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Influencing the Influencers
(Published 21 January 2005)

Though 2005, the industry NHS customer base can be expected to continue to broaden. Here Alan Jones begins an occasional look-see at some of the UK's key Influencing Centres.

As we come to the end of 2004 and start to move into 2005, companies continue to work out the best ways of dealing with PCTs, SHAs and Health Boards in the never ending story of healthcare reform musical chairs. But in any serious attempt at trying to proactively managing the external environment there are many other 'national influencing centres' to be borne in mind. Companies will of course be prioritising NICE, the Scottish Medicines Consortium and the All-Wales Medicines Strategy Group and will have put resources aside for this next year. But there are many many more! So how do we know which of these other National Influencing Centres we should be deploying resources on? Are their measures one can use to gauge their importance and significance? Should we be 'mapping' out all these other various groups and whether we should interact with them or not? Some very good questions perhaps to ponder through 2005. In this series we will be attempting to map out some of these for you and this month we begin with the NHS Confederation.

The NHS Confederation represents 93% of all NHS organisations across the UK. The organisation has gone through various iterations over the last decade or so and from October became the employer's organisation for the NHS. It is a hotbed of health policy development and encourages active health policy debate amongst its members. One of the best ways of seeing the NHS Confederation in action is to attend its annual conference and exhibition. This year's meeting was held at the Birmingham ICC (my favorite venue) and as always it was a cracking meeting, bursting at the seams with the highest number of delegates ever - so much so that the exhibition had to be moved to the National Indoor Arena, miles and miles away….. I do think that this is the best NHS meeting of the year to go to, either as a delegate and/or exhibitor, but one has to 'work' it very hard with often lots of late-light schmoozing….. In the crammed full programme, there was stuff to interest everybody with sell-out sessions on Foundation Trusts, Payment by Results, Chronic Disease Management, PCT commissioning, Patient Choice, Public Health, the Healthcare Commission, nGMS, the new pharmacist's contract and so on and so on. Everybody who is anybody was there so a great place for networking through the day too! The meeting is also extremely useful to see what other companies are up to and Pfizer had a particularly fascinating stand under a Access 2 Medicines banner and run jointly with the Centre for Healthy Ageing and the Patients Association. And a particular highlight was Dr Gill Morgan, Confed Chief Executive, making lots of jokes about her having just been made a Dame……

For those not able to get to the conference, some of the key healthcare themes going forward are covered in a series of useful documents, launched by the Confederation at their conference. It is worth briefly outlining some of these:

~ Meeting the challenge. This about PCTs and the different integrated management models now appearing, from partial integration to almost full integration. Derby, Peterborough and West Wiltshire PCTs are given as case studies. The document also picks up on commissioning developments and PCT consortia.

~ Making a difference. This about how PCTs are 'transforming' the NHS. South Cambridgeshire, North Bradford, Northumberland, Selby & York and Waltham Forest PCTs detailed. Good for local 'intelligence'…

~ Working Together. This about strengthening the relationships between PCTs and Acute Trusts and the result of some NatPaCT workshops which explored the 'often troubled relationships between the two - fraught with baggage, vagueness and stereotypes. "….neither side properly understands nor appreciates the other, there is often a degree of hostility, a failure to share, a disconnection between vision and goals, poor communication and a misunderstanding of each other's objectives and motives"….. Sound a bit familiar? Actually there is a lot of learning here that could usefully be transferred to pharmaco/NHS relationships. Companies could also try and broker better relationships between the two. A high-risk strategy but if it worked!….. A survey captured some particular comments - PCTs described acute trusts as 'bottomless pits for resources', 'often hostile', 'lacking understanding of primary care', and often led by 'insular and arrogant chief executives'….. Acute Trusts said PCTs were 'suspicious', 'unable to commission', and led by leaders 'who don't measure up'……

~ Breaking the Rules. This about in healthcare systems a lot of what is done is done because it has always been done in a certain way…. Folk assume that there are unwritten rules but they are not actually there…. The piece suggests that folk should think more about what if this 'rule' doesn't actually apply and then attempt to 'break' the rule. For instance, these unwritten rules seem to suggest that patients should have face-to-face encounters in healthcare facilities but now we have telephone triage/consultations and NHS Direct. Also ambulances as mobile hospitals rather than taxis and what about PCTs managing some hospital wards? The publication usefully plots the new rules of the game and perhaps companies could 'challenge' the NHS here too, particularly with CDM now in the melting pot.

~ Fast forward: setting a manifesto for health. Early ideas from the NHS Confederation on what health issues should be in the political party manifestos next year, then out for consultation. The Confederation's full manifesto proposals were launched at the party conferences this autumn.

And in the NHS Confederation's forward influencing programme for 2005, a useful little booklet highlights 5 key priorities. These are

  • PCTs and the new system. This about the challenges facing PCTs and the health policy implementation jigsaw they face.
  • Medicine & Management. This about doctor-manager relationships and joint working.
  • New models of care. This about the work that the Future Healthcare Network is doing around service redesign, the future for mental health and new approaches to managing long-term conditions.
  • Leadership, Management and governance. Self-explanatory and working with the NHS Leadership Centre.
  • New relationships with patients and the public. The patient and public involvement agenda.

If any of these areas are of particular interest - well you now know where to go!…. The booklet also says that this programme of work sits alongside the Confederation's focus on ensuring that existing policies are effectively implemented, including work on the GMS and consultant contracts, Foundation status, the national IT programme, payment by results and choice - quite a lot to go at then!

Of all the environmental factors in play in 2005, chronic disease management/long term conditions should be at the top of everyone's list within the industry because of the symmetry with commercial operations for most companies. You might like to know then that the NHS Confederation was key in getting this on the government's agenda and on that alone one would have to rank it as a key influencing body and an important organisation to forge links with. So if folk didn't know, the NHS Confederation does have a commercial associate scheme. You would have access to the member's only section of their website; get regular e-bulletins (!) and publications; have the opportunity to consult with NHS Confederation teams about aspects of their work relevant to your organisation and get involved in focus groups and specially designed forums for commercial associates in key areas like 'The NHS as a customer' and 'Future roles for the private sector in CDM'. About 90 companies are currently enrolled across a wide swathe of industries with around some 15% being pharmacos.

So it is certainly this author's belief that the NHS Confederation is an important and major National Influencing Centre (NIC). Bottom line though, such organisations are always defined by the people they employ and in any moves towards account managing such NICs these key influencers would of course come to the fore. Do folk know who these people are within the NHS Confederation? Find out more at www.nhsconfed.org. Next year's annual conference and exhibition is again in Birmingham on the 15th-17th June 2005. Have a good one…

Article first pulished in PharmaTimes January 2005

About the author

Alan Jones is an independent health policy analyst and adviser. He writes and presents widely on the New NHS. Alan spent some 20 years in the Pharmaceutical Industry in a variety of sales, marketing and business development roles including some 10 years at Glaxo Wellcome UK where he was responsible for relationship building between Glaxo Wellcome and the Department of Health, and in developing a corporate understanding of current NHS policy initiatives and their likely implications and impact on the business.

Alan is also managing consultant at ajc healthcare, which specialises in NHS policy issues for both the Pharmaceutical Industry and the NHS and aiming to support organisations in steering the right strategic course through a rapidly changing NHS environment.

Alan has a Masters in Business Administration and is a fully qualified teacher - before joining the Pharmaceutical Industry, he spent a decade teaching and lecturing in colleges, schools and universities in the UK, the United States and West Africa. He is also a reviewer with the NHS National Co-ordinating Centre for Health Technology Assessment (NCCHTA) and was a member of the UK Local Organising Committee for the International Society for Technology Assessment in Health Care (ISTAHC) held in Edinburgh in June 1999.

Click here to contact Alan Jones or call 01730 265718

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