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David Campbell
Royal Pharmaceutical Society Member
The next few years will provide health and social care systems with significant challenge as national governments continue to wrestle with austerity. The drive for continuous improvement in efficiency and productivity will be a constant. 
Hospital pharmacy already makes a significant contribution to this by adopting roles traditionally undertaken by others (or otherwise positively influencing clinical practice), using formulary controls, implementing prescribing efficiencies, providing antibiotic stewardship in the context of a growing concern with resistance, managing effective stock management/logistics systems and reducing waste. Quite rightly, more will be expected, particularly of those organisations that are not performing to the standard of those who are ‘best in class’. 
Other efficiencies may be possible by further centralising operational services, outsourcing to third party providers where there is a financial advantage in doing so, driving down the costs of human inputs to processes to the lowest common denominator – all part of the traditional approach to driving efficiency, that is, getting a desired output with minimum resources. 
Accompanying many of these efficiencies will be the requirement to adopt new technology as a means of delivery; certainly this will become the way in which successful hospitals manage their medicines in the future. Ward-based automation, dispensing robots, electronic prescribing systems and barcoding at the point of medicine administration will all feature and deliver associated improvements in quality and safety.
Hospital pharmacy also helps manage some of the potential negative impacts of public austerity: responding to decisions made by national governments about those medicines which they are no longer willing to pay for; dealing with the unintended consequences of cost cutting, for example, medicines shortages; coping with a reduction in staffing levels or staff training/development opportunities as a result of a squeeze on budgets in pursuit of cost reduction; providing quality assurance at arm’s length when dealing with an expanding medicines homecare market or when services are otherwise outsourced to third parties.
But in this context, probably the greatest challenge facing hospital pharmacy is not to lose sight of what is most important, that being the impact of medicines on patients, their outcomes and their experience.
Whereas an ‘efficient’ supply system can dispense a patient’s twenty medicines, for example, into a compliance aid to ensure it is available at the point when they are ready to go home, an ‘effective’ system ensures that the same frail elderly patient leaves hospital only with those medicines that are really needed/wanted and they are confident that they will be able to manage these when they are at home. 
Are twenty medicines good for anyone? To help achieve this we need to see quality conversations and shared decision-making with patients (and/or their carers) as routine practice. Shared decision-making uses the knowledge and experience of clinicians alongside the patient’s beliefs/values to help make informed decisions. With medicines, if patients are properly involved in decision-making, it is possible to stop a lot of medicines that they don’t want and also improve adherence. Better patient experience and lower overall healthcare costs also result.
Therefore, 2016 should be the time when hospital pharmacists across Europe stand up for what is important: championing the value of patient engagement and adopting these skills to bring this into routine clinical practice. As for improving efficiency with medicines, that just needs to get done.