Remember the Government’s rather breathless aspiration back in the summer of 2010 to turn the NHS into the biggest social enterprise sector in the world? If you work for Central Surrey Healthcare – the social enterprise owned and run by 770 entrepreneurial community nurses, therapists and other community staff and praised by Labour and Coalition ministers alike for doing better with less – you’d probably like to forget that boast. Try whistling the Gracie Field’s tune about outsized aspidistras instead, because recent events suggest that aspidistras have more prospect of being bigger in Surrey than social enterprises providing community health services.
Is Surrey sure about Assura?
Why is that? The change of tune is because NHS Surrey decided on 16th September “that following a rigorous evaluation process Assura Medical Limited is the preferred bidder for the services currently provided by Surrey Community Health.” Assura will take on services in North West and South West Surrey, as well as some delivered Surrey-wide, including sexual health services and prison healthcare.
Those words could set off squawking in the NHS human resources henhouse as well as in the wider public sector procurement world. What the Surrey population thinks about it, no one knows. Surrey LINks were said to be “fully involved throughout the process”. We do not think that is sufficient involvement when the contract is worth at least £450m and the services are so fundamental to the well-being of the Surrey public.
There should be active citizens involved in all stages of the procurement process for something of this magnitude. On a local health centre procurement I am involved with at the moment, there is also a very able representative of the patient participation group at the practice being tendered. It makes a difference.
Up until now, Assura Medical has been mainly a health care property developing organisation, 75% owned by Virgin Group since 2010. They design and build primary care centres and community hospitals. That’s all fine, but are they the right kind of business to start providing community health services themselves? This is not elective surgery after all, but long term, usually complex stuff – “messy” as one of my community nursing friends described it. And you can’t “cherry pick” it.
Probity, accountability, not to mention conflict of interest?
It’s surprising to a lot of people I talk to that a company like Assura is interested in a major community service provider business. After all, they only disposed of their pharmacy business in June this year in order to focus on the property development side. But if they can add value within budget and achieve quality outcomes – including user/carer satisfaction of course – perhaps we are about to be surprised? The local social enterprise providers in Surrey might be surprised as well, but that’s another story yet to be written.
It will be interesting to see how the new Assura business model works and is able to avoid conflicts of interests with local GPs. Assura’s usual operating model is to provide primary care services via partnerships with local doctors in “GP provider companies”, of which it currently has 25 across the country. Each provider company is half owned by the local GPs, with the remaining half owned by Assura. And who is it that makes referrals to community health services? Oh yes, it’s local GPs.
A lean time for mutuals in “Open Public Services”?
The “Open Public Services” white paper approach could have a sting in the tail for social enterprises, mutuals in particular, if the Surrey decision sets a precedent.
The last word -for the moment – should go to Peter Holbrook, Chief Executive of Social Enterprise UK, quoted in the Financial Times about the decision:
“If Central Surrey Health, the government’s flagship mutual social enterprise, which has demonstrated considerable success in transforming health services and increasing productivity can’t win, what does this say for the future of the mutuals agenda? Central Surrey Health reinvests all the profits it makes locally. It is difficult to imagine how Assura, with shareholders expecting a financial return, could do more to benefit people in Surrey.”
Meanwhile back in Surrey
While all this is going on, over in East Surrey a new “right to request” social enterprise “First Community Health and Care” – a CIC (Community Interest Company) – is “going live” on 1st October. What must the former PCT community staff leading this be thinking now that Assura is moving in as the new big boy on the Surrey community health block?
Clearly our neighbour to the South is somewhere to keep an eye on for signs of what the future of community health and care businesses might look like. Maybe a future blog post will have the title “It’s an Assura Thing – Mutuals Defeated in The Battle of Surrey 2011”. Time will tell.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.