Power of partnership

Public–private partnerships (PPPs) have demonstrated themselves to be effective in meeting global public health challenges in the developing world, but currently are underexploited in the UK. But, in light of fiscal pressures facing the public sector to contain health expenditures, they should be given greater attention.

A year ago this month, the Royal College of Physicians published the report of a working group entitled Innovating for Health: Patients, Physicians, the Pharmaceutical Industry and the NHS. The report noted that 'Co-operation between the medical profession and the pharmaceutical industry is important and necessary at all stages of the development and use of medicines to secure safety of patients and efficacy of therapy.' Indeed, a year earlier, the Department of Health (DH) itself published its own best-practice guidance on joint working between the NHS and pharmaceutical industry. But as we look to 2010, and an NHS and government facing unprecedented deficits and certain cuts (unless we are to believe David Cameron's billboard promise), why aren't we seeing more of these innovative partnerships that could be of such benefit to both parties?

Certainly, the framework and excellent examples exist for the implementation of effective partnerships for healthcare delivery, particularly at a global level, so let us look at the mechanisms of how this might best happen, and that we might consider here in the UK.

To begin with, let us consider the basic question: why develop public–private partnerships in health? Certainly, with the government's patchy record on private finance initiatives (PFIs) where the bill for transport and infrastructure has often ultimately been footed by the taxpayer rather than the shared risk envisaged by their creators, what makes such approaches attractive in health?

Well, first, there are the obvious attractions that remain, despite past difficulties in implementation: shared financing brings shared commitment to any given project. For companies this is a sound investment that may be illustrated to the shareholder, and for the health service this could mean efficient improvements in service delivery.

Private involvement often brings with it innovation that long-standing habit in such enormous organisations such as the NHS can stifle. Already we can look to the Global Fund for AIDS, Tuberculosis and Malaria, and the GAVI Alliance for childhood immunisation as international examples of where private initiative and an understanding of market forces have helped to focus efforts of the global health community on the biggest killers in the developing world in alignment with national governmental strategies and needs.

And these types of public–private partnerships also do more than focus on specific issues. They can – and should, particularly as we look to local replication of such successes – also strengthen health systems themselves by building capacity to deliver services. By finding areas of common interest that are of benefit to both industry and the NHS, for example, we begin to see potential ways that we, as a sector of private enterprise, can help address the coming squeeze on health budgets and resources.

Perhaps a less obvious, and yet important, benefit of coming together is the enhanced community support that these partnerships can engender in local situations. Uncertainty about the longevity or durability of government programmes can be somewhat alleviated by the perceived level of sustainability and financial commitment of a recognised third party such as the pharmaceutical industry.

It is important perhaps, that we take a moment here to note that PPPs are most emphatically not outright privatisation or a move to American-style insurer-covered healthcare. Neither the UK nor the majority of European governments appear to have any desire to replicate a system that essentially takes up, for example, 16 per cent of the US's GDP – and projected to rise to 31 per cent by 2035.

PPPs for health should be specific, defined, time-based projects or programmes, under the aegis of government, to deliver specific objectives within public health policies. They may not always be perfect – think of the overordering of H1N1 flu vaccine – but they may still demonstrate value: while swine flu has not materialised in the way feared, no one regrets the demonstrated ability of quick scale-up of epidemic preparedness realised from the combined efforts of pharma and the WHO.

So, in the UK context, industry and government should seek to find mutual ground in public–private partnerships. Such programmes are conducive to all elements of the standard pharmaceutical promotional mix: public relations, medical education, issues advertising, new media, public affairs activities.

Some companies are making important forays in these areas. For example, in rheumatology, the NHS has embraced partnership with industry, calling upon some of the leading pharma companies for strategic planning expertise and support through facilitating Clinician Engagement meetings, strategic business management training courses for key stakeholder groups, and even working with them to develop integrated care pathways.

And where multiple companies come together, the effects are even greater and can withstand any potential criticisms more readily. For example, several pharmaceutical companies involved in the manufacture of HIV treatments have come together to fund innovative internet-based 'virtual' clinics for people living with HIV. These are successful examples because these companies have recognised the value of bringing private sector discipline and public sector priorities together.

But what does all this mean for the pharma front-liner? These are five considerations for those interested in exploring greater joint working between the NHS and industry. Above all, relationships between pharmaceutical companies and the DH, NHS institutions and other public health bodies can and should be based on equal partnership with the shared goal of positively affecting behaviour change, tackling health inequalities, improving access to medicines and reducing long-term health system costs.

1. Transparency. Transparency plays a crucial role in making partnerships work and holding participants accountable – it is an indispensable precondition. Many recent steps have been taken contributing to a stronger culture of transparency between industry and third parties, notably ABPI's guidance on working with patient-centred voluntary health organisations, healthcare professionals and the media. Disclosure and sharing of information go hand in glove with transparency. This core principle must also be applied in PPPs from the very beginning to ensure the reputation of the industry does not get tainted

2. Core competencies. Partnerships between public health bodies and private sector companies should be developed in which the core competencies of both parties are valued and leveraged. They must create a shared vision. Though financial contributions may sometimes be easier to accept and use, action would benefit significantly from access to the expertise and resources of the private sector. Readers of this magazine should think about how they can bring to bear their marketing savvy and expertise to address public health challenges.

3. Results orientation. At the beginning of negotiations, both parties should agree to mutually beneficial SMART objectives. Agreement on overall goals and priorities allows the parties to use result-driven steering mechanisms for project completion. This will provide scope for innovative and efficient approaches. Distinct measurement criteria and agreed adjustment processes in changing environments provide the basis for effectively achieving the goals. Thus independent evaluators should be strongly considered for impartial assessments of goal achievement and return on investment.

4. Communication. This is essential for sustaining the shared vision. The more open the communication channels are and the more they are used, the greater the prospects for a sustainable public–private partnership. Consider both internal and external communications needs and opportunities. Map your stakeholders and communicate early and often

5. Change of mindset. Probably the biggest barrier to effective PPPs is that conventional wisdom doesn't get challenged. Both parties in a health-based PPP need to approach the opportunity with fresh and open minds. For marketers, PPPs are not about 'pushing product' although market shaping and market expansion may be a commercial goal in your business plan. For public health professionals, PPPs are not about accepting charity, but rather about receiving added value from the private sector.

Innovations like PPPs will be required for pharma companies to thrive in the next ten years. But it may require a change of corporate strategy – moving from being a provider of medicines to a facilitator of health solutions. And it also means adopting greater willingness to do business differently. The companies that know and appreciate this are doing it already.

The Authors
Brian Tjugum, head of public health, EMEA, Weber Shandwick
John Lotspeich, director, healthcare communications, London, Weber Shandwick

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