On Friday, July 3, Jeremy Hunt unveiled a new plan to save money for the NHS: all prescription medications that cost more than £20 will have the price written on them.
The idea is that people will realise what a huge burden they are, and thus complete the entire course of their prescription. Because a lack of drug adherence is a big problem, costing the NHS more than £300 million a year. Between 30 and 50 per cent of patients don’t complete their medication courses in the way they are supposed to.
The thinking goes that this is expensive because by not finishing an entire course of medication, patients will get sick again, and cost the NHS more money. Whereas, if they completed the initial course, they would get better.
For somen, including Mr. Hunt, this is an easy problem to fix: simply remind people that drugs are expensive and they have to take them all. There were a lot of words about taking “personality responsibility,” but it isn’t really clear what that means.
“We intend to publish the indicative medicine costs to the NHS on the packs of all medicines costing more than £20, which will also be marked ‘funded by the UK taxpayer,'” said Hunt.
“This will not just reduce waste by reminding people of the cost of medicine, but also improve patient care by boosting adherence to drug regimens.”
The plan won’t work. Not even if they also mark medication with “funded by the UK taxpayer,” which is another measure that Mr. Hunt plans to implement. None of this will work, because the problem of drug adherence is a lot more complex than Mr. Hunt and his supporters seem to realise.
The measures could even be dangerous. Pharmacy Voice, which represents the interests of high street pharmacists, said:
“Pharmacy Voice believes that although this may seem superficially attractive, there is little evidence that it will have the desired effect, and there may be unintended negative consequences.
“The value of a medicine to an individual is about a good deal more than the price. Research shows that some patients, particularly older people, could be deterred from taking the medicines they need because they are worried about the impact on the public purse.”
Neither is there anything to suggest that reminding people how expensive they are will improve medication adherence. We could quite easily end up with a situation in which medication is just as frequently wasted, but more people don’t take necessary medicine out of guilt.
Mr. Hunt is looking for simple answers where there aren’t any. Patient adherence to medicine is a complex issue that goes right to heart of how healthcare is structured.
The National Institute for Health and Care Excellence (NICE) addressed the issue back in 2009. The report, called “Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence,” argues that patient-centred prescriptions will reduce the lack of medication adherence affecting the NHS:
“Addressing non-adherence is not about getting patients to take more medicines per se. Rather, it starts with an exploration of patients’ perspectives of medicines and the reasons why they may not want or are unable to use them. Healthcare professionals have a duty to help patients make informed decisions about treatments and use appropriately prescribed medicines to best effect.”
The report then goes on to define two categories of non-adherence: intentional and non-intentional. Non-intentional reasons for non-adherence include the inability to understand the instructions, or forgetting to take it. More commonly, people choose not to take the medication any more.
“It follows that to understand adherence to treatment we need to consider the perceptual factors […] that influence motivation to start and continue with treatment, as well as the practical factors that influence patients’ ability to adhere to the agreed treatment.”
In other words, we need to talk. Patients shouldn’t be blamed and scared, they should be understood. Medical professionals should ensure that patients understand the options available to them and why they are taking a particular medicine. That way, they’ll be more comfortable taking it.
But that requires a certain kind of relationship between doctor and patient: one that’s trusting and compassionate. NICE describes this as an “interactional relationship,” and it involves creating a space for “patient narrative,” which gives meaning and context to their medical history.
But building those kinds of relationships takes time between doctor and patient; something which the NHS is notoriously short on. Instead, patient-centred care often ends up being closer to a “transactional relationship,” in which the patient is treated more like a customer and allowed to dictate their own treatment.
At best, Jeremy Hunt’s plan is poorly thought-out. At worst, it’s scapegoat scaremongering, a lazy solution to a problem that merely provides someone to blame – in this case, the scrounger who wastes taxpayer’s money by not taking their medication. By passing the buck, people don’t put any pressure on a healthcare system – or, more importantly, the health secretary running it – that has a complex problem with its doctor-patient relationships; a problem that needs to be scrutinised and resolved.
It’s a hugely difficult balance to strike, making sure a patient feels comfortable with their treatment without letting them dictate it, but it’s important we get it right; the NHS spends over £300 million on unused medication every year. However we approach the issue, we need to appreciate its complexity more than Jeremy Hunt does.
