In a time of austerity and strained budgets, it has never been more essential for the NHS to get partnerships and collaboration right. Every day, clinical teams save lives – and if the NHS is to survive and thrive, it must draw on this collective strength. Yet collaboration can be patchy among the higher echelons of the NHS, with many potential partners complaining of the health service’s seeming inability to work effectively and courteously with others.
Would the NHS be in a different place if health leaders had, over the past 20 years, facilitated collaboration in the same way they had done for competition? That was one of the questions from the floor at a seminar hosted by the Guardian and supported by business solutions and technology company Brother.
In front of an audience of invited healthcare professionals, an expert panel, chaired by the Guardian’s public services editor David Brindle, discussed and debated the gaps in healthcare provision in the UK, as well as if – and how – they could be solved by more effective partnerships. Could the health, social care and voluntary sectors work more closely together, how might this be achieved and what would it mean for patients?
Fragmentation means duplication and duplication costs money; we can’t afford that
“We too often dish out lazy cliches about different sectors and different parts of the system, whether it be the private sector describing the public sector as inefficient or the public sector [describing the private sector] as ethically questionable,” said David Hare, chief executive of NHS Partners Network, which represents independent sector providers of NHS clinical services. “For the patients, some of those divides are false. Even within the NHS we’ve had divides between primary care and secondary care, physical health and mental health. The future has to look at how to integrate and bring all that together for the service user. If you have that fragmentation, you have an element of duplication; duplication costs money and we can’t afford that in the current climate. We have to work our way through this.”
Integration, or joined-up working, has long been the buzzword of choice among professionals in both health and social care. But years of talking have brought few benefits for the social care and voluntary sectors, which continue to be the “poor relations” of the NHS, according to Grainne Siggins, policy lead at the Association of Directors of Adult Social Services (Adass) and director of adult social services for the London borough of Newham. “There are different cultures across health and care and we shouldn’t underestimate the impact of that in terms of trying to work collaboratively and as partners across a whole system,” she said. Asked if the picture was improving, she replied that it wasn’t, adding: “You’ve only got to look at the approach to sustainability and transformation plans [five-year plans for the future of health and care services in local areas] to see that equality wasn’t important in that partnership.”
There are chinks of light in the gloom, however – areas where improved collaboration is beginning to happen. Take Manchester, where powers and responsibilities for health and social care, among others, have been devolved from national government. John Patterson, a GP and clinical director of of Hope Citadel Healthcare, says people now understand that wellbeing is about a range of factors, including health, housing, friends and diet and that healthcare and social care must reflect that. “A housing officer with 30 years of experience can’t be replaced by an app,” he said. “We need to find out how to get that experience and compassion into the health system. How do we get the experience of a community matron into the social care system? The thing I love most about Manchester is that here we’re trying to do that with and through people.”
Another positive associated with “Devo Manc”, he added, is that people are brave enough to try new things. “We were one of the first organisations in the country to get double-badged workers. We had a care navigator that had a council badge and an NHS badge – somebody who would walk between worlds, find the sickest people and help them the most.”
It’s not so much an austerity issue as about doing the right thing for people
Anu Singh, director of patient and public participation at NHS England, pointed out that the challenge she faces is that people see partnerships as an accounting trick or something that is about saving money. Instead, she said, people needed to realise that traditional models of healthcare hadn’t worked and hadn’t met the needs in the community. “We’re trying to work differently with localities because we know that if we don’t get housing right – if we don’t have people helping with social isolation – this will add to the pressure on care and things will continue to spiral out of control,” she said. “It’s not so much an austerity issue as about doing the right thing for people.”
She recalled how one GP had told her that when a patient came to him in the past with mental health problems, they would prescribe prozac; now, they can help that patient get a job. She believes this example highlights how the NHS can work differently and more effectively. “As always with health, you have innovators and policy people trying to pull strings in different directions,” she said. “People know we’ve not quite got it right so far – I don’t think all the parts have come together before – but the time is now.”
This was a point that Dr Mahiben Maruthappu, a London-based doctor and social entrepreneur, agreed with. He said that the challenges were social, demographic and economic – and that the frontline and national decision-making bodies were not aligned. “I think the vision in the Five Year Forward View still stands – we need a radical upgrade in prevention, better integration of services, and to overcome fractures between primary and secondary services.”
He also explained how technology could save cash while enforcing a better quality of service by being “an enabler” of healthcare that can support doctors, nurses and patients. “We always ask how the health and care system can be more sustainable – if we allow patients to identify and manage their conditions better, that’s going to relieve a tremendous amount of pressure.”
The panellists agreed that the patient or service user must be at the centre of all decisions and Singh admitted that patients could get “pushed around clinical pathways” in the current system. “If the health service is going to be more sustainable, we need to shift that paradigm,” she said.
A question from an audience member about whether there was too much focus on external partnerships and not enough on bringing a “highly disillusioned” workforce into decisions then prompted the panel to discuss healthcare staff.
Singh said she learned the difference between how those on the frontline and policymakers think when she was trying to introduce a scheme to help clinicians empower patients: “What seemed obvious to the policymakers seemed alien to a lot of the clinicians we were talking to.” Talking initially to those involved in care, to see if they had a solution, is key, she said.
Maruthappu, a doctor himself, pointed out that clinicians work in partnership every day – in multidisciplinary teams made up of doctors, nurses, occupational therapists, physiotherapists and more. He suggested that the model be amplified and replicated higher up.
Siggins, meanwhile, highlighted the importance of getting clinicians involved in social care. Now that local authorities have taken over responsibility for commissioning a range of public health services, GPs need to be involved in conversations, she said: “It’s our job to support GPs so we can support people coming into the system.”
All panellists recognised that the current work climate is a difficult one for everyone – but will this strain drive people working in the health, social and voluntary sectors apart? Hare acknowledged the danger, but pointed out that this has only made collaboration more necessary. “We’ve got no alternative. We’re going to have to do things differently. There isn’t going to be a magic pot of money.”
Maruthappu agreed: “Healthcare is a team sport and we need to embrace that far better than we do at the moment.”
At the table
- David Brindle (chair), public services editor, the Guardian
- Dr Mahiben Maruthappu, co-founder, NHS Innovation Accelerator
- Anu Singh, director of patient and public voice and insight, NHS England
- David Hare, chief executive, NHS Partners Network
- Grainne Siggins, policy lead, Adass, and director of adult social services, London borough of Newham
- Dr John Patterson, co-founder, Focused Care scheme
Bridging the divide: how can the NHS get collaboration right?
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