NewsOpinion

Where next? The health and care system re-set and what it means for you

By Zoe Bedford

As the NHS and its partners come to terms with the events of the last few months and start COVID Phase 3 planning, ZPB spoke to 14 healthcare leaders to understand what has changed and what comes next.

In the first in a series of essays, ZPB chief executive Zoe Bedford examines what this means for the whole system, including the NHS and social care, life sciences, private sector suppliers and academia. 

WHERE NEXT PART I: SYSTEM RE-SET AND THE DAWN OF A NEW VALUE PROPOSITION

Coronavirus will be an extinction event for NHS organisations working in silos: the drive towards integrated systems will accelerate; and distinctions between primary, secondary and tertiary care will become blurred as systems reorganise around patient groups and adopt a multi-disciplinary approach.

This was the clear message we heard during our recent research with 14 healthcare leaders from the NHS, academia, health tech, clinical research and pharma, as we sought to understand which of the ‘good bits’ of the NHS’s response to the COVID-19 pandemic should be captured and taken forward as healthcare systems start to re-set.

The public sector alone cannot solve all the challenges. Industry, life sciences and academia need to be let in. Collaboration is more important than ever.

There was a unanimous agreement that no single organisation will be able to respond on its own. This has two clear implications:

1. The public sector alone cannot solve all the challenges. Industry, life sciences and academia need to be let in. Collaboration is more important than ever.

2. The hospital cannot be the centre of healthcare. We need integration, a plurality of provision, better-integrated care and local authorities to become part of the solution.

This, of course, mirrors NHS England and Improvement’s priorities for the third phase of the NHS response to the COVID-19 pandemic, as outlined in Simon Stevens and Amanda Pritchard’s letter to the NHS of 31st July.

The three key areas of focus for Phase Three are:
1. Accelerating the return to near-normal levels of non-COVID health services
2. Preparing for winter pressures in the context of likely local COVID spikes
3. Learning from the first wave of COVID, specifically supporting staff, guarding against inequalities; and prevention

There is a clear focus on Integrated Care Systems (ICSs) and Sustainability and Transformation Plans (STPs). This is predictable, but it is another step forward for these fledgeling organisations and the clear directive that commissioning is to be done via a single CCG in each patch is the proof in the pudding. This does change things somewhat, and partners and suppliers to the NHS will need to quickly understand who the lead commissioners are in each region. In spite of the move to a ‘simpler’ healthcare system, it’s essential to understand the differences arising within the seven NHS regions, both in strategy and operational design, perhaps related to the fact they now run their own P&L. This requires a significant rethink from industry about who their customers and stakeholders are, and how they engage with the NHS.

A positive development has been collaborative working across boundaries, driven by people being expected to get on with the job rather than look up the chain for answers.

There are new groups emerging too. Community services have stepped up during the pandemic, and the well-led ones will emerge bigger and stronger from this. The community model feels like a build to ICS now. Before it was standalone, and they have often been overlooked by industry as a key partner or customer group, but now community services seem to have found a natural home as part of that wider integrated care model and leadership.

A positive development has been collaborative working across boundaries, driven by people being expected to get on with the job rather than look up the chain for answers. We know from our research that this collaboration, notably involving the commercial sector, is seen by many as a necessity to help with this. And yet, the commercial sector was notably absent in Stevens’s recent outline: ‘Working across systems, including NHS, local authority and voluntary sector partners, has been essential for dealing with the pandemic and the same is true in recovery.’

An opportunity to rethink value

The value proposition for many treatments has now fundamentally changed, and industry should be asking where else can they drive value.

PPE and track and trace apps aside, there has been significant progress in the NHS’s ability to roll out new technologies to give faster, wider access to treatments to more people. There has been a new, temporary definition of ‘value’, as indicated by the NHS temporarily expanding access to certain, higher-cost therapies in its response to COVID. These factors combined with a clear timetable for an accelerated move towards integrated care systems should herald the dawn of a new era for value propositions.

Almost all our interviewees identified with this, but the question remains: how do we move the NHS permanently away from price and towards value?

There are a number of considerations: The NHS now has to face a backlog of 6.5 million appointments, whilst operating within the severe physical and operational constraints imposed by COVID-safe practice. Anything that genuinely reduces the burden on physical services (e.g. outpatients) should be of interest.

The inequalities and the disproportionate impact on BAME communities have been deeply wounding to the national health service. This is a failure of one of the key pillars of the NHS constitution: namely equal access to high-quality care for all.

Now is the time for the heavy baggage of the past to finally be put to one side, it’s time for greater investment in understanding the differing perspectives and drivers of all parties, and it’s time for a different discussion about the concept of value.

Treatments with fewer complications or a lower infection rate; drugs with lower service utilisation that reduce the need for physical intervention (such as outpatient follow-ups); therapies that offer equal access across all patient groups and communities – all these suddenly become more attractive; platforms that build resilience and more infrastructure into a depleted system. Indeed, the value proposition for many treatments has now fundamentally changed, and industry should be asking where else can they drive value.

We should be cautious here though – many of the partnerships and deals that were agreed between NHS and commercial sector aren’t sustainable in the longer term and it is unclear how long the commercial sector will be able to maintain these low-cost rates, or the NHS these higher-cost treatments.

This throws some risk to patient care so clearly needs to be a priority focus. What came through loud and strong from most we’ve spoken to is that now is the time for the heavy baggage of the past to finally be put to one side, it’s time for greater investment in understanding the differing perspectives and drivers of all parties, and it’s time for a different discussion about the concept of value.


Next week we will explore the role technology has played during the pandemic, the battles fought on IP and centralisation and what happens next.

If you would like to discuss the insight from our interviews further, we are offering free 60-minute video consultations to help organisations understand what this insight might mean for their business. Please contact Zoe at zoe.bedford@zpb-associates.com to book yours.