2. WHAT DO YOU SEE AS THE MAIN BENEFITS OF THE MUTUAL MODEL IN ADDRESSING THE STRATEGIC CHALLENGES IDENTIFIED AT (1) ABOVE AND ON IMPROVING SERVICES TO PATIENTS?
1. Benefit: Employee engagement and morale.
NAViGO (a mental health services mutual) reduced staff absence from 6.8% to <3% in the two years after mutualising, and has staff turnover below 2% and the highest scores in 65% of the NHS Staff survey items. These are levels most mental health operations can only dream of.
Our starting scenario is to evaluate mutualising the whole of NSFT. For this a key question is “will the benefits of mutualisation be achieved at our organisation size (NAViGO has 500 employees, and NSFT has 4,000)?” Research for us on this by McKinsey, and supported by a range of our other contacts (including Social adVentures and the Health Care Co-operatives Federation of Canada), indicates that there are simply no health services mutuals at c.4,000 employees, globally. Some theorise that this may be due to a diseconomy at this size between the ‘working with my friends in our own organisation’ atmosphere of a small mutual, and the use of big internal employee communications processes in very large mutuals (e.g. John Lewis Partnership). A consistent feedback is ‘member and staff engagement is tough, especially as the mutual grows in size.’
We are planning to explore the possibilities of;
(a) a ‘mini-JLP’ model, using strong internal communications (we are not convinced one needs to be at ‘monster’ size to make this work, although we are realistic that the costs will be significant),
(b) a ‘federation’ model, in which a single central organisation provides a corporate, financial, legal and regulatory structure, but the operating activities are broken up into ‘human-sized’ and ‘local’ units (say of 500 employees) which have autonomy and ownership of their own operations and budgets, and strong local community involvement and fit.
(c) breaking the Trust up into perhaps 8 independent local mutuals
(d) mutualisation of particularly suitable parts of the trust (see Q5)
(e) what benefits of mutualisation can be achieved in the current FT model.
2. Benefit: more innovative culture.
Mental health faces very adverse trends in rising referrals, poor reporting of outcomes, and cost inflation (with a very high % of costs being staff).
In this environment there is a real need to explore further new approaches in prevention (e.g. pre-emptive CBT to prevent depression and psychosis), computerised tools, mobile technology, remote staff from lower wage countries (e.g. via Skype), and Recovery project attitudes (e.g. the service user taking some self-management of his/her condition).
To progress such initiatives needs a culture where innovation, trial and experiment are welcomed. This occurs best when staff feel trusted and positive about their organisation, and their focus is on helping sufferers. In our view this is a key benefit of mutualisation.
3. Benefit: improving outcomes.
In mental health the quality and tenor of staff interactions can have a key impact on patient recovery. We expect mutualisation to have a direct impact in this way, through raising outcomes through higher staff morale and engagement, as well as through enabling innovation.
We believe that each of the above benefit areas (a) impacts directly on the quality of service received by patients, and (b) is readily identifiable and measureable.