Lamb announcement of NHS mutuals review is a valuable move

Elliot Bidgood, 15 October 2013

Thursday saw the launch of a new NHS staff engagement review by Lib Dem Care Minister Norman Lamb, which will explore expanding the role of mutuals, cooperatives and social enterprises in the NHS. Notably, Lamb made a bold claim that the Mid Staffordshire care scandal would not have occurred in a staff-run organisation, stating that “At Mid Staffs you had bullying managers who tried to drive through some pretty irrational changes internally. You can’t do that in a mutual. It couldn’t happen as it happened in Mid Staffs.”

King’s Fund Chief Executive Chris Ham will lead a review panel including former Blair advisor Julian Le Grand and Foundation Trust CEOs Andrew Foster and Sir Robert Naylor.

Civitas has long advocated a larger role for mutualism within the NHS, so this new review is encouraging. In July in the report After Francis, I noted that non-profit NHS social enterprises – including Plymouth Community Healthcare, NAViGO (Lincolnshire) and the North Somerset Community Partnership – tended to perform better than other NHS organisations on the friends and family test, according to the NHS’s own 2012 Staff Survey.

In some areas, non-profit GP cooperatives provide out-of-hours GP and NHS 111 services where public or private providers failed – just this weekend, Serco Health began discussing handing its scandal-hit Cornwall GP service to a cooperative, Devon Doctors. Additionally, in February I noted interesting clinical improvements at Hinchingbrooke NHS hospital following its takeover by the health firm Circle Partnership, part-run as a cooperative.

For the coalition, this announcement fits the “Big Society” agenda, but it could also be a potential basis for long-term cross-partisan consensus on public service reform. At a Progress event on public services in April, Labour’s Shadow Care Minister Liz Kendall spoke positively about mutuals and social enterprises in the NHS, describing them as “where Labour came from” in reference to the Labour movement’s early civil society origins. Shadow Secretary Andy Burnham once argued that while he supported the establishment of the theoretically cooperative-run Foundation Trusts, “too many trusts paid lip service to true community involvement”, a sentiment Lamb has perhaps echoed by mooting fully mutualised FTs. Moreover, in a speech yesterday to Civitas, Labour policy review chair Jon Cruddas pledged to “devolve power to encourage and free local and combined authorities to innovate [and] reform public services”.

However, while the coalition review is focusing primarily on staff engagement, it should be said it could also be an opportunity to examine how mutualisation could tackle the inter-linked issue of public and patient engagement in the NHS as well. To this end, Civitas author Anton Howes has made a bold proposal for patient-led mutual organisations to take charge of some NHS commissioning in a recent publication, “A National Health Service for Patients”.

Overall, however, there should be plenty to look forward to in the review’s eventual findings, due in April 2014.

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