Delivering the Five Year Forward View: the role of public-private partnerships: part 1

12 July 2016

One of the best things about working as a leader of the institutions of the NHS is being so loved by the public that pay for you and that you serve. The meaning you gain from this relationship is bigger than any other institution in our country and if you are the NHS you feel a strong relevance to peoples’ lives every day.

The downside is that if you are that loved, that important and that big, you get to think you make the weather, and the whole country, politics, other institutions and patients revolve around you. If you lead an NHS institution you are very likely to have worked in the NHS all your life; you will spend a lot of time with other NHS leaders in a world of weird organisations, even weirder acronyms and being at the centre of the universe.

Such a mentality doesn’t automatically make you a great partner. You tend not to notice much else going on in our society because so much of it is looking at you.

In the 1990s I worked in London local government (abolished twice at the GLC and ILEA). Local borough chief officers heard that the three things their constituents really worried about were, in various orders, crime, health and jobs. When you tried to do something for your constituents about these three crucial areas of their lives you quickly realised that your local authority wasn’t in charge of any of them.

Then, if you had any sense, you went in search of those organisations that were in charge of them. After a short interlude when you went around saying that because you were elected you should be in charge of all three and why wouldn’t someone pass a law making it so, you got down to the difficult world of partnering.

Given you had no direct power you had to develop the skills of gaining influence. You had to understand the language and the culture of very, very different worlds of police employers and NHS and you quickly found out that if you didn’t, you didn’t get much done. Often you had to be a supplicant – but over time it paid off. The police recognised that it was only with you that they could create safety on the streets. The employers recognised that your influence over physical infrastructure and labour would change the terms of trade for their business and the NHS – well even the NHS felt you could might know something about the health of the local people. Most senior local government officers became good at partnering because, if they wanted to be relevant, they had to.

Being loved, central and important – as the NHS is – teaches a different attitude.

It’s been hard to learn that the third sector has more power over how patients with long-term conditions can better manage their conditions than the NHS. Those parts of the NHS that want to succeed now recognise that they need to influence how the third sector works.

It’s been hard to learn that hospital discharge is only marginally to do with hospitals. Going home safely is much better managed by social care, relatives and local community than the NHS can ever manage itself. Those parts of the NHS that want to succeed now recognise that they need to influence social care for this to work.

It’s been hard to learn that the only really interesting aspects of new technology that are changing our lives has been created by young people from the private sector. Every day we leave the technology impoverished NHS and go home to a life of wonder where the technology in our home opens up lovely life possibilities. Those parts of the NHS that want to succeed now recognise that they need to influence new technology companies for this to work.

Every now and again the NHS has a spasm of wanting to own and run its own voluntary sector social care and new technology. It reverts to the old idea that it’s so important it needs to own run everything. Within a day it rebounds from this when it realises it has no skills in these areas whatsoever.

But slowly the reality is growing that if an NHS leader wants patients to manage their long term conditions in a better way; if it wants to work with social care and if it really wants new technology to transform its services there isn’t a single chance it can do this on its own. If will have to give up some of the illusion of power for the reality of influence that partnership brings. Hard but absolutely necessary skills are emerging.

Professor Paul Corrigan CBE, Adjunct Professor of Health Policy, Imperial College London and former Senior Health Policy Adviser to Tony Blair



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