It’s complicated

Devil’s in the detail – why aren’t all NHS-industry collaborative partnerships firing?

Despite individual success stories and learnings during the pandemic, the NHS and industry just don’t seem to be able to collaborate at scale. Why is that and how might that be addressed?

The NHS is generally well loved by the public (just think back to the London Olympic opening ceremony) and has recently celebrated its 75th birthday. To this day, it still stands by the principles set out in 1948 such as being free at the point of need for everyone and based on clinical need rather than the ability to pay – unlike many other healthcare systems.

It has evolved significantly over time – in the last decade alone we have seen the abolition of strategic health authorities (SHAs) and Primary Care Trusts (PCTs), the evolution of practice-based commissioning through Clinical Commissioning Groups (CCGs) only for these to be replaced in 2022 by Integrated Care Boards (ICBs).

What is the overall aim of all this change? To bring health, social care, and public health bodies together to plan and address the wider health and care needs of the population. Well, let’s hope it works as the UK currently lags behind other comparable countries in terms of health outcomes, ranking 16/19 for preventable and 18/19 for treatable causes of mortality.

Something must clearly change for UK patient outcomes to improve. The 2022 Health and Care Act can drive that change on paper, but ‘joining up care for people, places and populations’ will take more than a system change, it will require true partnership and collaboration.

There is hope of course, just look at the experience during the pandemic when organisations – the entire NHS, life sciences industry in its broadest sense and Government departments – all worked together to address a common goal with traditional barriers and reservations set aside.

So, given the burning platform and recent positive experiences, you would think that the appetite for collaborative working would be healthy? Well, our recent 2023 survey on the State of the Relationship (a repeat of our 2019 survey) suggests otherwise and, in fact, the dials have not shifted much.

Industry is generally more positive than the NHS about the state of collaborative working over the last four years, and in terms of facilitating industry-NHS partnerships the NHS respondents cited AstraZeneca and Novartis as the clear front-runners with Bayer, Baxter, Eli Lilly, Johnson & Johnson (Janssen) and MSD following.

Nevertheless, challenges remain deep rooted. There are the obvious compliance guard rails to stay within but despite industry having a strict code of practice – with the ABPI and NHS England both stating that safeguards are in place to ensure collaborative working benefits patients and the healthcare system – you occasionally see hard-hitting newspaper headlines. These typically pull details from the UK Disclosure database that raise concerns about inducement to prescribe.

In terms of operational challenges on the ground, our survey noted that ‘local apathy’, ‘how to make a partnership truly collaborative’ and ‘having established practices’ as the bottom scoring attributes from an NHS perspective.

Anyone working in the healthcare sector would pride themselves on being solution orientated, especially when such solutions also matter to patients, so how might we go about resolving this dilemma?

• Be a change agent: Begin with aligning your goals with those of the NHS, such as supporting the identified medical optimisation priorities that ICBs need to select from.
  For example, outcomes in population health, inequalities in healthcare, antidepressant prescribing, identifying and managing hypertension, improving respiratory outcomes while reducing carbon emissions, to name but a few, or work with GPs to support the management of long-term conditions by streamlining the diagnosis of COPD, asthma, cardiovascular disease and heart failure.
  Bottom line, any customer-facing teams will need unique capabilities that position themselves as collaborative partners who have credibility and can be trusted and to stay focused on improving patient pathways and patient outcomes.
• Flip the script: In terms of organisational structure, think beyond the product portfolio and more broadly about how your therapeutic areas could be reconfigured differently e.g., how can your therapeutic technologies address some of the NHS priorities like backlog recovery or health inequalities?
• Set the right tone: Senior leaders should consider the culture within their organisation – do you have a culture that fosters collaborative working? Is the associated governance in place to be able to mobilise and support partnership working? Are these supplemented with learning and development programmes to reinforce the required skills and capabilities?
• Representation matters: Lastly, and whilst not directly linked to collaborative working per se, keep fighting for global investment into UK clinical trial sites because when your teams are talking to C-Suite stakeholders in NHS England, ICBs and Hospital Trusts, having a UK R&D footprint still matters.

• Build bridges: NHS leaders need to be ambassadors across their organisation who open doors, foster opportunities for collaboration and provide the often much-needed facilitation across the heterogenous NHS organisations.
• Define operating standards: There may be a need to systematise how to execute collaborative working on the ground (stakeholders, processes, governance, metrics and data recording etc) to make the operationalisation and implementation more efficient
• Have a point person: Every ICB should have a Life Sciences Partnership or Innovation Lead identified, who has industry engagement listed as a clear responsibility. Industry needs to know who to approach and how to conduct meaningful engagement
• Upskill: The NHS will need to invest in capability building to support a positive collaborative approach with industry e.g., skills in external partnership management, identifying and managing conflicts of interests etc.

• Find common ground: A true partnership needs to be underpinned by a genuine shared purpose with clear and shared benefits e.g., for patients and/or the healthcare systems
• Strengthen the relationship: Both parties need to up their level of transparency to continue to find common goals and build mutual trust and respect
• Make some noise: We all need to celebrate successes and that means measuring and sharing the positive impact of collaborative working, to elevate its value, showcase exemplar partnerships thereby driving greater investment.
 
Dynamic inter-industry relationships are possible and there are some great examples of this already happening! They do, however, need to be more systematic in order to have a broader impact in supporting the sustainability of the NHS and improving UK healthcare outcomes.

Roshani Perera is Commercial Director at Visions4Health.
Go to visions4health.com