Partnering with purpose: how integrated care systems and industry can work better together

Foreword

The formation of integrated care systems (ICSs) a year and a half ago offers an opportunity to improve patient outcomes and address health inequalities across England. At the same time, the NHS is experiencing some of the most severe pressures it has faced in its 75-year history. ¹  From the elective backlog to growing financial pressures, there is undoubtedly a need to think about innovative ways patients can receive the care they deserve in this new model of working. 

The opportunity now exists to better embed strategic partnerships across industry, patient organisations and the NHS, creating a thriving health ecosystem that works for patients, society and the economy. We all saw the role that collective partnerships can play in delivering care during the COVID-19 pandemic, when a deep partnership allowed the NHS to carry out research at an unprecedented scale to find the world’s first effective treatment for COVID-19, dexamethasone, which was made available across every hospital on the same day it was approved. This partnership also enabled the NHS to not only deliver the first accredited COVID-19 vaccine in the world but also to roll out the vaccination programme rapidly and with high patient uptake across the country. It highlighted what could be achieved when cross-sector collaboration is at the heart of the NHS’s approach, and we have an opportunity to repeat this success now that ICSs are becoming embedded into the healthcare landscape. 

To understand how ICSs can play a role in confronting the challenges of improving the health of populations they serve through partnership working, the NHS Confederation and the Association of the British Pharmaceutical Industry (ABPI) jointly hosted a series of masterclasses for selected ICS and industry leaders between October 2022 and May 2023. These events explored how industry can support systems to develop innovation solutions and spread good practice. The publication of this report brings together the insights from this series in the form of tangible priorities to enhance the role cross-sector partnerships can play in helping to improve the health of patients and the performance of the NHS. 

We are thankful to all our colleagues who gave up their time to share their insights, expertise and perspectives as part of this masterclass series, and we look forward to building on this work to maximise the opportunities presented by partnership working to improve patient outcomes for the entire population.

Sarah Walter, Director, ICS Network, NHS Confederation

Brian Duggan, Strategic Partnership Policy Director, ABPI

Background

The passage of the Health and Care Act in April 2022 put integrated care boards (ICBs) on a statutory footing from 1 July 2022. This makes them responsible for planning and funding health and care services in the area they cover in England. ²  The Hewitt review and the accompanying government response endorsed the need to shift to a more preventative model of care, which ICSs will begin to integrate within their operating framework. ³  

Responsibility for primary pharmacy, ophthalmology and dentistry services and some specialised services have been delegated to ICBs. ⁴  These wider responsibilities enable commissioning across care pathways to go further with transformation. However, several operational and capacity-related issues impede the ability of ICSs to effectively deliver transformation, as set out in the Hewitt review. 

NHS England has confirmed that ICBs must cut their running costs by 30 per cent by 2025/26, just seven months into their existence as statutory bodies. ⁵ ,  ⁶  This is taking place at a time when the elective backlog remains stubbornly high and access to primary care continues to be impacted by the COVID-19 pandemic. ⁷  ,  ⁸  All of this contributes to poorer health outcomes in the UK compared to its peers, with the country ranking 16th and 18th respectively for preventable and treatable causes of mortality against 19 comparable countries. ⁹  

As outlined in our previous joint publication, Transforming Lives, Improving Health Outcomes: Tackling the True Cost of Variation in Uptake of Innovative Medicines, geographical and structural disparities can have a significant impact on the quality of care a patient can expect to receive. The report assessed the impact of variable uptake of National Institute for Health and Care Excellence (NICE)-approved medicines in four treatment areas – stroke prevention, kidney disease, asthma and type 2 diabetes – concluding that 1.2 million patients in these four categories alone are missing out on the treatments they are entitled to. ¹⁰  There are several reasons for this: practical barriers include a lack of capacity in the workforce to develop the pathways for medicines, and innovations can also be seen as a risk or additional burden on limited resources rather than a solution to existing challenges. 

NHS England (NHSE) has identified that a core pillar to improving healthcare across communities is through enabling ICSs to embed local partnerships. ¹¹  Indeed, cross-sector partnerships are essential in helping the NHS to overcome the many challenges local organisations currently face, bringing in additional capacity to enable systems to improve quality of care for patients and introduce much-needed expertise, skills and resources, as well as reducing the inequitable uptake of NICE-approved medicines. ¹²  

Against this backdrop, this report aims to support ICSs in strengthening collaborations and building capacity with system partners to ensure that the NHS and industry can work as partners in solving the health challenges we face as a nation. 

It is based on a series of masterclasses which brought together senior industry leaders and system leaders, including ICB chairs, chief executives, directors of innovation, chief pharmacists, chief medical officers and directors of medicine optimisation. In total, 13 ICSs were represented, and 80 system and industry leaders attended.

Table 1: Masterclass series guide

Priority areas

Four priority areas emerged from the masterclass series which can support partnership working to improve patient outcomes, make more efficient use of NHS resources and deliver economic growth. These will inform the NHS Confederation and ABPI collaboration in supporting system partners:

Masterclass 1: Becoming an anchor institution?

“NHS, industry and wider partnerships have enormous potential in taking forward collaborative anchor approaches for the benefit of local communities. It is vital to recognise the value of bringing together diverse groups of leaders to explore these opportunities and develop shared resources.” Dr Dominique Allwood, Chief Medical Officer and Health Innovation Network Deputy, UCLPartners

Masterclass summary

The first masterclass assessed how ICSs can stimulate partnerships across sectors to improve the health and wealth of their populations and reduce health inequalities. In particular, the conversation focused on the economic potential of the NHS and how an ICS can successfully engage and support a growing local economy through innovative partnership and alliance building. 

In November 2020, NHS England published Integrating Care: Next Steps to Building Strong and Effective Integrated Care Systems Across England. ¹³  This signalled a new direction of travel for health and care policy and described a core purpose of an ICS as helping the NHS support broader social and economic development in local communities. This principle is particularly important given the wider impact of the pandemic and the inextricable relationship between health outcomes and socio-economic factors. 

To develop this approach more coherently, greater emphasis is being placed on the NHS becoming an anchor institution. This will ensure that the NHS can have an even greater impact on the wider factors that ensure populations remain healthy, such as partnership working to deliver economic growth and social benefits. The NHS Confederation published Unlocking the NHS’s Social and Economic Potential: Creating a Productive System. This looked at how ICSs can deliver on this purpose and reflects the next phase of the anchor journey – moving from an institutional view of what one can do to a system view of what we can change.

What is an anchor institution?

An anchor institution is one that, alongside its main function, plays a significant and recognised role in a locality by making a strategic contribution to the local economy. ¹⁴  ‘Anchors’ tend to be large, rooted in the place and have a strong social ethos. They traditionally include councils, universities, colleges, voluntary and community sector organisations, sports clubs and, of course, the NHS. Many private sector organisations and businesses now also see themselves as anchors and have expressed an interest in developing strategies that can support the development of their place. ¹⁵

NHS organisations are renowned as important local anchor institutions given their size, workforce, procurement budget, environmental impact and general economic, social and civic influencing power. They also operate in every part of the country, meaning the NHS voice matters in a rural, urban and metropolitan economies. ¹⁶  

Early challenges for ICSs are to understand this inherent value to the local economy, link together institutional approaches to become more of an anchor system and understand how best to collectively deliver, particularly when addressing their fourth purpose – supporting broader economic and social development. 

Early anchor system work has focused on areas where ICSs believe they can make a difference to local strategic economic and social development. This has included the areas of: workforce, skills and employment; social value and procurement; estates; research, development and innovation; and areas linked with prevention. These priority areas represent a good starting point for discussions about what an ICS-industry partnership could target and deliver.

Key insights

• There is a strong ambition to harness the value of anchor approaches across the NHS, industry, academia and other partners to help ICSs achieve their aims for the benefit of local communities. The UK is facing challenging economic conditions, which highlights the importance of anchors’ strategic contribution to the local economy.
• The NHS does not necessarily need to operate as the lead organisation on this agenda. ICSs have valuable convening power and opportunity to learn from and partner with local industry, local enterprise partnerships, higher and further education organisations, local government, large employers and other bodies. It is important to recognise that economic development efforts are taking place and the NHS can join longstanding conversations. 
• Partners need to continually reflect and act on how anchor approaches are made real to people and are understandable in relation to tangible impact for local communities. 
• A successful anchor approach is one that runs throughout collaborative activity and is a contribution to solutions, not a standalone workstream. 
• Industry partners offer a range of potential resources and expertise relevant to NHS system ambitions. 
• The NHS Confederation has an ongoing programme of ‘health economic partnerships’ and is supporting ICSs to develop and implement anchor approaches and impactful industry partnerships.

Case studies

The five case studies below exemplify the impact that partnership working can have on reducing health inequalities and generating health and wealth for their populations:

Masterclass 2: Innovation – burden or benefit?

“If we can apply the learnings of the masterclass series and create more collaborations between industry and the NHS, then together will have a golden opportunity to improve the performance of the healthcare system and better support patients. Industry stands ready to work hand in hand with the NHS to achieve its goals.” Marie-Andrée Gamache, Country President, Novartis UK and Ireland

Masterclass summary

The second masterclass offered a space for system leaders to explore case studies, identify opportunities and share what is working well and where the greatest challenges lie in fulfilling their missions. This session explored how ICSs can stimulate partnerships across sectors to access innovation and resources to help achieve system ambitions. In particular, the focus was on the potential for collaborating with biomedical innovators. 

Three local examples were presented by NHS and industry leaders for discussion, with each of the cross-sector partnerships taking a ‘triple-win approach’ – benefiting patients, healthcare organisations including the NHS and pharmaceutical companies. In the context of the UK’s recovery from the elective backlog and the broader challenges facing healthcare organisations, these are more important than ever. Provided below are examples of the potential benefits that can be delivered through partnership working.

Table 2: The benefits of partnership work – ‘the triple win’

Examples of the potential benefits that cross-sector working can achieve.

Key insights

• There are opportunities for innovative support from industry in areas such as leadership development, change management and supporting new working arrangements for teams across health and care. Alongside clinical and care pathway knowledge, industry partners offer a range of practical resources and expertise relevant to NHS system ambitions, including project management, stakeholder involvement and multidisciplinary team mobilisation. 
• The lack of clarity in terms of the ‘point of entry’ for building system partnerships was expressed by both ICS leaders and industry partners. These practical barriers need to be identified and overcome for the benefits of innovation to be accessed more effectively. 
• There is a strong ambition to harness the value of innovative approaches across the NHS, industry, academia and other partners to help ICSs achieve their aims for the benefit of local communities. 
• Partners need to continually reflect and act on how innovation is made real to people and how partnership support from industry can be aligned to system ambitions.
• In the context of system working, there is a potential perception that pharmaceutical industry and life sciences companies are only relevant to NHS partners. This can act as a barrier to collaboration, where some partners are not aware of the value of life sciences organisations in areas such as secondary prevention and reducing health inequalities.

Case studies

Masterclass 3: The missing million – tackling health inequality

“ICSs have great potential to support collaboration and partnership working with industry to deliver improvements in clinical care for patients. This masterclass series also brings home the importance of cross-sector partnerships to help the NHS deliver on its overarching priorities and improve health outcomes across communities.” Todd Manning, VP and General Manager, AbbVie UK

Masterclass summary

Masterclass 3 focused on implementing the 13 recommendations drawn from the report Transforming Lives, Improving Health Outcomes: Tackling the True Cost of Variation in Uptake of Innovative Medicines. The report builds on analysis by PwC which estimates that the UK economy would achieve £17.9 billion in additional productivity gains through the increased uptake of NICE-approved treatments. ¹⁹  

Participants from the masterclass cited the significant benefits that could be achieved if the report’s recommendations were implemented. They highlighted the transformative role that innovative medicines can have on individual patient lives, as well as the significant benefits brought to the economy and society through greater patient, NHS and carer productivity. Participants stressed that for the NHS and the wider health and care system to survive and thrive for the benefit of its users, innovation at every stage and in every aspect is not only desirable but necessary. 

A number of industry and NHS partnerships demonstrating the impact of collaboration across the health system were shared. It was clear that while success can occur when partnerships are able to thrive, such achievements often occur only at a local level and not all patients are able to benefit. National scaling of successful local initiatives remains a challenge, even when best practice is demonstrated, and patient outcomes are improved. Failure to spread success across the NHS exacerbates health inequalities, and it is essential that HINs, ICS leaders and industry share learning more effectively across localities, regions and UK nations to address these issues.

Key insights

• Adoption of innovation is challenged by the fact that NHS leaders face ongoing operational pressures. 
• Strategic partnerships between the NHS, patient organisations and industry are essential to create a thriving health and life sciences ecosystem. 
• Opportunities for impactful partnerships include tackling the slower and inequitable uptake of innovative medicines which contributes to poorer health outcomes for the UK, including for those populations currently disproportionately impacted by disease. 
• Core20PLUS5 is a helpful example of a national approach designed to support ICSs to drive targeted action in healthcare inequalities improvement. 
• Innovation for Healthcare Inequalities Programme is another positive example of a programme that addresses local health inequalities by supporting systems to improve access to innovations. 
• Many conversations on this topic concentrate on secondary care. It is vital to shift mindsets to allow the creation of pathways that ensure specialist drugs are available to patients at the most appropriate point on the pathway, acknowledging that this may vary from person to person. 
• System value propositions are essential to effectively implement innovative medicines. Real-world evaluation frameworks are required from the offset and can help with predictive health models to demonstrate value. 
• Upskilling primary care pathways could help to grow primary care clinicians’ confidence and competence in prescribing directly.

Case studies

Masterclass 4: A new public-private partnership?

“In order to achieve the greatest positive impact across the health and care ecosystem, partners need to align capabilities, capacity and culture from across NHS, industry, academia and elsewhere. Support from NHS Confederation and ABPI is helpful in strengthening these connections and guiding implementation.” Arjun Sikand, Director of Innovation, NHS Surrey Heartlands Integrated Care System

Masterclass summary

Masterclass 4 focused on the key impacts that partnership working can have, as well as the barriers and core principles required for a successful partnership.

Impact of partnership working

Better patient outcomes: Participants were clear that partnership working has the potential to change the lives of millions of individuals and families across the nation. As evidenced by the case studies featured from page 20, partnerships can support delivery of NHS priorities and enable the ‘triple win’ of improved patient outcomes, more efficient use of NHS resources and evidence of impact for industry and have the potential of being replicated and scaled across the NHS. 

Reducing operational pressures: Participants highlighted that partnerships could play a critical role in reducing operational pressures, such as primary care access and urgent and emergency care, at a time when there are significant constraints on the NHSE’s finances and workforce. 

Supporting preventative care: Cross-sector collaborations can support health services towards moving resources upstream on the care pathway towards prevention, particularly in the form of secondary preventions, which can ensure patients remain healthier for longer. Indeed, the use of earlier interventions will pay dividends for the NHS by reducing repeat usage of the services, freeing up resources and allowing greater scope to reduce the elective backlog.

Barriers to partnership working

Participants also highlighted areas where inhibitors to partnership working can exist: 

Lack of shared understanding of process and assurance: An understandable variance in system and industry governance structures and lack of understanding around how joint collaborations can be established between different systems and companies can confuse potential stakeholders and act as a barrier to effective partnership working. While flexibility to adapt to local circumstances is key for ICSs, systems and partners will benefit from clarifying and communicating strategic priorities and decision-making processes, in order to identify potential alignment and making engagement collaboration easier to commence and facilitate. 

Cultural barriers: Participants highlighted that there can be a degree of mistrust and anxiety towards working with industry, which, coupled with scepticism towards industry motives, can discourage innovation and new practices. 

Challenge of upscaling: While excellent examples of partnership working exist, there is a lack of concerted effort to systematically scale these successes.

Core principles enabling effective partnership working

The masterclass cohort also considered key principles that need to underpin a successful partnership: 

Clear frameworks and agreements: To ensure that cross-sector collaborations can operate in a smooth and efficient manner, clear joint frameworks for partnership working must be established. These must consider clear contracting and data-sharing agreements that also allow for other stakeholders from across the life sciences ecosystem to support fulfilment, such as HINs and patient organisations. 

A shared vision: A shared vision is critical to reduce cultural barriers between the NHS and industry. This can be achieved by articulating a common set of values and collective purpose from the outset of a partnership and ensuring these are backed up by transparent and accountable project management mechanisms. As part of this, joint working agreements should effectively address process and evaluate overall outcomes. To ensure understanding of what is possible within cross-sector partnerships, it is also important for ICS leaders to enhance their understanding of the ABPI Code of Practice. This can be facilitated through training sessions offered by the Prescription Medicines Code of Practice Authority (PMCPA) or other providers. 

Sustaining partnerships: Participants also made it clear that partnerships must take a sustainable approach, with future commissioning built in to help ensure that successful projects can eventually be scaled and adopted across systems.

Key insights

• The topic of innovation is a crucial one for the NHS and the wider health and care system. However, leaders face the ongoing pressure of meeting high demand with insufficient capacity while simultaneously trying to reimagine services transformed by a new focus on population health, partnership working and innovation. 
• Public-private partnerships in healthcare offer various opportunities and face certain obstacles. These partnerships, when done well, can drive innovation, improve service delivery, expand infrastructure and enhance the wellbeing of individuals and communities.
• It is crucial to establish transparent governance frameworks, clear accountability mechanisms and equitable distribution of benefits to ensure the success and sustainability of these collaborations. This may also require joint efforts to strengthen trust and nurture a pro-innovation culture across the NHS and industry.
• ICSs present a real opportunity to drive accountability and uptake of new and innovative treatments and technologies – and consequently to reduce health inequalities and support broader social and economic development. 
• The NHS Confederation and the ABPI want to support NHS teams to think long term, with improved awareness of available innovations, greater collaboration with relevant partners, more effective risk taking and, ultimately, improved uptake of innovations that boost patient outcomes and increase productivity. 
• Whether through capacity building and knowledge exchange, service delivery innovation, research and development or financing and investment, there are numerous opportunities to leverage the strengths of both sectors in the interest of local communities. 
• With the completion of the final masterclass, it was clear that there was a strong appetite for partnership working, particularly if clear guardrails and assurance can be put in place to ensure alignment with strategic priorities and joint expectations of way of working.

Case studies

Further reading

• Transforming Lives, Improving Health Outcomes: Tackling the True Cost of Variation In Uptake Of Innovative Medicines 
• NHS-industry partnership case studies library 
• Working Together - A Guide for The NHS, Healthcare Organisations and Pharmaceutical Companies 
• Transforming Lives, Raising Productivity 
• Scaling Innovation Within Healthcare Systems: Practical Considerations 
• The State of Integrated Care Systems 2022/23: Riding The Storm 
• How does the NHS compare to the health care systems of other countries? 
• From Delegation To Integration: Lessons From Early Delegation Of Primary Pharmacy, Optometry And Dentistry Commissioning To Integrated Care Boards