Nottingham CityCare Partnership is a staff-led social enterprise offering a variety of easily accessible health services and is the leading provider of NHS community services in Nottingham. They deliver a wide variety of services including: from health visiting for young families to school nursing for children and young people; from community nursing for people with conditions such as respiratory problems or heart failure, to podiatry and diabetes services; and support following a stroke or a fall.
Why they developed?
Their vision is better health and complete care, owned and delivered locally.
Their strategic objectives are:
- Prevent ill-health, improve well-being and provide services that improve local health outcomes
- Deliver services that are responsive to the needs of our local communities and our commissioners
- Deliver financial duties and ensure the efficient use of resources
- Be an employer of choice and an organisation that supports local employment
- Provide high quality, accessible and equitable services, investing in the wider community interest
- To grow a successful, sustainable organisation that creates social value and invests in the wider community
What they do?
Nottingham CityCare offers a wide variety of community NHS services in a variety of locations including health centres, Children’s Centres, GP Practices, other community settings, and in some cases in an individual’s own home or care home.
They are a provider of NHS services registered with the Care Quality Commission. Their service provision includes 43 distinct services, each covering a different aspect of health and wellbeing: from the Community Stroke Team to Speech and Language Therapy; from Wound Care to their Homelessness Health Team.
Nottingham CityCare is embedded within the local community and is an integral part of the delivery of better health and complete care, which is owned and delivered locally.
Nottingham CityCare is led by a Board of 8 Directors and have a staff team of 1,175. They are registered as a company limited by guarantee – no: 07548602
Nottingham CityCare have invested in the their local community by sponsoring Nottingham’s Young Creative Awards, which support Nottingham’s talented young people and place them on the creative map.
Furthermore, they have invested in the Champion’s Centre at The City Ground with Nottingham Forest in the Community. Focusing on three core activities – Healthy Lifestyles, Education and Sports Participation – Nottingham Forest in the Community aims to engage 150,000 young people in the next three years. CityCare has invested in the Champions’ Centre and other projects to help young people live healthier lives. The newly refurbished facility will offer state-of-the-art resources, providing an exciting and high-tech learning environment for teaching and training.
CSH Surrey is an award winning community services provider with a passion for quality and innovation. They provide community health services for adults, children and their families, in the homes, schools, clinics or community hospitals of mid Surrey.
Why they developed?
CSH Surrey’s managing directors, Jo Pritchard (nurse and health visitor) and Tricia McGregor (speech and language therapist), set up what was then known as Central Surrey Health back in 2006 when they were asked by the Chief Executive of the then PCT to come up with a new and better way of delivering community services in mid Surrey. Jo and Tricia were clear they wanted three things from their new model:
- A healthcare organisation that was led by clinicians not business managers
- They wanted CSH to be employee-owned because this creates higher staff engagement and ultimately higher quality services (their model is similar to the John Lewis Partnership, although CSH co-owners do not receive dividends)
- They wanted CSH to be a social enterprise – so a business that has a social ethos and purpose rather than existing purely to make profit for shareholders. When they set up, they repeatedly took views from across the workforce about whether individuals wanted to make personal profit from CSH – the firm answer was always ‘no’. They chose instead to invest profits back into improving and expanding their healthcare services so more people can benefit from CSH services. They also allocate surplus into their Community Fund, which awards grants to community groups to support health and wellbeing.
In 2006, after 18 months of research, Jo and Tricia launched their pioneering co-owned social enterprise, and together with more than 650 nurses and therapists, became the first group in the country to spin out of the NHS as they believed they could deliver higher quality healthcare independently
The government’s subsequent Mutuals Policy is partly based on CSH’s experience and the quality and performance improvements they have been able to make through their model.
After being successfully operational for seven years as Central Health Surrey, they rebranded as CSH Surrey in 2013 as part of their strategy to grow and diversify.
What they do?
Their health professionals provide a wide range of inpatient and outpatient nursing and therapy services for adults: from End of Life Care to Domiciliary Physiotherapy; from Podiatry to a Rapid Response Team.
They support the health, development and wellbeing of children and young people aged 0-19 years, and their families: from Child Health Clinics to Speech and Language Therapy; from Immunisations and Breast Feeding Support Services. Furthermore, they provide specialist therapy support for children with additional needs.
Their vision is to be ‘recognised nationally for transforming health and care through pioneering, innovative and integrated services that deliver exceptional care for patients and customers’. They do this by putting patient care at the heart of everything they do, listening and responding to patients, co-owners and customers, continually improving their services, working collaboratively with partners and building on their strong co-ownership culture.
Business Structure and Partners
CSH Surrey’s unique co-ownership model has delivered higher levels of engagement, motivation, productivity and loyalty than other business models. Its annual co-owner survey results outstrip its NHS counterparts in almost every aspect, from ethos to effort. Through its co-ownership model, CSH Surrey is able to deliver higher quality healthcare through highly engaged employees who are more motivated to lead the way and continually improve services.
CSH Surrey is owned by its employees, who are called ‘co-owners’, in a model similar to the John Lewis Partnership (except CSH Surrey’s co-owners don’t benefit from dividends). Its co-ownership model has a legal and a cultural basis, and is written into CSH Surrey’s Articles of Association. CSH Surrey was the first co-owned co-owned organisation of its kind to be created out of the NHS in 2006.
CSH Surrey’s shares are held by four co-owner Guardian Shareholders, whose primary roles are to vote on behalf of their fellow co-owners at Annual General Meetings. They are accountable to CSH Surrey’s Guardian Trust, a group of six Trustee Directors who ensure the Guardian Shareholders act in the best interests of patients, co-owners and CSH Surrey.
CSH Surrey’s experience has influenced Government thinking around the delivery of public sector services. In 2011 CSH Surrey’s Managing Director Jo Pritchard was invited to join the Government’s Mutuals Taskforce to help develop its mutuals policy. Since then, thousands of public sector workers have chosen to follow CSH Surrey’s example, setting up their own, independently owned mutuals.
CSH Surrey is a member of the Employee Ownership Association.
- CSH Surrey has a Community Fund that have awarded grants of more than £18,000 to local groups to support health and wellbeing projects that benefit local communities
- Achieved an average Friends and Family Test (FFT) score of 90 (out of a maximum of 100 and a minimum of -100) across their inpatient services and the Community Assessment Unit during 2014 (this nationally mandated question asks patients how likely they are to recommend the healthcare services to friends and family)
- 87% patients answered agree/strongly agree to survey satisfaction statements in 2014
- Enabled an average of 85% of patients known to us to die at home, significantly higher than the 67% national target
- During 2013/2014, CSH Surrey reduced pressure ulcer rates to better than the national average through a focused campaign that increased awareness and knowledge among co-owners and patients/carers
- In 2014 CSH Surrey was awarded the contract by NHS England to set up and deliver the Family Nurse Partnership programme across Surrey to better support vulnerable, first time, teenage mothers and thus improve the health outcomes and life chances for the teenagers and their babies
- CSH Surrey is committed to supporting personal development, hosting 120 students during 2014 and supporting 20 of these through MSc and Degrees. They also supported 40 people through work experience placements
- 98% of new joiners said they were made to feel welcome and 87% say working at CSH Surrey has lived up to their expectations (2013 CSH Surrey co-owner survey)
- 95% of co-owners say their manager is supportive if they have a problem, compared with just 69% in NHS Community Trusts (2013 CSH Surrey and NHS surveys)
- 96% of co-owners say their immediate manager considers their ideas and suggestions, compared with 76% in NHS Community Trusts (2013 CSH Surrey and NHS surveys)
- 70% of co-owners feel CSH is concerned about their health and wellbeing, compared with just 46% of NHS staff (2013 CSH Surrey and NHS staff surveys)
Benefits to partners
- Following feedback from local GPs, in 2012 CSH Surrey launched a centralized Referrals Management Centre so referrers had just one point of access to their services. This improved the quality of referrals, reduced wasted time and ultimately benefitted patients through a more seamless and coordinated experience. To date in 2014 it has handled more than 67,000 referrals, up 3.2% on 2013
- In 2012 local GPs became the first in the country to benefit from being able to receive clinical communication from CSH Surrey direct into their own electronic systems. This has reduced costs and saved significant admin and clinical time that used to be spent scanning letters and reports to patient records, as well as improved communication between primary care and CSH Surrey.
- CSH Surrey is integrating children’s nursing and therapy services through a ground-breaking ‘team around the family’ approach – based on listening and responding to parents’ needs and experiences. GPs and families are starting to benefit from a single point of access for referrals, multi-disciplinary assessments and interventions, as well as more timely and better supported discharges. This model will be rolled out across children’s services during 2014/15.
- Quote from GP about palliative care at NEECH “Nothing was too much trouble (on the ward) and everybody was willing to go the extra mile, unasked. This was an excellent example of how the NHS could and should be.”
Wellbeing Enterprises CIC
Wellbeing Enterprises CIC has an established 10 year track record of providing high quality health and wellbeing services which have been co-designed and co-delivered with local citizens, health and social care professionals and partner agencies. All of their community led wellbeing approaches are informed by the evidence base, which describes ‘what works’ to promote and protect wellbeing for individuals and communities now and for future generations. Fundamental to achieving greater levels of wellbeing is the extent to which citizens feel heard, understood and respected – and because of this, all of the wellbeing innovations they deliver at Wellbeing Enterprises CIC have local citizens at the heart of the design, delivery and evaluation processes. They also have an established track record of developing and delivering evidence based training courses covering a wide range of topics.
Why They Developed?
Wellbeing Enterprises CIC was developed to: decrease the amount of people with mental distress; increase resilience; promote positive behaviour change; and prevent the increase in people suffering from distress as a result of mental health.
What they do?
- They work with individuals to design holistic interventions that help them to develop the skills and knowledge to improve their own wellbeing, and to become resilient in the face of difficulties
- 97% of people who undertake their interventions implement positive behaviour change to enhance their health and wellbeing
For Health & Social Care Professionals
- They work with partners in the NHS, Local Authorities and Third Sector to develop integrated services in which wellbeing stands at the core
- Co-design new ways of working to reduce the impact on services by approaching health and wellbeing in an asset based way
- 60% of participants in our programmes have shown an improvement in their SWEMWBS score (a validated measure of a person’s subjective wellbeing)
- Working collaboratively with residents and local organisations to mobilise the skills and talents of people and to empower them to gain a greater sense of control over their health and wellbeing. They also help to connect people to assets in the wider community.
- Deliver training and consultancy services to businesses across the UK helping them embed wellbeing practices into their organisations. They create programmes to ensure they maintain healthy, happy and resilient workplaces.
Business Structure and Partners
A team of seventeen people, led by a Chief Executive Officer makes up Wellbeing Enterprises CIC. They also work with organisations who support them and commission their work including – National Association of Primary Care, NHS, 2020 Health and Wellbeing, Barnardo’s, Big Lottery Fund, Blackburne House Group, Comic Relief, Community Foundation for Merseyside, European Union, Halton Borough Council, Halton & St Helens Voluntary and Community Action, Mark McQueen Foundation, primhe, Santander, School for Social Entrepreneurs, St Helens Chamber, Coalition of Disabled People, St Helens Council, TACT, time to change and UnLtd.
97% of people who undertake their interventions implement positive behaviour changes to enhance their health and wellbeing
60% of participants in their programmes have shown an improvement in their SWEMWBS score (a validated measure of a person’s subjective wellbeing)
Benefits to Partners
Wendy Davies, Practice Manager at Windmill Hill Medical Centre states;
“I myself have referred patients for a Wellbeing Review – it’s great to know that we have that extra support on hand for patients to be able to improve their health and wellbeing. I have watched these patients grow and develop with the support offered to them, and I look forward to seeing the initiative grow further in 2015 to benefit even more of our patients”
Since 1998, the NHS has launched many policy initiatives aimed at improving staff engagement. Despite some success, there is evidence that exhortation and guidance alone will not bring widespread changes to practice, and that ways for staff to participate formally in the running of their organisations should be explored.
NHS Mutual covers all the key issues, discusses them clearly and comes up with helpful policy conclusions.
Professor Jonathan Michie, President, Kellogg College, Oxford
NHS Mutual: Engaging staff and aligning incentives to achieve higher levels of performance considers how an employee ownership model could help drive staff engagement in the NHS. The authors conclude that there are at least five ways in which employee ownership can be fostered within the health service, and that the time is now right for the Government to support those willing to test different approaches.
NHS Mutual is important reading for health care leaders and policy-makers. It will also be of interest to researchers and academic institutions with an interest in this area, as well as all those concerned with improving staff motivation and reviewing the options for social ownership in the public sector.
Read the full report here.
To help provoke discussion and debate about the future of social enterprise, the British Council are commissioning think-pieces that address specific issues of current relevance in social enterprise and social investment.
As a contribution to the European Commission’s event Social Entrepreneurs: Have your Say in Strasbourg 16–17 January 2014, the British Council published a thought-piece ‘What will Social Enterprise look like in Europe by 2020?’ based on a series of interviews with social enterprise experts in the region. It offers an opinion of where social enterprise might be heading in the coming years in Europe.
Download the full report here.
This resource offers practical tools and support to CCGs, HWBs and VCSE organisations to develop effective partnerships to deliver better health care. Published February 2013.
Its aim is to help people working in health think differently, more creatively and more practically than ever before, about the opportunities they have to meet changing health needs in difficult economic times.
Download the full report here.
Susan Smith explores the role of community health initiatives in improving the quality of life of Scotland’s poorest
7th January 2015 by Susan Smith
Spartans Community Football Academy teaches children how to brush their teeth properly as well providing them with a safe place to play. Pilmeny Youth Group feeds kids fruit and healthy eating messages in partnership with Edinburgh Community Food, which also works with older people’s groups, young parents and other groups who need help learning how to cook and eat healthily.
This is just a fraction of the good work voluntary and community health initiatives provide in one small area of Scotland. These sorts of initiatives are doing practical work to break down health inequalities every day.
And according to MSPs, other approaches, such as public health campaigns like the Scottish Government’s Eat Better Feel Better campaign launching this week, do not help. Neither can the NHS provide the answer alone – by the time someone goes to their GP with symptoms that turn out to be Type 2 Diabetes, for example, it is already too late.
The problem is clear, poor people in Scotland continue to live considerably shorter lives blighted by far more ill health than the rest of society
The Scottish Government spent £12 billion on health and wellbeing in 2013/14, 35% of total public spending in Scotland. Yet projects like those mentioned above are struggling on a short-term shoestring of funding. With grants that last at best 12 months, underpaid staff spend far too much time filling in applications for the core costs needed to support their own jobs.
The health and sport committee report into health inequality provides much food for thought; not least that the committee has decided further investigation is unnecessary. The problem is clear, poor people in Scotland continue to live considerably shorter lives blighted by far more ill health than the rest of society.
These people don’t want to be told what to do by their GP or out of touch public health campaigns – a key message of the Eat Better Feel Better campaign, for example, is to get “behind the mums of Scotland to support them to make sure they buy and cook healthier food for their families”.
People living in Scotland’s poorest communities, however, do want to live as long and healthily as everyone else. Investing more in the projects that exist on the streets they live in and ensuring a healthy lifestyle is affordable to everyone is how to fix this problem.
(Taken from: Third Force News, 09/01/15)