Respiratory Futures tackled the provocative topic of public private partnerships at their first live debate event, sponsored by Napp Pharmaceuticals Limited, at the Royal College of Physicians on 19th January. The lively session attracted approximately 70 delegates, including many highly-regarded thought leaders and experts from across the respiratory community whose rich and varied experience provided context to much of the discussion.
The big challenges for us are around big data and personalised medicines. These areas would really benefit from public sector and private enterprise collaborations.
The event began with an audience poll, showing that opinion was clearly divided regarding the role of public-private partnerships within the NHS. But the contributions throughout the night led to a significant shift in opinion from the audience. The conclusion of the event saw a reduction in delegates undecided on the role of health partnerships and an increase from 28% to 65% in delegates who agreed with the panel’s recommendations that much tighter regulation and evaluation would enable these types of collaborations to become an accepted element of the UK health system.
A panel of experts, chaired by Dr Phil Hammond, discussed the benefits to care and potential pitfalls associated with commercial and public sector collaborations from the perspective of the health service, patients, the pharmaceutical industry and the media. The panel’s passion for the NHS was evident throughout the night, recognising the role that industry has to play in sustaining and improving the ever-changing health service, enabling it to modernise and evolve to provide exceptional standards of care.
Governance and a shared vision: the keys to success
As health budgets continue to be stretched beyond capacity, care providers are increasingly looking to the commercial sector for much-needed resources and support. However, public-private partnerships are often viewed with cynicism and perceptions are heavily influenced by the media who are instinctively hostile to the idea of commercial involvement. “I don’t think we often hear about good public-private partnerships in the media” David Brindle, Public Services Editor, The Guardian, acknowledged. “Unfortunately, the shocking failures tend to taint the concept of these partnerships and give them a poor image.”
Ensuring high quality governance, regulation and transparency to address concerns surrounding commercial partnerships were prominent themes throughout the debate. Andrew Roberts, Director of Market Access and External Affairs at Napp, stressed the importance of having these measures in place from the start: “You can’t operate any successful collaborative project without putting the governance arrangements in place at an early stage; getting all of the stakeholders aligned from day one with an agreed common purpose is important.”
Kay Boycott, Chief Executive Asthma UK, emphasised that each partner should bring complementary assets to these projects: “True collaborations deliver outcomes that could not have been delivered by one of the partners alone. Shared objectives are key to success.” Andrew Roberts agreed, pointing out that commercial support may often involve provision of specialist knowledge and skills, such as high quality project management, rather than funding alone.
Reassuringly, public sector and commercial partners recognise that patients are critical stakeholders in many of these projects. Partners often turn to patient organisations to enable a greater focus on patient benefit. Ms Boycott shared: “Asthma UK are increasingly being asked to host meetings where there is a patient present - to ground the conversation and maintain focus on the unmet need.” She also stressed the potential role for these partnerships within public health where commercial organisations have the power to make changes that will provide tangible health improvements (e.g. air pollution).
Commercial partners’ actions must stand the test of the media scrutiny… If the focus is on improvement of patient care – that is a great starting point.
Putting patients at the heart of care provision and research will also ensure that healthcare services are more relevant to the people who use them. Prof. Anoop Chauhan, Consultant Respiratory Physician, noted: “There is nothing in the NHS constitution that demands patients are included on the board or within the clinical delivery teams. If patients were more involved in the delivery of NHS services, communication and services would be enhanced.” Dr Hammond agreed that, although technologies have an important role to play in improving patient care, effective communication and trust is critical. “Successful health and social care often relies on the quality of relationships between healthcare professionals and patients. Continuity of care is the most under-rated area of medicine!” he said.
Leveraging big data to improve delivery of care
Dr Chauhan and Andrew Roberts agreed that access to big data is currently a major challenge with the potential to revolutionise approaches to diagnosis and delivery of care. The NHS generates and stores vast amounts of data that may hold the key to innovations in patient care, but the data systems, such as EMIS and SystmOne, are not capable of communicating with one another and little is being done to maximise the potential of this powerful data set. Mr Roberts highlighted that specialist software systems may be able to identify high risk patients such as those who regularly experience seasonal asthma exacerbations, but the NHS lacks the capacity and resource to implement this. However, usage of health data is a complex, technical are and there is an ongoing ethical debate that is likely to evolve alongside relevant technologies. Ms Boycott advised that all parties involved have a responsibility to raise their level of knowledge regarding data sharing and the regulations surrounding it.
The trauma of austerity has changed everything around public services and healthcare. As a consequence, attitudes are changing and there is more of an understanding regarding commercial sectors that have a role to play in improving service.
The panel agreed that large scale clinical trials, supported by industry funding (e.g. Salford Lung Study), have demonstrated that collation of patient data and facilitation of communication across primary and secondary care can lead to measurable improvements in patient care.
Challenging perceptions and looking to the future David Brindle suggested that opinion may be starting to change regarding public-private partnerships - driven in part by the financial pressures affecting the UK as a whole: “The trauma of austerity has changed everything around public services and healthcare. As a consequence, attitudes are changing and there is more of an understanding regarding commercial sectors that have a role to play in improving service.” He encouraged the pharmaceutical industry to be more proactive in order to change perceptions: “If we are going to embrace this approach moving forward we need to make a fresh start. The private sector needs to be more confident and less reticent about coming forward and owning the conversation.” Dr Chauhan said that there is a need to re-educate individuals to change perceptions regarding the pharmaceutical industry’s involvement in improving patient care. These organisations may have leading-edge technologies that can help improve care pathways and the NHS should set a challenge to innovators, explaining existing issues and where solutions are required.
As the debate drew to a close, Dr Hammond asked the panel for their final perspectives on the future of public-private partnerships. “These partnerships are here to stay and we need to make the best of them” said Prof. Anoop Chauhan, “We need to focus on areas that work, such as research and development, and ensure that we govern them properly.” Andrew Roberts agreed that partnerships will continue to be a focus moving forward: “The future is collaboration, focusing on data and using it for patient benefit.”
Kay Boycott added: “Nobody can solve the issues we have alone. Science and healthcare need help... Through necessity, we will see further collaborations because everybody brings something different.” “We need to reboot the conversation around public-private partnerships” concluded David Brindle, “We need a new narrative because, when you look at the numbers and the scale of the health challenge concerning long-term conditions, the private sector has got to play a full role.” Following the second audience vote (see Figure 1) it was evident that as the NHS continues to innovate and adapt to the growing demands of the populations it serves, there will no doubt be a need for further discussions regarding how best to address the role of public-private partnerships for the future of the NHS.
This article was written for and published in the March 2017 edition of NHE, funded and edited by Napp Pharmaceuticals: www.nationalhealthexecutive.com