Public and Private in Partnership

The first quarter of 2016-2017 saw 54,000 more A&E attendances a month in the UK compared to the previous year.

It’s no secret that the UK’s National Health Service has limited resources to provide medical services to the vast majority of the population. This constantly increasing demand from an aging and growing population puts added pressure on the NHS to offer low-cost high-quality services.

One potential answer to this call is greater partnership between the NHS and private and voluntary sectors. By including more skilled physicians and experts, a broader knowledge base, and a greater capacity for clinical care, public health services can reach beyond their current abilities and create a strategy for the benefit of the entire population.

Bridging the gap

The terms “public” and “private” in relation to healthcare systems are not always cut and dry. In general, public healthcare relies on government involvement, while private healthcare refers to involvement by businesses, not-for-profit organisations, and even individual benefactors. In reality the two sectors are often closely related.

Many NHS hospitals rely on private trusts and charitable organisations to provide additional funding for facilities and training. While this provision is monitored by the government, it comes down to volunteers or privately employed individuals to promote and fundraise.

On the other hand, the US healthcare system depends on a combination of privately owned (21%), government-owned (21%) and non-profit owned (58%) facilities, with significant government subsidisation of otherwise predominantly private services.

When it comes to public healthcare systems’ ultimate goal of achieving universal healthcare (UHC), it’s important to fill the gaps in underdeveloped or under-resourced systems with any available private assistance.

In many cases, however, private providers can have a negative impact on their healthcare ecosystems. Their necessary focus on profit and individual business goals risk drawing skilled workers away from the public sector, creating a socio-economic gap, and undermining the case for UHC.

Any partnership between government-funded healthcare systems and private providers needs to be carefully orchestrated, taking into account the different needs of both sectors.

Potential for partnership

Instead of viewing public and private healthcare systems’ differing needs as a challenge, we can start to imagine collaboration as a win-win scenario. Private sector providers are primarily interested in a high client load, leading to increased profits, while the public sector has a responsibility toward patient outcomes.

A combination of these concerns will lead to better regulation across the board, with chances for private practitioners to engage in a universal standard of training, and for better control over cost and quality of medicines. This will benefit the public sector by improving public health across the board, while private providers will benefit from increased trust and enhanced status, which can translate into greater sales opportunities.

Responding to change

It is important to note that the NHS - as are all public healthcare initiatives - is in a period of flux and disruption. The challenges facing healthcare and the solutions being offered are constantly changing - in no small part due to the technological advances of private companies and researchers.

Big data and predictive analytics allow for a deeper understanding of individuals while allowing us to plan ahead for the entire population. Privately funded research into genomics is changing the way we diagnose and treat illnesses. Mobile and wearable devices are giving patients more control over their own health, and allowing researchers to understand the relationships between lifestyle and health to an unprecedented level.

In many ways, the NHS is already changing in line with the developments of the private sector. These changes are only due to accelerate over time. In order for public health providers to meet patients’ increasing expectations, they need to facilitate closer collaboration.

Existing technological initiatives such as AbbieVie’s Live:Lab are already yielding positive results, reducing the strain on the NHS by reaching out to people who are unlikely to engage with public health information, and encouraging them to take a preventative stance toward their own health. This will free up vital NHS resources, allowing for a more hospitable and patient-centric approach.

Finding common ground

One thing that public and private healthcare do have in common, however, is a reliance on the trust of their patients. In the opinion of Dr Paul Hodgkin, founder of patient review portal Care Opinion, the NHS is too inward-looking, and stand to learn from the experiences of private providers and their patients.

He cites Brazil’s burgeoning state-provided care system, which has collaborated with private and volunteer organisations to boost antenatal care and immunisation rates to near 100% over the past 10 years, causing infant mortality rates to plummet.

Indeed, in many cases the NHS is already collaborating closely with private carers to meet patient expectations, including paying for patients to be treated at some of BMI healthcare’s 69 private hospitals via the Choose and Book system. This is an important step toward achieving a standard level of care across both sectors, ensuring that patients who are unable to afford private care are still confident in the quality of service they will receive.

While many patients have a preconception of private healthcare as more efficient, accountable or effective than public provision, studies into healthcare performance in low-to-middle income countries suggest that this is rarely the case. In fact, private healthcare tends only to outrank public healthcare insofar as the latter lacks time and resources, which can lead to patients feeling rushed through the system without adequate hospitality.

By working alongside private practitioners to ease the burden, and learning from their experiences of providing efficient, patient-centric healthcare, government-owned systems stand to change these perceptions.

Encouraging collaboration

In summer 2016, the Cancer Vanguard medicines optimisation team created an opportunity for the pharma and life sciences industries to identify ways in which they could effectively and innovatively partner with the NHS.

Challenges covered by the project included efficient use of NHS resources, patient-centric understanding, and optimisation of medicines, with the ultimate goal of achieving world-class outcomes for cancer patients in the UK.

The partnership used powerful data analysis to benchmark current public and private provision for cancer patients, and visualise a roadmap going forward. The pharmaceutical companies involved were required to meet the full costs of their proposals themselves, demonstrating both ROI and wider benefit to the NHS.

40 proposals were received, with input from the Association of British Pharmaceutical Industries and the Ethical Medicines Industry Group. Four companies were selected to move forward with their projects, and a joint working agreement was established, ensuring that industry-leading companies interact amongst themselves and with the NHS to achieve mutually beneficial outcomes.

This one-off challenge is an example of how collaborative work between sectors can be leveraged to benefit both public and private healthcare providers, opening the way for dialogue and combining specialist knowledge to enhance patient experiences and improve quality of life. 

A call for conversation

In a survey of over 280 UK healthcare industry leaders, 99% of NHS leaders and 98% of private and third sector leaders expressed a belief that collaboration between sectors would be beneficial.

The potential benefits of such a collaboration are vast, but fall into three general categories: meeting demand for frontline services, meeting patient expectations and improving the patient experience, and keeping ahead of the game by harnessing technological advances.

In order to support and explore these benefits, we need to encourage interaction between key players across the industry, from physicians and care providers to insurers and consultants, so that a cohesive, clear and accessible system can be agreed upon.

Do you believe public and private practitioners can work together to achieve universal healthcare? Join the debate on LinkedIn.