Natalie Douglas, Healthcare at Home

9 May 2016

A sustainable NHS requires collaboration with innovative private sector firms, but that’s not always easy

As chief executive of a supplier to the National Health Service, Natalie Douglas is concerned by the popular suggestion that it is in the “worst place it’s ever been”. But she is clear that the very real focus on cost has put pressure on Healthcare at Home – and companies like it – and limits the long-term strategic approach the business would rather take.

“I had a meeting about eight months ago with a group of service providers who were really frustrated about the fact that there’s so much support we can give,” says Douglas. “There’s so much more we could do if we had the opportunity to work more collaboratively with the NHS.”

Healthcare at Home currently provides services to 150,000 NHS patients every year, delivering both medicines and clinical care in the home, where patients “typically do better”, she says. It’s a model she believes could save the NHS millions.

“We’ve got a much greater opportunity over the next couple of years to accelerate home care for British patients. It’s down to us to provide the evidence to the NHS, and show them the benefits of working in partnership with companies like us.”

Proving the case

Although she recognises the government’s commitment to driving innovation, challenges around entrenched opinions, trust and bureaucracy mean dialogue with the NHS remains at a local level. “We’re still in the early adopters phase,” says Douglas.

As part of that, Healthcare at Home is running a number of “recovery at home” projects with innovative trusts across the country to identify patients that can be discharged early from hospital. And to ease the chronic pressure on accident and emergency departments, it is developing admission avoidance projects in partnership with clinical commissioning groups within the community.

It is also working with the pharmaceutical industry to help demonstrate the value of medicines, helping to ensure patients stick to their prescription regime and understanding when the drugs are effective or not for patients away from hospital.

“We’re uniquely positioned because, historically, clinical trials by pharma companies are carried out in a very controlled setting. But we’ve got the clinicians right at the coal face to actually see what’s happening and measure how people are really feeling,” explains Douglas.

We all need to be more honest about how difficult some of the decisions are

It’s through such data that Healthcare at Home aims to establish greater confidence in their ability to manage patients. But she adds that it would also be helpful if the government was more open with the public to drive the changes that are needed.

“I think the government needs to explain that you can’t have healthcare free at the point of care just when it suits you, for everything. There’s a responsibility we have as humans to take care of our health and we all need to be more honest about how difficult some of the decisions are. The NHS is too much of a political football.”

Patients are already changing and making their own choices, she adds, referring to virtual services being set up, and nurses and pharmacists taking a greater proportion of the management and care of patients. “We want every suitable patient in Britain to know that clinical home care is a choice,” she explains.

“It’s about creating a dynamic health service. Encouraging public and private partnership should be the way to do that – and it needs to be designed in such a way that makes it achievable. There have been too many failures, and we need to have a desire and a commitment from government to make these partnerships work.”

Overcoming growing pains

Douglas is remarkably comfortable talking about Healthcare at Home’s own failures, as the company hit the news in 2014 when a number of patients were left without their prescriptions. With a career that started at Johnson & Johnson, before launching her own start-up providing patients drugs, internationally, which weren’t available commercially, Douglas was brought in to overhaul systems and processes to solve the issues.

“The business has grown to quite a size,” she says. “It’s a £1.3bn business. We have over 1,500 staff. 50 percent of them are clinicians. And we’ve got growing demand for our services. But what can quite typically happen is companies grow exponentially and they get to the point where things start to creak.

“The only way to create more capacity in the business is to transform the way we operate. This has been a very manually operated business. We need to become data driven and technology enabled and establish new processes.”

That has been a challenge when every trust operates differently, and Healthcare at Home handles more than 300 different types of prescriptions, for example. The company was also used to selling into the NHS at a more tactical level.

Shifting the emphasis and developing the right relationships to have more of a strategic influence – and to stand any chance of standardising practices – has been a big change of focus for the company over the past two years.

Douglas has also brought in more experts from the healthcare and pharmaceutical industries in senior management positions.

“We have a very large proportion of staff who’ve come from the NHS. From a clinical perspective that’s fantastic because you can’t get better training anywhere,” she explains. “But we also needed some more commercial skills, to professionalise the company and transition from what was perhaps a more entrepreneurial culture into more of a corporate culture.”

Alongside investment in a new head office in Burton-on-Trent, the company is also looking to build its own educational academy – with an eye both on the national shortage of nurses and on retention to ensure continuity of patient care.

“We want to be the best place in Britain for nurses to work,” she says.

Healthcare at Home is measuring its progress by aiming for accreditation as an Investor in People champion by 2020. In January, it was awarded bronze – a year ahead of schedule. It has also focused on improving both internal and external communications, and now publishes regular reports on its performance.

We're very happy to stand up and be counted, by publishing the results of how we're performing

“Even throughout that very difficult operational phase, more than 90 percent of our patients were happy with our service. But what was in the public domain gave the complete opposite perspective. It was where the communications were really lacking,” explains Douglas.

“But we’re very happy to stand up and be counted, by publishing the results of how we’re performing on a quarterly basis and measuring ourselves against competitors and other service providers. We’re driving a gold standard service in this industry.”

Unfortunately, she adds: “Frankly the NHS doesn’t forgive that quickly.”

That’s an additional challenge when Healthcare at Home is trying to create new models of care for the country, something Douglas herself says requires “big behaviour change”. But she’s determined to prove the value of what the company can offer, one partnership at a time.