13 – Reforming the NHS (a bit)

by Steve Bates and Paul Corrigan

This is a joint post with my friend Steve Bates. Steve is the current CEO of the UK BioIndustry Association. Older readers may recall that he and I were both special advisers to John Reid, when he was Secretary of State for Health 2003-2005.

In those days we spent time and effort arguing for, and helping to create, partnerships between parts of the NHS and the private sector. Nowadays, given the scale of the national crisis, Steve is spending all his time trying to create new and ever more innovative partnerships. So we thought it might be useful to compare these two experiences – then and now.

First let’s be clear, even the first time around – in 2003 – this wasn’t easy. We all recognised that the NHS had always had a series of strong relationships with non-public sector bodies. Run through any trip to hospital and note the number of private sector relationships that contribute to patient NHS experiences. From being driven in the ambulance to being treated in the bed.  Throughout the history of the NHS public-private relationships have been necessary.

But in 2003 that was not what people felt. Whenever you discussed this – with either the public or the private sector – the culture and practices of both ‘sides’ were at best mistrustful and at worse antagonistic. Mostly it went beyond not understanding each other to a deep mistrust of what drove them. We stress this was on both sides. We had tough confrontations with both public and private sectors when trying to argue for partnerships. Both sides seem to have lots of reasons for not getting on with each other.

At the time the Government was very committed to creating trusting new relationships so it was our job to create them. At the time the political atmosphere created by senior Government ministers was – almost every week – making very strong public arguments for partnerships and how they would help the public – by, for example, reducing the maximum waiting times that were such a problem then (as now).  Sometimes we persuaded these partnerships to work and sometimes we didn’t.

Now, in 2020 and in the midst of a life threatening major national crisis, Steve has over the last 10 weeks been once more working in this area to develop not just the capacity to meet the crisis, but also innovation as a way out of it.  A good example of the new ways of working together is the  Testing Methods Sourcing Platform, which, as its website says is “seeking new and novel solutions to help increase Coronavirus testing methods, supplies and capacity across the UK”. The platform is a partnership between the Department of Health and Social Care, the UK Bioindustry Association, British In Vitro Diagnostics Association and the Royal College of Pathologists.

Actually creating these partnerships may be harder now than it was 15 years ago and we wanted to explore both why this might be and what to do about it.

First the large-scale political debate over the last 10 years has made such partnerships much harder to create. On the one hand we have had a Government that has consistently argued that the private sector has the answers to most things and during the decade the public sector has been hollowed out. On the other hand, for most of this time the Labour Party has strongly argued the other way round. For Labour the private sector has rarely won praise for anything it has achieved and mainly gets brickbats for its failures. For Labour the public sector has been the answer to most problems and contains very few faults.

The far left has always had a problem with the private sector making profits from their work. But this is one of the main drivers for the creation of wealth in our society. The private sector makes a profit from its work and it’s important that the public sector has the ability to tax that profit.  Profit is a part of the way our economy thrives and a thriving economy provides the tax base for a publicly funded health system.

10 years of high-level political argument either in favour of, or opposed to (but never both) public or private sectors, has left the actors on the ground being engulfed by the opposition between public and private.

For the last 3 months the nation has been struggling with a crisis that is killing tens of thousands and destroying the livelihood of millions. But even given this national crisis it has proved extraordinarily difficult for both public and private sectors to set aside their differences and work together for the common good. Simply saying that there is a common national good does not in itself overcome the mistrust.

There are some who, even during the crisis, are more driven by this mistrust between the sectors than by trying to find joint solutions to save lives and relieve pain and distress. There are some that still feel that the two sides should not be reconciled but must fight this fight to the destruction of the ‘other side’.   Leaving them aside, let’s work out some lessons from the last few weeks for making this work.

Let’s not start off by being naïve. When trying to work together, always remember that culturally organisations have different drivers. Sitting in a room with a group of individuals – some of whom might run labs for PHE, some work for a large pharma company, plus 5 small start-ups and a research institute, it’s important to remember that they come from very different cultures. They all run labs – but they do so for a different purpose. If they are now going to be parts of a single network don’t expect things to work just like that.

These differences matter to organisations and the people in them and unless you are constantly aware of that – they will jump up and cut across any joint venture. Don’t assume that because people are in the same Zoom session that they think and feel alike.

Then, whilst being mindful of and talking through your differences, constantly underline the common goals driving the partnership. This is not an exercise in meeting numeric targets set by the Government but is about saving lives and reducing infections in the current crisis. The 100,000th test isn’t a number, but just like the 99,999th gives reassurance to a family about their mum or allows a nurse to go back to work. Motivate the partnership with strong joint moral goals.

Thirdly, use your differences to create better teams. The public sector is really good at recognising the national (and international) service of much of their work. Directly reducing infection has been a joint goal for decades. Research institutes have experience in moving science forward whilst, at the same time, replicating scientific processes over and over again. Large multi-national companies have flexible capacity in different countries. If a production line goes down in the UK using capacity in another country is both a normal and good thing. Ask everyone to do exactly the same thing in exactly the same way and you will lose the advantage of having access to the different skills of partners.

Finally explain everything to the public – all the time. The last 10 years of public-private political rows haven’t just influenced the organisations in your partnership, but also the public. A large percentage of the population no longer believe that any partnerships will work. Make the case for why you are doing what you are doing and how you are doing it. Never assume that the case for public-private partnership makes itself. Make the case again and again

And, even though you might be working hard on something to help us through a national crisis, don‘t expect it to be easy.