At the roundtable discussion there was general agreement that there are both ‘hard’ and ‘soft’ barriers to effective cross-sector collaboration in England. Tackling the ‘soft’ barriers was agreed as being particularly critical to making progress.
Capacity: The system is geared towards dealing with the here and now rather than exploring future models.
Incentivisation: Life sciences are not seen as part of the ‘core mission’ and can in fact be perceived as being in competition with health policy.
Resource: Collaboration requires sustained resource from both parties, which is often overlooked or underestimated when setting up joint initiatives. This is particularly a problem when the driver for establishing the initiative in the first place is lack of resource within the NHS.
Ability to scale: This is a perennial challenge in the NHS, and not just for cross-sector partnerships. One participant at the roundtable argued that the speed of uptake at scale in the UK is slow when compared with other countries such as China, Brazil and the US. This affects decisions about where companies will place resource for large-scale partnerships. There is a plethora of successful local projects, but few go on to have national impact for a range of reasons – ‘not invented here’ syndrome, lack of awareness of what has already been done elsewhere, lack of incentives in the system to encourage leaders to ‘steal with pride’.
Lack of clarity about the problem we’re trying to solve: In establishing cross-sector initiatives, there can be a focus on solving for a pressing ‘symptom’– such as lack of resource or expertise – rather than a focus on improving the health and wellbeing of the patient population. It was agreed that projects where industry resource is being brought in to compensate for an internal NHS resource deficit are rarely sustainable.
Trust: For a variety of reasons, the levels of trust between industry and the NHS were perceived to be variable. Some views are ideological and based on concern that involvement of the private sector will erode the fundamental principles which underpin the NHS. There is also a view among some in the service that organisations which are driven by profit have a different ethos, and that the profit motive may take precedence over patient interest. Other factors impacting trust include ‘guilt by association’ – single examples of poor practice by a single company are often extrapolated into a generalised mistrust of industry. At the same time, patients do not always recognise the value of industry even though it may be responsible for innovations they depend on such as MRIs, pacemakers and statins.
(Mis)perceptions:These included the belief that there is only interest from industry in collaborating to establish proof of concept for novel therapies, rather than using real-world data to bring innovation to everyday services. Participants also reflected that there is generally an assumption that industry is not interested in prevention, whereas industry representatives pointed out that primary and secondary prevention are key drivers for life sciences innovation.
Leadership and culture: There was agreement that successful collaboration is built on an understanding from the outset that both sides need to benefit, and that this needs to be explicit and communicated to staff within the partnership. There were also reflections that the health service could be complex to do business with and accessing decision making was sometimes difficult.
Permission: Sometimes it was felt that cross-sector partnership needs to happen ‘under the radar’, and that NHS leaders could be reluctant to celebrate or communicate success. Some NHS organisations described being actively instructed not to deal with industry by their local leadership. There was acknowledgement that multiple forms of governance exist to support cross-sector partnerships and that these need to be more widely and positively communicated to build confidence in the process of working across sectors. Equally, there needs to be an unambiguous signal not only of permission but of encouragement from the highest levels of NHS leadership.