(pic: Steve Gall/UNP)
In North East Lincolnshire, former NHS social care services are now being run as a social enterprise. Chief executive Lance Gardner tells Mithran Samuel of his plans and how keeping staff onside is one of his main challenges
After a 30-year career in the NHS, former nurse Lance Gardner has just started running a multi-million pound health and social care business, the Care Plus Group in North East Lincolnshire.
The services for which he is responsible – including supported employment, intermediate care and district nursing – were previously part of the organisation that commissions them, North East Lincolnshire Care Trust Plus. Now Care Plus must prove itself in the care marketplace against public, private and voluntary providers.
And although the group’s 800 staff have transferred on NHS terms and conditions, these could be watered down in future.
This is what moving from the public sector to a social enterprise means and Gardner is blunt about the challenges he has faced in ensuring the organisation, now in shadow form, can go live on 1 July this year.
“I think the staff’s view was that we don’t want to change and, to be fair to them, they’ve been through so much change already,” says the chief executive.
Many affected social care staff transferred to the care trust in 2007 from North East Lincolnshire Council. “That had just settled down and now we’re saying, ‘we’re off again’.” However, the status quo was not an option.
The government’s Transforming Community Services programme specifies that the commissioning and provision of community health have to be separated, meaning the care trust could no longer provide these services.
Besides a social enterprise, other options included becoming or joining a foundation trust, attaching the services to GP practices or for the adult social services concerned to return to the council.
The latter would have broken up the integrated provision that the care trust had developed, while Gardner says the other options would not have fitted with his values or those of the staff.
“There was no way we were going to have social care delivered by a foundation trust,” he says. “Being employed by GPs was a closer fit but it was still very much a medical model. And we were clear we wanted a person-centred model.”
Technically, a social enterprise is a business with a social purpose in which all profits are reinvested to further that objective. However, Gardner also saw it as a way of preserving a social model of care.
Staff were not so sure.
“You have to keep going over it time and again,” he says. “We do a newsletter every Monday to tell people what we are doing and why. Some of them won’t get it but at least they’ve heard it.”
Part of the message was that staff would be given a say in running the organisation.
It will have a board of governors with a majority of staff representatives, elected by colleagues; this board holds the executive board to account, appoints the chair and ratifies the chief executive’s appointment.
“There’s a degree of suspicion,” he says of the staff reaction to this. “The proof of the pudding comes in the eating.”
But employee democracy has its price.
While all staff have transferred on NHS terms and conditions, Gardner is clear that these may be reduced in future because of cost and competitive pressures.
“They understand we need to compete. It’s not much good protecting terms and conditions if we lose contracts and staff.”
However, staff will have a say on any changes through the organisation’s ownership structure, he points out.
Care Plus has a three-year contract with the care trust to provide adult health and social care services, and has a target to deliver a 1% surplus by 2014 through efficiency savings and service redesign.
It also plans to expand its business, though is not looking much beyond North East Lincolnshire.
Its contract will become the responsibility of the area’s GP commissioning consortium when it succeeds the care trust as the local commissioning authority for health and social care in 2013.
Gardner says he would be disappointed if the consortium contract was the only one he had in 2014, and is hoping to pick up many direct contracts with service users on personal budgets.
He is aware the Care Plus Group will appear relatively expensive compared with other providers. But he says its integrated health and social care offer makes it unique, meaning such benchmarks are like “comparing apples with oranges”.
And it is clear that it is on quality, not cost, where he wants the provider to distinguish itself: “Our mission statement is to be the provider of choice – that people want to work for, that people want their care from and that people want to commission from.”
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