SEUK’s Content Manager spoke to Charlotte Vitty, CFO at CSH Surrey about what it means to be a social enterprise delivering health and care services, the impact of COVID and how the organisation is supporting other social enterprises in the communities in which it works.

This was part of a special series of interviews we carried out for our Choose Communities: Buy Social campaign, to listen to Charlotte’s section tune in from 14:20 to 33:34. You can also read the written interview below.

Could you tell us a bit about the work that you do at ch s and how you support the communities that you work in?

CSH was the first social enterprise to be rolled out of the NHS delivering health care services in 2006 – quite a profound and bold move at the time and we were very unique. CSH provides health care in the community so actually, us being a social enterprise and working for our communities is almost in our DNA, because it’s what we do. We are embedded in our communities all across Surrey and we deliver health care across both adults and childrens, so quite a wide-ranging spectrum. We have five community hospitals with bedded units in them and then all sorts of other services including district nurses and school nurses so we’re very much out in the beating heart of our community. I think by essence, a social enterprise model really suits us and I think that, over the years the focus on social enterprise has kind of strengthened and weakened, but I think we really are starting to really find that and we want to put it right back in the centre of how we how we operate.

Can you give us a sense of the scale as kind of the types of services that you provide?

So we have between 1500- 1800 employees at any one time so we’re quite large and our revenue contracts with NHS are anywhere up to £80 million annually. And we deliver, I believe in excess of 25 to 30 different types of health care services. Some of them are really challenging for us – so we deliver continuing health care for our children’s contract so really poorly at home children and their families 24 hours a day.  We deliver all the school nursing to every single school child across the whole of Surrey, so hundreds of thousands of school children. 

And then adult services, mainly focusing on the frail and elderly. We’re working a lot in partnership as that kind of critical cog between acute trusts and large hospitals and social care. So being that go between – really, we feel like we are the glue that holds lots of the other parts of the system together. So certainly helping manage the frail and elderly out into care homes and managing their health as best we can in a place it’s really important to them -so in their home allowing them to live the healthiest life they possibly can out in a community with their carers and their families.

Which is so important, isn’t it? It’s interesting describing it as this kind of pivot between the health system and the social care system. Is that something that you don’t commonly find across the country?  I sometimes struggle to get my head around how the health system works, how the social care system works, and I’m sure a lot of people listening to this call probably struggle with it too. There’s a lot of talk about joint working and health and social care integration. Are you showing that this kind of stuff can happen and is already happening?

Yes! I think we’re really lucky to be in Surrey, which is one of the first devolved healthcare systems. So we really are one of the counties that is leading the way in terms of the ICS and ICP (integrated care system and integrated care partnership structure) which is definitely where health is moving. I know I’m really lucky to be part of it, looking at how health and social care, health and the local authority can come much closer together. We’re just starting some really interesting work around population health management. So moving away from that old base of commissioner contract owner while we deliver against the contract and actually the whole system thing is that we put the patient at the centre of it all.

Does the patient really care who is looking after them? They just need to be looked after And that should be the responsibility of healthcare professionals and deliverers across local authorities, social care and the healthcare system who all need to pull together to best do that. And actually, what I believe Surrey has got a really big opportunity in is the plethora of different providers, so they are really embracing social enterprise. There’s two very important social enterprise deliverers within the healthcare economy in Surrey, both us and another called First Community. We are working in really close partnership and have been embraced by the health sector who see us as being within the tent,  they see us as part of the NHS, even though we are a  private provider.

So we work with our healthcare partners, and also the local authority boroughs and councils and also with mental health providers. So we’ve got absolutely every partner around the table with a critical voice, focusing on putting the patient in the middle of this journey. So it’s really exciting, actually, and is hopefully a  system that can shine the light for the rest.

So moving on moving on to COVID. How did things change when lockdown started and could you tell us a little bit more about how you changed how services were delivered o make sure that people got the care that they needed?

I mean, the NHS has been in the public eye and the press, you know, hourly, minutely, across the whole of COVID and many people will know the challenges that all providers have had. Now we, as a service provider, had to follow national guidance. So we had to go back to delivering the primary first and critical care so we couldn’t deliver all of our services and some of them had to be stopped. We had to focus on the ones that were nationally prescribed as part of the emergency planning response. So we follow guidance but equally, it’s really important for us in that landscape to keep delivering to as many patients as we could, so it was about pivoting.

We as an organisation, delivered our digital services app to our patients in the most phenomenally quick time and were top of the league table in Surrey as the most appointments being delivered digitally for quite some time, which was great for us and meant our patients suddenly got another avenue to contact us in and we were able to deliver some alternative methods of care, which is really important. I would say that it does bring challenges because some of the things that you get from being out in the community, which you don’t get through digital means is that feeling that living and breathing, that whole environment of the community, which helps you inform, it helps our medical people inform themselves about the patient. So there are challenges but I think there are people who have performed incredibly under such difficult circumstances.

As an organisation we put our people at the centre of what we do because if you put your people first, they put the patient first and that’s how it works. So we delivered out in excess of 300 lunch bags every day to our district nurses across areas, across our whole contract to make sure that they just weren’t having to queue with all of their PPE on. So we just thought what’s important is to keep our people delivering care. Social enterprise gives you a real sense of belonging to your organisation. And actually, all of our people from digital to finance, to contracts to project management all came together to help our clinicians continue to deliver care and that was astounding. When you look back you can get quite emotional about it so yes, it is a difficult but rewarding time.

That’s such a nice way to phrase it as well, about that sense of belonging that social enterprise brings, which kind of moves on to the next question. I know when I started at  Social Enterprise UK learning about social enterprises and social enterprise landscape, the idea of social enterprises delivering health services confused me a little bit and I think a lot of people still sometimes struggle to get their head around it? What does it mean to be a social enterprise healthcare provider, and what makes you different as a social enterprise from other healthcare providers?

I would absolutely agree with you on that challenge. I’ve been at CSH for two years, and it’s taken me a long time to get my head around being an NHS provider that is a social enterprise structured corporate that also is an employee owned business, as well! And equally, the NHS has such little money anyway, so you’re creating a social enterprise where you want to do some really great things with your surplus that’s really difficult, really difficult especially as the CFO. So for me what I guess I’ve learned over the last few years is that actually for patients it doesn’t matter. They don’t care, they want to see the NHS logo and actually, to us the NHS logo is really important. Great patient care, it shouldn’t matter to the patient where they got it from, it should be great and it should be exceptional and that’s what they want.

Now, what I think the social enterprise does for us is for our people and our partners. So for our people, I think that gives us a bit of belonging, it means it gives them the autonomy to be kind of NHS plus – don’t just think about the patient sitting in front of you in your clinic rooms it’s about actually the whole community you’re in. So if you see their carer or their families, and when they need something extra – that’s what being a social enterprise gives to our people. I can distinctly remember a really profound example around a young girl who had been pushed through different types of medical interventions for many, many years. She’s in her early 20s and ended up oddly in our elderly services because of all the different things you have on there, it kind of fitted. What we were able to do was stand back and work with our partners in the GPs and social care and actually really bring everyone together and put a package of care around her. What was a profound impact was actually her mother, who was a headteacher, and her father had both given up their careers to care for this individual. By solving her problems, we actually enabled her mother to go back to work. The actual patient’s story centered around the impact we have on her family life.

And in other ways we work with our partners – our partners can engage with us knowing full well, that any surplus that we happen to make for any reason gets directly reinvested back into their communities through investment. So they’re not losing money. So actually, the governance around us happens to be much more of a collaborative partnership. “Do you know what invest in us because we invest in our people that invest in the community” and that’s profoundly different. So I think that that, for me is what social enterprise does. That as a CFO, is how I lead with any form of contract negotiations, engagements or partners. And that I believe, is what we started to build on our team, I think that’s what sets us apart.

And you’re employee owned as well, right?

We’re employee owned and it’s different from John Lewis, they don’t get bonuses. I think that’s what motivates healthcare professionals, they don’t go into it for the money. But what they do have is they have a say in the business. So we have a voice board, it’s driven by employees, they come to our board meetings, and as executive directors we are as accountable to our employee boards as we are to our actual board. That gives you a whole different dimension of engagement with your people, which is also really exciting.

And does that allow people on the frontline to make those decisions to build care around patients so that they don’t have to go through lots of hurdles?

Yeah, I mean, with the organisation that we have geographically spread as it is, you can imagine sustaining that at that level is really hard. So you have pockets of really great innovation and other pockets of people just going it’s just hard enough in my day job. And what we want to do is really use all these different mechanisms to drive that innovation, because it’s actually the small things that make the difference. And that’s what I really want to start looking at how we can use social enterprise and employee ownership to drive a small innovation.

One thing that I know you’re really passionate about is buying social yourself at CSH and supporting social enterprises. Could you tell us a bit about how CSH supports social enterprises in your area, not just necessarily buying from them, but also supporting other social enterprises in your community.

So I think it’s a mindset, it’s, it’s a mindset buy social – it needs to be ethically part of your morals and the integrity of your business and I and I really strongly believe in it. So for me it started with buy social week, and it really got us quite excited because we decided that we were going to do a buy social item everyday and we bought some socks on one day, I bought some chocolate and sent it around all of our hospitals and we bought a load of hand soap for our patient areas on another day and we did it all through buy social. So it’s about raising awareness to our people, raising awareness to the communities that are coming in and engaging with us, we have a really good footfall and a really good marketing base. And also just joining in the fact that we shouldn’t just expect social enterprises to be bought by other corporates, we should be buying social.

It made me start to realise that we’ve got a load of social enterprises in our area, we’ve got a massive office, and we’re really a big vehicle. I’m at tables with local authority CEOs and other people, and these smaller social enterprises never get an opportunity to even get in front of the PA, let alone at these tables. So we invited all the local social enterprises in just to talk about what life is like and how difficult it is. We used this form to help us to coach and almost as a self help group but also to get them to understand what’s out there. So for example the local authority regenerating Woking town centre want to plant trees and I now know there’s a Woking social enterprise that does tree planting with schools for health and wellbeing and stress. And actually, my goodness, wouldn’t it be amazing if I could get the CEO of the local authority to talk to this organisation and buy trees and plant them through them, and that’s what’s happening! So we’ve connected people up. So I think there’s an element of we should be buying social, we should be banging the drums for our local social enterprises, we should also be supporting with our skill sets and helping people because buying coaching and mentoring and things is really expensive, and social enterprises will never be successful if we can’t also share our skills, so you know what come and send me your P&L and I’ll have a look at your financials and I’ll do it for free, you know, don’t buy it. That’s what we should be doing and creating our own communities, as a community. So I feel really strongly about those opportunities.

cshsurrey.co.uk