Is the working relationship between the NHS and private partners under threat?

This article was first published in HealthInvestor.

Last week the National Audit Office concluded that, despite the exceptional circumstances in dealing with Covid-19, “standards of transparency” had not been “consistently met” in the way private sector contracts were awarded during the first wave of the pandemic.

Independent providers of health and care services to the NHS and local authorities have spent many years building partnerships, shared processes and trust to provide high-quality services to health systems, their patients and staff.

What impact has the past six months had on those relationships? As we emerge next spring – and the hard work of rebuilding not just our health system but our whole economy begins – will we look back and think it has been a positive catalyst for greater cross-sector partnerships? Or do some of the crisis manoeuvres we have seen pose a longer-term threat to the very notion of partnership?

Opinion among service commissioners seems to be split. While some view the crisis as a unique situation bringing opportunities for new types of conversation with external parties, others have adopted more of a siege mentality during Covid-19 and are unresponsive.

Rightly so, there has been plenty of reporting and public conversation about the heroic response of NHS front line staff to Covid-19. However, there has been far less recognition of the contribution from other parts of the system – the unsung heroes who ensure that the most vulnerable people still receive community support; that people are being discharged safely and efficiently back home or to other care settings; or the independent providers who signed up to a block contract to backfill NHS care in a bid to support the front line Covid-19 effort.

ZPB brought together a group of senior leaders in the independent health and care sector – from community services to acute providers, outsourcing giants and staffing providers – to discuss some of these issues.  By collecting these experiences during this critical period, we hope to highlight future challenges and the unintended consequences of the UK’s response to Covid-19 as well as to share ideas on how these challenges could be addressed.

The following shifts and trends were identified by the service providers as consequences of the health and care sector tackling the pandemic:

• The impact on public services has meant that provider interactions with commissioners have changed significantly. While this is inevitable during a time of crisis, there is widespread concern that the demonstrable value of integrated partnership working between the NHS and independent sector is now at risk of being undermined – not just now but for the future.

• Independent service providers have been mobilised to tackle the pandemic, from staffing testing stations to plugging gaps in care for vulnerable groups. However, there’s been a shift towards commissioners procuring many of these services in a way that is not sustainable for providers in the long term. This shift is mirrored for healthtech and digital providers. While expediency is understandable during a crisis phase, urgent consideration needs to be given to reassessing these arrangements in a way that is mutually affordable.

• Partners and suppliers to the NHS have a dichotomous view on how the future of NHS-industry partnerships will emerge from this year:
  • Concrete steps being taken to create a genuinely integrated service, wherein each component focuses on its strengths; or
  • The NHS becoming a deified structure increasingly resistant to exploring outside partnerships, having become more ‘closed’ to cope with Covid-19.
• Spending is another area where there seems to be a polarisation of attitudes among commissioners. This ranges from eagerness to introduce new initiatives now, while there is less scrutiny of spending due to the immediate pressures of Covid-19, through to – at the other end of the scale – extreme caution about committing to anything new for fear of scrutiny of overspend post-Covid.

How should the future look?

• First and foremost, acceptance is needed that external partners can help to address unmet needs. When the NHS accepts where it needs support (for example with technology), it takes a more open approach to partnerships and there is a willingness to look outside the NHS to plug those gaps. Where there are shortfalls – or at times failure – in what is deemed to be more ‘core’ business for the NHS, such as the provision of key services like patient discharge, there can be a reluctance to seek outside help and support. Will the NHS ever look for new ways of doing old things or will it just continue to do old things the old way, albeit with a few modifications based on ‘lessons learned’? There seems to be a degree of ‘bunker mentality’ among some NHS managers whose reaction to proposed support – in managing patient flow for example – is that, having coped thus far through Covid-19, they can manage on their own.

• More cross-learning is needed between the two different commissioning systems – the NHS and local authorities.  Independent service providers often feel they have more impact at a local level when working with local authorities, who know and understand their own population needs down to the postcode enabling them to move forward with delivery as equal partners. Clearly-defined areas such as sexual health services are held up as an example of good practice.

Free thinking is the most important common factor in those who engage in constructive dialogue with independent providers. There are some real innovators in the NHS, particularly among trusts embracing technology. Likewise, there are some exemplars in service delivery. These include an initiative currently being delivered by an independent provider on behalf of the NHS to transfer elderly dermatology patients from acute to primary care. Refreshingly, it is based on collaborative working between primary care networks, community trusts and acute trusts. In these instances, it’s usually force of personality that drives change rather than the system.

Independent providers have a willing role to play in ensuring good procurement that can happen at pace. They can work with government to help define this, based on providing the right services for the right population at the right time. In this way, we can have a system fit for the future.

ZPB’s take on partnership is that successful working with the NHS has to bring a quadruple win – for patients and the public, for the health and social care system, for providers and for taxpayers. This can be achieved only if combined public and private services are fairly and effectively mobilised.

By Zoe Bedford, Chief Executive & Lauren Saldanha, Account Director