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  • Writer's pictureAndrew Laird

The next phase of NHS mutualisation is about to begin!

Updated: Apr 6, 2021

On Monday 11th August, a range of NHS leaders gathered for an event hosted by Mutual Ventures, the Cabinet Office and the Department of Health to mark the start of the next phase of NHS mutualisation. It’s not a panacea but it could fundamentally change the way we deliver healthcare.

The catalyst for the event was Chris Ham’s Department of Health report into staff engagement. The report drew heavily on the growing body of evidence that independent staff-led mutuals are a delivery model worth exploring.

Setting up a mutual is not a panacea to the lack of staff engagement and the resulting appalling levels of care so prevalent in cases like the Mid Staffordshire NHS Foundation Trust (wiki link). However, this approach embeds shared accountability and responsibility across an entire organisation if the principles are truly embraced and implemented in the right way. This empowerment of front-line staff, who are ready to take responsibility, is surely the golden thread that should run through all public services.

Mutualisation is not a new concept in the NHS. The first phase of mutualisation was initiated under the last government as Primary Care Trusts were splitting commissioner and provider functions. The Right to Request programme supported trailblazer groups of staff who wanted to seize the opportunity to set up as social enterprises and staff-led mutuals. Many of these organisations (such as Social adVentures in Salford, Navigo in Grimsby and Spiral Health in Blackpool) are now held up as shining examples of what can be achieved if staff are given more freedom and trusted to use their professional judgement. These organisations come in all shapes and sizes delivering a huge range of services including early intervention public health services, specialist mental health provision and nurse-led therapy units.

More recently, the pace of mutualisation in the NHS has slowed somewhat as other areas of public services including adult and children’s social care, school support services, community libraries and even probation services have started to explore the model. Examples of organisations which are now delivering successfully include: Sandwell Inspired Partnerships Services and the Buckinghamshire Learning Trust on the school support front; and Leading Lives and Accession delivering adult social care. An enhanced level of staff engagement and empowerment is at the heart of all of these organisations.

Having allowed other sectors to play catch up, it seems the health sector is now ready to pick up the baton again.

Chris Ham’s review panel, which also included Julian Le Grand, the Richard Titmuss Professor of Social Policy at the London School of Economics and senior policy advisor to former Prime Minister Tony Blair, confirmed the growing acceptance that higher levels of staff engagement and empowerment through a staff-led mutual model leads to a happier staff group which in turn can result in better outcomes for service users (and the evidence base is growing). The report makes the case for an “accelerated evolution” and evaluation of alternative delivery models for health services and that NHS organisations, including hospitals, should have greater freedom to become mutuals on a voluntary basis.

The Department for Health and the Cabinet Office have responded with admirable speed, wasting no time in throwing their weight behind the recommendations of this report with the launch of a £1m fund. This will support a programme of “pathfinders” within the NHS who want to explore a mutual model. Health Minister Norman Lamb and Cabinet Office Minister Francis Maude have written to NHS Trusts to invite them to participate in the programme. Already some major trusts (including one of the biggest in the country, the University Hospitals of Leicester Trust) are very interested in exploring this approach.

This feels like exactly the right moment to challenge the accepted delivery norms within the health sector. The findings of the Mid Staffordshire NHS Foundation Trust Public Inquiry are too shocking to ignore – even if it means disruption and challenge to business as usual. The evidence clearly points to the need for new delivery models with staff leadership at their core. What we need now are forward-thinking leaders within the NHS to step forward, grasp this opportunity and lead the way. Judging by the response at this week’s event – we already have a number of excellent candidates!

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