• Andrew Laird

Are nurse-led mutuals the future of NHS care delivery?

Updated: Apr 6

Writing in the British Journal of Nursing, Andrew Laird and Robin Barton ask whether nurse-led mutuals are the future of NHS care delivery.


A flexible, innovative and patient-focused health service delivered by nurses who have direct ownership and control. Does this sound too good to be true? Yet this is what can, and has been, achieved by nurse-led mutuals. The current challenges facing the NHS make it difficult to ignore the potential benefits.


The concept of nurses taking over the ownership and running of a service is not new. Central Surrey Health (CSH), a nurse-led therapy and community nursing service, was the first group to ‘spin out’ of the NHS back in 2006 to form an independent mutual (an organisation owned by its staff). It is co-owned and run by the 800 nurses and therapists who deliver services across central Surrey. Managing Directors Jo Pritchard (registered nurse) and Tricia McGregor (speech and language therapist), together with the CSH Surrey team, have won numerous awards for their service and are an example of what can be achieved through the mutual model. A recent survey found that 100% of the co-owners could see how their work directly related to patient care (even if they didn’t have direct contact with patients). This compared to 84% in the NHS staff survey.


In July 2013, NHS England commenced a national consultation exercise ‘The NHS belongs to the People: A Call to Action’ (NHS England, 2013a). The consultation document identifies the need for the NHS to take ‘bold and transformative action’ through the adoption of radically different delivery models to safeguard the future of NHS services. At the same time, NHS England (2013b) has set out the NHS’s first priorities to be greater patient satisfaction and increases to staff motivation. Nurse-led mutuals are a compelling response to these challenges for three key reasons.


First, they empower nurses with direct control and influence on the way that services are delivered. There are many different ways in which the enterprise can be structured, and central to this is the ability of all employees to influence the way that the organisation is run and the services it delivers.


Second, this level of nurse influence over the whole organisation means that services can become intrinsically patient-focused. Warrilow and Jones (2012) reported on the positive experience of Lymphcare UK, a nurse-led mutual, in creating a more bespoke, responsive service for patients .


Third, nurse-led enterprises have demonstrated a unique ability to deliver services more efficiently. Importantly, though, this is not achieved through top-down efficiency drives, but through self-generating productivity gains that arise from services that are delivered by a staff team who feel engaged and empowered. Published evidence from a health spin-out in the Midlands (Hughes, 2011) showed that average sick leave fell from 22 days to 0.6 days following mutualisation.


Another great example of a pioneering nurse-led spin-out is Spiral Health based in Blackpool. In April 2012 the nurse-led team gained their independence from Blackpool Teaching Hospital NHS Foundation Trust. The team run a 40-bed rehabilitation unit and staff are involved in the running of the organisation either as non-executive directors or within strategy working groups, and, perhaps most significantly, as company members with voting rights.


The Department of Health’s Right to Request policy (initiated under the last government) saw more than 40 frontline staff teams take their service to independence. This was followed up by the Right to Provide policy under the current government, which continues to give frontline teams the chance to explore independence. However, despite the positive impact these organisations are having locally, there are still nowhere near enough of them to have a significant impact on the overall health market. So what can be done to deliver the benefits of nurse-led mutuals to more NHS services?


First, staff groups interested in making this bold step need expert support to plan and implement the complex transition process. Staff in a foundation trust, who are seriously exploring mutualisation as an option, can now receive specialist support funded through the Cabinet Office’s Mutuals Support Programme.


Second, as Clinical Commissioning Groups (CCGs) develop their future commissioning plans, they must acknowledge the growing evidence base, showing the benefits of nurse-led enterprises and take firm steps to support this delivery model. CCGs will be looking to procure NHS services from providers that are best qualified to meet the needs of patients, and improve service quality and efficiency. Our experience certainly suggests that an empowered and motivated team of nurses, operating within a staff-led mutual, will be very well placed to meet these requirements.