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Kept in the Dark: NSFT’s Mutualisation Application Part II

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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.

 

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3 thoughts on “Kept in the Dark: NSFT’s Mutualisation Application Part II

  1. Terry skyrme says:

    YOU CANNOT BE SERIOUS! “Pre-emptive CBT”???  “Therapy from lower wage countries via Skype” CCCBT? Call Centre CBT? It’s hard enough to get therapy when you are ill, yet alone “pre-emptive” CBT. Are the authors of this application grounded in reality. And as if patients dont already take the main responsibilty for managing their illness. This application is all about the business model, reducing staff numbers; it smacks of desperation and a failure to learn any of the lessons of the radical redesign disaster. I wonder what will happen to the bed crisis if NSFT is divided up into 8 mutuals; presumably there would be no obligation to accept an inpatient from another mutual.

    Reply
  2. carly says:

    This seems all about shifting blame.

    Norman lamb, nhs England,  ccgs, nsft board of directors and governors aren’t responsible for the crisis.

    Let’s ‘liberate ” staff to take the blame for trying to run a service on no resources and cut their pay too (Oh yes this means coming out of agenda for change and no access to nhs pension for new employees). At the same time blame patients for not engaging in all these “recovery opportunities” or self managing well enough.  Classic divide and rule. What’s the collective noun for investment bankers?

    Reply
  3. carly says:

    This seems all about shifting blame.

    Norman lamb, nhs England,  ccgs, nsft board of directors and governors aren’t responsible for the crisis.

    Let’s ‘liberate ” staff to take the blame for trying to run a service on no resources and cut their pay too (Oh yes this means coming out of agenda for change and no access to nhs pension for new employees). At the same time blame patients for not engaging in all these “recovery opportunities” or self managing well enough.  Classic divide and rule. What’s the collective noun for investment bankers?

    Reply

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