The government is taking applications for a new round of NHS services to be delivered by social enterprises and run by NHS staff, but while the initiative is based on business ideas submitted by staff, getting everyone on board could prove difficult.
Under the Right to Request (RR) scheme, primary care trust staff can request their PCT set up a social enterprise to deliver services. The PCT is duty bound to consider credible plans and if the social enterprise is approved, staff then transfer over to run the services. The initiative forms part of the government's plan to encourage entrepreneurship in the public sector through mutuals, as announced today by cabinet minister Francis Maude.
The Department of Health (DH) said that RR enabled public sector workers to "take over the services they deliver" and put NHS staff "in the driving seat of innovative projects to transform patient care." But while staff are encouraged to "share information and work together for the RR to succeed," there could be problems if the idea doesn't engage the majority of staff – as Shropshire and West Essex PCTs have found.
Shropshire ran into opposition to its plans and was accused of pushing ahead despite staff objections. Union stepped in to criticise it as a "half-way house" to NHS privatisation.
Argument at Shropshire was only averted after the PCT decided it would opt for creating a joint community foundation trust with NHS Telford and Wrekin to run services which included district nursing and physiotherapy, after a staff majority of 1,200 voted against the idea of a social enterprise.
Fears for the future
Voicing some of the fears of NHS staff, Mike Jackson, Unison's senior national officer for health, said the initiative was more "management buy out rather than staff buy in."
"They are a massive business risk, do not help patients and will bring private health companies in to do NHS work," he said, adding that the government was playing "Russian roulette with healthcare by hiving NHS services off into small organisations to try their luck against the big private healthcare companies. They risk business failure, takeover, or losing their contracts after the three year period is up."
A spokesman for Shropshire said "there were certain issues to resolve especially the social enterprise sitting outside the NHS. The trust model gets round this. Staff and union reps are very positive towards this option."
Reassuring staff over what the future holds and engaging them in what benefits a social enterprise might mean for services, then, will be the difference between success and failure of the idea.
"It is essential that staff are fully involved and engaged with plans to set up a social enterprise," says a DH spokeswoman. "Staff members will need to get support among colleagues, share information and work together for RR to succeed. Therefore any objections or concerns would have to be taken seriously and addressed. A RR project will have to demonstrate to its Strategic Health Authority that staff have been involved in the development of the social enterprise. How staff engagement is done is a matter for local determination."
West Essex, one of 20 PCTs to win funding last November, is another that fell victim to staff revolt after it planned to transfer 41 services, including dental services and community inpatients to a social enterprise called West Essex Community Health Services.
Despite 15 months in the planning, three months of staff engagements and consultations and an allocation of £30,000 and a mentor for the project, the majority of staff voted against the plans because of fears that it would not be able to win tenders and concern over pensions.
Although staff were told that they would remain "part of the NHS family in the same way as GPs", they failed to be reassured.
"Two key messages from staff during the consultation was a lack of assurance that a social enterprise would be seen as a preferred NHS provider or that new staff coming into a social enterprise would have access to the NHS pension," the PCT's chief executive, Catherine O'Connell, told Social Enterprise. "There is no doubt that some staff were concerned that becoming a social enterprise would mean leaving the NHS, although we explained they would remain part of the NHS family in the same way as GPs."
The government case
Last week Paul Burstow, the care services minister, announced a further 15 projects covering a range of services including psychological therapy to improving end of life care.
"NHS staff have the local knowhow on how resources can best be used. RR combines NHS values with business principles in an effective way," Burstow says. "We want to empower millions of public sector workers to become their own boss and help them to deliver better services."
So while the new coalition government is keen to encourage RR, there may be yet more instances where staff – and unions – fail to be convinced that sub-contracting services, even with them at the helm, is a better option.
From Flip Chart Fairy Tales
From Bubb's Blog
From Whitehall Watch
