Monitor, the Government’s economic regulator, is intervening to force a specialist hospital to improve its financial performance.

The Royal National Hospital for Rheumatic Diseases in Bath, Avon, is failing to meet the financial criteria for Foundation Trust status due to its specialist nature and limited size.

According to the Care Quality Commission, the quality of patient care at the Trust is not an issue.

The rheumatic diseases hospital has limited opportunities to achieve economies of scale and cannot prevent fluctuations in its income.

Monitor said that the Trust alone cannot meet FT criteria, and so a “long-term strategy” is needed to increase its profitability.

While the strategic option (a merger or takeover) is determined, the Trust is required to develop and deliver a business plan that includes the funding necessary to support it in the interim.

Monitor’s Chief Operating Officer, Stephen Hay, said: “In this case, there is no single cause for the problems, but the relatively small size of the Trust and limited number of specialist services it provides are important factors.

“That is why the Trust is focused on delivering a long-term strategy setting out how these services will be provided in the future.”

The statement follows the recent decision of Torbay and Southern Devon Health and Care Trust, a pioneering provider of integrated care, to merge with an existing or emerging FT rather than seek independent FT status.

The £648m NHS funding assigned to developing ‘reablement’ care in 2011 has largely been used to plug gaps in existing social care.

According to health consultancy MHP Mandate, nearly half of councils have failed to invest the money in new integrated care systems to support early discharge from hospital and home-based treatment.

However, the Local Government Association claims that deep cuts in local government budgets rendered the initiative impossible.

In January 2011, the Government reassigned £2bn from the NHS to social care over two years in order to develop integrated care systems that would enable patients to leave hospital earlier, receive care at home and avoid readmission.

This programme focused on a major area of the NHS Outcomes Framework.

However, the report from MHP Health Mandate found that investment in the new services varied strongly between councils, with nearly half spending most of the money on established services.

For example, the proportion of the new funding spent on special discharge schemes providing temporary support to people leaving hospital was only 8% on average, despite reaching 40% in one Kent council.

Mike Birtwistle, Managing Director of MHP Health Mandate, said: “Simply funding more of the same will not deliver better social care services.”

However, Cllr David Rogers, Chairman of the Local Government Association’s community wellbeing board, noted that councils had suffered a 28% funding cut in 2011, which “gifts of extra cash here and there” could not redress.

Three Commissioning Support Service (CSS) organisations in Yorkshire have turned to the private sector to provide assistance during the development of CCGs in the region.

Private firms such as Attain have been sourced to bring commercial nous and expertise to the CSSs to develop new skills required as part of the reformed health service.

Attain, who will become a “strategic commercial and delivery partner” supporting North Yorkshire and Humber CSS, says it provides a service that “truly delivers for its customers”.

The firm has also been involved with South Yorkshire CSS providing “business planning expertise”; management experts KPMG have also joined forces with West Yorkshire CSS to provide “senior level commercial input”.

The cost of private sector support has not been revealed – however it’s reportedly in region of hundreds of thousands of pounds.

Previous reports on the development of CCGs in the region claim private sector assistance is needed to “increase capacity to undertake the work and provide senior level commercial input”.

Maddy Ruff, Interim Managing Director for North Yorkshire and Humber CSS, said the partnership with commercial firms was part of the organisation’s plans to tailor services for GPs. “We have been very clear from the start that if we are to make our service work, we have to adopt new ways of working and more business-oriented principles which put our customers, the clinical commissioning groups, at the heart of our operating model,” she said.

The DH has encouraged the support of external assistance during the development of CSSs and CCGs.

Merton’s public health grant of £7.4m has been questioned by Councillor Suzanne Evans after it fell way below the London average.

Residents in the borough have been allocated the equivalent of £34 per person per year by the DH – £26 less than the average in the capital – despite a 5% increase on its 2010/11 budget.

Councillor Evans (pictured) says residents have been “short-changed” and called for a review of the budget.

The DH based the estimated spending allocation on the outgoings of NHS Sutton and Merton PCT in 2012/13.

However, Councillor Evans says the spending at the PCT has been “ridiculously low” on public health after a “long history of outrageous financial mismanagement” at the Trust.

Only six other London boroughs are estimated to receive less than Merton. Across the border at Wandsworth Council, residents will receive the equivalent of £76 per person.

Val Day, Interim Director of Public Health at the PCT, welcomed any increase in the public health budget. She said an increase would “provide new opportunities for the council going forward” and “to address the health and wellbeing” of residents.

A spokesperson for the DH said it was “premature” to discuss estimated budgets, which are yet to be finalised.

Selling medicines in today’s marketplace should be built on partnership principles. ABPI CEO Stephen Whitehead talks exclusively to Pharmaceutical Field about the importance of NHS/industry partnerships.

Back in 2009, Chris Brinsmead – then President of the ABPI – told Pharmaceutical Field that the future role of the pharma field force would be to facilitate partnerships between the NHS and industry. Three years later and the partnership agenda is slowly inching forward. Progress has been made, but adoption of a more collaborative approach across the country has been variable. As ever, there are early adopters, and those that wait. Last month, Pf led with an ABPI announcement that predicted the NHS and industry would ‘become partners within 3-5 years’. Why not now, came the familiar cry? Why not, indeed. The ABPI seems determined to address this.

This month, Pf spoke exclusively to Stephen Whitehead as he approached the first anniversary of his tenure as CEO at the ABPI. It is clear that, in challenging times for the UK industry as it battles to ensure that patients gain access to life-changing medical innovations, partnership sits at the heart of the ABPI agenda.

“There is a currently a big commitment to move the joint working agenda forward,” says Stephen. “Strategically, over the past 15 years there has been the emergence of many different influences on prescribing – NICE, local commissioning and local formularies are obvious examples. The industry now has to work with a wide variety of stakeholders to demonstrate the value of its medicines. And traditional sales representatives have to work with many different and more complex audiences than they used to when they were purely detailing. Increasingly, I think joint working is the vehicle best suited to satisfy these varying demands.”

Innovation Health and Wealth
The environment for a more collaborative approach is certainly improving. The Innovation Health and Wealth review last December reiterated the need for greater partnership working to help accelerate the adoption and diffusion of innovation in the UK. Crucially, it said that the NHS needed to be ‘open for business’ on partnership. As such, advocates from both parties are working hard to raise the profile (and the benefits) of the approach. But resistance and misunderstandings around joint working remain.

“One of the problems is that there are variable definitions and understandings of what joint working is,” says Stephen. “In simple terms, joint working is a partnership approach focused on solving a patient-driven issue. The industry has disease expertise, it knows how to manage conditions and has developed medicines in those areas. Joint working is about bringing that expertise together with the providers and focusing on patient outcomes. And often we can find cost savings in delivering those outcomes as well.”

Importantly, says Stephen, joint working is not sponsorship. “This is not about industry paying for something. Historically we have funded a lot of things and sometimes there is a real benefit to us bringing money to the table. But this is about changing that perception. Partnership is where two parties, with different strengths and weaknesses, come together to focus on a shared goal. In this case, that has to be patient care.

“The fundamental issue is about recognising the value of innovation and its implications for a pathway of care. By working together to find out how these medicines can be used appropriately, we can save money in the system, we can prevent unnecessary and costly hospitalisation and we can improve patient care.”

Medicines in the middle
In recent years, discussion has focused on whether UK pharma companies should reconsider their product-centric approach to customer engagement, and concentrate instead on developing services with the NHS. The caveat being that a specific medicine would form the core part of any service. But joint working is not an exact science. There is no one-size-fits-all solution – it’s simply about working together to establish the most appropriate approach in a given disease area. “It’s about products and services,” says Stephen. “Some of our members do offer services. But the way I look at joint working is that there is always a medicine in the middle of it – because that’s what we discover, develop and sell. In today’s environment, the only way that the value of that medicine can be truly realised is through joint working that reengineers the pathway of care.”

At present, most joint working initiatives are being built around new innovations – and are being used to redesign services and improve the care pathway. A good example of this is in the field of anticoagulants, where a number of new brands are coming to market. “The new class of drugs have gone through NICE have been recommended and should therefore be utilised,” says Stephen. “Old warfarin clinics should now be closing as patients move onto the new drugs. But to achieve that, and to free up the funds to be able to use the new innovations, we need to take other measures. And you can only do that, in my view, through joint working.

“It is my passionate belief that in most cases, innovative medicines will save money in the system – in the short, medium and long term. We simply need to work together to deliver it.”

Implications for pharma sales
The implications for pharmaceutical sales professionals are significant. While joint working is not always appropriate – aspects such as disease area or where a particular product is along its lifecycle are key factors in whether the approach is applicable – adopting a partnership approach most certainly is. “Joint working is a natural evolution of partnership principles,” says Stephen. “Industry engagement has changed from being a simple seller/buyer transaction, into seeking to work in partnership with customers to ensure the NHS properly maximises the value of medicines. The UK has a low price and a slow uptake of medicine – and as a consequence, the UK system is not as efficient as it could be. It would be more efficient if it adopted innovation more quickly. And if it did, we would certainly have better patient outcomes.

“Joint working is best used when you want to coax the system into innovation. It is not always the most appropriate approach. But whatever you have in your medicine chest, partnership is always applicable. In today’s marketplace, how you approach selling that medicine should always be built upon partnership principles.”