Your healthcare - A social enterprise perspective


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  • - - Offer a series of reflections from the journey - Share all the bear trap moments and some tips on how to avoid them
  • Social Enterprise is an organisation which is set up to mutually benefit its’ owners, and the owners of this organisation are the people to whom the services are provided and the staff.
  • May 2009 – February 2010 Launch (x2) Cobbetts and Capsticks
  • Independent support – Board members/assessors Peter Cutler, Tribal, Age concern, Chamber of Commerce
  • Prepare to be shocked at the banality and craziness of some of this (e.g. turnover at the SHA!) Maintain a sense of humour
  • Nuffield Study on mutualism (2009) showed a 5% productivity gain from just being a membership based organisation Programmes of work are already underway which enables us and patient to increase access to fast, convenient, high quality and cost effective care, e.g. rapid response service. , which incentivises the organisation to deliver a robust financial model and associated productivity improvements
  • My position in the Commissioners' organisation
  • YHC – bold, innovative – a pioneer With that comes a real opportunity to carve out a niche which we can exploit by positioning YHC as the ‘go-to- people for advice and interviews about social enterprises
  • Your healthcare - A social enterprise perspective

    2. 2. THE BASICS <ul><li>Your Healthcare CIC is the registered name of our business and is the successor organisation to NHS Kingston’s Provider Services </li></ul><ul><li>We deliver services in partnership to a Kingston registered GP community of 187,000 people and to people in Richmond with a learning disability </li></ul><ul><li>It is a £25m business employing c550 staff </li></ul><ul><li>Successful TUPE transfer, A4C and NHS Pensions </li></ul><ul><li>We are a 1st wave Department of Health ‘Right to Request’ Social Enterprise organisation committed to the founding principles of the NHS </li></ul><ul><li>We will be governed by elected members of staff and the community we serve </li></ul>
    3. 3. January 2008 – August 2010 TU’S Internal separation ✔ Assessment of viability and capability Joint ‘case for change’ road shows Independent Options appraisal PCT Board confirm their decision for SE To the market (or not)! Business Plan written TCS – ‘Right to Request’ invoked (1 st ) 5 year contract awarded – Mar 2009 Shadow form – April 2009 – July 2010 Tech. Guidance pub. Sept 2009 IBP rewritten Nov 09. Due diligence tests ✔✔✔ B2B’s at NHS L and SHA Board July 2010 YHC established Aug 2010
    4. 4. CONSULTATION AND ENGAGEMENT <ul><li>Working with the representatives of our staff / Trade Unions was a fundamental plank of our process, and our success </li></ul><ul><li>Managers and staff identify service specifications </li></ul><ul><li>Briefings and Road shows - HR Surgeries </li></ul><ul><li>Choosing a name for OUR organisation </li></ul><ul><li>Workshop with Leadership and Staffside to develop our form (mutual organisation) and constitution </li></ul><ul><li>‘ Potential’ </li></ul>
    5. 5. SIX MONTHS ON ? <ul><li>Sound and robust governance frameworks, systems and processes - independently validated (RSM Tenon) </li></ul><ul><li>Registered with the CIC Regulator who approved our Constitution to enable us to trade on 1 st April 2010 </li></ul><ul><li>Attained CQC registration </li></ul><ul><li>Awarded Social Enterprise Mark </li></ul><ul><li>NHS Litigation Authority plus insurance cover in place </li></ul><ul><li>Ipsos MORI undertaking a full suite of service surveys – early results are very favourable – above the London comparative average scores (all areas) </li></ul>
    6. 6. MEASURES OF SUCCESS <ul><li>Seamless transition to SE – no impact on business continuity </li></ul><ul><li>Month on month delivery of the financial plan </li></ul><ul><li>& continued financial viability </li></ul><ul><li>We have a history of successful strategic financial management delivering to our forecast, and realising year on year savings. Last year (2009/2010) we forecast a surplus of £873k and delivered £876k </li></ul><ul><li>Track record of reinvesting these savings in service improvements for the local community e.g. safeguarding team capacity </li></ul><ul><li>We have a legally binding contract not an SLA </li></ul>
    7. 7. MORE SMUGNESSES <ul><li>Incremental planned business expansion </li></ul><ul><li>Successful record of partnership development and delivery </li></ul><ul><li>Demonstrating improved performance through effective service quality improvements and productivity benefits as a result of information systems. </li></ul><ul><li>Ever improving staff retention and recruitment indicators BUT – brings it’s own problems! </li></ul><ul><li>Memorandum of Agreement – Joint statement with Trade Unions </li></ul>
    8. 8. ACHEIVEMENTS <ul><li>Above 90% of patients referred to rapid response team are seen within 4 hrs.(6 partners in this scheme) </li></ul><ul><li>Ability to demonstrate performance by activity and quality by improved data quality (% of appointments without an outcome is below 1%). </li></ul><ul><li>Childhood Obesity: Above 95% of children in year 6 and reception are measured and only 6% and 16% in reception and year 6 were recorded as obese in year 2009-10. </li></ul><ul><li>Breast feeding coverage for Apr 10 to Feb 11 is 95% with the prevalence target of 75%. </li></ul>
    9. 9. MORE ACHEIVEMENTS <ul><li>Leg ulcer healing rate within 12 weeks is above 65%. </li></ul><ul><li>Increased District Nursing productivity by 15% </li></ul><ul><li>We win awards for our services – e.g. KU19 and now we’ve started to be asked to judge awards (Young Enterprise Finals & Kingston Business Awards) </li></ul><ul><li>Partnership development for Hawkes, with GP’s and Age Concern </li></ul>
    10. 10. REFLECTIONS <ul><li>Form must follow function </li></ul><ul><li>Independent support – people are willing to join you because they think it is a good idea </li></ul><ul><li>Remember that the people that ‘sign you out’ don’t know half as much as you do – help them with examples </li></ul><ul><li>Be prepared to be met by doubters </li></ul><ul><li>Communication, constant, transparent, using different media </li></ul>
    11. 11. FURTHER REFLECTIONS <ul><li>Make this transformational not transactional where you can </li></ul><ul><li>Work with your staff side and full time officers – it’s fundamental - Be Honourable in all your dealings with staff and partners </li></ul><ul><li>Get used to the tests (and the criticism and doubt) </li></ul><ul><li>Raising your head above the parapet and becoming noticed is scary </li></ul><ul><li>But </li></ul><ul><li>It makes a real difference to the wellbeing of your patients and people - then it is undoubtedly worth it. </li></ul>
    12. 12. IS IT WORTH IT? WITHOUT A DOUBT <ul><li>The organisation exists to mutually benefit the owners -Where you have ‘ownership’ you have productivity gains. </li></ul><ul><li>We retain our surpluses and these have to be used to innovate and invest to benefit the members </li></ul><ul><li>We can be wholly congruent with the Transforming Community Service (TCS) initiatives without the fear of being sidetracked. </li></ul><ul><li>Still experiencing “Policy disconnect”- where other organisations don’t grasp the concepts of Right to Request/Run and providing NHS Healthcare services from outside the NHS </li></ul>
    13. 13. WHAT’S NEXT? <ul><li>Consolidation and Growth </li></ul><ul><li>Supporting others of a like mind, partnerships with other providers/hosting . </li></ul><ul><li>Talking to Local Authorities about possibilities </li></ul><ul><li>Enabling Potential to find its way </li></ul><ul><li>Releasing time to care – the “productive Ward” in both the hospital and the community </li></ul><ul><li>Developing the membership base </li></ul><ul><li>Electing the Governors </li></ul>
    14. 14. With apologies to the Labour Party, Conservatives, Gene Hunt, and Life on Mars
    15. 15. The questions that we get asked most frequently and the answers…. <ul><li>Q: How are you going to transform your services? </li></ul><ul><li>A: This question assumes that your services weren’t very good in the first place but it is fairer to say that this vehicle gives us the opportunity to tailor services to suit service users’ needs, to transform our partnerships and business approaches – in other words ‘freedom to act’. </li></ul><ul><li>Q: What if a large American conglomerate approaches the commissioner to buy your organisation? </li></ul><ul><li>A: The organisation isn’t for sale! It can’t be sold. It belongs to the tax payer. </li></ul>
    16. 16. Q &A’S <ul><li>Q : What are your plans for business growth? </li></ul><ul><li>A: Strangely no one asks you this in the NHS! YHC has a target to grow by 2% per year. Our productivity target is much more of a stretch…. </li></ul><ul><li>Q: Are you too small? </li></ul><ul><li>A: NO! </li></ul><ul><li>Q: Is this the thin end of the wedge to privatisation of the NHS? </li></ul><ul><li>A: NO! </li></ul><ul><li>Q: What you describe is just like a Foundation Trust; what’s the difference? </li></ul><ul><li>A: The overhead costs and the regulatory application. </li></ul><ul><li>Q: Why were you prepared to take what many commentators call a bold step without the model being trialled more rigorously? </li></ul>
    17. 17. <ul><li>A: ‘You don’t learn to swim by exercising on the beach.’ </li></ul><ul><li>(Ronald Cohen 2007) </li></ul><ul><li>Thank you </li></ul>