Mount Gould is a small community hospital, a mile east of the centre of Plymouth. Its main reception is in a pleasant airy building, opened in 2006, with a cafe. But the signs and the lino look like those in hundreds of NHS hospitals.
Mount Gould is not, strictly speaking, an NHS hospital – nor a private one. It is run byPlymouth community healthcare, which believes it is the UK's largest social enterprise providing NHS services. As a community interest company (CIC), it has no shareholders and pays no dividends. It has recently taken over Plymouth’s social care under a £71m deal, making it a pioneer in health and social care integration.
In 2011, the government forced England's primary care trusts to transfer community care to other organisations. Most chose NHS trusts, but some set up companies. The south-west’s since-abolished strategic health authority favoured the latter, and Bristol, Cornwall, North Somerset and Plymouth all have CICs.
"It has given us the opportunity to really celebrate the fantastic role community services play, as opposed to being in the shadow of a wider, bigger organisation," says Steve Waite, chief executive of Plymouth community healthcare, from his small office overlooking hills south-east of the city.
He adds that a CIC can focus on what’s right for its locality rather than follow national policies, and move faster.
On 1 April, it took on Plymouth’s social care work with the transfer of 172 social workers, occupational therapists, community care workers and management. Changes are being introduced gradually, with staff initially remaining in their existing offices. But over time, Waite says that integrating health and social care should provide “excellence in people’s experience of care”, a single point of contact, shared information and the development of the workforce, as well as avoid duplication.
“We’ve had really poor health outcomes across the city,” says Carole Burgoyne, Plymouth city council’s strategic director for people.
There is almost a decade’s difference in life expectancy between Devonport, around the naval dockyard on the west of the city, and the eastern and northern suburbs. To change this, the city is integrating services. As well as moving social care, it has pooled its £462m commissioning of healthcare, social care, children’s services, community safety, housing and leisure. Other places, including Torbay, have integrated some of these services.
However, Sir John Oldham, chair of the independent commission on whole person care, has described Plymouth’s move as “Torbay on steroids”.
Social worker James Shannon's care coordination team, which provides crisis response, had already been part of a pilot joint-working programme, and he sees health and social care integration as desirable: "There are clear advantages in terms of pooling resources, skills and experiences."
There is less risk of people falling between gaps between health and social care provision, and they only have to deal with one organisation.
He moved to Mount Gould when the pilot started, so has worked alongside healthcare professionals for some time and “we learn from each other”. Of his transfer of employment, he says: “It’s still a work in progress in terms of the IT.” The organisation has a single SystmOne care record from TPP, also accessible by GPs. “But the bigger picture is very positive,” Shannon adds.
Despite being outside the NHS, Plymouth community healthcare is working closely with Plymouth hospitals NHS trust. The CIC has set up a community assessment hub that aims to offer patients alternatives to the trust’s Derriford hospital, such as home treatment with intravenous antibiotics by community nurses. In its first week, 25 of the 30 people who used the unit were treated at home. To help patients leave Derriford, it has set up an integrated discharge team.
Waite says the CIC structure lets it promote health in new ways. People in employment tend to be healthier, so the organisation works with jobcentres to provide paid placements and has expanded its volunteering programme, both of which help participants find jobs. It runs apprenticeships, pays a living wage to its staff and has set up a live well at work scheme to encourage all the area's workplaces to become healthier.
Dan O’Toole, finance director of Plymouth community healthcare, says the organisation can support the local economy in a way that would be difficult for NHS institutions, which often have to use national procurement arrangements. The CIC prefers to use local suppliers, including other social enterprises. It moved its health visiting team to North Prospect, a redevelopment by Plymouth Community Homes, also a CIC spun out by the council, and is considering using CATERed, a catering co-operative owned by 67 local schools and the council, to replace cook-chill meals.
This fits with Plymouth’s ambitions to become a leader in social enterprise and to innovate more generally, says Burgoyne. "When you’re on a peninsula as we are, you have to find different ways of developing things and creating things, with the people who live and work here," she says.
She is happy with the CIC expanding its coverage outside Plymouth: “It fits with the growth agenda for the city.”
Plymouth community healthcare has won a four-year contract from Northern, Eastern and Western Devon NHS clinical commissioning group to provide care for adults with complex needs in Plymouth, South Hams and West Devon.
The election campaign saw Labour accusing the Conservatives of having a secret plan for NHS privatisation. Plymouth community healthcare is a company, although one set up under what was until May’s local elections a Labour-controlled city council. Is this NHS privatisation in action?
Waite says that company status generated some opposition early on, particularly from national offices of trade unions. But he adds that many NHS services are provided by the private sector, including GPs. He says the fact that the CIC spends its money locally rather than supporting distant shareholders has helped win people over.
“The national health service is national by its nature,” says O’Toole. “We can work in a very different way. For us, the challenge was taking the best of the NHS and enhancing it. We wouldn’t go back into the NHS as an organisation.”
The above article by SA Mathieson first published on theguardian.com in July, 2015.
