Conor Burke explores the results of a survey and offers advice at a time when a good relationship between industry and the NHS has never been more important
The NHS and life-sciences industry serve a common purpose: to improve population and patient health and wellbeing. Over many years, a range of initiatives have been established to encourage and promote greater collaboration between the sectors.
Industry has significant skills and resources that could be utilised more effectively by the NHS, and the NHS offers a unique opportunity to develop and test new products and services. This would benefit the UK economy and population, as well as providing a test‑bed for global developments.
Industry has significant skills and resources that could be utilised more effectively by the NHS …
However, despite many attempts to promote better governance, increase transparency, and develop more collaborative working,1–3 there remains a gap between understanding the importance of the opportunity and making it happen on the ground.
The lack of enthusiasm for collaboration has been exacerbated by headlines such as ‘Who let the drug companies in?’4 and other media coverage suggesting that the NHS is being held to ransom by pharmaceutical companies.5,6
In 2017, the UK government published the Life Sciences Industrial Strategy, outlining its commitment to securing a better and more effective relationship between the life-sciences sector and the NHS. The strategy aims to improve population health outcomes, enhance consumer experience, and drive value on a global stage.7
Subsequently, in 2018, the government published the Life Sciences Sector Deal 2, which aims to strengthen the UK’s position as a world leader in health research.⁸ The sector deal outlines the joint commitments of government and industry to make the UK a global leader in life sciences for the benefit of UK citizens, with the NHS pivotal as a delivery partner. It includes the development of Digital Innovation Hubs to maximise the potential of industry and NHS health data to help people live longer and healthier lives.
The scope and remit of the Accelerated Access Collaborative has also increased to lead the uptake and adoption of innovations. Its role is to ensure that the UK continues to be a world leader in health technology, with the NHS acting as both a real-world test-bed and beneficiary of many of the innovations flowing from the life‑sciences industry.
© Visions4Health. State of the relationship.
ABPI=Association of the British Pharmaceutical Industry; ABHI=Association of British HealthTech Industries; MEAT=most economically advantageous tender; SBRI=small business research initiatives; ITT=innovation and technology tariff; ITP=innovation and technology payment.
Alongside the sector deal, the NHS Long Term Plan was published in January 2019.⁹ The plan focuses on integrating patient care at a place‑based level, and is underpinned by the adoption of improved population health-management tools. It also recognises that care pathways are fragmented. For example, the separation of NHS England specialised and CCG commissioning may hinder opportunities to focus on prevention, increasing demand for more expensive and complex treatments. There is now a move to align and manage specialised commissioning budgets at the level of sustainability and transformation partnership (STP)/integrated care system (ICS) footprints.10
Against this policy backdrop, there are many opportunities for the NHS and life-sciences sector to partner in the interest of patients. However, the state of the relationship and whether this collaboration can be realised is unclear. Visions4Health evaluated the effectiveness of existing strategies to develop strategic partnerships between NHS organisations and the life-sciences sector to establish a baseline upon which to improve.
State of the Relationship survey
Between December 2018 and January 2019, we conducted an online survey of NHS and life-sciences industry leaders.11 We received 132 responses, and the respondents were evenly split between both sectors. Most respondents were middle management or above. The survey results were then shared and debated by NHS and senior industry leaders at a roundtable meeting held in March 2019. The participants reviewed the survey findings, provided insights based on their collective knowledge and experience, and developed a set of recommendations to realise the aim of improved collaboration between the NHS and life-sciences industry (see Box 1).
© Visions4Health. State of the relationship.11
Figure 1 demonstrates that there is limited understanding and knowledge of published policy and initiatives designed to foster NHS and industry collaboration. Of most interest was that NHS respondents, particularly clinicians, were less familiar with initiatives designed to foster effective partnerships than life-sciences respondents. Those least familiar with such initiatives cited a lack of understanding of how industry can help as a key barrier to collaboration between the NHS and life-sciences sector. Both life-sciences and NHS respondents were closely aligned on the importance of specific attributes of effective partnerships: ‘mutual trust and respect’ and ‘having a shared vision’ were rated as the key enablers (Figure 2). However, when participants were asked to rate their satisfaction of working in partnerships in respect of these attributes, NHS respondents were significantly less satisfied in all areas. The largest gap in importance to satisfaction were those attributes relating to mutual trust and respect and a shared vision/purpose and clarity around the partnership (Figure 3). Mistrust and a lack of respect were restated on several occasions in the qualitative feedback, with comments such as:
- NHS respondent: ‘Industry has tried to make as much profit as possible from the NHS and worked unscrupulously with clinical staff, bribing them with hospitality and incentives’
- life-sciences respondent: ‘Still so much negativity around pharmaceutical industry, with zero understanding of the role of pharmaceutical manufacturers… No understanding of the drug pricing model, patent length etc.’
When asked for their opinions about NHS and industry partnerships, most respondents scored below the midpoint, showing that work needs to be done to evolve a more mature relationship (Figure 3). Concerningly, the survey indicated that the NHS was no more likely to look to the life‑sciences industry for partnerships now than 5 years ago.
Well-established government and NHS policies have set out a clear ambition for more effective partnerships between NHS and industry, with a strong focus on prevention and earlier intervention. However, despite clear intentions and local action, change is still not happening. The findings of the survey imply that engagement at a national level does not always translate to change at the level of local health systems. The absence of local joint vision, shared values, and mutual understanding leads to mistrust and a lack of confidence, and suggests that improving the state of the relationship is a necessity. To transform services and deliver benefit for patients, the NHS, life-sciences sector, and policy makers must now focus on creating the conditions and incentives that enable more collaborative relationships at the local health system level. By April 2021, all current STPs are expected to become ICSs across the whole of England.12 For an STP to become an ICS, it must agree to take on a budget for a defined population and demonstrate system leadership, a shared culture, and effective population health management capabilities. The development of place-based strategic commissioning arrangements and integrated provision will require reduction in the fragmentation of data in commissioning silos and alignment of clinical, financial, and activity data to enable the measurement of patient outcomes. This will shift the focus of specialised commissioning towards prevention and improved pathway planning and utilisation across the patient life course.
© Visions4Health. State of the relationship.11
For both parties, it will require a significant change in culture and mindset …
Population health partnerships
Collaborative working may be achieved through the formation of population health partnerships. Bringing together NHS and life-sciences sector capabilities into new partnerships within ICSs focused on implementing population health strategies would demonstrate quality improvement, address the self-care/prevention agenda, and actively pursue patient activation and engagement, with more effective use of data and digital technology. This initiative may help all parties to gain a better understanding of their sectors and develop confidence in each other, which over time will improve trust and create mature relationships.
The NHS is always striving to improve the care of patients, enabling them to live longer, healthier lives at a lower cost.9 The life-sciences industry has always had a role in achieving this goal, and the NHS has an opportunity to derive even greater value from this important resource. The Visions4Health State of the Relationship survey highlights that this opportunity is being missed, and provides a baseline on which to build, for the benefit of both parties and the patients they serve.
Box 1: Key findings and insights from the State of the Relationship survey11
- Currently, partnerships are not working for either party despite a clear recognition of their potential value
- The NHS is not incentivised to develop partnerships because of a lack of encouragement and/or ‘permission’ by regulators and policy makers
- This is compounded by mistrust, fears, and negative beliefs about working with the industry at a time when more trust and openness is required to establish meaningful relationships
- There appears to be little drive and energy at a local system level to actively invest time and energy to pursue the development of partnerships
- A clear business case for partnership has not yet been made and there is no policy mandating greater collaboration between sectors
- The life-sciences industry is not clear how to shape its ‘offer’ in order to generate the conditions for successful partnership; this includes adjusting commercial expectations and the timelines to achieve them
- The life-sciences sector does not believe the NHS is ready to partner and the NHS does not believe the industry knows where or how it could best add value as a partner
- The key areas in which the NHS would seek to partner with the life‑sciences sector are strategic thinking, cost-saving initiatives, and capacity to support the delivery of services
- Both NHS and life-sciences respondents are in favour of more strategic‑level measures to support and encourage partnerships
- It is now critical to create the right conditions and incentives that enable more collaborative relationships at local health system level if we are to realise the potential benefits of partnerships.
Adapted from Visions4Health. State of the relationship.11
- Association of the British Pharmaceutical Industry. NHS and pharmaceutical industry working together for patients. London: ABPI, 2005. Available at: www.abpi.org.uk/media/1229/jointworking_05.pdf
- Department of Health, Association of the British Pharmaceutical Industry. Moving beyond sponsorship—joint working between the NHS and pharmaceutical industry. London: DH, 2010. Available at: webarchive.nationalarchives.gov.uk/20130123193137/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_119052.pdf
- NHS PrescQIPP, Eastern Academic Health Science Network, Association of the British Pharmaceutical Industry. Preparing for joint working and the seven steps—a guide for NHS organisations. London: NHS, 2014. Available at: www.prescqipp.info/media/2319/preparing-for-joint-working-202.pdf
- Salisbury H. Helen Salisbury: who let the drug companies in? BMJ 2019; 365: l1581.
- Withers I. Is the NHS being held to ransom by big pharma? www.telegraph.co.uk/business/2017/10/07/nhs-held-ransom-big-pharma/ (accessed 12 August 2019).
- Nsubuga J. NHS being ‘held to ransom’ by US firm over drug that could save boy’s life. metro.co.uk/2019/06/12/nhs-held-ransom-us-firm-drug-save-boys-life-9916433/ (accessed 12 August 2019).
- HM Government. Life sciences industrial strategy—a report to the government from the life sciences sector. London: HM Government, 2017. Available at: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/650447/LifeSciencesIndustrialStrategy_acc2.pdf
- HM Government. Industrial strategy—life sciences sector deal 2. London: HM Government, 2018. Available at: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/768570/life-sciences-sector-deal-2-web-ready-update.pdf
- NHS. NHS Long Term Plan. London: NHS, 2019. Available at: www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf
- NHS England. Annex E—integration of specialised services with local health and care systems. London: NHS England, 2019. Available at: www.england.nhs.uk/wp-content/uploads/2018/12/ANNEXE1.pdf
- Visions4Health. State of the relationship. Sunbury on Thames: Visions4Health, 2019. Available at: www.visions4health.com/wp-content/uploads/2019/06/SOR-Final-Report_May2019.pdf
- NHS England. Local sustainability and transformation partnerships. www.england.nhs.uk/integratedcare/stps/view-stps/ (accessed 12 August 2019).