Forty thousand pounds saved — and a child who can finally just get on with climbing.
An eleven-year-old named Jess used to dread taking her medicine. The liquid tasted so bad there were days she simply didn't want to swallow it. Now she takes a tablet, does it herself, and gets on with climbing and school without much fuss. That shift — small in appearance, significant in practice — sits at the center of a project out of Great Ormond Street Hospital that is drawing attention across the NHS.
The work involves children with congenital hyperinsulinism, a condition in which the body produces dangerously high levels of insulin. Managing it requires diazoxide, taken multiple times a day. For years, the standard approach for pediatric patients was a liquid formulation. GOSH's endocrinology team decided to ask whether older children could manage a tablet instead.
The answer, for 19 children aged seven and above, was yes. The team moved each of them from liquid diazoxide to the tablet form and tracked their blood glucose levels throughout. None of the children showed adverse effects. The clinical outcome held; the practical experience improved considerably.
The cost difference between the two formulations is striking. Liquid diazoxide runs about £15.50 per 50mg dose. The tablet version costs £1.15 for the same amount. Across a year of treatment, that gap translates to roughly £40,000 saved per patient. With 19 children already switched, the arithmetic becomes substantial quickly — and GOSH is now exploring whether younger patients with the same condition might also make the transition.
But the numbers, as Kate Morgan, a clinical nurse specialist on the endocrinology team, pointed out, were almost secondary to what the team observed in the children themselves. Morgan said the scale of quality-of-life improvement for patients and their families was something the team hadn't fully anticipated going in. Children, she noted, are more than their diagnoses — they have full lives, and their conditions affect everyone around them. Small, positive changes ripple outward.
Jess put it plainly. Taking medicine that doesn't taste horrible has made a real difference. She can handle it on her own now, it doesn't eat into time at school, and it doesn't interrupt the things she loves. That kind of independence matters at eleven.
The project didn't simply hand children a tablet and hope for the best. GOSH's play team and psychologists built learning materials for patients who found swallowing tablets difficult, and all participants were monitored carefully to ensure their glucose levels stayed stable. The infrastructure around the switch was as deliberate as the switch itself.
Jasmine Shah of the National Pharmacy Association offered broader context, noting that solid medications carry practical advantages beyond cost — they're easier to store, and they reduce the risk of inconsistent dosing that can come with liquids or crushed tablets. Taste, she added, is a real barrier to treatment completion for children, and removing it matters clinically.
Holly Barker, lead clinical pharmacist in paediatrics at Royal Devon University Healthcare NHS Trust, called the GOSH project a model worth replicating. She described a persistent assumption in medical training — that children simply can't swallow tablets — that the evidence doesn't support. When she asks junior doctors what they'd prescribe a child, they reach for liquids by default. That default, she argued, needs examining. Liquid formulations remain essential in many situations: for very young patients, for enteral tubes, for doses too small to achieve in solid form. But for children who are good candidates, the combination of cost savings, environmental benefit, and improved daily experience makes the case for tablets worth making loudly and often.
GOSH has framed the project within its green plan running from 2024 to 2027, and the hospital is now investigating whether similar formulation switches are possible for other drugs. The work with diazoxide is a proof of concept — one that a child named Jess, climbing walls and managing her own medication, has already lived out.
Notable Quotes
We knew the potential this trial had for savings, but the scale of the quality-of-life improvements for children and their families we are seeing is something we didn't anticipate.— Kate Morgan, clinical nurse specialist, GOSH endocrinology team
We so often hear parents state in front of their child 'they can't swallow tablets' when we have a wealth of evidence that with the right training and support they can.— Holly Barker, lead clinical pharmacist, Royal Devon University Healthcare NHS Trust
The Hearth Conversation Another angle on the story
Why does it matter so much that a child takes a tablet instead of a liquid? It seems like a small thing.
It stops being small when you're doing it three times a day, every day, and the taste makes you want to skip it. Adherence is the whole game in chronic illness management.
Is the cost difference really that dramatic?
Forty thousand pounds per patient per year. That's not a rounding error — that's a ward budget line. Multiply it across a patient population and it becomes a policy argument.
What stopped this from happening sooner?
Assumption, mostly. The default in pediatric prescribing is liquid. It feels safer, more intuitive. The evidence that children can be taught to swallow tablets has been there, but it hasn't displaced the habit.
What did GOSH actually do differently to make the switch work?
They didn't just prescribe differently — they built support around it. Psychologists, play specialists, learning materials. The clinical change was wrapped in a human process.
What's the environmental angle here?
Liquid medicines have a larger manufacturing and storage footprint. The hospital's green plan is pushing toward lower-impact formulations where clinically appropriate. This fits that frame.
Is there a risk that this gets oversimplified — that someone reads it and assumes all children should be on tablets?
That's the tension. The pharmacists involved were careful to say liquids still have their place — young children, enteral tubes, doses that can't be achieved in solid form. The point is to stop defaulting to liquid when a tablet would serve better.
What does Jess's story add that the numbers don't?
The numbers tell you what was saved. Jess tells you what was gained. She's climbing. She's independent. That's the part that doesn't fit in a cost-benefit table.