A blog piece written in conjunction with Rachel Murphy of Difrent. Originally edited and published on DigitalHealth.net captured here in its uncut form.
Rachel Murphy (CEO of Diferent) and Richard Corbridge (Director of High Street Healthcare at Boots UK) have worked in digital health and care and public sector transformation for many years, never quite working together but with very aligned views on what needs to be done, what needs to be changed and what can be achieved. During lockdown they have come together to consider their views on collaboration where partnerships are required across a multiplicity of organisations. Here are there thoughts…
Rachel – COVID19 has thrown suppliers together who haven’t ever worked together before. Asking suppliers who are not renowned for their partnership ethos from all types of organisations has at times been one of the key challenges to delivery, but we have all had to learn fast, make compromises and evolve. The delivery of a remote first capability was becoming the norm, the current crisis has pushed that so hard that there can be no going back. Customers, patients and the healthcare organisations will not want to return to what was accepted and therefore different, unusual and complex partnerships between organisations that can make this work must now be made to partner for the creation of successful environments and eco-systems to be created.
Rich – For the last two or three years I think the digital health leadership environment in the UK has been slowly evolving its perspective towards partnerships, some of that I believe is because of organisations like the Digital Academy, KLAS, Digital Health and CHIME and some of it is related to the maturing of personal relationships across the digital leadership in the NHS. Maybe some of it is simply down to the changes in the NHS (and maybe just as much the lack of change). CIOs across health have come together as a necessity, to learn from each other, to share success and to learn from things that could have gone better. Maybe this is another reason why partnerships suddenly are more possible.
Rachel – As working at home and dealing with varying levels of anxiety/panic and stress, kids running around, shopping for relatives or shielding in my case has taken its toll and its hold on how we work the idea of how we partner and who we can turn to. I’ve spoken many times about multi supplier delivery and my desire to see more of it. I have an inherent belief that the only way we can transform is by bringing the views, capabilities and capacity of the many to the front line of change in a way that is collaborative. As an SME we were trusted by NHSX early doors as a delivery partner to jump in and help out with a number of their cells responding to COVID19. Working across volunteering, emergency leave volunteering, provision of kit to doctors returning, and the piece de resistance that of testing; home testing to be specific and therefore working closely with NHS BSA standing up the infrastructure and with Amazon managing the fulfilment. An exciting group to come together.
Rich – Like Rachel my view on partnerships is that they are now needed more than ever before, we (and others) can no longer go it alone. Working with NHS England it was clear that we could assist in the delivery of NHS 111, we had some capacity, we definitely had the skills and expertise and the desire and there was a clear need. Our colleagues wanted to be part of the response, even if they were working at home for all manner of reasons. Working with NHS England we knew we could do more than simply substitute the resource, we wanted to redefine the problem in partnership with the delivery functions of NHS 111, what were the needs and where could community Pharmacy help-out in the most appropriate way. Creating a Pharmacy led response service on NHS 111 is collaboration at in the fullest of its sense for us with many parties involved and the removal of ego from the creation of the eco-system of partners entirely necessary.
Rachel – The BSA were a known quantity to Difrent as we run a few of their services and have nearly 3 years working history with them; albeit with different people, but their culture permeates through their staff; all of them; that can do positive attitude, pragmatic thinking, less is more and focus on delivery first driven right from the top by Darren and more recently reinforced by Michael Brodie. Amazon were an unknown quantity we had not worked with before but my team were blown away; the guys they worked alongside were cut from the same cloth; a ‘just do it’ approach that meant long days, 18 hours average, and the squad on this as I write are on day 35 without a break, we now have to explore how we back fill them to make sure they don’t burn out and yet maintain the relationship. The team from Blenheim Chalcot were again unknown quantities to us albeit over the years I have had varying dalliances with them doing there ADBL, exploring opportunities with Agillisys, Avado and lucky enough to have recruited one of their senior team into Difrent.
Rich – The relationships required to build the Pharmacy NHS 111 service had to be created quickly and at all organisational levels, this was going to be a clinical service with basis in legal contract with technology that was to be implemented remotely and standards that were engrained into every inch of the service. And the relationships and partnerships now needed to be set up remotely to facilitate this across several stakeholders and organisations. Most interesting in this though was the way in which the organisations came together as selflessly as they could, leaving at the door old drivers for delivery, commercial and attitude based priorities, what was important was to get the capacity into NHS 111 at pace for the good of patients and indeed for the good of our own colleagues who were desperate to provide their expertise in support of the NHS in its time of need.
Rachel – Of course it wasn’t all a bed of roses; blockers and obstacles were thrown up; some legitimate in the form of governance and some probably driven out of fear from organisations (public and private) who were not used to working in this new agile environment. We were releasing new code and new process two or three times a day, which is the normal for us but frightening for some of the partners involve; they were more comfortable with a CAB process that releases once or twice a month. It became an education for us all and an education we had to conduct remotely and at a pace unlike ever before. Eight days in we had a service up and running; the supply chain worked; the tech worked; capacity and fulfilment of product is a well reported issue but that is being handled and addressed, ultimately we had, in partnership, achieved something that many would have described as unachievable.
Rich – Again in a similar way to the Difrent story it wasn’t easy to make happen, the mismatch of how contracts can be agreed between government organisations and commercial organisations will always be difficult, bringing the right people together to hear each other’s blockers is the same problem that we have always had and it is compounded by working remotely that’s for sure. The principles of why were partnering though hung true, and in less than 10 days we all went from bright idea to the first pharmacist trained, provided with the technology and happy to take the first calls, and the calls came in. The partnership that has now been created I hope will see community pharmacists (not ‘just’ Boots pharmacists) delivering the NHS 111 service for many years to come, a community pharmacist is a qualified healthcare professional, a clinician who can help patients in their time of need. This morning my step-son woke up with an eye infection, what is the first thing we now think of doing, speaking to a community pharmacist for advice, in the new world this has to become a behaviour that sticks and I believe the partnership we have created will enable this to be so.
Rachel – I think the success of this proves is can be done; if there is clarity on the problem statement and people are working to an outcome NOT trying to build a thing, and that thing can be the ‘ego’ of their own organisation, then great things can be achieved. As this service starts to scale up; 15,000 last week and 25,000 by this week this will evolve, the suppliers will become different and the ways of working will be built forward from learnings, we all accept that and welcome it; this will need to be more industrialised but the relationships that have built, the ways of working, the joint sweat and blood won’t ever be forgotten!
Rich – We have now created an environment that supports the building of the eco-system of partnerships that digital healthcare leaders always dreamed of. Some of that is new attitude, some of that is new organisations like NHS X who actively are pushing to see partnerships happen and some of that is need, we have moved away from ego based partnerships where a winner was accepted and expected to eco-partnerships where we are all in it together to deliver better results for everyone. Long may this be the case.