and that such a prolonged consultation is unnecessary, but any plan on the NHS’s future must consider trade-offs and preferences, as recommended by The BMJ’s NHS Commission (BMJ 2024;384:e078903 BMJ 2024;384:e079341). It will be better for being informed by the difficulties, solutions, and ideas that patients and staff can articulate. Buy-in from these interested parties is essential to the plan’s success.
However, the government might find that the public and staff aren’t sold on the “given” of creeping privatisation. A trial of a new weight loss drug, for example, sounds entirely sensible, but against a background of failing obesity services and a collaboration with Eli Lilly its virtue becomes less clear (doi:10.1136/bmj.q2281).5 A global misjudgment by politicians is that holding industry close will be met with approval. The question, therefore, is whether clinical need is secondary to competing priorities.
A new BMJ investigation finds that funds flowing to healthcare organisations from the drug industry are large and not properly accounted for (doi:10.1136/bmj.q2264).6 The thrill of the new—whether it’s breast cancer therapies (doi:10.1136/bmj-2024-079603 doi:10.1136/bmj.q2088),78 HIV treatments (doi:10.1136/bmj.q2254),9 weight loss drugs (doi:10.1136/bmj-2024-080340 doi:10.1136/bmj.q1986),1011 or direct oral anticoagulants (doi:10.1136/bmj-2024-079520)12—comes with uncertainty (doi:10.1136/bmj-2024-079322)13 and a risk of harm. What influence do the hundreds of millions of pounds paid by drug companies buy? Restrictions on industry payments to individual clinicians have shifted focus to nebulous payments made to healthcare organisations.
The drug industry isn’t throwing money at NHS trusts for reasons of philanthropy. That’s a given. What’s also clear is that systems for regulating, reporting, and accounting for payments to healthcare organisations and health professionals are inadequate and insufficiently transparent. If something needs fixing, it’s the myriad murky interfaces between commercial organisations and healthcare providers.