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  • Jamie McMahon

Transforming care by improving support services – how can we enable the enablers?

Updated: Mar 30, 2021

MV’s Jamie McMahon argues the importance of prioritising support services and asks how we can enable the enablers?

Alongside excellent clinical care, support services are the foundation of an effective health service. Without hospital porters, cleaners, building managers and procurement officers doing their job, patients would not get the care that they need. These support services are important enablers of care – and vital to a well-functioning system.

The siloed nature of support services is often seen as one of the most significant barriers to delivering integrated care across acute, primary, community and local authorities. Reform of support services is seen as an essential part of the NHS’s transformation agenda and forms a central plank of local Sustainability and Transformation Plans (STPs), as well as the implementation of the Carter and Naylor reports.

However, services are increasingly asking themselves challenging questions. How can we ensure our services are sustainable for the long time? How do I ensure my organisation takes a leadership role in designing the future of service delivery locally? How can I ensure that I drive the change agenda, rather than have it driven by others?

Reform to support services: enabling the enabler

When clinical delivery takes priority, it can be challenging for NHS senior leaders to devote the time and investment required to ensure essential support services keep pace with changing patient and clinician demands. This management challenge is compounded by issues related to the competitiveness of the labour market. Trusts regularly complain of difficulties in recruiting and retaining skilled support services staff, who can usually command higher salaries by moving to other sectors.

As a result of these pressures, many Trusts chose to outsource services, with firms such as Carillion picking up contracts to deliver estates and facilities services. But the sustainability of this approach is in question. Even before the demise of Carillion, cracks had started show, with contracts cancelled and services returned in house. High profile examples include the cancelling of Nottingham University Hospitals NHS Trust’s £200m contract and the early ending of a £300m contract with Interserve in Leicester, Leicestershire and Rutland.

Is there an alternative approach to delivering support services?

Up to now, the choice for support services has largely been presented as a binary one: provide in-house or outsource to the private sector. But there is an alternative.

That other way is a new delivery model – a wholly owned company, Public Service Mutual or joint venture with other NHS organisations – which can continue to put public service first but has a greater degree of commercial autonomy and staff empowerment. These models can provide a way to hand greater freedom and control to the professionals managing and delivering the service, whilst retaining public ownership.

A recently launched NHS Improvement consultation recognises the ability of new delivery models to drive innovation. It also documents a welcome direction of travel towards evidence-based decision making that requires a strong case for change, ensures all options have been robustly considered and that staff have been actively engaged.

Mutual Ventures is working with a number of teams of NHS support service staff to explore the advantages of a new delivery model, using our robust and objective options appraisal process to decide the best delivery model for the service. Some see the potential for economies of scale and greater integrated working with neighbouring NHS organisations. Others see the benefit of more motivated staff, empowered to drive change and take ownership of the future of their service. In another case it’s about freeing support services from the constraints of a large Trust and developing commercial strategies to be more sustainable in the long-term.

The Mutual Ventures team are passionate about securing the future of successful, sustainable, publicly owned, NHS services which prioritise the empowerment of staff in order to enable the enablers. New delivery models are already proving to be innovative solutions that ensure services can respond to the demands of 21st century NHS care delivery and we look forward to delivering more innovative local solutions in the coming months.

If your service could benefit from the support of the Mutual Ventures team, get in touch at


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