City Health Care Partnership
Andrew transferred from his role as managing director (designate) of Hull Hull Primary Care Trust to chief executive on the 1 June 2010, the date that City Health Care Partnership CIC became an independent co-owned "for better profit" company which invests its profits into the services, staff and communities.
It was really nice to see that the importance and value of community services was recognised in the long term plan. The fact that community services, working in partnership with GPs and primary care colleagues with what appeared to be new money attached, was a key element of the delivery of the plan was welcome. However, missing from the plan itself are links with colleagues in social care. The lack of the social care green paper is quite a gap. The Department for Health and Social Care needs to wake up to the fact that a hell of a lot of community service provision is via the local authority. That needs to be funded properly.
Over the last decade or more, community services always seem to have faced the most cutbacks and most disinvestment. We are where we are, but we we need to make the best of that and demonstrate the value and worth of the services we provide. They provide the glue that sticks most of the service together – most people spend the best part of their time at home in the community where they live – not within a ward or sitting in A&E.
The centre has to understand that through the further development of the integrated care system approach in the plan, there will be a different approach in each area. My hope is that we’re seeing some fundamental changes in the way in which general practice will be contracted. The notion of the network approach working at populations of 30-50,000 comes with risks for these services but, if you’re looking at the fundamental principles, there are opportunities at population health level, looking at how our datasets and evidence base can help facilitate quality improvement. For years we’ve been trying to get our frontline staff to really engage with their broader role in the wider determinants of health in the communities they are working in. Though we do have capacity and demand issues.
The Department for Health and Social Care needs to wake up to the fact that a hell of a lot of community service provision is via the local authority. That needs to be funded properly.Chief executive, City Health Care Partnership
You tend to have a big fanfare that there will be 20,000 new workers in primary care, from pharmacists through all the way to physiotherapists – but where are they going to come from? If you have all these primary care networks trying to employ individual members of staff, we’ll just be taking those from existing services. My hope is that the more forward-thinking networks and groups of practices will be looking more imaginatively at how that can be commissioned and provided.
Opportunities to work together
There is an opportunity for us to work together to enhance the attractiveness of integrated primary, community and social care, and share people, but also rotate staff much more and give people much broader experiences of the value that working in the community can offer. We’ve all got a job to do – how can we utilise this new plan and contract in the way that we want to work, with population health?
Most community providers are coterminous with either one or two local authorities. We can then really start to think about integrating provision supported by a different way of commissioning which is seen as a partnership in collaboration. I’m quite happy for us to be part of a system that doesn’t get into large amounts of tendering but works together in partnership. We may lose some of our current community service, but if it’s a better service then we’re all for it.
There is an opportunity for us to work together to enhance the attractiveness of integrated primary, community and social care, and share people, but also rotate staff much more and give people much broader experiences of the value are that working in the community can offer.Chief Executive, City Health Care Partnership
Commissioning a patient-led NHS really gave rise to our type of organisation (the community interest company) out of necessity. We were born out of policy but we’re also forgotten in policy in some respects – it is important to maintain and understand the value and worth that our type of organisation can bring to a local partnership, and to a wider system partnership as well.
All the profit we make, which is only 1-2% on contract value, we put back into the service and into the community. We’ve got business flexibility, we’ve got the ability to do what the NHS was set up to do and which it gets distracted from, through being driven by political circumstances beyond its control and a very hierarchical system.
Value of social enterprise
Our staff themselves are the shareholders of the company. There is a value and a worth there which it would be a pity to lose. I do think that centrally, the value of the social enterprise sector needs to be seen. As an organisation we’ve driven 3-4% efficiencies for the last 10 years. We’ve made a profit every year, we have high levels of patient satisfaction and we’ve grown. There are around four to six of us and there are not many in the red. Nobody seems to look at us and think "how have they done that? What’s the difference? What is it about our system that’s different?".
I’ve only got two non-executives (NEDs) and a company secretary. We’re a group so we have other companies as part of the board as well but those are run by members of staff. We are set up differently – the two NEDS we have are from business but from the local communities that we serve, and are still active. We don’t structure things in the same way as other NHS organisations but we still have robust governance.
We’ve got business flexibility, we’ve got the ability to do what the NHS was set up to do and which it gets distracted from, through being driven by political circumstances beyond its control and a very hierarchical system.Chief executive, City Health Care Partnership
Our flexibility has allowed us to make acquisitions, so to say we are a community service provider is a misnomer because we are an integrated care provider. I have a care home business, I have an estates business, we bought out the intermediate care service from the local authority. We have a range of community pharmacies that we link into the business and drive efficiencies through that and we run specialist out-of-hours primary care. It’s such a wide range of things, but through that you can drive productivity and efficiency.
Investing in modern tech
We’ve invested millions in IT. A lot of things in the plan we’re already getting on with. We haven’t been able to drive 3-4% efficiency sat back twiddling our thumbs. We’re all on mobile working and we’ll be using logistics management for community nurses very shortly. We’re looking at how we develop our own app with others and we’ve got conversations with other providers around further digitisation of communities. We’ve just won an award with Amazon and our local university, developing a system to go into a care homes around assistive technology using Raspberry Pi and an Alexa. It will probably cost around £50 but it’s extremely interesting in terms of what it can and can’t do. We’ve got our own care coordination centre and 24-7 NHS 111 cover, which we put in ourselves.
Hull and the East Riding is the birthplace of quite a bit of modern tech. Although sometimes people forget it, it’s quite a forward-thinking, innovative place. We tend to have partners that are up for helping us. Technology is an enabler but it’s not going to solve all the problems of the world. The biggest thing people forget is culture – how do you get people to change - because they can take the technology and walk around with it but if they can’t see the benefit, they don’t use it.
Our flexibility has allowed us to make acquisitions, so to say we are a community service provider is a misnomer because we are an integrated care provider.Chief Executive, City Health Care Partnership
It’s also very important that some of the emotional intelligence stuff doesn’t get lost. It can get lost in high-pressure environments and some of those softer skills are really important because community provision is a different type of mindset – you are much closer to people in their own homes. I’ve been a community nurse in the past and a health visitor – you come at it from a different angle. Get rid of hierarchy, get rid of yes sir, no sir – it’s more about tenacity. Your value is your people and if you forget they’re your most important asset, you’re doomed.
The thing I suppose that I’ve learned most is that in the community you tend to get nowhere by trying to be bombastic and clever – one has to be far more facilitative, inclusive and extremely global in your view of how to solve problems. The community sector has a character that should be celebrated, not squashed. At the end of the day, it can’t be homogenised into a one size fits all – people seem to forget that, but they will forget that at their peril.