EAHP The stakeholder Mandate Summit 15 th May 2014 delivered - Barcelona 27 th March 2014

1. EAHPThe stakeholder MandateSummit 15th May 2014delivered - Barcelona 27th March 2014 Dr David Gerrett Senior Pharmacist Patient Safety NHS England

2. Background • A survey of European Union hospital pharmacy was conducted specifically for this Summit • It sought to answer questions that you might have on the capacity of hospital pharmacy to implement changes to practice and improve the safe and effective use of medicines NHS England Presentation the EAHP 27th March 2014

3. Q: Are there enough pharmacists/pharmacies to make a difference? • There are over 25,000 hospital pharmacists and many more hospital pharmacy technicians in the EU • Virtually all hospitals have a discrete pharmacy department • Professional bodies and Associations like EAHP have specific networks and mechanisms for contact A: We can say that if change is needed then the message can be received nationally and a response disseminated to your local health-service provider

4. Q: If something needs to happen, can pharmacy communicate at the level where decisions are made? • We found 77% (n=410) of chief pharmacists report to only one other person or directly to the person ultimately in charge of the hospital A: We can say that if the Summit encourages hospital pharmacy to act in improving the safe and effective use of medicines then pharmacists can take their concerns and solutions, without the message being altered, to those with the power to enable local change

5. Q: Can Hospital Pharmacy influence the use of medicines? • We found 65% (n=410) of hospital pharmacies were in charge of over 90% of the drugs budget. A: How, why and when a medicine is use in hospital is a multidisciplinary affair; however, available finance has a huge impact. Hospital pharmacy commonly makes the case for local use in the context of the drugs budget. It can act on your behalf if it knows your wishes.

6. Q: healthcare resources are limited. Has pharmacy been prevented in providing services? • We found that last year 81% (n=410) of hospital pharmacy departments were constrained in continuing to provide one or more patient-orientated service(s) or develop a new one(s), due to insufficient resources A: Hospital pharmacy is attempting to maintain or improve services but does not currently have formal backing from the public. We believe this sub-optimal service is likely to continue without support.

7. Q: what sort of services may not happen? • Implementing an IT system for anticoagulation • covering wards • maintaining IT and procurement • visits on wards missed • evaluation of infusions • Clinical pharmacy service at ward level • delivery of an antimicrobial stewardship programme • greater involvement in oncology chemo prescribing and screening • deliverance of pharmacy produced products in the evening after six o'clock

8. Q: if told to make change is pharmacy delegated the authority? • We found in 64% (n=410) of cases the hospital pharmacy was given ‘shared’, ‘most’ or ‘total’ authority to introduce a new service. A: We can say that hospital pharmacy has a track record of being trusted by organisations to bring about new services. It is likely that with the Summit’s backing it can build on this and deliver more.

9. Q: if told to make change, did management understand what was happening? • We found in 63% (n=410) of cases the general hospital management understood what was required to implement a new service ‘somewhat’, ‘mostly’ or ‘completely’ A: We can say that hospital pharmacy has a track record of helping healthcare organisations understand what is required to bring about new services.

10. Q: if its all possible why does it not happen? • We found in 68% (n=410) of cases barriers prevented the implementation of improvement in hospital pharmacy services ‘somewhat’, ‘mostly’ or made them ‘impossible’ • Financial constraints featured strongly as the reason A: While the infrastructure is there in organisation and hospital pharmacy is positioned to do the right thing by patients, clearly there are still barriers. The Summit may provide a new way of responding to such barriers.

11. In summary, hospital pharmacy…. • is in a position to influence policy and bring about change • is often in control of the flow of medicines funding • can command authority to bring about change • can explain what it is trying to do ….but • The barriers are real, they are challenging and they are stopping benefits to patients

12. To quote ‘if you can make more Money with the Innovation then you'll get it. Also, if you can prove that you can prevent more costs (liability for negligence) or if a process will be quicker (you produce a mixture of a medicine what allows the doctor to be 10 minutes faster in operating room).’….we seek your opinion and direction to provide a new and positive authority for hospital pharmacy to implement improved medication-related services for patients