Can pharma help the NHS to change?
pharmafile | November 27, 2006 | Feature | Sales and Marketing |Â Â NHS, healthcare, industry relations, strategyÂ
If there has been one constant during the 58 years of the NHS, it has been change - continuous, relentless and sometimes confusing. But as the health service reels from perhaps its most tumultuous year ever, the need for firm and effective leadership has never been stronger.
NHS leaders are being asked to implement unprecedented change and, simultaneously, bring financial control to a system that has rarely known stability.
Coupled with this is an ageing population suffering from chronic diseases, which is placing greater demand on NHS services and has higher expectations than ever before about standards of care and involvement in decision-making. The government is determined to create a truly patient-centred NHS, unleashing seemingly irreversible reforms; but are expectations running too far ahead of the NHS's abilities to meet them?
Moreover, can NHS managers and clinicians take the lead in the process of change?
Some of those inside the service fear that its managers are at the mercy of forces beyond their control – a combination of political considerations, public expectation and a Whitehall leadership, which is unable or unwilling to demand the kind of change needed to create an organisation that is well-managed and effective.
The issues of change and leadership were tackled recently at a meeting organised jointly by Innovex and the ABPI. Speakers from both sides of the NHS/ industry fence set out the issues facing both the NHS and pharma companies, now and in the future. One thing was clear the leadership gap, exposed by a difficult year, creates some good opportunities for the industry to take the lead provided it can also embrace the kind of change faced by the NHS.
There are some salutary lessons to be learned from the past few years. No-one disputes that many NHS organisations are struggling to cope with the government's reform programme, particularly in terms of achieving financial stability. A report by the Audit Commission published in July – the Review of the NHS Financial Management and Accounting Regime – identified weaknesses in the system, with ineffective leadership blamed for much of the malaise currently blighting the health service.
As well as calling for specific improvements to the Department of Health's and strategic health authorities' management of the service, the Audit Commission stated it hoped that the changes will enable trusts to behave in a more businesslike way, increasing the capacity of individual bodies to manage their affairs and, at the same time, increase their accountability for doing so.
Speaking at the Innovex/ABPI meeting, former Deputy Chief Medical Officer Professor Aidan Halligan didn't pull his punches when it came to what is happening: "This is an historical moment. I wouldn't want to underestimate or over-dramatise it, but we are at a most remarkable, pivotal point in our health service."
Although industry currently faces confusion over exactly who are the customers – the healthcare professionals or the patients – it recognises that it must align itself with a patient-centred NHS, and in this regard, its knowledge of the system is better than anyone's, as Professor Halligan acknowledged.
"The industry knows more about the NHS than we do ourselves, because that's where you have your business," he admitted, adding that often patients are better informed about their conditions than many senior medics, a situation which he blamed on clinicians spending too much of their time trying to meet targets.
"The NHS needs to address its culture of work and attitude. Having a strategic goal isn't enough. Good strategic leadership is needed to provide support for change and to push for a change in culture towards a greater patient focus, and a more holistic provision of healthcare.
"The issue is the way we work; it's cultural. Culture eats strategy for breakfast, every time – you cannot force people to change, they have to choose to change. You cannot force them: pay will not do it, perks will not do it. You have to inspire them from the inside out. Leadership is all about teamwork – but NHS staff haven't been trained to understand leadership and team-work."
Operating in this kind of environment, with the pace of change outstripping the markets capabilities in dealing with it, is of course, not restricted to the healthcare market. As an industry, we constantly pay lip service to the need to learn from other, more consumer-facing, sectors.
To try to address this, Innovex invited Barbara Cassani, founder and former chief executive of Go!, British Airways low-cost airline, to speak at the meeting. She drew parallels between the aviation sector 10 years ago and where the healthcare market is now.
She said: "The airline industry had undergone great change. BA's response to the emergence of low-cost flying was to look at how to justify higher prices, and to allow the silo thinking to continue. Nobody talked about the profitability within offering lower prices." Ring any bells?
"I've learned over the past decade that you have to take risks," she continued. "You have to do radical things, if you really want to do things differently to make change happen. There's a learning that has to go on. In a new business, it's a life or death issue; in a big company, it's still life or death, but it just doesn't feel like it.
"So, if you can create that life or death quality of taking risks and making decisions, you can get a lot further in a big company and I think those are the big companies that will survive and prosper through the changes that are inevitable, particularly in the pharmaceutical industry."
One lesson, which Ms Cassani said could be carried over to the healthcare market, was Go!'s commitment to team working at every level of the business. Recruitment to customer-facing roles was based on employees' personalities as well as their skills. As a result, staff turnover was low and relationships good between colleagues, who had the same values and respected each other.
"Once the idea of team working at every level has been accepted – and pilots can be as arrogant as doctors – it's an amazing energy that can be created."
So, if huge change is creating a leadership vacuum in the NHS, how can the pharma industry harness these kinds of lessons and put them to work to improve patient care – not to mention its own commercial imperatives? Surely, it can do nothing until the problems of the NHS become resolved and a new way of working emerges?
Not so. The industry needn't be a spectator, powerless to influence, or even lead change. Instead, it has to be proactive in forging new relationships and ways of working. The industry needs to work directly with the NHS to embrace its problems and issues. In short, it should be taking the leadership initiative.
The NHS has thrown open its doors to challenge the industry to work closer with it as it attempts to find strong and effective leadership to carry forward the programme of change. Now is the time for pharma to be brave enough to step forward and embrace these changes – and these opportunities.
As Professor Halligan says, this may involve a gamble – but no business ever succeeded without taking a few risks. He said: "Take a really big punt and subscribe to leadership development. If one of you took a punt and actually thought about how you could make NHS staff feel better about their own professional development, you would improve the health of the people in this country."
Getting more closely involved is essential, says Alison Clough of Innovex UK, who summed up the meeting. "Change is inevitable. The issue now for the pharmaceutical industry is how to handle that change. It is not possible to sell effectively to our customers unless we are wholly entwined with them. The only way to know how a hospital or PCT works is to engage with it – our customers.
"We need to challenge everything. We need to actually go to where the problems are, learn from mistakes and be brave enough to change. Change presents threat and opportunity in equal measures, but change must be embraced.
"Following a radical set of PCT mergers, November will see the appointment of a new set of PCT executives. However, reports suggest that by the beginning of September, up to one third of PCTs had still to receive their new appointments. The need for decisive leadership within the NHS is obvious."
Alison went on to say: "We are either led by [change] or we take the lead. In an NHS which is crying out for strong leadership, it's just possible that the industry can provide exactly that, for the benefit of everyone the NHS itself, our own industry and, most importantly in a patient-focused system, the health of the nation."
Jane Mackenzie-Lawrie is associate marketing director at Innovex UK
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