Forming partnerships can help organisations create value for the NHS, generate revenue, reduce cost, access capital to invest in new schemes, improve technology, services or infrastructure, and bring new talent, expertise and ideas into the system. Crucially a good partner brings constructive challenge and asks 'why'?
- Partnerships have the benefit of longevity. They can save NHS organisations money in the long term by driving down costs, increasing knowledge and improving efficiency, helping deliver ‘future-proofed’ models of care.
- Services can often be delivered at a lower cost and higher quality if designed and delivered with an external partner. This can be because of economies of scale that facilitate cheaper purchasing, the better utilisation of staff, or because good outcome-based arrangements drive appropriate value-based behaviours.
- Where organisations collaborate, the product of that partnership can go to market and be sold to third parties, thus generating income for both partners.
- The current NHS recruitment pool and market does not have the depth of skills or capital required. At any one time, one in three Trusts has Director level vacancies. Partnerships bring new talent and ideas into the system and pooled skills and ideas will help to improve patient outcomes.
- Two or more organisations working together are likely to create a better solution that those working in isolation. It is difficult for lone entities to change methodology. This helps to bring about new models of care and delivery, and shared experience and skills.
- The NHS needs the external challenge. Partnerships with other sectors help deliver this challenge in a constructive way.
In October 2010, Ryhurst and Lancashire Care NHS Foundation Trust entered into a joint venture company, Red Rose Corporate Services (RRCS), to provide investment in new inpatient facilities and meet efficiency savings. The parties pool their resources and expertise to achieve particular goals. Risks and rewards are shared.
RRCS has an impressive record of achievements including:
- Delivery of a strategic estates plan that responds to the operational and strategic needs of the Trust.
- 50% reduction in consultancy costs
- £5m in revenue savings.
- Improved rates of statutory compliance across the estate from 45% to 98%
- A Space Utilisation programme that has reduced the space occupied by the Trust by circa 13% and increased overall space utilisation by 39%.
- Reduction in FM costs on a PFI contract through contract enforcement that led to a saving of £300k.
- Management of the estates and facilities function and year on year successful delivery of CIP targets.
- Project management of the Harbour, a 154-bed residential mental health facility.
- A £20m saving on the cost of the Harbour through renegotiating an existing ProCure21+ capital project.
- Successful management of the Trust’s minor capital works programme with an annual spend of between £3million and £5million per annum.
- Planning approval for a new 72 bed residential facility in Blackburn with the planning submission made in 12 weeks from a standing start.
- A Care Hotel facility to support frail and elderly ‘Step-up/Step-down’ care.
In addition, RRCS has led a programme to integrate estates, health informatics and clinical services under a single programme to rationalise the estate, improve productivity and increase efficiency across the Trust.
Critical success factors: no fixed supply chain; flexible contractual arrangements; shared risk and rewards; shared objectives.
Organisations will put in place successful partnerships by:
- Basing them on outcomes. Do not create an input-driven situation where the ‘buyer’ believes they know the answer to their problem and tenders in a restrictive way for this solution only.
- Use the procurement process to positively drive clear rules of engagement, rather than to negatively discriminate against potential partners.
- Seting realistic goals. Partnerships fail where either side’s expectations of success is unrealistic or too optimistic, as trust and transparency can be lost.
- Being open to new ideas. A partnership would not be required if there wasn’t a mutual recognition that a new approach and innovation is required. The ‘not invented here’ mentality must be absent from successful partnerships.
- Educating stakeholders and disseminating objectives. Partnerships will fail if stakeholders within both organisations are not on board and clear on the rationale, business (and sometimes moral) case for entering into the partnership. This is particularly true of clinicians. Stakeholders should include the public and wider community. This means that outcomes are known, money flow is transparent and accountability is clear. Where the relationship underpinning the partnership sits with an individual, the partnership is at risk should that individual leave.
- Explaining the benefits to staff and stakeholders. Many employees are wary of outsourcing, led by a fear of redundancy or TUPE. Take time to help staff, unions and the wider community (including patient groups, local politicians and the media) understand the objectives and reasons for a partnership. partnership doesn't mean outsourcing!
- Truly understanding shared risks. Avoid loading all the risk on to one side of the partnership. Both organisations must share responsibility for success and crucially, both parties must have a similar attitude to, and understanding of, risk and reward.
- By not over-specifying. The more specificity there is in how the relationship should and not be conducted, the more likely it is that the element of partnership is lost, because process metrics replace trust. This does not mean to say that there are not clear gateways, processes and metrics, but that the right things are measured for the right reasons. If a contract or partnership is appropriately outcome-based, then the specifics and process for achieving those outcomes should be seen as a means to an end, and not an end in itself.
- Allowing the transfer of skills. This will improve the quality, efficiency and outputs of both parties.