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Heavyweight union

Powerful partnerships are built on trust, mutual understanding and innovative solutions

Two wrestlers, one wearing a mask with 'NHS' written on it and one wearing a mask with 'Pharma' written on itThe NHS Life Sciences Innovation Delivery Board (LSIDB), which I support, was set up to improve relationships between the life sciences sector and the NHS. Bringing together senior leaders from the NHS and life sciences industry, along with regulators at the National Institute for Health and Clinical Excellence, (NICE) and senior policy makers, it champions innovation in drugs and medical technologies, with the aim of increasing the use of cost-effective medicines and medical technologies.

The LSIDB also works to increase the attractiveness of the UK as a site for clinical trials and product development. Currently we are promoting an exemplar programme, originally from the North West, nationally across the NHS. Although this is still at an early stage, results have seen dramatically shortened trial set-up and recruitment times: significantly shorter even than the standard suggested to the NHS by the Association of the British Pharmaceutical Industry (ABPI).

Building relationships
Collaboration with industry has been shown to achieve real benefits – saving money and improving patient care at the same time. It is also the key to innovation. The NHS can't solve all of its problems by looking within, and industry needs to deepen its knowledge of its customers. As such, the motive for joint working is clear, however, a number of obstacles still stand in the way of industry and the NHS meeting their partnership objectives.

At its most basic level, there is limited understanding, on both sides, about how and why decisions are made. A better exchange of information would lead to greater knowledge, insight and, ultimately, the deep level of trust required for the development of an equal and co-dependent relationship.

Elements of the NHS remain 'culturally resistant' to collaboration, and so, for pharma, developing personal relationships at all levels within the NHS is vital. In recognition of this fact, the LSIDB recently set up a shadowing scheme between Strategic Health Authority (SHA) chief executives and pharmaceutical company bosses, which has been successful in breaking down barriers and helping people identify opportunities for collaboration.

The basis is trust
When I presented recently at the ABPI annual conference, I highlighted the need for increased trust between the NHS and industry. Trust is imperative for effective working, and for bringing about new ideas and working practices. Everyone is aware of the inherent differences between the public and private sectors, and the legacy of mistrust we have to overcome in some quarters. However, we are also all aware that the ultimate goal is to achieve a shared vision, values and co-operation across all levels and functions of industry and the NHS. We cannot lose sight of the fact that, by working together, we can make the greatest improvements, for the ultimate benefit of patients.

The first step towards this is to identify just what the existing relationship between the NHS and life sciences industry is; where it's working well and where there are barriers that need to be removed. Once we have hard facts to show where we are, we can work together on moving forward. As an enabler, the LSIDB is commissioning a piece of research to establish a baseline position against which to measure future changes in relationships between the NHS and industry. The results of the research will allow us to gain better insight into the features and behaviours of both parties and see what changes are required to improve the strategic relationship, as well as what might hinder it. (Findings of this research will be published in future issues of Pharmaceutical Marketing).

Partnership in action
The case for closer working between the NHS and the pharmaceutical industry is stronger now than ever. Yet, despite this widely held agenda, relationships still are underdeveloped at all levels and the full potential for skills development and innovation in service delivery is seldom realised. The two sides are gradually starting to come together and although we are under no illusion that there is still a long way to go, I'm pleased to say genuine progress is being made.

Joint events and meetings to discuss joint working are helping. One example is a series of events organised by the ABPI and the NHS in the North West. These events have been set up to improve dialogue between the NHS and pharma, and to help identify specific areas where both can work in partnership to benefit the lives of patients. At one event, NHS groups got the opportunity to present their Quality, Innovation, Productivity and Prevention (QIPP) related challenges to an invited audience of senior pharmaceutical company managers. (The QIPP programme challenges the NHS to achieve between £15bn and £20bn efficiency savings over the next four years, and the life sciences industry has been encouraged to put forward ideas that will drive improvement in treatment of priority areas and support the NHS in delivering 'more for less').

At the same session, pharmaceutical companies had the chance to present their proposals for validated joint-working schemes that improve both quality and productivity.

Other new approaches are allowing NHS organisations to talk about their QIPP challenges with pharmaceutical companies that are seeking to develop bespoke solutions to meet their needs. And this is resulting is positive outcomes. In the management of long-term conditions, for instance, GlaxoSmithKline (GSK) UK is now collaborating with the NHS to deliver improvements in quality and productivity. The company has also put together a proposal to improve the management of patient care in the area of Chronic Obstructive Pulmonary Disease (COPD).

A working example
Affecting an estimated 3.7m people and killing over 30,000 each year, COPD is a major health challenge in the UK. Up to an estimated one in eight emergency hospital admissions are due to COPD and it is the second most common cause of emergency admissions to hospital. The disease is also extremely expensive to treat, and costs the NHS in England and Wales around £982m each year.

GSK partnered with the NHS in Salford to improve COPD patient care. The NHS and GSK's shared objectives were to improve COPD management, up-skill all clinical staff and reduce inappropriate hospital admissions and referrals.

Salford PCT worked with GSK to develop and implement a programme for COPD management, which included an automated patient audit tool (POINTS), to optimise the treatment of COPD patients, and the deployment of specialist COPD nursing resources.

Initial results show that the average length of hospital stay was reduced from 7.4 days to 6.9 days; PCT expenditure on hospital admissions was reduced by £167,000 compared to the previous year and an estimated 255 hospital admissions were avoided. The NHS and GSK are now looking to roll out the COPD management programme nationally, to deliver both quality and productivity gains.

Focus on innovation
Innovation is essential if NHS organisations are to achieve their quality and productivity goals. But, while there are already success stories, a lot remains to be done. Both the NHS and industry need to move away from a focus on buying 'widgets', towards redesigning healthcare services. Industry needs to align product and service offerings with health needs in specific geographical or service areas while, for the NHS, the challenge is about not seeing innovative new technologies or drugs as simply increasing cost. Often, new technologies and drugs will cost more in the short term but, if they are accompanied by service redesign and a focus on reducing costs, they can deliver big overall benefits to the NHS.

The need for innovative products, which drive both higher quality and productivity, has never been greater and this is recognised across all levels in the NHS. The NHS can't afford products where the price reflects innovation, but the realised benefits fail to match up. The LSIDB's objective, therefore, is to bring about increased uptake of cost-effective drugs and medical technologies – a vision it shares with industry. It is, however, up to the NHS to work with industry to ensure our requirements are understood.

SHAs now have a statutory duty to promote innovation in their geographical areas and have been given additional government funding for this. Regional innovation services have been established with the aim of maximising the potential of innovation, assisting NHS organisations in managing it and helping industry access NHS innovation and expertise.

To make all this happen, collaborative working is crucial. By working in partnership, both the NHS and industry will gain, and ultimately patient services will improve. Effective innovation will lead to a win-win situation and that has got to be good all round.

The Author
Mark Wilkinson is director of life sciences innovation for the NHS

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28th July 2010


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