Run community hospitals as social enterprises and save the NHS millions

NHS England chief executive Simon Stevens talks about reinventing community hospitals, not preserving them. So, what if staff in your local community hospital were employed not by the NHS, but by a social enterprise?

‘Our relative independence gives us enormous scope for innovation. When we have an idea, there really isn’t any red tape’

For the past two years I have been running Spiral Health, a small social enterprise in the North West performing just that role. In April 2012, ours was the first to take over a NHS secondary care unit.

There are 62,000 social enterprises in the UK, contributing £24bn to the economy, and it is estimated that 9 per cent of them operate in health and social care.

To those concerned about privatisation, I want to be clear that a social enterprise is not a private organisation and has no shareholders. Our organisation is mutually owned, with employees having a say in how the business is run. Any profit made is ploughed back into patient care or community projects.

In short, we exist for the benefit of the community.

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Staff led culture

Running a hospital, or in our case a nurse led rehabilitation unit, as a social enterprise is rather like running an academy in the education sector. Whereas most schools are centrally funded and follow the protocol set out by their local authority, academies have more freedom to use their budgets in the way that suits their school, teachers and pupils.

We operate within the NHS, but our community interest company status allows us to direct our resources into the areas that we have identified as most important. 

We are commissioned by our local clinical commissiong group to take “step down” referrals from the local acute hospital, for patients needing a period of therapy or bed rest before returning home.

We also take “step up” referrals from GPs and community teams, helping to keep patients out of acute wards.

‘If staff identify changes that will benefit our business and the community, we give them the freedom to drive these through’

By working with community teams, last year we saved the public purse more than £21,000 that would have been spent on GP visits. More than 150 patients avoided accident and emergency visits, coming to us instead.

Most tellingly, our focus on an active recovery for patients in small, homely units means our patients stay for an average of 17 days. The average time taken to rehabilitate on an acute ward is 28 days.

Our ability to achieve this comes from the fact that our organisation is staff owned and staff led, so our team is highly motivated. It was tough establishing this culture.

A new culture

Back at the very beginning, I was faced with bringing the close knit NHS team running the unit into a new way of working, within which they were going to be a huge part of shaping strategy.

We made it clear from the outset that we were listening. Two members of our team were appointed to our board as non-executive directors and we set up three staff working groups: an operations group, a business development group and a workforce group. If staff identify changes that will benefit our business and the community, we give them the freedom to drive these changes through. 

‘By getting patients back to their homes more quickly than an acute ward can, our small organisation saves the NHS £2.7m per year’

It took time for staff to accept all our cultural changes, but two years on, I’m proud of the choices our team has made. Among many other initiatives they have set up an employee pension scheme and initiated a follow up physiotherapy service at home for former hip replacement patients, who were having to wait up to six weeks for community based therapy.

Although we are part of the NHS, our relative independence gives us enormous scope for innovation.

When we have an idea, there really isn’t any red tape to wade through. For example, we joined forces with a personalisation expert to introduce a new approach to compassionate patient care, which has since achieved national recognition, including being shortlisted for an HSJ Award.

Means of engagement

As the market opens up for independent providers within the NHS, this is an exciting time to be a mutual with a new approach. However, taking the road less travelled has been challenging.

The commissioning process is so complex that it can divert your attention from everything else you are trying to achieve and short termism is an issue.

My main concern is that organisations such as ours don’t have any means of engaging with commissioners. I’d like to see a Healthwatch style vehicle for providers created.

‘We have the autonomy to make our own decisions and stand by them’

I believe passionately that social enterprise has a role in the provision of local healthcare.

At my organisation, we have an energised workforce that owns the company and cares about its reputation. We have the autonomy to make our own decisions and stand by them.

And we forge relationships with GPs and community teams, which means our patients benefit from a merging of health and social care.

Finally, by getting patients back to their homes more quickly than an acute ward can, our small organisation saves the NHS £2.7m per year. Is this what you meant by reinvention, Mr Stevens?

Tracey Bush is managing director of Spiral Health