SEUK’s Public Services Lead, Nancy Towers, spent a day observing the Rapid Response Team at health and social care social enterprise, Your Healthcare. In this blog Nancy looks at how being a social enterprise allows it to empower staff to make decisions and create a way of working which puts the needs of service users at the heart of how it operates.
As part of my relatively new role as Public Services Lead at SEUK I’m keen to get a better insight into what makes our health and social care members tick, what they do well, as well as learning more about their current challenges so we can better support and champion them and the impact they have.
A couple of weeks ago I visited one of our healthcare members Your Healthcare CIC (YH) in Surbiton (South West London) and spent the day with their Rapid Response Team.
There were a few things I was particularly interested in finding out:
What’s it like to work there?
I’ve always viewed these social enterprises as pioneers in health and social care and been intrigued to know what’ it’s like to work for one – particularly in comparison to the NHS. Developing an engaging, innovative and supportive working culture has been incredibly important for social enterprises in this sector to deliver high quality and efficient care. YH spun out of the NHS back in August 2010 so nearly 10 years later I’m interested to see how this is sustained with existing and new employees.
What does it mean for users of their services?
I’d also like to know what difference being a social enterprise can make for the people who use their services.
What’s important at the moment?
Like many social enterprises in this sector, YH transitioned out of the NHS in a very different context, before austerity and the rising demand for services really hit – how are they adapting, coping or thriving with the new demands and changes in policy and funding? And what on the horizon do they see as potential opportunities and challenges?
What I found out
My visit started with a whistle stop tour of the building followed by an opportunity to meet the staff members of the circa 40 teams within YH, including: community nurses, neurodevelopmental services, children’s speech and language therapists, reablement services, physiotherapy, bereavement councillors, school health teams, and more. As most of them are based in the same building, a revelation for anyone who’s been referred on to a different service via the NHS, the teams have face to face conversations to confirm which service(s) a person is best placed to be referred to, rather than ‘faxing’ a referral and crossing their fingers! After getting a good idea of the wide range of services YH provide, I spent the rest of my day with the Rapid Response Team.
The YH Rapid Response service was set up way back in 2011 and offers a now mature service model of sub-acute clinical and therapeutic interventions to housebound people unable to attend their GP and who experience an unexpected and more acute episode of ill health. Most referrals are received directly from local GPs, the London Ambulance Service and other healthcare professional within the organisation. Through a process of advanced assessment and clinical decision-making, the Rapid Response Team formulate person centred management plans to ensure people remain in their own homes and so do not get transported to A&E.
Your Healthcare CIC innovatively operates a distributed leadership model with a lean senior leadership team*. Authority and decision making is genuinely distributed (not delegated) to YH’s independently led teams who deliver YH’s services. All of its around 600 employees are staff members and have a full day’s induction to the social enterprise and the innovative way YH operates, when they start. As members of an independently led team, all staff members are given five Freedoms:
- Freedom to change things for the better
- Freedom to ask questions
- Freedom to tell our great stories to help retain and grow our business
- Freedom to innovate
- Freedom to talk to partners about aligning services for greater gain for our community and best value for our commissioners.
The YH structure means that teams have the freedom to continuously improve service delivery and develop partnerships, without the need to seek permission from senior management.
For example, responding to their patient’s needs the Rapid Response Team developed a new referral pathway for Deep Vein Thrombosis (DVT) which allows them to initiate treatment and directly refer to the hospital, eliminating at least one visit to hospital, which is a major deal when you’re a frail 94 year old, suffering from dementia.
The Freedoms also give individuals autonomy over their work, which is often a big thing in terms of employee happiness and job satisfaction. It really seemed to be working for this team. They can intelligently respond to the referrals they receive in a day, and logically schedule their visits (NB: this service responds to all referrals within 2 hours). They are trusted to do their job well.
Using their services
I’m hazarding a guess but the two patients I met on call outs, a 92 year and 97 year old respectively, would have had no idea that the team visiting them were part of a social enterprise. And I don’t think that’s really the point, the point is that they’re getting the care when they need it, in the place that they need it and preventing an unnecessary hospital visit while also reducing pressure on primary care. They are getting a service that effectively links up with other care they might need, so referrals can be made quickly with an understanding of the patient’s needs. The healthcare professionals often have a better understanding of their patients because they can get a fuller picture of them from conversations with colleagues and so make effective treatment decisions more quickly.
Before going out on one call, we bumped into the specialist dementia nurse who knew the patient. She was able to update us on her recent contact with them explaining why their walking frame needed to be kept out of view – to prevent falls.
What’s important at the moment for the YH Rapid Response Team
The Rapid Response Team are looking at how to receive even more appropriate referrals from London Ambulance Services, to reduce some of the pressure on that service and minimise unnecessary transportation to hospitals.
Like many organisations recruitment and retention of nurses is harder than it has been, the number of nurse vacancies in the UK is currently over 43,000 – worth noting that organisation wide YH’s vacancy rate is a mere 3.1%!
Organisationally YH is making the case for social enterprise when NHS priorities are driving to consolidate power and money into NHS Trusts.
What can SEUK do to support and enable social enterprises like these to thrive?
It’s been a tricky time in healthcare, with increasing demand, under investment and politically a relative decline in interest in social enterprise as a model for health and care since the initial championing and support for them to ‘spin out’ of the NHS in the early 2010s.
Optimistically I’d like to think the tide is turning, and SEUK is working hard to challenge some of the current policy changes that have unintended consequences for social enterprises in this sector as well as promoting the model of social enterprise for health and care delivery. We are working with NHS England, NHS Improvement and the Department for Digital, Culture, Media and Sport (DCMS) on ways to create a more level playing field for social enterprises in health and care. In October 2019 we hosted a roundtable with NHS England and DCMS to examine the challenges faced by social enterprises and mutuals, and explore ways to address those challenges.
In November 2019 Sir Simon Stevens CEO of NHS England and NHS Improvement visited the outstanding Here/Care Unbound in Brighton and left impressed by their work and the role they play in the health and care system locally.
We are also building the evidence case for social enterprises working in health and care – to demonstrate their scale as well as impact. A Freedom of Information Request with CCGs and NHS trusts has identified over 900 social enterprises that deliver commissioned services for the NHS, and we know that social enterprises are more likely to have good or outstanding CQC ratings than NHS providers (CQC rated YH ‘Good’).
This work will continue this spring, with more evidence and reports due in February and March 2020 and visits by key NHS stakeholders to support our arguments to alter the proposed changes to NHS Primary Legislation.
* YH strive to operate as “Teal”. See this excellent short cartoon describing different leadership approaches: https://vimeo.com/121517508
For more information about Your Healthcare CIC visit – yourhealthcare.org